Depressive Symptoms and the Experience of Pleasure in Daily Life: An Exploration of Associations in Early and Late Adolescence

A cognitive-computational account of mood swings in adolescence

Teenagers have a reputation for being fickle, in both their choices and their moods. This variability may help adolescents as they begin to independently navigate novel environments. Recently, however, adolescent moodiness has also been linked to psychopathology. Here, we consider adolescents' mood swings from a novel computational perspective, grounded in reinforcement learning (RL). This model proposes that mood is determined by surprises about outcomes in the environment, and how much we learn from these surprises. It additionally suggests that mood biases learning and choice in a bidirectional manner. Integrating independent lines of research, we sketch a cognitive-computational account of how adolescents' mood, learning, and choice dynamics influence each other, with implications for normative and psychopathological development.

The Mood and Resilience in Offspring (MARIO) project: a longitudinal cohort study among offspring of parents with and without a mood disorder

BACKGROUND

One of the most robust risk factors for developing a mood disorder is having a parent with a mood disorder. Unfortunately, mechanisms explaining the transmission of mood disorders from one generation to the next remain largely elusive. Since timely intervention is associated with a better outcome and prognosis, early detection of intergenerational transmission of mood disorders is of paramount importance. Here, we describe the design of the Mood and Resilience in Offspring (MARIO) cohort study in which we investigate: 1. differences in clinical, biological and environmental (e.g., psychosocial factors, substance use or stressful life events) risk and resilience factors in children of parents with and without mood disorders, and 2. mechanisms of intergenerational transmission of mood disorders via clinical, biological and environmental risk and resilience factors.

METHODS

MARIO is an observational, longitudinal cohort study that aims to include 450 offspring of parents with a mood disorder (uni- or bipolar mood disorders) and 100-150 offspring of parents without a mood disorder aged 10-25 years. Power analyses indicate that this sample size is sufficient to detect small to medium sized effects. Offspring are recruited via existing Dutch studies involving patients with a mood disorder and healthy controls, for which detailed clinical, environmental and biological data of the index-parent (i.e., the initially identified parent with or without a mood disorder) is available. Over a period of three years, four assessments will take place, in which extensive clinical, biological and environmental data and data on risk and resilience are collected through e.g., blood sampling, face-to-face interviews, online questionnaires, actigraphy and Experience Sampling Method assessment. For co-parents, information on demographics, mental disorder status and a DNA-sample are collected.

DISCUSSION

The MARIO cohort study is a large longitudinal cohort study among offspring of parents with and without mood disorders. A unique aspect is the collection of granular data on clinical, biological and environmental risk and resilience factors in offspring, in addition to available parental data on many similar factors. We aim to investigate the mechanisms underlying intergenerational transmission of mood disorders, which will ultimately lead to better outcomes for offspring at high familial risk.

Cognitive Signatures of Depressive and Anhedonic Symptoms and Affective States Using Computational Modeling and Neurocognitive Testing

BACKGROUND

Deeper phenotyping may improve our understanding of depression. Because depression is heterogeneous, extracting cognitive signatures associated with severity of depressive symptoms, anhedonia, and affective states is a promising approach.

METHODS

Sequential sampling models decomposed behavior from an adaptive approach-avoidance conflict task into computational parameters quantifying latent cognitive signatures. Fifty unselected participants completed clinical scales and the approach-avoidance conflict task by either approaching or avoiding trials offering monetary rewards and electric shocks.

RESULTS

Decision dynamics were best captured by a sequential sampling model with linear collapsing boundaries varying by net offer values, and with drift rates varying by trial-specific reward and aversion, reflecting net evidence accumulation toward approach or avoidance. Unlike conventional behavioral measures, these computational parameters revealed distinct associations with self-reported symptoms. Specifically, passive avoidance tendencies, indexed by starting point biases, were associated with greater severity of depressive symptoms (R = 0.34, p = .019) and anhedonia (R = 0.49, p = .001). Depressive symptoms were also associated with slower encoding and response execution, indexed by nondecision time (R = 0.37, p = .011). Higher reward sensitivity for offers with negative net values, indexed by drift rates, was linked to more sadness (R = 0.29, p = .042) and lower positive affect (R = -0.33, p = .022). Conversely, higher aversion sensitivity was associated with more tension (R = 0.33, p = .025). Finally, less cautious response patterns, indexed by boundary separation, were linked to more negative affect (R = -0.40, p = .005).

CONCLUSIONS

We demonstrated the utility of multidimensional computational phenotyping, which could be applied to clinical samples to improve characterization and treatment selection.

An integrative analysis of potential mechanisms of reduced positive affect in daily life in depression: an ESM study

Decreased levels of positive affect (PA) are a hallmark of depression. Current models propose as potential main mechanisms a dysfunctional use of emotion regulation (ER) strategies (i.e. dampening, positive rumination), and a maladaptive activation of pro-hedonic goals. However, the role of these mechanisms in PA in daily life remains understudied. We used a 10-day ESM design to assess how these mechanisms influence each other and contribute to depressive symptomatology-related low momentary PA in 139 individuals. Higher depressive symptoms were associated with lower PA, pro-hedonic goals, more frequent use of positive rumination, and higher use of dampening. Further, experiencing higher levels of PA predicted lower following time point use of dampening in individuals with higher symptoms. Finally, using positive rumination was more beneficial (i.e. predicted higher PA increases one moment later) for individuals with higher symptomatology. Our findings suggest that moment-to-moment changes in PA daily life are affected by, and have an effect on, both pro-hedonic goals and the use of dampening and positive rumination, highlighting specific cognitive-affective mechanisms that should be considered when designing interventions aimed at improving low PA characterising depression symptomatology.

Do markers of daily affect mediate associations between interpretation bias and depressive symptoms? A longitudinal study of early adolescents

INTRODUCTION

Early adolescence represents a time of heightened vulnerability for depression. Negative interpretation biases have been associated with increases in depressive symptoms during this developmental period; however, the mechanisms underlying the association between interpretation biases and depression remain poorly understood. Cognitive theories posit that interpretation biases give rise to depression by modulating daily affect, particularly in the context of stress. However, this has not yet been directly examined. The present study tested affect intensity and instability as mechanisms linking negative interpretation biases with change in adolescent depressive symptoms.

METHODS

Ninety-four adolescents (aged 11-13 years; 51% boys) from Vancouver, Canada, were recruited for this longitudinal study. At baseline (Time 1), participants self-reported depressive symptoms and completed the Scrambled Sentences Task to assess negative interpretation biases. Next, participants completed daily diaries to assess positive affect (PA) and negative affect (NA) during a naturalistic stressor-the first 2 weeks of high school (Time 2). Finally, participants self-reported depressive symptoms 3 months later (Time 3). Path models were conducted to test whether PA and NA intensity and instability mediated prospective associations between negative interpretation biases and depressive symptom changes.

RESULTS

Although NA intensity, NA instability, and PA instability predicted increases in depressive symptoms, only NA intensity mediated associations between interpretation biases and symptom changes. Neither PA intensity nor instability mediated these associations.

CONCLUSIONS

Elevated daily NA represents a specific mechanism through which stronger negative interpretation biases predict increases in depressive symptoms in adolescence.

Establishing the measurement precision of the patient health questionnaire in an adolescent sample

BACKGROUND

Technically sound measures are necessary for accurately identifying youth at risk for depression, but many studies rely on classical test theory metrics or adult samples to evaluate measures. This study examined the use of the PHQ-8, a common and freely available pediatric depression screener, in an adolescent sample using item response theory (IRT).

METHODS

Secondary analyses were conducted on data from a study conducted in Midwestern middle schools in which 1224 youth completed the PHQ-8 as part of a battery of surveys. Polytomous IRT analyses (a Graded Response Model) were used to evaluate the PHQ-8. Items were examined for their ability to distinguish between respondents of different latent depression severity and for differential item functioning (DIF) across demographic categories.

RESULTS

All PHQ-8 items had adequate discriminative abilities. Items measuring anhedonia and psychomotor disturbances performed relatively poorly, and items measuring somatic symptoms (appetite and sleep) were most informative when respondents endorsed extreme response options ("not at all" or "nearly every day"). No DIF was found across grade level or race, but several items were flagged for DIF by gender and student income level.

LIMITATIONS

These results might not be generalizable to a broader youth population due to administration setting and the unique demographic characteristics of this sample (76.0 % African American).

CONCLUSIONS

Tools such as the PHQ-8 are appropriate to quickly screen for depression in adolescents, but further scrutiny of adolescent response patterns is warranted. Future research should examine items measuring anhedonia and psychomotor and somatic disturbances in adolescents.

Parent and adolescent emotional variability and adolescent psychopathology

Emotional variability has been posited as a risk factor for adolescent psychopathology. However, it is unclear whether parent emotional variability may also function as a risk factor that heightens adolescent mental health problems. To fill this gap, the present study examined whether parent and adolescent emotional variability in both positive emotion (PE) and negative emotion (NE) is associated with adolescent psychopathology and potential sex differences in these associations. Participants were 147 adolescents and their parents in Taiwan who completed a baseline assessment, a 10-day daily diary study, and a 3-month follow-up assessment. The results indicated that parent NE variability was associated with risk for adolescent internalizing problems and depressive symptoms, after accounting for baseline levels, adolescent NE variability, parent internalizing problems, and mean levels of parent and adolescent NE. Adolescent PE variability was also associated with the risk for adolescent externalizing problems. Furthermore, higher parent PE variability was associated with more internalizing problems only for female but not male adolescents. The findings highlight the importance of assessing emotion dynamics in both parents and adolescents to better understand the development of adolescent psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Increased affective reactivity among depressed individuals can be explained by floor effects: An experience sampling study

Experience sampling studies into daily-life affective reactivity indicate that depressed individuals react more strongly to both positive and negative stimuli than non-depressed individuals, particularly on negative affect (NA). Given the different mean levels of both positive affect (PA) and NA between patients and controls, such findings may be influenced by floor/ceiling effects, leading to violations of the normality and homoscedasticity assumptions underlying the used statistical models. Affect distributions in prior studies suggest that this may have particularly influenced NA-reactivity findings. Here, we investigated the influence of floor/ceiling effects on the observed PA- and NA-reactivity to both positive and negative events. Data came from 346 depressed, non-depressed, and remitted participants from the Netherlands Study of Depression and Anxiety (NESDA). In PA-reactivity analyses, no floor/ceiling effects and assumption violations were observed, and PA-reactivity to positive events, but not negative events, was significantly increased in the depressed and remitted groups versus the non-depressed group. However, NA-scores exhibited a floor effect in the non-depressed group and naively estimated models violated model assumptions. When these violations were accounted for in subsequent analyses, group differences in NA-reactivity that had been present in the naive models were no longer observed. In conclusion, we found increased PA-reactivity to positive events but no evidence of increased NA-reactivity in depressed individuals when accounting for violations of assumptions. The results indicate that affective-reactivity results are very sensitive to modeling choices and that previously observed increased NA-reactivity in depressed individuals may (partially) reflect unaddressed assumption violations resulting from floor effects in NA.

Exploring the digital footprint of depression: a PRISMA systematic literature review of the empirical evidence

BACKGROUND

This PRISMA systematic literature review examined the use of digital data collection methods (including ecological momentary assessment [EMA], experience sampling method [ESM], digital biomarkers, passive sensing, mobile sensing, ambulatory assessment, and time-series analysis), emphasizing on digital phenotyping (DP) to study depression. DP is defined as the use of digital data to profile health information objectively.

AIMS

Four distinct yet interrelated goals underpin this study: (a) to identify empirical research examining the use of DP to study depression; (b) to describe the different methods and technology employed; (c) to integrate the evidence regarding the efficacy of digital data in the examination, diagnosis, and monitoring of depression and (d) to clarify DP definitions and digital mental health records terminology.

RESULTS

Overall, 118 studies were assessed as eligible. Considering the terms employed, "EMA", "ESM", and "DP" were the most predominant. A variety of DP data sources were reported, including voice, language, keyboard typing kinematics, mobile phone calls and texts, geocoded activity, actigraphy sensor-related recordings (i.e., steps, sleep, circadian rhythm), and self-reported apps' information. Reviewed studies employed subjectively and objectively recorded digital data in combination with interviews and psychometric scales.

CONCLUSIONS

Findings suggest links between a person's digital records and depression. Future research recommendations include (a) deriving consensus regarding the DP definition and (b) expanding the literature to consider a person's broader contextual and developmental circumstances in relation to their digital data/records.

The Emotion Dynamics Conundrum in Developmental Psychopathology: Similarities, Distinctions, and Adaptiveness of Affective Variability and Socioaffective Flexibility

A recent emphasis in developmental psychopathology research has been on emotion dynamics, or how emotional experience changes over time in response to context, and how those emotion dynamics affect psychosocial functioning. Two prominent emotion dynamics constructs have emerged in the developmental psychopathology literature: affective variability and socioaffective flexibility. Affective variability is most often measured using momentary methods (e.g., EMA) and is theorized to reflect reactivity and regulation in response to context, whereas socioaffective flexibility is typically measured in the context of parent-child interactions and theorized as the ability to move effectively through a range of affective states. Notably, affective variability is considered broadly maladaptive; however, socioaffective flexibility is theorized to be fundamentally adaptive. Despite these diametric views on adaptability, these two constructs share an underlying dependency on non-effortful emotion change in response to context, which raises questions about whether these constructs are, at their core, more similar than dissimilar. This review examined the literatures on affective variability and socioaffective flexibility in child and adolescent samples, examining associations with psychosocial and clinical correlates, as well as conceptual and methodological similarities and distinctions. Findings indicate that despite considerable theoretical overlap, there are sufficient differences-albeit largely methodological-that justify continuing to treat these constructs as distinct, most notably the influence of parents in socioaffective flexibility. The review closes with several recommendations for future study targeted at further clarifying the distinctions (or lack thereof) between affective variability and socioaffective flexibility.

Predicting Negative and Positive Affect During COVID-19: A Daily Diary Study in Youths

The COVID-19 pandemic has the potential to profoundly affect youths' mental health. Understanding predictors of affective responding to the pandemic is critical for prevention and intervention efforts. This study examines emotion regulation as an important predictor of youth's changes in positive and negative affect. The present study of 115 participants (62 girls, M_age  = 11.77) explores the relation between pre-existing emotion regulation strategies, as measured by multi-week daily diaries pre-COVID, and youths' mean positive and negative affect levels and variability during a 28-day period amidst the pandemic, while including COVID-related worries and isolation as important moderators. The findings provide important insight into interactions between pre-existing vulnerabilities and COVID-related stressors in predicting affective adjustment in youth.

Prevention and early intervention of depression in young people: an integrated narrative review of affective awareness and Ecological Momentary Assessment

Depression has a devastating impact on young people around the world. This impact is pervasive and long-long lasting, still causing havoc as young people transition into adulthood. Prevention and timely early intervention efforts are necessary to lessen the disease burden of depression in young people. There is some evidence for the effectiveness of existing prevention and early intervention programs when delivered early. However, there is no consensus on what the active ingredients of these programs are. Identifying these ingredients is important because focusing on those that have maximal benefit will help to minimise the costs and resourcing of (already intensive) therapeutic approaches. We explored whether, and in what circumstances, affective awareness (i.e., knowing how one feels) is a candidate for protecting against and decreasing vulnerability to depression in young people. We specifically looked at how Ecological Momentary Assessment methods (EMA) were used to measure and/or increase affective awareness. We integrated three streams of data, including narrative review findings, perspectives from young people and psychologists, and publicly available information online (e.g., discussion forums). Across data sources, we found converging evidence that affective awareness is important in the prevention and early intervention of depression although there were considerable gaps in knowledge. More work needs to be done with young people and their health care teams to build affective awareness in the right way, at the right time, with individual differences in mind. The identification of how EMA can be best incorporated into young people's lives to facilitate these outcomes is also needed.

Social reinforcement learning as a predictor of real-life experiences in individuals with high and low depressive symptomatology

BACKGROUND

Several studies have reported diminished learning from non-social outcomes in depressed individuals. However, it is not clear how depression impacts learning from social feedback. Notably, mood disorders are commonly associated with deficits in social functioning, which raises the possibility that potential impairments in social learning may negatively affect real-life social experiences in depressed subjects.

METHODS

Ninety-two participants with high (HD; N = 40) and low (LD; N = 52) depression scores were recruited. Subjects performed a learning task, during which they received monetary outcomes or social feedback which they were told came from other people. Additionally, participants answered questions about their everyday social experiences. Computational models were fit to the data and model parameters were related to social experience measures.

RESULTS

HD subjects reported a reduced quality and quantity of social experiences compared to LD controls, including an increase in the amount of time spent in negative social situations. Moreover, HD participants showed lower learning rates than LD subjects in the social condition of the task. Interestingly, across all participants, reduced social learning rates predicted higher amounts of time spent in negative social situations, even when depression scores were controlled for.

CONCLUSION

These findings indicate that deficits in social learning may affect the quality of everyday social experiences. Specifically, the impaired ability to use social feedback to appropriately update future actions, which was observed in HD subjects, may lead to suboptimal interpersonal behavior in real life. This, in turn, may evoke negative feedback from others, thus bringing about more unpleasant social encounters.

The Role of Old Photos in Reminiscence Therapy in Elderly Women With Depressive Symptoms: A Functional Magnetic Resonance Imaging Study

Background:

Although evidence shows that reminiscence therapy relieves depression in the elderly, few studies have explored its mechanisms and it is unclear whether old public photos rather than personal photos are effective prompts.

Objectives:

The aims of this functional magnetic resonance imaging (fMRI) study with an event-related design were to explore whether old public photos can evoke autobiographical memories and compare brain-activation responses to photos between elderly women with depressive symptoms (DS) and normal controls (NC).

Methods:

Elderly women with DS ( n = 16) and NC ( n = 18) were recruited from urban communities in Southwest China. Participants responded with a key press to indicate which of 40 photos evoked autobiographical memories at first sight during 3.0 T scanning. Afterward, they rated photos on a 9-point Likert-type scale on the degrees of recall (DOR), arousal, and pleasure elicited and the degree to which photos felt old.

Results:

Mean DOR scores were 8.47 ± 0.77 and 1.37 ± 1.09 for high- and low-DOR photos, respectively. Response time was longer in DS compared to NC participants. Brain areas activated by exposure to high-DOR photos differed between groups, with reminiscence leading to decreased activation of the bilateral superior temporal gyrus, left inferior frontal gyrus, right parahippocampal gyrus, left cingulate gyrus, right insular lobe, and bilateral cerebellum anterior lobe in DS compared to NC participants.

Conclusion:

Old public photos can evoke autobiographical memory. DS are associated with brain dysfunction. Early intervention for DS is recommended in the elderly.

Compliance and Retention With the Experience Sampling Method Over the Continuum of Severe Mental Disorders: Meta-Analysis and Recommendations

Background

Despite the growing interest in the experience sampling method (ESM) as a data collection tool for mental health research, the absence of methodological guidelines related to its use has resulted in a large heterogeneity of designs. Concomitantly, the potential effects of the design on the response behavior of the participants remain largely unknown.

Objective

The objective of this meta-analysis was to investigate the associations between various sample and design characteristics and the compliance and retention rates of studies using ESM in mental health research.

Methods

ESM studies investigating major depressive disorder, bipolar disorder, and psychotic disorder were considered for inclusion. Besides the compliance and retention rates, a number of sample and design characteristics of the selected studies were collected to assess their potential relationships with the compliance and retention rates. Multilevel random/mixed effects models were used for the analyses.

Results

Compliance and retention rates were lower for studies with a higher proportion of male participants (P<.001) and individuals with a psychotic disorder (P<.001). Compliance was positively associated with the use of a fixed sampling scheme (P=.02), higher incentives (P=.03), higher time intervals between successive evaluations (P=.02), and fewer evaluations per day (P=.008), while no significant associations were observed with regard to the mean age of the sample, the study duration, or other design characteristics.

Conclusions

The findings demonstrate that ESM studies can be carried out in mental health research, but the quality of the data collection depends upon a number of factors related to the design of ESM studies and the samples under study that need to be considered when designing such protocols.

From laboratory to life: associating brain reward processing with real-life motivated behaviour and symptoms of depression in non-help-seeking young adults

BACKGROUND

Depression has been associated with abnormalities in neural underpinnings of Reward Learning (RL). However, inconsistencies have emerged, possibly owing to medication effects. Additionally, it remains unclear how neural RL signals relate to real-life behaviour. The current study, therefore, examined neural RL signals in young, mildly to moderately depressed - but non-help-seeking and unmedicated - individuals and how these signals are associated with depressive symptoms and real-life motivated behaviour.

METHODS

Individuals with symptoms along the depression continuum (n = 87) were recruited from the community. They performed an RL task during functional Magnetic Resonance Imaging and were assessed with the Experience Sampling Method (ESM), completing short questionnaires on emotions and behaviours up to 10 times/day for 15 days. Q-learning model-derived Reward Prediction Errors (RPEs) were examined in striatal areas, and subsequently associated with depressive symptoms and an ESM measure capturing (non-linearly) how anticipation of reward experience corresponds to actual reward experience later on.

RESULTS

Significant RPE signals were found in the striatum, insula, amygdala, hippocampus, frontal and occipital cortices. Region-of-interest analyses revealed a significant association between RPE signals and (a) self-reported depressive symptoms in the right nucleus accumbens (b = -0.017, p = 0.006) and putamen (b = -0.013, p = .012); and (b) the quadratic ESM variable in the left (b = 0.010, p = .010) and right (b = 0.026, p = 0.011) nucleus accumbens and right putamen (b = 0.047, p < 0.001).

CONCLUSIONS

Striatal RPE signals are disrupted along the depression continuum. Moreover, they are associated with reward-related behaviour in real-life, suggesting that real-life coupling of reward anticipation and engagement in rewarding activities might be a relevant target of psychological therapies for depression.

Diminished Anticipatory and Consummatory Pleasure in Dysphoria: Evidence From an Experience Sampling Study

Anhedonia, the experience of diminished pleasure, is a core feature of major depressive disorder and is often present long before the diagnosis of depression. Most previous studies have investigated anhedonia with self-report measures of trait anhedonia or with behavioral paradigms using laboratory stimuli, and the real-time characteristics of hedonic processing in subclinical depression remain under-investigated. We used the experience sampling method to evaluate momentary experience of hedonic feelings in the context of daily life. Dysphoric (n = 49) and non-dysphoric (n = 51) college students completed assessments of their current positive affect (PA), as well as state anticipatory and consummatory pleasure, 3 or 4 times a day every day for 2 weeks. The results showed that dysphoric individuals reported less state anticipatory and consummatory pleasure compared with non-dysphoric individuals. Moreover, significant time-lagged associations between anticipatory pleasure and follow-up consummatory pleasure were found in the whole sample, after adjustment for current PA. The current findings thus hold considerable promise in advancing our understanding of anhedonia as well as the important role of state anticipatory pleasure in relation to depression.

Daily Affect and Self-Esteem in Early Adolescence: Correlates of Mean Levels and Within-Person Variability

Emotions and self-esteem are critical components of well-being and adaptation during adolescence. People differ in their average levels of affect and self-esteem, as well as in how much their affect and self-esteem fluctuate from moment to moment. Fluctuations in affect in particular have not been extensively examined in relation to adolescent-relevant variables. The present study investigates internalizing symptoms, social functioning, and overt and relational aggression as correlates of average levels and within-person variability in daily positive and negative affect (PA and NA) and self-esteem. Crucially, unique association were examined controlling for the other variables. Early adolescents (mean age 10.8 years, N = 94) completed daily diaries across four days on PA, NA, and self-esteem. They also completed general questionnaires, as did peers. Some key findings were that more internalizing symptoms were significantly associated with more variability in NA. The importance of peer relationships for adolescents' daily mean levels of PA and NA were shown. Peer-perceived social functioning was associated with less fluctuations in self-esteem. Some unexpected, non-significant, findings for aggression appeared. Finally, higher mean NA were associated with more NA fluctuations, whereas higher mean PA and self-esteem were associated with less fluctuations.

The dynamical signature of anhedonia in major depressive disorder: positive emotion dynamics, reactivity, and recovery

BACKGROUND

Major Depressive Disorder (MDD) is the leading cause of disability worldwide. The cardinal features of MDD are depressed mood and anhedonia. Anhedonia is defined as a "markedly diminished interest or pleasure in all, or almost all, activities of the day", and has generally been investigated on group-level using retrospective data (e.g. via questionnaire/interview). However, inferences based on group-level findings not necessarily generalize to daily life experiences within individuals.

METHODS

We repeatedly sampled pleasurable experiences within individuals' daily lives by means of Experience Sampling Methods, and compared how positive affect unfolded in the daily life of healthy controls versus patients diagnosed with MDD and anhedonia. We sampled Positive Affect (PA) and reward experiences on 10 semi-random time points a day, for seven days in the daily lives of 47 MDD patients with anhedonia, and 40 controls.

RESULTS

Multilevel models showed that anhedonia was associated with low PA, but not to differences in PA dynamics, nor reward frequency in daily life. In reaction to rewards, MDD patients with anhedonia showed no difference in their increase in PA (i.e., PA reactivity), and showed no signs of a faster return to baseline thereafter (i.e., PA recovery).

CONCLUSIONS

Our results suggest that the dynamical signature of anhedonia in MDD can be described best as a lower average level of PA, and "normal" in terms of PA dynamics, daily reward reactivity and reward recovery. Preregistration: https://osf.io/gmfsc/register/565fb3678c5e4a66b5582f67 . Preprint: https://osf.io/cfkts.

Socioeconomically Disadvantaged Adolescents with Elevated Externalizing Symptoms Show Heightened Emotion Reactivity to Daily Stress: An Experience Sampling Study

Numerous theories assert that youth with externalizing symptomatology experience intensified emotion reactivity to stressful events; yet scant empirical research has assessed this notion. Using in-vivo data collected via experience sampling methodology, we assessed whether externalizing symptoms conditioned adolescents' emotion reactivity to daily stressors (i.e. change in emotion pre-post stressor) among 206 socioeconomically disadvantaged adolescents. We also assessed whether higher externalizing symptomology was associated with experiencing more stressors overall, and whether adolescents' emotional upheavals resulted in experiencing a subsequent stressor. Hierarchical linear models showed that adolescents higher in externalizing symptoms experienced stronger emotion reactivity in sadness, anger, jealously, loneliness, and (dips in) excitement. Externalizing symptomatology was not associated with more stressful events, but a stress-preventative effect was found for recent upheavals in jealousy among youth low in externalizing. Findings pinpoint intense emotion reactivity to daily stress as a risk factor for youth with externalizing symptoms living in socioeconomic disadvantage.

Prefrontal cortex activation during a cognitive reappraisal task is associated with real-life negative affect reactivity

The neural substrate of cognitive reappraisal has been well-mapped. Individuals who successfully downregulate negative affect (NA) by reshaping their thoughts about a potentially emotional situation show augmented activity in the prefrontal cortex (PFC), with attenuated activity in the amygdala. We performed functional neuroimaging with experience sampling to determine whether individual differences in brain activation correspond to differences in real-life NA. While being scanned, 69 female students (aged 18–25 years) were asked to perform a cognitive reappraisal task. In addition, repeated assessments (5/day, 14 days) of affect and minor events in real-life were conducted. Individual t-maps were created for an instructed downregulation contrast (downregulate negative–attend negative) and an uninstructed regulation contrast (attend negative–attend neutral). Mean beta values were extracted from a priori defined regions of interest in the bilateral amygdala and PFC and were correlated with three daily life NA measures: baseline (mean) NA, NA variability, and NA reactivity to negative events. Only one out of twelve correlations for the amygdalae was nominally significant, which did not survive correction for multiple comparisons. PFC activation in the instructed and uninstructed regulation contrasts explained approximately 10% of the variance in NA reactivity; stronger recruitment during the attend-negative condition was correlated with lower reactivity levels. The degree to which individuals spontaneously engage frontal clusters may be a critical aspect of real-life emotional reactivity. The findings of this study provide a partial external validation of the cognitive reappraisal task, suggesting that frontal brain activation during implicit task conditions may have the strongest connection with real-life behaviors.

Experience sampling methodology in mental health research: new insights and technical developments

In the mental health field, there is a growing awareness that the study of psychiatric symptoms in the context of everyday life, using experience sampling methodology (ESM), may provide a powerful and necessary addition to more conventional research approaches. ESM, a structured self-report diary technique, allows the investigation of experiences within, and in interaction with, the real-world context. This paper provides an overview of how zooming in on the micro-level of experience and behaviour using ESM adds new insights and additional perspectives to standard approaches. More specifically, it discusses how ESM: a) contributes to a deeper understanding of psychopathological phenomena, b) allows to capture variability over time, c) aids in identifying internal and situational determinants of variability in symptomatology, and d) enables a thorough investigation of the interaction between the person and his/her environment and of real-life social interactions. Next to improving assessment of psychopathology and its underlying mechanisms, ESM contributes to advancing and changing clinical practice by allowing a more fine-grained evaluation of treatment effects as well as by providing the opportunity for extending treatment beyond the clinical setting into real life with the development of ecological momentary interventions. Furthermore, this paper provides an overview of the technical details of setting up an ESM study in terms of design, questionnaire development and statistical approaches. Overall, although a number of considerations and challenges remain, ESM offers one of the best opportunities for personalized medicine in psychiatry, from both a research and a clinical perspective.

Adolescents' Daily Perception of Internalizing Emotional States by Means of Smartphone-based Ecological Momentary Assessment

This study uses ecological momentary assessment (EMA) with smartphone devices to examine community adolescents' perceptions regarding both the intensity of and variability in their daily sadness/depression, anxiety, and somatic problems over the period of one week. Participants were 90 high-school students (M age = 14.61, SD = 1.64; range 12-18). The sample was divided according to gender (61.1% girls), migratory status (68.5% Spanish nationals and 31.5% Latin American immigrants), and level of psychological symptoms (17% risk group). Sadness/depression, anxiety, and somatic problems were examined using a smartphone app, five times per day, semi-randomly, for seven days (35 possible moments). A high proportion of adolescents did not report feelings of sadness (80.0%) or worry (79.3%) or physical symptoms on a daily basis (84.9%). Girls and the risk group reported greater intensity levels for the three analyzed problems than did boys and the normal group, respectively (p .05 in all cases). Day-to-day fluctuations in mood during the week were statistically significant but not meaningful (b = 0.0004, 95% CI [0.0001, 0.0008], p = .001).

Constructing a Reward-Related Quality of Life Statistic in Daily Life-a Proof of Concept Study Using Positive Affect

Background: Mental healthcare needs person-tailored interventions. Experience Sampling Method (ESM) can provide daily life monitoring of personal experiences. This study aims to operationalize and test a measure of momentary reward-related Quality of Life (rQoL). Intuitively, quality of life improves by spending more time on rewarding experiences. ESM clinical interventions can use this information to coach patients to find a realistic, optimal balance of positive experiences (maximize reward) in daily life. rQoL combines the frequency of engaging in a relevant context (a 'behavior setting') with concurrent (positive) affect. High rQoL occurs when the most frequent behavior settings are combined with positive affect or infrequent behavior settings co-occur with low positive affect. Methods: Resampling procedures (Monte Carlo experiments) were applied to assess the reliability of rQoL using various behavior setting definitions under different sampling circumstances, for real or virtual subjects with low-, average- and high contextual variability. Furthermore, resampling was used to assess whether rQoL is a distinct concept from positive affect. Virtual ESM beep datasets were extracted from 1,058 valid ESM observations for virtual and real subjects. Results: Behavior settings defined by Who-What contextual information were most informative. Simulations of at least 100 ESM observations are needed for reliable assessment. Virtual ESM beep datasets of a real subject can be defined by Who-What-Where behavior setting combinations. Large sample sizes are necessary for reliable rQoL assessments, except for subjects with low contextual variability. rQoL is distinct from positive affect. Conclusion: rQoL is a feasible concept. Monte Carlo experiments should be used to assess the reliable implementation of an ESM statistic. Future research in ESM should asses the behavior of summary statistics under different sampling situations. This exploration is especially relevant in clinical implementation, where often only small datasets are available.

Discrete- vs. Continuous-Time Modeling of Unequally Spaced Experience Sampling Method Data

The Experience Sampling Method is a common approach in psychological research for collecting intensive longitudinal data with high ecological validity. One characteristic of ESM data is that it is often unequally spaced, because the measurement intervals within a day are deliberately varied, and measurement continues over several days. This poses a problem for discrete-time (DT) modeling approaches, which are based on the assumption that all measurements are equally spaced. Nevertheless, DT approaches such as (vector) autoregressive modeling are often used to analyze ESM data, for instance in the context of affective dynamics research. There are equivalent continuous-time (CT) models, but they are more difficult to implement. In this paper we take a pragmatic approach and evaluate the practical relevance of the violated model assumption in DT AR(1) and VAR(1) models, for the N = 1 case. We use simulated data under an ESM measurement design to investigate the bias in the parameters of interest under four different model implementations, ranging from the true CT model that accounts for all the exact measurement times, to the crudest possible DT model implementation, where even the nighttime is treated as a regular interval. An analysis of empirical affect data illustrates how the differences between DT and CT modeling can play out in practice. We find that the size and the direction of the bias in DT (V)AR models for unequally spaced ESM data depend quite strongly on the true parameter in addition to data characteristics. Our recommendation is to use CT modeling whenever possible, especially now that new software implementations have become available.

Study protocol for a randomized controlled trial to explore the effects of personalized lifestyle advices and tandem skydives on pleasure in anhedonic young adults

BACKGROUND

Anhedonia is generally defined as the inability to feel pleasure in response to experiences that are usually enjoyable. Anhedonia is one of the two core symptoms of depression and is a major public health concern. Anhedonia has proven particularly difficult to counteract and predicts poor treatment response generally. It has often been hypothesized that anhedonia can be deterred by a healthy lifestyle. However, it is quite unlikely that a one-size-fits-all approach will be effective for everyone. In this study the effects of personalized lifestyle advice based on observed individual patterns of lifestyle behaviors and experienced pleasure will be examined. Further, we will explore whether a tandem skydive following the personalized lifestyle advice positively influences anhedonic young adults' abilities to carry out the recommended lifestyle changes, and whether this ultimately improves their self-reported pleasure.

METHODS

Our study design is an exploratory intervention study, preceded by a cross-sectional survey as a screening instrument. For the survey, 2000 young adults (18-24 years old) will be selected from the general population. Based on survey outcomes, 72 individuals (36 males and 36 females) with persistent anhedonia (i.e., more than two months) and 60 individuals (30 males and 30 females) without anhedonia (non-anhedonic control group) will be selected for the intervention study. The non-anhedonic control group will fill out momentary assessments of pleasure and lifestyle behaviors three times a day, for one month. The anhedonic individuals will fill out momentary assessments for three consecutive months. After the first month, the anhedonic individuals will be randomly assigned to (1) no intervention, (2) lifestyle advice only, (3) lifestyle advice plus tandem skydive. The personalized lifestyle advice is based on patterns observed in the first month.

DISCUSSION

The present study is the first to examine the effects of a personalized lifestyle advice and tandem skydive on pleasure in anhedonic young adults. Results of the present study may improve treatment for anhedonia, if the interventions are found to be effective.

TRIAL REGISTRATION

Dutch Trial Register, NTR5498 , registered September 22, 2015 (retrospectively registered).