How do practitioners spontaneously use ESM / EMA in clinical practice?
TL;DR
Most research on the implementation of experience sampling methodology (ESM) / ecological momentary assessment (EMA) in clinical practice looks at how therapists might use it, not how they actually do. Our latest qualitative study filled that gap. We interviewed 19 mental health practitioners who already integrated m-Path into their daily work. Their stories reveal spontaneous and creative uses of ESM / EMA in therapy, from diagnosing triggers to visualizing progress. At the same time, clinicians also pointed to a clear need for better visual feedback, more training, and stronger organizational support.
Experience sampling methodology (ESM) or ecological momentary assessment (EMA) has long been a corner stone of psychological research, helping scientists capture how people feel and behave in real time.
But this approach is proving just as valuable in mental health care, where it lets clinicians explore client-specific patterns in daily life, to translate those insights into personalized treatment plans.
Until recently, however, most studies on the clinical use of ESM / EMA focused on perceived usefulness (what therapists think about it) or instructed use (how they apply it when given strict protocols).
What has been missing is the spontaneous story: how clinicians naturally pick up a platform like m-Path and integrate it into therapy without anyone telling them how.
Our study at a glance
With a large and active clinical user base, m-Path is uniquely positioned to study how practitioners already use ESM / EMA in the wild. We invited 19 psychologists and psychiatrists for an in-depth, one-hour interview about their hands-on experiences.
All interviews were analyzed using qualitative content analysis in NVivo. Following an inductive coding approach, themes were not predefined, but emerged from practitioners’ own words.
Below, we briefly discuss the highlights of each theme.
How therapists actually use ESM / EMA in their daily routines
Practitioners rarely used one-size-fits-all questionnaires. Instead, they sat down with clients to build diaries around each person’s problems, triggers, and daily rhythms. This co-creation made the data feel more relevant and boosted motivation to respond.
Practitioner: “I really enjoy discussing with my clients: What do you currently think of the assignment? Should the question be adjusted? Is the timing good for you?”
Most practitioners reviewed data together with their patients. Graphs and summaries became starting points for discussion, helping clients recognize change or link emotions to situations.
Practitioner: “I show them the graphs during our sessions so they can see for themselves that standing up for themselves (instead of just accepting everything) was actually good for their feelings.”
However, this process was time-intensive. Some admitted they skipped reviews when pressed for time, and patients noticed:
Practitioner: “After a few weeks, one person said they stopped because I didn’t show the results anymore.”
Interestingly, many also said they waited until after establishing trust before introducing m-Path: a reminder that ESM works best once the therapeutic relationship feels safe and collaborative.
ESM / EMA feedback can be an ideal conversation starter in therapy.
Why they use it: the therapeutic goals behind ESM / EMA
Therapists spontaneously described three main goals for collecting ESM / EMA data with m-Path: gaining insight, monitoring progress, and providing real-time interventions.
Improving insights
Practitioners used m-Path to uncover links between mood, activities, and context:
Practitioner: “I think I use it the most when worrying. Because worrying behavior is such an automated behavior and there really needs to be some kind of awareness of, wow, then I do that too. Ah right, I didn’t even notice it, when I drive there by car, I was worrying too.
Some tracked specific patterns such as cravings or psychosomatic symptoms:
Practitioner: “For addiction problems, I find it very useful because you can record more: when do you use? And effectively intervene when someone uses.”
Monitoring progress and evaluation
Therapists used longitudinal data to evaluate interventions:
Practitioner: “I did a specific intervention, and we could track the progress. The graphs showed improvement in mood, which they found very enjoyable to see.”
Visual feedback also helped detect relapses early:
Practitioner: “I find the graphs very valuable. You can clearly see the evolution... I had one person who relapsed, and it was very evident in the graph.”
Real-time interventions
Although still emerging, some clinicians already leveraged m-Path for in-the-moment exercises:
Practitioner: “I regularly use it to give tips, like exercises at home or how to handle negative thoughts.”
When and for whom ESM / EMA fits best
Therapists emphasized that m-Path works well across a broad range of issues, especially depression, anxiety, stress, and addiction.
For depression, daily diaries helped counter memory bias and support behavioral activation. Practitioners reported that reviewing data gave clients a more balanced, factual picture of their week.
Practitioner: “It helps reduce the tendency to only remember the negative things”
However, not every condition fit easily. A few therapists warned that ESM / EMA could feel intrusive for clients with psychosis or paranoia:
Practitioner: “Formulating appropriate questions is challenging, especially for patients with persecutory delusions, such as being surveilled.”
Overall, practitioners saw the strongest value when the method was flexibly tailored to the client’s comfort and readiness.
What needs to change to make ESM / EMA part of standard care
Finally, the study revealed that successful adoption of m-Path depends not only on clinicians, but also on their environment.
In terms of organizational support, clinicians reported that they would benefit from more training and peer learning opportunities.
For our developers, they shared the following suggestions to improve the m-Path platform:
- Add clear documentation and short video tutorials for common setup steps.
- Make the question builder more intuitive
- Offer automatic alerts for prolonged patient inactivity.
Practical take-aways
This study shows that ESM / EMA can truly enrich therapy, as illustrated by the many ways in which clinicians spontaneously integrated m-Path into their daily routines. To make the most of its potential, several lessons stand out:
- Collaboration is key. When therapists and clients co-create diaries and interpret results together, ESM / EMA becomes more than a data stream. It turns data into dialogue, making experiences visible, meaningful, and actionable.
- Personalization matters more than pathology. ESM / EMA works best when adapted to the individual rather than the diagnosis (perhaps with the exception of psychosis). When questions and feedback reflect a client’s real context (their daily stressors, sleep patterns, routines, and recovery moments) engagement increases and insights deepen.
- Clinicians need the right scaffolding. Intuitive design, clear documentation, and supportive colleagues or helpdesks are crucial for sustained implementation.
- Implementation depends on an ecosystem. Beyond the clinician, software developers and the broader mental health organization play a vital role by refining tools based on user feedback and by recognizing and rewarding innovative, data-informed care.
The practical take-aways from our interview study.
In short, implementing ESM / EMA successfully is a shared effort. When practitioners, clients, developers, and organizations align, digital self-monitoring evolves from a method into a sustainable, human-centered approach to mental health care.
Check out our dedicated manual page on how to use our (simplified) clinical dashboard.
👉 Explore the full paper here: XXXXX, 2024.
