The goal of this clinical trial is to test whether photography-based, smartphone exercises can increase well-being and reduce depressive symptoms in college and graduate students. The main questions it aims to answer are:

Can savoring and/or social sharing of positive experiences via smartphone photography improve emotional well-being? Does attentional retraining toward positive stimuli reduce depressive symptoms?

Researchers compared:

Picture This! (21 days of taking daily photos of things that elicited a positive emotion, savoring the moment, and reviewing the photos at the end of each day) Picture This! Plus Social Sharing (21 days taking daily photos of things that elicited a positive emotion, savoring the moment, and reviewing the photos at the end of each day + sharing photos each week with a friend/family member) Document This! (21 days of taking "day in the life" photos each day and reviewing them each evening) Passive control group (21 days without instructions to take photos)

To see if the positive emotion-focused intervention conditions (Picture This! and Picture This! Plus Social Sharing) outperformed neutral (Document This!0 or no-photo conditions in improving psychological health.

Participants were:

Randomly assigned to one of four groups. Asked to complete baseline and follow-up questionnaires and computer tasks.

Three active conditions:

Take 2+ photos daily for 3 weeks. Upload photos to a secure drive. Complete nightly savoring exercises and surveys. (Social Sharing group only) Share photos weekly with a friend/family member.

All participants completed weekly surveys and a final lab visit with follow-up assessments.

The proposed intervention draws primarily from two paradigms, positive psychology interventions (PPI) and cognitive bias modification (CBI), and marries components of each into a technology-enhanced program designed to increase global well-being and decrease social isolation and depressive symptoms among college students. Although both intervention paradigms are in relatively early stages of investigation, they have garnered an impressive amount of empirical support indicating their success with regard to increasing psychological health. While they have grown out of very different traditions and theoretical cloths, both approaches also aim to uplift individuals who are languishing rather than flourishing and provide behavioral, cognitive, and attentional tools to increase the experience of positive emotion.

Although they come in various forms ranging from the intentional practice of positive thinking to writing letters of gratitude and increasing social interactions, all positive psychology interventions (PPIs) utilize practices, tools, and exercises to cultivate or increase the participant's sense of subjective well-being. They are, by definition, strengths-based and so do not necessarily intend to address deficits or heal pathology; rather, they are designed to optimize, to build, and to elevate. Recently, PPIs have been utilized with participants suffering from depression. While this application may at first blush seem at odds with the definition, a closer look provides clarity. Depression is characterized not only by high levels of negative affect but also low levels of positive affect. Research to date indicates that increased positive emotion in depressed individuals is beneficial with regard to "increased broad-minded coping,", resilience from negative emotions, and even in preventing relapse. Accordingly, such interventions are a natural fit for depression. A recent meta-analysis suggests that PPIs are superior to control or comparison groups in enhancing well being and in addressing depressive symptoms; however, PPIs may be relatively more successful for depressed participants and participants who self-select into the interventions.

Cognitive models of depression have long posited that individuals suffering from affective disorders (namely, Major Depressive Disorder) show information processing deficits that include increased attention to negatively-valenced cues. For example, when presented with both sad and neutral faces, subjects diagnosed with MDD selectively attended to the sad face, whereas control subjects divided attention between the sad and neutral faces. More recent work indicates that dysphoric individuals lack a protective bias toward positive stimuli and that they have difficulty disengaging from "mood-congruent (i.e., sad, negative)" stimuli. There is also some evidence that depressed individuals may be more likely to interpret ambiguous stimuli as threatening. Recently, researchers have tested cognitive bias modification interventions (CBI), which are designed explicitly to modify dysfunctional patterns of information processing including both attentional and interpretation biases. In their meta-analysis of 45 CBM studies, one research group found, overall, a medium effect size for the CBMs on cognitive biases and a small, but significant, effect on anxiety and depressive symptoms before the data was corrected for publication bias. Although the effects were no longer significant after correction for publication bias, the authors report a larger and more robust (while still insignificant) effect for CBMs when measured in the context of a stressor, giving credence to the diathesis-stress cognitive paradigm. They also noted that interpretational biases were impacted relatively more than attentional biases by the intervention manipulation, and anxiety symptoms relatively more than depressive symptoms.

Building upon these two disparate bodies of research, the current project aims aim to test a set of exercises using Smartphones with college and graduate students designed to retrain attention toward moments/events/people that elicit positive emotions, encourage the savoring of such moments, increase social connectedness, and in turn, decrease depressive symptoms. The aims will be achieved by recruiting college/university/graduate students who provide consent to participate in a randomized trial of the intervention and who will be randomly be assigned to 1 of 4 conditions.

1. Those participants who are randomized to the active Picture This! savoring condition will be asked to use their Smartphones to take at least two photographs each day for 3 weeks of something that brings them joy or peace and to upload their pictures daily to a drive accessed by study staff (instructions for each condition may be found in Appendix A). Each evening, they will be directed to complete an online exercise in which they review the photograph(s) taken that day. They are also asked to complete several questions via an internet survey.
2. Participants randomized to the Picture This! Plus Social Sharing will do everything as described for the Picture This! group. In addition, each week, they will be directed to share the photos they took during the prior week with a friend or family member (see script provided in Appendix B).
3. Those participants who are randomized to the active control condition (Document This!) will also be asked to take 2 photographs each day using a Smartphone and to upload their pictures daily to a drive accessed by study staff. Rather than focusing on and capturing a photo of stimuli that evokes positive emotion, however, they will be directed to take pictures of things in their lives or surroundings that are representative of a "day in the life". Like the participants in the Picture This! and Picture This! Plus Social Sharing Groups, they will also be asked to complete an online exercise each evening in which they review their documentary photos each evening and also asked to complete a series of questions via an internet survey.
4. Finally, participants randomized to the passive control group will NOT be directed to take any pictures during the 3 week intervention period.

All research participants in all 4 groups will be asked to complete a weekly online survey asking about whether they shared the pictures they took as a part of the study or as a part of their regular life (see Appendix F).

At the end of the intervention, all subjects will be provided a list of local mental health resources and will also be provided with the instructions for all 3 picture taking conditions (should they wish to implement any of the other exercises on their own time).

Inclusion Criteria:

• College, university, or grad student in urban area where data collection was taking place
• 18 years old or older
• daily access to a Smartphone with a camera
• daily access to the internet and active email address
• interest in the study

Exclusion Criteria:

• none

When the participants were consented, they were not asked whether their data could be shared outside of the individuals on the research team. Given that they did not give their consent to have data shared outside the research team, we have chosen not to do so.