Experience sampling-based personalized feedback and positive affect: a randomized controlled trial in depressed patients

Abstract

Objectives: Positive affect (PA) plays a crucial role in the development, course, and recovery of depression. Recently, we showed that a therapeutic application of the experience sampling method (ESM), consisting of feedback focusing on PA in daily life, was associated with a decrease in depressive symptoms. The present study investigated whether the experience of PA increased during the course of this intervention.

Design: Multicentre parallel randomized controlled trial. An electronic random sequence generator was used to allocate treatments.

Settings: University, two local mental health care institutions, one local hospital.

Participants: 102 pharmacologically treated outpatients with a DSM-IV diagnosis of major depressive disorder, randomized over three treatment arms.

Intervention: Six weeks of ESM self-monitoring combined with weekly PA-focused feedback sessions (experimental group); six weeks of ESM self-monitoring combined with six weekly sessions without feedback (pseudo-experimental group); or treatment as usual (control group).

Main outcome: The interaction between treatment allocation and time in predicting positive and negative affect (NA) was investigated in multilevel regression models.

Results: 102 patients were randomized (mean age 48.0, SD 10.2) of which 81 finished the entire study protocol. All 102 patients were included in the analyses. The experimental group did not show a significant larger increase in momentary PA during or shortly after the intervention compared to the pseudo-experimental or control groups (χ2(2) = 0.33, p = .846). The pseudo-experimental group showed a larger decrease in NA compared to the control group (χ2(1) = 6.29, p =.012).

Conclusion: PA-focused feedback did not significantly impact daily life PA during or shortly after the intervention. As the previously reported reduction in depressive symptoms associated with the feedback unveiled itself only after weeks, it is conceivable that the effects on daily life PA also evolve slowly and therefore were not captured by the experience sampling procedure immediately after treatment.

Trial registration: Trialregister.nl/trialreg/index.asp. NTR1974.

Conflict of interest statement

Competing Interests: The tool with which momentary assessments were performed (the PsyMate) is developed under the auspices of the Maastricht University technology transfer office, partially supported by unrestricted grants from Servier and Janssen-Cilag. JvO is or has been an unrestricted research grant holder with, or has received financial compensation as an independent symposium speaker from, Eli Lilly, BMS, Lundbeck, Organon, Janssen-Cilag, GlaxoSmithKline, AstraZeneca, Pfizer, and Servier. JvO is a PlOS ONE Editorial Board Member. This does not alter the authors’ adherence to all the PloS ONE policies on sharing data and materials. One or more authors are affiliated to commercial companies (GGzE, Institute of Mental Health Care Eindhoven and the Kempen; Mondriaan Mental Health Trust). There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PlOS ONE policies on sharing data and materials.

Figures

Fig 1. Participant flow diagram.

Completer: Participant who attended all six intervention sessions; Partial Completer: Participant who attended less than six intervention sessions but did not withdrew from the study; non-completer: Participant who attended less than six intervention sessions and withdrew from the study.

Fig 2. Individual PA series across the study protocol for three participants either randomized into the experimental (subject A), pseudo-experimental (subject B) or control group (subject C).

Dots represent the average momentary ratings on the adjectives composing PA (cheerful, enthusiastic, relaxed, satisfied) during one beep. One day comprises ten beeps; pre- and post-assessment comprises five days; the intervention period comprises three days of ESM monitoring per week.

Fig 3. Part A: Box-Whisker plot of PA across the intervention period, by condition.

The bottom and top of box indicate first (Q1) and third quartile (Q3), the band indicates the median; whiskers represent upper and lower adjacent values (within Q3+1.5(Q3-Q1) and Q1-1.5(Q3-Q1), respectively. Part B: Means per week across intervention period, by condition.