Daan Hulsmans

149 Case study challenging behavior 6 have induced our (un)observed transitions. After all, within-day affective instability is a well-documented correlate of challenging behaviors in borderline personality disorder (Gee et al., 2020, Scott et al., 2017). The case records did provide within-day detail, but because we eventually quantified these into dichotomous codes per day (present vs. absent), the richness of within-day information was lost. Future research should zoom further into what happens within the day of (or days before) a transition. Statistical process control charts (Snippe et al., 2023) could then be used to detect whether significant rises in tensions predict challenging during the day. The participant selection in this study was solely based on convenience sampling, that is, she was the only one in dialectical behavior therapy who adhered to the diaries this consistently for this long. The uniqueness of the already collected diary data, both in terms of the chronicity of her challenging behavior (van den Bogaard et al., 2017, 2018) and her devoted compliance to the diaries, was the reason she and her legal guardians were asked for this study. Whether or not these study procedures can be replicated in different cases depends on how well the implemented diary procedure elicits an intrinsic motivation to stay compliant. There were certain participant- and study characteristics that contributed to her uniquely long-term compliance, which are lessons for scientists or practitioners who wish to collect similar data. First, the diaries were an integral part of her dialectical behavior therapy program – for which she was already highly motivated. Second, the diaries items were constructed in collaboration with the participant, and thus tailored to her experience world. A personalized approach to EMA in practice, by integrating it in therapy and individualizing item-selection, is an opportunity for increasing participant involvement and compliance (Hulsmans et al., 2023; Riese et al., 2021). Third, for compliance it may have been helpful that the participant has lived in residential care since childhood. This institutionalization – at least with our participant – contributed to the responsibility she felt to follow through on prescribed activities in her care plan. Completing the diaries became part of her daily routine structure. It is likely that this played a part in her continued compliance to the diaries, even when the Covid pandemic made dialectical behavior therapy impossible. Nevertheless, further research into factors that enhance or hamper EMA compliance is necessary. Importantly, personalized daily diary monitoring – and therefore this study’s three-step analytical procedure – is already certainly feasible for other individuals (Hulsmans et al., 2023). Replicating this design is therefore encouraged. Complex systems theoretical principles have already guided

RkJQdWJsaXNoZXIy MTk4NDMw