Comparison of Two Ecological Momentary Intervention Modules for Treatment of Depression on Momentary Positive and Negative Affect

Background: Ecological Momentary Assessment (EMA), comprising repeated self-assessments in daily life, have shown promise as an intervention strategy for depression. Whether the content of such assessments influences affect has hardly received attention. The current study consists of two EMA intervention (EMI) modules, enabling us to compare the impact of EMI content on the course of momentary affect during the intervention. Methods: The intervention, implemented as add-on to regular depression treatment, consists of intensive self-monitoring (5x/day, 28 days) and weekly personalized feedback. Patients with depressive complaints (N = 110; M-age = 32.9, SD = 12.2; 44.5% male) were randomly assigned to one of two treatment modules focusing on activities and positive affect ("Do") or on thoughts and negative affect ("Think"). Results: Linear mixed models showed no significant (p > .18) differences between the two modules on both positive and negative affect over time. Across modules positive affect showed an initial decreasing trend, leveling off towards the end of the intervention period. Negative affect did not change significantly over time (p > .06). Limitations: Both modules assessed positive and negative affect, enabling a direct comparison but potentially decreasing the impact of their differential focus. Conclusions: In our sample, the focus of the EMI was not associated with differential effects on momentary affect. This implies that a focus on thoughts and negative affect compared to positive affect and activities may not lead to added adverse effects on mood, which is an often-voiced concern when using EMA in both research and clinical practice

Effect of Daily Life Reward Loop Functioning on the Course of Depression

Engagement in activities increases positive affect (Reward Path 1), which subsequently reinforces motivation (Reward Path 2), and hence future engagement in activities (Reward Path 3). Strong connections between these three reward loop components are considered adaptive, and might be disturbed in depression. Although some ecological nomentary assessment (EMA) studies have investigated the cross-sectional association between separate reward paths and individuals’ level of depression, no EMA study has looked into the association between individuals’ reward loop strength and depressive symptom course. The present EMA study assessed reward loop functioning (5x/day, 28 days) of 46 outpatients starting depression treatment at secondary mental health services and monitored with the Inventory of Depressive Symptomatology—Self-Report (IDS-SR) during a 7-month period. Results of multilevel regression analyses showed significant within-person associations for Reward Path 1 (b = 0.21, p &lt; .001), Reward Path 2 (b = 0.43, p &lt; .001), and Reward Path 3 (b = 0.20, p &lt; .001). Stronger average reward loops (i.e., within-person mean of all reward paths) did not relate to participants’ improvement in depressive symptoms over time. Path-specific results revealed that Reward Paths 1 and 2 may have partly opposite effects on depressive symptom course. Together, our findings suggest that reward processes in daily life might be best studied separately and that further investigation is warranted to explore under what circumstances strong paths are adaptive or not.</p

Comparison of Two Ecological Momentary Intervention Modules for Treatment of Depression on Momentary Positive and Negative Affect

Ecological Momentary Interventions (EMI), comprising repeated self-assessments in daily life, have shown promise as intervention strategy for depression. Whether the content of such assessments influences affect has hardly received attention. The ZELF-i study consists of two EMA intervention (EMI) modules, enabling us to compare the impact of EMI content on the course of momentary affect during the intervention. Methods: ZELF-i is an add-on to depression treatment comprising intensive self-monitoring (5x/day, 28 days) and weekly personalized feedback. Patients with depressive complaints (N = 110; Mean age = 32.9, SD = 12.2; 44.5% male) were randomly assigned to one of two treatment modules focusing on activities and positive affect (“Do”) or on thoughts and negative affect (“Think”). Linear mixed models showed no significant (p &gt; .18) differences between the two modules on both positive and negative affect over time. Across modules positive affect showed an initial decreasing trend, leveling off towards the end of the intervention period. Negative affect did not change significantly over time (p &gt; .06). In our sample, the focus of the EMI did not impact momentary affect beyond any general effect of systematic self-monitoring. This means that a focus on negative affect instead of more general self-monitoring may not lead to added adverse effects on mood, which is an often voiced concern when using EMA in both research and clinical practice. Keywords: Depression, Ecological Momentary Assessment, Affect, Measurement Reactivity, Emotions, Pragmatic Clinical Tria

An evaluation of the efficacy of two add-on ecological momentary intervention modules for depression in a pragmatic randomized controlled trial (ZELF-i)

Background Depression treatment might be enhanced by Ecological Momentary Interventions (EMI) based on self-monitoring and person-specific feedback. This study is the first to examine the efficacy of two different EMI modules for depression in routine clinical practice. Methods Outpatients starting depression treatment at secondary mental health services (N = 161; MIDS-DEPRESSION = 35.9, SD = 10.7; MAGE = 32.8, SD = 12.1; 46% male) participated in a pragmatic randomized controlled trial with three arms. Two experimental groups engaged in 28 days of systematic self-monitoring (5 times per day), and received weekly feedback on either positive affect and activities (Do-module) or negative affect and thinking patterns (Think-module). The control group received no additional intervention. Participants completed questionnaires on depressive symptoms (primary outcome), social functioning, and empowerment before and after the intervention period, and at four measurements during a 6-month follow-up period. Results Of the 90 (out of 110) participants who completed the intervention, 86% would recommend it. However, the experimental groups did not show significantly more or faster changes over time than the control group in terms of depressive symptoms, social functioning and empowerment. Furthermore, trajectories of the two EMI modules were very similar. Conclusions We did not find statistical evidence that this type of EMI augments the efficacy of regular depression treatment, regardless of module content. We cannot rule out that EMIs have a positive impact on other domains or provide a more efficient way of delivering care. Nonetheless, EMI’s promise of effectiveness has not materialized yet

Protocol paper

We have published the study protocol of our ZELF-i trial in BMC Psychiatry (Open Access): https://doi.org/10.1186/s12888-018-1847-z. The postprint is available on this OSF page

Effect of daily life reward loop functioning on the course of depression

Engagement in activities increases positive affect (reward path 1), which subsequently reinforces motivation (reward path 2) and hence future engagement in activities (reward path 3). Strong connections between these three reward loop components are considered adaptive, and might be disturbed in depression. Although some Ecological Momentary Assessment (EMA) studies have investigated the cross-sectional association between separate reward paths and individuals’ level of depression, no EMA study has looked into the association between individuals’ reward loop strength and depressive symptom course. The present EMA study assessed reward loop functioning (5x/day, 28 days) of 46 outpatients starting depression treatment at secondary mental health services and monitored with the Inventory of Depressive Symptomatology Self Report (IDS-SR) during a 7-month period. Results of multilevel regression analyses showed significant within-person associations for reward path 1 (b = 0.21; p &lt; .001); reward path 2 (b = 0.43; p &lt; .001) and reward path 3 (b = 0.20; p &lt; .001). Stronger average reward loops (i.e., within-person mean of all reward paths) did not relate to participants’ improvement in depressive symptoms over time. Path-specific results revealed that reward paths 1 and 2 may have partly opposite effects on depressive symptom course. Together, our findings suggest that reward processes in daily life might be best studied separately and that further investigation is warranted to explore under what circumstances strong paths are adaptive or not

Patient perspective

All files, materials, code and communication regarding the Patientperspectives paper on ZELF-