Addressing mental health with daily-life ecological momentary interventions (ALERT) in people at increased risk for mental disorders: A micro-randomized trial

Background Elevated levels of mental distress are associated with increased risk for developing mental disorders. Ecological momentary interventions (EMIs) constitute a scalable, low-barrier approach for early intervention. We conducted a micro-randomized trial to investigate the proximal (short-term) and distal (longer-term) effects of EMIs based on gratitude, savoring, cognitive restructuring, and acceptance. Methods 72 participants at-risk for developing mental disorders (mean age = 22.9, 67.6% female) completed a 16-day intervention phase during which they received four ecological momentary assessments (EMA) at semi-random moments each day assessing proximal outcomes negative (NA) and positive affect (PA). Each day, two randomly-selected EMAs were immediately followed by an EMI. All participants received each EMI over the course of the study. Thirty minutes following each EMA, NA and PA were assessed again. Before and after the intervention phase, distal outcomes symptoms of depression, anxiety and well-being were assessed. Results Multilevel models showed proximal improvements in PA following EMIs based on gratitude, savoring, and acceptance. NA decreased following gratitude and savoring, while the acceptance-based EMI specifically decreased NA during moments of higher NA. The cognitive reappraisal EMI neither improved NA nor PA. Significant distal improvements in symptoms of depression, anxiety and well-being were observed. Discussion This study provides support for the beneficial proximal effects of EMIs based on gratitude and savoring. Acceptance-based EMIs may be particularly helpful for improving positive affect and in moments of higher distress. Future research should further investigate the benefits of EMIs in critical moments to advance evidence-based just-in-time support.