Self-monitoring and personalized feedback as a tool to boost depression treatment

The leading cause of disability worldwide is depression, a common mental
disorder that is characterized by two core symptoms: depressed mood and/or
decreased interest or pleasure in activities. A pioneer Randomized Controlled
Trial (RCT) has shown that systematic self-monitoring and personalized feedback
on contextualized patterns of positive affect through the Experience Sampling
Method (ESM) could provide an empowering and effective add-on tool to treatment
as usual (TAU). While promising, the intervention was highly labor intensive,
including manual statistical analyses and an extensive face-to-face component.
In addition, the intervention targeted only one of depression*s core symptoms.
This project takes the next logical step: (re)examine the effectiveness of
ESM-derived personalized feedback in a format that is optimized for clinical
practice for two ESM variants, each targeted at one of depression*s core
symptoms. We expect that the use of ESM as a self-management tool will benefit
depressed patients not only by reducing depressive symptomatology, but also by
increasing psychosocial functioning and enhancing patients* feelings of
empowerment.

The main aim of the ZELF-i project is to investigate the effectiveness of
self-monitoring and personalized feedback as an add-on tool in the treatment of
depression. By starting directly after intake, patients can make the most out
of the usual waiting list period, and commence subsequent treatment programs
with a kick-start.

RCT with three treatment arms: wait-list (WL), ESM *Do*-module, ESM *Think*-
module. Randomization (allocation ratio 1:1:1) will be stratified according to
the duration of antidepressant pharmacotherapy (new/switch vs. maintenance,
i.e. receiving antidepressant or mood stabilizing medication for less vs.
longer than 8 weeks prior to study entry), and current psychotherapy (yes or
no).

28 days of systematic self-monitoring (5 times per day) with weekly
personalized feedback. The Do-module focuses on positive affect and activities,
the Think-module focuses on negative affect and thinking patterns.

There are no risks involved in participating in the study. The burden
associated with participation comprises: an instruction session and
questionnaires before the ESM period (2 hours), filling in a diary using a
mobile application five times a day for 28 days (~2 minutes per measurement), a
debriefing session and questionnaires after the ESM period (2 hours in total),
and 4 follow-up assessments (1 hour per assessment). Benefits are an increased
insight in (fluctuations in) one*s own mood states and person-specific factors
that may promote the increase of positive affect or reduction of negative
affect. The intervention could also increase feelings of empowerment, improve
(social) functioning, and help patients bridge the usual wait list in a
constructive way. The burden for the control group consists of an instruction
session and filling out the same questionnaires at the same time points as the
intervention groups. The control group does not fill out electronic diaries,
nor engage in a debriefing session after the intervention.