This study evaluates a Just-In-Time Adaptive Intervention (JITAI) aiming to foster social support processes for adults with elevated depressive symptoms awaiting outpatient psychotherapy. Utilizing a daily-level micro-randomized trial (MRT) design conducted over 21 days, participants are assessed six times daily. Participants are randomized across four conditions: (1) vulnerability-triggered, (2) vulnerability and receptivity-triggered, (3) support-need-triggered, and (4) a no-intervention control. The primary objective of this study is to evaluate the effectiveness of the JITAI in reducing daily depressive symptoms and increasing received social support (primary outcomes), as well as reducing daily loneliness and enhancing perceived social support (secondary outcomes). Furthermore, the study aims to compare the relative efficacy of three distinct triggering strategies to identify the most effective timing for intervention delivery.
indicating to seek outpatient psychotherapy
elevated levels of self-reported depressive symptoms (Beck Depression Inventory-II (BDI) score > 13 (out of 63); Kühner et al., 2007)
owning a smartphone
signing the informed consent form
first session for outpatient psychotherapy is scheduled within four weeks
suicidal ideation (values > 2 in BDI item 9)
presence of manic symptoms (Mood Disorder Questionnaire (MDQ) score > 7), - shift work
age below 18 or above 70
Parallel
Social Support Just-in-Time Adaptive Intervention
BehavioralThe intervention is a smartphone-based system designed to encourage the activation of social support networks during critical moments. Triggers are based on real-time Ecological Momentary Assessment (EMA) data. When a condition is met, the app prompts participants to identify a specific type of support needed and a person from their social network to contact. It then provides one of three evidence-based recommendations to facilitate effective support-seeking behavior (direct communication, solution-focused discussion, and reframing the situation). If no social contact is available, the app suggests alternative self-help activities. Detailed information can be found on the OSF project page: https://osf.io/4e8gz
Depressive Symptoms
PHQ-2, adapted for daily measurement "Today, I felt down, depressed, or hopeless." "Today, I had little interest or pleasure in my activities." (7-point Likert scale with 1 = "strongly disagree" to 7 = "strongly agree")
Received Social Support
"Today, I received emotional support from others." "Today, I received practical help from others." (7-point Likert scale with 1 = "strongly disagree" to 7 = "strongly agree") Before that the participants were shown a definition of emotional and practical support: "Support can be emotional (e.g., listening, offering comfort, encouraging, etc.) or involve practical assistance (e.g., giving advice, gathering information, running errands, etc.)."
Loneliness
"I felt lonely today" (5-point Likert scale with 1 = "strongly disagree" to 5 = "strongly agree")
Perceived Social Support
(i) "If I had fallen ill today, I could have asked friends/relatives to take care of important things for me without hesitation." (ii) "If I were feeling very depressed right now, I would know who I could easily turn to." (7-point Likert scale with 1 = "strongly disagree" to 7 = "strongly agree")
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