Just-in-time adaptive interventions for adolescent and young adult health and well-being: protocol for a systematic review.

INTRODUCTION: Health behaviours such as exercise and diet strongly influence well-being and disease risk, providing the opportunity for interventions tailored to diverse individual contexts. Precise behaviour interventions are critical during adolescence and young adulthood (ages 10-25), a formative period shaping lifelong well-being. We will conduct a systematic review of just-in-time adaptive interventions (JITAIs) for health behaviour and well-being in adolescents and young adults (AYAs). A JITAI is an emerging digital health design that provides precise health support by monitoring and adjusting to individual, specific and evolving contexts in real time. Despite demonstrated potential, no published reviews have explored how JITAIs can dynamically adapt to intersectional health factors of diverse AYAs. We will identify the JITAIs' distal and proximal outcomes and their tailoring mechanisms, and report their effectiveness. We will also explore studies' considerations of health equity. This will form a comprehensive assessment of JITAIs and their role in promoting health behaviours of AYAs. We will integrate evidence to guide the development and implementation of precise, effective and equitable digital health interventions for AYAs. METHODS AND ANALYSIS: In adherence to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, we will conduct a systematic search across multiple databases, including CENTRAL, MEDLINE and WHO Global Index Medicus. We will include peer-reviewed studies on JITAIs targeting health of AYAs in multiple languages. Two independent reviewers will conduct screening and data extraction of study and participant characteristics, JITAI designs, health outcome measures and equity considerations. We will provide a narrative synthesis of findings and, if data allows, conduct a meta-analysis. ETHICS AND DISSEMINATION: As we will not collect primary data, we do not require ethical approval. We will disseminate the review findings through peer-reviewed journal publication, conferences and stakeholder meetings to inform participatory research. PROSPERO REGISTRATION NUMBER: CRD42023473117.

From the COVID-19 lockdown to the new normal: Two-year changes in daily stress and positive event processes.

The emergence of the novel COVID-19 disease and the social distancing measures implemented to curb its spread affected most aspects of daily life. Past work suggests that during times of more severe stress, people respond to daily stressors with relatively higher negative affect. However, little is known about how people responded to daily stressors and positive events at different moments in time during the COVID-19 pandemic. Thus, we examined longitudinal changes in daily event-related affect (covariation of daily stressors or positive events with same-day affect) from Spring 2020 (wave 1) to 2022 (wave 2). The sample consisted of 324 adults aged 18-80 (mean = 52 years; 89% women) from the US and Canada who completed weeklong daily diaries at both waves. The results revealed improvements in affective well-being, stressor-related affect (i.e., smaller fluctuations in affect on stressor days vs. nonstressor days), and positive event-related affect (i.e., lower negative affect on days with vs. without positive events). Furthermore, as people gradually resumed their social activities from 2020 to 2022, people reported being exposed to an increased frequency of both stressors and positive events. This study highlights the potential influence of socio-historical phenomena, such as an ongoing pandemic, on the events that people encounter and how they emotionally respond to them.

Postmigration stress compromises refugee parents' self-efficacy and autonomy-supportive parenting: An experience sampling study.

Refugee parents raise their adolescent children in a world that is different from the world they themselves grew up in, often experiencing postmigration stress. This may hamper parents' confidence in their parenting skills and make it difficult for them to grant adolescent children the autonomy they desire and need. In this preregistered study, we aimed to advance our understanding of this process by examining, in daily life, whether postmigration stress contributes to less autonomy-supportive parenting through compromised feelings of parental self-efficacy. Fifty-five refugee parents of adolescent children resettled in the Netherlands (72% Syrian; Mage children = 12.81) reported on their postmigration stress, parental self-efficacy, and parental autonomy support up to 10 times a day for 6-8 days. We fit a dynamic structural equation model to test whether postmigration stress predicted reductions in parental autonomy support, and whether parental self-efficacy explained this link. Results showed that when parents experienced more postmigration stress, they granted their children less autonomy at a later timepoint, in part, through parents feeling less efficacious after having experiencing postmigration stress. Findings held after controlling for parents' posttraumatic stress symptoms, and when controlling for all possible temporal and lagged associations. Our results highlight that postmigration stress shapes parenting practices, above and beyond symptoms of war-trauma, in the daily lives of refugee families. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Strengthening parental self-efficacy and resilience: A within-subject experimental study with refugee parents of adolescents.

Post-migration stress and parenting adolescents can reduce parental self-efficacy. This study tested the effects of strengthening parental self-efficacy in refugee parents of adolescents and whether this makes parental self-efficacy less impacted by post-migration stressors. Using a within-subject experimental design, experience sampling data were collected in 2019 from 53 refugee parents of adolescents (Mage  = 39.7, SDage  = 5.59, 73% Syrian, 70% mothers) in the Netherlands. Data were analyzed by dynamic structural equation modeling using interrupted time-series analysis. The single-session personalized intervention strengthened parental self-efficacy (small effect: between case standardized mean difference = 0.09) and made refugee parents less vulnerable to post-migration stressors. Findings suggest that parental self-efficacy is malleable and strengthening it fosters refugee parents' resilience. Replications with longer-term follow-ups are needed.

Distinguishing dimensions of emotion dynamics across 12 emotions in adolescents' daily lives.

Research on emotion dynamics as indices of emotion functioning has become muddled by conceptual confusion, methodological heterogeneity, and seemingly conflicting results. One way to address this chaos is the study of profiles of emotion dynamics across 12 emotions and how they differ between 246 adolescents. The interpretation of these dynamic profiles was guided by auxiliary variables including age, personality, depressive symptoms, and social experiences. During 6 days, 246 adolescents (Mage = 14.20; 65% female) rated nine times daily the intensity of 12 emotions (cheerful, happy, energetic, joyful, content, relaxed, anxious, worried, irritable, insecure, down, and guilty) and their social experiences with family, friends, and classmates. Additional baseline measures included neuroticism, extraversion (Revised Junior Eysenck Personality Questionnaire Short Form), and depressive symptoms (Center for Epidemiological Studies Depression Scale). A three-mode principal component analysis (3MPCA Tucker3-based) model was estimated on the person-specific dynamic parameters of emotional intensity (mean), variability (standard deviation), instability (mean squared successive difference), and inertia (autocorrelation). The 3MPCA identified three emotion-mode components (positive affect, negative affect, and irritability) and three dynamic-mode components (emotional intensity, lability, and inertia). Five individual-mode components captured interactions between these modes, of which positive affect explained most variation in the data. These emotion dynamic profiles correlated differently with social experiences. Additional 3MPCA model structures based on imputed data (correcting missing autocorrelations) and affect scale composites (low- and high-arousal positive and negative affect) showed strong resemblance. The identified emotion dynamic profiles capture meaningful interpersonal differences in adolescents' emotional experiences and change. Future work should focus on irritability and positive affect as these were uniquely informative in adolescents' emotional experiences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Parent-adolescent interaction quality and adolescent affect-An experience sampling study on effect heterogeneity.

Person-environment interactions might ultimately drive longer term development. This experience sampling study (Data collection: 2019/20 the Netherlands) assessed short-term linkages between parent-adolescent interaction quality and affect during 2281 interactions of 124 adolescents (Mage  = 15.80, SDage  = 1.69, 59% girls, 92% Dutch, Education: 25% low, 31% middle, 35% high, 9% other). Adolescents reported on parent-adolescent interaction quality (i.e., warmth and conflict) and momentary positive and negative affect five to six times a day, for 14 days. Preregistered dynamic structural equation models (DSEM) revealed within-family associations between parent-adolescent interaction quality and adolescent affect (concurrently: r = -.22 to .39; lagged effects: ß = -.17 to .15). These effects varied significantly between families. These findings stress the need for more person-specific research on parenting processes.

Parenting adolescents in times of a pandemic: Changes in relationship quality, autonomy support, and parental control?

This Dutch multi-informant study examined effects of the first COVID-19 lockdown (LD; e.g., school closure and social restrictions) on parent-adolescent relationships. Four biweekly measurements before and 4 biweekly measurements during the LD were collected among adolescents (N = 179, Mage = 14.26 years, 69% girls) and their parents (N = 144, Mage = 47.01 years, 81% female). Parents' educational level was relatively diverse: 12% low (high school or lower), 33% medium (vocational training), and 55% high (college or university). Adolescents and parents reported on parental support, parent-adolescent conflict, autonomy support, psychological control, behavioral control, and time spent on various activities. Adolescents spent more time with their parents during LD (before M = 8.6 hr, during M = 12.7 hr), but less time with friends (before M = 8.1 hr, during M = 2.1 hr), and reported on average 13 COVID-19-related rules. Preregistered piecewise growth models confirmed that autonomy support decreased immediately during the LD, but no mean level changes were observed in the other relationship dimensions. During the first 2 months of the LD, parents reported gradual increases in autonomy support and decreases in behavioral control. Moreover, significant differences between families were found in sudden and more gradual relationship changes, which correlated strongly with pre-LD characteristics of the relationship, and in some models with adolescent oppositional defiance and legitimacy beliefs. In sum, findings suggest resilience in most families, but also heterogeneity: Some families were negatively affected, and others were positively affected. A tailored approach is therefore needed to mitigate the impact of COVID-19 on family functioning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Personalized lifestyle advice alters affective reactivity to negative events in anhedonic young adults.

BACKGROUND: Anhedonia is a common symptom of several disorders, but cost-effective treatments that focus on anhedonia specifically have been lacking. Therefore, personalized lifestyle advice has recently been investigated as a suitable means of enhancing pleasure and positive affect (PA) in young adults with anhedonia. This intervention provided individuals with a personalized lifestyle advice which was based on observed individual patterns of lifestyle behaviors and experienced pleasure in daily life. The present study extends this previous work by examining a potential mechanism of treatment success, affective reactivity. METHODS: We explored changes in affective reactivity to events in daily life from pre- to post-intervention in a subclinical sample of young adults with anhedonia (N = 69). Using the Experience Sampling Method (ESM), participants answered questions on their activities, their pleasure levels, PA and negative affect (NA) before and after the intervention. RESULTS: Multilevel analysis revealed that participants did not experience an altered affective reactivity to positive events after the intervention. The affective reactivity to negative events depended on the level of improvement in mean-PA after the lifestyle advice intervention. LIMITATIONS: The present study used a subclinical sample with the majority of participants being female which limited the generalizability of the findings. CONCLUSION: This study suggests that an altered affective reactivity to negative events is an underlying mechanism of the effectiveness of a personalized lifestyle advice.

Grumpy or depressed? Disentangling typically developing adolescent mood from prodromal depression using experience sampling methods.

INTRODUCTION: This study aimed at differentiating normative developmental turmoil from prodromal depressive symptoms in adolescence. METHOD: Negative and positive mood (daily) in different contexts (friends, home, school), and (subsequent) depressive symptoms were assessed in Dutch adolescents. RESULTS & CONCLUSION: Mixture modeling on one cross-sectional study, using a newly developed questionnaire (CSEQ; subsample 1a; n = 571; girls 55.9%; Mage = 14.17) and two longitudinal datasets with Experience Sampling Methods data (subsample 1b: n = 241; Mage = 13.81; 62.2% girls, sample 2: n = 286; 59.7% girls; Mage = 14.19) revealed three mood profiles: 18-24% "happy", 43-53% "typically developing", and 27-38% "at-risk". Of the "at-risk" profile between 12.5% and 25% of the adolescents scored above the clinical cut-off for depression. These mood profiles predicted later depressive symptoms, while controlling for earlier symptoms. In subsample 1b, parents were not always aware of the mental health status of their adolescent.

Depressive Symptoms Amplify Emotional Reactivity to Daily Perceptions of Peer Rejection in Adolescence.

During adolescence, interpersonal stressors such as peer rejection pose challenges to emotion regulation. Yet, very little is known about how these transactional processes unfold in adolescents' daily lives. This study investigated adolescents' (a) emotional reactivity to daily perceptions of peer rejection, which concerns concurrent changes in negative and positive emotions, and (b) emotional recovery from daily perceptions of peer rejection, which concerns subsequent changes in negative and positive emotions. Because depressive symptoms can compromise effectiveness of emotion regulation, it was investigated as a moderator for emotional reactivity and recovery to daily perceptions of peer rejection. The sample consisted of 303 adolescents (59% girls; Mage = 14.20, SD = 0.54; range 13-16 years) who reported depressive symptoms at baseline and completed ecological momentary assessments of emotions and perceived peer rejection at nine random time-points per day for six consecutive days. Results from multi-level modeling analyses showed that perceived peer rejection was related to emotional reactivity (i.e., higher levels of negative emotions and lower levels of positive emotions). This effect was stronger for those with higher depressive symptoms. For emotional recovery, perceived peer rejection had lasting effects on adolescents' negative emotions, but was not related to positive emotions. Depressive symptoms did not moderate effects of perceived peer rejection on emotional recovery. This study provides a more nuanced understanding of how depressive symptoms amplify the emotional impact of perceived peer rejection in adolescents' day-to-day lives.

A Review of Current Ambulatory Assessment Studies in Adolescent Samples and Practical Recommendations.

The use of ambulatory assessment (AA) and related methods (experience sampling, ecological momentary assessment) has greatly increased within the field of adolescent psychology. In this guide, we describe important practices for conducting AA studies in adolescent samples. To better understand how researchers have been implementing AA study designs, we present a review of 23 AA studies that were conducted in adolescent samples from 2017. Results suggest that there is heterogeneity in how AA studies in youth are conducted and reported. Based on these insights, we provide recommendations with regard to participant recruitment, sampling scheme, item selection, power analysis, and software choice. Further, we provide a checklist for reporting on AA studies in adolescent samples that can be used as a guideline for future studies.

Reciprocal associations between positive emotions and motivation in daily life: Network analyses in anhedonic individuals and healthy controls.

Anhedonia reflects a dysfunction in the reward system, which can be manifested in an inability to enjoy pleasurable situations (i.e., lack of positive emotions), but also by a lack of motivation to engage in pleasurable activities (i.e., lack of motivation). Little is known about the interrelations between positive emotions and motivation in daily life, and whether these associations are altered in anhedonic individuals. In the present study, we used a network approach to explore the reciprocal, lagged associations between positive emotions and motivation in anhedonic individuals (N = 66) and controls (N = 68). Participants (aged between 18 and 24 years) filled out momentary assessments of affect 3 times per day for 30 consecutive days. Our results showed that (a) anhedonic individuals and controls had similar moment-to-moment transfer of positive emotions; (b) in the anhedonic network feeling cheerful was the node with the highest outstrength, both within this group and compared with the control group; (c) feeling relaxed had the highest outstrength in the control network, and (d) anhedonic individuals had stronger pathways from positive emotions to motivation than controls. Taken together, our findings suggest that low levels of positive emotions lead to decreased motivation in the anhedonic group, which could instigate a negative spiral of low pleasure and low motivation. On a more positive note, we showed that cheerfulness had the highest outstrength in the network of anhedonic participants. Hence, interventions may focus on increasing cheerfulness in anhedonic individuals, as this will likely have the greatest impact on other positive emotions and motivations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Alpha-amylase reactivity and recovery patterns in anhedonic young adults performing a tandem skydive.

BACKGROUND: Anhedonia (loss of pleasure) is characterized by low responsiveness to rewards and, by virtue of being one of the two core symptoms of depression, by altered responses to stress. We investigated the effect of an acute stress experience (i.e., a tandem skydive) that was expected to elicit both intense fear and intense euphoria in a sample of anhedonic young adults. OBJECTIVE: (1) To examine individual differences in alpha-amylase reactivity to and recovery from a tandem skydive in anhedonic young adults; (2) to investigate whether trait depressive and anxiety problems, trait positive affect (PA), i.e., level of pleasure and reward responsiveness, and state anxiety, PA and self-esteem prior to the skydive were associated with alpha-amylase reactivity and recovery patterns; (3) to investigate whether alpha-amylase reactivity and recovery patterns were associated with pre- to post-jump changes in state anxiety, PA, and self-esteem. METHOD: Participants were 61 individuals with persistent anhedonia (Mage = 21.38, 78.7% female), who filled out a baseline questionnaire at the start of the study, and momentary questionnaires (3 times per day) before and after the tandem skydive. Alpha-amylase was measured at four time points by means of salivettes (2 before and 2 after the skydive). RESULTS: Alpha-amylase reactivity and recovery patterns were highly similar across individuals, although mean levels varied greatly. No associations were found between any of the trait and state measures and reactivity and recovery. Only state self-esteem was affected by the reactivity and recovery patterns, in that individuals who showed high reactivity and low recovery experienced decreases in self-esteem after the skydive. CONCLUSIONS: Alpha-amylase patterns following a tandem skydive in anhedonic individuals are highly similar to patterns previously found in healthy individuals. Although replication is warranted, our findings tentatively suggest that a strong stress response that cannot be downregulated well predicts a decrease in self-esteem.

Variation in the serotonin transporter polymorphism (5-HTTLPR) and inertia of negative and positive emotions in daily life.

An important element of understanding the genotype-phenotype link in psychiatric disorders lies in identifying the psychological mechanisms through which genetic variation impacts mental health. Here we examined whether emotional inertia, the tendency for a person's emotions to carry over from 1 moment to the next and a prospective predictor of the development of depression, is associated with a known genetic risk factor for emotional dysregulation, a polymorphism in the serotonin transporter gene (5-HTTLPR). Two hundred thirty-six adolescents recorded their positive and negative emotions in daily life 9 times a day for 6 consecutive days using smartphones, completed a depression questionnaire, and were genotyped for the 5-HTTLPR polymorphism. Carriers of the short 5-HTTLPR were characterized by higher inertia for negative emotions, even after controlling for depressive symptoms. These findings suggest a possible psychological pathway how the serotonin transporter gene contributes to risk for depression. (PsycINFO Database Record

Trait and State Levels of Loneliness in Early and Late Adolescents: Examining the Differential Reactivity Hypothesis.

According to the differential reactivity hypothesis, lonely individuals respond differently to their environment compared to nonlonely individuals, which may sustain their loneliness levels. However, this interesting hypothesis has not yet been explored in daily life: Do lonely individuals feel lonely all the time, or do they feel more or less lonely in specific social contexts? The main aim of the present study was to test the differential reactivity hypothesis in daily life by examining in three samples whether trait levels of loneliness affected the levels of state loneliness in different social contexts. We used baseline questionnaires to measure trait loneliness and the Experience Sampling Method to collect data on state loneliness, in early adolescents (N = 269, Mage = 14.49, 59% female) and late adolescents (N = 223, Mage = 19.60, 91% female) from the Netherlands and late adolescents from the United States (N = 126, Mage = 19.20, 51% female). Results provided evidence for the differential reactivity hypothesis in the total sample, as high lonely adolescents experienced higher levels of state loneliness in situations in which they were alone than low lonely adolescents, but also benefited more from being with intimate company than low lonely adolescents. In sum, the present study provided evidence for the differential reactivity hypothesis and showed that the experience of loneliness in daily life was remarkably similar across age and culture. Our findings provide important insights into the daily experiences of trait lonely people, which may provide starting points for interventions.

Reward and punishment learning in daily life: A replication study.

Day-to-day experiences are accompanied by feelings of Positive Affect (PA) and Negative Affect (NA). Implicitly, without conscious processing, individuals learn about the reward and punishment value of each context and activity. These associative learning processes, in turn, affect the probability that individuals will re-engage in such activities or seek out that context. So far, implicit learning processes are almost exclusively investigated in controlled laboratory settings and not in daily life. Here we aimed to replicate the first study that investigated implicit learning processes in real life, by means of the Experience Sampling Method (ESM). That is, using an experience-sampling study with 90 time points (three measurements over 30 days), we prospectively measured time spent in social company and amount of physical activity as well as PA and NA in the daily lives of 18-24-year-old young adults (n = 69 with anhedonia, n = 69 without anhedonia). Multilevel analyses showed a punishment learning effect with regard to time spent in company of friends, but not a reward learning effect. Neither reward nor punishment learning effects were found with regard to physical activity. Our study shows promising results for future research on implicit learning processes in daily life, with the proviso of careful consideration of the timescale used. Short-term retrospective ESM design with beeps approximately six hours apart may suffer from mismatch noise that hampers accurate detection of associative learning effects over time.

An Exploratory Randomized Controlled Trial of Personalized Lifestyle Advice and Tandem Skydives as a Means to Reduce Anhedonia.

Anhedonia is a major public health concern and has proven particularly difficult to counteract. It has been hypothesized that anhedonia can be deterred by engagement in rewarding social and physical events. The aims of the present study were to examine (1) the effects of personalized lifestyle advice based on observed individual patterns of lifestyle factors and experienced pleasure in anhedonic young adults; and (2) whether a tandem skydive can enhance the motivation to carry out the recommended lifestyle changes. Participants (N = 69; Mage = 21.5, SD = 2.0; 79.7% female) were selected through an online screening survey among young adults. Inclusion criteria were persistent anhedonia and willingness to perform a tandem skydive. Participants filled out questionnaires on their smartphones for 2 consecutive months (3 times per day). After the first month, they were randomly assigned to one of three groups: (1) no intervention, (2) lifestyle advice, and (3) lifestyle advice and tandem skydive. The momentary questionnaire data were analyzed using interrupted time series analyses (ITSA) in a multilevel model and monthly pleasure and depression questionnaires by repeated measures ANOVA. No group differences were found in monthly depression and pleasure scores, but the momentary data showed higher positive affect (PA) and pleasure ratings in the month following the intervention in the two intervention groups than in the control group. The tandem skydive did not have any effects above the effects of the lifestyle advice. Our results indicate that providing personalized lifestyle advice to anhedonic young adults can be an effective way to increase PA and pleasure.

Study protocol for a randomized controlled trial to explore the effects of personalized lifestyle advices and tandem skydives on pleasure in anhedonic young adults.

BACKGROUND: Anhedonia is generally defined as the inability to feel pleasure in response to experiences that are usually enjoyable. Anhedonia is one of the two core symptoms of depression and is a major public health concern. Anhedonia has proven particularly difficult to counteract and predicts poor treatment response generally. It has often been hypothesized that anhedonia can be deterred by a healthy lifestyle. However, it is quite unlikely that a one-size-fits-all approach will be effective for everyone. In this study the effects of personalized lifestyle advice based on observed individual patterns of lifestyle behaviors and experienced pleasure will be examined. Further, we will explore whether a tandem skydive following the personalized lifestyle advice positively influences anhedonic young adults' abilities to carry out the recommended lifestyle changes, and whether this ultimately improves their self-reported pleasure. METHODS: Our study design is an exploratory intervention study, preceded by a cross-sectional survey as a screening instrument. For the survey, 2000 young adults (18-24 years old) will be selected from the general population. Based on survey outcomes, 72 individuals (36 males and 36 females) with persistent anhedonia (i.e., more than two months) and 60 individuals (30 males and 30 females) without anhedonia (non-anhedonic control group) will be selected for the intervention study. The non-anhedonic control group will fill out momentary assessments of pleasure and lifestyle behaviors three times a day, for one month. The anhedonic individuals will fill out momentary assessments for three consecutive months. After the first month, the anhedonic individuals will be randomly assigned to (1) no intervention, (2) lifestyle advice only, (3) lifestyle advice plus tandem skydive. The personalized lifestyle advice is based on patterns observed in the first month. DISCUSSION: The present study is the first to examine the effects of a personalized lifestyle advice and tandem skydive on pleasure in anhedonic young adults. Results of the present study may improve treatment for anhedonia, if the interventions are found to be effective. TRIAL REGISTRATION: Dutch Trial Register, NTR5498 , registered September 22, 2015 (retrospectively registered).

Depressive Symptoms and the Experience of Pleasure in Daily Life: An Exploration of Associations in Early and Late Adolescence.

Although loss of pleasure (i.e., anhedonia) is one of the two core symptoms of depression, very little research has examined the relation between depressive symptoms and the experience of pleasure in daily life. This exploratory study in two population-based adolescent samples aimed to examine how depressive symptoms and anhedonia specifically were related to (1) the proportion and intensity of positive events, (2) mean and variability of positive affect (PA), (3) reactivity to positive events, and (4) reactivity to PA (i.e., whether PA elicits positive events). We used Experience Sampling to measure positive events and PA several times a day during 6 to 14 days in early (N = 284) and late (N = 74) adolescents. Results showed that depressive symptoms were related to a lower proportion and intensity of positive events, lower mean PA, and higher variability in PA regardless of sex and stage of adolescence. No clear evidence was found for differential reactivity to positive events or to PA. Anhedonia was not associated with most daily life experiences of pleasure. Our findings, though preliminary, suggest that although adolescents with many depressive symptoms experience less positive events and lower PA, they are able to enjoy pleasurable events to the same extent as individuals with fewer depressive symptoms.