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 O.; Bassett, Sarah M.; Kwok, Ian; Schuette, Stephanie; Shiu, Eva; Yang, Dershung; Cohn, Michael; Leykin, Yan; Saslow, Laura R.; Moskowitz, Judith T.

doi:10.1016/j.jad.2019.07.049

Cited by 37 publications

(31 citation statements)

References 75 publications

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“…Conditions 1-8 received the MARIGOLD program, a positive psychological intervention that consisted of eight skills that specifically targeted positive emotions: noticing positive events, capitalizing, gratitude, behavioral activation, mindfulness, positive reappraisal, personal strengths, and acts of kindness. Additional details of the positive emotion skills intervention can be found elsewhere [ 21 , 22 , 39 - 43 ]. The skills were delivered over the course of 5 weeks in a self-guided, web-based format, and each week had associated home practice activities.…”

Section: Methodsmentioning

confidence: 99%

“…In this study, we tested the following three enhancements to a self-guided web-based intervention for people experiencing depressive symptoms: brief facilitator contact (FC), an online discussion board (ODB), and virtual badges (VB). These features were developed in previous phases of the program [ 21 , 22 ] and were selected based on research suggesting that personal contact, interactive components, and incentivizing participation increased engagement in web-based programs [ 7 , 23 - 29 ].…”

Section: Introductionmentioning

confidence: 99%

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Facilitator Contact, Discussion Boards, and Virtual Badges as Adherence Enhancements to a Web-Based, Self-guided, Positive Psychological Intervention for Depression: Randomized Controlled Trial

Moskowitz¹,

Addington²,

Shiu³

et al. 2021

J Med Internet Res

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Background Adherence to self-guided interventions tends to be very low, especially in people with depression. Prior studies have demonstrated that enhancements may increase adherence, but little is known about the efficacy of various enhancements in comparison to, or in combination with, one another. Objective The aim of our study is to test whether 3 enhancements—facilitator contact (FC), an online discussion board, and virtual badges (VB)—alone, or in combination, improve adherence to a self-guided, web-based intervention for depression. We also examined whether age, gender, race, ethnicity, comfort with technology, or baseline depression predicted adherence or moderated the effects that each enhancement had on adherence. Methods Participants were recruited through web-based sources and, after completing at least 4 out of 7 daily emotion reports, were sequentially assigned to 1 of 9 conditions—the intervention alone; the intervention plus 1, 2, or all 3 enhancements; or an emotion reporting control condition. The intervention was a positive psychological program consisting of 8 skills that specifically targeted positive emotions, and it was delivered over 5 weeks in a self-guided, web-based format. We operationalized adherence as the number of skills accessed. Results A total of 602 participants were enrolled in this study. Participants accessed, on average, 5.61 (SD 2.76) of 8 skills. The total number of enhancements participants received (0-3) did not predict the number of skills accessed. Participants who were assigned to the VB+FC condition accessed significantly more skills than those in the intervention only conditions. Furthermore, participants in arms that received the combination of both the VB and FC enhancements (VB+FC and VB+FC+online discussion board) accessed a greater number of skills relative to the number of skills accessed by participants who received either VB or FC without the other. Moderation analyses revealed that the receipt of VB (vs no VB) predicted higher adherence among participants with moderately severe depression at baseline. Conclusions The results suggested that the VB+FC combination significantly increased the number of skills accessed in a self-guided, web-based intervention for elevated depression. We have provided suggestions for refinements to these enhancements, which may further improve adherence. Trial Registration ClinicalTrials.gov NCT02861755; http://clinicaltrials.gov/ct2/show/NCT02861755

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Facilitator Contact, Discussion Boards, and Virtual Badges as Adherence Enhancements to a Web-Based, Self-guided, Positive Psychological Intervention for Depression: Randomized Controlled Trial

Moskowitz¹,

Addington²,

Shiu³

et al. 2021

J Med Internet Res

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“…Our team consulted with 5 medical students at Northwestern University's Feinberg School of Medicine to inform adaptation of the intervention content, exercises, and skills to optimize the acceptability and relevance for medical trainees. The medical students were asked to review the existing positive psychology intervention that had previously been delivered to populations coping with health-related stress, [27][28][29][30] so that they could provide feedback on the skills and offer suggestions of how the intervention could be adapted for medical students.…”

Section: Methodsmentioning

confidence: 99%

Development of a Positive Psychology Program (LAVENDER) for Preserving Medical Student Well-being: A Single-Arm Pilot Study

Cheung

Kwok

Ludwig

et al. 2021

Glob Adv Health Med

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Background Mental health tends to worsen over the course of medical school, with steep declines in well-being in students’ clerkship year (M3). Positive emotion promotes adaptive coping to stress and may help preserve medical student well-being. Objective This study describes the development of LAVENDER (Leveraging Affect and Valuing Empathy for Nurturing Doctors’ Emotional Resilience), a program aimed at increasing positive emotion to preserve well-being in medical students. Methods We conducted a single-arm pilot of LAVENDER, a positive psychology intervention developed for medical students delivered in an interactive classroom format to a cohort of 157 third-year medical students at the Albert Einstein College of Medicine. Our primary outcome was the acceptability of LAVENDER. We also examined preliminary efficacy using measures of emotion, stress and burnout collected at each intervention session. Results LAVENDER showed good acceptability: 76% of participants agreed that the LAVENDER skills were useful and 72% agreed that they would recommend the LAVENDER program to others. Qualitative feedback suggested that medical students enjoyed the program and found the skills to be useful for coping with stress, but also reported the following barriers to engagement: lack of time to practice the skills, resistance to the mandatory nature of the wellness sessions, and difficulty integrating the skills in daily life. We did not find support for the preliminary efficacy of LAVENDER for improving medical student well-being in students’ clerkship year. Participants showed decreases in positive emotion and increases in symptoms of burnout over the intervention period ( ps < .01). Conclusion The current paper describes the development and a single-arm pilot test of LAVENDER, a positive psychology program tailored for medical students. Although we found preliminary evidence for the acceptability of LAVENDER, we did not find support for the preliminary efficacy. Lessons learned and next steps for the program are discussed.

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“…Some PPIs focus on a single skill and others are multicomponent interventions that teach a collection of positive skills. Various delivery modes have been tested including in person delivered to individuals (e.g., Moskowitz et al, 2017) or groups (e.g., Chaves et al, 2017), and self-guided via Internet (e.g., Addington et al, 2019; Peters et al, 2017) or with telephone support (e.g., Hausmann et al, 2018; Huffman et al, 2016).…”

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confidence: 99%

Measuring Positive Emotion Outcomes in Positive Psychology Interventions: A Literature Review

Moskowitz¹,

Cheung²,

Freedman

et al. 2020

Emotion Review

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Accumulating evidence for the unique social, behavioral, and physical health benefits of positive emotion and related well-being constructs has led to the development and testing of positive psychological interventions (PPIs) to increase emotional well-being and enhance health promotion and disease prevention. PPIs are specifically aimed at improving emotional well-being and consist of practices such as gratitude, savoring, and acts of kindness. The purpose of this narrative review was to examine the literature on PPIs with a particular focus on positive emotion outcomes. We evaluated the evidence on the effects of PPIs on positive emotion specifically, and discussed the range of evidence regarding the relative responsiveness of emotion measures to PPIs in order to gain a better understanding of the specific emotional pathways through which PPIs influence psychological and physical well-being. We conclude with recommendations for best evaluating effects of PPIs on positive emotion outcomes.

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

Cited by 37 publications

References 75 publications

Facilitator Contact, Discussion Boards, and Virtual Badges as Adherence Enhancements to a Web-Based, Self-guided, Positive Psychological Intervention for Depression: Randomized Controlled Trial

Facilitator Contact, Discussion Boards, and Virtual Badges as Adherence Enhancements to a Web-Based, Self-guided, Positive Psychological Intervention for Depression: Randomized Controlled Trial

Development of a Positive Psychology Program (LAVENDER) for Preserving Medical Student Well-being: A Single-Arm Pilot Study

Measuring Positive Emotion Outcomes in Positive Psychology Interventions: A Literature Review

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