The MARIGOLD study: Feasibility and enhancement of an online intervention to improve emotion regulation in people with elevated depressive symptoms

Elizabeth L. Addington*, Elaine Ooi Yan Cheung, Sarah M. Bassett, Ian Kwok, Stephanie A. Schuette, Eva Shiu, Dershung Yang, Michael A. Cohn, Yan Leykin, Laura R. Saslow, Judith Tedlie Moskowitz

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: This manuscript describes the first two phases of pilot testing MARIGOLD, an online self-guided positive emotion skills intervention for adults with elevated depressive symptoms, along with enhancements to overcome retention and adherence problems reported in previous research. Methods: Adults with elevated depressive symptoms were recruited online and assessed at baseline, post-intervention, 1- and 3-month follow-up. Phase 1 participants (n = 58) were randomized to MARIGOLD, daily emotion reporting, or waitlist. Phase 2 participants (n = 79) were randomized to MARIGOLD plus one enhancement: online discussion board (ODB), virtual badges (VB), or facilitator contact (FC). Post-intervention interviews assessed acceptability. Intention-to-treat analyses examined retention, adherence, and preliminary efficacy. Results: In both phases, retention and adherence did not differ between groups. MARIGOLD skills were highly acceptable, but qualitative results indicate web-based features (e.g., log-in, ODB, VB) require refinement prior to larger testing. Neither phase demonstrated between-group differences in preliminary efficacy. In Phase 1 within-group analyses, MARIGOLD and emotion reporting control demonstrated a similar pattern of findings (stable depressive symptoms, increased positive emotion, decreased negative emotion and stress), whereas the waitlist group significantly increased in depressive mood. Most Phase 2 within-group analyses demonstrated the expected pattern of results (i.e., decreases in PHQ-8 and negative emotion, increases in positive emotion). However, CES-D scores were stable in FC; perceived stress was stable in FC and ODB. Limitations: This pilot study is not powered to evaluate efficacy. Conclusion: Positive emotion skills, plus enhancements for web-based, self-guided delivery, warrant additional study in people with elevated depressive symptoms.

Original languageEnglish (US)
Pages (from-to)352-364
Number of pages13
JournalJournal of Affective Disorders
Volume257
DOIs
StatePublished - Oct 1 2019

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Feasibility Studies
Emotions
Depression
Intention to Treat Analysis
Interviews
Research

Keywords

  • Depression
  • Emotions
  • Happiness
  • Internet
  • Telemedicine

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Addington, Elizabeth L. ; Cheung, Elaine Ooi Yan ; Bassett, Sarah M. ; Kwok, Ian ; Schuette, Stephanie A. ; Shiu, Eva ; Yang, Dershung ; Cohn, Michael A. ; Leykin, Yan ; Saslow, Laura R. ; Moskowitz, Judith Tedlie. / The MARIGOLD study : Feasibility and enhancement of an online intervention to improve emotion regulation in people with elevated depressive symptoms. In: Journal of Affective Disorders. 2019 ; Vol. 257. pp. 352-364.
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The MARIGOLD study : Feasibility and enhancement of an online intervention to improve emotion regulation in people with elevated depressive symptoms. / Addington, Elizabeth L.; Cheung, Elaine Ooi Yan; Bassett, Sarah M.; Kwok, Ian; Schuette, Stephanie A.; Shiu, Eva; Yang, Dershung; Cohn, Michael A.; Leykin, Yan; Saslow, Laura R.; Moskowitz, Judith Tedlie.

In: Journal of Affective Disorders, Vol. 257, 01.10.2019, p. 352-364.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The MARIGOLD study

T2 - Feasibility and enhancement of an online intervention to improve emotion regulation in people with elevated depressive symptoms

AU - Addington, Elizabeth L.

AU - Cheung, Elaine Ooi Yan

AU - Bassett, Sarah M.

AU - Kwok, Ian

AU - Schuette, Stephanie A.

AU - Shiu, Eva

AU - Yang, Dershung

AU - Cohn, Michael A.

AU - Leykin, Yan

AU - Saslow, Laura R.

AU - Moskowitz, Judith Tedlie

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: This manuscript describes the first two phases of pilot testing MARIGOLD, an online self-guided positive emotion skills intervention for adults with elevated depressive symptoms, along with enhancements to overcome retention and adherence problems reported in previous research. Methods: Adults with elevated depressive symptoms were recruited online and assessed at baseline, post-intervention, 1- and 3-month follow-up. Phase 1 participants (n = 58) were randomized to MARIGOLD, daily emotion reporting, or waitlist. Phase 2 participants (n = 79) were randomized to MARIGOLD plus one enhancement: online discussion board (ODB), virtual badges (VB), or facilitator contact (FC). Post-intervention interviews assessed acceptability. Intention-to-treat analyses examined retention, adherence, and preliminary efficacy. Results: In both phases, retention and adherence did not differ between groups. MARIGOLD skills were highly acceptable, but qualitative results indicate web-based features (e.g., log-in, ODB, VB) require refinement prior to larger testing. Neither phase demonstrated between-group differences in preliminary efficacy. In Phase 1 within-group analyses, MARIGOLD and emotion reporting control demonstrated a similar pattern of findings (stable depressive symptoms, increased positive emotion, decreased negative emotion and stress), whereas the waitlist group significantly increased in depressive mood. Most Phase 2 within-group analyses demonstrated the expected pattern of results (i.e., decreases in PHQ-8 and negative emotion, increases in positive emotion). However, CES-D scores were stable in FC; perceived stress was stable in FC and ODB. Limitations: This pilot study is not powered to evaluate efficacy. Conclusion: Positive emotion skills, plus enhancements for web-based, self-guided delivery, warrant additional study in people with elevated depressive symptoms.

AB - Background: This manuscript describes the first two phases of pilot testing MARIGOLD, an online self-guided positive emotion skills intervention for adults with elevated depressive symptoms, along with enhancements to overcome retention and adherence problems reported in previous research. Methods: Adults with elevated depressive symptoms were recruited online and assessed at baseline, post-intervention, 1- and 3-month follow-up. Phase 1 participants (n = 58) were randomized to MARIGOLD, daily emotion reporting, or waitlist. Phase 2 participants (n = 79) were randomized to MARIGOLD plus one enhancement: online discussion board (ODB), virtual badges (VB), or facilitator contact (FC). Post-intervention interviews assessed acceptability. Intention-to-treat analyses examined retention, adherence, and preliminary efficacy. Results: In both phases, retention and adherence did not differ between groups. MARIGOLD skills were highly acceptable, but qualitative results indicate web-based features (e.g., log-in, ODB, VB) require refinement prior to larger testing. Neither phase demonstrated between-group differences in preliminary efficacy. In Phase 1 within-group analyses, MARIGOLD and emotion reporting control demonstrated a similar pattern of findings (stable depressive symptoms, increased positive emotion, decreased negative emotion and stress), whereas the waitlist group significantly increased in depressive mood. Most Phase 2 within-group analyses demonstrated the expected pattern of results (i.e., decreases in PHQ-8 and negative emotion, increases in positive emotion). However, CES-D scores were stable in FC; perceived stress was stable in FC and ODB. Limitations: This pilot study is not powered to evaluate efficacy. Conclusion: Positive emotion skills, plus enhancements for web-based, self-guided delivery, warrant additional study in people with elevated depressive symptoms.

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