Objective. Osteoarthritis is a leading cause of disability for which there is no cure. Psychosoci... more Objective. Osteoarthritis is a leading cause of disability for which there is no cure. Psychosocialoriented treatments are underexplored. We developed and tested an intervention to build positive psychological skills (e.g., gratitude) to reduce osteoarthritis symptom severity, including pain and functioning, and to improve psychosocial wellbeing in patients with knee or hip osteoarthritis.
Knee osteoarthritis is a painful, disabling condition that disproportionately affects African Ame... more Knee osteoarthritis is a painful, disabling condition that disproportionately affects African Americans. Existing arthritis treatments yield small to moderate improvements in pain and have not been effective at reducing racial disparities in the management of pain. The biopsychosocial model of pain and evidence from the positive psychology literature, suggest that increasing positive psychological skills (e.g., gratitude, kindness) could improve pain and functioning and reduce disparities in osteoarthritis pain management. Activities to cultivate positive psychological skills have been developed and validated; however, they have not been tested in patients with osteoarthritis, their effects on racial differences in health outcomes have not been examined, and evidence of their effects on health outcomes in patients with other chronic illnesses is of limited quality. In this article we describe the rationale and design of Staying Positive with Arthritis (SPA) study, a randomized controlled trial in which 180 African American and 180 White primary care patients with chronic pain from knee osteoarthritis will be randomized to a 6-week program of either positive skill-building activities or neutral control activities. The primary outcomes will be self-reported pain and functioning as measured by the WOMAC Osteoarthritis Index. We will assess these primary outcomes and potential, exploratory psychosocial mediating variables at an in-person baseline visit and by telephone at 1, 3, and 6months following completion of the assigned program. If effective, the SPA program would be a novel, theoretically-informed psychosocial intervention to improve quality and equity of care in the management of chronic pain from osteoarthritis.
Assessing the efficacy of Internet interventions that are already in the market introduces both c... more Assessing the efficacy of Internet interventions that are already in the market introduces both challenges and opportunities. While vast, often unprecedented amounts of data may be available (hundreds of thousands, and sometimes millions of participants with high dimensions of assessed variables), the data are observational in nature, are partly unstructured (eg, free text, images, sensor data), do not include a natural control group to be used for comparison, and typically exhibit high attrition rates. New approaches are therefore needed to use these existing data and derive new insights that can augment traditional smaller-group randomized controlled trials. Our objective was to demonstrate how emerging big data approaches can help explore questions about the effectiveness and process of an Internet well-being intervention. We drew data from the user base of a well-being website and app called Happify. To explore effectiveness, multilevel models focusing on within-person variation explored whether greater usage predicted higher well-being in a sample of 152,747 users. In addition, to explore the underlying processes that accompany improvement, we analyzed language for 10,818 users who had a sufficient volume of free-text response and timespan of platform usage. A topic model constructed from this free text provided language-based correlates of individual user improvement in outcome measures, providing insights into the beneficial underlying processes experienced by users. On a measure of positive emotion, the average user improved 1.38 points per week (SE 0.01, t122,455=113.60, P<.001, 95% CI 1.36-1.41), about an 11% increase over 8 weeks. Within a given individual user, more usage predicted more positive emotion and less usage predicted less positive emotion (estimate 0.09, SE 0.01, t6047=9.15, P=.001, 95% CI .07-.12). This estimate predicted that a given user would report positive emotion 1.26 points (or 1.26%) higher after a 2-week period when they used Happify daily than during a week when they didn't use it at all. Among highly engaged users, 200 automatically clustered topics showed a significant (corrected P<.001) effect on change in well-being over time, illustrating which topics may be more beneficial than others when engaging with the interventions. In particular, topics that are related to addressing negative thoughts and feelings were correlated with improvement over time. Using observational analyses on naturalistic big data, we can explore the relationship between usage and well-being among people using an Internet well-being intervention and provide new insights into the underlying mechanisms that accompany it. By leveraging big data to power these new types of analyses, we can explore the workings of an intervention from new angles, and harness the insights that surface to feed back into the intervention and improve it further in the future.
ABSTRACT As PPI research embraces the use of the Internet, it is incumbent on the research commun... more ABSTRACT As PPI research embraces the use of the Internet, it is incumbent on the research community to keep up with the ever-evolving best practices in online intervention research. This paper provides an overview of current practices in online positive psychological intervention (OPPI) research and suggests improvements to those practices. Drawing from the broader online intervention literature, the paper outlines important considerations in the design of OPPIs (including user engagement, dosage, and free choice) as well as in their empirical evaluation (including sample selection, statistical approaches, and comparison groups).
Happiness-increasing interventions demonstrate significant variation in outcomes, suggesting that... more Happiness-increasing interventions demonstrate significant variation in outcomes, suggesting that the people who use them might be as important as the interventions themselves to determine efficacy. In light of this, instructive interventions might not be necessary to increase happiness given a population with knowledge of happiness-increasing strategies. We recruited 270 participants with knowledge of positive psychology to receive six weeks of online psychoeducation. We explored participants' use of the website, reported use of happiness strategies, and changes in well-being. Those who spent more time on the website reported smaller changes in well-being than those who spent less time on the website. Conversely, those who reported employing more happiness strategies reported greater increases in well-being than those who used fewer strategies. This shows that for those already familiar with positive psychology, information, rather than instruction, might increase well-being. This has implications for studies evaluating the efficacy of happiness-increasing interventions more broadly.
Low positive and high negative affect (NA) predict low rates of smoking abstinence among smokers ... more Low positive and high negative affect (NA) predict low rates of smoking abstinence among smokers making a quit attempt. Positive psychotherapy can both increase positive affect (PA) and decrease NA and, therefore, may be a useful adjunct to behavioral smoking counseling. The purpose of the present study was to assess the feasibility and acceptability of a positive psychotherapy for smoking cessation (PPT-S) intervention that integrates standard smoking cessation counseling with nicotine patch and a package of positive psychology interventions. We delivered PPT-S to 19 smokers who were low in PA at baseline. Rates of session attendance and satisfaction with treatment were high, and most participants reported using and benefiting from the positive psychology interventions. Almost one-third of the participants (31.6%) sustained smoking abstinence for six months after their quit date. Future studies to assess the relative efficacy of PPT-S compared to standard smoking cessation treatment are warranted.
Inducing temporary positive states reduces pain and increases pain tolerance in laboratory studie... more Inducing temporary positive states reduces pain and increases pain tolerance in laboratory studies. We tested whether completing positive activities in one's daily life produces longterm reductions in self-reported bodily pain in a randomized controlled trial of an online positive activities intervention. Participants recruited via the Web were randomly assigned to complete 0, 2, 4, or 6 positive activities administered online over a 6-week period. Follow-up assessments were collected at the end of 6 weeks and at 1, 3, and 6 months postintervention. We used linear mixed effects models to examine whether the intervention reduced pain over time among those who had a score <67 on the bodily pain subscale of the Short Form-36 at baseline (N = 417; pain scores range from 0 to 100; higher scores indicate less pain). Mean pain scores improved from baseline to 6 months in the 2-activity (55.7 to 67.4), 4-activity (54.2 to 71.0), and 6-activity (50.9 to 67.9) groups. Improvements were significantly greater (P < .05) in the 4-activity and 6-activity groups than in the 0activity control group (54.1 to 62.2) in unadjusted and adjusted models. This study suggests that positive activities administered online can reduce bodily pain in adults with at least mild to moderate baseline pain.
ABSTRACT Positive psychology aims to understand the positive side of human functioning, expanding... more ABSTRACT Positive psychology aims to understand the positive side of human functioning, expanding research on positive behaviors, cognitions, emotions, and character traits. The findings of this research have highlighted strategies (e.g., savoring, gratitude, kindness, social relationships, and hope and meaning) that, when practiced, lead to increases in individual happiness. Researchers and practitioners have translated these strategies into effective interventions that can be disseminated directly to individuals, allowing them to actively pursue greater levels of happiness. We present a summary of the current state of positive psychological interventions as they pertain to self-help. A major focus in the application of positive psychological interventions for self-help is dissemination—ensuring that those interested have access to evidence-based strategies to increase their happiness. The future of self-help involves spreading these practices through classes, workshops, books, and increasingly prevalent technologies such as Internet sites and mobile applications. We outline unique concerns related to providing self-help in the absence of professional support including motivation and engagement, variety and flexibility, and person-activity fit. As positive psychology has developed a host of evidence-based practices, the next stage of research requires implementing these strategies in ways to support their use in real-world contexts. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
Objective. Osteoarthritis is a leading cause of disability for which there is no cure. Psychosoci... more Objective. Osteoarthritis is a leading cause of disability for which there is no cure. Psychosocialoriented treatments are underexplored. We developed and tested an intervention to build positive psychological skills (e.g., gratitude) to reduce osteoarthritis symptom severity, including pain and functioning, and to improve psychosocial wellbeing in patients with knee or hip osteoarthritis.
Knee osteoarthritis is a painful, disabling condition that disproportionately affects African Ame... more Knee osteoarthritis is a painful, disabling condition that disproportionately affects African Americans. Existing arthritis treatments yield small to moderate improvements in pain and have not been effective at reducing racial disparities in the management of pain. The biopsychosocial model of pain and evidence from the positive psychology literature, suggest that increasing positive psychological skills (e.g., gratitude, kindness) could improve pain and functioning and reduce disparities in osteoarthritis pain management. Activities to cultivate positive psychological skills have been developed and validated; however, they have not been tested in patients with osteoarthritis, their effects on racial differences in health outcomes have not been examined, and evidence of their effects on health outcomes in patients with other chronic illnesses is of limited quality. In this article we describe the rationale and design of Staying Positive with Arthritis (SPA) study, a randomized controlled trial in which 180 African American and 180 White primary care patients with chronic pain from knee osteoarthritis will be randomized to a 6-week program of either positive skill-building activities or neutral control activities. The primary outcomes will be self-reported pain and functioning as measured by the WOMAC Osteoarthritis Index. We will assess these primary outcomes and potential, exploratory psychosocial mediating variables at an in-person baseline visit and by telephone at 1, 3, and 6months following completion of the assigned program. If effective, the SPA program would be a novel, theoretically-informed psychosocial intervention to improve quality and equity of care in the management of chronic pain from osteoarthritis.
Assessing the efficacy of Internet interventions that are already in the market introduces both c... more Assessing the efficacy of Internet interventions that are already in the market introduces both challenges and opportunities. While vast, often unprecedented amounts of data may be available (hundreds of thousands, and sometimes millions of participants with high dimensions of assessed variables), the data are observational in nature, are partly unstructured (eg, free text, images, sensor data), do not include a natural control group to be used for comparison, and typically exhibit high attrition rates. New approaches are therefore needed to use these existing data and derive new insights that can augment traditional smaller-group randomized controlled trials. Our objective was to demonstrate how emerging big data approaches can help explore questions about the effectiveness and process of an Internet well-being intervention. We drew data from the user base of a well-being website and app called Happify. To explore effectiveness, multilevel models focusing on within-person variation explored whether greater usage predicted higher well-being in a sample of 152,747 users. In addition, to explore the underlying processes that accompany improvement, we analyzed language for 10,818 users who had a sufficient volume of free-text response and timespan of platform usage. A topic model constructed from this free text provided language-based correlates of individual user improvement in outcome measures, providing insights into the beneficial underlying processes experienced by users. On a measure of positive emotion, the average user improved 1.38 points per week (SE 0.01, t122,455=113.60, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001, 95% CI 1.36-1.41), about an 11% increase over 8 weeks. Within a given individual user, more usage predicted more positive emotion and less usage predicted less positive emotion (estimate 0.09, SE 0.01, t6047=9.15, P=.001, 95% CI .07-.12). This estimate predicted that a given user would report positive emotion 1.26 points (or 1.26%) higher after a 2-week period when they used Happify daily than during a week when they didn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;t use it at all. Among highly engaged users, 200 automatically clustered topics showed a significant (corrected P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001) effect on change in well-being over time, illustrating which topics may be more beneficial than others when engaging with the interventions. In particular, topics that are related to addressing negative thoughts and feelings were correlated with improvement over time. Using observational analyses on naturalistic big data, we can explore the relationship between usage and well-being among people using an Internet well-being intervention and provide new insights into the underlying mechanisms that accompany it. By leveraging big data to power these new types of analyses, we can explore the workings of an intervention from new angles, and harness the insights that surface to feed back into the intervention and improve it further in the future.
ABSTRACT As PPI research embraces the use of the Internet, it is incumbent on the research commun... more ABSTRACT As PPI research embraces the use of the Internet, it is incumbent on the research community to keep up with the ever-evolving best practices in online intervention research. This paper provides an overview of current practices in online positive psychological intervention (OPPI) research and suggests improvements to those practices. Drawing from the broader online intervention literature, the paper outlines important considerations in the design of OPPIs (including user engagement, dosage, and free choice) as well as in their empirical evaluation (including sample selection, statistical approaches, and comparison groups).
Happiness-increasing interventions demonstrate significant variation in outcomes, suggesting that... more Happiness-increasing interventions demonstrate significant variation in outcomes, suggesting that the people who use them might be as important as the interventions themselves to determine efficacy. In light of this, instructive interventions might not be necessary to increase happiness given a population with knowledge of happiness-increasing strategies. We recruited 270 participants with knowledge of positive psychology to receive six weeks of online psychoeducation. We explored participants&amp;amp;amp;amp;#39; use of the website, reported use of happiness strategies, and changes in well-being. Those who spent more time on the website reported smaller changes in well-being than those who spent less time on the website. Conversely, those who reported employing more happiness strategies reported greater increases in well-being than those who used fewer strategies. This shows that for those already familiar with positive psychology, information, rather than instruction, might increase well-being. This has implications for studies evaluating the efficacy of happiness-increasing interventions more broadly.
Low positive and high negative affect (NA) predict low rates of smoking abstinence among smokers ... more Low positive and high negative affect (NA) predict low rates of smoking abstinence among smokers making a quit attempt. Positive psychotherapy can both increase positive affect (PA) and decrease NA and, therefore, may be a useful adjunct to behavioral smoking counseling. The purpose of the present study was to assess the feasibility and acceptability of a positive psychotherapy for smoking cessation (PPT-S) intervention that integrates standard smoking cessation counseling with nicotine patch and a package of positive psychology interventions. We delivered PPT-S to 19 smokers who were low in PA at baseline. Rates of session attendance and satisfaction with treatment were high, and most participants reported using and benefiting from the positive psychology interventions. Almost one-third of the participants (31.6%) sustained smoking abstinence for six months after their quit date. Future studies to assess the relative efficacy of PPT-S compared to standard smoking cessation treatment are warranted.
Inducing temporary positive states reduces pain and increases pain tolerance in laboratory studie... more Inducing temporary positive states reduces pain and increases pain tolerance in laboratory studies. We tested whether completing positive activities in one's daily life produces longterm reductions in self-reported bodily pain in a randomized controlled trial of an online positive activities intervention. Participants recruited via the Web were randomly assigned to complete 0, 2, 4, or 6 positive activities administered online over a 6-week period. Follow-up assessments were collected at the end of 6 weeks and at 1, 3, and 6 months postintervention. We used linear mixed effects models to examine whether the intervention reduced pain over time among those who had a score <67 on the bodily pain subscale of the Short Form-36 at baseline (N = 417; pain scores range from 0 to 100; higher scores indicate less pain). Mean pain scores improved from baseline to 6 months in the 2-activity (55.7 to 67.4), 4-activity (54.2 to 71.0), and 6-activity (50.9 to 67.9) groups. Improvements were significantly greater (P < .05) in the 4-activity and 6-activity groups than in the 0activity control group (54.1 to 62.2) in unadjusted and adjusted models. This study suggests that positive activities administered online can reduce bodily pain in adults with at least mild to moderate baseline pain.
ABSTRACT Positive psychology aims to understand the positive side of human functioning, expanding... more ABSTRACT Positive psychology aims to understand the positive side of human functioning, expanding research on positive behaviors, cognitions, emotions, and character traits. The findings of this research have highlighted strategies (e.g., savoring, gratitude, kindness, social relationships, and hope and meaning) that, when practiced, lead to increases in individual happiness. Researchers and practitioners have translated these strategies into effective interventions that can be disseminated directly to individuals, allowing them to actively pursue greater levels of happiness. We present a summary of the current state of positive psychological interventions as they pertain to self-help. A major focus in the application of positive psychological interventions for self-help is dissemination—ensuring that those interested have access to evidence-based strategies to increase their happiness. The future of self-help involves spreading these practices through classes, workshops, books, and increasingly prevalent technologies such as Internet sites and mobile applications. We outline unique concerns related to providing self-help in the absence of professional support including motivation and engagement, variety and flexibility, and person-activity fit. As positive psychology has developed a host of evidence-based practices, the next stage of research requires implementing these strategies in ways to support their use in real-world contexts. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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