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 journalArticlepeer-review

25 Scopus citations


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
StatePublished - Oct 1 2019


  • Depression
  • Emotions
  • Happiness
  • Internet
  • Telemedicine

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology


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