Positive Psychology Interventions for Chronic Physical Illnesses: A Systematic Review

The positive side of living with tinnitus: a cross-sectional study

OBJECTIVE

The aim of the current study was to examine the presence of positive experiences reported by individuals with tinnitus in the United States.

DESIGN

The study used a cross-sectional survey design. The data were analysed using qualitative (content analysis) and quantitative (t-test or Chi-square test) analyses.

STUDY SAMPLE

Study participants were individuals participating in clinical trials involving Internet-based cognitive behavioural therapy (ICBT) for tinnitus. A total of 439 respondents, 211 (48.1%) male and 228 (51.9%) female responded, and data were collected via an online questionnaire.

RESULTS

Of the 439 participants, 164 (i.e. 37.4%) reported at least one positive experience. Younger participants and those with lower hearing disability were more likely to report positive experiences. The responses were categorised into six categories: Outlook (n = 139), Personal development (n = 42), Treatment-related (n = 42), Coping (n = 29), Support (n = 19), and Disease-specific (n = 19).

CONCLUSIONS

The ability of individuals with chronic tinnitus to identify positive experiences may give insights regarding acceptance and coping with tinnitus as well as the temperament of individuals reporting positive experiences. Considering these variables may help when planning individualised rehabilitation programs.

A web-based positive-affect intervention to reduce stress and improve well-being in women living with HIV - feasibility and acceptability of a single-arm, pilot study

Women living with HIV (WLWH) experience high rates of depression but are underrepresented in mental health research. Positive emotions are associated with beneficial health outcomes in WLWH and should be a targeted component of psychological interventions in this population. Positive psychological interventions aim to increase positive emotions through the use of simple exercises, such as keeping a gratitude journal. We conducted a single-arm feasibility/acceptability study of a five-week, self-guided, web-based positive affect skills intervention in a sample of WLWH (N = 23) who also participate in a longitudinal observational study, the Women's Interagency HIV Study. The intervention was feasible as measured by home practice and post-intervention assessment completion, and acceptable as measured by exit interview feedback regarding recommendation of the program to friends or others living with HIV. On average, participants completed home practice for about 8 out of 9 skills. The mean response for recommendation of the program to a friend was 9.26/10 (SD = 1.63) and the mean response for recommendation of the program to others living with HIV was 9.68/10 (SD = 0.82). Participant feedback will be used to adapt and enhance the delivery of this intervention. Further studies are needed to assess efficacy and impact on psychological outcomes.

Wellbeing and distress in young people with chronic conditions: how do positive psychology variables relate to mental health outcomes?

Objective

The aim of this study was to determine the unique and shared contributions of various positive psychology constructs (gratitude, optimism, hope, self-compassion, self-efficacy, and emotion regulation) to wellbeing and distress outcomes in young people living with a diverse range of chronic health conditions.

Methods and Measures

169 Australians (84.0% female, mean age = 21.2) who reported living with a chronic physical condition completed a cross-sectional survey assessing wellbeing, distress, and each positive psychology variable. Two multiple regressions were used to determine the unique and shared contributions of the positive psychology variables to wellbeing and distress outcomes.

Results

When considered alongside symptom severity, the variables explained 53.4% and 38.1% of variance in distress and wellbeing, respectively. Only optimism and self-efficacy accounted for unique and significant variance in the model predicting wellbeing, accounting for 6.1% and 4.6% of unique variance, respectively. For the distress model, optimism, self-compassion, and emotion regulation each accounted for significant variance. When considered alongside other variables, hope and gratitude did not contribute to either model.

Conclusion

Findings suggest that individual positive psychology variables differentially contribute to wellbeing and distress outcomes in young people with chronic conditions. Optimism appears to account for unique variance in both outcomes, suggesting it may be a parsimonious target to promote complete mental health in this population.

Positive Psychology Interventions for Improving Self-management Behaviors in Patients with Type 1 and Type 2 Diabetes: a Narrative Review of Current Evidence

PURPOSE OF REVIEW

Interests have been emerging in using positive psychology interventions (PPIs) to improve diabetes self-management (DSM) behaviors (e.g., blood glucose monitoring, physical activity). To explore the impact of those interventions on DSM behaviors, we summarized the evidence of PPIs on self-management behaviors among both type 1 diabetes (T1D) and type 2 diabetes (T2D) patients between 2012 and 2022.

RECENT FINDINGS

Among the eight studies identified, different study designs and types of PPIs were apparent. Typical PPIs (e.g., activities enhancing positive affect/gratitude/self-affirmation/optimism) were usually applied to T1D patients (N = 5); PPIs were usually combined with motivational interviewing for T2D patients (N = 3). Contrary to expectations, PPIs did not consistently demonstrate positive effects on self-management behaviors' change regardless of the types of diabetes patients, compared to the control groups. Improvements in diabetes patients' self-management behaviors from PPIs are still unclear. Future studies should more rigorously evaluate and identify the active ingredients of PPIs for behavioral changes among diabetes patients.

The Impact of Resilience, Health Literacy, and Social Support on Medication Adherence and Self-care Among Adults With Heart Failure

BACKGROUND

Personal and psychological factors, such as depression, have a considerable influence on nonadherence to medications and self-care in those with heart failure. More evidence is needed about positive personal factors that motivate adherence to medications and self-care in those with heart failure.

OBJECTIVE

The purpose of this study was to investigate whether there was a relationship between the personal resources of resilience, hope, health literacy, social support, and self-care activation and adherence to HF self-care and medications and whether race impacts adherence.

METHODS

This study used a cross-sectional, correlational design. Stepwise regression was used to test whether resilience, hope, health literacy, self-care activation, and race significantly predicted medication adherence and self-care. A diverse sample was recruited for this study.

RESULTS

Of the 174 participants, 51% were female, 51.7% were White, and the mean age was 62 years. After adjustment for differences in age and depressive symptoms, a predictive relationship remained between resilience, health literacy, and medication adherence. Hope, activation, and race were not selected in the final regression model. A high level of perceived social support was the only predictor of better HF self-care.

CONCLUSION

Persons with heart failure may have better medication adherence and overall self-care if sufficiently resilient, health literate, and supported regardless of their degree of hope or activation. Race and age may be important factors to consider. More research is needed to understand the connection between resilience and medication adherence.

Positive psychology interventions can improve mental health for chronic pain patients: a systematic review and meta-analysis

OBJECTIVE

This study examines the efficacy of positive psychology interventions (PPIs) for patients with chronic pain through a systematic review and meta-analysis. PPIs are defined as strategies that involve focusing on positive emotions, thoughts, and behaviors that improve mental health by increasing mental well-being and reducing psychological distress.

DESIGN

The search was conducted using the PubMed, Scopus, PsycINFO, and Cochrane Library databases.

MAIN OUTCOME MEASURES

Subjective, psychological, and social well-being were used as indicators of mental well-being, and depression, anxiety, and stress symptoms were used as indicators of psychological distress. Results: Nine studies were included. Eight studies evaluated subjective well-being, seven evaluated depression, and three evaluated anxiety symptoms. No studies examined psychological well-being, social well-being, or stress. PPIs were found to be effective in promoting subjective well-being post-treatment (Hedges' g = 0.40; 95% CI [0.06, 0.73]) and reducing anxiety (Hedges' g = -0.32, 95% CI [-0.59, -0.06]), but no significant results were found for depression (Hedges' g = -0.23, 95% CI [-0.50, 0.04]).

CONCLUSION

The included investigations, while limited, suggest the utility of PPIs in mitigating the psychological consequences of chronic pain. Researchers and practitioners are encouraged to implement PPI practices.

Applying Stress and Coping Theory to Understand Diuretic Adherence Experiences in Persons with Heart Failure

Despite the benefits of diuretics for treating the symptoms of heart failure (HF), patients may report side effects and intentionally not adhere to diuretic regimens. Positive internal motivators, such as positive emotions, may benefit individuals in their adaptation to medication-related stress. However, there has been limited study of these potential motivators in those with HF. Using a descriptive qualitative approach, 82 adults taking diuretics for HF were interviewed. This study applied stress and coping theory to understand the diuretic-taking experiences of patients with HF. Data analysis revealed three themes: (a) diuretics are bothersome, (b) staying positive in the mid of hardship, and (c) adapting to endure. Findings suggest that adherent participants stayed positive amid the perceived hardship, maintaining resilient and grateful attitudes. Adherent participants adapted to bothersome diuretic effects and utilized creative strategies. More research is needed to understand the relationships between resilience, adaptive coping, and diuretic adherence.

Understanding the impact of 'wish-granting' interventions on the health and well-being of children with life-threatening health conditions and their families: A systematic review

This review aimed to explore how wish-granting interventions impact on the health and well-being of children with life-threatening health conditions and their families, using any study design. Six electronic databases (Medline; PsycINFO; CINAHL; Embase; AMED and HMIC) were systematically searched to identify eligible research articles. Studies were critically appraised using a Mixed Methods Appraisal Tool. Findings were synthesized narratively. 10 papers were included, reporting studies conducted across five countries, published from 2007 to 2019. Study designs were diverse (four quantitative; two qualitative and four mixed method). Results indicated improvements to physical and mental health, quality of life, social well-being, resilience and coping for wish children, parents and siblings. In conclusion, wish-granting interventions can positively impact health and therefore should not be discouraged; however, more research is needed to define and quantify the impact of wish fulfilment and to understand how it can be maximized.

Do Positive Psychological Factors Equally Predict Resistance to Upper Respiratory Infections in African and European Americans?

Research has consistently shown that positive psychological constructs are linked to better physical health, but few studies have examined the role that race plays in this connection. We explored whether positive self-evaluations were equally protective against upper respiratory infection for 271 African American adults and 700 European American adults in a series of virus-exposure studies. Participants were assessed at baseline for psychological functioning and physical health, quarantined and exposed experimentally to a respiratory virus, and then monitored for infection and symptoms. Regression analyses revealed significant interactions between race and multiple positive psychological factors; several factors that were helpful to European Americans were unhelpful or even harmful to African Americans. Building on past work showing cross-cultural variation in the health correlates of affect, this study provides evidence that the health benefits of positive psychological constructs may not be universal and points to the need to explore factors that underpin these observed differential patterns.

Do Positive Psychology Interventions Impact on the Subjective Wellbeing and Depression of Clients? A Systematic Methodological Review

Mental health services are placing a greater emphasis on wellbeing and recovery. The current research investigated if positive psychology interventions (PPIs) increase peoples’ subjective wellbeing and reduce clinical depression. A systematic methodological review was conducted on randomized-control-trials with people attending clinical services. Five databases were searched. A hand search was then completed on the reference lists of the identified articles and the associated journals. Eleven research interventions were reviewed. PPIs were found to significantly increase wellbeing, relative to controls and there were fewer studies indicating a difference in decreasing depression. However, subsequent analysis revealed that the interventions were heterogeneous which limits the drawing of definitive systematic conclusions. A methodological evaluation also found that there were recurring issues: in delivering the interventions, measuring subjective wellbeing, and applying the design. Thus, the methodological quality of the research interventions, as measured by the current review was low. There is emerging evidence that PPIs improve peoples’ mental health. However, there is scope to standardize and to improve the quality of the research interventions.

Design and evaluation of a positive intervention to cultivate mental health: preliminary findings

The past two decades have witnessed a proliferation of positive psychological interventions for clinical and non-clinical populations, and recent research, including meta-analyses, is providing evidence of its effectiveness. Most interventions have focused on increasing life satisfaction, positive affect, and psychological well-being. Manualized, multi-component interventions based on a comprehensive theory are scarce. Keyes’ concept of mental health and flourishing (subjective, psychological, and social well-being) is an overarching theoretical framework to guide the design of a multi-component psychological intervention to cultivate well-being and personal development. Therefore, the purpose of this study was to design a theory-driven positive intervention and to pilot test the intervention. The manual presents an 8-week group program that includes homework activities. A sample of 56 young adults completed the intervention. Participants were assessed at base line, after termination, and at a 6-month follow-up session. Standardized instruments were used to assess the dimensions of mental health proposed by Keyes. Pre- and post-test measures of subjective, psychological, and social well-being showed significant differences, as did the total mental health scores. At 6-month follow-up, differences remained in subjective and psychological well-being and in positive mental health, with smaller effect sizes. Limitations of these preliminary findings as well as future lines of research and improvements in this manualized intervention are proposed in the light of current research on positive interventions.

Comparative study of life satisfaction among patients with psoriasis versus healthy comparison group: the explanatory role of body image and resource profiles

Purpose

The aim of the study was first to examine the heterogeneity of body image and resources, as described by the conservation of resources theory (COR), in a sample of psoriatic patients and explore whether heterogeneity within these variables explains the possible differences in levels of life satisfaction among the participants. Second, we aimed to investigate if life satisfaction level among the observed profiles of psoriatic patients, extracted on the basis of their body image and resources, differed from that of the healthy comparison group.

Methods

The sample consisted of 735 participants, including 355 adults with a medical diagnosis of psoriasis and 380 healthy adults recruited from a non-clinical general population. Participants filled the Satisfaction with Life Scale, the Multidimensional Body-Self Relations Questionnaire and the COR evaluation questionnaire.

Results

Latent profile analysis revealed four classes of psoriatic patients with different levels of resources and body image. The group with the highest level of resources and the most positive body image did not differ from the healthy comparison group regarding satisfaction with life. The group with the lowest level of resources and the most negative body image was characterized by the lowest satisfaction with life.

Conclusions

The results of our study may change the simplifying trend that highlights the traditionally very poor well-being of psoriatic patients. Moreover, the discovery of specific profiles of these patients, which differ with regard to psychological variables, can lead to rethinking contemporary forms of psychological counselling in psoriatic patients.

The relationship of self-compassion and hope with quality of life for individuals with bleeding disorders

INTRODUCTION

Minimal research has been conducted examining the relationship of positive psychology variables with quality of life (QOL) for individuals with bleeding disorders. While many individuals manage their bleeding disorders well, some are at higher risk of developing psychosocial complications due to the daily stressors of managing illness-related symptoms.

AIM

The purpose of this study is to better understand the relationships between two positive psychology variables, self-compassion and hope and QOL (overall, psychosocial and physical) among individuals diagnosed with bleeding disorders.

METHODS

Participants completed a survey identifying demographic information as well as rating scales of self-compassion, hope and quality of life. We conducted Pearson correlational and standard multiple regression analyses to explore the bivariate and linear relationships between the aforementioned variables in a sample of 86 patients with bleeding disorders between the ages of 15 and 65.

RESULTS

Self-compassion and hope were significantly related to QOL. Together, self-compassion and hope were predictive of overall QOL, psychosocial QOL and physical QOL. However, hope was the only individual predictor of all three QOL dimensions.

CONCLUSION

Due to the significant relationships found between self-compassion, hope and QOL in this sample, it may be beneficial to incorporate positive psychology factors into the treatment of those diagnosed with bleeding disorders, especially those at higher risk for decreased QOL.

An Opportunity to Grow or a Label? Performance Appraisal Justice and Performance Appraisal Satisfaction to Increase Teachers' Well-Being

Performance management is a key factor to enhance professional development and improve teaching quality. This process is successful only if teachers perceive it as fair, clear, and effective: namely, if it is satisfying. Carefully considering teachers' attributions in the performance appraisal process is fundamental to better clarify the relations between performance management and positive individual outcomes. Therefore, this study aims to investigate the effects of perceived performance appraisal justice on teachers' well-being, in terms of job performance, job satisfaction, and life satisfaction, hypothesizing the mediation role of performance appraisal satisfaction. Data from a sample of Italian teachers were analyzed through structural equation modeling. Results confirm the mediation role of performance appraisal satisfaction. In particular, perceived performance appraisal justice was positively associated to performance appraisal satisfaction, which, in turn, was positively associated with job performance, job satisfaction, life satisfaction. Consequently, performance appraisal satisfaction totally mediated the relations between performance appraisal justice and the outcomes considered. Findings are relevant for two reasons. First, they contribute to better understanding the performance management process in educational settings - an issue requiring further attention. Second, they contribute to highlighting the importance of performance management efficacy, which is essential not only to improve individual well-being but also to enhance teaching quality.

[Intervention focused on resources to reduce anxiety and depression disorders in cancer patients: A pilot study]

INTRODUCTION

Cancer, a widespread chronic disease, represented 400,000 diagnoses in France in 2017. The diagnoses as well as the treatments are a major source of stress for most patients concerned. Secondary effects may be painful and disturbing (pain, nausea, fatigue, loss of social and/or professional status, anxiety of death), and may lead to maladaptive coping strategies (avoidant coping), psychological inflexibility, anxiety, depression, and suicide risks which are twice as important as in the general population. Research in the field of psychotherapy for cancer patients represents an important international target, in particular in what concerns enhanced patient quality of life during and after treatment. Cognitive Behavioral Therapy, Mindfulness-Based Stress Reduction, as well as adapted physical activity have shown promising results to enhance patients' quality of life at different stages of the process. However, results mainly show significant short-term effects and usually only for patients with high levels of anxiety and depression symptoms. With the development of third wave Cognitive Behavioral Therapy, more global interventions (not just aimed at anxiety and depression symptoms) have emerged. Research has underlined their efficacy on both symptom reduction (anxiety and depression) and quality of life enhancement through the development of more varied and adaptive responses to stressful situations. Positive psychology interventions, mindfulness, and Acceptance and Commitment Therapy have inspired third wave Cognitive Behavioral Therapy. Emotional acceptance, mindful awareness of thoughts and emotions, and engaging in actions that are coherent with one's values all form part of the means by which these interventions may help patients to find ways to better adjust to their stressful situation. The results of the efficacy trials carried out using these approaches were mixed, and effects were mainly modest. Furthermore, most of the studies only tested one approach at a time, while each approach activated mechanisms, which can be useful for these patients. Hence, the aim of the current study was to test an integrative program based on classical second wave Cognitive Behavioral Therapy as well as on practices from the third wave of Cognitive Behavioral Therapy. We aimed at carrying out a preliminary study assessing the potential effects of the program on cancer patients' anxiety, depression symptoms, well-being and psychological flexibility.

METHOD

Sixteen cancer patients were enrolled in a second and third wave Cognitive Behavioral Therapy workshop composed of six sessions. In-session practices were based on validated practices. Participants completed the following questionnaires before the first workshop (T1) and at the end of the sessions (T2) in order to assess anxiety, depression symptoms, well-being and psychological flexibility: HAD, WEMWBS, MPFI, AAQ-2. Qualitative data regarding acceptability were also collected at the end of the last session.

RESULTS

Among the sixteen participants, nine women (mean age=56.1years old) completed the questionnaires seven of whom had breast cancer. The results of this preliminary study showed a significant pre-to-post reduction in anxiety and depression symptoms (P=0.017) as well as on certain dimensions of psychological flexibility: reduced "self as content" (P=0.011), and enhanced cognitive diffusion (P=0.018). Only marginal differences were found on other dimensions: reduced inaction (P=0.074) and experiential avoidance (P=0.089), and enhanced "self as context" (P=0.062). Content analysis showed (1) increased positive perceptions about experiences with more serenity, (2) positive attitudes towards self (self-compassion), (3) enhanced positive relationships, and (4) ability to accept negative affect.

CONCLUSION

Patients' qualitative feedback highlighted the potential feasibility and adaptability of the program for this population. The results of this preliminary study show promising avenues for research in the field of cancer patients' adaptive coping enhancement as well as reduce anxiety and depression symptoms. This type of workshop can be considered as complementary to individual psychotherapies as they may tap into different mechanisms that help foster psychological flexibility as the group format enhances decentering processes. Further research avenues are proposed in order to assess the efficacy of such interventions in cancer patients compared to other types of interventions. Further research should also look into individual differences in order to orient patients towards practices that fit them best.