Silhouette Hall - Marinela

Examining the Everyday Environment to Better Understand and Intervene with Patients

Jürgen Hoyer, Philiop Santangelo Speaker

Only a small minority of a patient’s week is spent together with a therapist. Whereas this time is intended to stimulate change, the time outside the therapy room is where a patient must attempt to implement the changes initiated during therapy in their everyday lives. Each of the presentations in this symposium will examine patients’ everyday lives via Event Sampling Methodology (ESM), a methodology that captures patients’ experiences in their self-chosen daily environments and close to the time of occurrence. ESM increases external validity while simultaneously reducing memory bias. The rich longitudinal data generated by ESM provides insight into the natural unfolding of important experiences and behaviors over time and information about how patients respond to daily challenges. Thus, detailed intra-personal and interpersonal data is generated that informs about the antecedents and consequences of salient events. The first presentation will examine the transdiagnostic relevance of post-event rumination using a large ESM data set of depressed and socially anxious individuals. The second presentation will present ESM data from two studies: a) a large ESM data set on the interaction between stress, well-being, and social interactions in depressed, socially anxious and controlled individuals; b) ESM data from patients at baseline and post-treatment to monitor changes in daily experiences. The third presentation will examine how monitoring the dynamics of psychopathological reactions can be used to provide just-in-time interventions. Each of the presentations will discuss how understanding the everyday conditions that patients face can be used to facilitate positive change and overcome obstacles.

Convenor: Gloster or Hoyer

Chair: Gloster

 Presenters: Jürgen Hoyer 1*, Andrew Gloster 2*, Philiop Santangelo 3*

1 Technische Universität Dresden, Germany; Institute of Clinical Psychology and Psychotherapy
2 University of Basel, Switzerland; Division of Clinical Psychology and Intervention Science
3 Karlsruhe Institute of Technology, Germany; Department of Sport & Sport Science – Applied Psychology

Discussant: Thomas Heidenreich


Paper 1:

“The transdiagnostic relevancy of post-event rumination: Comparing experience sampling data of depressed and socially anxious individuals”

Hoyer, Juergen

Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany


  1. Post-event rumination (PER) after social interactions significantly contributes to the persistence of social phobia (SP). The present study used experience sampling data to investigate to what extent PER also in major depression (MDD) and healthy controls (HC). Additionally, we tested whether PER is accounted for by trait levels of social anxiety (SA) or depression.
  2. Prospective experience sampling was used (seven days, six surveys per day). A total of n = 165 patients (n = 47 SP, n = 118 MDD) and n = 119 HC were included. PER was assessed following subjective embarrassment in social interactions.
  3. Individuals with SP or MDD experienced significantly more embarrassing social interactions than HC and, accordingly, more PER. The relative frequency of PER within embarrassing interactions was high in all groups (86-96%). After controlling SA, between-group differences in the number of embarrassing situations, and consequently in PER, dissipated. When controlling depression, PER was higher in SP compared to HC and to MDD.
  4. The study demonstrates the close link between feelings of embarrassment and PER and that PER related to social events is primarily accounted for by SA.

Paper 2:

“Using ESM to better understand social interaction in patients with social phobia, MDD, and controls” 

Andrew Gloster
University of Basel

Background: Social interactions (SIs) are a crucial part of human existence. Lack of SIs is a risk factor for various physical and mental health outcomes. Event sampling methods (ESM) offer unique insights into psychological processes as they unfold in participants’ daily lives. This study examined the mechanisms and contexts that facilitate and impede SIs in patients with impairments in social functioning, and controls.

Methods: ESM was administered for seven days, with six surveys per day. A total of n = 165 patients (n = 47 Social Phobia [SP], n = 118 Major Depression Disorder [MDD]) and n = 119 Controls were included. A total of n = 6965 SIs were recorded.

Results: Patients and Controls experienced the same number of meaningful SIs, but patients rated them as lower quality. When SIs were not experienced, patients engaged in more avoidance behaviors. Flexible emotional coping facilitated social interactions relative to rigid emotional coping.

Discussion: These results elucidate contexts that facilitate SIs and suggest possible intervention targets. Results will also be discussed with relation to how ESM can be used at pre-treatment and post-treatment in treatment studies and interventions designed to increase well-being.


Paper 3:

“Monitoring the dynamics of real life psychopathology in patients with Borderline personality disorder as well as clinical and healthy controls using ambulatory assessment”

Presenter name and professional affiliations: Philip Santangelo, Applied Psychology/Mental mHealth Lab, Karlsruhe Institute of Technology, Germany

  1. Borderline personality disorder (BPD) is commonly characterized by instability.The investigation of dynamic processes has proved chalenging in the past due to the incapacity of single assessments to capture symptom dynamics. Offering the possibility of repeated assessments, ambulatory assessment methods (e.g., e-diaries) are suited to investigate unstable symptoms in the most important context, patients’ everyday lives. Even though BPD is the only disorder for which affective instability is a diagnostic criterion, recent studies revealed heightened instability in other disorders.
  2. We addressed the neglected criterion of self-esteem instability and repeatedly assessed momentary self-esteem and affective state 12 times a day for four consecutive days in 80 BPD patients, 80 healthy controls, and 80 patients with anxiety disorders. We used established instability indices and analyzed multilevel models to determine group differences.
  3. Affective instability was elevated in both BPD patients and those with anxiety disorders compared to HC. However, patients with BPD showed heightened self-esteem instability compared to both HC as well as patients with anxiety disorders.
  4. The results highlight the importance of self-esteem instability being potentially specific for patients with BPD.