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Cited by 188Diabetes Management and EducationPsychological Well-being and Life SatisfactionDigital Mental Health Interventions

An online positive affect skills intervention reduces depression in adults with type 2 diabetes

Open access
Cohn, Michael A., Pietrucha, Martha E., Saslow, Laura R., Hult, Jen R., Moskowitz, Judith T.·2014·The Journal of Positive Psychology
DOI 10.1080/17439760.2014.920410PMC PMC4157680
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Abstract

Positive affect predicts improved glycemic control and longevity in adults with type 2 diabetes. We tested Developing Affective HeaLth to Improve Adherence (DAHLIA), a self-paced online intervention for type 2 diabetes that teaches positive affect skills such as savoring, gratitude, and acts of kindness. Participants (n = 49) were randomized to the five-week DAHLIA course or an emotion-reporting wait-list control. DAHLIA was understood and accepted by participants and showed good retention (78%). At post-intervention, DAHLIA participants showed a significantly greater decrease in depression than controls (−4.3 vs. +0.6 points on the CES-D, p = 0.05). Secondary analyses found that this effect was considerably stronger in intervention recipients recruited online than those recruited in person. Intervention recipients recruited online also showed significantly increased positive affect, reduced negative affect, and reduced perceived stress. There were no effects on measures of diabetes-specific efficacy or sense of burden, or preliminary measures of health behaviors. This successful feasibility and efficacy trial provides support for a larger trial focusing more specifically on health behavior.

AI snapshot

Written from the paper’s full text.

TL;DR

A 5-week self-paced online positive affect skills intervention (DAHLIA) reduced depressive symptoms in adults with type 2 diabetes compared with an emotion-reporting waitlist control. Effects were strongest among participants recruited online, with no significant effects on diabetes-specific efficacy, distress, or preliminary health behaviors.

Key findings

  • Depression decreased significantly more in the DAHLIA condition than control: −4.3 vs. +0.6 points on the CES-D (β = −.21, p = .05), with intervention scores falling from 16.9 to 12.6.
  • Exploratory analyses found the depression effect was considerably stronger for online-recruited participants: a 7.2-point reduction vs. 1.4 points for in-person recruits; adding recruitment type strengthened the condition effect (β = −.34, p = .02).
  • Among online recruits, the intervention also significantly reduced perceived stress when recruitment type was included (βcond = −.43, p = .01) and increased retrospective positive affect (βcond = .32, p = .05), with marginal reductions in negative affect.
  • No significant intervention effects were found for diabetes self-efficacy, diabetes distress, or health behaviors (all |β| < .19, p > .20); retention was 79% for final questionnaires and 72% met full-completer criteria.

Methods

  • Randomized pilot trial: 53 adults with type 2 diabetes recruited in person from UCSF diabetes education classes (n = 28) or online via Craigslist (n = 25); 49 completed the emotion-reporting run-in and were randomized to the 5-week DAHLIA course or an emotion-reporting waitlist control, and 42 completed final questionnaires used in analyses.
  • DAHLIA taught 8 positive affect/coping skills (e.g., savoring, gratitude, mindfulness, positive reappraisal, acts of kindness); participants practiced skills daily and completed daily emotion reports.
  • Main analysis used regression models predicting Time 2 scores from Time 1 scores and treatment condition; follow-up models added recruitment type and recruitment-by-condition interactions. Outcomes included CES-D depression, PSS perceived stress, DES positive/negative affect, CIDS diabetes self-efficacy, DDS diabetes distress, and daily self-reported health behaviors.

Limitations

  • The paper states it was a pilot not powered to detect downstream changes from psychological benefits to health behaviors or health outcomes, and it lacked long-term follow-up.
  • The paper states future studies need a more potent control than the emotion-reporting waitlist, and that paid assessments increased per-participant cost and reduced generalizability.
  • The paper notes the intervention was less effective in the in-person clinic sample, with a marginally significant suggestion of reduced diabetes self-efficacy in that subset; evident from the text, the small sample and multiple exploratory subgroup analyses make the online-vs-offline findings tentative.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1080/17439760.2014.920410

Cites

83 of 83 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 47 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The DAHLIA intervention produced a significantly greater decrease in depression symptoms than control at post-intervention.

    “Depression scores dropped significantly in the intervention condition compared to control (β = −.21, p = .05).”
    • Also stated in: § Abstract · plain
      “At post-intervention, DAHLIA participants showed a significantly greater decrease in depression than controls (−4.3 vs. +0.6 points on the CES-D, p =.05).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The emotion-reporting-only control condition is an appropriate comparator for testing DAHLIA's efficacy.
  • Findingown data

    The intervention's effect on depression was limited to negative-affect CES-D items, not positive-affect items.

    “Exploratory analysis found that this effect did not appear for the subset of positive affect CES-D items (β = .05, p = .71), but only the negative items (β = −.25, p = .03).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the intervention condition, depression scores fell by 4.3 points, from a mean of 16.9 to 12.6.

    “Scores in the intervention condition dropped by 4.3 points, from a mean of 16.9 – above the threshold for probable clinical depression – to 12.6, well below the threshold.”
    Quote in the paperSubstantial claim
  • Findingown data

    The DAHLIA intervention did not significantly affect perceived stress overall.

    “The intervention did not have a significant effect on PSS scores (β = −.13, p = .31).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The emotion-reporting-only control condition is an appropriate comparator for testing DAHLIA's efficacy.
  • Findingown data

    The DAHLIA intervention did not significantly affect positive or negative affect overall on either measure.

    “There was no significant effect of condition for positive or negative affect, using either measure (|β| < .15, p > .20).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The emotion-reporting-only control condition is an appropriate comparator for testing DAHLIA's efficacy.
  • Classified as probably not a substantial claim. 25
  • May combine two claims. 25
  • The quote only partly states this claim. 1

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

    Findingown data

    Control participants visited the study website significantly more often than intervention participants (5.8 vs. 4.5 visits per week).

    “Control participants visited significantly more frequently than intervention participants (5.8 vs. 4.5 visits / week; F = 4.28, p = .05, η2 = .10)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The DAHLIA intervention did not significantly affect diabetes self-efficacy or diabetes distress.

    “Neither the diabetes self-efficacy scale nor the diabetes distress scale showed any intervention effect (|β| < .09, p > .20).”
    • Also stated in: § Abstract · plain
      “There were no effects on measures of diabetes-specific efficacy or sense of burden, or preliminary measures of health behaviors.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The emotion-reporting-only control condition is an appropriate comparator for testing DAHLIA's efficacy.

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

    Findingown data

    Retrospective and averaged daily measures of positive and negative affect were strongly correlated at both timepoints.

    “The retrospective and averaged daily measures were strongly correlated with each other for both PA and NA and at both timepoints (rs ranging from .61 to .85, p < .001).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants who left the study usually mentioned time constraints, and none objected to the intervention content.

    “Participants who dropped out generally cited time constraints; none raised issues with the content of the intervention.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    For perceived stress, the treatment-by-recruitment interaction became substantially smaller after baseline depression was included (β moved from .62 to .37; p = .19).

    “The interaction between treatment group and recruitment method was substantially reduced for perceived stress (β changed from .62 to .37, new p = .19).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Adding recruitment group did not change diabetes-specific results, except for a marginal interaction between condition and recruitment group for the CIDS.

    “Adding recruitment group did not change these results (|β| < .13, p > .20), with the exception of a marginal interaction between condition and recruitment group for the CIDS (β = .−.45, p = .08).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For positive affect, online recruits improved on the retrospective measure but not on the averaged daily measures.

    “For positive affect, they improved according to the retrospective measure but not the averaged daily measures.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Glucose testing was highly dichotomized, with nearly all participants scoring either 0 or 1 at baseline and post-intervention.

    “Glucose testing was highly dichotomized, with nearly all participants scoring either 0 (never tested twice or more in a day) or 1 (tested twice or more every day; 88% scored 0 or 1 at baseline and 80% at post-intervention).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    DAHLIA was understood and accepted by participants.

    “DAHLIA was understood and accepted by participants and showed good retention (78%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In post-study interviews, participants said they understood the intervention content and found it sensitive and useful.

    “During post-study interviews, participants expressed that they understood the intervention content and found it sensitive and useful.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Condition assignment was not related to completing final measures or reaching the full completer criterion.

    “Condition assignment was not related to either completing the final measures or reaching the full completer criterion (χ2 < .13, p> .72).”
    Quote in the paperNot a substantial claim

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

    Findingown data

    After adjusting for recruitment type, the intervention significantly increased retrospective positive affect (β = .32, p = .05).

    “When recruitment type was added, a significant effect of condition emerged for retrospective PA (βcond = .32, p = .05); a marginal interaction indicated that the intervention increased PA only for intervention participants recruited online (βinteraction = −.35, p = .10).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The emotion-reporting-only control condition is an appropriate comparator for testing DAHLIA's efficacy.

  • May combine two claims.

    Findingown data

    The intervention reduced negative affect for online-recruited participants but not offline-recruited participants, with marginal effects on retrospective and daily measures.

    “For NA, the retrospective measure had a similar pattern of marginal effects (βcond = −.35, p = .08; βinteraction = .46, p = .10), indicating that the intervention reduced NA for participants recruited online but not offline. The averaged daily measure showed the same pattern, though the interaction fell short of significance (βcond = −.32, p = .09; βinteraction = .38, p = .13; see Figure 3).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The emotion-reporting-only control condition is an appropriate comparator for testing DAHLIA's efficacy.

  • May combine two claims.

    Findingown data

    The interaction between recruitment type and condition on retrospective positive affect was marginal, suggesting the intervention increased positive affect only for online-recruited participants.

    “When recruitment type was added, a significant effect of condition emerged for retrospective PA (βcond = .32, p = .05); a marginal interaction indicated that the intervention increased PA only for intervention participants recruited online (βinteraction = −.35, p = .10).”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Recruitment method did not affect frequency of website visits, and there was no interaction between recruitment method and condition.

    “Frequency of visits was not affected by recruitment method and there was no interaction between recruitment method and condition. (F < .78, p > .38).”
    Quote in the paperNot a substantial claim

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

    Findingreasoning

    Visit frequency was somewhat higher in the emotion-reporting control group.

    “Visit frequency was slightly higher in the emotion-reporting control condition, possibly due to the lower time requirement for control visits.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    There was a hint that in-person intervention participants had lower diabetes self-efficacy, but this was marginal and possibly chance.

    “In fact there was some suggestion of reduced diabetes self-efficacy among intervention participants recruited in person, though this was a marginally significant finding and may have occurred by chance.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Recruitment method did not predict whether participants reached randomization.

    “Recruitment method did not predict likelihood of reaching randomization (χ2 = .85, p = .36).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Online-recruited participants were significantly more likely than in-person-recruited participants to complete final measures and to be full completers.

    “However, participants recruited online were significantly more likely to complete the final measures (92% vs. 68%, χ2 = 4.68, p = .03) and to be full completers (88% vs. 57%, χ2 = 6.20, p = .01).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among online-recruited participants, the intervention significantly reduced perceived stress, but not among offline-recruited participants.

    “Scores dropped significantly for participants in the intervention who were recruited online, but not those recruited offline (see Figure 2).”
    • Also stated in: § Abstract · plain
      “Intervention recipients recruited online also showed significantly increased positive affect, reduced negative affect, and reduced perceived stress.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The emotion-reporting-only control condition is an appropriate comparator for testing DAHLIA's efficacy.

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

    Premisecitation

    Observational studies show that positive affect is linked to a greater likelihood of physical activity.

    “In observational studies, positive affect is associated with an increased likelihood of physical activity[4,5,6,7] and healthy eating[5,8], as well as a lower likelihood of tobacco use [9,10].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [4] source

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    • cites [5] source

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    • cites [6] Carrico A. W., 2013, Health Psychology

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    • cites [7] source

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

    Premisecitation

    Observational studies show that positive affect is linked to a greater likelihood of healthy eating.

    “In observational studies, positive affect is associated with an increased likelihood of physical activity[4,5,6,7] and healthy eating[5,8], as well as a lower likelihood of tobacco use [9,10].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] source

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    • cites [8] source

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  • May combine two claims.

    Premisecitation

    Depression in people with type 2 diabetes is associated with poorer glycemic control, more symptoms and complications, and poorer adherence to exercise and diet recommendations.

    “Depression is common in people with type 2 diabetes[21] and is associated with poorer glycemic control, increased symptoms and complications, poorer adherence to exercise and diet recommendations[22], and elevated risk of mortality, over and above the elevations in risk associated with diabetes itself[23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] source

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

    Premisecitation

    Depression is common among people with type 2 diabetes.

    “Depression is common in people with type 2 diabetes[21] and is associated with poorer glycemic control, increased symptoms and complications, poorer adherence to exercise and diet recommendations[22], and elevated risk of mortality, over and above the elevations in risk associated with diabetes itself[23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] source

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

    Premisecitation

    Observational studies show that positive affect is linked to a lower likelihood of tobacco use.

    “In observational studies, positive affect is associated with an increased likelihood of physical activity[4,5,6,7] and healthy eating[5,8], as well as a lower likelihood of tobacco use [9,10].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [9] source

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    • cites [10] source

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

    Premisecitation

    In people newly diagnosed with HIV, positive affect prospectively predicts greater engagement in care and better medication adherence.

    “Research on individuals newly diagnosed with HIV indicates that positive affect prospectively predicts greater liklihood of engagement in care and better medication adherence [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] source

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    Premisecitation

    The most successful internet interventions include varied components and interactive elements to encourage engagement.

    “The most successful of these interventions have a variety of components and interactive elements to encourage engagement (including Beating the Blues, which is approved for use by the British National Institute for Health and Clinical Excellence [35,36,37,38,39,40].)”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [35] Lent R. W., 2005, Journal of Consulting and Clinical Psychology

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    • cites [36] source

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    • cites [40] source

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  • May combine two claims.

    Premisecitation

    A meta-analysis of 25 positive psychology programs found a medium median effect size for depression relief (r = .26), with stronger effects in currently depressed participants.

    “A meta-analysis of 25 programs targeting constructs such as gratitude, happiness, and optimism found a medium effect size for relief of depression symptoms (median r = .26), with stronger effects for currently-depressed participants[24].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] source

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  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Depressive symptoms were measured with the CES-D, a measure of clinical and subclinical depressive symptomatology.

    “Depressive Symptoms were measured using the CES-D[69], a measure of clinical and subclinical depressive symptomatology.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [69] source

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  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Participants who completed four emotion reports within the first seven days were randomized to the intervention or to a control condition of emotion reporting only.

    “Those who completed four emotion reports within the first 7 days were randomized to begin the intervention or to the control condition in which participants continued for 60 days of emotion reporting only1.”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    Diabetes self-efficacy was measured with a type 2 diabetes adaptation of the Confidence in Diabetes Self-Care scale.

    “Diabetes self efficacy was measured using a version of the Confidence in Diabetes Self-Care scale (CIDS;[73]) adapted for type 2 diabetes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] source

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

    Premisecitation

    Behavioral Activation therapies are substantially effective at treating depression.

    “The focus on pleasurable and rewarding activities of positive psychology interventions resembles the approach of Behavioral Activation (BA) therapies, which have also shown substantial effectiveness at treating depression [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] source

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  • May combine two claims.

    Study design and conductown data

    At baseline, intervention and control groups did not differ in age, gender, or any racial category.

    “Intervention and control groups did not differ on age (F = 2.59, p = .11), gender (χ2 = .66, p = .42), or any racial category (χ2 < .1.63, p > .20).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Online diabetes self-management interventions have small but statistically significant effects on HbA1c, diet, and lipids, but do not consistently improve depression symptoms.

    “In a meta-analysis, Pal and colleagues[30] found that online diabetes self-management interventions have a small, but statistically significant, effects on HbA1c, diet, and lipids, but do not consistently improve depression symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] source

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

    Study design and conductcitation

    Positive and negative affect were measured with the Differential Emotions Scale.

    “Positive and Negative Affect were measured with the Differential Emotions Scale (DES; [72]).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [72] Van’t Hof E., 2009, CNS Spectrums source

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

    Study design and conductcitation

    Diabetes-related distress was measured with the Diabetes Distress Scale.

    “Diabetes-related distress was measured using the Diabetes Distress Scale (DDS; [74]).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] source

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  • May combine two claims.

    Premisecitation

    Online interventions for diabetes self-management and depression are feasible and have shown some efficacy for depression symptoms and some health outcomes.

    “Online interventions for diabetes self-management and depression are feasible and have shown some efficacy [28]|[29] at improving symptoms of depression and some health outcomes.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [28] source

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    • cites [29] source

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

    Study design and conductown data

    Of 53 recruited participants, 49 (92%) completed the initial emotion-reporting run-in and were randomized.

    “Of the 53 participants recruited, 49 (92%) completed the initial emotion reporting run-in and were randomized (see Figure 1 for the CONSORT flow diagram).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Thirty-eight participants (72% of the original sample) met the full completer criterion.

    “Thirty-eight participants (72% of the original sample) met this criterion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Internet interventions can reduce depression symptoms, including for people who might otherwise lack access to treatment.

    “Several meta-analyses of internet and computerized interventions, both self-help and clinician-assisted[31,32,33,34], found that internet interventions can reduce symptoms of depression, including among those who might otherwise lack access to treatment.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [31] source

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    • cites [32] source

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    • cites [33] source

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    • cites [34] Lazarus R. S., 1984

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  • May combine two claims.

    Premisecitation

    Such diabetes-targeted psychological interventions tend to be time intensive, expensive, and hard to disseminate in home or non-clinic settings.

    “Psychological interventions that specifically target depression in samples of people with type 2 diabetes have shown some efficacy (e.g.[26]) but tend to be time intensive for both the patient and the provider, expensive to deliver, and difficult to disseminate in home or other non-clinic settings [27].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] source

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    Study design and conductcitation

    Perceived stress was measured with the 10-item Perceived Stress Scale, a widely used measure of psychological stress for community samples.

    “Perceived Stress was measured with the Perceived Stress Scale (PSS; [70,71]). The PSS is a widely-used measure of psychological stress designed for community samples.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [70] source

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    Study design and conductown data

    Forty-two participants (79% of the original sample) completed the final questionnaires and were used in the analyses.

    “Forty-two participants (25 intervention and 17 control; 79% of the original sample) completed the final questionnaires. This is the sample used in the analyses reported below.”
    Quote in the paperSubstantial claim

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

    Interpretationown data

    The intervention may have reduced diabetes self-efficacy for offline-recruited participants, based on a marginally significant pre-post CIDS change.

    “The pre-post change in CIDS score for intervention-offline participants was marginally significant on its own (t(10) = 1.92, p = .08), tentatively suggesting that the intervention may have led to reduced diabetes self-efficacy for this subset of participants.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The emotion-reporting-only control condition is an appropriate comparator for testing DAHLIA's efficacy.

  • May combine two claims.

    Premisecitation

    Positive-emotion interventions are accessible and effective for people who already have depression, not only for those with good mental health.

    “This adds to the growing evidence that interventions based on positive emotions are accessible and effective even for individuals already experiencing depression[75], rather than being restricted to those who are doing well.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] source

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  • May combine two claims.

    Study design and conductreasoning

    The study had no follow-up assessments, so long-term intervention effects could not be assessed.

    “Finally, this study did not include follow-up assessments that would allow us to assess long-term intervention effects.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Adults with type 2 diabetes find the online positive-emotion skills intervention engaging and feasible to complete.

    “We have demonstrated that individuals with type 2 diabetes find our online positive emotion skills intervention engaging and feasible to complete.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    This pilot trial provides preliminary support that adults with type 2 diabetes can receive an online positive-emotions program in a way that is effective, understandable, and sensitive, with high engagement and adherence.

    “This pilot study provides initial evidence that an online positive emotions intervention can be delivered in an effective, understandable, and sensitive manner to adults with type 2 diabetes, with strong participant engagement and adherence.”
    Quote in the paperSubstantial claim
48 of 48

  • The paper relies on this without support.

    The emotion-reporting-only control condition is an appropriate comparator for testing DAHLIA's efficacy.

    “control condition in which participants continued for 60 days of emotion reporting only1”

  • The authors state this as an assumption.

    Mindfulness exercises may help participants recognize and appreciate positive events even under chronic stress.

    “Mindfulness exercises are continued throughout the intervention because we believe they may also help participants recognize and appreciate positive events, even in the context of chronic stress.”

  • The paper relies on this without support.

    The intervention is low cost.

    “Because of the low cost of this intervention, and because individuals typically do not receive interventions of this type (i.e., there is no comparable treatment-as-usual), any degree of efficacy is of potential value.”

  • The paper relies on this without support.

    People with type 2 diabetes typically do not receive interventions of this type, so there is no comparable treatment-as-usual.

    “Because of the low cost of this intervention, and because individuals typically do not receive interventions of this type (i.e., there is no comparable treatment-as-usual), any degree of efficacy is of potential value.”
4 of 4

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?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentt(10) = 1.92reported p = .08 · recomputed p = .084

    “t(10) = 1.92, p = .08”

1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Post-intervention medication-adherence percentage uses the wrong denominator

    Minor

    The stated 21 of 24 participants is 87.5%, not 84%. The reported percentage would correspond to 21 of 25.

    Reported 84 · recomputed 87.5

  • Baseline medication-adherence percentage uses the wrong denominator

    Minor

    The stated 19 of 24 participants is 79.2%, not 76%. The reported percentage would correspond to 19 of 25.

    Reported 76 · recomputed 79.166667

  • CES-D response scale has inconsistent point count and endpoints

    Minor

    The measure is described as a 4-point scale, but its stated endpoints run from 0 to 4, which implies five consecutively numbered response points.

  • Negative-affect reduction is called significant despite marginal results

    Minor

    The discussion calls the reduction in negative affect among online intervention recruits significant relative to online controls, but the results describe the relevant effects as marginal, with p-values of .08 and .10.

4 of 4

Cites

Flagged first, then by citations

3 of the 86 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. 10.1111/jopy.1989.57.issue-4 · DOI
  2. Carrico A. W., 2013, Health Psychology
  3. Cohen S., 1988, The social psychology of health: The Claremont Symposium on Applied Social Psychology, 31
  4. Pal K., 2013, The Cochrane Library, 1
  5. 10.1002/jclp.v65:5 · DOI

Cited by

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Related

Authors
Cohn, M. A., Pietrucha, M. E., Saslow, L. R., Hult, J. R., & Moskowitz, J. T.
Affiliations
University of California, San Francisco (US)
Corresponding author
Cohn, Michael A.
ORCID
Venue
The Journal of Positive Psychology
Publisher
Informa UK Limited
Published
2014-06-10
Volume
9
Issue
6
Pages
523-534
ISSN
  • 1743-9760 (ISSN-L)
  • 1743-9779
DOI
10.1080/17439760.2014.920410
PMC
PMC4157680
OpenAlex
W2061783093
Semantic Scholar
1aff0866fbdbfe3818195e2d942041b1f336b7a8
Cited by
188
References
86
Citations by year
2026: 8 · 2025: 11 · 2024: 10 · 2023: 20 · 2022: 13 · 2021: 47 · 2020: 15 · 2019: 15 · 2018: 22 · 2017: 16 · 2016: 6 · 2015: 5
FWCI
7.24
Type
journal article
Language
en
Open access
Locations
  • The Journal of Positive Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (K24MH093225)
  • National Center for Research Resources (UL1RR024131)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
type 2 diabetes, depression, positive affect, online intervention, savoring, gratitude, acts of kindness, dahlias, perceived stress, glycemic control, health behavior, feasibility

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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