Advancing the measurement of psychotherapy outcomes for youth with irritability using in vivo ecological momentary assessment: an exploratory observational study

Abstract

Background: Ecological momentary assessment (EMA) can reveal naturalistic within-person changes in symptoms and behaviors, essential for examining psychotherapy's effectiveness. However, no prior study has leveraged EMA to assess real-time, naturalistic changes of clinical symptoms during psychotherapy in youth with clinically impairing irritability. The present study uses EMA to assess changes in both child-reported irritability symptoms and caregiver-reported parental behaviors over the course of treatment, as well as to explore real-time associations between changes in parental behaviors and youth symptoms. Method: Here, in an observational analysis, a total of 39 youth (Mage = 11.26 years [SD = 1.89 years]; 35.9% female; 79.5% White) undergoing exposure-based cognitive behavioral therapy, and their parent undergoing parent management skill training (PMT), completed EMA surveys three times a day for 7 days at pre-, mid-, and post-treatment. Given the nested nature of the data, multilevel analyses were conducted to observe change and associations over time. Results: Results from multilevel modeling showed that both youth and parents reported a statistically significant decrease in real-time irritability symptoms over the course of treatment (βs ≤ −.27, ps ≤.02). Parents reported a statistically significant increase in adaptive parental behaviors as taught during the PMT portion of treatment (βs ≥ |.22|, ps