Ecological Momentary Intervention for Reward in Anhedonia
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorPhilipps University Marburg
About this trial
The present study evaluates a two week ecological momentary intervention (EMI) in reducing anhedonia and psychological distress (i.e. elevated depression, stress and anxiety). Participants in the experimental group complete three daily exercises targeting reward-related processes, including positive mental imagery, savoring, gratitude, taking ownership for positive experience, and silver lining. These components were selected to improve reward anticipation as well as reward consumption and reward learning as the underlying mechanisms of anhedonia. An active control group receives progressive muscle relaxation training, matched in format and frequency. Exercise units are presented using audio recordings via smartphone app.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
German speaking
Smartphone available and willingness to participate in repeated training units and questions delivered via app
Clinically elevated anhedonia (SHAPS >= 25) and elevated depression (DASS-21-Depression >= 10), elevated anxiey (DASS-21-Anxiety >= 6) or elevated stress (DASS-21-Stress >= 10)
Disqualifiers
Psychotropic medication
Psychotherapy currently ongoing or planned during participation
Suicidality, lifetime diagnosis of bipolar disorders or psychotic episodes
Trial design
Design model
Parallel
Treatments tested in this trial
Training of reward processing/sensitivity
BehavioralParticipants in the experimental group complete a two-week ecological momentary intervention (EMI) consisting of three brief training units per day, each delivered via a smartphone. The exercises target different aspects of reward processing and are scheduled at specific times throughout the day. The morning unit (to be completed between 10:00 and 12:00 a.m.) involves a positive mental imagery task guided by audio recording. Participants are guided to vividly imagine a future situation with the most pleasurable and meaningful outcome possible. They are encouraged to mentally activate all senses, thoughts, and emotions associated with this scenario. The afternoon unit (to be completed between 3:00 and 5:00 p.m.) consists of a savoring exercise guided by audio recording. Participants recall a positive experience from the past and are instructed to re-experience and savor it mentally by focusing on its sensory details, emotional quality, and personal significance. The evening unit (to be
Relaxation Training (PMR)
BehavioralParticipants in the control group complete a two-week progressive muscle relaxation (PMR) program designed to match the reward training in both frequency and duration. The intervention consists of three daily units, each delivered via a smartphone app and guided by audio recordings. The first and second units of each day consist of short audio-guided PMR sessions (approximately 5 minutes each). These exercises systematically guide participants through alternating tension and relaxation of different muscle groups to promote physical and mental relaxation. The third unit of the day focuses on reflection. Participants are asked to evaluate their experiences with the relaxation exercises over the course of the day. They reflect on their ability to engage with the exercises, the perceived effects (e.g., feelings of relaxation), any difficulties they encountered, and strategies to enhance the effectiveness of relaxation in their daily life beyond the intervention.
Psychoeducation
Other interventionAll participants receive a psychoeducation session on the day before the respective intervention starts. In this session, a graduate-level study team member introduces the rationale behind the training (PMR or reward-training), and demonstrates each exercise. Participants also practice each task.
Treatment groups
60 Participants
are divided into 2 treatment groupsGroup A: Reward TrainingExperimental treatment 2 interventions
Group B: Relaxation TrainingActive comparator 2 interventions
Trial outcomes
Primary outcomes
1
Change in anhedonia/hedonic capacity; measured with the Snaith-Hamilton Pleasure Scale (SHAPS) from baseline to post-intervention and baseline to 3-months follow-up
The scale consists of 14 items rated on a four-point Likert-scale (1 = "I completely agree", 2 = "I agree", 3 = "I do not agree", 4 = "I completely disagree"). The SHAPS assesses participants' hedonic capacity/ability to feel pleasure. Sum scores range from 14 to 56, with a higher scores indicating more pronounced anhedonia. The scale is a standard survey method for anhedonia and has been validated by a large number of studies.
Time frame
Baseline, 2 weeks (completion of intervention) and 3 months2
Change in depression, anxiety and stress; measured with the Depression-Anxiety-Stress-Scale (DASS-21) from baseline to completion and baseline to follow-up
The questionnaire consists of 21 items rated on a four-point Likert-scale (0 = "Didn't apply to me at all", 1 = "Applied to me to a certain extent or sometimes", 2 = "Applied to me to a considerable extent or quite often", 3 = "Applied very strongly to me, or most of the time"). The questionnaire is used to assess the severity of depressive, and anxiety symptoms as well as symptoms of distress during the last week. Scores range from 0 to 63 with the overall score being an indicator of general psychopathology. Subscales for depression, anxiety and stress exist. The scale is a widely used survey method and has proven to be a valid measure many times.
Time frame
Baseline, 2 weeks (completion of intervention) and 3 monthsSecondary outcomes
1
Change in anhedonia; measured with the Dimensional Anhedonia Rating Scale (DARS) from baseline to completion and baseline to follow-up
The DARS is a 26-item scale (every item 5-point with 0 = "not at all", 1 = "a little", 2 = "moderately", 3 = "mostly", 4 = "very") that can be used to assess anhedonia/ability to respond to reward. Its advantage is that the subjects can rate their ability to enjoy certain activities/areas of reinforcement (non-social positive activities, favourite foods/drinks, positive social activities and sensory experiences) using their own examples and thus increased validity. Its value range extends from 0 to 104 with high values indicating higher reward responsiveness and thus lower anhedonia.
Time frame
Baseline, 2 weeks (completion of intervention) and 3 months2
Change in reward sensitivity and procession; measured with the Positive Valence System Scale-21 (PVSS-21) from baseline to completion and baseline to follow-up
The scale consists of 21 9-point-items (1 = "extremely unapplicable", 5 = "neutral", 9 = "extremely applicable" to assess one's ability to process reward/the systems of positive valence (Reward valuation, reward expectancy, effort valuation, reward anticipation, initial responsiveness and reward satiation) as introduced by the NIMH-Research Domain Criteria using different areas of reward as examples (food, physical touch, outdoors, positive feedback, social interactions, hobbies and goals). Its value range extends from 21 to 189 with higher values indicating more pronounced reward processing abilities.
Time frame
Baseline, 2 weeks (completion of intervention) and 3 months3
Trait-Positive Emotionality (PE) and its change as measured with the NEO-Five-Factor (NEO-FFI) Positive-Emotionality-Subscale from baseline to completion and baseline to follow-up
The scale consists of four five-point items (1 = "strong rejection", 2 = "rejection", 3 = "neutral", 4 = "approval", 5 = "strong approval") with a value range extending from 4 to 20. Second and fourth item are reverse coded. Higher values indicating higher ability to experience positive emotions easily.
Time frame
Baseline, 2 weeks (completion of intervention) and 3 months4
Positive and negative affect and their changes; measured with the Positive and Negative Affect Schedule (PANAS) from baseline to completion and baseline to follow-up
The PANAS consists of two 10-items scales, one measuring Positive Affect (PA) and the other measuring Negative Affect (NA). Each item on the measure is rated on a 5-point scale (1=not at all; 2=a little; 3=moderately; 4= quite a bit; and 5=extremely). Positive Affect (PA) "reflects the extent to which a person feels enthusiastic, active, and alert". Negative Affect (NA) is a "general dimension of subjective distress and unpleasurable engagement that subsumes a variety of aversive mood states". Higher scores on the PA dimension indicate a greater extent of positive affect, higher scores on the NA dimension indicate a greater extent of negative affect.
Time frame
Baseline, 2 weeks (completion of intervention) and 3 monthsSponsors and contacts
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Source ClinicalTrials.gov