The MARIGOLD study: Feasibility and enhancement of an online intervention to improve emotion regulation in people with elevated depressive symptoms.

Journal Article (Journal Article)


This manuscript describes the first two phases of pilot testing MARIGOLD, an online self-guided positive emotion skills intervention for adults with elevated depressive symptoms, along with enhancements to overcome retention and adherence problems reported in previous research.


Adults with elevated depressive symptoms were recruited online and assessed at baseline, post-intervention, 1- and 3-month follow-up. Phase 1 participants (n = 58) were randomized to MARIGOLD, daily emotion reporting, or waitlist. Phase 2 participants (n = 79) were randomized to MARIGOLD plus one enhancement: online discussion board (ODB), virtual badges (VB), or facilitator contact (FC). Post-intervention interviews assessed acceptability. Intention-to-treat analyses examined retention, adherence, and preliminary efficacy.


In both phases, retention and adherence did not differ between groups. MARIGOLD skills were highly acceptable, but qualitative results indicate web-based features (e.g., log-in, ODB, VB) require refinement prior to larger testing. Neither phase demonstrated between-group differences in preliminary efficacy. In Phase 1 within-group analyses, MARIGOLD and emotion reporting control demonstrated a similar pattern of findings (stable depressive symptoms, increased positive emotion, decreased negative emotion and stress), whereas the waitlist group significantly increased in depressive mood. Most Phase 2 within-group analyses demonstrated the expected pattern of results (i.e., decreases in PHQ-8 and negative emotion, increases in positive emotion). However, CES-D scores were stable in FC; perceived stress was stable in FC and ODB.


This pilot study is not powered to evaluate efficacy.


Positive emotion skills, plus enhancements for web-based, self-guided delivery, warrant additional study in people with elevated depressive symptoms.

Full Text

Duke Authors

Cited Authors

  • Addington, EL; Cheung, EO; Bassett, SM; Kwok, I; Schuette, SA; Shiu, E; Yang, D; Cohn, MA; Leykin, Y; Saslow, LR; Moskowitz, JT

Published Date

  • October 2019

Published In

Volume / Issue

  • 257 /

Start / End Page

  • 352 - 364

PubMed ID

  • 31302525

Pubmed Central ID

  • PMC6711819

Electronic International Standard Serial Number (EISSN)

  • 1573-2517

International Standard Serial Number (ISSN)

  • 0165-0327

Digital Object Identifier (DOI)

  • 10.1016/j.jad.2019.07.049


  • eng