Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV.

May combine two claims.

IRISS participants rated the intervention as very helpful in coping with HIV diagnosis (M=7.58, SD=2.31), significantly higher than control participants (M=5.93, SD=2.78), t(107)=-3.37, p=.001.

“participants in the IRISS condition rated the intervention to be very helpful in in coping with their HIV diagnosis (M = 7.58, SD = 2.31), indicating high acceptability of the intervention. Control participants also rated participation in their control interviews to be helpful for their coping (M = 5.93, SD = 2.78), though their helpfulness ratings were significantly lower than the IRISS condition”

May combine two claims.

Of the 79 control participants, 96% attended at least one session and 81.6% completed all six sessions.

“Of the 79 allocated to the control, 96% attended at least one session. Of these, 81.6% (62 of 76) completed all 6 sessions.”

May combine two claims.

The intervention did not influence the likelihood of participants being on antiretroviral therapy or the likelihood that participants reported any missed doses of ART (all ps > .35).

“Generalized estimating equations revealed that the intervention did not influence the likelihood of participants being on antiretroviral therapy or the likelihood that participants reported any missed doses of ART (all ps > .35; Table 4).”

May combine two claims.

Of the 80 intervention participants, 92.5% attended at least one session and 77% of these completed all six sessions.

“Of the 80 participants randomized to the intervention, 92.5% attended at least one session and 77% of these (57 of 74) completed all six.”

May combine two claims.

The intervention had a large and significant effect on the likelihood of antidepressant use over time (p=.006), with control increasing linearly and IRISS remaining stable between 15% and 20%.

“Generalized estimating equations revealed a large and significant effect of the intervention on the likelihood of using anti-depressants (1 = any use, 0 = no use) over time (p = .006; Table 3). The likelihood of antidepressant use in the control condition increased linearly over the course of the study, whereas the likelihood of antidepressant use in the IRISS condition remained relatively stable”

May combine two claims.

IRISS participants showed decreases in symptom severity over time whereas control participants showed relatively stable levels (p=.16 linear; p=.03 quadratic).

“Linear mixed effects modeling revealed that IRISS participants showed decreases in symptom severity over time whereas control participants showed relatively stable levels of symptom severity over time (p = .16 linear; p = .03 quadratic; Table 4.)”

May combine two claims.

There were no group differences in change over time in the likelihood of participants reporting any stimulant use (p=.25) or the likelihood of reporting transmission risk sexual behavior (p=.59).

“Finally, there were no group differences in change over time in the likelihood of participants reporting any stimulant use (p = .25) or the likelihood of reporting transmission risk sexual behavior (p = .59; Table 4).”

May combine two claims.

For past week positive affect, there were no significant group differences in change from baseline or within time point.

“For past week positive affect, there were no significant group differences in the primary analysis of change from baseline or for the secondary within time point group differences.”

May combine two claims.

The intervention condition only increased .28 on the DES, significantly short of the estimated effect of .48 based on the observational study.

“the intervention condition only increased .28 on the DES, significantly short of what we estimated as the effect based on the observational study.”

May combine two claims.

The between-group difference in change from baseline over time for past-day positive affect was not statistically significant (p = .12), with a small effect size (d = .30).

“the group difference in change from baseline over time was not statistically significant (p = .12) and the effect size was small (d = .30)”

May combine two claims.

Participants in the IRISS intervention showed a trend toward being more likely to have suppressed viral load (d = .43 for group difference in change from baseline to 15 months), but the effect did not reach statistical significance compared to the control condition.

“Our data suggest a trend for participants in the IRISS intervention to be more likely to have suppressed viral load (d = .43 for group difference in change from baseline to 15 months), although the effect did not reach statistical significance compared to the control condition.”

May combine two claims.

Daily recalled positive affect responded to the intervention, whereas past-week positive affect using the same emotion terms did not.

“Daily recalled positive affect was responsive to the intervention whereas past-week positive affect, using the same emotion terms, was not.”

May combine two claims.

For antidepressant use, the effect sizes were d=−.32 for change from baseline to 5 months, d=−.62 for 10 months, and d=−.78 for 15 months.

“For antidepressant use the effect sizes were d = −.32 for change from baseline to 5 months, d = −.62 for 10 months, and d = −.78 for 15 months.”

Classified as probably not a substantial claim. May combine two claims.

Positive affect and related constructs such as optimism are linked to better relationships, creativity, work quality, prosocial behavior, physical health, and lower mortality in healthy and chronically ill groups.

“Positive affect and related constructs like optimism are associated with a host of beneficial outcomes including better relationships, more creativity, better quality of work, higher likelihood of prosocial behavior (Lyubomirsky, King, & Diener, 2005), better physical health (Pressman & Cohen, 2005) and even a lower risk of mortality in healthy as well as chronically ill samples”

• cites Lyubomirsky et al., 2005Not checked yet

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• cites Pressman & Cohen, 2005Not checked yet

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• cites Chida & Steptoe, 2008Not checked yet

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May combine two claims.

The evidence base for positive psychological interventions has methodological weaknesses including small sample sizes, lack of randomized trials, and failure to report intent-to-treat analyses.

“However, the evidence base for positive psychological interventions is still fairly new and has suffered from a number of methodological weaknesses including small sample sizes, lack of randomized trials, and failure to report intent-to-treat analyses (Bolier et al., 2013).”

• cites Bolier et al., 2013Not checked yet

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May combine two claims.

The IRISS intervention has demonstrated feasibility, acceptability, and preliminary efficacy in pilot tests in a number of different samples.

“The intervention has demonstrated feasibility, acceptability, and preliminary efficacy in pilot tests in a number of different samples (Caponigro et al., 2013; Carrico et al., 2015; Cheung et al., in press; Cohn et al., 2014; Dowling et al., 2014; Moskowitz et al., 2012).”

• cites Caponigro et al., 2013Not checked yet

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• cites Carrico et al., 2015Not checked yet

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• cites Moskowitz et al., 2012Not checked yet

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Classified as probably not a substantial claim.

The study conducted intent-to-treat analyses using longitudinal growth models.

“We then conducted intent-to-treat analyses, using longitudinal growth models to examine patterns of longitudinal change as a function of intervention condition.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study was registered with Clinicaltrials.gov (#NCT00720733).

“The study was registered with Clinicaltrials.gov (#NCT00720733.)”

Classified as probably not a substantial claim. May combine two claims.

Randomization used block randomization with randomly varying block sizes of 2, 4, or 6, and the random number sequence was generated by the study statistician.

“the participant was randomly assigned to the intervention or control condition using block randomization with randomly varying block sizes of 2, 4, or 6, in order to prevent the project director from predicting what the next assignment would be. The random number sequence was generated by the study statistician.”

May combine two claims.

Retention through the 15-month post-diagnosis assessment was 71.6% and did not differ by condition.

“One hundred fourteen participants (71.6%) were retained through the 15-month post-diagnosis assessment and retention did not differ by condition”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Fidelity was assessed qualitatively with a checklist and comments for each session component, but quantitative ratings were not tracked.

“Fidelity was assessed qualitatively with a checklist and comments for each component of a session but quantitative ratings were not tracked.”

Classified as probably not a substantial claim.

Assessments were conducted by trained interviewers blind to study condition until the end of the 15-month interview.

“Assessments were conducted oneon-one by trained interviewers who were blind to study condition until the end of the 15-month interview.”

May combine two claims.

Among people living with HIV, negative affect is associated with increased sexual risk behavior, poorer linkage to HIV care, and more rapid HIV disease progression.

“which is associated with increased sexual risk behavior (Marks, Bingman, & Duval, 1998), poorer linkage to HIV care (Bhatia et al., 2011) and more rapid HIV disease progression (Ickovics et al., 2001; Leserman, 2007; Mayne, Vittinghoff, Chesney, Barrett, & Coates, 1996).”

• cites Marks et al., 1998Not checked yet

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• cites Bhatia et al., 2011Not checked yet

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• cites Ickovics et al., 2001Not checked yet

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May combine two claims.

In Charlson and colleagues' trials, positive affect intervention was associated with greater likelihood of achieving exercise recommendations in coronary angioplasty patients and significant improvements in medication adherence among African Americans with hypertension, but not with decreases in blood pressure in hypertension or increased physical activity in asthma.

“This intervention was associated with greater likelihood of achieving exercise recommendations in patients who had undergone coronary angioplasty (Peterson et al., 2012), significant improvements in adherence to medication among African Americans with hypertension (Ogedegbe et al., 2012), but was not associated with decreases in blood pressure in patients with hypertension (Boutin-Foster et al., 2”

• cites Peterson et al., 2012Not checked yet

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• cites Ogedegbe et al., 2012Not checked yet

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• cites Boutin-Foster et al., 2016Not checked yet

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May combine two claims.

Meta-analyses indicate that positive psychological interventions are effective for increasing positive affective states and reducing negative states, with small to medium effect sizes sustained over time.

“Meta analyses indicate that these interventions are effective for increasing positive affective states and reducing negative states, with small to medium effect sizes that are sustained over time (Bolier et al., 2013; Sin & Lyubomirsky, 2009).”

• cites Bolier et al., 2013Not checked yet

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• cites Sin & Lyubomirsky, 2009Not checked yet

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May combine two claims.

Participants in IRISS were not representative of people newly diagnosed with HIV in the U.S. and were more reflective of the demographics of people testing positive in the San Francisco Bay area.

“Participants in IRISS were not representative of people newly diagnosed with HIV in the U.S and, instead, were more reflective of the demographics of people testing positive in the San Francisco Bay area, where the study was conducted.”

May combine two claims.

The study met five of the six criteria established by the Cochrane collaboration, including longer term follow-up, baseline comparability of intervention and control conditions, N > 50, completeness of follow-up data, and intention to treat analyses.

“The study was high quality in that it met five of the six criteria established by the Cochrane collaboration (Higgins & Green, 2008) including longer term follow-up, baseline comparability of intervention and control conditions, N > 50, completeness of follow-up data, and intention to treat analyses.”

• cites Higgins & Green, 2008Not checked yet

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May combine two claims.

The pattern of increasing effects suggests that participants may be incorporating the skills into their lives, and as practice becomes more habitual, the benefits increase.

“This pattern suggests that participants may be incorporating the skills into their lives, and as the practice of the skills becomes more habitual, the benefits are increasing.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

To the authors' knowledge, this is the first test of a positive affect regulation intervention in people newly diagnosed with HIV.

“To our knowledge, this is the first test of a positive affect regulation intervention in people newly diagnosed with HIV.”

May combine two claims.

The results clearly show that the intervention is acceptable and feasible and holds promise as an efficacious intervention for people in the initial stages of adjustment to a serious chronic illness.

“The results clearly show that the intervention is acceptable and feasible and holds promise as an efficacious intervention for people in the initial stages of adjustment to a serious chronic illness.”

Probably not a substantial claim: may not pass S2 (checkable).

Overall, the findings of the present study, combined with the growing body of research supporting the efficacy of positive interventions, indicate that such interventions may produce key benefits for individuals faced with chronic illnesses, psychological disorders, or other types of life stress.

“Overall, the findings of the present study, combined with the growing body of research supporting the efficacy of positive interventions, indicate that such interventions may produce key benefits for individuals faced with chronic illnesses, psychological disorders, or other types of life stress.”

Classified as probably not a substantial claim.

The analytic strategy allowed the study to account for missing data.

“our analytic strategy allowed us to account for missing data.”

Classified as probably not a substantial claim. May combine two claims.

A positive affect/self-affirmation intervention predicted health behavior change but did not specifically demonstrate whether increases in positive affect mediated the effects.

“Charlson, and colleagues (Charlson et al., 2014; Peterson et al., 2013) report that a positive affect/self-affirmation intervention predicted health behavior change but did not specifically demonstrate whether increases in positive affect mediated the effects.”

• cites Charlson et al., 2014Not checked yet

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• cites Peterson et al., 2013Not checked yet

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May combine two claims.

The Day Reconstruction Method better approximates momentary emotion measurement than retrospective past-week reports, which may explain the stronger intervention effects observed for past-day versus past-week positive affect.

“The Day Reconstruction Method (Kahneman et al., 2004) we used to assess past-day emotion better approximates this momentary emotion measurement than does asking participants to report how they felt over the past week and may explain why we had stronger effects in the past-day vs. the past-week format.”

• cites Kahneman et al., 2004Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In a meta-analysis of positive interventions, the largest pre-post effect was on subjective well-being (d=.34), followed by depression (d=.23) and psychological health (d=.20).

“In their meta-analysis of positive interventions, Bolier and colleagues (2013) found that positive interventions had the largest pre-post effect on subjective well-being (the cognitive and/or affective appraisal of one's life as a whole; d=.34), followed by depression (d=.23), and psychological health (includes mastery, hope, and purpose in life; d=.20).”

• cites Bolier et al., 2013Not checked yet

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May combine two claims.

Blinding of subjects to condition was not possible once participants started sessions in their assigned condition, although they were blind to details of the content of the conditions at enrollment and randomization.

“The 6th criteria, blinding of subjects to condition, was not possible once participants started sessions in their assigned condition, although they were blind as to details of the content of the conditions at the time of enrollment and randomization”

Classified as probably not a substantial claim.

Positive thoughts, positive behaviors, and satisfaction of needs such as autonomy, relatedness, and competence are as important as positive emotions in mediating the beneficial effects of positive psychological interventions.

“Lyubormirsky and Layous (2013) suggest that positive thoughts, positive behaviors, and satisfaction of needs such as autonomy, relatedness, and competence are as important as positive emotions in mediating the beneficial effects of positive psychological interventions.”

• cites Lyubomirsky & Layous, 2013Not checked yet

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May combine two claims.

The IRISS intervention was delivered individually and in-person and was quite time intensive for both the study team and the participants, which lessens the likelihood that it can go to scale in this format.

“the IRISS intervention was delivered individually and in-person and thus was quite time intensive for both the study team and the participants which lessens the likelihood that it can go to scale in this format.”

Classified as probably not a substantial claim.

These results suggest that interventions such as IRISS may be a useful addition to programs designed to improve engagement in the full continuum of HIV care.

“these results suggest that interventions such as IRISS may be a useful addition to programs designed to improve engagement in the full continuum of HIV care (Mugavero, Amico, Horn, & Thompson, 2013).”

• cites Mugavero, Amico, Horn, & Thompson, 2013Not checked yet

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