{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T08:14:50Z","timestamp":1782548090409,"version":"3.54.5"},"reference-count":113,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Smoking, obesity, and insufficient physical activity are modifiable health risk behaviors. Self-regulation is one fundamental behavior change mechanism often incorporated within digital therapeutics as it varies momentarily across time and contexts and may play a causal role in improving these health behaviors. However, the role of momentary self-regulation in achieving behavior change has been infrequently examined. Using a novel momentary self-regulation scale, this study examined how targeting self-regulation through a digital therapeutic impacts adherence to the therapeutic and two different health risk behavioral outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective interventional study included momentary data for 28 days from 50 participants with obesity and binge eating disorder and 50 participants who smoked regularly. An evidence-based digital therapeutic, called Laddr\u2122, provided self-regulation behavior change tools. Participants reported on their momentary self-regulation via ecological momentary assessments and health risk behaviors were measured as steps taken from a physical activity tracker and breathalyzed carbon monoxide. Medical regimen adherence was assessed as daily Laddr usage. Bayesian dynamic mediation models were used to examine moment-to-moment mediation effects between momentary self-regulation subscales, medical regimen adherence, and behavioral outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the binge eating disorder sample, the perseverance [<jats:italic>\u03b2<\/jats:italic><jats:sub>1<\/jats:sub>\u2009=\u20090.17, 95% CI\u2009=\u2009(0.06, 0.45)] and emotion regulation [<jats:italic>\u03b2<\/jats:italic><jats:sub>1<\/jats:sub>\u2009=\u20090.12, 95% CI\u2009=\u2009(0.03, 0.27)] targets of momentary self-regulation positively predicted Laddr adherence on the following day, and higher Laddr adherence was subsequently a positive predictor of steps taken the same day for both perseverance [<jats:italic>\u03b2<\/jats:italic><jats:sub>2<\/jats:sub>\u2009=\u20090.335, 95% CI\u2009=\u2009(0.030, 0.717)] and emotion regulation [<jats:italic>\u03b2<\/jats:italic><jats:sub>2<\/jats:sub>\u2009=\u20090.389, 95% CI\u2009=\u2009(0.080, 0.738)]. In the smoking sample, the perseverance target of momentary self-regulation positively predicted Laddr adherence on the following day [<jats:italic>\u03b2<\/jats:italic>\u2009=\u20090.91, 95% CI\u2009=\u2009(0.60, 1.24)]. However, higher Laddr adherence was not a predictor of CO values on the same day [<jats:italic>\u03b2<\/jats:italic><jats:sub>2<\/jats:sub>\u2009=\u2009\u22120.09, 95% CI\u2009=\u2009(\u22120.24, 0.09)].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study provides evidence that a digital therapeutic targeting self-regulation can modify the relationships between momentary self-regulation, medical regimen adherence, and behavioral health outcomes. Together, this work demonstrated the ability to digitally assess the transdiagnostic mediating effect of momentary self-regulation on medical regimen adherence and pro-health behavioral outcomes.\n<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration<\/jats:title><jats:p><jats:uri>ClinicalTrials.gov<\/jats:uri>, identifier (NCT03774433).<\/jats:p><\/jats:sec>","DOI":"10.3389\/fdgth.2025.1467772","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T06:35:13Z","timestamp":1738650913000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Adherence to a digital therapeutic mediates the relationship between momentary self-regulation and health risk behaviors"],"prefix":"10.3389","volume":"7","author":[{"given":"Enzo 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