Investigating the Dynamic Relationship Between Anxiety and Spatial Memory Using Autonomous Ecological Momentary Assessment

Abstract Anxiety has been extensively studied in relation to memory, yet its dynamic association with spatial episodic memory in naturalistic clinical settings remains largely unexplored. We developed an anxiety-spatial-memory EMA protocol (asm-EMA) and deployed it in 30 epilepsy patients undergoing inpatient EEG monitoring, delivering combined momentary anxiety ratings and a validated spatial memory task pseudo-randomly every 90–150 minutes across multiple days. Subject-level asm-EMA means and session-to-session variability both correlated significantly with standard neuropsychological assessments, supporting the clinical validity of our design. Elevated within-person STAI-6 was selectively associated with faster retrieval responses, yet spatial memory accuracy was independent of all three anxiety measures, suggesting a shift in response strategy rather than memory impairment. Within-day anxiety showed short-term carryover between consecutive sessions, with little persistence beyond the next session. The asm-EMA protocol provides a feasible, autonomous framework for capturing moment-to-moment anxiety-memory dynamics in naturalistic settings. Competing Interest Statement In the past 3 years, Dr. Auerbach has received funding from NIH/NIMH, the Morgan Stanley Foundation, and the Erick Shirley Foundation for Mental Health. He serves on the scientific advisory board for the Jake Collective. Dr. Auerbach has received consulting fees and equity from Get Sonar, Inc., consulting fees from RPA Health Consulting, Inc., and consulting fees from Covington & Burling LLP, which is representing a social media company in litigation. The remaining authors declare no competing interests. Footnotes Ethical considerations The study was approved by the Columbia University Institutional Review Board. Consent to participate Written informed consent was obtained from all participants prior to enrollment. Declaration of conflicting interest In the past 3 years, Dr. Auerbach has received funding from NIH/NIMH, the Morgan Stanley Foundation, and the Erick Shirley Foundation for Mental Health. He serves on the scientific advisory board for the Jake Collective. Dr. Auerbach has received consulting fees and equity from Get Sonar, Inc., consulting fees from RPA Health Consulting, Inc., and consulting fees from Covington & Burling LLP, which is representing a social media company in litigation. The remaining authors declare no competing interests. Funding statement This work was supported by the NIH R61MH135405. Data availability Data supporting the study’s conclusions from the corresponding author is available upon reasonable request. Code availability The analysis code used in this study is available from the corresponding author upon reasonable request. Abbreviations - EMA - ecological momentary assessment - asm-EMA - anxiety-spatial-memory EMA - VAS - Visual Analog Scale - STAI - Spielberger State-Trait Anxiety Inventory - STAI-6 - six-item STAI - BAI - Beck Anxiety Inventory - BDI-II - Beck Depression Inventory-II - QOLIE-31 - Quality of Life in Epilepsy-31 - SBSOD - Santa Barbara Sense of Direction scale - EMU - Epilepsy Monitoring Unit - EEG - electroencephalography - SEEG - stereoelectroencephalography - ICC - intraclass correlation coefficient - RT - response time