Understanding Daily Fluctuations in Self-Regulation

Poor self-regulation and impulsivity are underlying symptoms of numerous mental health
problems such as obesity, substance abuse, Attention Deficit Hyperactivity Disorder (ADHD),
gambling, binge eating, bipolar disorder, borderline personality disorder, and suicidal
behaviors. This makes it one of the most important personal and public health intervention
targets. The classic Marshmallow Test done by Mischel and colleagues determined that the
inability to delay gratification in childhood was predictive of lower Scholastic Aptitude
Test (SAT) scores and higher BMI in adulthood. However, assessments of impulsivity and poor
self-regulation are rarely included in routine medical care because of time and financial
constraints.

The mobile phone has changed our ability to assess and intervene with individuals remotely,
providing an avenue for ambulatory diagnostic testing and just-in-time adaptive interventions
that can be accessed by billions of people. Newer methods of assessment using the mobile
phone, including Apple's ResearchKit, provide the opportunity for powerful assessments of
impulsivity beyond simple self-report. To date, there have been no measures of impulsivity
integrated into ResearchKit or any mobile application, aside from the beta version that the
investigators recently built, nor has the research community explored the possibilities of
passive impulsivity assessment using mobile analytics embedded in all phones. There is
preliminary evidence that mobile analytics, such as latency to respond to a text, can predict
personality traits associated with impulsivity such as extroversion and neuroticism, and
self-report studies reveal that there is a direct relationship between the inability to delay
gratification and different patterns of mobile phone use. These studies highlight potential
power of mobile phenotyping as a ubiquitous measure of health determinants in billions of
people by using passive data that doesn't require user participation. However, foundational
research is needed to validate assessments, build adaptive tools, and include individual
differences self-regulation capacity as well as interventions to improve regulation in the
discussion.

The investigators propose to test a new diagnostic self-regulation mobile assessment tool
app. The application built in Apple's ResearchKit(™) and Android's ResearchStack(™) includes
a self-report assessment, three continuous performance tasks, and passive data collection
developed for in-person use.

The goal is that by differentiating between high and low impulsive people using mobile
assessment tools, the investigators identify those at greatest risk for self-regulation
problems. Individuals higher in impulsivity have less self-control when faced with short-term
temptations regardless of their knowledge of the consequences of these choices. This would be
the first step in developing a completely remote measurement tool for this purpose.

The primary goal of this exploratory project is to develop and validate a mobile application
to test impulsivity remotely, and test how self-report indicators of impulsivity via mobile
assessment correlate with objective impulsivity tests on the mobile phone.

Because this is an exploratory study, the investigators are looking at how often participants
use the mobile app in the real-world and how the tasks perform over time once they leave the
laboratory. In addition, the investigators will test the validity of the measures over time.

Inclusion Criteria:

- be fluent and able to read in English at the eighth grade level (self-report and
consent form quiz),

- be between the ages of 18 and 75 (self-report, age in demographics),

- be willing to provide informed consent, and

- own a mobile smartphone (iOS or Android) and are willing to receive and respond to
text messages.

Exclusion Criteria:

- are pregnant or breast feeding,

- present with significant substance use which is defined as greater than once weekly
use in the past month (for any substance other than alcohol, nicotine or caffeine) or
greater than 21 standard alcoholic drinks per week for women and 24 for men,

- present with a serious psychiatric illness or suicide risk as measured by previous
inpatient treatment, medications for psychosis or recent suicidality; a current
self-reported or clinician determined diagnosis of Major Depression or past or present
bipolar disorder, delusional disorder or schizophrenia, and/or

- are unable to understand research study procedures as evidenced a score of less than 4
out of 5 on the consent form quiz.