Behavioral addictions in the natural environment: A systematic review on ambulatory assessment methods
Background: Ambulatory Assessment is an umbrella term for different types of assessment (e.g. ecological momentary assessment, end of day assessment, daily diaries) conducted in the natural environment. Advantages include higher ecological validity of empirical evidence, less recall bias than in laboratory settings and measures of daily behaviors of participants. With the technological development, this form of assessment is increasingly used in medical and psychological studies, including studies on behavioral addictions. These are assumed to arise from complex interactions between predisposing factors and psychological mechanisms (e.g. craving) by current theories such as the I-PACE Model. Recognizing the increasing number of studies investigating the underlying psychological mechanisms of behavioral addictions in the natural environment, we conducted a preregistered systematic review of the literature to examine empirical findings and methodological aspects in the context of studies using ambulatory assessments in behavioral addiction research.
Methods: We conducted a preregistered systematic review with searches in PubMed and Web of Science. Data on methodological approaches and empirical results focusing on psychological mechanisms as identified within the I-PACE model were extracted.
Results: A total of 36 studies met the inclusion criteria, with a primary emphasis on gambling (n=14), smartphone use (n=7), buying/shopping (n=6), and social-network use (n=4). In each included study (except one study on buying/shopping), characteristics of behavioral enactment were documented during the ambulatory assessment. Mood and affect emerged as the most frequently explored underlying psychological mechanisms, followed by craving which was associated with increased behavior enactment. Most of the studies (n=31) were based on digital assessments and notification-initiated assessments (n=22) and mean assessment period was four weeks (M=26.88 days).
Conclusions: Across all included studies, monitoring period, type of assessment device/application and quality of data reports differed significantly. A notification-initiated assessment design based on a semi-randomized schedule emerged as the most frequently chosen method. Notably, there were almost no ambulatory assessment studies on gaming disorder and pornography use disorder. Our knowledge on the mechanisms of the development and maintenance of behavioral addictions would benefit from more research conducted in the natural environment transferring evidence from laboratory settings into more ecologically valid settings. Regarding the underlying mechanisms of behavioral addictions, craving and affect appear to be of particular interest in this research field which corresponds to their central role within theoretical models such as the I-PACE Model.
