The role of motivational processes and physical activity in smartphone-based relapse prevention in depression

• Applicant: Dr. Gregor Wilbertz
• Subject Area: Personality Psychology, Clinical and Medical Psychology, Methodology
• Term: since 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 505386714

Although effective treatments against depression exist, many patients experience relapse and recurrence of depression at some time in their life. Considering the increasing risk with every new episode, models of depression propose a combination of constantly increasing vulnerability as well as momentary stress that causes recurrence. A reasonable relapse prevention strategy would therefore address both aspects, e.g. combining continuous health behavior (to control vulnerability) with state-dependent timely interventions (to manage early symptoms). Regular physical activity can attenuate one major vulnerability factor (deficient cognitive control and rumination). Smartphone apps can assist individuals to detect risk states and initiate brief interventions. Both strategies (regular physical activity and app use), however, need an explicit motivational perspective or may fail for motivational reasons, as indicated by deficits among depressed patients regarding motivation and effort, as well as high dropout rates in eHealth programs. One aim of the present project is to enhance our knowledge on motivational preconditions that allow individuals with recurrent depression to use relapse prevention programs over long time periods. We synthesized existing evidence for motivational deficits in depression as well as basic research on motivation, effort and delayed reward into a motivational model of relapse prevention and aim to test this model in a longitudinal study. Individuals currently remitted from depression are encouraged to engage in regular physical activity and are tracked over 12 months using a smartphone app. Process variables focus on experimental task paradigms to assess effort-related motivation and cognitive control as well as on accelerometry to assess daily physical activity. We expect that dropout is predicted by several motivational variables (apart from program acceptability) including steeper delayed reward discounting, higher sensitivity to effort costs and fatigue. Furthermore, we expect specific interactions between motivation, daily physical activity, affect and cognitive control as well as their joint effect on symptom suppression. Finally, the employment of a randomized control group design within the same study allows to answer the question of modifiability, i.e. whether motivation and physical activity can be increased by specific interventions and the risk of relapse reduced. Interventions are specifically tailored to the individual motivational deficits of depressed subjects and based on an established framework for the implementation of a healthy lifestyle. Overall, the proposed project is expected to provide major insights into mechanisms of relapse and long-term relapse prevention as well as motivational trajectories in recurrent depression. This will improve the usability of long-term relapse prevention programs based on advanced mobile technology and enduring behavioral change strategies.

• DFG Programme: Research Grants
• Co-Investigator: Professor Dr. Stephan Heinzel