The DOI matches its Crossref record; 62 of the 65 references it cites were found in a registry or an index; none of the 40 sources its claims cite is checked for support yet.
Feasibility and utility of positive psychology exercises for suicidal inpatients
Abstract
Objective The objective was to assess the feasibility and acceptability of nine positive psychology exercises delivered to patients hospitalized for suicidal thoughts or behaviors, and to secondarily explore the relative impact of the exercises.Method Participants admitted to a psychiatric unit for suicidal ideation or behavior completed daily positive psychology exercises while hospitalized. Likert-scale ratings of efficacy (optimism, hopelessness, perceived utility) and ease of completion were consolidated and compared across exercises using mixed models accounting for age, missing data and exercise order. Overall effects of exercise on efficacy and ease were also examined using mixed models.Results Fifty-two (85.3%) of 61 participants completed at least one exercise, and 189/213 (88.7%) assigned exercises were completed. There were overall effects of exercise on efficacy (χ(2)=19.39; P=.013) but not ease of completion (χ(2)=11.64; P=.17), accounting for age, order and skipped exercises. Effect (Cohen's d) of exercise on both optimism and hopelessness was moderate for the majority of exercises. Exercises related to gratitude and personal strengths ranked highest. Both gratitude exercises had efficacy scores that were significantly (P=.001) greater than the lowest-ranked exercise (forgiveness).Conclusion In this exploratory project, positive psychology exercises delivered to suicidal inpatients were feasible and associated with short-term gains in clinically relevant outcomes.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
In suicidal psychiatric inpatients, nine positive psychology exercises were feasible and acceptable, with 52/61 (85.3%) participants completing at least one exercise and 189/213 (88.7%) assigned exercises completed. Exercises were associated with short-term improvements in optimism and hopelessness, with gratitude and personal strengths ranking highest and the forgiveness letter lowest.
Key findings
- Feasibility: 52 (85.3%) of 61 consenting participants completed baseline measures and at least one exercise; 189/213 (88.7%) assigned exercises were completed, with a mean of 3.63 (S.D. 1.93) of 4.10 (S.D. 2.05) assigned exercises completed.
- There was an overall effect of exercise on efficacy (χ²=19.39; df=8; P=.013) but not ease of completion (χ²=11.64; P=.17), accounting for age, exercise order, and skipped exercises.
- Gratitude letter, counting blessings, and personal strengths had the highest efficacy/modified efficacy scores; forgiveness letter, best possible self (social relationships), and values-based activities had the lowest. The forgiveness letter had significantly lower adjusted mean modified efficacy than the gratitude letter (adjusted mean difference=1.9; 95% CI 0.8–3.0; P=.001) and counting blessings (adjusted mean difference=1.8; 95% CI 0.7–2.9; P=.001).
- Pre-post optimism and hopelessness improved across exercises, with adjusted mean changes of 0.24–1.12 for optimism and 0.30–1.20 for hopelessness. Cohen’s d for each exercise other than the forgiveness letter ranged from 0.48 to 1.19 for both optimism and hopelessness; the forgiveness letter had a nonsignificant change in optimism (P=.38). Qualitative comments were mostly positive: 138/190 (72.3%).
Methods
- Prospective exploratory pilot study on a 24-bed inpatient psychiatric unit; adults admitted for suicidal ideation or suicide attempt between May 2011 and February 2013 were enrolled. Of 61 consenting participants, 52 completed at least one exercise. Baseline measures included QIDS-SR, Beck Hopelessness Scale, and LOT-R; demographic and psychiatric characteristics came from chart review.
- Participants completed one randomly assigned positive psychology exercise daily under a study trainer, with pre/post 5-point Likert ratings of optimism and hopelessness plus ratings of ease and utility. Nine exercises were used: gratitude letter, personal strengths, acts of kindness, important/enjoyable/meaningful activities, counting blessings, best possible self (social relationships), best possible self (accomplishments), forgiveness letter, and behavioral commitment to values-based activities.
- Analyses used mixed-effects regression models with a patient-specific random effect and fixed effects for age and exercise order; modified efficacy and ease scores accounted for noncompleted exercises. Paired t tests and Cohen’s d assessed unadjusted pre-post changes, and qualitative responses were independently reviewed for themes.
Limitations
- Stated in the paper: the sample was largely Caucasian and from a single psychiatric unit; there were no sham or control exercises; participants concurrently received psychological and psychopharmacological interventions; ratings may have been influenced by desire to justify participation or please researchers; and the study did not serially measure suicidality with a validated scale or obtain postdischarge outcomes, so ultimate impact on suicide risk cannot be claimed.
- Evident from the text: this was a small exploratory pilot with no control group, limiting causal inference; outcomes were short-term self-report ratings; and missing exercise data required assumptions in modified efficacy/ease analyses.
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30 Own result · 16 Not checked yet · 14 Own method · 12 Own interpretation · 1 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Effect (Cohen ' s d ) of exercise on both optimism and hopelessness was moderate for the majority of exercises.”
plaindirectn = 61- Asserted: passes — The authors put it forward as true.
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In the paper
“The majority of qualitative comments were positive (138 of 190 comments [72.3%]), with most comments focusing on the high ease of”
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“which had a nonsigni fi cant change in optimism ( P =.38).”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“and moderate to severe hopelessness (BHS=11.37 [S.D. 5.80]; cutoff for high suicide risk=9 [50]).”
plainn = 52- Asserted: passes — The authors put it forward as true.
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In the paper
“Individual exercise completion ranged from 77% ( best possible self social relationships ) to 100% ( counting blessings ).”
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In the paper
“PP exercises were associated with improvement of hopelessness and optimism, central therapeutic targets in this clinical cohort because of their independent links to suicidal thoughts and behaviors [50,51], with moderate effect sizes on these key outcomes.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“However, a small proportion of participants were unable to participate in exercise completion”
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In the paper
“At least half of participants experienced a one-point improvement in optimism and hopelessness for each individual exercise except the forgiveness letter .”
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In the paper
“Participants who completed at least one exercise did not differ signi fi cantly on any baseline characteristic from those who dropped out (all P N .10).”
plainn = 61- Asserted: passes — The authors put it forward as true.
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In the paper
“Cohen ' s d for each exercise other than the forgiveness letter ranged from 0.48 to 1.19 for both optimism and hopelessness.”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Pre -post optimism and hopelessness improved across exercises, with adjusted mean change between 0.24 and 1.12 for optimism and between 0.30 and 1.20 for hopelessness.”
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“There was no signi fi cant effect of exercise on modi fi ed ease scores ( χ 2 =11.64; df=8; P =.17).”
plainn = 52- Asserted: passes — The authors put it forward as true.
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“Major depressive disorder was the primary diagnosis in 82.7% ( n =43)patients.”
plainn = 43- Asserted: passes — The authors put it forward as true.
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“The most common reported reason for exercise noncompletion was insuf fi cient time ( n =9).”
plainn = 9- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“Pre -post optimism and hopelessness improved across exercises, with adjusted mean change between 0.24 and 1.12 for optimism and between 0.30 and 1.20 for hopelessness.”
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“In a population of suicidal patients with high levels of hopelessness and depression, on our primary aim, we found that administration of PP exercises was feasible and well accepted.”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“the forgiveness letter had a signi fi cantly lower adjusted mean modi fi ed ef fi cacy score than the gratitude letter (adjusted mean difference=1.9 [95% con fi dence interval {CI} 0.8 -3.0]; P =.001) and counting blessings (adjusted mean difference=1.8 [95% CI 0.7 -2.9]; P =.001) independent of age and exercise order; these effects remain signi fi cant after Bonferroni correction.”
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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- The authors state this as an assumption: For uncompleted exercises, assuming no pre-post change and assigning the lowest utility score is appropriate for the modified efficacy score.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“exercises focused on life purpose and optimism had lower ef fi cacy ratings than most other exercises (though with Cohen ' s d N .4 on optimism and hopelessness in all cases).”
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In the paper
“The exercise focusing on a personal strength was also associated with substantial improvements in this population and was perceived as easy to complete”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“exercises on gratitude -the gratitude letter and counting blessings -had high utility scores and were associated with substantial improvements in optimism.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Qualitatively, many patients experienced a resurgence of anger or sadness when recalling a past slight and found it dif fi cult to move past these feelings in the midst of crisis [58].”
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“We chose hopelessness and optimism as key outcome measures due to their established links to suicidality [10 -12]. Hopelessness has been associated with completed suicide, independent of severity of mood symptoms [46,47]”
What the sources say
- Not checked yetcites [10] [10] [Hirsch JK, Conner KR, Duberstein PR. Optimism and suicide ideation among young adult college students. Arch Suicide Res 2007;11:177 -85.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0050) - source
- Not checked yetcites [11] [11] [Hirsch JK, Duberstein PR, Conner KR, Heisel MJ, Beckman A, Franus N, et al. Future orientation and suicide ideation and attempts in depressed adults ages 50 and over. Am J Geriatr Psychiatry 2006;14:752 -7.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0055) - source
- Not checked yetcites [12] [12] [Hirsch JK, Duberstein PR, Conner KR, Heisel MJ, Beckman A, Franus N, et al. Future orientation moderates the relationship between functional status and suicide ideation in depressed adults. Depress Anxiety 2007;24:196 -201.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0060) - source
- Not checked yetcites [46] [46] [Beck AT, Steer RA, Kovacs M, Garrison B. Hopelessness and eventual suicide: a 10year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry 1985;142:559 -63.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0220) - source
- Not checked yetcites [47] [47] [Hill RD, Gallagher D, Thompson LW, Ishida T. Hopelessness as a measure of suicidal intent in the depressed elderly. Psychol Aging 1988;3:230 -2.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0225) - source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Optimism, gratitude and other positive states have been associated with reductions in hopelessness, suicidal ideation and suicide attempts, often independent of depression [10 -16].”
What the sources say
- Not checked yetcites [10] [10] [Hirsch JK, Conner KR, Duberstein PR. Optimism and suicide ideation among young adult college students. Arch Suicide Res 2007;11:177 -85.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0050) - source
- Not checked yetcites [11] [11] [Hirsch JK, Duberstein PR, Conner KR, Heisel MJ, Beckman A, Franus N, et al. Future orientation and suicide ideation and attempts in depressed adults ages 50 and over. Am J Geriatr Psychiatry 2006;14:752 -7.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0055) - source
- Not checked yetcites [12] [12] [Hirsch JK, Duberstein PR, Conner KR, Heisel MJ, Beckman A, Franus N, et al. Future orientation moderates the relationship between functional status and suicide ideation in depressed adults. Depress Anxiety 2007;24:196 -201.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0060) - source
- Not checked yetcites [13] [13] [Li D, Zhang W, Li X, Li N, Ye B. Gratitude and suicidal ideation and suicide attempts among Chinese adolescents: direct, mediated, and moderated effects. J Adolesc 2012;35:55 -66.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0065) - source
- Not checked yetcites [14] [14] [Yamokoski CA, Scheel KR, Rogers JR. The role of affect in suicidal thoughts and behaviors. Suicide Life Threat Behav 2011;41:160 -70.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0070) - source
- Not checked yetcites [15] [15] [Heisel MJ, Flett GL. Purpose in life, satisfation with life, and suicide ideation in a clinical sample. J Psychopathol Behav Assess 2004;26:127 -35.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0075) - source
- Not checked yetcites [16] [16] [Seidlitz L, Conwell Y, Duberstein P, Cox C, Denning D. Emotion traits in older suicide attempters and non-attempters. J Affect Disord 2001;66:123 -31.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0080) - source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The order of exercise assignment for each participant wasdetermined via random number generator.”
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Overall, PP exercises have been successfully used by more than 4000 participants in over 50 clinical trials [20,21], though typically in nonclinical populations.”
What the sources say
- Not checked yetcites [20] [20] [Sin NL, Lyubomirsky S. Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly metaanalysis. J Clin Psychol 2009;65:467 -87.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0100) - source
- Not checked yetcites [21] [21] [Bolier L, Haverman M, Westerhof GJ, Riper H, Smit F, Bohlmeijer E. Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health 2013;13:119.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0105) - source
plaindirectn = 4,000- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“For example, optimism and depression are only moderately correlated (median r = -.43 in 10 studies [9]), signaling that these constructs are not simply two sides of the same coin.”
What the sources say
- Not checked yetcites [9] [9] [DuBois CM, Beach SR, Kashdan TB, Nyer MB, Park ER, Celano CM, et al. Positive psychological attributes and cardiac outcomes: associations, mechanisms, and interventions. Psychosomatics 2012;53:303 -18.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0045) - source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These exercises could be easily administered to hospitalized patients, with the goal of increasing positive psychological states by discharge, when suicide risk is high.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Such interventions have the potential to be useful for patients in crisis.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Patients who are psychiatrically hospitalized for a suicide attempt or suicidal ideation (SI) are at very high risk for suicide following discharge [1 -3], with rates of suicide shortly postdischarge more than 100 times greater than the rate in the general population [4].”
What the sources say
- Not checked yetcites [1] [1] [Appleby L, Dennehy JA, Thomas CS, Faragher EB, Lewis G. Aftercare and clinical characteristics of people with mental illness who commit suicide: a case -control study. Lancet 1999;353:1397 -400.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0005) - source
- Not checked yetcites [2] [2] [Appleby L, Shaw J, Amos T, McDonnell R, Harris C, McCann K, et al. Suicide within 12 months of contact with mental health services: national clinical survey. BMJ 1999;318:1235 -9.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0010) - source
- Not checked yetcites [3] [3] [Goldacre M, Seagroatt V, Hawton K. Suicide after discharge from psychiatric inpatient care. Lancet 1993;342:283 -6.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0015) - source
- Not checked yetcites [4] [4] [Qin P, Nordentoft M. Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Arch Gen Psychiatry 2005;62:427 -32.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0020) - source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The fi rst approach analyzed all available data assuming that noncompletion of an exercise was uninformative about the missing value and therefore used the efficacy score and ease as described above.”
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“we compared scores across the exercises on all outcome variables (change in hopelessness, change in optimism, utility, ease, efficacy score ) using mixed-effects regression models with a patient-speci fi c random effect and fi xed effects for age and exercise order.”
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, open-ended qualitative responses were transcribed and independently reviewed for themes by two staff members with experience in qualitative research. A list of themes was generated and combined, with disagreements resolved via discussion and review of the primary material.”
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In this exploratory project, positive psychology exercises delivered to suicidal inpatients were feasible and associated with short-term gains in clinically relevant outcomes.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“a second approach created a modified efficacy score that assumed no pre -post change and assigned the lowest utility score when an exercise was not completed.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“We chose to utilize this guided self-help approach (rather than creating a psychotherapeutic intervention) to provide participants some support and guidance around exercise completion without developing an intervention that would require extensive training, schooling or cost. These factors are aligned with suggestions to create interventions packaged for wide dissemination [48].”
What the sources say
- Not checked yetcites [48] [48] [Kazdin AE, Blase SL. Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on psychological science 2011;6: 21 -37.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0230) - source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Participants concurrently received psychological and psychopharmacological interventions during admission”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our sample was a largely Caucasian population on a single psychiatric unit.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Asking patients to take on ' big ' issues such as life purpose or imagining an optimal future might have been more dif fi cult for some patients at this stage.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“There were no sham or control exercises.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“consistent with prior work fi nding this exercise to be associated with prolonged improvement in depressive symptoms [19].”
What the sources say
- Not checked yetcites [19] [19] [Seligman ME, Steen TA, Park N, Peterson C. Positive psychology progress: empirical validation of interventions. Am Psychol 2005;60:410 -21.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0095) - source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“prior work that has linked gratitude to lower levels of depression, hopelessness and suicidal thoughts/attempts [13,52 -56]”
What the sources say
- Not checked yetcites [13] [13] [Li D, Zhang W, Li X, Li N, Ye B. Gratitude and suicidal ideation and suicide attempts among Chinese adolescents: direct, mediated, and moderated effects. J Adolesc 2012;35:55 -66.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0065) - source
- Not checked yetcites [52] [52] Rosmarin DH, Krumrei EJ, Pargament KI. Are gratitude and spirituality protective factors against psychopathology?. Int J Existential, Psychol Psychother 2010;3. -
- Not checked yetcites [53] [53] [Lyubomirsky S, Tkach C, DiMatteo MR. What are the differences between happiness and self-esteem? Soc Indic Res 2006;78:363 -404.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0250) - source
- Not checked yetcites [54] [54] [Fredrickson BL, Tugade MM, Waugh CE, Larkin GR. What good are positive emotions in crises? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. J Pers Soc Psychol 2003;84:365 -76.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0255) - source
- Not checked yetcites [55] [55] [Wood AM, Maltby J, Gillett R, Linley PA, Joseph S. The role of gratitude in the development of social support, stress, and depression: two longitudinal studies. J Res Pers 2008;42:854 -71.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0260) - source
- Not checked yetcites [56] [56] [Ng MY, Wong WS. The differential effects of gratitude and sleep on psychological distress in patients with chronic pain. J Health Psychol 2013;18:263 -71.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0265) - source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“patients may have felt compelled to rate higher improvements in symptoms after exercise completion than before, either to justify their participation or to please the researchers”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“although ratings were completed in the narrow window between exercise initiation and completion, minimizing potential ' noise ' from other interventions.”
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“a study that found a gratitude letter to reduce depressive symptoms in mildly, but not more severely, depressed participants [57]”
What the sources say
- Not checked yetcites [57] [57] [Sin NL, Della Porta MD, Lyubomirsky S. Tailoring positive psychology interventions to treat depressed individuals. In: Donaldson SI, Csikszentmihalyi M, Nakamura J, editors. Applied positive psychology: improving everday life, health, schools, work, and society. New York: Routledge; 2011. p. 79 -96.](http://refhub.elsevier.com/S0163-8343(13)00298-3/rf0270) -
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“we did not serially measure suicidality via a validated scale or obtain postdischarge outcomes”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
There has been relatively limited study of formal interventions to reduce suicidality during or shortly after psychiatric admission.
“Despite this high risk of suicide, there has been relatively limited study of formal interventions to reduce suicidality during or shortly after psychiatric admission.”
The paper relies on this without support.
It is unclear whether positive psychology exercises would be feasible or acceptable in a broad population of hospitalized suicidal patients, or whether they would impact clinical outcomes in this seriously ill cohort.
“Still, it has been unclear whether PP exercises would be feasible or acceptable in a broad population of hospitalized suicidal patients, or whether they would impact clinical outcomes in this seriously ill cohort, with valid concerns that such exercises may be a ' bridge too far. '”
The paper relies on this without support.
Positive psychology exercises require minimal provider training, are often straightforward and enjoyable, and are accessible to a variety of patients, including those who cannot attend in-person appointments.
“In contrast to more intensive interventions, PP exercises require minimal provider training, are often straightforward and enjoyable, and are accessible to a variety of patients, including those who cannot attend in-person appointments.”
The paper relies on this without support.
Clinical implementation of positive psychology exercises in this setting would likely occur across diagnoses rather than in a single diagnostic cohort.
“given that clinical implementation of the exercises in this setting would likely occur across diagnoses rather than in a single diagnostic cohort.”
The authors state this as an assumption.
Noncompletion of an exercise was uninformative about the missing value.
“The fi rst approach analyzed all available data assuming that noncompletion of an exercise was uninformative about the missing value and therefore used the efficacy score and ease as described above.”
The authors state this as an assumption.
For uncompleted exercises, assuming no pre-post change and assigning the lowest utility score is appropriate for the modified efficacy score.
“a second approach created a modified efficacy score that assumed no pre -post change and assigned the lowest utility score when an exercise was not completed.”
The paper relies on this without support.
The modified efficacy index and ease scores are valid measures of exercise efficacy and ease.
“Modi fi ed ef fi cacy index and ease scores accounted for participants who were assigned but did not complete an exercise.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Assuming the moderate (Cohen d = 0.5) immediate effect of positive psychology exercises on optimism and positive affect that was seen in our prior positive psychology intervention studies, 35 the study was powered at 96% for”
From Feasibility and acceptability of a positive psychological intervention for patients with type 2 diabetes (2016) · cites this paper as [35]
Experimental — accuracy not yet measuredIn the citing paper
“Although some evidence suggests that integrated, multi-session PAIs may be beneficial for individuals with mild-to-moderate depression68 or other health-related conditions (e.g., cardiovascular disease69, suicide70, and HIV71)”
From Upregulating the positive affect system in anxiety and depression: Outcomes of a positive activity intervention: Taylor et al. (2017) · cites this paper as [70]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| Values-based activities | 0.50 | 0.41 - 0.96 | 2.30 | 0.035 | 0.54 | 8/16 (50.0%) |”
Reported 0.5 · recomputed 0.685
Citations
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Metadata
- Authors
- Huffman, J. C., DuBois, C. M., Healy, B. C., Boehm, J. K., Kashdan, T. B., Celano, C. M., Denninger, J. W., & Lyubomirsky, S.
- Affiliations
- Harvard University (US)
- Massachusetts General Hospital (US)
- Chapman University (US)
- George Mason University (US)
- University of California, Riverside (US)
- Corresponding author
- Huffman, Jeff C.
- ORCID
- Venue
- General Hospital Psychiatry
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 36
- Issue
- 1
- Pages
- 88-94
- ISSN
- 0163-8343 (ISSN-L)
- OpenAlex
- W2111863514
- Semantic Scholar
- 7c42f5e5c5cf8c6e16b0b8f1ca48047ffdae691c
- Cited by
- 209
- References
- 65
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 7 · 2023: 22 · 2022: 14 · 2021: 15 · 2020: 8 · 2019: 16 · 2018: 66 · 2017: 14 · 2016: 17 · 2015: 10 · 2014: 8
- FWCI
- 12.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- General Hospital Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Center for Chronic Disease Prevention and Health Promotion (R01-DP00336)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
- Social Sciences › Psychology › Social Psychology › Mental Health via Writing
- Keywords
- suicidal ideation, suicidal behavior, hospitalized patients, feasibility, acceptability, optimism, hopelessness, gratitude, personal strengths, forgiveness, psychiatric hospitalization
- MeSH terms
- Suicide Prevention, Adult, Attitude, Feasibility Studies, Humans, Inpatients, Male, Middle Aged, Psychotherapy, Treatment Outcome, Suicidal Ideation, Hope
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