Ecological Momentary Assessment of Affect in Context After Traumatic Brain Injury

Purpose: To describe where, with whom, and how time was spent daily, and to characterize positive and negative affect, boredom, enjoyment, and perceived accomplishment as a function of time, activity, location, and social context, in people with chronic moderate-severe traumatic brain injury and depression/anxiety. Research Method: Participants (N = 23) responded to a smartphone app five times daily for approximately 2 weeks prior to treatment in a trial of Behavioral Activation. The app queried activity and physical/social context; concurrent positive and negative affect; and perceived boredom, enjoyment, and accomplishment. Descriptive statistics captured time use, and linear mixed models were used to analyze relations between affect and contextual factors. Results: Ecological Momentary Assessment (EMA) response rate was positively correlated with integrity of episodic memory and education. Participants spent most time at home versus elsewhere, and alone versus with others. The most frequent activity was watching TV. Mixed model results based on 17 participants with >33% response rate showed that positive affect was associated with being outside of home, and with other people; however, socializing was related to higher negative affect. TV watching was related to lower negative affect but also low accomplishment. Conclusions: EMA can provide unique information on the effects of social context and activity on mood in TBI. Clinicians should consider negative as well as positive affect associated with increasing social participation. Impact and Implications Ecological Momentary Assessment (EMA) is generally feasible for individuals with moderate-severe traumatic brain injury (TBI), but cognitive supports such as extra training and supervised practice might be needed to boost response rate for individuals with lower education or more severe memory impairment. Individuals with moderate-severe TBI may spend a large proportion of time alone and at home, and relatively little time engaged in outdoor activities and exercise. Positive affect is associated with productive activity such as working and doing chores. These findings point to the need for interventions that promote activity and community engagement after TBI. Spending time with others may be associated with both positive and negative emotional states, suggesting that clinicians might encourage a graded approach (beginning with lower-stress activities) to increasing socialization for people with moderate-severe TBI.

Automated summary

The study aimed to explore the relationships between time use, emotional states, and social context in individuals with chronic moderate-severe traumatic brain injury (TBI) and depression/anxiety. Results indicated that positive affect was associated with being outside of home and with others, while socializing was related to higher negative affect. Watching TV was linked to lower negative affect but also low perceived accomplishment.