Enhancing well-being and alleviating depressive symptoms in people with HIV/AIDS: An intervention based on if-then plans with self-affirming cognitions

Effective antiretroviral treatment has increased the life expectancy of people living with HIV, and currently, the challenges of prominent importance appear to be mental health issues. This preregistered study among adults living with HIV/AIDS investigated the effectiveness of a brief self‐affirmation intervention framed in terms of if–then plans (i.e. self‐affirming implementation intentions [S‐AII]) against both active and non‐active control conditions, forming non‐affirming implementation intentions and mere goal intentions, respectively. The primary outcomes were defined as a reduction of depressive symptoms and enhancement of well‐being, along with secondary outcomes as positive other‐ and self‐directed feelings. A total of 162 individuals were assessed for eligibility, and 130 (aged 18–74 years) were randomized to the study conditions. Intervention effects were estimated through intention‐to‐treat analysis, using linear mixed models. The S‐AII intervention yielded improvements in overall well‐being over 2 weeks (d = .23), primarily driven by positive changes in emotional (d = .24) and social (d = .30) dimensions of well‐being. There were no significant differences in depression or secondary outcomes. Based on a minimal clinically important difference index, the S‐AII intervention resulted in improvement in well‐being in approximately 40 percent of participants. Nevertheless, further systematic research is needed to optimize self‐affirmation‐interventions, before their application in real‐life contexts.

A Factorial Randomized Controlled Trial of Implementation-Intention-Based Self-Affirmation Interventions: Findings on Depression, Anxiety, and Well-being in Adults With Psoriasis

This study builds on growing evidence on implementation-intention-based self-affirmation intervention effects on mental health. Using a factorial design, this pre-registered study aimed to further investigate whether (1) strengthening the element of specificity within body-related self-affirming implementation intention (BS-AII) intervention compared to general self-affirming implementation intention (S-AII) would provide greater improvements in mental health outcomes for adults with psoriasis, and (2) whether the addition of a booster component would result in enhancing effectiveness at follow-up. A total of 306 adults with psoriasis were assessed for eligibility and 222 (aged 18-71 years) were randomized and received S-AII, BS-AII, or MGI (mere goal intention-control condition). Within each group, participants were again randomized to booster (B) or no-booster condition in a 3 × 2 factorial design, resulting in six groups: S-AII; S-AII + B; BS-AII; BS-AII + B; MGI; and MGI + B. Data were collected over three-time points, at baseline, 2 weeks post-intervention, and at 1-month later. Three primary outcomes were defined as a reduction of anxiety and depressive symptoms and enhancement of well-being. In terms of secondary outcomes, positive other- and self-directed feelings and also an emotional attitude toward the body were evaluated. To fully estimate intervention effects through intention-to-treat analysis, linear mixed models were used. A significant effect of time was observed, but no evidence of time-by-group interactions and no three-way interactions were detected. Exploratory analyses revealed two significant moderating effects of age and self-esteem, pointing to boundary conditions of the interventions. These findings offer to gain deeper insights on null (or negative) effects also reported in past works and highlight that self-affirmation interventions should be more thoroughly investigated and optimized before they can be broadly implemented in real-life contexts, especially to prevent backfiring and negative-enhancing effects.