{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:12:20Z","timestamp":1792789940123,"version":"4.5.0"},"reference-count":29,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ZonMw, The Dutch Organisation for knowledge and innovation in health, healthcare and well-being","award":["636320005"],"award-info":[{"award-number":["636320005"]}],"id":[{"id":"https:\/\/ror.org\/01yaj9a77","id-type":"ROR","asserted-by":"crossref"}]},{"award":["636320005"],"award-info":[{"award-number":["636320005"]}],"id":[{"id":"https:\/\/ror.org\/01yaj9a77","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Objective: Cognitive behaviour therapy (CBT) for binge eating disorder (BED) is fairly effective, yet relapse remains problematic. Treatment outcomes may be improved if patients gain more insight into symptom patterns. In this qualitative study embedded in BED treatment, we evaluated user experiences with an Ecological Momentary Assessment (EMA) smartphone application to self-monitor affect and binge eating episodes in daily life. Methods: Participants were 20 adults who received group-CBT for BED at a mental health institute in the Netherlands. Via an EMA smartphone app, the participants filled out 5 micro-questionnaires daily for 6 weeks. An overview of mood fluctuations and binge eating episodes was graphically displayed in the app and discussed with the therapist. Semi-structured interviews were conducted with 16 participants and 5 practitioners to evaluate feasibility and usefulness. Results: Qualitative analyses of the interviews showed that the app was perceived as user-friendly, yet invasive due to many registrations. This was reflected in low response rates (mean: 31.1%), with only 9 participants reaching a response rate above 30% (&gt;65 of 210 EMA micro-questionnaires completed). Some participants thought the daily registrations were insightful, but some also perceived the registrations as confronting and shameful, suggesting potential iatrogenic effects. Conclusions: This study offers a real-world example of using EMA in treatment and provides meaningful insights for developers of behaviour change-focused EMA tools. The experiences of the participants and practitioners were mixed, yet several indicated improved reflection and awareness of (fluctuations in) emotions. Given the cautiously positive feedback from several participants and therapists, we recommend a carefully designed evaluation, including a shorter assessment period, a control group and an assessment of emotional awareness.<\/jats:p>","DOI":"10.3390\/nu18183046","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:50:03Z","timestamp":1789995003000},"page":"3046","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Qualitative Feasibility and Usability Study of an Ecological Momentary Assessment (EMA) Smartphone Application in Binge Eating Disorder Treatment"],"prefix":"10.3390","volume":"18","author":[{"given":"Pauline W.","family":"Jansen","sequence":"first","affiliation":[{"name":"Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands"},{"name":"Department of Child and Adolescent Psychiatry\/Psychology, Erasmus MC University Medical Center, Wytemaweg 8, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]},{"given":"Ivonne P. M.","family":"Derks","sequence":"additional","affiliation":[{"name":"Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands"},{"name":"Research Department of Behavioural Sciences and Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"van Russen Groen","sequence":"additional","affiliation":[{"name":"Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2111-597X","authenticated-orcid":false,"given":"Jeffrey","family":"van der Starre","sequence":"additional","affiliation":[{"name":"Parnassia Psychiatric Institute, Max Euwelaan 70, 3062 MB Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Joran","family":"Jongerling","sequence":"additional","affiliation":[{"name":"Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan, 5037 DB Tilburg, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Hans W.","family":"Hoek","sequence":"additional","affiliation":[{"name":"Parnassia Psychiatric Institute, Max Euwelaan 70, 3062 MB Rotterdam, The Netherlands"},{"name":"Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"},{"name":"Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]},{"given":"Machteld","family":"Wery","sequence":"additional","affiliation":[{"name":"Parnassia Psychiatric Institute, Max Euwelaan 70, 3062 MB Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Femke","family":"Truijens","sequence":"additional","affiliation":[{"name":"Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands"},{"name":"Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/YCO.0000000000000750","article-title":"Epidemiology of binge eating disorder: Prevalence, course, comorbidity, and risk factors","volume":"34","year":"2021","journal-title":"Curr. 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Disord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.psc.2018.10.011","article-title":"Binge-eating disorder","volume":"42","author":"Hilbert","year":"2019","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1002\/eat.23324","article-title":"Comparing integrative cognitive-affective therapy and guided self-help cognitive-behavioral therapy to treat binge-eating disorder using standard and naturalistic momentary outcome measures: A randomized controlled trial","volume":"53","author":"Peterson","year":"2020","journal-title":"Int. J. Eat. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1037\/a0023660","article-title":"Revisiting the affect regulation model of binge eating: A meta-analysis of studies using ecological momentary assessment","volume":"137","author":"Keel","year":"2011","journal-title":"Psychol. Bull."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s11920-016-0672-7","article-title":"Ecological Momentary Assessment in Eating Disorder and Obesity Research: A Review of the Recent Literature","volume":"18","author":"Engel","year":"2016","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"102625","DOI":"10.1016\/j.cpr.2025.102625","article-title":"Binge eating as emotion regulation? A meta-analysis of ecological momentary assessment studies","volume":"121","author":"Borm","year":"2025","journal-title":"Clin. Psychol. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1002\/erv.469","article-title":"Does ecological momentary assessment improve cognitive behavioural therapy for binge eating disorder? A pilot study","volume":"10","author":"Dymek","year":"2002","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1002\/erv.2800","article-title":"Enhancing Integrative Cognitive-Affective Therapy with ecological momentary interventions: A pilot trial","volume":"29","author":"Juarascio","year":"2021","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s40337-025-01329-4","article-title":"Ecological momentary interventions for eating disorders: A systematic review of the nascent science and recommendations for future research","volume":"13","author":"Kruger","year":"2025","journal-title":"J. Eat. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Mao, W., Schmidt, R., Presseller, E.K., Juarascio, A., and Hilbert, A. (2026). Ecological Momentary Interventions in the Management of Eating Disorders and Obesity: A Systematic Review. Int. J. Eat. Disord., 1\u201316.","DOI":"10.1002\/eat.70140"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s11920-019-1046-8","article-title":"From Ecological Momentary Assessment (EMA) to Ecological Momentary Intervention (EMI): Past and Future Directions for Ambulatory Assessment and Interventions in Eating Disorders","volume":"21","author":"Smith","year":"2019","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2551","DOI":"10.1016\/j.brat.2007.06.003","article-title":"Predictors and mediators of treatment outcome in patients with binge eating disorder","volume":"45","author":"Dingemans","year":"2007","journal-title":"Behav. Res. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.eatbeh.2012.09.002","article-title":"Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q)","volume":"13","author":"Aardoom","year":"2012","journal-title":"Eat. Behav."},{"key":"ref_17","unstructured":"Fairburn, C.G. (2008). Eating Disorder Examination Questionnaire (EDE-Q 6.0). Cognitive Behavior Therapy and Eating Disorders, Guilford Press."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1037\/0022-3514.54.6.1063","article-title":"Development and validation of brief measures of positive and negative affect: The PANAS scales","volume":"54","author":"Watson","year":"1988","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Braun, V., and Clarke, V. (2012). Thematic analysis. APA Handbook of Research Methods in Psychology, Vol 2: Research Designs: Quantitative, Qualitative, Neuropsychological, and Biological, American Psychological Association.","DOI":"10.1037\/13620-004"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s40337-023-00817-9","article-title":"Perfectionism and binge eating association: A systematic review and meta-analysis","volume":"11","author":"Vicent","year":"2023","journal-title":"J. Eat. Disord."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1017\/S0033291711001875","article-title":"Rapid response predicts 12-month post-treatment outcomes in binge-eating disorder: Theoretical and clinical implications","volume":"42","author":"Grilo","year":"2012","journal-title":"Psychol. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"114437","DOI":"10.1016\/j.psychres.2022.114437","article-title":"Qualitative analysis of participant experiences during an ecological momentary assessment study of nonsuicidal self-injury among veterans","volume":"310","author":"Gromatsky","year":"2022","journal-title":"Psychiatry Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1002\/eat.24473","article-title":"Ecological Momentary Assessment in Eating Disorders Research: A Qualitative Examination of Participant Experience and Recommendations for Future Studies","volume":"58","author":"Wilson","year":"2025","journal-title":"Int. J. Eat. Disord."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/S0005-7967(01)00059-6","article-title":"Clinical perfectionism: A cognitive\u2013behavioural analysis","volume":"40","author":"Shafran","year":"2002","journal-title":"Behav. Res. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e10253","DOI":"10.2196\/10253","article-title":"Patient Experiences Using a Self-Monitoring App in Eating Disorder Treatment: Qualitative Study","volume":"6","author":"Lindgreen","year":"2018","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e29832","DOI":"10.2196\/29832","article-title":"A Smartphone Serious Game for Adolescents (Grow It! App): Development, Feasibility, and Acceptance Study","volume":"6","author":"Dietvorst","year":"2022","journal-title":"JMIR Form. Res."},{"key":"ref_28","unstructured":"Fairburn, C.G. (2008). Cognitive Behavior Therapy and Eating Disorders, Guilford Press."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"102730","DOI":"10.1016\/j.cpr.2026.102730","article-title":"Maintenance factors for eating disorder symptoms based on ecological momentary assessment studies: A systematic review","volume":"126","author":"Racine","year":"2026","journal-title":"Clin. Psychol. 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