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Randomized Controlled Trial
. 2019 Oct 1:257:352-364.
doi: 10.1016/j.jad.2019.07.049. Epub 2019 Jul 5.

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

Elizabeth L Addington  1 , Elaine O Cheung  2 , Sarah M Bassett  2 , Ian Kwok  2 , Stephanie A Schuette  3 , Eva Shiu  2 , Dershung Yang  4 , Michael A Cohn  5 , Yan Leykin  6 , Laura R Saslow  7 , Judith T Moskowitz  2
Affiliations
Randomized Controlled Trial

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

Elizabeth L Addington et al. J Affect Disord. .

Abstract

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.

Keywords: Depression; Emotions; Happiness; Internet; Telemedicine.

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Conflict of interest statement

Declarations of interest: None.

Figures

Figure 1.
Figure 1.
Sample of MARIGOLD skill content as displayed for web-based, self-guided delivery
Figure 2.
Figure 2.
Excerpt from Phase 2 ODB
Figure 3.
Figure 3.
Example of a VB “garden” arranged by a participant
Figure 4.
Figure 4.
Phase 1 CONSORT diagram.
Figure 5.
Figure 5.
Phase 2 CONSORT diagram
Figure 6.
Figure 6.
Phase 3 homepage display of access to VB (“personal gardens”) and ODB (“activity feed”)
See this image and copyright information in PMC

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