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

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 ( M age = 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, p s ≤ .02). Parents reported a statistically significant increase in adaptive parental behaviors as taught during the PMT portion of treatment (βs ≥ |.22|, p s < .04). Furthermore, statistically significant associations were found between increased levels of adaptive parental behaviors and decreased levels of youth irritability symptoms. Conclusion This study supports the utility of EMA in measuring psychotherapy symptom progress, outcomes, and change in therapy‐targeted behavior. Results suggest that parental behavior could play a substantively important role in the treatment of youth with irritability.