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

The DOI matches its Crossref record; 148 of the 148 references it cites were found in a registry or an index; none of the 183 sources its claims cite is checked for support yet.

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

Open access

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.

Overview

AI snapshot

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

Nothing to recompute.

Verification

Claims the paper makes

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

Show all 57 claims

  • Probably not a substantial claim. 26
  • It may state two separate claims as one. 46
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

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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.

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Citations

Cites

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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

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Metadata

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.
Venue
Journal of Diabetes Research
Publisher
Wiley
Published
2015
Volume
2015
Pages
1-18
ISSN
  • 2314-6745 (ISSN-L)
  • 2314-6753
OpenAlex
W2012476584
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
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

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