Computerized experience sampling method (ESMc): Assessing feasibility and validity among individuals with schizophrenia

The Experience Sampling Method (ESM) is an ecologically valid, time-sampling of self-reports developed to study the dynamic process of person-environment interactions. ESM with digital wristwatch and booklets (paper-based ESM; ESMp) has been used extensively to study schizophrenia. The present study is designed to test the feasibility and validity of using Computerized ESM (ESMc) among individuals with schizophrenia. ESMc is advantageous in allowing for recording of precise time-stamps of responses. We used PDAs ("Personal Digital Assistant"; Palm handheld computers) to collect data on momentary psychotic symptoms, mood, and thoughts over a one day period among 10 hospitalized schizophrenia patients and 10 healthy controls. ESMc was equally acceptable to both groups, with similar ratings of comfort carrying the PDAs and operating them, interference with daily activities, as well as response rates. The schizophrenia patients reported significantly higher ratings of auditory and visual hallucinations, suspiciousness, sense of unreality, lack of thought control, fear of losing control, difficulty expressing thoughts, as well as depression/sadness, loneliness and less cheerfulness. Significant inverse relationships were found among both groups between ratings of feeling cheerful and being stressed, irritated, and sad/depressed. Among the schizophrenia subjects, the correlation between ratings of suspiciousness on ESMc and Scale for Assessment of Positive Symptoms (SAPS) approached significance, as well as the link between suspiciousness and stress. Our results support the feasibility and validity of using ESMc for assessment of momentary psychotic symptoms, mood, and experiences among individuals with schizophrenia. The authors discuss the potential applications of combining ESMc with ambulatory physiological measures.