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Patients with heart failure (HF) frequently struggle to adhere to health behaviors, and psychological factors may contribute to nonadherence. We examined the feasibility and acceptability of a 10-week, positive psychology-(PP-) based intervention to promote health behavior adherence in patients (N=10) with mild to moderate HF and suboptimal health behavior adherence. Participants engaged in weekly phone sessions, completed PP exercises (e.g., writing a gratitude letter, using a personal strength), and set goals related to diet, medication adherence, and physical activity. Feasibility was assessed by the number of sessions completed, and acceptability by participant ratings of ease and utility. Preliminary efficacy was measured by changes in psychological and adherence outcomes. The intervention was feasible (87% of exercises completed) and acceptable. Furthermore, in exploratory analyses, the intervention was associated with improvements in psychological and health behavior adherence outcomes. Larger, randomized trials are needed to further investigate the utility of this intervention.

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, telephonedelivered 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 5-point Likerttype 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, nonsignificant effects on negative psychological constructs. Conclusions: Larger, randomized trials are needed to further evaluate the efficacy of this intervention in this high-risk population.

Most mid-life adults have at least one chronic medical condition (CMC) and are at risk for developing additional CMCs. Stressors specific to this life stage may contribute to CMC development by hindering healthy behaviors. The goal of this study was to compare sources and intensity of distress, as they relate to health behaviors, between mid-life and non-mid-life adults with CMCs. We utilized a mixed-methods approach by analyzing quantitative self-report measures of psychiatric symptoms and psychological well-being, with in-depth, semi-structured qualitative interviews to identify sources of stress in three cohorts of patients with CMCs (heart failure, type 2 diabetes, and coronary artery disease). Between-group differences on self-report measures were compared via independent samples t-tests and relevant themes from interview transcripts were compared via chi-square analysis. We found that mid-life participants (n = 30) reported greater psychological distress (depression/anxiety) than non-mid-life (n = 62) participants (Hospital Anxiety and Depression Scale scores 13.8 [SD 7.3] vs. 10.6 [SD 6.6]; t(90)=2.13; p = .035), and qualitative analysis revealed several specific sources of stress significantly more common (p < .001) in mid-life adults. Interventions targeting the needs of this population could reduce distress, improve health behaviors, and have a major impact on public health.

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