Discussion
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LENS, EMA
Changing behavior is difficult. Yet changing from unhealthy to healthy choices in day-to-day life, and preventing unhealthy choices, can improve long-term quality of life and longevity. Across two studies, we leveraged smartphones to administer two theory-driven interventions to change an important health behavior—alcohol use—among two samples of college students, as a basic science, proof of concept investigation. Within-person, we tested whether psychological distancing reminders, drawing on mindfulness and perspective-taking can decrease the frequency of alcohol occasions and the number of drinks per occasion on intervention weeks relative to non-intervention weeks over 28 days. We found that the psychological distance conditions drank directionally less frequently on active weeks, relative to inactive weeks in Study 1; and significantly less frequently on active weeks, relative to inactive weeks in Study 2, with a larger sample. Reminders, focused on creating psychological distance from alcohol cues, helped reduce the frequency of alcohol use occasions but did not impact the number of drinks consumed per occasion, within-person.On average, across both studies, the frequency of drinking occasions decreased about 2%, on weeks when participants received twice-a-day psychological distancing reminders. In Study 1, drinking occasion frequency decreased from once every 6 days to once every 8 days when intervention reminders were present. In Study 2, drinking occasion frequency reduced from once every 9 days to once every 11 days. These effects are meaningful in light of broader goals to motivate positive behavior change in daily life from a preventative lens. Decreasing the frequency of alcohol occasions is not the direct goal of most alcohol harm reduction interventions among young adults, which often target binge drinkingOur investigation builds on bodies of research that consider psychological distancing strategies, such as mindfulnessOne possibility is that repeated psychological distance reminders help offload cognitive effort when evaluating health-related optionsWith respect to intervention specificity, both the mindfulness and perspective-taking reminders reduced drinking frequency on active vs. inactive weeks to a similar degree. It is possible that different types of psychological distancing strategies, with repeated reminders, may be similarly effective in reducing the frequency of drinking occasions relative to an individual’s own baseline. Further, it is plausible that both interventions leverage a parallel psychological distance mechanism, though our data do not speak to this possibility directly. For example, neuroimaging research suggests that different forms of psychological distance are encoded similarly in the brainWhile promising, our intervention effects on reducing the frequency of drinking occasions should be interpreted with caution. We observed directional (Study 1) and significant (Study 2) within-person changes in drinking frequency from active to inactive weeks; with this change being greater than in the absence of active intervention reminders. However, participants in the intervention conditions did not necessarily drink less frequently than those assigned to the control condition, on average. One possibility is that random assignment did not completely overcome pre-existing differences in alcohol use between groups (see Intervention compliance, alcohol consumption and baseline differences in the Results section for more details). There also remains the possibility that the distancing reminders altered drinking by making individuals more reactive to being monitored, though participants also received instructions about how to approach alcohol and reported their drinking behavior daily during “inactive” weeks. Thus, our comparison likely represents a relatively conservative test of potential effects of distancing reminders on drinking behavior. Nevertheless, self-monitoring alcohol use may promote behavior changeOur results should also be interpreted considering design strengths and limitations. First, we employed theory-driven interventions within an EMA design, which allowed us to capture intervention effects in participants' natural environments and overcome common retrospective biases that ask participants to recall information about longer periods of time (e.g., amount of alcohol consumed in the previous 30 days). Next, the within-person manipulation allowed us to detect intervention effects while considering individuals’ personal drinking baselines. We employed this repeated measures design across two different samples, and across two different sites, thereby increasing the robustness of our findings. Further, we replicated these findings in a highly unusual and stressful time, the onset of the COVID-19 pandemic. Although intensive assessment often raises data compliance concerns, we observed little evidence of non-compliance in our data. The intensive sampling approach produced high response rates (approximately 95% median response rate in Study 1, with an in-person training component, and 91% median response rate in Study 2 with a fully remote delivery and a doubled sample size). These high response rates may support the feasibility of applying this approach for evaluating future interventions among college samples.It is important to note that our data cannot speak to long-term intervention effects on drinking beyond the length of 28 days, and our results may not generalize to samples beyond college students in urban college campuses in the Northeastern United States without alcohol dependence who are part of social groups. Specifically, we recruited students from pre-existing social groups (and included groups in which 80% or more expressed interest), with higher proportions of women than men. Although we controlled for non-independence of observations in statistical modeling, the non-independence may have confounded intervention effects in unmeasurable ways (e.g., spillover effects or social influence). Finally, when interpreting results, it is important to note that the psychological distancing reminders did not explicitly instruct individuals to decrease the quantity of alcohol consumed. As such, future work could test more explicit instructions to directly target the number of drinks when drinking. Finally, we used self-reported measures of drinking which may be subject to social desirability bias and may underestimate drinking levels