Feasibility and utility of positive psychology exercises for suicidal inpatients

The effectiveness of brief non-pharmacological interventions in emergency departments and psychiatric inpatient units for people in crisis: A systematic review and narrative synthesis

OBJECTIVE

Heterogeneous brief non-pharmacological interventions and guidelines exist to treat the burgeoning presentations to both emergency department and inpatient settings, for those in a crisis of mental ill-health. We systematically reviewed the literature to create a taxonomy of these brief non-pharmacological interventions, and review their evaluation methods and effectiveness.

METHOD

We conducted a systematic review across Cochrane, CINAHL, DARE, Embase, MEDLINE, PsycINFO databases. Studies meeting quality criteria, using Joanna Briggs Institute tools, were eligible. Interventions were categorised, and outcomes synthesised.

RESULTS

Thirty-nine studies were included: 8 randomised controlled trials, 17 quasi-experimental, 11 qualitative studies, and 3 file audits. Taxonomy produced six coherent intervention types: Skills-focussed, Environment-focussed, Special Observation, Psychoeducation, Multicomponent Group and Multicomponent Individual. Despite this, a broad and inconsistent range of outcome measures reflected different outcome priorities and prevented systematic comparison of different types of intervention or meta-analysis. Few brief non-pharmacological interventions had consistent evidential support: sensory modulation rooms consistently improved distress in inpatient settings. Short admissions may reduce suicide attempts and readmission, if accompanied by psychotherapy. Suicide-specific interventions in emergency departments may improve depressive symptoms, but not suicide attempt rates. There was evidence that brief non-pharmacological interventions did not reduce incidence of self-harm on inpatient wards. We found no evidence for frequently used interventions such as no-suicide contracting, special observation or inpatient self-harm interventions.

CONCLUSION

Categorising brief non-pharmacological interventions is feasible, but an evidence base for many is severely limited if not missing. Even when there is evidence, the inconsistency in outcomes often precludes clinicians from making inferences, although some interventions show promise.

Breaking the vise of hopelessness: Targeting its components, antecedents, and context

Hopelessness is a painful cognitive state that is related to depression and suicide. Despite its importance, only unsystematic efforts have been made to specifically target hopelessness in interventions, and no comprehensive review is currently available to guide future clinical studies. In this narrative review, we first analyze the phenomenon of hopelessness, by highlighting its components (e.g., dismal expectations, blocked goal-directed processing, and helplessness), antecedents (e.g., inferential styles), and contextual factors (e.g., loneliness and reduced social support). Then, we review the currently available interventions and manipulations that target these mechanisms, either directly or indirectly, and we highlight both their strengths and lacunae. Finally, we propose possible avenues to improve our clinical toolbox for breaking the vise of hopelessness.

Positive psychology interventions for family caregivers coping with cancer: Who will use them?

Background

Positive psychology-based (PPB) activities have been under-researched in cancer caregiving.

Objective

This study investigated caregiver: (1) attitudes toward using PPB activities while caregiving; and (2) characteristics associated with these attitudes.

Methods

Secondary analyses of a cross-sectional survey were conducted in a national caregiver sample of hematopoietic cell transplant (HCT) patients. Survey items assessed caregivers' likelihood of engaging in six PPB activities. Hierarchical regression was performed and potential predictors of PPB activity use (e.g., technology familiarity, coping style, caregiving duration) were examined.

Results

Most of the N = 948 respondents were White (78.9%), female (65.5%), married (86.7%), employed (78.4%), and college-educated (79.8%). Caregivers favorably disposed to positive activities were younger and female, provided care for 6-12 months and >40 h/week, and used coping styles involving religion and social support.

Conclusions

Our findings provide guidance for development and testing of PPB activities for cancer caregivers.

The effectiveness and equivalence of different versions of a brief online Best Possible Self (BPS) manipulation to temporary increase optimism and affect

BACKGROUND AND OBJECTIVES

The Best Possible Self (BPS) has been found to be an effective manipulation to temporarily improve optimism and affect. The BPS has been used in different formats. In some versions, participants just write about their best possible future, while in others this is combined with imagery. An imagery only version has not been tested yet. The aim of the current study was to examine the effectiveness of three different versions of the BPS and their equivalence in improving optimism and affect.

METHODS

In an online study format, participants (N = 141) were randomly assigned to one of four conditions: (1) writing and imagery BPS; (2) writing BPS; (3) imagery BPS; and (4) a typical day (TD) control condition.

RESULTS

Results showed that each BPS condition significantly improved optimism (i.e. increased positive future expectancies and decreased negative future expectancies) and affect (i.e. increased positive affect and decreased negative affect). Equivalence testing showed that all online BPS conditions were equivalent in increasing optimism and affect, thereby confirming that both the writing and imagery elements of the BPS can independently from each other increase optimism and positive affect in a healthy population.

LIMITATIONS

Only the immediate effects of the BPS formats on increasing optimism and affect were measured.

CONCLUSIONS

The BPS manipulation can be employed in different ways for potential future exploration, depending on the research question, design and context and/or E-mental health applications for the treatment of individuals suffering from psychological complaints.

The Catalyst Model of Change: Gratitude Interventions with Positive Long-Term Effects

How can gratitude interventions be designed to produce meaningful and enduring effects on people's well-being? To address this question, the author proposes the Catalyst Model of Change-this novel, practical, and empirically testable model posits five socially oriented behavioral pathways that channel the long-term effects of gratitude interventions as well as how to augment gratitude experiences in interventions to boost treatment effects and catalyze these behavioral pathways. Specifically, interventions that enhance the frequency, skills, intensity, temporal span, and variety of gratitude experiences are likely to catalyze the following post-intervention socially oriented behaviors: (a) social support-seeking behaviors, (b) prosocial behaviors, (c) relationship initiation and enhancement behaviors, (d) participation in mastery-oriented social activities, and (e) reduced maladaptive interpersonal behaviors, which, in turn, produce long-term psychological well-being. A unique feature of the Catalyst Model of Change is that gratitude experiences are broadly conceptualized to include not just gratitude emotions, cognitions, and disclosures, but also expressing, receiving, witnessing, and responding to interpersonal gratitude. To this end, gratitude interventions that provide multiple opportunities for social experiences of gratitude (e.g., members expressing gratitude to each other in a group) might offer the greatest promise for fostering durable, positive effects on people's psychological well-being.

Individual, Peer, and Family Correlates of Depressive Symptoms among College Students in Hong Kong

In this study, an ecological model and developmental psychopathology theory focusing on an ontogenic system (hopelessness) and microsystems (peer alienation and childhood abuse and trauma) was adopted to examine the individual, peer, and family correlates of depressive symptoms among college Chinese students in Hong Kong, China. A cross-sectional survey research design with a convenience sampling procedure was used to examine a sample of college students (n = 786) aged 18 to 21 years old in Hong Kong. Among them, 352 respondents (44.8%) reported having depressive symptoms, with a Beck Depression Inventory-II (BDI-II) score of 14 or above. The results of this study indicated that childhood abuse and trauma, peer alienation, and hopelessness were positively related to depressive symptoms. The underlying arguments and implications were discussed. The study results provided further support for the ecological model and the developmental psychopathology theory on the predictive roles of individual, peer, and family correlates of adolescent depression.

Childhood trauma and suicidal ideation among Chinese adolescents: The mediating effects of character strengths and perceived stress

WHAT IS KNOWN ON THE SUBJECT?: Prior research has demonstrated that childhood trauma can increase adolescents' suicidal ideation, and perceived stress plays a mediating role in the relationship between childhood trauma and adolescents' suicidal ideation. Character strengths, which are trait-like positive personality characteristics, have also been found to be closely related to decreased stress and suicidal ideation. However, it is unclear whether character strengths act as a transfer mechanism that links childhood traumatic experiences with perceived stress and eventually suicidal ideation. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study found that character strengths and perceived stress serially mediated the association between childhood trauma and suicidal ideation. Specifically, childhood trauma was associated with inferior character strengths, and the impaired character strengths further triggered high perceived stress, which was finally linked to a heightened risk of suicidal ideation. This study provided important theoretical implications for preventing suicidal risk among adolescents who are exposed to traumatic events during childhood. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study highlighted the roles of character strengths and perceived stress in the relationship between childhood traumatic experiences and suicidal ideation, which provided suggestions for designing nursing interventions to reduce adolescents' suicidal ideation, especially for those with traumatic childhood experiences. In addition to family nursing, school-based regular monitoring and interventions of character strengths and perceived stress are necessary. ABSTRACT: Aim This study sought to examine the mediating effects of character strengths and perceived stress on the relationship between childhood trauma and suicidal ideation among adolescents. Methods A cross-sectional survey was conducted on a sample of 1069 Chinese adolescents. The Chinese versions of the Suicidal Ideation Scale, Childhood Trauma Questionnaire, Perceived Stress Scale and Character Scale for Adolescents were used to assess adolescents' suicidal ideation, childhood trauma, perceived stress and character strengths. Results The findings showed that childhood trauma influenced suicidal ideation directly and indirectly via perceived stress. Moreover, character strengths and perceived stress serially mediated the association between childhood trauma and suicidal ideation, implying that childhood trauma was associated with inferior character strengths, and the impaired character strengths further triggered high perceived stress, which was finally linked to a heightened risk of suicidal ideation. Conclusions This study highlighted the joint contribution of childhood trauma, character strengths and perceived stress to suicidal ideation, providing theoretical and practical implications to guide mental health nurses to reduce the suicide risk among adolescents. Implications for Practice These findings highlighted the importance of developing character strengths and stress-coping strategies. Family nursing and school-based regular monitoring and interventions of character strengths and perceived stress are necessary among adolescents who exposed to a high level of childhood trauma experiences to reduce their suicidal ideation and foster mental health.

Temporal relationships between changes in depression and suicidal ideation: A mediation analysis in a randomized double-blinded clinical trial

OBJECTIVES

There is a considerable debate regarding the possible dependence between depression and suicidal ideation treatments. The present study used a novel mediation approach in a randomized comparison of pharmacotherapy and combined therapy to explore whether depressive symptoms mediate the association between treatment and suicidal ideation and whether it depends on the treatment condition.

DESIGN

This study is a randomized, controlled, parallel group (1:1), clinical trial using a novel mediation approach for longitudinal data. Latent difference score modelling was utilized to investigate whether changes in depressive symptoms drive subsequent changes in suicide ideation.

METHOD

Participants were 94 depressive suicidal outpatients who were assessed regarding depressive symptoms and suicidal ideation over the course of an experiment (0-2-7 months). Direct and indirect associations between (change in) depressive symptoms and (change in) suicidal ideation were explored using Pearson's correlations and latent difference score model.

RESULTS

The results showed that depression treatment affects not only suicidal ideation directly but also its influence on suicidal ideation occurs via improvement in depressive symptoms. It was found a more significant effect of combining pharmacotherapy and PPT (in comparison with the pharmacotherapy alone) on the early and late improvements of suicidal ideation (Δ 0-2 and Δ 2-7) via the early improvement of depressive symptoms (Δ 0-2).

CONCLUSIONS

The findings indicate that changes in depressive symptoms preceded changes in suicidal ideation. Our results highlighted that improving depressive symptoms could be a primary target in treating patients with depression experiencing suicidal thoughts.

Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention

BACKGROUND

Long-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties.

METHODS

This was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability.

RESULTS

The following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%.

CONCLUSIONS

The intervention was feasible to implement in the clinical setting and participants rated the final set of skills highly. Most of the skills were considered useful. Participant feedback was invaluable to improve the intervention, as evidenced by the large increase in the retention rate from 40 to 80%. Randomized clinical trials are needed to test the efficacy of this intervention in promoting well-being in participants with long-lasting BPD.

Inpatient suicide in psychiatric settings: Evaluation of current prevention measures

The risk of suicide in psychiatric hospitals is 50 times higher than in the general population, despite patient safety being a priority for any hospital. However, to date, due to the complexity of assessing suicide risk, there has been no consensus on the suicide prevention measures that should be in place in hospitals. The aim of this work is: To provide an overview of the progress that has been made in the field of inpatient suicide prevention in recent years; discuss the problems that remain; and suggest potential future developments. As new clinical dimensions (notably anhedonia, psychological pain and hopelessness) develop, they should become new therapeutic targets. Team training (like the Gatekeeper Training Program) and the latest advances in suicide risk assessment (such as the Collaborative Assessment and Management of Suicidality) should be implemented in psychiatric wards. Suicide prevention plans (e.g., ASSIP, SAFE-T, etc.) represent easy-to-administer, low-cost interventions. The Mental Health Environment of Care Checklist has been proven effective to reduce suicide risk at hospitals. Furthermore, the types of psychotherapy recommended to reduce suicide risk are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). There are several pharmacological treatments for suicide risk, such as lithium and clozapine, which have been shown to be effective in the long term, as well as ketamine and esketamine, which are more effective in the short term. Following some encouraging recent results, buprenorphine may also be proposed to patients with a suicide risk. Triple chronotherapy rapidly improves depressive symptoms over 9 weeks. Regarding brain stimulation techniques, rTMS has proven to be effective in alleviating multiple dimensions of suicidality.

Psychological well-being in US veterans with non-fatal suicide attempts: A multi-cohort population-based study

BACKGROUND

Most people who survive suicide attempts neither re-attempt suicide nor die by suicide. Research on suicide attempt survivors has primarily focused on negative endpoints (e.g., increased suicide risk) rather than positive outcomes. One important outcome is psychological well-being (PWB), defined as positive functioning across emotional, intrapersonal, and interpersonal domains. We compared PWB among US military veterans with (i.e., attempt survivors) and without (i.e., non-attempters) a history of suicide attempt(s) using data from three nationally representative cohorts.

METHODS

Each US veteran cohort (Cohort1: N = 3148; Cohort2: N = 1474; Cohort3: N = 4042) completed measures of suicidality (e.g., attempt history), character strengths (e.g., curiosity, optimism), psychological symptoms (e.g., depression), and indicators of PWB (e.g., happiness). t-Tests were conducted to examine group differences in PWB; hierarchical regressions were conducted to examine suicide attempt status as a predictor of PWB controlling for symptoms and demographics. Multivariable regressions were conducted to identify predictors of PWB among attempt survivors.

RESULTS

In each cohort, reported PWB was markedly lower among suicide attempt survivors than non-attempters (ds = 0.9-1.2), even after adjusting for mental health symptoms. Individual differences in PWB were observed, with a subset of suicide attempt survivors reporting higher PWB levels than non-attempters (1.4-7.4 %). Curiosity and optimism were positively associated with PWB among suicide attempt survivors (rs = 0.60-0.78).

LIMITATIONS

Data were cross-sectional, limiting inferences about causation and directionality of associations.

CONCLUSIONS

Findings highlight diminished PWB as an important and understudied concern among veteran attempt survivors. Collectively, our findings underscore the importance of considering PWB in the research, assessment, and treatment of suicidality.

Use of a positive psychology intervention (PPI) to promote the psychological well-being of children living in poverty: study protocol for a feasibility randomised controlled trial

INTRODUCTION

Poverty has a detrimental influence on psychological well-being of children. Existing evidence shows that positive psychology interventions are possible to mitigate such impact. Despite criticisms that positive psychology resembles a scientific Pollyannaism that promotes overly positivity, positive psychology is not the scientific Pollyannaism that denies the difficulties and emotions that people may experience. Whereas, positive psychology acknowledges the difficulties and emotions, alongside with building up human resilience, strength and growth to face adversity. This study examined the feasibility of implementing a positive psychology intervention among Hong Kong Chinese children living in poverty.

METHODS

A feasibility randomised controlled trial will be conducted. A convenience sample of 120 children aged 13-17 years will be recruited from a community centre in Kwai Tsing district. Participants who are randomised into the experimental group will join a 1.5-hour workshop covering four positive psychology techniques: (1) gratitude visits/letters, (2) three good things, (3) you at your best and (4) using signature strengths. A booster intervention will be provided at 1 week. Control group participants will not receive any intervention. Assessments will be conducted at baseline and at 1-week, 1-month, 3-month and 6-month follow-ups.

ANALYSIS

Descriptive statistics will be used to calculate the feasibility measures. Effect sizes on psychological outcomes (ie, self-esteem, depressive symptoms and quality of life) will be estimated by mixed between-within subjects analysis of variance using partial eta squared with poverty (yes, no) entering into the model as a factor.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Hong Kong Polytechnic University Institutional Review Broad. We will obtain parental consent as our subjects are below 18 years old. Findings from this study will be disseminated via international publications and conferences.

TRIAL REGISTRATION NUMBER

NCT04875507.

The Role of Hope and Resilience in Protecting Against Suicidal thoughts and Behaviors During the COVID-19 Pandemic

OBJECTIVE

The COVID-19 pandemic has impacted the mental health and wellbeing of populations across the world. This study aimed to examine: (1) which specific aspects of the COVID-19 pandemic were associated with the presence of suicidal thoughts and behaviors, and (2) the extent to which participants' hopelessness and resilience moderated the relationship between COVID-19 related stress and suicidal thoughts and behaviors.

METHOD

We administered an online survey to 12,989 adult (16+) participants across Wales from the 9th June to the 13th July 2020. Participants completed a series of questionnaires measuring the stressors they had experienced during the COVID-19 pandemic, their levels of hopelessness over the past two weeks, their levels of resilience, and whether they had experienced suicidal thoughts or behaviors since the onset of the COVID-19 pandemic.

RESULTS

Our findings revealed that: (1) food insecurity, domestic abuse, relationship problems, redundancy, social isolation and financial problems were the COVID-19 related stressors most strongly associated with suicidal thoughts and behaviors, and (2) that both hopelessness and resilience moderated the relationship between COVID-19 stress and suicidal thoughts, such that the relationship between COVID-19 stress and the presence of suicidal thoughts was much stronger for individuals with high hopelessness and low resilience.

CONCLUSIONS

These results highlight the aspects of the COVID-19 pandemic that are closely related to suicidal thoughts and behaviors and demonstrate the important role that hope for the future and resilience play in protecting individuals against the negative effects of the COVID-19 pandemic.HighlightsStressors caused by the pandemic are linked to increased suicidal thoughts.Hope protects individuals against the negative impact of the COVID-19 pandemic.Resilience also protects people from the negative impact of the COVID-19 pandemic.

Effectiveness of a resilience-targeted intervention based on "I have, I am, I can" strategy on nursing home older adults' suicidal ideation: A randomized controlled trial

BACKGROUND

Despite the potential for benefit, resilience remains an emergent area in late-life mental health care, and evidence of resilience intervention for suicide among nursing home residents is especially limited. This study aims to evaluate the effects of a resilience-targeted program based on the "I have, I am, and I can" strategy on suicidal ideation and related problems.

METHODS

From the 562 nursing home residents who were contacted, 68 with suicidal ideation were recruited and then randomly assigned to a resilience intervention group (eight-week resilience training; n = 34) or a wait-list control group (eight-week health education; n = 34). Self-reported suicidal ideation, and depression and anxiety symptoms as outcomes, and resilience as potential mediators were assessed at baseline, postintervention, and one-month follow-up.

RESULTS

Resilience training participants reported significant improvement in suicidal ideation (group × time interaction x²=12.564, p = 0.002) and depression symptoms (x²=9.441, p = 0.009) compared to wait-list control group participants. Changes in resilience mediated the intervention's effects on changes in suicidal ideation and depression symptoms. Limitations The observed effects must be considered preliminary due to the small sample size.

CONCLUSIONS

The findings support the benefits of resilience training based on the "I have, I am, and I can" strategy in reducing suicidal ideation and suicide-related symptoms in nursing home older adults, and provide insight into possible mechanisms.

Cognitive-affective responses to online positive-psychological interventions: The effects of optimistic, grateful, and self-compassionate writing

Growing evidence suggests that online positive-psychological interventions effectively increase well-being, and a wealth of evidence describes cognitive-affective responses to such interventions. Few studies, however, have directly compared responses across popular exercises such as the best-possible-self intervention, the gratitude letter, or self-compassionate writing. In addition, current evidence is ambiguous regarding the effects of potential moderator variables such as trait gratitude and emotional self-awareness. To address these issues, we randomized 432 German adults to perform either optimism, gratitude, self-compassion, or control writing interventions in an online setting. Participants reported trait gratitude and trait emotional self-awareness before the interventions, as well as momentary optimism, gratitude, self-compassion, positive affect, and current thoughts immediately after the interventions. Results indicate higher momentary optimism after the best-possible-self intervention and higher momentary gratitude after the gratitude letter than after the control task. There were no differences when comparing the best-possible-self intervention with the gratitude letter. Both interventions increased the number of positive self-relevant thoughts. The self-compassion condition showed no effects. Moderation analysis results indicate that neither emotional self-awareness nor trait gratitude moderated the intervention effects. Future studies should compare responses across different positive-psychological interventions using more comprehensive exercises to ensure larger effects.

Character Strengths Predict Subjective Well-Being, Psychological Well-Being, and Psychopathological Symptoms, Over and Above Functional Social Support

The increasing value of character strengths in the prediction of well-being and psychopathology, after the effects of functional social support and sociodemographic variables are accounted for, is examined. Participants were 1494 Spanish-speaking students between the ages of 18 and 68 (43.3% men and 56.7% women) who completed measures of character strengths, functional social support, subjective well-being, psychological well-being, and symptoms of psychopathology. Functional social support had predictive value in explaining the variability of each component of well-being and psychopathology. Regarding character strengths, theological strengths had the greatest predictive power for life satisfaction (β = 0.41), positive affect (β = 0.49), affect balance (β = 0.45), purpose in life (β = 0.60), self-acceptance (β = 0.50), environmental mastery (β = 0.47), and positive relations with others (β = 0.25). Emotional strengths made the strongest contribution to the variance explained (β = 0.41) of autonomy, and intellectual strengths were the strongest predictive variable for personal growth (β = 0.39). Strengths of restraint had the greatest predictive power for the global severity index of psychopathology (β = –0.27). Functional social support and character strengths have strong links to mental health. Positive interventions to develop these variables could contribute to enhance well-being and prevent psychological distress.

A Framework for the Adaptation of Positive Psychological Interventions to North American Indigenous Populations

Positive psychology research has led to the development of brief interventions designed to promote positive emotions: positive psychological interventions (PPIs). Randomized controlled trials examining PPIs have found them to be effective in increasing well-being and decreasing depressive symptoms. PPIs have been studied in samples consisting primarily of White Americans; however, PPIs may be useful for members of North American Indigenous groups. PPIs align well with Indigenous views on health, which tend to be strengths-based, holistic, and encompassing the whole body (including the medicine wheel's four dimensions of spirit, mind, heart, and body). This paper provides a framework for the adaptation of PPIs for Indigenous communities and a review of preliminary data on the relationships between positive psychological characteristics and health outcomes including substance use. Implications include the potential widespread impact of culturally adapted PPIs given their alignment with Indigenous thoughts on health and relative ease of administration.

Future Well-Being Among People Who Attempt Suicide and Survive: Research Recommendations

Over 48,000 people died by suicide in 2018 in the United States, and more than 25 times that number attempted suicide. Research on suicide has focused much more on risk factors and adverse outcomes than on protective factors and more healthy functioning. Consequently, little is known regarding relatively positive long-term psychological adaptation among people who attempt suicide and survive. We recommend inquiry into the phenomenon of long-term well-being after nonfatal suicide attempts, and we explain how this inquiry complements traditional risk research by (a) providing a more comprehensive understanding of the sequelae of suicide attempts, (b) identifying protective factors for potential use in interventions and prevention, and (c) contributing to knowledge and public education that reduce the stigma associated with suicide-related behaviors.

Life goal reconstruction for people with chronic health conditions: Feasibility of a brief internet-based writing intervention using a minimally monitored delivery

Examination of people's narratives after significant life changes revealed that engaging in current and future goal reconstruction was associated with higher levels of well-being while a failure to disengage from "what might have been" was associated with lower levels of well-being. This work led to the development of a life goal writing intervention that has received empirical support with most studies conducted among nonclinical populations. This study aims to assess the feasibility of a brief and minimally monitored internet-delivered writing therapy developed to facilitate life goal reconstruction among adults diagnosed with various chronic health conditions. Sixteen adults showing mild to moderate levels of anxiety or depression were recruited and a single group pretest/post-test design used. The 5-week program is comprised of psychoeducation, five weekly 30-min writing sessions, automated emails and symptom monitoring. Feasibility outcome measures included attrition, treatment adherence, acceptability and preliminary effectiveness. Primary outcome measures were The Patient Health Questionnaire -9 (PHQ-9) and the Generalized Anxiety Disorder -7 (GAD-7). Attrition was low (12%) and adherence high (93%). All but one study completer reported they would recommend the program. Mixed effects models revealed a significant and large reduction from pre-treatment to post-treatment on the PHQ-9 and GAD-7 and remission rates of 67% and 64% respectively. These findings suggest that it would be feasible to proceed to a larger trial. The brief duration of the intervention combined to a minimally monitored delivery may lend itself to implementation in routine clinical care milieus such as hospital settings.

Changes in neural reward processing following Amplification of Positivity treatment for depression and anxiety: Preliminary findings from a randomized waitlist controlled trial

Positive valence system (PVS) deficits are increasingly recognized as important treatment targets for depression and anxiety. Emerging behavioral treatments designed to upregulate the PVS show initial promise; however, neural mechanisms underlying these approaches remain unknown. This study investigated neural reward-processing-related changes following Amplification of Positivity (AMP)-a treatment designed to enhance positive thinking, emotions and behaviors through positive activity interventions (Clinicaltrials.gov: NCT02330627). Individuals with depression and/or anxiety (N = 29) were randomized to 10 sessions of AMP (n = 16) or waitlist (WL; n = 13). Participants completed a monetary incentive delay task during fMRI at baseline and post-assessment. Hypothesis-driven region of interest (ventral striatum, insula, anterior cingulate) and exploratory whole-brain activation and connectivity analyses evaluated pre-to-post changes for AMP vs. WL when anticipating potential monetary gain or loss. No between-group brain activation changes emerged in regions of interest or whole-brain analyses. Increased neural connectivity from pre-to-post-treatment was observed in AMP vs. WL, including ventral striatum, anterior insula, and anterior cingulate connectivity with prefrontal, limbic, occipital and parietal regions-predominantly during loss anticipation. This preliminary study is the first to examine neural mechanisms of positive activity interventions in depression and anxiety and suggests that AMP may strengthen brain connectivity in reward processing, attention, and emotion regulation networks.

The Practice of Character Strengths: Unifying Definitions, Principles, and Exploration of What's Soaring, Emerging, and Ripe With Potential in Science and in Practice

What does it mean to be “strengths-based” or to be a “strengths-based practitioner?” These are diffuse areas that are generic and ill-defined. Part of the confusion arises from the customary default of practitioners and leaders across many cultures to label anything positive or complimentary as “strengths-based,” whether that be an approach, a theoretical orientation, an intervention, or a company. Additional muddle is created by many researchers and practitioners not making distinctions between very different categories of “strength” in human beings – strengths of character, of talent/ability, of interest/passion, of skill/competency, to name a few. To add clarity and unification across professions, we offer seven characteristics and a comprehensive definition for a character strengths-based practitioner. We center on the type of strength referred to as character strengths and explore six guiding principles for understanding character strengths (e.g., character is plural; character is being and doing) and their practical corollaries. Reflecting this foundation and based on character strengths research, our longstanding work with strengths, discussions with practitioners across the globe, and a practitioner survey asking about strength practices (N = 113), we point out several character strengths practices or approaches we describe as soaring (e.g., explore and encourage signature strengths; practice strengths-spotting), emerging (e.g., the integration of mindfulness and character strengths), or ripe with potential (e.g., phasic strengths; the tempering effect; the towing effect). We use the same framework for describing general research domains. Some areas of research in character strengths are soaring with more than 25 studies (e.g., workplace/organizations), some are emerging with a handful of studies (e.g., health/medicine), and others are ripe with potential that have none or few studies yet opportunity looms large for integrating character science (e.g., peace/conflict studies). Using this framework, we seek to advance the exchange and collaboration between researcher and practitioner, as well as to advance the science and practice of character strengths.

POSITIVE PSYCHIATRY INTERVENTIONS IN GERIATRIC MENTAL HEALTH

PURPOSE OF REVIEW

Positive psychiatry shifts the focus of geriatric mental healthcare beyond studying disorders and psychopathology to studying factors that contribute to mental well-being and successful aging. An increasing number of interventional studies are using treatments that target modifiable positive psychosocial characteristics (PPCs) and study their impact on mental health. Here we provide an overview of the literature on positive psychiatry interventions using illustrative examples of interventions targeting social connectedness, meaning in life, wisdom, and resilience.

RECENT FINDINGS

There is growing evidence that PPCs are modifiable constructs that may be associated with improved well-being, physical health, and mental health outcomes.

SUMMARY

The preliminary evidence summarized in this narrative review indicates that positive psychiatry interventions targeting social connectedness, meaning in life, wisdom, and resilience can improve overall well-being and other positive health outcomes amongst older adults. The effect sizes of these interventions reported in RCTs and meta-analyses are typically small to medium, but occasionally large effect sizes are also reported. Current literature is restricted by heterogeneous methodology, limiting clinicians' abilities to extrapolate these principles of positive psychiatry into everyday practice. With the expanding body of evidence, positive psychiatry may have the potential to transform the landscape of geriatric mental health.

Positive psychological characteristics in patients with metabolic syndrome associated with prospective changes in diet and anthropometric factors

The prevalence of metabolic syndrome (MetS) is increasing worldwide, and diet therapy plays a key role in treating this disease. Since most patients show difficulties in adhering to nutritional interventions, research on the association of positive psychological characteristics with greater engagement in physical health is relevant to this field. The present study aimed to evaluate the association between positive psychology attributes (optimism, hope, self-esteem, positive/negative affect and life satisfaction) and changes in diet quality and anthropometric parameters of individuals with MetS who received nutritional counseling. The study assessed 63 patients at a nutrition outpatient clinic. Anthropometric parameters and 24-hour food recall data (for evaluation of the Brazilian Healthy Eating Index-Revised-BHEI-R) were collected at the first visit and subsequent return visit (on average five months later). Psychological data were collected at the first visit using validated and standardized scales. The results were adjusted in relation to the depression scores of the patients, which were evaluated using the Beck Depression Inventory-II (BDI-II). Changes in anthropometric factors and in the BHEI-R were assessed, and their associations with the psychological attributes were investigated. The results indicated that positive affect and hope were associated with improvement in the BHEI-R scores (Cohen effect sizes -0.65 and -0.58; p = 0.012 and 0.025, respectively). A significant association was also observed between optimism and a reduction in abdominal circumference (Cohen effect size 0.56; p = 0.031). The associations remained significant even after adjusting for the BDI-II scores (p = 0.022, p = 0.037 and p = 0.05, respectively). No statistically significant associations were observed for the other attributes assessed.The study suggests that some attributes may have a greater influence on the nutritional treatment of MetS and that future studies should be conducted in order to enable effective multidisciplinary interventions to treat MetS.

What character strengths are protective factors for suicidal ideation?: A cross-sectional study in Japan

One factor that has been studied as a protective factor for suicide is character strength and there are many studies that examined the relationship between gratitude and suicide. The problem of character strength research on suicide prevention is that the link between various character strengths and suicide has not been comprehensively examined. We explored which character strength is associated with suicidal ideation. The study is a cross-sectional, self-administered questionnaire survey. Participants were 2,000 Internet users in Japan aged 20 years or older. The online survey covered suicidal ideation, character strengths and demographic details. A hierarchical multiple regression analysis was performed with the suicidal ideation as the dependent variable and character strengths as the independent variable. A significant regression equation was found (F (22, 1977) = 64.65, P < 0.001), with an R² of 0.42. 'Engagement' (B = -0.38, P < 0.001), 'Love' (B = -0.33, P = 0.001), and 'Risk-taking' (B = 0.40, P < 0.001) were significant predictors of suicidal ideation. The positive trait of being able to actively engage with people and build a loving relationship could be a protective factor for suicide.

Developing a Psychological-Behavioral Intervention in Cardiac Patients Using the Multiphase Optimization Strategy: Lessons Learned From the Field

BACKGROUND

The Multiphase Optimization Strategy (MOST) is an approach to systematically and efficiently developing a behavioral intervention using a sequence of experiments to prepare and optimize the intervention.

PURPOSE

Using a 6 year MOST-based behavioral intervention development project as an example, we outline the results-and resulting decision-making process-related to experiments at each step to display the practical challenges present at each stage.

METHODS

To develop a positive psychology (PP) based intervention to promote physical activity after an acute coronary syndrome (N = 255 across four phases), we utilized qualitative, proof-of-concept, factorial design, and randomized pilot experiments, with iterative modification of intervention content and delivery.

RESULTS

Through this multiphase approach, we ultimately developed a 12 week, phone-delivered, combined PP-motivational interviewing intervention to promote physical activity. Across stages, we learned several important lessons: (a) participant and interventionist feedback is important, even in later optimization stages; (b) a thoughtful and systematic approach using all information sources is required when conflicting results in experiments make next steps unclear; and (3) new approaches in the field over a multiyear project should be integrated into the development process.

CONCLUSIONS

A MOST-based behavioral intervention development program can be efficient and effective in developing optimized new interventions, and it may require complex and nuanced decision-making at each phase.

Positive Mental Health, Stressful Life Events, and Suicide Ideation

Background: Stressful life events and suicide ideation regularly occur together. Yet, little is known about factors that buffer individuals against the development of suicide ideation. Aim: In a long-term follow-up study design, it was investigated whether positive mental health, that is, high levels of subjective and psychological well-being, buffers the association between stressful life events and suicide ideation. Method: A total of 126 German students (80.2% female; age: M = 24.29, SD = 5.21) were assessed at a baseline evaluation and again 24 months later. Data were collected using self-report questionnaires. Results: Linear hierarchical regression analysis was used to analyze the data. Positive mental health was considered to moderate the impact of stressful life events on suicide ideation - controlling for age and gender. Limitations: Current results are limited to university students. Conclusions: Positive mental health interacts with stressful life events, such that those with high levels of positive mental health show an attenuated increase in suicide ideation at elevated levels of stress. Positive mental health seems to confer resilience and should be focused on in counseling centers for students.

How imagining personal future scenarios influences affect: Systematic review and meta-analysis

Imagining the future is a fundamental human capacity that occupies a large part of people's waking time and impacts their affective well-being. In this meta-analysis, we examined the effect of (1) positive future imagination and (2) negative future imagination on affect, and (3) compared the affective responses between imagining the future and remembering the past; lastly, we (4) examined potential moderating variables in this regard. We identified 63 experimental studies (N = 6813) from different research areas and combined studies that applied the best possible self imagination task, future worry induction, and episodic future simulation, respectively. Findings yielded that imagining the future has a moderate to strong impact on affect, and it has a stronger influence on affect compared to remembering the past. Relevant moderator variables in each research area were also identified. We discuss the findings for the field of psychology in general and clinical psychology in particular. More elaborate research on personal future imagination seems crucial for the further advancement of clinical applications for mental health complaints. We conclude with recommendations for future research on the impact of future imagination on affective well-being.

A longitudinal study on the relationship among childhood emotional abuse, gratitude, and suicidal ideation of Chinese adolescents

BACKGROUND AND OBJECTIVE

Suicidal ideation is a significant predictor of suicidal attempt. Based on the developmental psychopathology perspective and the resilience theory, this study examines whether trait gratitude mediates the relationship between childhood emotional abuse and adolescent suicidal ideation.

PARTICIPANTS AND SETTING

A sample of 909 Grade 8 to Grade 9 adolescents aged 12-18 years in Hong Kong, a Special Administrative Region in China, was recruited from six secondary schools.

METHOD

A two-wave longitudinal study was conducted. Participants completed the same measures on Gratitude Quesitonnaire-6, Suicidal Ideation Scale, emotional subscale of Child Abuse and Trauma Scale at two time points 12 months apart.

RESULTS

Results of cross-lagged analyses showed that adolescents' suicidal ideation was positively associated with childhood emotional abuse and negatively associated with gratitude; further, the association between childhood emotional abuse and suicidal ideation was mediated by gratitude.

CONCLUSIONS

Findings of this study implied that while exposure to parental emotional abuse might have an adverse impact on the development of gratitude, adolescents' current level of gratitude still exerts its protective effect by directly reducing their suicidal ideation. Gratitude or other resilience factors that might comprise additional mediating mechanisms from childhood emotional abuse to mental health problems in later life is worthy of further investigation.

Gratitude diary for the management of suicidal inpatients: A randomized controlled trial

BACKGROUND

The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies.

METHODS

We conducted a randomized controlled trial based on a 7-day add-on positive psychology program: gratitude diary (intervention) versus food diary (control) in adults hospitalized for current suicidal ideation or a suicide attempt. The primary effectiveness outcome was between-group differences for mean change of current psychological pain, between the beginning and the end of the 7-day intervention. We measured between-group differences for mean change of suicidal ideation, hopelessness and optimism, and depression and anxiety between inclusion and after the completion of the 7-day intervention. We compared mean change of current psychological pain, suicidal ideation, and hopelessness and optimism between immediate pre and post daily journal completion.

RESULTS

Two hundred and one participants were enrolled and randomized. Between pretherapy and posttherapy: There were no significant between-group differences for mean change of severity and intensity of suicidal ideation and current hopelessness. Between-group difference for mean change of current psychological pain was trending (P = 0.05). Mean change of depression, anxiety, and optimism was significantly higher in the intervention than in the control group. Between immediate pre and post daily journal completion: Between-group differences favored gratitude (vs. food) diary for all outcomes (psychological pain, suicidal ideation, and hopelessness and optimism; P < 10^-3 ). Participants found the intervention to be more useful than the food diary.

CONCLUSIONS

Through gratitude diary appears a very straightforward intervention that could be developed as an adjunctive strategy for suicidal patients.

Positive mental health, positive affect and suicide ideation

BACKGROUND/OBJECTIVE

Positive mental health (PMH) has been shown to confer resilience against suicide ideation. However, the mechanisms underlying the positive effect of PMH on suicide ideation/behavior are largely unknown. The current study aimed to determine whether positive affect mediates the association between PMH and suicide ideation.

METHOD

A total of 150 adult outpatients (65.3%; female; age: M(SD)=37.79(13.50), range:18-77) completed measures on PMH, positive and negative affect, as well as suicide ideation. Data were collected using self-report questionnaires. Linear hierarchical regression analysis was used to analyze the data. Positive affect was considered to mediate the association between positive mental health and suicide ideation.

RESULTS

While positive affect fully mediated the significant negative association between PMH and suicide ideation, negative affect did not reveal to be a significant mediator of this relationship.

CONCLUSIONS

The protective influence of PMH against suicide ideation is due to heightened positive affect: If positive mental health translates into positive affect, then suicide ideation becomes less likely.

A positive psychology-motivational interviewing intervention for patients with type 2 diabetes: Proof-of-concept trial

OBJECTIVE

Eighteen million Americans with type 2 diabetes (T2D) do not follow recommended guidelines for physical activity. Motivational interviewing (MI) has had modest effects on activity and related behaviors in T2D. Positive psychological attributes (e.g., optimism) are associated with superior medical outcomes in T2D, and positive psychology (PP) interventions promote such attributes. There had been no study in T2D of a combined PP-MI intervention to promote well-being and health behavior adherence. We developed a novel, telephone-delivered, 16-week PP-MI intervention and explored its feasibility and impact in T2D patients in a single-arm, proof-of-concept trial.

METHOD

Participants completed PP-based exercises and MI-based physical activity goal-setting activities and reviewed these activities weekly with a study trainer for 16 weeks. Feasibility and acceptability were assessed via exercise completion rates and post-exercise ratings of ease/utility (0-10 scales). Impact was explored by examining changes in physical activity (via accelerometers and self-report), other health behaviors, psychological measures, and medical outcomes (e.g., hemoglobin A1c (A1C)) from baseline to 16 weeks, using paired t tests.

RESULTS

Twelve participants enrolled, and 10 provided follow-up data. Seventy-eight percent of PP-MI activities were completed, and participants rated the PP-MI content and sessions as easy (mean = 8.2/10, standard deviation (SD) = 1.9) and useful (mean = 9.1/10, SD = 1.5). PP-MI was associated with improved adherence to health behaviors and overall self-care, variable effects on accelerometer-measured activity and psychological outcomes, and modest beneficial effects on body mass index and A1C.

CONCLUSION

Further testing of this intervention is warranted in a larger, controlled trial to assess its effects on important health outcomes.

Positive mental health as a moderator of the association between risk factors and suicide ideation/behavior in psychiatric inpatients

In recent studies positive mental health has been shown as a resilience factor related to suicide ideation/behavior. It is not known if positive mental health buffers the effect of various risk factors (depression, perceived burdensomeness, hopelessness, childhood maltreatment) on suicide ideation/behavior in psychiatric inpatients-a high risk population. A total of 100 psychiatric inpatients were included in the survey. Four hierarchical regression analyses were conducted to examine, whether positive mental health moderates the association between the four risks factors and suicide ideation/behavior. Positive mental health was shown to moderate the association between perceived burdensomeness and suicide ideation/behavior. The association between the other three risk factors and suicide ideation/behavior was not moderated by positive mental health. Given the cross-sectional nature of the data, conclusions on causality cannot be drawn. The buffering effect of positive mental health suggests that positive mental health may improve the identification of individuals at risk of suicide ideation/behavior and may be an important area to target in the prevention and treatment of individuals at risk of suicide. Further research is needed.

Efficacy of the Best Possible Self protocol in diabetes self-management: A mixed-methods approach

Recent research has demonstrated that positive affect may facilitate illness self-management. This study used a sequential exploratory mixed-methods typology to assess whether a brief writing task designed to boost positive affect (the Best Possible Self protocol) could improve aspects of diabetes self-management, specifically. A qualitative investigation explored people with diabetes' (n = 20) views regarding Best Possible Self feasibility and acceptability, while a subsequent quantitative investigation assigned people with diabetes (n = 50) to a Best Possible Self or non-Best Possible Self condition and assessed affect and self-management behaviours over a 4-week period. Findings indicated that individuals were receptive to the Best Possible Self and that it provided benefits for diabetes self-management.

A positive psychology intervention for patients with bipolar depression: a randomized pilot trial

Background: There are few effective treatments for bipolar depression, a common and debilitating illness.Aims: We aimed to examine the feasibility and preliminary efficacy of a four-week, telephone-delivered positive psychology (PP) intervention for patients with bipolar depression.Methods: Twenty-five patients hospitalized for bipolar depression were randomized to receive a PP (n = 14) or control condition (CC; n = 11) intervention. Following discharge, participants completed weekly exercises and phone calls with a study trainer. PP intervention feasibility was assessed by the number of exercises completed, and acceptability was examined on five-point Likert-type scales of ease and utility. Between-group differences on psychological constructs at 4 and 8 weeks post-enrollment were assessed using mixed effects regression models.Results: Participants in the PP group completed an average of three out of four PP exercises and found PP exercises to be subjectively helpful, though neither easy nor difficult. Compared to CC, the PP intervention led to trends towards greater improvements in positive affect and optimism at follow-up, with large effect sizes (modified Cohen's d = 0.95-1.24). PP had variable, non-significant effects on negative psychological constructs.Conclusions: Larger, randomized trials are needed to further evaluate the efficacy of this intervention in this high-risk population.

Cyberbullying, positive mental health and suicide ideation/behavior

Cyberbullying has regularly been shown to be associated with suicide ideation/behavior. The present study investigated whether positive mental health, i.e., high levels of emotional, cognitive and psychological well-being, buffers the association between cyberbullying and suicide ideation/behavior. A total of 225 students completed measures of cyberbullying, suicide ideation/behavior, and positive mental health. Positive mental health fully mediated the association between cyberbullying and suicide ideation/behavior. Positive mental health seems to confer resilience and should be taken into account in clinical and preventive programs for student populations.

Character strengths as protective factors against depression and suicidality among male and female employees

BACKGROUND

So far, studies on workplace mental health have only focused on work-related environmental risk factors, disregarding both protective and individual factors of employees. Therefore, we aimed to identify character strengths that act as protective factors against depressive moods and suicidality in Korean employees.

METHODS

In total, 84 male and 151 female employees (aged 19-50 years) reported their sociodemographic characteristics; depressive symptoms, as measured by the Beck Depression Inventory-II; suicidality, as measured by the Korean version of the MINI International Neuropsychiatric Interview suicidality module; and character strengths, as measured by the 24 Character Strength Alphas on the Values in Action Survey-72. We conducted a hierarchical logistic regression, in which depressive mood and suicidality served as the categorical outcome variables.

RESULTS

In females, scores on the "curiosity" (B = 1.107, Wald = 10.207, odds ratio = 3.026, p = .001) and "love" (B = .862, Wald = 5.767, odds ratio = 2.367, p = .016) sub scales of the 24 Character Strength Alphas on the Values in Action Survey-72 were statistically significant predictors of having depressive mood. Additionally, females' scores on "judgment" (B = - 1.405, Wald = 5.663, odds ratio = .245, p = .017) and "kindness" (B = - 1.456, Wald = 6.486, odds ratio = .233, p = .011) were protective factors against suicidality. In males, the "love" (B = 1.746, Wald = 4.279, odds ratio = 5.729, p = .039) score was a predictor of having depressive mood, while "teamwork" (B = - 2.204, Wald = 4.666, odds ratio = .110, p = .031) and "creativity" (B = - 1.384, Wald = 4.202, odds ratio = .251, p = .040) scores were protective factors against having depressive mood and suicidality, respectively.

CONCLUSIONS

We suggest that focusing on "judgement" and "kindness" in female employees, and "teamwork" and "creativity" in male employees, and engaging in activities that use these strengths at the workplace can be protective factors against depression and suicidality. Future research should focus on developing interventions to promote these character strengths among employees at the workplace.

Smartphone delivery of a hope intervention: Another way to flourish

Positive interventions have shown promise for fostering hedonic (happiness) and eudaimonic (flourishing) well-being. However, few studies have focused on positive interventions that target hope as a means of increasing well-being, and none have examined the use of smartphone app-based systems for delivering interventions in the moments and contexts of daily life-an approach called ecological momentary intervention (EMI). We conducted a quasi-experimental pilot study using a pretest and posttest design to examine the feasibility and potential impact of a mobile app-based hope EMI. Participants appeared to engage with the intervention and found the experience to be user-friendly, helpful, and enjoyable. Relative to the control group, those receiving the intervention demonstrated significantly greater increases in hope; however, there were no between-group differences in hedonic and eudaimonic well-being. The authors recommend future research to examine the potential of EMI mobile apps to cultivate hope and promote flourishing.

Short Report: A Pilot Study of a Group Positive Psychology Intervention for Patients with Multiple Sclerosis

Background

Positive psychology uses targeted activities to increase the frequency and intensity of positive emotional experiences. Positive psychology interventions that increase positive constructs may facilitate adjustment and improve well-being in patients with multiple sclerosis (MS). The primary goal of this study was to assess the feasibility and acceptability of a 5-week group positive psychology intervention for patients with MS. In addition, we examined the utility of the group intervention to increase positive psychological constructs and health-related quality of life (HRQOL).

Methods

11 patients completed 5 weeks of group positive psychology training, one time per week (session duration, 45-60 minutes). Each week, patients completed one of the following positive psychology exercises: gratitude for positive events, personal strengths, gratitude letter, enjoyable and meaningful activities, and remembering past successes. Patients completed patient-reported outcome measures, including measures of positive affect, optimism, depression, anxiety, and HRQOL, at baseline and after 5 weeks.

Results

All the participants completed the 5-week group positive psychology intervention, and 82% attended four or more sessions. Improvements in fatigue (vitality) and depression after the group intervention were significant (P = .016 and .049, respectively). There were no statistically significant changes in positive or negative affect, optimism, anxiety, HRQOL, or cognition.

Conclusions

The 5-week group positive psychology intervention was feasible and acceptable to patients with MS. A randomized controlled trial is necessary to further explore the effectiveness of the group intervention.

Optimizing expectations and distraction leads to lower cortisol levels after acute stress

BACKGROUND

A new approach of psychological interventions prior to stress aiming to optimize expectations may have beneficial effects on a person's health status by reducing physiological stress. The purpose of this experiment was to determine whether a brief psychological intervention designed to optimize personal control expectations prior to acute stress would affect perceived and biological stress responsiveness in comparison to two more established interventions (fostering gratitude or distraction) in a healthy sample.

METHODS

74 healthy participants were randomized to one of three psychological interventions prior to stress: (i) writing about ways to influence stress to optimize personal control expectations (EXPECTATION), (ii) writing a gratitude-letter (GRATITUDE) (iii) or a distraction writing task (DISTRACTION). After completing the intervention, the Maastricht acute stress test was administered to induce (psychosocial and physiological) stress. Assessments took place at baseline, post-intervention (15 min writing task) and after stress induction (additional salivary assessments: 15 and 30 min after stress). Main outcomes were expectations, emotions, perceived stress, salivary cortisol and alpha-amylase. Personality traits (eg, optimism) were assessed at baseline.

RESULTS

EXPECTATION specifically increased personal control expectations (p = .016, d = .72) and GRATITUDE specifically increased gratitude (p = .026, d = .68). EXPECTATION and DISTRACTION led to lower cortisol concentrations after stress induction than GRATITUDE (time x group interaction: p < .001, d = .88). We detected no intervention effects on alpha-amylase or perceived stress. Optimism moderated intervention effects on cortisol (p = .023, d = .74).

CONCLUSIONS

Brief psychological interventions aiming to optimize expectations or distraction prior to stress reduce the cortisol response in healthy participants after an acute stressor.