Mobile Assessment of the Dynamic Relationships between Experiential Avoidance, Mood, Stress, and Adherence in Cardiopulmonary Rehabilitation

Abstract

Background: Despite the well-documented benefits of attending cardiopulmonary rehabilitation (CVPR) for many patients following acute cardiac or pulmonary events, adherence and completion rates remain suboptimal. Increased depressive symptoms is an important factor associated with program non-completion. Research has shown that experiential avoidance (EA) is a targetable dynamic transdiagnostic process that influences mood and is associated with better psychological well-being in cardiac rehabilitation patients. Ecological momentary assessment (EMA) is a method of real-time data collection that may provide a nuanced understanding of the dynamic relationships between EA and mood, and their impact on CVPR adherence. Methods: Participants (n = 47) were recruited from a CVPR program during their first two weeks of attendance. Participants completed two daily EMA prompts assessing momentary mood, stress, and experiential avoidance for two weeks using personal or loaner smart phones. Multilevel modeling (MLM) was employed to investigate the within-person within-prompt correlates, antecedents, and consequences of experiential avoidance. Binary logistic regression and multiple regression were utilized to examine the relationships between mood, stress, and their interactions with experiential avoidance, on CVPR outcomes. Results: Response rates indicated that mobile EMA is a feasible method for data collection in CVPR. MLM results showed that EA, negative mood, positive mood, and stress were significantly correlated in the hypothesized directions at the within-person within-prompt level. Lagged analyses demonstrated that EA was negatively related to change in next-day positive mood scores, and that greater EA and negative mood predicted poor next week CVPR attendance rates. Random effect analyses showed that relationships between EA and next-day negative mood, and EA and next-day stress, were highly variable amongst participants. Regression analyses revealed no significant relationships between the variables of interest and CVPR outcomes (i.e. completion rates, change in six-minute walk test, and change in body mass index). Discussion: The current study built upon previous research on the dynamic relationships between EA, mood, and stress, and extended the literature through the examination of these associations in an older chronic disease population. Results suggest that EA may be an important targetable mechanism related to CVPR program adherence and positive mood. In addition, the feasibility of mobile EMA monitoring provides support for a platform to further understand and address contextual barriers that may impact adherence and engagement as patients journey through rehabilitation programming.