{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T11:41:30Z","timestamp":1787917290103,"version":"build-2784847793"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Major Depressive Disorder (MDD) is characterized by high stress sensitivity and unsatisfactory response rates to standard treatments. Stress and depression share a bidirectional relationship. We, therefore, conducted a pilot randomized control trial (RCT) to understand if adjunctive stress management and resiliency training tailored for depression(SMART-D), can improve treatment outcomes in patients with MDD, receiving treatment as usual(TAU) with standard treatments (medications and\/or psychotherapy), in real-world clinical settings, compared to a group receiving TAU.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Participants with MDD, in a current depressive episode, were randomized to adjunctive SMART-D (delivered by video telehealth over 8 weeks), compared to TAU alone. Random assignment, blinding of raters and statistician were utilized. The primary outcome measure was baseline to end point change in depression [Hamilton Rating Scale for Depression (HAM-D] over a 6-month follow-up period using a mixed model regression analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>27 participants (mean age 47.9\u2009\u00b1\u200914 years, female 67%) enrolled in the study (TAU\u2009=\u200914, SMART-D\u2009+\u2009TAU\u2009=\u200913). Baseline mood ratings were in mild-moderate symptom severity (HAM-D)- SMART-D\u2009+\u2009TAU\u2009=\u200912.2\u2009\u00b1\u20096.6, TAU\u2009=\u200913.9\u2009\u00b1\u20095.7). Linear mixed model analysis showed significant Group*Time interaction for measures of depression (HAM-D) (B\u2009=\u20096.1 (CI\u2009=\u20091.5\u201310.8, P\u2009=\u2009.01) and perceived stress (PSS) (B\u2009=\u20095.5(0.5\u201310.6), p\u2009=\u2009.03) between the 2 groups at 3 months post follow-up ((HAMD)-SMART-D\u2009+\u2009TAU\u2009=\u20098.7\u2009\u00b1\u20094.3 Vs. TAU\u2009=\u200916.1\u2009\u00b1\u20096.3), but not at 6-months (SMART-D\u2009+\u2009TAU\u2009=\u20098.1\u2009\u00b1\u20095.4 Vs. TAU\u2009=\u200912.3\u2009\u00b1\u20095.5).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A RCT of 27 adults with MDD provide initial support that an adjunctive resiliency intervention (SMART-D) for patients with MDD may positively impact symptoms of depression and perceived stress, earlier than standard care. A small sample size limits ability to draw firm conclusions. Further investigation is warranted, using larger samples.<\/jats:p>\n<jats:p>Clinical Trials Registration I.D.# NCT04388748<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0328539","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T17:24:20Z","timestamp":1755624260000},"page":"e0328539","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Randomized controlled trial of stress management and resiliency training for depression (SMART-D)-pilot study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6386-7232","authenticated-orcid":true,"given":"Ashok","family":"Seshadri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Fuller-Tyszkiewicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2520-0946","authenticated-orcid":true,"given":"Laura","family":"Harper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew M.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7062-8192","authenticated-orcid":true,"given":"Balwinder","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherry","family":"Chesak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna S.","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"McGillivray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Frye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"pone.0328539.ref001","volume-title":"Social origins of depression: A study of psychiatric disorder in women","author":"GW Brown","year":"1978"},{"issue":"6","key":"pone.0328539.ref002","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1176\/ajp.156.6.837","article-title":"Causal relationship between stressful life events and the onset of major depression","volume":"156","author":"KS Kendler","year":"1999","journal-title":"Am J Psychiatry"},{"key":"pone.0328539.ref003","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1146\/annurev.psych.48.1.191","article-title":"The effects of stressful life events on depression","volume":"48","author":"RC Kessler","year":"1997","journal-title":"Annu Rev Psychol"},{"issue":"3","key":"pone.0328539.ref004","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1037\/0021-843X.105.3.313","article-title":"Life stress and treatment course of recurrent depression: II. 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