Amplification of Positivity to Enhance Social Connections in Anxiety and Depression

Change from pre- to post-assessment in neural activation in the striatum measured using functional magnetic resonance imaging (fMRI) during reward anticipation trials of the social incentive delay (SID) task. This is the primary target engagement outcome.

Composite score of the NIH Toolbox Friendship and Loneliness surveys. Items are answered on a 5 point scale, 1 (Never) to 5 (Always). The NIH Toolbox Friendship survey ranges from 8-40 and higher scores indicate greater perceived availability of friends or companions with whom to interact or affiliate. The NIH Toolbox Loneliness survey ranges from 5-25 and higher scores indicate greater social isolation and feelings of loneliness. The composite score will be the average of the standardized scores on the Friendship and Loneliness surveys. The composite index is the primary clinical outcome.

The state version of the Positive and Negative Affect Schedule (PANAS) will be used to measure current ("right now") positive affect in anticipation of and following the social affiliation task. Items are answered on a 5 point scale, 1 (Very slightly or not at all) to 5 (Extremely). The positive affect scale ranges from 10-50; higher scores indicate greater levels of positive affect.

Production of positive facial expressions will be coded offline using the Computer Expression Recognition Toolbox (CERT), software that objectively codes action units (AUs) according to the Facial Action Coding System (FACS). AU12 (zygomatic major) reflects positive emotional expressions. Intensity of positive expressions will be measured by the average of AU12 values greater than zero, which identifies when an action unit is more likely to be present than absent.

Observers will rate participant behavior on self-disclosure (the degree of personal information, thoughts, and feelings revealed) and responsiveness (verbal and nonverbal displays reflecting understanding, engagement, and validation). Items are answered on a 7 point scale, 1 (not at all) to 7(very much) with higher scores indicating greater levels of social approach behavior.

The Desire for Future Interaction Scale (DFI) measures the degree to which respondents would be willing to affiliate with their conversation partner again. Items are answered on a 7 point scale, 1 (not at all) to 7 (very much) with higher scores indicating higher levels of future approach motivation.

RSA will be obtained during a resting baseline and throughout the social interaction task using the MP150 data acquisition and analysis systems. RSA is an index of parasympathetic activation and will be computed from the R-wave to R-wave interbeat interval series in the frequency range of spontaneous breathing. Higher levels of RSA indicate higher levels of parasympathetic activation. RSA reactivity will be computed by subtracting RSA during baseline from RSA during the social interaction.

NIH Toolbox Friendship survey. Items are answered on a 5 point scale, 1 (Never) to 5 (Always). The NIH Toolbox Friendship survey ranges from 8-40 and higher scores indicate greater perceived availability of friends or companions with whom to interact or affiliate.

NIH Toolbox Loneliness survey. Items are answered on a 5 point scale, 1 (Never) to 5 (Always). The NIH Toolbox Loneliness survey ranges from 5-25 and higher scores indicate greater social isolation and feelings of loneliness.

The Social Network Survey measures social functioning by looking at the size and density of a participants social network. Higher scores indicate larger social networks.

The SCSR measures social connectedness. Items are answered on a 6 point scale, 1 (Strongly disagree) to 6 (Strongly agree). The SCSR ranges from 20-120 and higher scores indicate greater levels of social connectedness.

The Sheehan Disability Scale measures functional impairment. Items are rated on a 11 point scale, 0 (Not at all) to 10 (Extremely). The scale ranges from 0-30 and higher scores indicate higher levels of functional impairment.

The PROMIS Positive Affect - Short Form 15a survey measures positive affect. Items are answered in a 5 point scale, 1 (Not at all) to 5 (Very much). The PROMIS Positive Affect - Short Form 15a survey ranges from 15-75 and higher scores indicate higher levels of positive affect.

The Positive and Negative Affect Schedule (PANAS) measures positive affect. Items are answered on a 5 point scale, 1 (Very slightly or not at all) to 5 (Extremely). The positive affect scale ranges from 10-50 and higher scores indicate greater levels of positive affect.

The Modified Differential Emotions Scale (mDES) measures positive emotions. Items are answered on a 5 point scale, 0 (Never/Not at all) to 4 (Most of the time/Extremely). Higher scores on the positive emotions sub-scale indicate higher levels of positive emotion.

The PROMIS General Life Satisfaction - Short Form 5a survey measures psychological well-being. The PROMIS General Life Satisfaction items are answered on a 7 point scale, 1 (Strongly disagree) to 7 (Strongly agree). The PROMIS General Life Satisfaction survey ranges from 5-25 and higher scores indicate higher levels of life satisfaction.

The PROMIS Meaning and Purpose - Short Form 6a survey measure psychological well-being. The PROMIS Meaning and Purpose items are answered on a 5 point scale, 1 (Not at all) to 5 (Very much). The PROMIS Meaning and Purpose survey ranges from 6-30 and higher scores indicate higher levels of self reported meaning and purpose in ones life.

The Positive and Negative Affect Schedule (PANAS) measures negative affect. Items are answered on a 5 point scale, 1 (Very slightly or not at all) to 5 (Extremely). The negative affect scale ranges from 10-50 and lower scores indicate lower levels of negative affect.

The PROMIS Anxiety 7a survey measures symptoms of anxiety. Items are rated on a 5 point scale, 1 (Never) to 5 (Always). The scale ranges from 7-35 and higher scores indicate higher levels of anxiety.

The PROMIS Depression 8b survey measures symptoms of depression. Items are rated on a 5 point scale, 1 (Never) to 5 (Always). The scale ranges from 8-45 and higher scores indicate higher levels of depression.

The NIH Toolbox Emotional Support measures perceived emotional support from others. Items are rated on a 5 point scale, 1 (Never) to 5 (Always). The scale ranges from 8-40 and higher scores indicate greater perceived emotional support.

The PROMIS Satisfaction with Participation in Discretionary Social Activities measures perceived satisfaction with one's discretionary social activities such as leisure activity and relationships with friends. Items are rated on a 5 point scale, 1 (Never) to 5 (Always). The scale ranges from 7-35 and higher scores indicate greater perceived emotional support.

The PROMIS Satisfaction with Social Roles and Activities measures perceived satisfaction with one's social roles such as work and family responsibilities. Items are rated on a 5 point scale, 1 (Never) to 5 (Always). The scale ranges from 8-40 and higher scores indicate greater satisfaction with social roles.

The LSAS measures level of fear/anxiety and avoidance of social situations. Items are rated on a 4 point scale, 0 (None/Never) to 3 (Severe/Usually). The Fear subscale and the Avoidance subscale both range from 0-72 (total LSAS score range 0-144), with higher scores indicating greater fear and avoidance of social situations.

The SLIPS measures changes in anhedonic symptoms independent of broader depressive symptoms. Items are rated on a 4 point scale, 0 to 3, representing a range of anhedonia in various social situations. The scale ranges from 0-69 and higher scores indicate higher levels of social anhedonia.

The MASQ-SF measures mood and anxiety symptoms with 4 subscales. Items are rated on a 5 point scale, 1 (Not at all) to 5 (Extremely). The General Distress Anxiety subscale ranges from 11-55 and higher scores indicate greater anxiety-related distress.

The MASQ-SF measures mood and anxiety symptoms with 4 subscales. Items are rated on a 5 point scale, 1 (Not at all) to 5 (Extremely). The General Distress Depression subscale ranges from 12-60 and higher scores indicate greater depression-related distress.

The MASQ-SF measures mood and anxiety symptoms with 4 subscales. Items are rated on a 5 point scale, 1 (Not at all) to 5 (Extremely). The Anxious Arousal subscale ranges from 17-85 and higher scores indicate greater anxious arousal.

The MASQ-SF measures mood and anxiety symptoms with 4 subscales. Items are rated on a 5 point scale, 1 (Not at all) to 5 (Extremely). The Anhedonic Depression subscale ranges from 22-110 and higher scores indicate higher levels of anhedonia.

The ERQ measures habitual use of the emotion regulation strategies expressive suppression and cognitive reappraisal. Items are rated on a 7 point scale, 1 (Strongly Disagree) to 7 (Strongly Agree). The Expressive Suppression subscale ranges from 1-28 and the Cognitive Reappraisal subscale ranges from 1-42, with higher scores indicating greater use of each respective emotion regulation strategy.

The RPA measures how individuals regulate positive emotional experiences. Items are rated on a 4 point scale, 1 (Almost never) to 4 (Almost always). The Emotion-Focused Positive Rumination subscale ranges from 5-20. The Self-Focused Positive Rumination subscale ranges from 4-16. The Dampening subscale ranges from 8-40. Higher scores on each subscale indicate greater use of each respective positive emotion regulation strategy.

The CD-RISC-10 measures an individual's capacity to cope with adversity. Items are rated on a 5 point scale, 0 (Not true at all) to 4 (True nearly all the time). The scale ranges from 0-40 and higher scores indicate greater capacity to cope with adversity.

The ECR-R measures an individual's attachment style and experiences in close relationships. Items are rated on a 7 point scale, 1 (Disagree) to 7 (Agree). The Attachment Anxiety and the Attachment Avoidance subscales both range from 8-56, and higher scores indicate greater attachment insecurity.

The RESE measures emotion regulation self-efficacy beliefs. Items are rated on a 5 point scale, 1 (Not well at all) to 5 (Very well). The scale ranges from 1-60 and higher scores indicate greater emotion regulation self-efficacy beliefs.

The PROMIS Self-Efficacy - General measures an individual's perceived capacity to handle difficult problems and unexpected events. Items are rated on a 5 point scale, 1 (I am not at all confident) to 5 (I am very confident). The scale ranges from 4-20 and higher scores indicate greater perceived self-efficacy.

The FFMQ-SF measures trait mindfulness by assessing 5 separate facets of mindfulness, including acting with awareness, observing, describing, non-judging, and non-reacting. Items are rated on a 5 point scale, 1 (Never or very rarely true) to 5 (Very often or always true). Each subscale ranges from 3-15, with higher scores indicating greater mindfulness.

The IIP-32 measures interpersonal difficulties with 8 subscales: Domineering/Controlling, Vindictive/Self-Centered, Cold/Distant, Socially Inhibited, Nonassertive, Overly Accommodating, Self-Sacrificing, and Intrusive/Needy. Items are rated on a 5 point scale, 0 (Not at all) to 4 (Extremely). Each subscale ranges from 0-20, and higher scores indicate greater interpersonal difficulties.

The TPAS measures levels of low arousal positive emotion, such as "calm" or "at ease" during the past week. Items are rated on a 5 point scale, 1 (Very slightly or not at all) to 5 (Extremely). The scale ranges from 10-50 and higher scores indicate higher levels of low arousal positive emotion.

Subjective Mood ratings measure levels of anxiety, positive and negative mood, connectedness, and emotion suppression throughout a social interaction task. Each emotion is rated with a single-item, 0 (Not at all) to 100 (Extremely). Greater scores on each subscale indicate higher levels of each respective emotion or emotion suppression.

The SJQ measures two dimensions of behavior: Anxiety-Related Behavior and Social Approach Behavior. Each item is rated on a 7 point scale, 1 (Not at all) to 7 (Very much). The Anxiety-Related Behavior subscale ranges from 6-42, and the Approach-Related Behavior subscale ranges from 5-35, with higher scores on each subscale indicating more anxiety- and approach-related behavior, respectively.

The IOS measures how close or interconnected the respondent feels with a conversation partner, with respondents choosing from 7 pairs of circles representing "Self" and "Other" that range from barely touching to almost completely overlapping. The single item is rated on a 7 point scale, 1 (No overlap) to 7 (most overlap), which higher scores indicating greater perceived closeness.

The SBQ uses self-report to measure the use of safety behaviors intended to minimize or eliminate anticipated feared social outcomes. Items are rated on a 9 point scale, 0 (Not at all) to 8 (All the time). The scale ranges from 0-208 and higher scores indicate greater use of safety behaviors.

The CSSRS is a measure of suicidal ideation that asks about thoughts and feelings relating to suicide since the participant's last visit. Items are rated with a binary yes/no response, and are ordered to assess suicidal ideation with increasing risk of suicidal behavior, from Item 1 (Wish to be Dead) to Item 5 (Active Suicidal Ideation with Specific Plan and Intent). The score ranges from 0-5, based on the highest item rated yes.

The EMA state positive emotion scale measures momentary positive affect at the time of the survey prompt. Sample items include "content" and "enthusiastic." Items are rated on a 5 point scale, 1 (Not at all) to 5 (Extremely). The scale ranges from 4-20, and higher scores indicate greater momentary positive affect.

The EMA state negative emotion scale measures momentary negative affect at the time of the survey prompt. Sample items include "anxious/nervous" and "sluggish." Items are rated on a 5 point scale, 1 (Not at all) to 5 (Extremely). The scale ranges from 4-20, and higher scores indicate greater momentary negative affect.

Perceived quality of social interactions measures the perceived acceptance, connectedness, and satisfaction during a reported social interaction. The items are rated on a 5 point scale, 1 (Not at all) to 7 (Extremely). The scale ranges from 3-21, and higher scores indicate greater perceived quality of a social interaction.

Throughout the day, connectedness and loneliness are each measured with a single item rated on a 5 point scale, 1 (Not at all) to 5 (Extremely). During reported interactions, connectedness is measured with a single item rated on a 7 point scale, 1 (Not at all) to 7 (Extremely). At the end of the day, perceived social connectedness and loneliness are each rated with a single item rated on a 7 point scale, 1 (Not at all) to 7 (Very).