We investigated the discrepancy between competence and real-world performance in major depressive disorder (MDD) for adaptive and interpersonal behaviors, determining whether self-efficacy significantly predicts this discrepancy, after considering depressive symptoms. Forty-two participants (Mage = 37.64, 66.67% female) with MDD were recruited from mental health clinics. Competence, self-efficacy, and real-world functioning were evaluated in adaptive and interpersonal domains; depressive symptoms were assessed with the Beck Depression Inventory II. Hierarchical regression analysis identified predictors of functional disability and the discrepancy between competence and real-world functioning. Self-efficacy significantly predicted functioning in the adaptive and interpersonal domains over and above depressive symptoms. Interpersonal self-efficacy accounted for significant variance in the discrepancy between interpersonal competence and functioning beyond symptoms. Using a multilevel, multidimensional approach, we provide the first data regarding relationships among competence, functioning, and self-efficacy in MDD. Self-efficacy plays an important role in deployment of functional skills in everyday life for individuals with MDD.

Background Sleep disturbance and its daytime sequelae, which comprise complex, transdiagnostic sleep problems, are pervasive problems in adolescents and young adults (AYAs) and are associated with negative outcomes. Effective interventions must be both evidence based and individually tailored. Some AYAs prefer self-management and digital approaches. Leveraging these preferences is helpful, given the dearth of AYA treatment providers trained in behavioral sleep medicine. We involved AYAs in the co-design of a behavioral, self-management, transdiagnostic sleep app called DOZE (Delivering Online Zzz’s with Empirical Support). Objective This study tests the feasibility and acceptability of DOZE in a community AYA sample aged 15-24 years. The secondary objective is to evaluate sleep and related outcomes in this nonclinical sample. Methods Participants used DOZE for 4 weeks (2 periods of 2 weeks). They completed sleep diaries, received feedback on their sleep, set goals in identified target areas, and accessed tips to help them achieve their goals. Measures of acceptability and credibility were completed at baseline and end point. Google Analytics was used to understand the patterns of app use to assess feasibility. Participants completed questionnaires assessing fatigue, sleepiness, chronotype, depression, anxiety, and quality of life at baseline and end point. Results In total, 83 participants created a DOZE account, and 51 completed the study. During the study, 2659 app sessions took place with an average duration of 3:02 minutes. AYAs tracked most days in period 1 (mean 10.52, SD 4.87) and period 2 (mean 9.81, SD 6.65), with a modal time of 9 AM (within 2 hours of waking). DOZE was appraised as highly acceptable (mode≥4) on the items “easy to use,” “easy to understand,” “time commitment,” and “overall satisfaction” and was rated as credible (mode≥4) at baseline and end point across all items (logic, confident it would work, confident recommending it to a friend, willingness to undergo, and perceived success in treating others). The most common goals set were decreasing schedule variability (34/83, 41% of participants), naps (17/83, 20%), and morning lingering in bed (16/83, 19%). AYAs accessed tips on difficulty winding down (24/83, 29% of participants), being a night owl (17/83, 20%), difficulty getting up (13/83, 16%), and fatigue (13/83, 16%). There were significant improvements in morning lingering in bed (P=.03); total wake time (P=.02); sleep efficiency (P=.002); total sleep time (P=.03); and self-reported insomnia severity (P=.001), anxiety (P=.002), depression (P=.004), and energy (P=.01). Conclusions Our results support the feasibility, acceptability, credibility, and preliminary efficacy of DOZE. AYAs are able to set and achieve goals based on tailored feedback on their sleep habits, which is consistent with research suggesting that AYAs prefer autonomy in their health care choices and produce good results when given tools that support their autonomy. Trial Registration ClinicalTrials.gov NCT03960294; https://clinicaltrials.gov/ct2/show/NCT03960294

Individuals experiencing depressive symptoms interpret ambiguous situations negatively and use helpful emotion regulation strategies less often than those without symptoms. Theory suggests these strategies are used less due to interference from negatively biased interpretations. This study examined whether interpretation bias interferes with emotion regulation by experimentally manipulating interpretations in a positive or negative direction. Method: Undergraduate students were randomly assigned to positive and negative bias training groups. Interpretation bias and emotion regulation questionnaires were completed before and after training. Results: The training succeeded in inducing bias change only for the positive group, and emotion regulation strategy use did not change in either group. Discussion: Interpretation bias was not found to affect emotion regulation. Possible explanations include: bias change in the positive group was not large enough to alter emotion regulation; the task eliciting emotion regulation was ill-suited for this study; and interpretation bias and emotion regulation are unrelated.

Individuals experiencing depressive symptoms interpret ambiguous situations negatively and use helpful emotion regulation strategies less often than those without symptoms. Theory suggests these strategies are used less due to interference from negatively biased interpretations. This study examined whether interpretation bias interferes with emotion regulation by experimentally manipulating interpretations in a positive or negative direction. Method: Undergraduate students were randomly assigned to positive and negative bias training groups. Interpretation bias and emotion regulation questionnaires were completed before and after training. Results: The training succeeded in inducing bias change only for the positive group, and emotion regulation strategy use did not change in either group. Discussion: Interpretation bias was not found to affect emotion regulation. Possible explanations include: bias change in the positive group was not large enough to alter emotion regulation; the task eliciting emotion regulation was ill-suited for this study; and interpretation bias and emotion regulation are unrelated.