A Self-Paced, Web-Based, Positive Emotion Skills Intervention for Reducing Symptoms of Depression: Protocol for Development and Pilot Testing of MARIGOLD

Elaine O Cheung, Elizabeth L Addington, Sarah M Bassett, Stephanie A Schuette, Eva W Shiu, Michael A Cohn, Yan Leykin, Laura R Saslow, Judith T Moskowitz, Elaine O Cheung, Elizabeth L Addington, Sarah M Bassett, Stephanie A Schuette, Eva W Shiu, Michael A Cohn, Yan Leykin, Laura R Saslow, Judith T Moskowitz

Abstract

Background: Living with elevated symptoms of depression can have debilitating consequences for an individual's psychosocial and physical functioning, quality of life, and health care utilization. A growing body of evidence demonstrates that skills for increasing positive emotion can be helpful to individuals with depression. Although Web-based interventions to reduce negative emotion in individuals with depression are available, these interventions frequently suffer from poor retention and adherence and do not capitalize on the potential benefits of increasing positive emotion.

Objective: The aim of this study was to develop and test a Web-based positive emotion skills intervention tailored for individuals living with elevated depressive symptoms, as well as to develop and test enhancement strategies for increasing retention and adherence to that intervention.

Methods: This study protocol describes the development and testing for Mobile Affect Regulation Intervention with the Goal of Lowering Depression (MARIGOLD), a Web-based positive emotion skills intervention, adapted for individuals with elevated depressive symptomatology. The intervention development is taking place in three phases. In phase 1, we are tailoring an existing positive emotion skills intervention for individuals with elevated symptoms of depression and are pilot testing the tailored version of the intervention in a randomized controlled trial with two control conditions (N=60). In phase 2, we are developing and testing three enhancements aimed at boosting retention and adherence to the Web-based intervention (N=75): facilitator contact, an online discussion board, and virtual badges. In phase 3, we are conducting a multifactorial, nine-arm pilot trial (N=600) to systematically test these enhancement strategies, individually and in combination. The primary outcome is depressive symptom severity. Secondary outcomes include positive and negative emotion, psychological well-being, and coping resources.

Results: The project was funded in August 2014, and data collection was completed in May 2018. Data analysis is currently under way, and the first results are expected to be submitted for publication in 2018.

Conclusions: Findings from this investigation will enable us to develop an optimal package of intervention content and enhancement strategies for individuals with elevated symptoms of depression. If this intervention proves to be effective, it will provide a cost-effective, anonymous, appealing, and flexible approach for reducing symptoms of depression and improving psychological adjustment through increasing positive emotion.

Trial registration: ClinicalTrials.gov NCT01964820 (Phase 1); https://ichgcp.net/clinical-trials-registry/NCT01964820 (Archived by WebCite at http://www.webcitation.org/6zpmKBcyX). ClinicalTrials.gov NCT02861755 (Phase 2); https://ichgcp.net/clinical-trials-registry/NCT02861755 (Archived by WebCite at http://www.webcitation.org/6zpmLmy8k).

Registered report identifier: RR1-10.2196/10494.

Keywords: depression; emotions; happiness; mobile apps; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

©Elaine O Cheung, Elizabeth L Addington, Sarah M Bassett, Stephanie A Schuette, Eva W Shiu, Michael A Cohn, Yan Leykin, Laura R Saslow, Judith T Moskowitz. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 05.06.2018.

Figures

Figure 1
Figure 1
Flowchart of study timeline for phases 1 to 3. FC, facilitator contact; ODB, online discussion board; VB, virtual badges.
Figure 2
Figure 2
Example garden plot with virtual flower badges and accompanying key in the virtual badges enhancement.

References

    1. Pratt LA, Brody DJ. US Department of Health and Human Services. 2014. [2018-05-21]. Depression in the U.S. Household Population, 2009–2012 (NCHS data brief, no. 172) .
    1. Cuijpers P, de Graaf R, van Dorsselaer S. Minor depression: risk profiles, functional disability, health care use and risk of developing major depression. J Affect Disord. 2004 Apr;79(1-3):71–9. doi: 10.1016/S0165-0327(02)00348-8.
    1. Jeuring HW, Huisman M, Comijs HC, Stek ML, Beekman AT. The long-term outcome of subthreshold depression in later life. Psychol Med. 2016 Oct;46(13):2855–65. doi: 10.1017/S0033291716001549.
    1. Goldney RD, Fisher LJ, Dal Grande E, Taylor AW. Subsyndromal depression: prevalence, use of health services and quality of life in an Australian population. Soc Psychiatry Psychiatr Epidemiol. 2004 Apr;39(4):293–8. doi: 10.1007/s00127-004-0745-5.
    1. Cuijpers P, Smit F. Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatr Scand. 2004;109(5):325–31.
    1. Fogel J, Eaton WW, Ford DE. Minor depression as a predictor of the first onset of major depressive disorder over a 15-year follow-up. Acta Psychiatr Scand. 2006 Jan;113(1):36–43. doi: 10.1111/j.1600-0447.2005.00654.x.
    1. Gan Y, Gong Y, Tong X, Sun H, Cong Y, Dong X, Wang Y, Xu X, Yin X, Deng J, Li L, Cao S, Lu Z. Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies. BMC psychiatry. 2014 Dec;14:371. doi: 10.1186/s12888-014-0371-z.
    1. Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. J Am Med Assoc. 1990 Nov 21;264(19):2524–8.
    1. Greenberg PE, Fournier AA, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010) J Clin Psychiatry. 2015;76(2):155–62. doi: 10.4088/JCP.14m09298.
    1. González HM, Vega WA, Williams DR, Tarraf W, West BT, Neighbors HW. Depression care in the United States: too little for too few. Arch Gen Psychiatry. 2010 Jan;67(1):37–46. doi: 10.1001/archgenpsychiatry.2009.168.
    1. van Zoonen K, Kleiboer A, Beekman AT, Smit JH, Boerema AM, Cuijpers P. Reasons and determinants of help-seeking in people with a subclinical depression. J Affect Disord. 2015 Mar 1;173:105–12. doi: 10.1016/j.jad.2014.10.062.
    1. Andrews G, Issakidis C, Carter G. Shortfall in mental health service utilisation. Br J Psychiatry. 2001 Nov;179:417–25.
    1. Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, Angermeyer MC, Bernert S, de Girolamo G, Morosini P, Polidori G, Kikkawa T, Kawakami N, Ono Y, Takeshima T, Uda H, Karam EG, Fayyad JA, Karam AN, Mneimneh ZN, Medina-Mora ME, Borges G, Lara C, de Graaf R, Ormel J, Gureje O, Shen Y, Huang Y, Zhang M, Alonso J, Haro JM, Vilagut G, Bromet EJ, Gluzman S, Webb C, Kessler RC, Merikangas KR, Anthony JC, Von Korff MR, Wang PS, Brugha TS, Aguilar-Gaxiola S, Lee S, Heeringa S, Pennell BE, Zaslavsky AM, Ustun TB, Chatterji S, WHO World Mental Health Survey Consortium Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. J Am Med Assoc. 2004 Jun 2;291(21):2581–90. doi: 10.1001/jama.291.21.2581.
    1. Cuijpers P, Koole SL, van Dijke A, Roca M, Li J, Reynolds 3rd CF. Psychotherapy for subclinical depression: meta-analysis. Br J Psychiatry. 2014 Oct;205(4):268–74. doi: 10.1192/bjp.bp.113.138784. doi: 10.1192/bjp.bp.113.138784.
    1. Muñoz RF, Cuijpers P, Smit F, Barrera AZ, Leykin Y. Prevention of major depression. Annu Rev Clin Psychol. 2010;6:181–212. doi: 10.1146/annurev-clinpsy-033109-132040.
    1. Bradburn NM. The Structure of Psychological Well-Being. Chicago, IL: Aldine Publishing Company; 1969.
    1. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988 Jun;54(6):1063–70.
    1. Larsen JT, McGraw AP, Cacioppo JT. Can people feel happy and sad at the same time? J Pers Soc Psychol. 2001 Oct;81(4):684–96.
    1. Larsen JT, Hemenover SH, Norris CJ, Cacioppo JT. A psychology of human strengths: Fundamental questions and future directions for a positive psychology. Washington, DC: American Psychological Association; 2003. Turning adversity to advantage: On the coactivation of positivenegative emotions; pp. 211–25.
    1. Folkman S, Moskowitz JT. Positive affect and the other side of coping. Am Psychol. 2000 Jun;55(6):647–54.
    1. Chida Y, Steptoe A. Positive psychological well-being and mortality: a quantitative review of prospective observational studies. Psychosom Med. 2008;70(7):741–56. doi: 10.1097/PSY.0b013e31818105ba.
    1. Danner DD, Snowdon DA, Friesen WV. Positive emotions in early life and longevity: findings from the nun study. J Pers Soc Psychol. 2001 May;80(5):804–13.
    1. Pressman SD, Cohen S. Does positive affect influence health? Psychol Bull. 2005 Nov;131(6):925–71. doi: 10.1037/0033-2909.131.6.925.
    1. Clark LA, Watson D, Mineka S. Temperament, personality, and the mood and anxiety disorders. J Abnorm Psychol. 1994 Feb;103(1):103–16.
    1. Clark LA, Watson D. Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnorm Psychol. 1991;100(3):316–36.
    1. Benning SD, Ait Oumeziane B. Reduced positive emotion and underarousal are uniquely associated with subclinical depression symptoms: evidence from psychophysiology, self-report, and symptom clusters. Psychophysiology. 2017 Jul;54(7):1010–30. doi: 10.1111/psyp.12853.
    1. Nitschke JB, Heller W, Imig JC, McDonald RP, Miller GA. Distinguishing dimensions of anxiety and depression. Cognit Ther Res. 2001;25(1):1–22. doi: 10.1023/A:1026485530405.
    1. Kendall AD, Zinbarg RE, Mineka S, Bobova L, Prenoveau JM, Revelle W, Craske MG. Prospective associations of low positive emotionality with first onsets of depressive and anxiety disorders: results from a 10-wave latent trait-state modeling study. J Abnorm Psychol. 2015 Nov;124(4):933–43. doi: 10.1037/abn0000105.
    1. Raes F, Smets J, Nelis S, Schoofs H. Dampening of positive affect prospectively predicts depressive symptoms in non-clinical samples. Cogn Emot. 2012;26(1):75–82. doi: 10.1080/02699931.2011.555474.
    1. Werner-Seidler A, Banks R, Dunn BD, Moulds ML. An investigation of the relationship between positive affect regulation and depression. Behav Res Ther. 2013 Jan;51(1):46–56. doi: 10.1016/j.brat.2012.11.001.
    1. Feldman GC, Joormann J, Johnson SL. Responses to positive affect: a self-report measure of rumination and dampening. Cognit Ther Res. 2008;32(4):507–25. doi: 10.1007/s10608-006-9083-0.
    1. Nelis S, Holmes EA, Raes F. Response styles to positive affect and depression: concurrent and prospective associations in a community sample. Cognit Ther Res. 2015;39(4):480–91. doi: 10.1007/s10608-015-9671-y.
    1. Ong AD, Bergeman CS, Bisconti TL, Wallace KA. Psychological resilience, positive emotions, and successful adaptation to stress in later life. J Pers Soc Psychol. 2006 Oct;91(4):730–49. doi: 10.1037/0022-3514.91.4.730.
    1. Tugade MM, Fredrickson BL. Resilient individuals use positive emotions to bounce back from negative emotional experiences. J Pers Soc Psychol. 2004 Feb;86(2):320–33. doi: 10.1037/0022-3514.86.2.320.
    1. Fredrickson BL, Tugade MM, Waugh CE, Larkin GR. What good are positive emotions in crises? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. J Pers Soc Psychol. 2003 Feb;84(2):365–76.
    1. Sin NL, Lyubomirsky S. Enhancing well-being and alleviating depressive symptoms with positive psychology intervention: a practice-friendly meta-analysis. J Clin Psychol. 2009;65(5):467–87. doi: 10.1002/jclp.20593.
    1. Geraghty AW, Wood AM, Hyland ME. Attrition from self-directed interventions: investigating the relationship between psychological predictors, intervention content and dropout from a body dissatisfaction intervention. Soc Sci Med. 2010 Jul;71(1):30–7. doi: 10.1016/j.socscimed.2010.03.007.
    1. Seligman MEP, Rashid T, Parks AC. Positive psychotherapy. Am Psychol. 2006 Nov;61(8):774–88. doi: 10.1037/0003-066X.61.8.774.
    1. Smalley KB, Yancey CT, Warren JC, Naufel K, Ryan R, Pugh JL. Rural mental health and psychological treatment: a review for practitioners. J Clin Psychol. 2010 May;66(5):479–89. doi: 10.1002/jclp.20688.
    1. Andersson G, Titov N. Advantages and limitations of internet-based interventions for common mental disorders. World Psychiatry. 2014 Feb;13(1):4–11. doi: 10.1002/wps.20083. doi: 10.1002/wps.20083.
    1. Rickwood DJ, Deane FP, Wilson CJ. When and how do young people seek professional help for mental health problems? Med J Aust. 2007 Oct 1;187(7 Suppl):S35–9.
    1. Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry. 2014;13(3):288–95. doi: 10.1002/wps.20151.
    1. Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Send to Cogn Behav Ther. 2009;38(4):196–205. doi: 10.1080/16506070903318960.
    1. Saddichha S, Al-Desouki M, Lamia A, Linden IA, Krausz M. Online interventions for depression and anxiety - a systematic review. Health Psychol Behav Med. 2014;2(1):841–81.
    1. Christensen H, Griffiths KM, Farrer L. Adherence in internet interventions for anxiety and depression. J Med Internet Res. 2009 Apr 24;11(2):e13. doi: 10.2196/jmir.1194.
    1. Eysenbach G. The law of attrition. J Med Internet Res. 2005 Mar 31;7(1):e11. doi: 10.2196/jmir.7.1.e11.
    1. Geraghty AW, Torres LD, Leykin Y, Pérez-Stable EJ, Muñoz RF. Understanding attrition from international internet health interventions: a step towards global eHealth. Health Promot Int. 2013 Sep;28(3):442–52. doi: 10.1093/heapro/das029.
    1. Christensen H, Griffiths KM, Mackinnon AJ, Brittliffe K. Online randomized controlled trial of brief and full cognitive behaviour therapy for depression. Psychol Med. 2006 Dec;36(12):1737–46. doi: 10.1017/S0033291706008695.
    1. Farvolden P, Cunningham J, Selby P. Using e-health programs to overcome barriers to the effective treatment of mental health and addiction problems. J Technol Hum Serv. 2009;27(1):5–22. doi: 10.1080/15228830802458889.
    1. Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012;32(4):329–42. doi: 10.1016/j.cpr.2012.02.004.
    1. Cheung EO, Cohn MA, Dunn LB, Melisko ME, Morgan S, Penedo FJ, Salsman JM, Shumay DM, Moskowitz JT. A randomized pilot trial of a positive affect skill intervention (lessons in linking affect and coping) for women with metastatic breast cancer. Psychooncology. 2017 Dec;26(12):2101–8. doi: 10.1002/pon.4312.
    1. Moskowitz JT, Hult JR, Duncan LG, Cohn MA, Maurer S, Bussolari C, Acree M. A positive affect intervention for people experiencing health-related stress: development and non-randomized pilot test. J Health Psychol. 2012 Jul;17(5):676–92. doi: 10.1177/1359105311425275.
    1. Cohn MA, Pietrucha ME, Saslow LR, Hult JR, Moskowitz JT. An online positive affect skills intervention reduces depression in adults with type 2 diabetes. J Posit Psychol. 2014 Jan 1;9(6):523–34. doi: 10.1080/17439760.2014.920410.
    1. Moskowitz JT, Carrico AW, Duncan LG, Cohn MA, Cheung EO, Batchelder A, Martinez L, Segawa E, Acree M, Folkman S. Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV. J Consult Clin Psychol. 2017;85(5):409–23. doi: 10.1037/ccp0000188.
    1. Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009 Apr;114(1-3):163–73. doi: 10.1016/j.jad.2008.06.026.
    1. Steptoe A, Wardle J. Positive affect measured using ecological momentary assessment and survival in older men and women. Proc Natl Acad Sci U S A. 2011 Nov 8;108(45):18244–8. doi: 10.1073/pnas.1110892108.
    1. Almeida DM, Wethington E, Kessler RC. The daily inventory of stressful events: an interview-based approach for measuring daily stressors. Assessment. 2002;9(1):41–55.
    1. Almeida DM, Stawski RS, Cichy KE. The Handbook of Stress Science: Biology, Psychology, and Health. New York, NY: Springer Publishing Company; 2011. Combining checklist and interview approaches for assessing daily stressors: The Daily Inventory of Stressful Events; pp. 583–95.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606–13.
    1. Michael Cohn: UX Research. [2018-05-17]. PingQuest .
    1. Qualtrics Survey Software: Handbook for Research Professionals. Provo, Utah: Qualtrics Lab Inc; 2012.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–81. doi: 10.1016/j.jbi.2008.08.010.
    1. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401. doi: 10.1177/014662167700100306.
    1. Murrell SA, Norris FH. Resources, life events, and changes in positive affect and depression in older adults. Am J Community Psychol. 1984 Aug;12(4):445–64.
    1. Zautra AJ, Reich JW. Life events and perceptions of life quality: developments in a two-factor approach. J Community Psychol. 1983;11(2):121–32. doi: 10.1002/1520-6629(198304)11:2<121::AID-JCOP2290110206>;2-V.
    1. Langston CA. Capitalizing on and coping with daily-life events: expressive responses to positive events. J Pers Soc Psychol. 1994;67(6):1112–25. doi: 10.1037/0022-3514.67.6.1112.
    1. Bryant FB. A four-factor model of perceived control: avoiding, coping, obtaining, and savoring. J Pers. 1989;57(4):773–97. doi: 10.1111/j.1467-6494.1989.tb00494.x.
    1. Emmons RA. Thanks!: How the New Science of Gratitude Can Make You Happier. New York, NY: Houghton Mifflin Company; 2007.
    1. Kashdan TB, Uswatte G, Julian T. Gratitude and hedonic and eudaimonic well-being in Vietnam war veterans. Behav Res Ther. 2006 Feb;44(2):177–99. doi: 10.1016/j.brat.2005.01.005.
    1. Sheldon KM, Houser-Marko L. Self-concordance, goal attainment, and the pursuit of happiness: can there be an upward spiral? J Pers Soc Psychol. 2001 Jan;80(1):152–65.
    1. Carver CS, Scheier MF. Origins and functions of positive and negative affect: a control process view. Psychol Rev. 1990;97(1):19–35. doi: 10.1037/0033-295X.97.1.19.
    1. Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clin Psychol Sci Pr. 2003;10(2):144–56. doi: 10.1093/clipsy/bpg016.
    1. Fredrickson BL, Cohn MA, Coffey KA, Pek J, Finkel SM. Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. J Pers Soc Psychol. 2008 Nov;95(5):1045–62. doi: 10.1037/a0013262.
    1. Folkman S. Positive psychological states and coping with severe stress. Soc Sci Med. 1997 Oct;45(8):1207–21.
    1. Sears SR, Stanton AL, Danoff-Burg S. The yellow brick road and the emerald city: benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer. Health Psychol. 2003 Sep;22(5):487–97. doi: 10.1037/0278-6133.22.5.487.
    1. Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York, NY: Springer Publishing Company; 1984.
    1. Reed M. Self-affirmation reduces biased processing of health-risk information. Motiv Emot. 1998;22(2):99–132. doi: 10.1023/A:1021463221281.
    1. Musick MA, Wilson J. Volunteering and depression: the role of psychological and social resources in different age groups. Soc Sci Med. 2003 Jan;56(2):259–69.
    1. Oman D, Thoresen CE, McMahon K. Volunteerism and mortality among the community-dwelling elderly. J Health Psychol. 1999 May;4(3):301–16. doi: 10.1177/135910539900400301.
    1. Cuijpers P, van Straten A, Warmerdam L. Behavioral activation treatments of depression: a meta-analysis. Clin Psychol Rev. 2007;27(3):318–26.
    1. Dimidjian S, Barrera Jr M, Martell C, Muñoz RF, Lewinsohn PM. The origins and current status of behavioral activation treatments for depression. Annu Rev Clin Psychol. 2011;7:1–38. doi: 10.1146/annurev-clinpsy-032210-104535.
    1. Kanter JW, Manos RC, Bowe WM, Baruch DE, Busch AM, Rusch LC. What is behavioral activation? A review of the empirical literature. Clin Psychol Rev. 2010 Aug;30(6):608–20. doi: 10.1016/j.cpr.2010.04.001.
    1. Mazzucchelli T, Kane R, Rees C. Behavioral activation treatments for depression in adults: a meta-analysis and review. Clin Psychol Sci Pr. 2009;16(4):383–411. doi: 10.1111/j.1468-2850.2009.01178.x.
    1. Faulkner L. Beyond the five-user assumption: benefits of increased sample sizes in usability testing. Behav Res Methods Instrum Comput. 2003 Aug;35(3):379–83.
    1. Proudfoot J, Goldberg D, Mann A, Everitt B, Marks I, Gray JA. Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice. Psychol Med. 2003 Feb;33(2):217–27.
    1. Clarke G, Eubanks D, Reid E, Kelleher C, O'Connor E, DeBar LL, Lynch F, Nunley S, Gullion C. Overcoming Depression on the Internet (ODIN) (2): a randomized trial of a self-help depression skills program with reminders. J Med Internet Res. 2005 Jun 21;7(2):e16. doi: 10.2196/jmir.7.2.e16.
    1. Ebert DD, Buntrock C, Lehr D, Smit F, Riper H, Baumeister H, Cuijpers P, Berking M. Effectiveness of web- and mobile-based treatment of subthreshold depression with adherence-focused guidance: a single-blind randomized controlled trial. Behav Ther. 2018;49(1):71–83. doi: 10.1016/j.beth.2017.05.004.
    1. Titov N, Dear BF, Johnston L, Lorian C, Zou J, Wootton B, Spence J, McEvoy PM, Rapee RM. Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: randomised controlled trial. PLoS One. 2013;8(7):e62873. doi: 10.1371/journal.pone.0062873.
    1. Mira A, Bretón-López J, García-Palacios A, Quero S, Baños RM, Botella C. An Internet-based program for depressive symptoms using human and automated support: a randomized controlled trial. Neuropsychiatr Dis Treat. 2017;13:987–1006. doi: 10.2147/NDT.S130994. doi: 10.2147/NDT.S130994.
    1. Proudfoot J, Parker G, Manicavasagar V, Hadzi-Pavlovic D, Whitton A, Nicholas J, Smith M, Burckhardt R. Effects of adjunctive peer support on perceptions of illness control and understanding in an online psychoeducation program for bipolar disorder: a randomised controlled trial. J Affect Disord. 2012 Dec 15;142(1-3):98–105. doi: 10.1016/j.jad.2012.04.007.
    1. Perini S, Titov N, Andrews G. Clinician-assisted Internet-based treatment is effective for depression: randomized controlled trial. Aust N Z J Psychiatry. 2009 Jun;43(6):571–8. doi: 10.1080/00048670902873722.
    1. Titov N, Andrews G, Davies M, McIntyre K, Robinson E, Solley K. Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. PLoS One. 2010 Jun 08;5(6):e10939. doi: 10.1371/journal.pone.0010939.
    1. Horvath KJ, Oakes JM, Rosser BR, Danilenko G, Vezina H, Amico KR, Williams ML, Simoni J. Feasibility, acceptability and preliminary efficacy of an online peer-to-peer social support ART adherence intervention. AIDS Behav. 2013 Jul;17(6):2031–44. doi: 10.1007/s10461-013-0469-1.
    1. Pfeiffer PN, Heisler M, Piette JD, Rogers MA, Valenstein M. Efficacy of peer support interventions for depression: a meta-analysis. Gen Hosp Psychiatry. 2011;33(1):29–36. doi: 10.1016/j.genhosppsych.2010.10.002.
    1. Linehan C, Kirman B, Lawson S, Chan G. Practical, appropriate, empirically-validated guidelines for designing educational games. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; May 07-12, 2011; Vancouver, BC, Canada. 2011. pp. 1979–88.
    1. Klopfer E, Osterweil S, Salen K. Cambridge, MA: The Education Arcade; 2009. [2018-05-21]. Moving learning games forward .
    1. Singer JD, Willett JB. Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence. New York: Oxford University Press; 2003.
    1. Bauer DJ, Preacher KJ, Gil KM. Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: new procedures and recommendations. Psychol Methods. 2006 Jun;11(2):142–63. doi: 10.1037/1082-989X.11.2.142.
    1. Preacher KJ, Zyphur MJ, Zhang Z. A general multilevel SEM framework for assessing multilevel mediation. Psychol Methods. 2010 Sep;15(3):209–33. doi: 10.1037/a0020141.
    1. Mackinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivariate Behav Res. 2004 Jan 1;39(1):99. doi: 10.1207/s15327906mbr3901_4.
    1. Preacher KJ, Selig JP. Advantages of Monte Carlo confidence intervals for indirect effects. Commun Methods Meas. 2012;6(2):77–98. doi: 10.1080/19312458.2012.679848.

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