A therapeutic application of the experience sampling method in the treatment of depression: a randomized controlled trial

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Abstract
In depression, the ability to experience daily life positive affect predicts recovery and reduces relapse rates. Interventions based on the experience sampling method (ESM‐I) are ideally suited to provide insight in personal, contextualized patterns of positive affect. The aim of this study was to examine whether add‐on ESM‐derived feedback on personalized patterns of positive affect is feasible and useful to patients, and results in a reduction of depressive symptomatology. Depressed outpatients (n=102) receiving pharmacological treatment participated in a randomized controlled trial with three arms: an experimental group receiving add‐on ESM‐derived feedback, a pseudo‐experimental group participating in ESM but receiving no feedback, and a control group. The experimental group participated in an ESM procedure (three days per week over a 6‐week period) using a palmtop. This group received weekly standardized feedback on personalized patterns of positive affect. Hamilton Depression Rating Scale – 17 (HDRS) and Inventory of Depressive Symptoms (IDS) scores were obtained before and after the intervention. During a 6‐month follow‐up period, five HDRS and IDS assessments were completed. Add‐on ESM‐derived feedback resulted in a significant and clinically relevant stronger decrease in HDRS score relative to the control group (p<0.01; −5.5 point reduction in HDRS at 6 months). Compared to the pseudo‐experimental group, a clinically relevant decrease in HDRS score was apparent at 6 months (B=−3.6, p=0.053). Self‐reported depressive complaints (IDS) yielded the same pattern over time. The use of ESM‐I was deemed acceptable and the provided feedback easy to understand. Patients attempted to apply suggestions from ESM‐derived feedback to daily life. These data suggest that the efficacy of traditional passive pharmacological approach to treatment of major depression can be enhanced by using person‐tailored daily life information regarding positive affect.

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