experienced in the moment while interacting with
the natural environment.
Indeed, this reflects the second advantage of
ambulatory assessment—it is more ecologically
valid. That is, ratings and assessments are collected
on the client’s experiencing in his or her natural
environment. Therefore, these assessments are
more likely to generalize to the client’s typical expe-
rience than are retrospective assessments gathered in
the clinician’s office. A third advantage is that multi-
ple assessments on the same client are possible,
enabling the clinician to explore the variability of
moods states, for example, within each individual.
A number of important psychological constructs
involve variability, like variable mood states, levels
of cravings, and intrusive thoughts. A one-time,
static assessment will not capture the variability
inherent in these symptoms.
A fourth advantage for ambulatory assessment
is the possibility that multiple forms of ambula-
tory assessment, focusing on different response
domains, can be conducted and combined for
the single client. For example, a client with an
anxiety disorder could provide ambulatory assess-
ment data in three realms: psychological (self-
ratings of her mood state over a 7-day period,
multiple times per day); psychophysiological (bio-
sensors recording galvanic skin response [sweating]
as well as heart rate); and behavioral (activity level
assessed via actometers, self-winding wristwatches
that have been modified to measure activity
instead of time).
A final advantage is that ambulatory assess-
ment can be easily incorporated with treatment
or even computer-assisted therapy, which we dis-
cuss next (Clough & Casey, 2011). There are sev-
eral ways that ambulatory assessment might be
combined with treatment. Perhaps the most obvi-
ous application is the use of ambulatory assessment
to establish baseline (before-treatment) function-
ing and to monitor progress throughout the course
of treatment. For example, a client presenting
for treatment of panic disorder might complete
ambulatory assessments before treatment to estab-
lish the frequency, severity, and typical locations
of panic attacks. After treatment is initiated, ambu-
latory assessment could be used to see if the fre-
quency and intensity of panic attacks decrease and
to see if the client is avoiding certain situations less.
Another application of ambulatory assessment to
treatment might be for certain responses to
an electronic diary or smart phone survey to send
an“alert”outtoatherapistortoane-therapist
so that some coaching or instruction could be
provided to the client. For example, a client who
is attempting to abstain from alcohol might receive
a phone call from a therapist or peer counselor if
he rates his craving for alcohol at that moment to
be extremely high. Concerning an e-therapist, in
this same situation a text message might automati-
cally be sent with coping instructions if this high
level of craving is endorsed. As you see, this appli-
cation begins to blur the boundaries between
ambulatory assessment and treatment. Ultimately,
perhaps, treatment itself might be administered
and received while clients are in their natural
environments. We should remind ourselves that
being able to experience emotions and behave
adaptively in one’s daily life is the ultimate treat-
ment success!Computer-Assisted Therapy
As we mentioned in the context of telehealth,
computer-assisted therapy has the potential to be
less stigmatizing, more efficient, more accessible,
and more convenient for clients. Whether treat-
ment is administered though videoconferencing or
through e-mail, text messaging, or recent therapy-
based“apps,”clients who might not present to a
mental health professional for face-to-face treat-
ment because of embarrassment or shame seem
more likely to be willing to initiate a treatment
contact if this can occur in the privacy of the clients’
own choosing. Because the fear of stigma is one of
the biggest reasons those in need do not seek out
mental health treatment, this advantage is quite
important.
Further, other reasons commonly cited for
not pursuing treatment is lack of accessibility and82 CHAPTER 3