A Positive Psychology–Motivational Interviewing Intervention to Promote Positive Affect and Physical Activity in Type 2 Diabetes: The BEHOLD-8 Controlled Clinical Trial

Huffman, Jeff C.; Golden, Julia; Massey, Christina N.; Feig, Emily H.; Chung, Wei-Jean; Millstein, Rachel A.; Brown, Lydia; Gianangelo, Taylor; Healy, Brian C.; Wexler, Deborah J.; Park, Elyse R.; Celano, Christopher M.

doi:10.1097/psy.0000000000000840

Cited by 40Physical Activity and HealthDiabetes Management and EducationBehavioral Health and Interventions

A Positive Psychology–Motivational Interviewing Intervention to Promote Positive Affect and Physical Activity in Type 2 Diabetes: The BEHOLD-8 Controlled Clinical Trial

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Huffman, Jeff C., Golden, Julia, Massey, Christina N., Feig, Emily H., Chung, Wei-Jean, Millstein, Rachel A., Brown, Lydia, Gianangelo, Taylor +4 more·2020·Psychosomatic Medicine

DOI 10.1097/psy.0000000000000840PMC PMC7676457

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Abstract

Objective: Physical activity is associated with superior health outcomes in patients with type 2 diabetes (T2D), but most T2D patients do not follow physical activity recommendations. The objective of this study was to assess the feasibility and impact of a novel combined positive psychology–motivational interviewing (PP-MI) intervention to promote physical activity in T2D. Methods: This controlled clinical trial compared an 8-week, phone-delivered PP-MI intervention to an attention-matched MI-enhanced behavioral counseling condition among 60 participants with T2D and suboptimal moderate to vigorous physical activity (MVPA; <150 min/wk). The primary study outcome was feasibility (proportion of sessions completed) and acceptability (0–10 ease and utility ratings of each session). Secondary outcomes were between-group differences in changes in positive affect (main psychological outcome) and accelerometer-measured physical activity (MVPA and steps per day), using mixed-effects regression models, at 8 and 16 weeks. Results: Ninety-two percent of PP-MI sessions were completed, and mean participant ratings of ease/utility were 8.5 to 8.8/10, surpassing a priori benchmarks for feasibility and acceptability. PP-MI participants had small-medium effect size (ES) difference improvements in positive affect compared with MI (8 weeks: estimated mean difference [EMD] = 3.07 [SE = 1.41], p = .029, ES = 0.44; 16 weeks: EMD = 2.92 [SE = 1.73], p = .092, ES = 0.42). PP-MI participants also had greater improvements in MVPA (8 weeks: EMD = 13.05 min/d [SE = 5.00], p = .009, ES = 1.24; 16 weeks: EMD = 7.96 [SE = 4.53], p = .079, ES = 0.75), with similar improvements in steps per day. Conclusions: The PP-MI intervention was feasible and well accepted. Next-step efficacy studies can more rigorously explore the intervention’s effects on physical activity and clinical outcomes. Trial Registration: ClinicalTrials.gov Registration No. NCT03150199.

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Effects of positive psychology-based programs on cardiac biomarkers or other disease markers have been mixed, with some observed effects on markers of inflammation in small trials in patients with heart failure or coronary artery disease, modest effects on glycosylated hemoglobin in small studies in diabetes, but minimal effects on other markers.
“Effects of such programs on cardiac biomarkers (eg, inflammatory markers, heart rate variability) or other disease markers have been mixed, with some observed effects on markers of inflammation in small trials in patients with heart failure 209 or coronary artery disease, 210 modest effects on glycosylated hemoglobin in small studies in diabetes, 206,207 but minimal effects on other”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [206]
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A majority, but not all, of randomized studies found positive psychology-based interventions to be associated with greater improvements in physical activity compared with control conditions.
“Several such programs, either alone or combined with motivational interviewing, have focused on the promotion of physical activity in patients with cardiac disease or cardiac risk conditions in randomized studies, with a majority, 203-207 but not all, 208 of such studies finding positive psychology-based interventions to be associated with greater improvements in physical activity compared”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [206]

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“It was performed in a single urban academic medical center, and the intervention was delivered by trained psychologists, potentially limiting clinical implementation in front-line settings, although in prior work, our PP and PP-MI interventions have been delivered by social workers and bachelor’s-level clinicians with…”
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Exploring the feasibility and impact of positive psychology-motivational interviewing interventions to promote positive affect and physical activity in type 2 diabetes: design and methods from the BEHOLD-8 and BEHOLD-16 clinical trials
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Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development
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Authors: Huffman, J. C., Golden, J., Massey, C. N., Feig, E. H., Chung, W.-J., Millstein, R. A., Brown, L., Gianangelo, T., Healy, B. C., Wexler, D. J., Park, E. R., & Celano, C. M.
Affiliations: Harvard University (US)
Corresponding author: Huffman, Jeff C.
ORCID: Huffman, Jeff C.
Massey, Christina N.
Feig, Emily H.
Millstein, Rachel A.
Brown, Lydia
Gianangelo, Taylor
Healy, Brian C.
Wexler, Deborah J.
Park, Elyse R.
Celano, Christopher M.
Venue: Psychosomatic Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2020-07-14
Volume: 82
Issue: 7
Pages: 641-649
ISSN: 0033-3174 (ISSN-L)
1534-7796
DOI: 10.1097/psy.0000000000000840
PMC: PMC7676457
OpenAlex: W3042567149
Cited by: 40
References: 47
Citations by year: 2026: 2 · 2025: 6 · 2024: 5 · 2023: 14 · 2022: 10 · 2021: 2 · 2020: 1
FWCI: 4.06
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Psychosomatic Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Minerva Access (University of Melbourne) (submittedVersion)
Funders: National Institutes of Health (UL1TR002541)
National Heart, Lung, and Blood Institute (K23HL123607, K23HL135277)
National Institute of Diabetes and Digestive and Kidney Diseases (R21DK109313, P30DK111022)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords: type 2 diabetes, positive psychology, motivational interviewing, physical activity promotion, positive affect, telephone-delivered intervention, feasibility and acceptability, moderate-to-vigorous physical activity, step count, behavioral counseling
MeSH terms: Psychology, Positive, Diabetes Mellitus, Type 2, Female, Humans, Telephone, Exercise, Motivational Interviewing

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A Positive Psychology–Motivational Interviewing Intervention to Promote Positive Affect and Physical Activity in Type 2 Diabetes: The BEHOLD-8 Controlled Clinical Trial

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