Clinical benefits and challenges of ecological momentary assessment in individuals who self-injure and seek mental health treatment

Rafaël A. Bonnier; Joanne R. Beames; Laurence Claes; Olivia J. Kirtley; Lena de Thurah; Jeroen D.M. Weermeijer; Lotte Uyttebroek; Mirthe Luijsmans; Inez  Myin-Germys; Glenn Kiekens

doi:10.1016/j.ijchp.2025.100618

Clinical benefits and challenges of ecological momentary assessment in individuals who self-injure and seek mental health treatment

Rafaël A. Bonnier
, Joanne R. Beames
, Laurence Claes
, Olivia J. Kirtley
, Lena de Thurah
, Jeroen D.M. Weermeijer
, Lotte Uyttebroek
, Mirthe Luijsmans
, Inez Myin-Germys
, Glenn Kiekens^*

^*Corresponding author for this work

Medical and Clinical Psychology

Research output: Contribution to journal › Article › Scientific › peer-review

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Abstract

Introduction
Non-suicidal Self-Injury (NSSI) is a prevalent transdiagnostic behavior. The use of Ecological Momentary Assessment (EMA) shows clinical potential, but the potential utility for individuals who self-injure remains unclear. This prospective study evaluates self-reported benefits (e.g., self-insight and self-efficacy)
and challenges (e.g., beep disturbances and emotional discomfort) associated with using EMA among treatment-seeking individuals with past-month NSSI.

Methods
In this cohort study, 124 treatment-seeking adolescents and adults who self-injure completed a 28-day EMA protocol with six daily assessments of emotions, cognitions, and behaviors (including self-injury). After one month, participants completed an EMA feedback survey.

Results
A total of 98 patients completed the feedback survey (Response Rate = 79.03%). Average EMA compliance was 74.87% (SD = 18.78) and decreased linearly across time. Four in five patients (78.57%) reported experiencing at least one benefit. After using EMA, 32.65% reported increased general self-insight, 64.58% reported
increased NSSI-specific self-insight, 9.28% reported increased general self-efficacy, and 41.67% reported improved self-efficacy to resist NSSI. Across the sample, 7.29% experienced EMA in treatment as tiring, stressful,
at times overwhelming, and not enjoyable. Higher levels of emotional discomfort were significantly associated with lower compliance (r=-0.29, p=.004), higher beep disturbance (r=.37, p < .001), and lower general selfinsight
(r=-0.28, p=.006). When participants felt more overwhelmed by their emotions than usual, they also reported higher beep disturbance within the same and the next assessment.

Conclusion
Although the use of EMA in treatment may evoke emotional discomfort in patients, it may help
promote NSSI-specific self-insight and self-efficacy outside the therapy room in patients who self-injure.

Original language	English
Article number	100618
Number of pages	12
Journal	International Journal of Clinical and Health Psychology
Volume	25
Issue number	3
DOIs	https://doi.org/10.1016/j.ijchp.2025.100618
Publication status	Published - 2025

Keywords

Ecological momentary assessment
Experience sampling method
Non-suicidal self-injury
Mental health treatment
Clinical psychology

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Clinical benefits and challengesFinal published version, 988 KBLicence: CC BY

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Bonnier, R. A., Beames, J. R., Claes, L., Kirtley, O. J., de Thurah, L., Weermeijer, J. D. M., Uyttebroek, L., Luijsmans, M., Myin-Germys, I., & Kiekens, G. (2025). Clinical benefits and challenges of ecological momentary assessment in individuals who self-injure and seek mental health treatment. International Journal of Clinical and Health Psychology, 25(3), Article 100618. https://doi.org/10.1016/j.ijchp.2025.100618

@article{e47f7516b35d4f46a6ac681b3c43ecc7,

title = "Clinical benefits and challenges of ecological momentary assessment in individuals who self-injure and seek mental health treatment",

abstract = "Introduction Non-suicidal Self-Injury (NSSI) is a prevalent transdiagnostic behavior. The use of Ecological Momentary Assessment (EMA) shows clinical potential, but the potential utility for individuals who self-injure remains unclear. This prospective study evaluates self-reported benefits (e.g., self-insight and self-efficacy) and challenges (e.g., beep disturbances and emotional discomfort) associated with using EMA among treatment-seeking individuals with past-month NSSI. Methods In this cohort study, 124 treatment-seeking adolescents and adults who self-injure completed a 28-day EMA protocol with six daily assessments of emotions, cognitions, and behaviors (including self-injury). After one month, participants completed an EMA feedback survey. Results A total of 98 patients completed the feedback survey (Response Rate = 79.03\%). Average EMA compliance was 74.87\% (SD = 18.78) and decreased linearly across time. Four in five patients (78.57\%) reported experiencing at least one benefit. After using EMA, 32.65\% reported increased general self-insight, 64.58\% reported increased NSSI-specific self-insight, 9.28\% reported increased general self-efficacy, and 41.67\% reported improved self-efficacy to resist NSSI. Across the sample, 7.29\% experienced EMA in treatment as tiring, stressful, at times overwhelming, and not enjoyable. Higher levels of emotional discomfort were significantly associated with lower compliance (r=-0.29, p=.004), higher beep disturbance (r=.37, p < .001), and lower general selfinsight (r=-0.28, p=.006). When participants felt more overwhelmed by their emotions than usual, they also reported higher beep disturbance within the same and the next assessment. Conclusion Although the use of EMA in treatment may evoke emotional discomfort in patients, it may help promote NSSI-specific self-insight and self-efficacy outside the therapy room in patients who self-injure.",

keywords = "Ecological momentary assessment, Experience sampling method, Non-suicidal self-injury, Mental health treatment, Clinical psychology",

author = "Bonnier, \{Rafa{\"e}l A.\} and Beames, \{Joanne R.\} and Laurence Claes and Kirtley, \{Olivia J.\} and \{de Thurah\}, Lena and Weermeijer, \{Jeroen D.M.\} and Lotte Uyttebroek and Mirthe Luijsmans and Inez Myin-Germys and Glenn Kiekens",

year = "2025",

doi = "10.1016/j.ijchp.2025.100618",

language = "English",

volume = "25",

journal = "International Journal of Clinical and Health Psychology",

issn = "1697-2600",

publisher = "Elsevier B.V.",

number = "3",

}

Bonnier, RA, Beames, JR, Claes, L, Kirtley, OJ, de Thurah, L, Weermeijer, JDM, Uyttebroek, L, Luijsmans, M, Myin-Germys, I & Kiekens, G 2025, 'Clinical benefits and challenges of ecological momentary assessment in individuals who self-injure and seek mental health treatment', International Journal of Clinical and Health Psychology, vol. 25, no. 3, 100618. https://doi.org/10.1016/j.ijchp.2025.100618

Clinical benefits and challenges of ecological momentary assessment in individuals who self-injure and seek mental health treatment. / Bonnier, Rafaël A.; Beames, Joanne R.; Claes, Laurence et al.
In: International Journal of Clinical and Health Psychology, Vol. 25, No. 3, 100618, 2025.

Research output: Contribution to journal › Article › Scientific › peer-review

TY - JOUR

T1 - Clinical benefits and challenges of ecological momentary assessment in individuals who self-injure and seek mental health treatment

AU - Bonnier, Rafaël A.

AU - Beames, Joanne R.

AU - Claes, Laurence

AU - Kirtley, Olivia J.

AU - de Thurah, Lena

AU - Weermeijer, Jeroen D.M.

AU - Uyttebroek, Lotte

AU - Luijsmans, Mirthe

AU - Myin-Germys, Inez

AU - Kiekens, Glenn

PY - 2025

Y1 - 2025

N2 - Introduction Non-suicidal Self-Injury (NSSI) is a prevalent transdiagnostic behavior. The use of Ecological Momentary Assessment (EMA) shows clinical potential, but the potential utility for individuals who self-injure remains unclear. This prospective study evaluates self-reported benefits (e.g., self-insight and self-efficacy) and challenges (e.g., beep disturbances and emotional discomfort) associated with using EMA among treatment-seeking individuals with past-month NSSI. Methods In this cohort study, 124 treatment-seeking adolescents and adults who self-injure completed a 28-day EMA protocol with six daily assessments of emotions, cognitions, and behaviors (including self-injury). After one month, participants completed an EMA feedback survey. Results A total of 98 patients completed the feedback survey (Response Rate = 79.03%). Average EMA compliance was 74.87% (SD = 18.78) and decreased linearly across time. Four in five patients (78.57%) reported experiencing at least one benefit. After using EMA, 32.65% reported increased general self-insight, 64.58% reported increased NSSI-specific self-insight, 9.28% reported increased general self-efficacy, and 41.67% reported improved self-efficacy to resist NSSI. Across the sample, 7.29% experienced EMA in treatment as tiring, stressful, at times overwhelming, and not enjoyable. Higher levels of emotional discomfort were significantly associated with lower compliance (r=-0.29, p=.004), higher beep disturbance (r=.37, p < .001), and lower general selfinsight (r=-0.28, p=.006). When participants felt more overwhelmed by their emotions than usual, they also reported higher beep disturbance within the same and the next assessment. Conclusion Although the use of EMA in treatment may evoke emotional discomfort in patients, it may help promote NSSI-specific self-insight and self-efficacy outside the therapy room in patients who self-injure.

AB - Introduction Non-suicidal Self-Injury (NSSI) is a prevalent transdiagnostic behavior. The use of Ecological Momentary Assessment (EMA) shows clinical potential, but the potential utility for individuals who self-injure remains unclear. This prospective study evaluates self-reported benefits (e.g., self-insight and self-efficacy) and challenges (e.g., beep disturbances and emotional discomfort) associated with using EMA among treatment-seeking individuals with past-month NSSI. Methods In this cohort study, 124 treatment-seeking adolescents and adults who self-injure completed a 28-day EMA protocol with six daily assessments of emotions, cognitions, and behaviors (including self-injury). After one month, participants completed an EMA feedback survey. Results A total of 98 patients completed the feedback survey (Response Rate = 79.03%). Average EMA compliance was 74.87% (SD = 18.78) and decreased linearly across time. Four in five patients (78.57%) reported experiencing at least one benefit. After using EMA, 32.65% reported increased general self-insight, 64.58% reported increased NSSI-specific self-insight, 9.28% reported increased general self-efficacy, and 41.67% reported improved self-efficacy to resist NSSI. Across the sample, 7.29% experienced EMA in treatment as tiring, stressful, at times overwhelming, and not enjoyable. Higher levels of emotional discomfort were significantly associated with lower compliance (r=-0.29, p=.004), higher beep disturbance (r=.37, p < .001), and lower general selfinsight (r=-0.28, p=.006). When participants felt more overwhelmed by their emotions than usual, they also reported higher beep disturbance within the same and the next assessment. Conclusion Although the use of EMA in treatment may evoke emotional discomfort in patients, it may help promote NSSI-specific self-insight and self-efficacy outside the therapy room in patients who self-injure.

KW - Ecological momentary assessment

KW - Experience sampling method

KW - Non-suicidal self-injury

KW - Mental health treatment

KW - Clinical psychology

U2 - 10.1016/j.ijchp.2025.100618

DO - 10.1016/j.ijchp.2025.100618

M3 - Article

C2 - 41050767

SN - 1697-2600

VL - 25

JO - International Journal of Clinical and Health Psychology

JF - International Journal of Clinical and Health Psychology

IS - 3

M1 - 100618

ER -

Clinical benefits and challenges of ecological momentary assessment in individuals who self-injure and seek mental health treatment

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Keywords

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