Outcome studies have shown that several forms of psychotherapy are effective for depression, but questions about how, why, and when these treatments work remain. The proposed study answers the call for innovative research designs that allow for more intensive, individualized data collection that can address complex questions about the dynamic nature of treatment-related change. In this R21 application, we propose a proof-of-concept study using an innovative application of experience sampling methodology (ESM) that combines the idiographic advantages of single-subject research with the statistical advantages associated with larger samples and multilevel analyses. ESM involves sampling aspects of behavior occurring in the participant's everyday environment, thereby enhancing ecological validity and reducing retrospective bias. Thirty-four adults with primary major depressive disorder will be randomly assigned to 16 weeks of either self-system therapy (SST), a new short-term, empirically-supported psychotherapy for depression that targets deficits in incentive motivation and goal pursuit, or treatment-as-usual (TAU). Participants will complete a battery of individual difference and diagnostic measures at pretreatment. One week of intensive ESM will be collected at both pre- and post-treatment, during which participants will be signaled at random times during each day to answer questions about current functioning in several domains (e.g., affect, cognition, and goal pursuit) delivered via a phone-based interactive voice response (IVR) system. Throughout the 16 weeks of treatment, participants will complete similar IVR assessments on two randomly-selected days per week. The proposed study will test three main hypotheses. (1) Patients in SST will show greater increases in engagement with promotion goals and activities as well as greater increases in goal-related daily experiences of positive affect over the course of treatment compared to patients in TAU. (2) Patients in SST will show greater decreases in engagement with prevention goals and activities as well as greater decreases in goal- related daily experiences of negative affect over the course of treatment compared to patients in TAU. (3) Within the SST condition, a history of failure to pursue or achieve promotion goals and individual differences in chronic regulatory orientation (i.e., strength of orientation toward promotion and prevention goals) will moderate the effects of SST on changes in depressive symptoms and on daily experiences of promotion goal engagement. The proposed research will have a significant impact on an important public health problem and will expand our knowledge of how psychotherapy for depression works. The data to be obtained from this study will provide a sound empirical and theoretical framework for larger-scale programmatic research on the nature of treatment-induced change processes in patients with depression.

Public Health Relevance

Depression is a major public health concern and a leading cause of morbidity and disability in industrialized nations. The proposed project will examine how adults with clinical depression change over the course of short-term psychotherapy by assessing how they are functioning in their daily lives. This project will lead to a more comprehensive understanding of how therapy affects patients'everyday functioning, and it has direct relevance for improving treatment outcomes.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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Adult Psychopathology and Disorders of Aging Study Section (APDA)
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Muehrer, Peter R
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University of North Carolina Greensboro
Schools of Arts and Sciences
United States
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Hoet, Ariana C; Burgin, Chris J; Eddington, Kari M et al. (2018) Reports of Therapy Skill Use and Their Efficacy in Daily Life in the Short-term Treatment of Depression. Cognit Ther Res 42:184-192
Eddington, Kari M; Burgin, Chris J; Silvia, Paul J et al. (2017) The Effects of Psychotherapy for Major Depressive Disorder on Daily Mood and Functioning: A Longitudinal Experience Sampling Study. Cognit Ther Res 41:266-277
Strauman, Timothy J; Eddington, Kari M (2017) Treatment of Depression From a Self-Regulation Perspective: Basic Concepts and Applied Strategies in Self-System Therapy. Cognit Ther Res 41:1-15
Eddington, Kari M; Burgin, Chris J; Majestic, Catherine (2016) Individual Differences in Expectancies for Change in Depression: Associations with Goal Pursuit and Daily Experiences. J Soc Clin Psychol 35:629-642
Eddington, Kari M; Silvia, Paul J; Foxworth, Tamara E et al. (2015) Motivational deficits differentially predict improvement in a randomized trial of self-system therapy for depression. J Consult Clin Psychol 83:602-16
Eddington, Kari M; Majestic, Catherine; Silvia, Paul J (2012) Contrasting Regulatory Focus and Reinforcement Sensitivity: A Daily Diary Study of Goal Pursuit and Emotion. Pers Individ Dif 53:335-340