A Positive Psychology Intervention in Allogeneic Hematopoietic Stem Cell Transplantation Survivors (PATH): A Pilot Randomized Clinical Trial.

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (HSCT) survivors experience significant psychological distress and low levels of positive psychological well-being, which can undermine patient-reported outcomes (PROs), such as quality of life (QoL). Hence, we conducted a pilot randomized clinical trial to assess the feasibility and preliminary efficacy of a telephone-delivered positive psychology intervention (Positive Affect for the Transplantation of Hematopoietic stem cells intervention [PATH]) for improving well-being in HSCT survivors. METHODS: HSCT survivors who were 100 days post-HSCT for hematologic malignancy at an academic institution were randomly assigned to either PATH or usual care. PATH, delivered by a behavioral health expert, entailed 9 weekly phone sessions on gratitude, personal strengths, and meaning. We defined feasibility a priori as >60% of eligible participants enrolling in the study and >75% of PATH participants completing ≥6 of 9 sessions. At baseline and 9 and 18 weeks, patients self-reported gratitude, positive affect, life satisfaction, optimism, anxiety, depression, posttraumatic stress disorder (PTSD), QoL, physical function, and fatigue. We used repeated measures regression models and estimates of effect size (Cohen's d) to explore the preliminary effects of PATH on outcomes. RESULTS: We enrolled 68.6% (72/105) of eligible patients (mean age, 57 years; 50% female). Of those randomized to PATH, 91% completed all sessions and reported positive psychology exercises as easy to complete and subjectively useful. Compared with usual care, PATH participants reported greater improvements in gratitude (ß = 1.38; d = 0.32), anxiety (ß = -1.43; d = -0.40), and physical function (ß = 2.15; d = 0.23) at 9 weeks and gratitude (ß = 0.97; d = 0.22), positive affect (ß = 2.02; d = 0.27), life satisfaction (ß = 1.82; d = 0.24), optimism (ß = 2.70; d = 0.49), anxiety (ß = -1.62; d = -0.46), depression (ß = -1.04; d = -0.33), PTSD (ß = -2.50; d = -0.29), QoL (ß = 7.70; d = 0.41), physical function (ß = 5.21; d = 0.56), and fatigue (ß = -2.54; d = -0.33) at 18 weeks. CONCLUSIONS: PATH is feasible, with promising signals for improving psychological well-being, QoL, physical function, and fatigue in HSCT survivors. Future multisite trials that investigate PATH's efficacy are needed to establish its effects on PROs in this population.

Gratitude, optimism, and satisfaction with life and patient-reported outcomes in patients undergoing hematopoietic stem cell transplantation.

OBJECTIVE: Associations between positive psychological well-being (PPWB) and patient-reported outcomes (PROs, e.g., quality of life [QOL]) have yet to be studied extensively in patients with hematologic malignancies who are allogeneic hematopoietic stem cell transplant (HSCT) survivors, despite substantial evidence that PPWB impacts PROs of other medical populations. METHODS: We conducted a secondary analysis of cross-sectional data examining the association of PPWB and PROs at day 100 post-transplant among 158 allogeneic HSCT recipients. Optimism, gratitude, life satisfaction, and PROs (i.e., QOL, anxiety, depression, and PTSD symptoms) were assessed using the Life Orientation Test-Revised, Gratitude Questionnaire, Satisfaction with Life Scale, Functional Assessment of Cancer Therapy-Bone Marrow Transplant, Hospital Anxiety and Depression Scale, and Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian Version, respectively. We used linear and multivariate regressions for all analyses and controlled for patient factors. RESULTS: Optimism was associated with better QOL (ß = 1.46; p < 0.001) and lower levels of anxiety (ß = -0.28; p < 0.001), depression (ß = -0.31; p < 0.001), and PTSD (ß = -0.58; p < 0.001). Gratitude was associated with better QOL (ß = 1.11; p < 0.001) and lower levels of anxiety (ß = -0.21; p = 0.001), depression (ß = -0.14; p = 0.021), and PTSD (ß = -0.32; p = 0.032). Finally, satisfaction with life was associated with better QOL (ß = 1.26; p < 0.001) and lower levels of anxiety (ß = -0.18; p < 0.001), depression (ß = -0.21; p < 0.001), and PTSD (ß = -0.49; p < 0.001). CONCLUSION: Optimism, gratitude, and satisfaction with life were all associated with better QOL and lower levels of psychological distress in allogeneic HSCT survivors. These data support studies to harness PPWB as a therapeutic intervention for this population throughout HSCT recovery.

Using Positive Psychology to Address Emotional Barriers to Physical Activity After Bariatric Surgery: Proof-of-Concept Trial of the Gaining Optimism After Weight Loss Surgery (GOALS) Project.

Physical activity promotes health and longevity after metabolic/bariatric surgery (MBS), but most patients do not meet recommended levels. The Gaining Optimism After weight Loss Surgery (GOALS) Project was a positive psychological intervention designed to address common emotional barriers to physical activity in patients who have recently undergone MBS (e.g., low confidence around exercise, internalized weight bias, fear of injury) and use motivational interviewing and standard behavior change techniques (e.g., self-monitoring) to increase physical activity. This single-arm proof-of-concept trial was designed to refine the intervention, test feasibility and acceptability, and explore pre-post changes in behavioral and psychological outcomes. Participants were 12 adults 6-12 months post-MBS (M age of 46, 58% female, 67% non-Hispanic white). GOALS was a 10-week telephone counseling program that introduced new positive psychological skills and physical activity topics each week. Participants tracked physical activity with a Fitbit and set weekly goals. Results showed that the intervention was feasible (85% of sessions completed) and acceptable (average participant ratings of session ease and utility above 8.0 on a 0-10 scale). There were medium-to-large effect size improvements in physical activity and psychological well-being (e.g., depressive symptoms). The GOALS intervention will next be tested in a pilot randomized controlled trial with longer-term follow-up to assess its effect more robustly.

Risk Stratification of QTc Prolongation in Critically Ill Patients Receiving Antipsychotics for the Management of Delirium Symptoms.

BACKGROUND: Patients experiencing significant agitation or perceptual disturbances related to delirium in an intensive care setting may benefit from short-term treatment with an antipsychotic medication. Some antipsychotic medications may prolong the QTc interval, which increases the risk of potentially fatal ventricular arrhythmias. In this targeted review, we describe the evidence regarding the relationships between antipsychotic medications and QTc prolongation and practical methods for monitoring the QTc interval and mitigating arrhythmia risk. METHODS: Searches of PubMed and Cochrane Library were performed to identify studies, published before February 2023, investigating the relationships between antipsychotic medications and QTc prolongation or arrhythmias. RESULTS: Most antipsychotic medications commonly used for the management of delirium symptoms (eg, intravenous haloperidol, olanzapine, quetiapine) cause a moderate degree of QTc prolongation. Among other antipsychotics, those most likely to cause QTc prolongation are iloperidone and ziprasidone, while aripiprazole and lurasidone appear to have minimal risk for QTc prolongation. Genetic vulnerabilities, female sex, older age, pre-existing cardiovascular disease, electrolyte abnormalities, and non-psychiatric medications also increase the risk of QTc prolongation. For individuals at risk of QTc prolongation, it is essential to measure the QTc interval accurately and consistently and consider medication adjustments if needed. CONCLUSIONS: Antipsychotic medications are one of many risk factors for QTc prolongation. When managing agitation related to delirium, it is imperative to assess an individual patient's risk for QTc prolongation and to choose a medication and monitoring strategy commensurate to the risks. In intensive care settings, we recommend regular ECG monitoring, using a linear regression formula to correct for heart rate. If substantial QTc prolongation (eg, QTc > 500 msec) is present, a change in pharmacologic treatment can be considered, though a particular medication may still be warranted if the risks of discontinuation (eg, extreme agitation, removal of invasive monitoring devices) outweigh the risks of arrhythmias. AIMS: This review aims to summarize the current literature on relationships between antipsychotic medications and QTc prolongation and to make practical clinical recommendations towards the approach of antipsychotic medication use for the management of delirium-related agitation and perceptual disturbances in intensive care settings.

Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association.

As clinicians delivering health care, we are very good at treating disease but often not as good at treating the person. The focus of our attention has been on the specific physical condition rather than the patient as a whole. Less attention has been given to psychological health and how that can contribute to physical health and disease. However, there is now an increasing appreciation of how psychological health can contribute not only in a negative way to cardiovascular disease (CVD) but also in a positive way to better cardiovascular health and reduced cardiovascular risk. This American Heart Association scientific statement was commissioned to evaluate, synthesize, and summarize for the health care community knowledge to date on the relationship between psychological health and cardiovascular health and disease and to suggest simple steps to screen for, and ultimately improve, the psychological health of patients with and at risk for CVD. Based on current study data, the following statements can be made: There are good data showing clear associations between psychological health and CVD and risk; there is increasing evidence that psychological health may be causally linked to biological processes and behaviors that contribute to and cause CVD; the preponderance of data suggest that interventions to improve psychological health can have a beneficial impact on cardiovascular health; simple screening measures can be used by health care providers for patients with or at risk for CVD to assess psychological health status; and consideration of psychological health is advisable in the evaluation and management of patients with or at risk for CVD.

Can positive psychological interventions improve health behaviors? A systematic review of the literature.

Positive psychological interventions (PPIs), which aim to cultivate psychological well-being, have the potential to improve health behavior adherence. This systematic review summarized the existing literature on PPI studies with a health behavior outcome to examine study methodology, quality, and efficacy. Of the 27 identified studies, 20 measured physical activity, eight measured medication adherence, seven measured diet, and three measured smoking (eight targeted multiple behaviors). Twenty studies were randomized controlled trials (RCTs; 13 fully powered), and seven had a single-arm design. Study samples were usually adults (n = 21), majority non-Hispanic white (n = 15) and female (n = 14), and with a specific disease (e.g., diabetes, n = 16). Most interventions combined a PPI with health behavior-focused content (n = 17), used a remote delivery method (n = 17), and received a moderate or low study quality rating. Overall, 19/27 studies found a health behavior improvement of at least medium effect size, while six of the 13 studies powered to detect significant effects were statistically significant. Of the behaviors measured, physical activity was most likely to improve (14/20 studies). In summary, PPIs are being increasingly studied as a strategy to enhance health behavior adherence. The existing literature is limited by small sample size, low study quality and inconsistent intervention content and outcome measurement. Future research should establish the most effective components of PPIs that can be tailored to different populations, use objective health behavior measurement, and robustly examine the effects of PPIs on health behaviors in fully powered RCTs.

Predictors of completion and response to a psychological intervention to promote health behavior adherence in heart failure.

OBJECTIVE: Most individuals with heart failure (HF) struggle to adhere to one or more health behaviors, and interventions to promote adherence are time-intensive and costly. In this analysis, we examined the predictors of engagement and response related to a telephone-delivered health behavior intervention for individuals with HF. METHOD: Using data from two pilot trials (N = 25) of a behavioral intervention for individuals with New York Heart Association (NYHA) class I-II HF, we examined predictors of intervention engagement and response using linear and mixed effects regression analyses. Predictors included medical (NYHA class, physical health-related quality of life [HRQoL], and HF symptoms) and intervention (ease and usefulness/utility ratings of the first intervention exercise) characteristics. Outcomes included percentage of sessions completed, accelerometer-measured physical activity, and sodium intake. RESULTS: Lower physical HRQoL and more frequent HF symptoms were associated with completion of more sessions. In contrast, more frequent HF symptoms and higher NYHA class were associated with less physical activity improvement. Finally, participants' ratings of the first session's utility were associated with greater improvements in physical activity at follow-up. CONCLUSIONS: These findings suggest that while individuals with greater functional impairment are more engaged in a behavioral intervention, they may be less able to increase physical activity in response to the program. Furthermore, the perceived utility of an initial session may predict longer-term behavior change. Larger studies are needed to clarify the presence of additional predictors and determine how they can be used to better tailor health behavior interventions.

The Effects of Mindfulness and Meditation on Vagally Mediated Heart Rate Variability: A Meta-Analysis.

OBJECTIVE: Heart rate variability (HRV) is a marker of autonomic nervous system function associated with both physical and mental health. Many studies have suggested that mindfulness and meditation-based interventions (MBIs) are associated with improvements in HRV, but findings are mixed, and to date, no comprehensive meta-analysis has synthesized results. METHODS: Systematic literature searches were conducted using PsycINFO, Embase, Medline, CINAHL, ERIC, and Scopus to identify randomized controlled trials (RCTs) investigating the effects of predominantly seated MBIs on resting-state vagally mediated HRV. Risk of bias was judged using the Cochrane Risk of Bias tool. RESULTS: Nineteen RCTs met the criteria for inclusion in the meta-analysis. Random-effects meta-analysis found that MBIs were not efficacious in increasing vagally mediated resting-state HRV relative to control conditions (Hedges g = 0.38, 95% confidence interval [CI] = -0.014 to 0.77). When removing an outlier (g = 3.22), the effect size was reduced, CI narrowed, and findings remained nonsignificant (g = 0.19, 95% CI = -0.02 to 0.39). High heterogeneity in results (I2 = 89.12%) could not be explained by a priori-determined moderators including intervention duration, study setting, and control type. CONCLUSIONS: There is currently insufficient evidence to indicate that MBIs lead to improvements in vagally mediated HRV over control conditions. Future large, well-designed RCTs with low risk of methodological bias could help add to the current evidence to elucidate any role MBIs might play in impacting HRV.

Increase in Daily Steps During the Early Phase of a Physical Activity Intervention for Type 2 Diabetes as a Predictor of Intervention Outcome.

BACKGROUND: This pilot study aimed to test whether increase in daily steps and day-to-day consistency in daily steps during the first several weeks of a physical activity intervention predicted outcomes. METHODS: This was a secondary analysis from two concurrent studies testing a positive psychology-motivational interviewing intervention to increase physical activity and positive affect in individuals with type 2 diabetes. Steps were measured with accelerometers at study assessments (baseline, end-of-treatment, and 8-week follow-up) and were measured daily throughout the intervention by participants using provided pedometers. We calculated change in steps from intervention week 1 to week 3, along with variability in daily steps over the first 3 weeks, using the best fitting regression line modeling their change. Multiple regression analyses tested whether these predictors were associated with change in physical activity at the end of treatment and at 8-week follow-up. Additionally, we explored the utility of specific cutoffs (e.g., 500 steps) for early step change using a minimum p-value approach. RESULTS: In 52 participants, larger step increases by week 3 predicted activity increase at end-of-treatment and follow-up. Variability in early steps was not associated with outcomes. Early increase cutoffs of 500 and 2000 steps may have practical relevance. CONCLUSION: Early response to a physical activity intervention appears to be a useful predictor of outcome and could be used to identify those unlikely to succeed in a given intervention early in treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifiers NCT03150199 and NCT03001999.

Is Optimism a Protective Factor for Cardiovascular Disease?

PURPOSE OF REVIEW: Does optimism contribute to superior cardiovascular health? We examined prospective studies investigating the connections between optimism and cardiovascular health and examining the biological and behavioral mechanisms that may mediate such connections. RECENT FINDINGS: Optimism, independent of sociodemographic, medical, and negative psychological factors, has been prospectively associated with a lower risk of cardiovascular disease and lower rates of cardiac and all-cause mortality. The mechanisms by which optimism may prevent cardiovascular disease remain unclear, but one mechanism may be through health behaviors. Indeed, optimism has been linked with physical activity, healthy diet, and smoking cessation, all of which are associated with better cardiovascular health. Additional studies are needed to: (1) understand the relationships between more dynamic measures of optimism and health outcomes, (2) delineate the mechanisms underlying the relationships between optimism and cardiovascular health, and (3) assess the potential for interventions to modify optimism.

Improving Quality of Life in Hematopoietic Stem Cell Transplantation Survivors Through a Positive Psychology Intervention.

Despite advances in transplantation medicine, psychological distress and quality of life and functional deficits continue to compromise survivorship after hematopoietic stem cell transplantation (HSCT). With increasing numbers of HSCT survivors, supportive oncology interventions that target health-related outcomes in HSCT survivorship are needed. Here we aimed to test the feasibility and acceptability of a group format phone-delivered positive psychology (PP) intervention in HSCT survivors. This is a one-arm pilot study design that adapted and tested an individual PP intervention used in cardiac disease to a phone-delivered group-based program for HSCT survivors who were .4 to 39 years post-transplantation. All participants received an 8-session weekly PP intervention. We assessed feasibility by the enrollment and intervention completion rates. We examined acceptability on a 10-point Likert scale of ease and utility. Unstructured qualitative interviews were used to obtain participant feedback on the intervention for future application in a larger trial. Self-reported assessments on psychological, functional, and quality of life outcomes were administered at baseline and at follow-up (the end of the intervention). Of 64 eligible participants, 29 (45%) enrolled in the study. For the main aim of intervention feasibility and acceptability, participants completed 96% of all PP sessions and rated the ease (7.6 ± 1.7) and utility (8.1 ± 1.1) of sessions highly. Of the self-reported assessments obtained, the PP intervention resulted in improvements in the resilience scale (mean difference, 2.4 ± 5.4; P = .03). From unstructured qualitative interviews, participants reported the PP exercises and intervention helped them to focus on positive emotions and the group format fostered a sense of community and social support. An 8-week phone-delivered group format PP intervention is feasible and acceptable in HSCT survivors. The piloted intervention could be tested with minor modifications in a randomized study to definitively examine the impact of the group format PP intervention on health-related outcomes.

Does Desire to Pursue Pleasurable Activities Matter? The Impact of Pretransplantation Anhedonia on Quality of Life and Fatigue in Hematopoietic Stem Cell Transplantation.

Anhedonia, the loss of the capacity to experience pleasure, is subjectively and biologically distinct from depressed mood. Few studies have specifically examined the association of pretransplantation anhedonia with key functional outcomes (eg, health-related quality of life [QOL]) in patients with hematologic malignancies who have undergone hematopoietic stem cell transplantation (HSCT). Among 248 HSCT recipients enrolled in 2 intervention trials, we examined the associations between pretransplantation anhedonia and both QOL and fatigue at 2 weeks and 6 months post-transplantation. Across time points, patients completed the Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy-Bone Marrow Transplant, and Functional Assessment of Cancer Therapy-Fatigue subscale, which we used to measure depressive symptoms, QOL and fatigue, respectively. Pretransplantation anhedonia was assessed using the corresponding item in the Patient Health Questionnaire-9. The Functional Assessment of Cancer Therapy-Bone Marrow Transplant and the Functional Assessment of Cancer Therapy-Fatigue subscales were used to measure QOL and fatigue. Associations between pretransplantation anhedonia and outcomes were assessed using regression analyses, adjusting for age, sex, transplant type, and intervention group. Ninety-eight patients (39.5%) reported pretransplantation anhedonia, of whom 60 (61%) did not meet the criteria for elevated depressive symptoms. Pretransplantation anhedonia was negatively associated with QOL at 2 weeks (B = -17.21; 95% confidence interval [CI], -23.05 to -11.30; P < .001) and at 6 months (B = -15.10; 95% CI, -21.51 to -8.69; P< .001). Pretransplantation anhedonia was also negatively associated with fatigue (2 weeks: B = -9.35; 95% CI, -12.47 to -6.22; P< .001; 6 months: B = -5.68; 95% CI, -9.07 to -2.28; P= .001). The association between pretransplantation anhedonia and QOL and fatigue remained significant after adjusting for depression scores. Pretransplantation anhedonia is negatively and significantly associated with QOL and fatigue in HSCT recipients. These findings underscore the need to incorporate anhedonia assessment in the evaluation and management of psychological distress in these patients.

The Impact of an Optimism Training Intervention on Biological Measures Associated With Cardiovascular Health: Data From a Randomized Controlled Trial.

OBJECTIVE: Positive psychological constructs, such as optimism, are associated with cardiovascular health, and changes in biological measures associated with heart health have been proposed as potential mediators of these relationships. In this analysis of data from a randomized controlled trial, we examined the impact of an optimism training intervention on biological measures associated with cardiac health in patients with coronary artery disease. METHODS: We analyzed data from an 8-week, randomized, controlled trial of a group-based optimism training intervention in 61 patients with coronary artery disease. High-sensitivity C-reactive protein (hs-CRP), interleukin 6, irisin, and fibrinogen were measured at baseline, 8 weeks, and 16 weeks. Mixed-effects regression analyses were performed to examine the effects of the intervention on changes in biological measures at 8 and 16 weeks. RESULTS: At 8 weeks, the intervention led to significantly greater reductions in hs-CRP (B = -0.851 [standard error {SE} = 0.273, p = .002) and fibrinogen (B = -0.148 [SE = 0.062], p = .016), and a greater increase in irisin (B = 0.252 [SE = 0.114], p = .027) compared with the control condition. These changes persisted at 16 weeks (hs-CRP: B = -1.078 [SE = 0.276], p < .001; fibrinogen: B = -0.270 [SE = 0.062], p < .001; irisin: B = 0.525 [SE = 0.116], p < .001), and interleukin 6 additionally was impacted at this time point (B = -0.214 [SE = 0.064], p = .001). Exploratory mediation analyses failed to identify significant psychological or health behavior mediators of these relationships. CONCLUSIONS: A group-based optimism training intervention resulted in significant, robust, and sustained changes in biological measures associated with cardiac health. Further studies are needed to confirm these findings in a larger sample and identify potential mediating variables. TRIAL REGISTRATION: Iran Registry of Clinical Trials No. 2016070328769 N1.

A Positive Psychology-Motivational Interviewing Intervention to Promote Positive Affect and Physical Activity in Type 2 Diabetes: The BEHOLD-8 Controlled Clinical Trial.

OBJECTIVE: Physical activity is associated with superior health outcomes in patients with type 2 diabetes (T2D), but most T2D patients do not follow physical activity recommendations. The objective of this study was to assess the feasibility and impact of a novel combined positive psychology-motivational interviewing (PP-MI) intervention to promote physical activity in T2D. METHODS: This controlled clinical trial compared an 8-week, phone-delivered PP-MI intervention to an attention-matched MI-enhanced behavioral counseling condition among 60 participants with T2D and suboptimal moderate to vigorous physical activity (MVPA; <150 min/wk). The primary study outcome was feasibility (proportion of sessions completed) and acceptability (0-10 ease and utility ratings of each session). Secondary outcomes were between-group differences in changes in positive affect (main psychological outcome) and accelerometer-measured physical activity (MVPA and steps per day), using mixed-effects regression models, at 8 and 16 weeks. RESULTS: Ninety-two percent of PP-MI sessions were completed, and mean participant ratings of ease/utility were 8.5 to 8.8/10, surpassing a priori benchmarks for feasibility and acceptability. PP-MI participants had small-medium effect size (ES) difference improvements in positive affect compared with MI (8 weeks: estimated mean difference [EMD] = 3.07 [SE = 1.41], p = .029, ES = 0.44; 16 weeks: EMD = 2.92 [SE = 1.73], p = .092, ES = 0.42). PP-MI participants also had greater improvements in MVPA (8 weeks: EMD = 13.05 min/d [SE = 5.00], p = .009, ES = 1.24; 16 weeks: EMD = 7.96 [SE = 4.53], p = .079, ES = 0.75), with similar improvements in steps per day. CONCLUSIONS: The PP-MI intervention was feasible and well accepted. Next-step efficacy studies can more rigorously explore the intervention's effects on physical activity and clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Registration No. NCT03150199.

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.

Beyond depression, anxiety and post-traumatic stress disorder symptoms: Qualitative study of negative emotional experiences in hematopoietic stem cell transplant patients.

OBJECTIVE: Psychological distress impacts a variety of health outcomes in hematopoietic stem cell transplantation (HSCT). Focused qualitative studies on a wider range of psychological distress in HSCT patients are lacking. However, understanding the subtleties of psychological distress (e.g. fear, guilt, loss of control) in HSCT patients is imperative to optimising the psychological well-being of this vulnerable population. To explore psychological distress after transplantation, we conducted semi-structured interviews with 25 HSCT patients. METHODS: Interviews were completed in the first 100 days after transplantation. Interview modules explored psychological distress symptoms in the hospital and during the first 100 days after HSCT, along with the perceived impact of these symptoms on their recovery. RESULTS: Of the negative emotional experiences reported, feeling trapped, fear, guilt, discouragement and powerlessness were frequently expressed. Patients reported that negative emotional states interfered with their motivation to participate in health behaviours important to the transplant recovery. CONCLUSION: As one of the few qualitative studies broadly characterising the nature of negative emotional experiences after HSCT, these findings add to our understanding of the specific psychological challenges in this growing patient population and can inform development of targeted interventions and overall management of psychological distress during HSCT recovery.

Positive psychological constructs and health behavior adherence in heart failure: A qualitative research study.

Psychological well-being may play an important role in health behavior adherence and cardiovascular health, but there has been limited study of well-being in patients with heart failure. In this descriptive qualitative research study, we interviewed 30 patients with heart failure to explore their psychological experiences with heart failure and the perceived associations between positive psychological constructs and adherence to physical activity, diet, and medication recommendations. Interviews were transcribed, then coded in NVivo using directed and conventional content analysis, and the Consolidated Criteria for Reporting Qualitative Research checklist was applied to report our findings. Participants spontaneously reported positive psychological constructs both during an acute phase of illness and 3 months later. Participants most commonly experienced gratitude, acceptance, connectedness, and faith in the setting of heart failure. In contrast, pride, determination, and hope were identified most frequently as playing a role in health behavior adherence. Finally, participants reported a reinforcing relationship between positive constructs and health behavior engagement. These findings suggest that interventions to boost positive constructs have the potential to improve well-being and health behavior adherence in patients with heart failure.

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.

Use of text messages to increase positive affect and promote physical activity in patients with heart disease: The Promoting Activity in Cardiac Patients via Text Messages (PACT) pilot study.

Adherence to physical activity in patients with serious heart disease is critical to recovery and survival. In-person programs to promote activity in cardiac patients have been poorly attended, and increasingly patients are focused on mobile, self-management-based approaches to health. Accordingly, we completed a one-arm trial of a novel one-way 14-day text message intervention among 40 patients with a prior acute coronary syndrome (ACS). The two-pronged psychological-behavioral intervention alternated daily messages focused on promoting psychological well-being with messages providing specific education/advice regarding physical activity. All messages were successfully transmitted, and nearly all participants found the intervention to be helpful (n=37; 92.5%) and performed at least one specific health-related action in response to a text message (n=35; 87.5%). Post-intervention, participants had improvements in happiness (Cohen's d=0.25), determination (d=0.37), depression (d=-0.01), and anxiety (d=-0.13), though not optimism. Moreover, participants reported an increase in moderate physical activity of 105 minutes/week (baseline: 261 [SD 265] minutes/week, follow-up: 366 [SD 519]; d=0.25). These improvements were largely maintained two weeks later, with further increases in physical activity (414 [SD 570] minutes/week). Text messaging focused on well-being and physical activity was well-accepted and associated with improvements in activity and mental health in this high-risk clinical population.

Positive Psychological Constructs and Health Outcomes in Hematopoietic Stem Cell Transplantation Patients: A Systematic Review.

Positive psychological constructs (eg, optimism, positive affect) have been independently associated with superior health outcomes across many medical populations. However, there has been little synthesis of the literature examining these associations among patients with hematologic malignancies receiving hematopoietic stem cell transplantation (HSCT). To address this gap we completed a systematic review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, of studies examining relationships between positive psychological constructs and health-related outcomes (eg, psychiatric symptoms, function, health-related quality of life [HRQoL], or treatment compliance) after HSCT. Eighteen eligible studies (N = 4201; 47% women; mean age, 47.1) were identified. Optimism (n = 12 studies) was the most frequently studied positive construct and HRQoL (examined in n = 11 studies) the most common outcome. All 17 studies with quantitative analyses found a significant (P < .05) association between a positive psychological construct and a health outcome; most but not all controlled for 1 or more relevant covariates. Among patients with hematologic malignancies who receive HSCT, positive psychological constructs appear to be associated with improved HRQoL and other health outcomes. Further work is warranted to more comprehensively understand the independent effects of positive psychological constructs on a variety of health outcomes and to develop interventions to promote well-being that are adapted to the needs of this population.