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Cited by 127Diabetes Management and EducationOptimism, Hope, and Well-beingBehavioral Health and Interventions

Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development

Open access
Huffman, Jeff C., DuBois, Christina M., Millstein, Rachel A., Celano, Christopher M., Wexler, Deborah·2015·Journal of Diabetes Research
DOI 10.1155/2015/428349PMC PMC4442018
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Abstract

Most patients with type 2 diabetes (T2D) have suboptimal adherence to recommended diet, physical activity, and/or medication. Current approaches to improve health behaviors in T2D have been variably effective, and successful interventions are often complex and intensive. It is therefore vital to develop interventions that are simple, well-accepted, and applicable to a wide range of patients who suffer from T2D. One approach may be to boost positive psychological states, such as positive affect or optimism, as these constructs have been prospectively and independently linked to improvements in health behaviors. Positive psychology (PP) interventions, which utilize systematic exercises to increase optimism, well-being, and positive affect, consistently increase positive states and are easily delivered to patients with chronic illnesses. However, to our knowledge, PP interventions have not been formally tested in T2D. In this paper, we review a theoretical model for the use of PP interventions to target health behaviors in T2D, describe the structure and content of a PP intervention for T2D patients, and describe baseline data from a single-arm proof-of-concept (N=15) intervention study in T2D patients with or without depression. We also discuss how PP interventions could be combined with motivational interviewing (MI) interventions to provide a blended psychological-behavioral approach.

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Written from the paper’s full text.

TL;DR

This paper presents the rationale, theoretical model, and development of a 12-week phone-delivered positive psychology (PP) intervention for patients with type 2 diabetes (T2D), plus baseline data from a single-arm proof-of-concept trial (N = 15). It reports feasibility of recruitment and baseline characteristics but not yet efficacy outcomes, and proposes combining PP with motivational interviewing.

Key findings

  • The authors developed a 12-week PP intervention with 7 exercises—Gratitude for Positive Events, Using Personal Strengths, Gratitude Letter, Enjoyable and Meaningful Activities, Recalling Past Success, Participant’s Choice (repeat an exercise or Acts of Kindness), and Week 12 planning—delivered weekly for the first 4 weeks and biweekly thereafter, with 15–30 minute phone sessions.
  • The theoretical model proposes five mediators linking positive psychological states to health behaviors: attention/cognitive processing, self-regulation/motivation, active coping/resilience, self-efficacy/perceived control, and social interactions/perceived social support; energy/vitality is also noted as a possible additional factor.
  • In the proof-of-concept trial, 69 patients with T2D were identified, 44 were judged potentially eligible, 29 agreed to hear about the study, and 15 were enrolled. Baseline mean age was 60.1 ± 8.8 years, 9 (60%) were women, mean MOS SAS adherence score was 11.4/18, LOT-R optimism was 13.0 ± 6.8, GQ-6 gratitude was 35.7 ± 6.7, HADS-D was 7.0 ± 3.7, and HADS-A was 7.9 ± 4.2.
  • At the time of report, 9 participants had completed the study and 6 were still undergoing procedures; of the 9 initial participants, 7 (78%) fully completed at least three PP exercises. There were no differences in age (t = 0.35; P = 0.71), race (χ² = 1.86; P = 0.17), or gender (χ² = 0.47; P = 0.49) between decliners and enrollees.

Methods

  • Design: a rationale and theoretical-model paper plus intervention development, with baseline data from a 12-week single-arm proof-of-concept feasibility/acceptability trial.
  • Sample: English-speaking adults with T2D by ADA criteria and suboptimal adherence (MOS SAS score <15/18) recruited from the outpatient diabetes center and inpatient medical units of an urban academic medical center; exclusions were cognitive impairment and lack of telephone access. N = 15 enrolled.
  • Measures/analysis: baseline self-report measures included LOT-R, GQ-6, HADS, DDS, PROMIS-10, SDSCA, and MOS SAS. Planned feasibility analyses use descriptive statistics and paired t-tests for pre/post optimism and positive affect; planned clinical outcome analyses use random effects regression and Cohen’s d, with Stata 11.2. Reported results are recruitment and baseline data only.

Limitations

  • Stated: not all patients may be interested in or willing/able to complete positive activities; there is less evidence regarding PP effects on physiologic outcomes; the field is in very early stages; the trial used only one inpatient and one outpatient site at an academic medical center, and most participants were white, limiting generalizability.
  • Stated: the proof-of-concept study was not designed or powered to detect statistically significant differences in clinical outcomes, and interventionist-collected pre/post ratings may be influenced by social desirability.
  • Evident: the trial is small (N = 15), single-arm, and without a control condition, and follow-up was incomplete at the time of report, so efficacy and durability cannot be assessed from these data.

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Integrity signals

Registry

Crossref · 10.1155/2015/428349

Cites

148 of 148 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

0 of 183 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The majority of enrolled participants had one or more additional cardiovascular risk factors (e.g., hypertension and hyperlipidemia).

    “Overall, the mean age of participants was 60.1 ± 8.8 years, 9 (60%) were women, and the majority had one or more additional cardiovascular risk factors (e.g., hypertension and hyperlipidemia).”
    Quote in the paperNot a substantial claim
  • Findingcitation

    Participants had relatively low baseline optimism (LOT-R = 13.0 ± 6.8) compared to the general population mean of 15.2 ± 3.8.

    “Participants had relatively low baseline optimism (LOT-R = 13.0 ± 6.8, compared to general population mean of 15.2 ± 3.8 [34])”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Schueller S. M. Parks A. C. Disseminating self-help: positive psychology exercises in an online trial Journal of Medical Internet Research 2012 14 3, article e63 10.2196/jmir.1850 2-s2.0-84864196986 PMC3414858 22732765 source

      Not checked in the free run.

  • Findingown data

    Participants' mean level of depression (HADS-D = 7.0 ± 3.7) was just below the standard cutoff of 8 for clinically significant symptoms.

    “Participants' mean levels of depression (mean HADS-D = 7.0 ± 3.7) and anxiety (mean HADS-A = 7.9 ± 4.2) were just below the standard cutoff of 8 for clinically significant symptoms [100].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [100] Bjelland I. Dahl A. A. Haug T. T. Neckelmann D. The validity of the hospital anxiety and depression scale: an updated literature review Journal of Psychosomatic Research 2002 52 2 69 77 10.1016/s0022-3999(01)00296-3 2-s2.0-0036188619 11832252 source

      Not checked in the free run.

  • Findingown data

    Participants' mean level of anxiety (HADS-A = 7.9 ± 4.2) was just below the standard cutoff of 8 for clinically significant symptoms.

    “Participants' mean levels of depression (mean HADS-D = 7.0 ± 3.7) and anxiety (mean HADS-A = 7.9 ± 4.2) were just below the standard cutoff of 8 for clinically significant symptoms [100].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [100] Bjelland I. Dahl A. A. Haug T. T. Neckelmann D. The validity of the hospital anxiety and depression scale: an updated literature review Journal of Psychosomatic Research 2002 52 2 69 77 10.1016/s0022-3999(01)00296-3 2-s2.0-0036188619 11832252 source

      Not checked in the free run.

  • Findingcitation

    Participants had relatively low baseline gratitude (GQ-6 = 35.7 ± 6.7) compared to the general population mean of 36.9 ± 4.9.

    “and gratitude (GQ-6 = 35.7 ± 6.7, general population mean 36.9 ± 4.9 [35]).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] McCullough M. E. Emmons R. A. Tsang J.-A. The grateful disposition: a conceptual and empirical topography Journal of Personality and Social Psychology 2002 82 1 112 127 10.1037//0022-3514.82.1.112 2-s2.0-0036364933 11811629 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. 26
  • May combine two claims. 46

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

    Findingown data

    The mean age of enrolled participants was 60.1 ± 8.8 years.

    “Overall, the mean age of participants was 60.1 ± 8.8 years, 9 (60%) were women, and the majority had one or more additional cardiovascular risk factors (e.g., hypertension and hyperlipidemia).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most participants were moderately nonadherent, with a mean MOS SAS score of 11.4 out of 18, consistent with a mean rating of 3.8 out of 6 for completion of each health behavior (diet, activity, and medication adherence).

    “Most participants were moderately nonadherent, with a mean MOS SAS score of 11.4 out of 18, consistent with a mean rating of 3.8 out of 6 for completion of each health behavior (diet, activity, and medication adherence).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There were no differences in age, race, or gender between participants who declined participation and those who enrolled.

    “There were no differences in the age (t = 0.35; P = 0.71), race (χ 2 = 1.86; P = 0.17), or gender (χ 2 = 0.47; P = 0.49) of participants who declined participation compared to those who enrolled; additional data on decliners was not collected.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    During recruitment periods, 69 patients with T2D were identified, 44 were judged potentially eligible, 29 agreed to hear about the study, and 15 were eligible and enrolled.

    “In total, during time periods when study staff were available for recruitment for this unfunded feasibility trial, 69 patients with T2D were identified, 44 were judged by clinicians to be potentially eligible, 29 agreed to hear about the study, and 15 were eligible and enrolled.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Nine (60%) of enrolled participants were women.

    “Overall, the mean age of participants was 60.1 ± 8.8 years, 9 (60%) were women, and the majority had one or more additional cardiovascular risk factors (e.g., hypertension and hyperlipidemia).”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Thus far, nine participants have completed the study, and six participants are still undergoing study procedures.

    “Thus far nine participants have completed the study, with six participants still undergoing study procedures; of the nine initial participants, seven (78%) fully completed at least three PP exercises.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In type 2 diabetes, positive psychological states are prospectively associated with lower HbA1c, fewer diabetes complications, and lower rates of cardiac events/mortality.

    “In T2D, positive psychological states (e.g., positive affect, well-being) are prospectively associated with lower HbA1c, fewer diabetes complications, and lower rates of cardiac events/mortality [26–28]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [26] Moskowitz J. T. Epel E. S. Acree M. Positive affect uniquely predicts lower risk of mortality in people with diabetes Health Psychology 2008 27 1, supplement S73 S82 10.1037/0278-6133.27.1.s73 2-s2.0-41949116245 18248108 source

      Not checked in the free run.

    • cites [27] Papanas N. Tsapas A. Papatheodorou K. Glycaemic control is correlated with well-being index (WHO-5) in subjects with type 2 diabetes Experimental and Clinical Endocrinology & Diabetes 2010 118 6 364 367 10.1055/s-0029-1243623 2-s2.0-77953661689 20140846 source

      Not checked in the free run.

    • cites [28] van der Does F. E. E. de Neeling J. N. D. Snoek F. J. Symptoms and well-being in relation to glycemic control in type II diabetes Diabetes Care 1996 19 3 204 210 10.2337/diacare.19.3.204 2-s2.0-0030029843 8742562 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Positive psychology interventions consistently increase positive states and are easily delivered to patients with chronic illnesses.

    “Positive psychology (PP) interventions, which utilize systematic exercises to increase optimism, well-being, and positive affect, consistently increase positive states and are easily delivered to patients with chronic illnesses.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [41] Bolier L. Haverman M. Westerhof G. J. Riper H. Smit F. Bohlmeijer E. Positive psychology interventions: a meta-analysis of randomized controlled studies BMC Public Health 2013 13, article 119 10.1186/1471-2458-13-119 2-s2.0-84873463456 PMC3599475 23390882 source

      Not checked in the free run.

    • cites [43] Sin N. L. Lyubomirsky S. Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis Journal of Clinical Psychology 2009 65 5 467 487 10.1002/jclp.20593 2-s2.0-67449162049 19301241 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Nonadherence in type 2 diabetes is independently associated with poor glycemic control, increased rates of vascular, renal, and other complications, and mortality.

    “Nonadherence in T2D is independently associated with poor glycemic control, increased rates of vascular, renal, and other complications, and mortality [7, 8, 11].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [7] Ho P. M. Rumsfeld J. S. Masoudi F. A. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus Archives of Internal Medicine 2006 166 17 1836 1841 10.1001/archinte.166.17.1836 2-s2.0-33749006625 17000939 source

      Not checked in the free run.

    • cites [8] Dunkler D. Dehghan M. Teo K. K. Diet and kidney disease in high-risk individuals with type 2 diabetes mellitus JAMA Internal Medicine 2013 173 18 1682 1692 10.1001/jamainternmed.2013.9051 2-s2.0-84885900768 23939297 source

      Not checked in the free run.

    • cites [11] Sloan F. A. Bethel M. A. Lee P. P. Adherence to guidelines and its effects on hospitalizations with complications of type 2 diabetes The Review of Diabetic Studies 2004 1 1 29 38 17491662 PMC1783530 source

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  • May combine two claims.

    Premisecitation

    To the authors' knowledge, positive psychology interventions have not been formally tested in type 2 diabetes, outside of a single small positive affect skills intervention trial that led to improvements in depressive symptoms.

    “However, to our knowledge, PP interventions have not been formally tested in T2D.”
    • Also stated in: § 2.1. PP Interventions · hedged
      “To our knowledge, PP interventions have never been tested in a T2D population, outside of a single small positive affect skills intervention trial that led to improvements in depressive symptoms [54].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [54] Cohn M. A. Pietrucha M. E. Saslow L. R. Hult J. R. Moskowitz J. T. An online positive affect skills intervention reduces depression in adults with type 2 diabetes The Journal of Positive Psychology 2014 9 6 523 534 10.1080/17439760.2014.920410 25214877 PMC4157680 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Successful interventions to improve health behaviors are often complex and intensive, making practical implementation a challenge.

    “successful interventions are often complex and intensive”
    • Also stated in: § 1. Introduction · plain
      “successful interventions are often complex and intensive [13–15], making practical implementation a challenge [16].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [13] Knowler W. C. Barrett-Connor E. Fowler S. E. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin The New England Journal of Medicine 2002 346 6 393 403 10.1056/nejmoa012512 2-s2.0-0037034257 11832527 PMC1370926 source

      Not checked in the free run.

    • cites [14] Stevens V. J. Obarzanek E. Cook N. R. Long-term weight loss and changes in blood pressure: results of the trials of hypertension prevention, phase II Annals of Internal Medicine 2001 134 1 1 11 10.7326/0003-4819-134-1-200101020-00007 2-s2.0-0035793139 11187414 source

      Not checked in the free run.

    • cites [15] Svetkey L. P. Stevens V. J. Brantley P. J. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial Journal of the American Medical Association 2008 299 10 1139 1148 10.1001/jama.299.10.1139 2-s2.0-40749141596 18334689 source

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    • cites [16] United States Centers for Disease Control Diabetes: Successes and Opportunities for Population-Based Prevention and Control 2011 http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/Diabetes-AAG-2011-508.pdf

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  • May combine two claims.

    Premisecitation

    Positive experiences and cognitions can help people better attend to and process health information, including unbiased and open appraisal of negative health information.

    “Positive experiences and cognitions can help people better attend to and process health information [37], including unbiased and open appraisal of negative health information [56].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] Reed M. B. Aspinwall L. G. Self-affirmation reduces biased processing of health-risk information Motivation and Emotion 1998 22 2 99 132 10.1023/a:1021463221281 2-s2.0-0032338605 source

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    • cites [56] Aspinwall L. G. Tedeschi R. G. The value of positive psychology for health psychology: progress and pitfalls in examining the relation of positive phenomena to health Annals of Behavioral Medicine 2010 39 1 4 15 10.1007/s12160-009-9153-0 2-s2.0-77957283295 20091429 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Optimism and gratitude are only somewhat correlated with depression (r = 0.3 and r = 0.2-0.3, respectively).

    “Constructs like optimism (r = 0.3) and gratitude (r = 0.2–0.3) are only somewhat correlated with depression [34, 35]”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [34] Schueller S. M. Parks A. C. Disseminating self-help: positive psychology exercises in an online trial Journal of Medical Internet Research 2012 14 3, article e63 10.2196/jmir.1850 2-s2.0-84864196986 PMC3414858 22732765 source

      Not checked in the free run.

    • cites [35] McCullough M. E. Emmons R. A. Tsang J.-A. The grateful disposition: a conceptual and empirical topography Journal of Personality and Social Psychology 2002 82 1 112 127 10.1037//0022-3514.82.1.112 2-s2.0-0036364933 11811629 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Positive affect can restore or improve self-regulation and goal-directed behaviors.

    “Positive affect can restore or improve self-regulation [38] and goal-directed behaviors [61].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [38] Tice D. M. Baumeister R. F. Shmueli D. Muraven M. Restoring the self: positive affect helps improve self-regulation following ego depletion Journal of Experimental Social Psychology 2007 43 3 379 384 10.1016/j.jesp.2006.05.007 2-s2.0-33947726049 source

      Not checked in the free run.

    • cites [61] Aspinwall L. G. Rethinking the role of positive affect in self-regulation Motivation and Emotion 1998 22 1 1 32 10.1023/a:1023080224401 2-s2.0-0032363704 source

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  • May combine two claims.

    Premisecitation

    Self-monitoring leads to improved diet and physical activity along with greater medication adherence.

    “Self-monitoring is a critical health management task that requires careful attention to health stimuli and leads to improved diet and physical activity [59] along with greater medication adherence [60].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [59] Burke L. E. Wang J. Sevick M. A. Self-monitoring in weight loss: a systematic review of the literature Journal of the American Dietetic Association 2011 111 1 92 102 10.1016/j.jada.2010.10.008 2-s2.0-78650318876 21185970 PMC3268700 source

      Not checked in the free run.

    • cites [60] Karter A. J. Ackerson L. M. Darbinian J. A. Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes Registry The American Journal of Medicine 2001 111 1 1 9 10.1016/s0002-9343(01)00742-2 2-s2.0-0034939686 11448654 source

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  • May combine two claims.

    Premisecitation

    Positive psychology exercises are simple, can be delivered remotely, and require minimal training of providers.

    “In contrast to complex multicomponent health behavior or psychology interventions, PP exercises are simple, can be delivered remotely (e.g., by phone), and require minimal training of providers [34, 41, 42].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [34] Schueller S. M. Parks A. C. Disseminating self-help: positive psychology exercises in an online trial Journal of Medical Internet Research 2012 14 3, article e63 10.2196/jmir.1850 2-s2.0-84864196986 PMC3414858 22732765 source

      Not checked in the free run.

    • cites [41] Bolier L. Haverman M. Westerhof G. J. Riper H. Smit F. Bohlmeijer E. Positive psychology interventions: a meta-analysis of randomized controlled studies BMC Public Health 2013 13, article 119 10.1186/1471-2458-13-119 2-s2.0-84873463456 PMC3599475 23390882 source

      Not checked in the free run.

    • cites [42] Huffman J. C. Mastromauro C. A. Boehm J. K. Development of a positive psychology intervention for patients with acute cardiovascular disease Heart International 2011 6 2, article e14 10.4081/hi.2011.e13 2-s2.0-80655148048 PMC3699107 23825741 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Positive psychology-based exercises do not require high educational attainment or significant time commitment, and they have been enjoyable for patients and completed at high rates in diverse medical cohorts.

    “PP-based exercises do not require high educational attainment or significant time commitment, and they have been enjoyable for patients (and completed at high rates) in diverse medical cohorts [42, 53].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [42] Huffman J. C. Mastromauro C. A. Boehm J. K. Development of a positive psychology intervention for patients with acute cardiovascular disease Heart International 2011 6 2, article e14 10.4081/hi.2011.e13 2-s2.0-80655148048 PMC3699107 23825741 source

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    • cites [53] Moskowitz J. T. Hult J. R. Duncan L. G. A positive affect intervention for people experiencing health-related stress: development and non-randomized pilot test Journal of Health Psychology 2012 17 5 676 692 10.1177/1359105311425275 2-s2.0-84863188944 22021272 PMC3498769 source

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  • May combine two claims.

    Premisecitation

    Positive psychology interventions have been found to increase well-being and decrease depression, with effect sizes comparable to other psychological interventions.

    “PP interventions have been used in over 4000 mostly healthy subjects and have been found to increase well-being and decrease depression [41, 43], with effect sizes comparable to other psychological interventions [44, 45].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [41] Bolier L. Haverman M. Westerhof G. J. Riper H. Smit F. Bohlmeijer E. Positive psychology interventions: a meta-analysis of randomized controlled studies BMC Public Health 2013 13, article 119 10.1186/1471-2458-13-119 2-s2.0-84873463456 PMC3599475 23390882 source

      Not checked in the free run.

    • cites [43] Sin N. L. Lyubomirsky S. Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis Journal of Clinical Psychology 2009 65 5 467 487 10.1002/jclp.20593 2-s2.0-67449162049 19301241 source

      Not checked in the free run.

    • cites [44] Cuijpers P. Geraedts A. S. van Oppen P. Andersson G. Markowitz J. C. van Straten A. Interpersonal psychotherapy for depression: a meta-analysis The American Journal of Psychiatry 2011 168 6 581 592 10.1176/appi.ajp.2010.10101411 2-s2.0-79960294601 21362740 PMC3646065 source

      Not checked in the free run.

    • cites [45] Cuijpers P. Smit F. Bohlmeijer E. Hollon S. D. Andersson G. Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias British Journal of Psychiatry 2010 196 3 173 178 10.1192/bjp.bp.109.066001 2-s2.0-77749271346 20194536 source

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  • May combine two claims.

    Premisecitation

    Positive coping shares roots with resilience, which has been shown to impact health behaviors such as diet, physical activity, and overall type 2 diabetes self-management.

    “Positive coping shares roots with resilience, which has also been shown to impact health behaviors such as diet, physical activity, and overall T2D self-management [67–69].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [67] Steinhardt M. A. Mamerow M. M. Brown S. A. Jolly C. A. A resilience intervention in African American adults with type 2 diabetes: a pilot study of efficacy The Diabetes Educator 2009 35 2 274 284 10.1177/0145721708329698 2-s2.0-63849110007 19204102 PMC3001398 source

      Not checked in the free run.

    • cites [68] Bradshaw B. G. Richardson G. E. Kumpfer K. Determining the efficacy of a resiliency training approach in adults with type 2 diabetes The Diabetes Educator 2007 33 4 650 659 10.1177/0145721707303809 2-s2.0-34548631593 17684166 source

      Not checked in the free run.

    • cites [69] Robertson S. M. Stanley M. A. Cully J. A. Naik A. D. Positive emotional health and diabetes care: concepts, measurement, and clinical implications Psychosomatics 2012 53 1 1 12 10.1016/j.psym.2011.09.008 2-s2.0-84859541641 22221716 source

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  • May combine two claims.

    Premisecitation

    Positive psychological states and attributes can increase social interactions and perceived social support.

    “Positive psychological states and attributes can also increase social interactions and perceived social support.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [76] Lyubomirsky S. King L. Diener E. The benefits of frequent positive affect: does happiness lead to success? Psychological Bulletin 2005 131 6 803 855 10.1037/0033-2909.131.6.803 2-s2.0-29644438373 16351326 source

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  • May combine two claims.

    Premisecitation

    Positive states may improve energy and vitality, which can increase health behaviors and lead to better health.

    “positive states may improve energy and vitality [64, 79], which can increase health behaviors and lead to better health [80].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [64] Pressman S. D. Cohen S. Does positive affect influence health? Psychological Bulletin 2005 131 6 925 971 10.1037/0033-2909.131.6.925 2-s2.0-29644434367 16351329 source

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    • cites [79] Ryan R. M. Frederick C. On energy, personality, and health: subjective vitality as a dynamic reflection of well-being Journal of Personality 1997 65 3 529 565 10.1111/j.1467-6494.1997.tb00326.x 2-s2.0-0031216460 9327588 source

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    • cites [80] Chandler-Laney P. C. Brock D. W. Gower B. A. Alvarez J. A. Bush N. C. Hunter G. R. Self-reported low vitality, poor mental health, and low dietary restraint are associated with overperception of physical exertion Journal of Obesity 2010 2010 7 207451 10.1155/2010/207451 2-s2.0-84865354165 PMC2948900 20936158 source

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

    Study design and conductnone given

    Institutional review board approval from the healthcare system was obtained prior to any study procedures.

    “Institutional review board approval from our healthcare system was obtained prior to any study procedures.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The study interventionist was trained in several stages and sessions were reviewed for quality control and intervention fidelity.

    “The study interventionist for the subsequent proof-of-concept trial (CD) was trained in several stages by staff (JH, CC) experienced in delivering PP interventions.”
    • Also stated in: § 2.3. PP Intervention Design and Development · plain
      “For quality control, sessions were reviewed by a multidisciplinary study team at weekly meetings, and specific feedback about intervention delivery and fidelity was provided in an ongoing manner.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Optimism and positive affect appear to lead to greater social outreach and perception of social support, and people with higher positive psychological well-being report more social satisfaction.

    “Optimism and positive affect appear to lead to greater social outreach and perception of social support [76], and people with higher ratings of positive psychological well-being report more social satisfaction [64, 76].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [76] Lyubomirsky S. King L. Diener E. The benefits of frequent positive affect: does happiness lead to success? Psychological Bulletin 2005 131 6 803 855 10.1037/0033-2909.131.6.803 2-s2.0-29644438373 16351326 source

      Not checked in the free run.

    • cites [64] Pressman S. D. Cohen S. Does positive affect influence health? Psychological Bulletin 2005 131 6 925 971 10.1037/0033-2909.131.6.925 2-s2.0-29644434367 16351329 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with type 2 diabetes may have significant functional limitations, transportation challenges, or insufficient time to attend in-person visits.

    “patients with T2D may have significant functional limitations, transportation challenges, or insufficient time to attend in-person visits [81–83].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [81] Chiu C.-J. Wray L. A. Gender differences in functional limitations in adults living with type 2 diabetes: biobehavioral and psychosocial mediators Annals of Behavioral Medicine 2011 41 1 71 82 10.1007/s12160-010-9226-0 2-s2.0-79952282098 20827519 source

      Not checked in the free run.

    • cites [82] Lawton J. Parry O. Peel E. Douglas M. Diabetes service provision: a qualitative study of newly diagnosed Type 2 diabetes patients' experiences and views Diabetic Medicine 2005 22 9 1246 1251 10.1111/j.1464-5491.2005.01619.x 2-s2.0-24044517188 16108856 source

      Not checked in the free run.

    • cites [83] Khoza S. R. Kortenbout W. An investigation of compliance in type II diabetic patients attending clinic at Church of Scotland hospital Curationis 1995 18 4 10 14 2-s2.0-0029451860 8697530 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The study used validated measures to assess optimism, gratitude, anxiety/depression, diabetes distress, health-related quality of life and function, diabetes self-care, and health behavior adherence.

    “noninterventionist study staff obtained the following validated measures (Table 1):Life Orientation Test-Revised (LOT-R [95]) to assess optimism.Gratitude Questionnaire-6 (GQ-6 [35]) for gratitude.Hospital Anxiety and Depression Scale (HADS [96]) for anxiety/depression.Diabetes Distress Scale (DDS [97]) for diabetes-related distress.Patient-Reported Outcomes Measurement Information System 10-Item”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [95] Scheier M. F. Carver C. S. Bridges M. W. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test Journal of Personality and Social Psychology 1994 67 6 1063 1078 10.1037/0022-3514.67.6.1063 2-s2.0-0028725058 7815302 source

      Not checked in the free run.

    • cites [35] McCullough M. E. Emmons R. A. Tsang J.-A. The grateful disposition: a conceptual and empirical topography Journal of Personality and Social Psychology 2002 82 1 112 127 10.1037//0022-3514.82.1.112 2-s2.0-0036364933 11811629 source

      Not checked in the free run.

    • cites [96] Zigmond A. S. Snaith R. P. The hospital anxiety and depression scale Acta Psychiatrica Scandinavica 1983 67 6 361 370 10.1111/j.1600-0447.1983.tb09716.x 2-s2.0-0020527558 6880820 source

      Not checked in the free run.

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

    Study design and conductreasoning

    Participants were enrolled from both an outpatient diabetes center and inpatient medical units of an urban academic medical center to capture both stable outpatients and those with more significant comorbid medical illness.

    “Participants were enrolled from the outpatient diabetes center and inpatient medical units of an urban academic medical center; we included both populations to capture both stable outpatients and those with more significant comorbid medical illness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Self-efficacy and perceived control are influenced by positive cognitions and emotions and are associated with improved health behaviors.

    “Self-efficacy and perceived control are influenced by positive cognitions and emotions and are associated with improved health behaviors [17, 58].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [17] Celano C. M. Beale E. E. Moore S. V. Wexler D. J. Huffman J. C. Positive psychological characteristics in diabetes: a review Current Diabetes Reports 2013 13 6 917 929 10.1007/s11892-013-0430-8 2-s2.0-84889083094 24048687 source

      Not checked in the free run.

    • cites [58] Yi-Frazier J. P. Hilliard M. Cochrane K. Hood K. The impact of positive psychology on diabetes outcomes: a review Psychology 2012 3 12A 1116 1124 10.4236/psych.2012.312A165 source

      Not checked in the free run.

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

    Premisecitation

    Mindfulness-based stress reduction (MBSR) has been successful in improving symptoms in a variety of medical conditions.

    “One such intervention is mindfulness-based stress reduction (MBSR), which has been successful in improving symptoms in a variety of medical conditions [102–105].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [102] la Cour P. Petersen M. Effects of mindfulness meditation on chronic pain: a randomized controlled trial Pain Medicine 2015 16 4 641 652 10.1111/pme.12605 25376753 source

      Not checked in the free run.

    • cites [103] Grossman P. Niemann L. Schmidt S. Walach H. Mindfulness-based stress reduction and health benefits: a meta-analysis Journal of Psychosomatic Research 2004 57 1 35 43 10.1016/s0022-3999(03)00573-7 2-s2.0-3142646773 15256293 source

      Not checked in the free run.

    • cites [104] Labelle L. E. Campbell T. S. Faris P. Carlson L. E. Mediators of mindfulness-based stress reduction (MBSR): assessing the timing and sequence of change in cancer patients Journal of Clinical Psychology 2015 71 1 21 40 10.1002/jclp.22117 25099479 source

      Not checked in the free run.

    • cites [105] Lengacher C. A. Shelton M. M. Reich R. R. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT) Journal of Behavioral Medicine 2014 37 2 185 195 10.1007/s10865-012-9473-6 2-s2.0-84896405909 23184061 PMC3627743 source

      Not checked in the free run.

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

    Premisecitation

    MBSR focuses on mindfulness techniques and relaxation exercises in an intensive format typically requiring eight weekly 1.5-hour sessions and daily homework completion.

    “MBSR focuses on several mindfulness techniques and relaxation exercises in an intensive intervention format typically requiring eight weekly 1.5-hour sessions and a commitment to daily homework completion [106].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [106] University of Massachusetts Medical School Mindfulness-Based Stress Reduction 8-Week Program 2014 Worcester, Mass, USA University of Massachusetts Medical School http://www.umassmed.edu/cfm/stress-reduction/mbsr-8-week

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    MI has been successfully used to target physical activity and other health behaviors in T2D patients in several studies, but MI alone may not always be sufficient to effect change.

    “MI has been successfully used to target physical activity and other health behaviors in T2D patients in several studies [114], but MI alone may not always be sufficient to effect change.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [114] Christie D. Channon S. The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in paediatric and adult populations: a clinical review Diabetes, Obesity and Metabolism 2014 16 5 381 387 10.1111/dom.12195 2-s2.0-84898776629 PMC4237607 23927612 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    MI has been associated with improvements, but its effect size has only been moderate (e.g., ES for physical activity = 0.19).

    “While MI has been associated with improvements, the effect size of this technique has only been moderate (e.g., ES for physical activity = 0.19) [115].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [115] Avery L. Flynn D. van Wersch A. Sniehotta F. F. Trenell M. I. Changing physical activity behavior in type 2 diabetes: a systematic review and meta-analysis of behavioral interventions Diabetes Care 2012 35 12 2681 2689 10.2337/dc11-2452 2-s2.0-84869778531 23173137 PMC3507564 source

      Not checked in the free run.

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

    Premisecitation

    MBSR typically requires extensive provider training programs that include practicums and retreats.

    “MBSR also typically requires extensive provider training programs that include practicums and retreats [106].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [106] University of Massachusetts Medical School Mindfulness-Based Stress Reduction 8-Week Program 2014 Worcester, Mass, USA University of Massachusetts Medical School http://www.umassmed.edu/cfm/stress-reduction/mbsr-8-week

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    MI is not effective for all patients; MI studies have been mixed, with some studies finding no greater effect of MI compared to control conditions.

    “Furthermore, MI is not effective for all patients. MI studies have been mixed, with some studies finding no greater effect of MI compared to control conditions [116, 117].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [116] Befort C. A. Nollen N. Ellerbeck E. F. Sullivan D. K. Thomas J. L. Ahluwalia J. S. Motivational interviewing fails to improve outcomes of a behavioral weight loss program for obese African American women: a pilot randomized trial Journal of Behavioral Medicine 2008 31 5 367 377 10.1007/s10865-008-9161-8 2-s2.0-51849107297 18587639 source

      Not checked in the free run.

    • cites [117] Rosenbek Minet L. K. Wagner L. Lønvig E. M. Hjelmborg J. Henriksen J. E. The effect of motivational interviewing on glycaemic control and perceived competence of diabetes self-management in patients with type 1 and type 2 diabetes mellitus after attending a group education programme: a randomised controlled trial Diabetologia 2011 54 7 1620 1629 10.1007/s00125-011-2120-x 2-s2.0-79959745830 21455729 source

      Not checked in the free run.

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

    Premisecitation

    In MET, the discrepancy between normative behavior and a client's current behavior is presented and discussed in a nonconfrontational manner with the goal of engaging clients in increasing intrinsic motivation towards change.

    “This discrepancy between normative behavior and a client's current behavior is presented and discussed in a nonconfrontational manner with the goal of engaging clients in increasing intrinsic motivation towards change [111, 112].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [111] Ball S. A. Martino S. Nich C. Site matters: multisite randomized trial of motivational enhancement therapy in community drug abuse clinics Journal of Consulting and Clinical Psychology 2007 75 4 556 567 10.1037/0022-006x.75.4.556 2-s2.0-34548824878 17663610 PMC2148493 source

      Not checked in the free run.

    • cites [112] Miller W. R. Zweben A. DiClemente C. C. Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence 1992 2 Rockville, Md, USA National Institute on Alcohol Abuse and Alcoholism Project MATCH Monograph Series

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The ability to deliver MI remotely is well suited to T2D patients, who may have functional, time, financial, or transportation barriers that preclude frequent inpatient visits.

    “Furthermore, as with PP, the ability to deliver MI remotely is very well suited to T2D patients, who may have functional, time, financial, or transportation barriers that preclude frequent inpatient visits.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Motivational enhancement therapy (MET) is a brief (typically 4-session) adaptation of MI sometimes used in clinical trials that includes normative feedback to clients about their behavior.

    “Motivational enhancement therapy (MET) is a brief (typically 4-session) adaptation of MI sometimes used in clinical trials that includes normative feedback to clients about their behavior.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [111] Ball S. A. Martino S. Nich C. Site matters: multisite randomized trial of motivational enhancement therapy in community drug abuse clinics Journal of Consulting and Clinical Psychology 2007 75 4 556 567 10.1037/0022-006x.75.4.556 2-s2.0-34548824878 17663610 PMC2148493 source

      Not checked in the free run.

    • cites [112] Miller W. R. Zweben A. DiClemente C. C. Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence 1992 2 Rockville, Md, USA National Institute on Alcohol Abuse and Alcoholism Project MATCH Monograph Series

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

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

    Premisecitation

    MI is a patient-centered approach specifically focused on having patients generate reasons for change and assisting them in resolving ambivalence about changing their behavior.

    “First, it is a patient-centered approach, specifically focused on having patients generate reasons for change and assisting them in resolving ambivalence about changing their behavior.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [110] Miller W. R. Rollnick S. Motivational Interviewing: Preparing People for Change 2012 3rd New York, NY, USA Guilford Press source

      Not checked in the free run.

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

    Premisenone given

    In MI, direct confrontation and persuasion are discouraged in the therapist, whose role is to help the client thoughtfully examine his or her behavior and its consequences.

    “Direct confrontation and persuasion are discouraged in the therapist, whose role is to help the client to thoughtfully examine his or her behavior and its consequences.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    The provider training process for PP (training manual, role play, and audiotaped practice sessions) is much simpler than that required for MBSR, improving applicability to real-world settings.

    “The provider training process (completed via a training manual, role play, and audiotaped practice sessions for PP) is much simpler than that required for MBSR, improving applicability to real-world settings.”
    Quote in the paperNot a substantial claim

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

    Interpretationown data

    Phone delivery of the PP intervention has been straightforward.

    “Thus far it appears that recruitment and enrollment for a proof-of-concept study of a PP intervention in T2D is feasible in both inpatient and outpatient settings, and phone delivery of the intervention has been straightforward.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    In contrast to MBSR, PP exercises are briefer, can be completed independently, and do not require in-person sessions.

    “In contrast to MBSR, PP exercises are briefer and can be completed independently, and in-person sessions are not required.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Because MI is adaptable to patients at any stage of change, it can apply to a large number of patients.

    “By being adaptable to patients at any stage of change, it can apply to a large number of patients.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    MI is a patient-centered method for enhancing intrinsic motivation to change and facilitating behavior change.

    “MI is a patient-centered method for enhancing intrinsic motivation to change and facilitating behavior change [110].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [110] Miller W. R. Rollnick S. Motivational Interviewing: Preparing People for Change 2012 3rd New York, NY, USA Guilford Press source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients who may struggle to benefit from health behavior interventions like MI include those with low expectation of improvement, low overall optimism, and low perceived social support.

    “There appear to be specific characteristics of patients who may struggle to benefit from health behavior interventions like MI, such as those who have low expectation of improvement and low overall optimism and those who have low perceived social support [118–120].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [118] Scheier M. F. Helgeson V. S. Schulz R. Moderators of interventions designed to enhance physical and psychological functioning among younger women with early-stage breast cancer Journal of Clinical Oncology 2007 25 36 5710 5714 10.1200/JCO.2007.11.7093 2-s2.0-37649011766 17998547 source

      Not checked in the free run.

    • cites [119] Goossens M. E. J. B. Vlaeyen J. W. S. Hidding A. Kole-Snijders A. Evers S. M. A. A. Treatment expectancy affects the outcome of cognitive-behavioral interventions in chronic pain Clinical Journal of Pain 2005 21 1 18 26 10.1097/00002508-200501000-00003 2-s2.0-10944236788 15599128 source

      Not checked in the free run.

    • cites [120] Joseph C. L. M. Havstad S. L. Johnson D. Factors associated with nonresponse to a computer-tailored asthma management program for urban adolescents with asthma Journal of Asthma 2010 47 6 667 673 10.3109/02770900903518827 2-s2.0-77955533866 20642376 PMC4017358 source

      Not checked in the free run.

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

    Interpretationcitation

    Physical activity may be an ideal target for a combined PP-MI intervention, given that positive states may be most linked with physical activity among health behaviors and given the substantial evidence base for MI on physical activity.

    “Physical activity may be an ideal target for such an intervention, given that positive states may be most linked with physical activity among the health behaviors [122, 123] and given the substantial evidence base for MI on physical activity.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [122] Scheier M. F. Matthews K. A. Owens J. F. Dispositional optimism and recovery from coronary artery bypass surgery: the beneficial effects on physical and psychological well-being Journal of Personality and Social Psychology 1989 57 6 1024 1040 10.1037//0022-3514.57.6.1024 2-s2.0-0024796213 2614656 source

      Not checked in the free run.

    • cites [123] Giltay E. J. Geleijnse J. M. Zitman F. G. Buijsse B. Kromhout D. Lifestyle and dietary correlates of dispositional optimism in men: The Zutphen Elderly Study Journal of Psychosomatic Research 2007 63 5 483 490 10.1016/j.jpsychores.2007.07.014 2-s2.0-35548953128 17980220 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    A combined PP-MI intervention could be delivered by phone, maintaining broad accessibility.

    “This combined PP-MI intervention could be delivered by phone, maintaining broad accessibility.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a comparative effectiveness trial, MET alone was not effective in improving outcomes in patients with type 1 diabetes, but when combined with a second intervention it resulted in improved clinical outcomes.

    “For example, in a comparative effectiveness trial, MET alone was not effective in improving outcomes in patients with type 1 diabetes, but when combined with a second intervention it did result in improved clinical outcomes [121].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [121] Ismail K. Thomas S. M. Maissi E. Motivational enhancement therapy with and without cognitive behavior therapy to treat type 1 diabetes: a randomized trial Annals of Internal Medicine 2008 149 10 708 719 10.7326/0003-4819-149-10-200811180-00005 2-s2.0-56549130043 19017589 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    There is evidence to suggest that higher levels of positive affect, optimism, and well-being can lead to improved health behavior adherence (and outcomes) in patients with chronic illnesses like T2D.

    “In sum, there is evidence to suggest that higher levels of positive affect, optimism, and well-being can lead to improved health behavior adherence (and outcomes) in patients with chronic illnesses like T2D.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    PP exercises have led to increased optimism and outcome expectancy, confidence and self-efficacy, and greater perceived social support and interpersonal connectedness.

    “PP exercises have led to increased optimism and outcome expectancy [124, 125], confidence and self-efficacy [126], and greater perceived social support and interpersonal connectedness (pathway A1) [127, 128].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [124] King L. A. The health benefits of writing about life goals Personality & Social Psychology Bulletin 2001 27 7 798 807 10.1177/0146167201277003 2-s2.0-0035536247 source

      Not checked in the free run.

    • cites [125] Meevissen Y. M. C. Peters M. L. Alberts H. J. E. M. Become more optimistic by imagining a best possible self: effects of a two week intervention Journal of Behavior Therapy and Experimental Psychiatry 2011 42 3 371 378 10.1016/j.jbtep.2011.02.012 2-s2.0-79953061840 21450262 source

      Not checked in the free run.

    • cites [126] Smeets E. Neff K. Alberts H. Peters M. Meeting suffering with kindness: effects of a brief self-compassion intervention for female college students Journal of Clinical Psychology 2014 70 9 794 807 10.1002/jclp.22076 2-s2.0-84897349100 24691680 source

      Not checked in the free run.

    • cites [127] Fredrickson B. L. Cohn M. A. Coffey K. A. Pek J. Finkel S. M. Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources Journal of Personality and Social Psychology 2008 95 5 1045 1062 10.1037/a0013262 2-s2.0-56349159522 18954193 PMC3156028 source

      Not checked in the free run.

    • cites [128] Lyubomirsky S. Layous K. How do simple positive activities increase well-being? Current Directions in Psychological Science 2013 22 1 57 62 10.1177/0963721412469809 2-s2.0-84872788641 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    MI leads to decreased ambivalence, greater intention to change, and increased feelings of control, all of which are consistently associated with greater physical activity.

    “Furthermore, MI itself leads to decreased ambivalence, greater intention to change, and increased feelings of control (pathway C1) [113, 133–137], all of which are consistently associated with greater physical activity (pathway C2) [138–140].”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [113] Miller W. R. Rose G. S. Toward a theory of motivational interviewing American Psychologist 2009 64 6 527 537 10.1037/a0016830 2-s2.0-70349428558 19739882 PMC2759607 source

      Not checked in the free run.

    • cites [133] Martins R. K. McNeil D. W. Review of motivational interviewing in promoting health behaviors Clinical Psychology Review 2009 29 4 283 293 10.1016/j.cpr.2009.02.001 2-s2.0-67349224650 19328605 source

      Not checked in the free run.

    • cites [134] Bean M. K. Powell P. Quinoy A. Ingersoll K. Wickham E. P. Mazzeo S. E. Motivational interviewing targeting diet and physical activity improves adherence to paediatric obesity treatment: results from the MI Values randomized controlled trial Pediatric Obesity 2015 10 2 118 125 10.1111/j.2047-6310.2014.226.x 24729537 PMC4197118 source

      Not checked in the free run.

    • cites [135] Wing R. R. Hamman R. F. Bray G. A. Achieving weight and activity goals among diabetes prevention program lifestyle participants Obesity Research 2004 12 9 1426 1434 10.1038/oby.2004.179 2-s2.0-16544383008 15483207 PMC2505058 source

      Not checked in the free run.

    • cites [136] Smith D. E. Heckemeyer C. M. Kratt P. P. Mason D. A. Motivational interviewing to improve adherence to a behavioral weight-control program for older obese women with NIDDM: a pilot study Diabetes Care 1997 20 1 52 54 10.2337/diacare.20.1.52 2-s2.0-0031026384 9028693 source

      Not checked in the free run.

    • cites [137] Miller W. R. Rollnick S. Ten things that motivational interviewing is not Behavioural and Cognitive Psychotherapy 2009 37 2 129 140 10.1017/S1352465809005128 2-s2.0-63749102282 19364414 source

      Not checked in the free run.

    • cites [138] Boudreau F. Godin G. Participation in regular leisure-time physical activity among individuals with type 2 diabetes not meeting Canadian guidelines: the influence of intention, perceived behavioral control, and moral norm International Journal of Behavioral Medicine 2014 21 6 918 926 10.1007/s12529-013-9380-4 2-s2.0-84892396570 24442932 source

      Not checked in the free run.

    • cites [139] Plotnikoff R. C. Trinh L. Courneya K. S. Karunamuni N. Sigal R. J. Predictors of physical activity in adults with type 2 diabetes American Journal of Health Behavior 2011 35 3 359 370 2-s2.0-79957970626 21683024 source

      Not checked in the free run.

    • cites [140] Moreau M. Gagnon M. P. Boudreau F. Development of a fully automated, web-based, tailored intervention promoting regular physical activity among insufficiently active adults with type 2 diabetes: integrating the I-change model, self-determination theory, and motivational interviewing components JMIR Research Protocols 2015 4 1, article e25 10.2196/resprot.4099 PMC4376153 25691346 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both MI and the effects of PP on mood, well-being, and optimism are associated with greater self-efficacy, confidence, and motivation, which are in turn linked to physical activity.

    “In addition, both MI (pathway D1) [113, 133, 141–145] and the previously described effects of PP on mood, well-being, and optimism (pathway E) [52, 95, 146] are associated with greater self-efficacy, confidence, and motivation, which are in turn linked to physical activity (pathway D2) [139, 147–151].”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [113] Miller W. R. Rose G. S. Toward a theory of motivational interviewing American Psychologist 2009 64 6 527 537 10.1037/a0016830 2-s2.0-70349428558 19739882 PMC2759607 source

      Not checked in the free run.

    • cites [133] Martins R. K. McNeil D. W. Review of motivational interviewing in promoting health behaviors Clinical Psychology Review 2009 29 4 283 293 10.1016/j.cpr.2009.02.001 2-s2.0-67349224650 19328605 source

      Not checked in the free run.

    • cites [141] Gourlan M. Sarrazin P. Trouilloud D. Motivational interviewing as a way to promote physical activity in obese adolescents: a randomised-controlled trial using self-determination theory as an explanatory framework Psychology & Health 2013 28 11 1265 1286 10.1080/08870446.2013.800518 2-s2.0-84887060011 23756082 source

      Not checked in the free run.

    • cites [142] Lilienthal K. R. Pignol A. E. Holm J. E. Telephone-based motivational interviewing to promote physical activity and stage of change progression in older adults Journal of Aging and Physical Activity 2014 22 4 527 535 24226309 source

      Not checked in the free run.

    • cites [143] Bennett J. A. Young H. M. Nail L. M. Winters-Stone K. Hanson G. A telephone-only motivational intervention to increase physical activity in rural adults: a randomized controlled trial Nursing Research 2008 57 1 24 32 10.1097/01.nnr.0000280661.34502.c1 2-s2.0-37349015233 18091289 source

      Not checked in the free run.

    • cites [144] Wagner C. C. Ingersoll K. S. Beyond cognition: broadening the emotional base of motivational interviewing Journal of Psychotherapy Integration 2008 18 2 191 206 10.1037/1053-0479.18.2.191 2-s2.0-45449102673 20631922 PMC2903073 source

      Not checked in the free run.

    • cites [145] Miller W. R. Rollnick S. Talking oneself into change: motivational interviewing, stages of change, and therapeutic process Journal of Cognitive Psychotherapy 2004 18 4 299 308 10.1891/jcop.18.4.299.64003 2-s2.0-17444406296 source

      Not checked in the free run.

    • cites [52] Fredrickson B. L. The role of positive emotions in positive psychology: the broaden-and-build theory of positive emotions American Psychologist 2001 56 3 218 226 10.1037//0003-066x.56.3.218 2-s2.0-0035289375 11315248 PMC3122271 source

      Not checked in the free run.

    • cites [95] Scheier M. F. Carver C. S. Bridges M. W. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test Journal of Personality and Social Psychology 1994 67 6 1063 1078 10.1037/0022-3514.67.6.1063 2-s2.0-0028725058 7815302 source

      Not checked in the free run.

    • cites [146] He F. Cao R. Feng Z. Guan H. Peng J. The impacts of dispositional optimism and psychological resilience on the subjective well-being of burn patients: a structural equation modelling analysis PLoS ONE 2013 8 12 e82939 10.1371/journal.pone.0082939 2-s2.0-84892910753 PMC3866201 24358241 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    PP interventions could boost the efficacy of standard MI.

    “First, PP interventions could boost the efficacy of standard MI.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    PP has established benefits on mood, resilience, well-being, and optimism.

    “Regarding direct effects of PP on activity, the established benefits of PP on mood, resilience, well-being, and optimism (pathway B1) [41, 54, 124, 125] are associated with increased physical activity (pathway B2) [48, 88, 123, 131, 132].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [41] Bolier L. Haverman M. Westerhof G. J. Riper H. Smit F. Bohlmeijer E. Positive psychology interventions: a meta-analysis of randomized controlled studies BMC Public Health 2013 13, article 119 10.1186/1471-2458-13-119 2-s2.0-84873463456 PMC3599475 23390882 source

      Not checked in the free run.

    • cites [54] Cohn M. A. Pietrucha M. E. Saslow L. R. Hult J. R. Moskowitz J. T. An online positive affect skills intervention reduces depression in adults with type 2 diabetes The Journal of Positive Psychology 2014 9 6 523 534 10.1080/17439760.2014.920410 25214877 PMC4157680 source

      Not checked in the free run.

    • cites [124] King L. A. The health benefits of writing about life goals Personality & Social Psychology Bulletin 2001 27 7 798 807 10.1177/0146167201277003 2-s2.0-0035536247 source

      Not checked in the free run.

    • cites [125] Meevissen Y. M. C. Peters M. L. Alberts H. J. E. M. Become more optimistic by imagining a best possible self: effects of a two week intervention Journal of Behavior Therapy and Experimental Psychiatry 2011 42 3 371 378 10.1016/j.jbtep.2011.02.012 2-s2.0-79953061840 21450262 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    A novel health behavior intervention that combines MI and PP in T2D may be very effective.

    “A novel health behavior intervention that combines MI and PP in T2D may be very effective.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    PP could be combined with other behavioral interventions (e.g., MI) to boost engagement and adherence with little added burden.

    “As described, another potential use is that PP could be combined with other behavioral interventions (e.g., MI) to boost engagement and adherence with little added burden.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    A combination of a psychological component (that can boost optimism, confidence, and positive experiences) alongside a goal-oriented and cognitive MI component may be much more powerful in this complex and vulnerable population than either approach alone.

    “This combination of a psychological component (that can boost optimism, confidence, and positive experiences) alongside a more tightly focused, goal-oriented, and cognitive MI component may be much more powerful in this complex and vulnerable population than either approach alone.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    Additional customization of the PP intervention more specifically to T2D will likely be useful.

    “However, we have just begun to test PP interventions in patients with T2D and suboptimal health behavior adherence, and it is likely that additional customization of the intervention more specifically to T2D will be useful.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Prior attempts to combine health behavior interventions with psychological interventions have been successful in T2D but thus far have been designed only for a minority of patients with clinical depression.

    “Prior attempts to combine health behavior interventions with psychological interventions have been successful in T2D but thus far have been designed only for minority of patients with clinical depression [152].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [152] Safren S. A. Gonzalez J. S. Wexler D. J. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (cbtad) in patients with uncontrolled type 2 diabetes Diabetes Care 2014 37 3 625 633 10.2337/dc13-0816 2-s2.0-84896708270 24170758 PMC3931377

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Limitations of the proof-of-concept trial include the use of only a single inpatient and a single outpatient site in an academic medical center and a majority of white participants; these factors may limit generalizability of findings.

    “Limitations of our specific proof-of-concept trial also include the use of only a single inpatient and a single outpatient site in an academic medical center and the fact that the majority of participants were white; these factors may limit generalizability of findings.”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    This line of work is still in very early stages and PP interventions (alone or combined) are far from established health-promoting interventions.

    “Overall, this line of work is still in very early stages and PP interventions (alone or combined) are far from established health-promoting interventions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    PP interventions appear to reliably increase positive states, have been well accepted in other populations, and are distinct from other behavioral interventions in their ease of administration, high acceptability, and specific focus on promoting positive psychological well-being.

    “In addition, PP interventions appear to reliably increase these positive states, have been well accepted in other populations, and are distinct from other behavioral interventions in their ease of administration, high acceptability, and specific focus on promoting positive psychological well-being.”
    Quote in the paperNot a substantial claim
62 of 62

  • The paper relies on this without support.

    Type 2 diabetes patients share the preference for phone over internet observed in medically ill patients.

    “Our qualitative interviews with medically ill patients have found that such patients consistently express a preference for phone over internet because of this personal connection [84].”

  • The paper relies on this without support.

    The proposed mediation pathways from positive psychological states to health behaviors are causal and applicable to type 2 diabetes.

    “We present a conceptual model of proposed mediation pathways from which additional empirical support is generated (Figure 1; also see Figure 3 for integration of PP and motivational interviewing interventions, discussed in Section 4.4).”

  • The paper relies on this without support.

    PP and MI have never been combined and evaluated in a T2D population.

    “PP and MI have never been combined and evaluated in a T2D population.”

  • The paper relies on this without support.

    There have not been comparative effectiveness trials of the wide array of psychological interventions that aim to increase self-efficacy and well-being.

    “Still, there have not been comparative effectiveness trials of the wide array of psychological interventions that aim to increase self-efficacy and well-being, and caution is warranted before clear distinctions can be made in terms of feasibility and efficacy.”

  • The paper relies on this without support.

    There is less evidence regarding the impact of PP interventions on physiologic outcomes important to health.

    “Furthermore, though there is ample data linking positive psychological states to health behaviors, there is less evidence regarding the impact of PP interventions on physiologic outcomes (e.g., inflammation) important to health.”

  • The paper relies on this without support.

    Not all patients may be interested in activities to boost their affect and well-being, and not all patients may be willing or able to complete positive activities on a regular basis.

    “Not all patients may be interested in activities to boost their affect and well-being, and, despite the exercises' straightforward nature, not all patients may be willing or able to complete positive activities on a regular basis.”
6 of 6

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?

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.

  • Power calculation refers to between-group differences in a single-arm study

    Minor

    The stated power calculation concerns between-group differences, but the described study has only one arm and therefore has no groups to compare.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. 2012, The American Journal of Managed Care, 18, S49
  2. 1996, Journal of Research in Personality, 10, 34
  3. 2008, The American Journal of Managed Care, 14, 95
  4. 10.1023/a:1023080224401 · DOI · Paper page
  5. 1995, Curationis, 18, 10
  6. 2005, AMIA Annual Symposium Proceedings, 111
  7. 1992, Oncology, 6, 50

Cited by

Sorted by citations

Related

Authors
Huffman, J. C., DuBois, C. M., Millstein, R. A., Celano, C. M., & Wexler, D.
Affiliations
  • Harvard University (US)
  • Massachusetts General Hospital (US)
Corresponding author
Huffman, Jeff C.
ORCID
Venue
Journal of Diabetes Research
Publisher
Wiley
Published
2015
Volume
2015
Pages
1-18
ISSN
  • 2314-6745 (ISSN-L)
  • 2314-6753
DOI
10.1155/2015/428349
PMC
PMC4442018
OpenAlex
W2012476584
Semantic Scholar
780654562c47294d734802cd8c419a99cc85e5e2
Cited by
127
References
148
Citations by year
2026: 2 · 2025: 7 · 2024: 6 · 2023: 14 · 2022: 10 · 2021: 10 · 2020: 12 · 2019: 11 · 2018: 43 · 2017: 8 · 2016: 4
FWCI
2.75
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Diabetes Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Institutes of Health (R01HL113272)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Social Sciences › Psychology › Applied Psychology › Optimism, Hope, and Well-being
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
type 2 diabetes, positive psychology interventions, optimism, positive affect, well-being, health behavior change, medication adherence, depression, motivational interviewing, theoretical model, intervention development
MeSH terms
Behavior Therapy, Depression, Diabetes Mellitus, Type 2, Diet, Humans, Models, Psychological, Patient Compliance, Health Behavior, Exercise

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.

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