A positive affect intervention for people experiencing health-related stress: Development and non-randomized pilot test

“Mindfulness is defined as ‘the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally’ (Kabat-Zinn, 2003: 145).”

“Self-report mindfulness was assessed at the start of the first intervention session, and at the follow-up sessions with items from the Five Factor Mindfulness Scale (FFMQ; Baer et al., 2006).”

“Intervention development Theoretical foundation The intervention presented here is based on revised Stress and Coping Theory (Folkman, 1997, 2008) and the Broaden-and-Build theory of positive emotion (Fredrickson, 1998).”

“Mindfulness is thought to allow people to tolerate and reflect on strong emotions rather than responding impulsively (Brown et al., 2007).”

“…of attention and specific actions tendencies associated with negative affect, positive affect broadens the individual’s attentional focus (Fredrickson and Branigan, 2005; Rowe et al., 2007; Wadlinger and Isaacowitz, 2006) and behavioral repertoire (Cunningham, 1988; Fredrickson and Branigan, 2005).”

“…programs (e.g. Fava and Ruini, 2003; Fava et al., 1998; Fordyce, 1981, 1983; Seligman et al., 2006) as well as studies of single skills (e.g. Emmons, 2007; Langston, 1994; Lyubomirsky et al., 2005), and our own program of observational research (e.g. Folkman et al., 1997; Moskowitz et al., 1996).”

“A recent meta-analysis by Sin and Lyubomirsky (2009) provides support for this decision, finding that multiple component interventions are more effective than those that focus on a single skill.”

“, 2007) and in measures of cortical activation (Davidson et al., 2003).”

“…at week one, at an in-person session one week after the completion of the intervention (Follow-up one) and by phone four weeks after that (Follow-up two) using a version of the Differential Emotions Scale (DES) modified by Fredrickson et al. (2003) to include additional positive affect words.”

“…affect and greater life satisfaction are found among people who perceive that they are making progress toward their goals (Brunstein et al., 1998; Carver and Scheier, 1990; Lent et al., 2005), and pursuing attainable goals (goals that are short-term and specific versus distant and global) is…”

“Introduction A growing body of research and theory suggests that addressing chronic stress only in terms of the negative affect it evokes is too narrow and that positive affect may play a critical part in the maintenance of psychological and physical well-being (Folkman and Moskowitz, 2000).”

“The modified DES has shown acceptable validity in terms of agreement with other affect measures and change in response to intervention (Fredrickson et al., 2008).”

“…and chronically ill samples, independent of the effects of negative affect (Chida and Steptoe, 2008; Moskowitz, 2003; Moskowitz et al., 2008; Pressman and Cohen, 2005), and research is beginning to provide evidence for possible physiological and behavioral mechanisms linking positive affect…”

“The revised model suggests that the negative affect associated with chronic unfavorable resolution motivates coping processes that draw on important goals and values, including positive reappraisal and goal-directed problem-focused coping (Folkman, 1997).”

“…associated with lower risk of morbidity and mortality in healthy and chronically ill samples, independent of the effects of negative affect (Chida and Steptoe, 2008; Moskowitz, 2003; Moskowitz et al., 2008; Pressman and Cohen, 2005), and research is beginning to provide evidence for…”

“Altruistic behavior may lead to positive affect because it provides a sense of self-efficacy, increases self-esteem, or provides a distraction from one’s own problems (Penner et al., 2005).”

“…the eight skills based on evidence from previous multiple-component programs (e.g. Fava and Ruini, 2003; Fava et al., 1998; Fordyce, 1981, 1983; Seligman et al., 2006) as well as studies of single skills (e.g. Emmons, 2007; Langston, 1994; Lyubomirsky et al., 2005), and our own program of…”

“Self-affirmation is also associated with better psychological adjustment to physical illness (Taylor and Lobel, 1989; Taylor et al., 1992) and healthier biological profiles (Taylor et al., 2003).”

“Repeated experiences of positive affect build social, intellectual, and physical resources (Fredrickson et al., 2003; Gable et al., 2004, 2006; Waugh and Fredrickson, 2006).”

“Folkman (1997) proposed a revision to Stress and Coping Theory that explicitly posits a role for positive affect in the coping process.”

“Mindfulness can effectively be taught, and brief, secular mindfulness meditation training has been found to increase positive affect, both in selfreports (Grossman et al., 2007; Shapiro et al., 2007) and in measures of cortical activation (Davidson et al., 2003).”

“…of attention and specific actions tendencies associated with negative affect, positive affect broadens the individual’s attentional focus (Fredrickson and Branigan, 2005; Rowe et al., 2007; Wadlinger and Isaacowitz, 2006) and behavioral repertoire (Cunningham, 1988; Fredrickson and Branigan, 2005).”

“In large, representative samples, altruistic behaviors such as volunteerism are associated with lower risk of serious physical illness (Moen et al., 1993) and lower risk of mortality (Musick and Wilson, 2003; Oman et al., 1999).”

“This is one of the few ways of coping that is consistently empirically associated with increased positive affect (Carver and Scheier, 1994; Folkman, 1997; Sears et al., 2003).”

“There is evidence that keeping a regular journal of things you are grateful for is associated with higher levels of positive affect (Emmons and McCullough, 2003).”

“This is one of the few ways of coping that is consistently empirically associated with increased positive affect (Carver and Scheier, 1994; Folkman, 1997; Sears et al., 2003).”

“Higher levels of positive affect and greater life satisfaction are found among people who perceive that they are making progress toward their goals (Brunstein et al., 1998; Carver and Scheier, 1990; Lent et al., 2005), and pursuing attainable goals (goals that are short-term and specific versus…”

“…programs (e.g. Fava and Ruini, 2003; Fava et al., 1998; Fordyce, 1981, 1983; Seligman et al., 2006) as well as studies of single skills (e.g. Emmons, 2007; Langston, 1994; Lyubomirsky et al., 2005), and our own program of observational research (e.g. Folkman et al., 1997; Moskowitz et al., 1996).”

“Repeated experiences of positive affect build social, intellectual, and physical resources (Fredrickson et al., 2003; Gable et al., 2004, 2006; Waugh and Fredrickson, 2006).”

“Mindfulness has been used in many other successful intervention trials, most commonly in the form of MindfulnessBased Stress Reduction (MBSR; Kabat-Zinn, 1990), a secular meditation training course.”

“Repeated experiences of positive affect build social, intellectual, and physical resources (Fredrickson et al., 2003; Gable et al., 2004, 2006; Waugh and Fredrickson, 2006).”

“Mindfulness can effectively be taught, and brief, secular mindfulness meditation training has been found to increase positive affect, both in selfreports (Grossman et al., 2007; Shapiro et al., 2007) and in measures of cortical activation (Davidson et al., 2003).”

“creating valued and attainable goals) is commonly used in behavioral health interventions (Strecher et al., 1995) and has been included in programs for people with serious physical illness such as HIV (e.”

“…(Bormann et al., 2009; Hollywell and Walker, 2009; McCain et al., 2008; Miller et al., 2008), meaning-making (Bower et al., 2003; Lee et al., 2006), forgiveness (Freedman and Enright, 1996; Lundahl et al., 2008; Waltman et al., 2009), and positive writing (Burton and King, 2004; Low et al., 2006).”

“(e.g. Fava and Ruini, 2003; Fava et al., 1998; Fordyce, 1981, 1983; Seligman et al., 2006) as well as studies of single skills (e.”

“Self-affirmation is also associated with better psychological adjustment to physical illness (Taylor and Lobel, 1989; Taylor et al., 1992) and healthier biological profiles (Taylor et al., 2003).”

“…who perceive that they are making progress toward their goals (Brunstein et al., 1998; Carver and Scheier, 1990; Lent et al., 2005), and pursuing attainable goals (goals that are short-term and specific versus distant and global) is associated with higher subjective well-being (Emmons, 1986, 1992).”

“…(Bormann et al., 2009; Hollywell and Walker, 2009; McCain et al., 2008; Miller et al., 2008), meaning-making (Bower et al., 2003; Lee et al., 2006), forgiveness (Freedman and Enright, 1996; Lundahl et al., 2008; Waltman et al., 2009), and positive writing (Burton and King, 2004; Low et al., 2006).”

“In large, representative samples, altruistic behaviors such as volunteerism are associated with lower risk of serious physical illness (Moen et al., 1993) and lower risk of mortality (Musick and Wilson, 2003; Oman et al., 1999).”

“We selected the eight skills based on evidence from previous multiple-component programs (e.g. Fava and Ruini, 2003; Fava et al., 1998; Fordyce, 1981, 1983; Seligman et al., 2006) as well as studies of single skills (e.g. Emmons, 2007; Langston, 1994; Lyubomirsky et al., 2005), and our own program…”

“…satisfaction are found among people who perceive that they are making progress toward their goals (Brunstein et al., 1998; Carver and Scheier, 1990; Lent et al., 2005), and pursuing attainable goals (goals that are short-term and specific versus distant and global) is associated with higher…”

“Reed and Aspinwall (1998) found that women who were given the opportunity to affirm a positive aspect of themselves were more receptive to information about a serious disease risk, and retained more of the information over the following week.”

“We selected the eight skills based on evidence from previous multiple-component programs (e.g. Fava and Ruini, 2003; Fava et al., 1998; Fordyce, 1981, 1983; Seligman et al., 2006) as well as studies of single skills (e.g. Emmons, 2007; Langston, 1994; Lyubomirsky et al., 2005), and our own program…”

“…of attention and specific actions tendencies associated with negative affect, positive affect broadens the individual’s attentional focus (Fredrickson and Branigan, 2005; Rowe et al., 2007; Wadlinger and Isaacowitz, 2006) and behavioral repertoire (Cunningham, 1988; Fredrickson and Branigan, 2005).”

“…(Bormann et al., 2009; Hollywell and Walker, 2009; McCain et al., 2008; Miller et al., 2008), meaning-making (Bower et al., 2003; Lee et al., 2006), forgiveness (Freedman and Enright, 1996; Lundahl et al., 2008; Waltman et al., 2009), and positive writing (Burton and King, 2004;…”

“Self-affirmation is also associated with better psychological adjustment to physical illness (Taylor and Lobel, 1989; Taylor et al., 1992) and healthier biological profiles (Taylor et al., 2003).”

“Our focus on positive affect is consistent with a strengths-based, client centered approach (Corcoran, 2005), will likely make the proposed intervention more attractive to providers and participants alike, and serve as an antidote to ‘prevention fatigue’, which is increasingly pervasive in communities at high risk for…”

“Reappraisal is a cognitive technique and it has been taught in several therapeutic interventions for people with serious physical illness (e.g. Antoni et al., 2008; Bova et al., 2008; Chesney et al., 1996, 2003).”

“…risk of morbidity and mortality in healthy and chronically ill samples, independent of the effects of negative affect (Chida and Steptoe, 2008; Moskowitz, 2003; Moskowitz et al., 2008; Pressman and Cohen, 2005), and research is beginning to provide evidence for possible physiological and…”

“, 2007; Wadlinger and Isaacowitz, 2006) and behavioral repertoire (Cunningham, 1988; Fredrickson and Branigan, 2005).”

“…programs (e.g. Fava and Ruini, 2003; Fava et al., 1998; Fordyce, 1981, 1983; Seligman et al., 2006) as well as studies of single skills (e.g. Emmons, 2007; Langston, 1994; Lyubomirsky et al., 2005), and our own program of observational research (e.g. Folkman et al., 1997; Moskowitz et al., 1996).”

“The period immediately following HIV+ serostatus notification is characterized by increases in depression and anxiety (Ironson et al., 1990; Jacobsen et al., 1990; LaPerriere et al., 1990; Ostrow et al., 1989; Perry et al., 1992; Rundell et al., 1988).”

“…and mortality in healthy and chronically ill samples, independent of the effects of negative affect (Chida and Steptoe, 2008; Moskowitz, 2003; Moskowitz et al., 2008; Pressman and Cohen, 2005), and research is beginning to provide evidence for possible physiological and behavioral mechanisms…”

“Instead we believe that the key is to have an array of skills so that any given individual can find something that will work for him or her (Schueller, 2010).”

“…that could potentially have been included that were not, such as spirituality/religiosity/prayer (Bormann et al., 2009; Hollywell and Walker, 2009; McCain et al., 2008; Miller et al., 2008), meaning-making (Bower et al., 2003; Lee et al., 2006), forgiveness (Freedman and Enright, 1996; Lundahl et…”

“…(Bormann et al., 2009; Hollywell and Walker, 2009; McCain et al., 2008; Miller et al., 2008), meaning-making (Bower et al., 2003; Lee et al., 2006), forgiveness (Freedman and Enright, 1996; Lundahl et al., 2008; Waltman et al., 2009), and positive writing (Burton and King, 2004; Low et al., 2006).”

“The period immediately following HIV+ serostatus notification is characterized by increases in depression and anxiety (Ironson et al., 1990; Jacobsen et al., 1990; LaPerriere et al., 1990; Ostrow et al., 1989; Perry et al., 1992; Rundell et al., 1988).”

“Reappraisal is a cognitive technique and it has been taught in several therapeutic interventions for people with serious physical illness (e.g. Antoni et al., 2008; Bova et al., 2008; Chesney et al., 1996, 2003).”

“…as spirituality/religiosity/prayer (Bormann et al., 2009; Hollywell and Walker, 2009; McCain et al., 2008; Miller et al., 2008), meaning-making (Bower et al., 2003; Lee et al., 2006), forgiveness (Freedman and Enright, 1996; Lundahl et al., 2008; Waltman et al., 2009), and positive writing…”

“…(Bormann et al., 2009; Hollywell and Walker, 2009; McCain et al., 2008; Miller et al., 2008), meaning-making (Bower et al., 2003; Lee et al., 2006), forgiveness (Freedman and Enright, 1996; Lundahl et al., 2008; Waltman et al., 2009), and positive writing (Burton and King, 2004; Low et al., 2006).”

“…designed to reduce depression in people living with HIV have met with some moderate success (Antoni et al., 2007; Bova et al., 2008; Chesney et al., 2003; Himelhoch et al., 2007), none has targeted those who were newly diagnosed with HIV and none has explicitly targeted positive affect.”

“…have been included that were not, such as spirituality/religiosity/prayer (Bormann et al., 2009; Hollywell and Walker, 2009; McCain et al., 2008; Miller et al., 2008), meaning-making (Bower et al., 2003; Lee et al., 2006), forgiveness (Freedman and Enright, 1996; Lundahl et al., 2008; Waltman…”

“For example, positive affect is associated with lower systolic and diastolic blood pressure (Ostir et al., 2006) and more adaptive immune responses in both laboratory and naturalistic studies (e.g. Stone, Cox, Keywords chronic illness, feasibility, HIV, intervention, positive affect,…”

“The period immediately following HIV+ serostatus notification is characterized by increases in depression and anxiety (Ironson et al., 1990; Jacobsen et al., 1990; LaPerriere et al., 1990; Ostrow et al., 1989; Perry et al., 1992; Rundell et al., 1988).”

“…to include noticing positive events (Skill one) was based on our prior research with people caring for a partner with AIDS, which indicated that people experience positive events even in the midst of severe stress, and noting these events may help them cope with the stress (Folkman et al., 1997).”

“Along these lines, there are a number of skills that could potentially have been included that were not, such as spirituality/religiosity/prayer (Bormann et al., 2009; Hollywell and Walker, 2009; McCain et al., 2008; Miller et al., 2008), meaning-making (Bower et al.”

“The period immediately following HIV+ serostatus notification is characterized by increases in depression and anxiety (Ironson et al., 1990; Jacobsen et al., 1990; LaPerriere et al., 1990; Ostrow et al., 1989; Perry et al., 1992; Rundell et al., 1988).”

“Our focus on positive affect is consistent with a strengths-based, client centered approach (Corcoran, 2005), will likely make the proposed intervention more attractive to providers and participants alike, and serve as an antidote to ‘prevention fatigue’, which is increasingly pervasive in communities at high risk for…”

“People newly diagnosed with HIV face significant challenges, including the need to interact with a complex health care system; constraints on sexual behavior; the need for disclosure of serostatus to friends, family, and sexual partners; stigma; and, in many cases, a struggle to come to terms with a new identity as so…”

“…(Bormann et al., 2009; Hollywell and Walker, 2009; McCain et al., 2008; Miller et al., 2008), meaning-making (Bower et al., 2003; Lee et al., 2006), forgiveness (Freedman and Enright, 1996; Lundahl et al., 2008; Waltman et al., 2009), and positive writing (Burton and King, 2004; Low et al., 2006).”

“The period immediately following HIV+ serostatus notification is characterized by increases in depression and anxiety (Ironson et al., 1990; Jacobsen et al., 1990; LaPerriere et al., 1990; Ostrow et al., 1989; Perry et al., 1992; Rundell et al., 1988).”

“Behavioral factors including healthy diet, exercise, and adherence to medication are likely mediators of the association between positive affect and better health outcomes (Carrico et al., 2007; Connell, 1990).”

“The period immediately following HIV+ serostatus notification is characterized by increases in depression and anxiety (Ironson et al., 1990; Jacobsen et al., 1990; LaPerriere et al., 1990; Ostrow et al., 1989; Perry et al., 1992; Rundell et al., 1988).”

“Goal setting (i.e. creating valued and attainable goals) is commonly used in behavioral health interventions (Strecher et al., 1995) and has been included in programs for people with serious physical illness such as HIV (e.g. Antoni et al., 2007; Sikkema et al., 1995).”

“Although interventions designed to reduce depression in people living with HIV have met with some moderate success (Antoni et al., 2007; Bova et al., 2008; Chesney et al., 2003; Himelhoch et al., 2007), none has targeted those who were newly diagnosed with HIV and none has explicitly targeted…”

“…(Corcoran, 2005), will likely make the proposed intervention more attractive to providers and participants alike, and serve as an antidote to ‘prevention fatigue’, which is increasingly pervasive in communities at high risk for HIV (Chen et al., 2003; Ostrow et al., 2002; Stockman et al., 2004).”

“Reappraisal is a cognitive technique and it has been taught in several therapeutic interventions for people with serious physical illness (e.g. Antoni et al., 2008; Bova et al., 2008; Chesney et al., 1996, 2003).”

“1 for a summary diagram of the intervention showing the program, intervention, technique, and sub-technique levels of description (Marks, 2009, 2010).”

“1 for a summary diagram of the intervention showing the program, intervention, technique, and sub-technique levels of description (Marks, 2009, 2010).”

“Behavioral factors including healthy diet, exercise, and adherence to medication are likely mediators of the association between positive affect and better health outcomes (Carrico et al., 2007; Connell, 1990).”

“Rationale for inclusion of each of the positive emotion skills is provided elsewhere [38].”

“…on PAIs (Huffman et al., 2011, 2014; Layous, Chancellor, Lyubomirsky, Wang, & Doraiswamy, 2011; Layous et al., 2014; Lyubomirsky & Layous, 2013; Moskowitz et al., 2012) and emotion science findings regarding the function of positive thoughts, emotions, and behaviors (Fredrickson, 1998, 2001,…”

“Topics were drawn from two prior behavioral intervention models for diet and health behavior change, including components aimed at increasing positive affect and decreasing depressive symptoms [6] and teaching mindful eating techniques [7].”

“IRISS included multiple skills that had each shown, either alone or as part of other multicomponent interventions, to improve psychological well-being (Moskowitz et al., 2012) and meta-analytic studies indicate that multiple-component interventions are more effective than those that focus on a single skill (Sin & Lyub…”

“We have developed an intervention consisting of skills to increase positive emotion that shows promise for improving psychological well-being in people experiencing significant life stress (Dowling et al., 2014; Moskowitz et al., 2012; Saslow, Cohn, & Moskowitz, 2014).”

“…interactions with more PA. Similar individual interventions aimed at increasing the PA that people can cultivate in their lives have been successful at treating depression (behavioral activation; e.g., Kanter et al., 2010) and helping those with serious health conditions (Moskowitz et al., 2012).”

“Details on development of the intervention are published elsewhere (Dowling et al., 2014; Moskowitz et al., 2014; Moskowitz et al., 2012; Verstaen, Moskowitz, Snowberg, Merrilees, & Dowling, 2018).”

“, 2014) provided reference to a methodology paper detailing the development of the intervention (Moskowitz et al., 2012).”

“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].”

“, noticing positive events, gratitude, and personal strengths) has been applied to newly diagnosed PLWH and was found effective in increasing positive affect and reducing negative affect [84].”

“A small positive affect induction study used a similar design (single-arm study followed by prospectively recruited control cohort) and PP-related exercises in HIV patients (Moskowitz et al. 2012).”

“Interventions that aim to improve psychological well-being, rather than solely addressing maladaptive thoughts or behaviors, are effective for enhancing positive states and alleviating depressive symptoms (51,52); such interventions have been adapted for patients experiencing healthrelated stress (53).”

“We have developed a 5‐session positive affect skill intervention that shows promise for improving psychological and physical well‐being among people experiencing significant life stress.(13) This intervention involves teaching participants 8 empirically validated skills for increasing the frequency of positive affect…”

“…is a multi-component, individually delivered, fivesession intervention targeting positive affect that was adapted from prior clinical research testing the feasibility and acceptability of a positive affect intervention for recently diagnosed HIV-positive persons (Moskowitz et al., 2012).”

“While interventions to promote positive affect, which include exercises in gratitude, self-affirmations, and small gifts, have been tested in adults (Moskowitz et al., 2012) and have successfully improved adherence to medication and physical activity recommendations in adults (Charlson et al.”

“This intervention was adapted from prior clinical research testing a positive affect intervention for recently diagnosed HIVpositive persons (Moskowitz et al., 2017; Moskowitz et al., 2012).”

“, 2005), positive affectivity (Emmons &McCullough, 2003; Moskowitz et al., 2012) and life satisfaction (Lyubomirsky, Sousa, & Dickerhoof, 2006), as well as better physical and mental health (Lyubomirsky et al.”

“In contrast to the theories that view positive affect as a trait, and therefore unlikely to be modifiable, recent intervention studies have increased positive affect in persons with cardiopulmonary disease (40) and with newly diagnosed human immunodeficiency virus (41).”

“The PP portion (see Table 1) of the intervention was adapted from prior PP intervention studies (DuBois et al., 2016; Huffman et al., 2016; Moskowitz et al., 2012; Seligman et al., 2005) in both healthy and medically ill populations.”

“Likewise, Moskowitz et al. (2012) found that noting positive events was most frequently practiced by the participants of their study.”

“This intervention was adapted from prior clinical research testing the feasibility and acceptability of a positive affect intervention for recently diagnosed HIV-positive persons [37].”

“A 6-week intervention that involved weekly sessions where savoring skills were taught reduced negative affect and increased positive affect in a sample of people newly diagnosed with HIV [43].”

“Hamdani (2021) devised her program based on a clinical well-being instructional course, originally developed by Moskowitz et al. (2012), and intended to increase trainees’ positive affect and sense of well-being.”

“Positive activity interventions such as daily positive reflection, gratitude journals, and conducting acts of kindness have been used in other medical populations including those with cardiovascular disease, cancer, diabetes, and chronic pain [35-38], but not in caregivers of HCT patients.”

“More recently, trials in patients with coronary heart disease, hypertension, and HIV have found that such programs have had beneficial effects on well-being, depression, and in some cases, health behaviors [25-29].”

“Positive activity interventions such as daily positive reflection, gratitude journals, and conducting acts of kindness have been used in the context of heart disease, cancer, diabetes, and chronic pain [68-73].”

“3 What aspects of this experience are still unfinished for you? (Cognitive processing) Capitalizing on positive events (Moskowitz et al., 2012)”

“Caregivers experiencing sleep problems who have depressive symptoms or low PA might be good candidates for interventions that increase PA (Moskowitz et al., 2012) and reduce depressive symptoms.”

“Until now, positive reframing appeared to be positively related to different domains of QoL among PLWH in a few studies, but gender differences were not taken into account (Armon and Lichtenstein 2012; Moskowitz et al. 2009, 2012).”

“Content of the intervention Elsewhere, we have detailed the rationale for inclusion of each of the positive affect skills.(78) Briefly, the IRISS intervention consists of five in-person sessions and one phone session in which facilitators teach participants eight empirically-supported behavioral and cognitive “skills”…”

“…was found to have reduced depressive symptom severity when administered either in person or online, had high retention even among individuals with high levels of depressive symptoms [51-53], and was associated with increased positive emotion in the midst of stressful life events [52-54].”

“It has also been used within interventions designed to produce positive affect (Moskowitz et al., 2011).”

“REVIEW ARTICLE published: 07 August 2013 doi: 10.3389/fnhum.2013.00452 Improving the neural mechanisms of cognition through the pursuit of happiness”

“In another study, people with acute and severe medical illness who participated in a five-session, one-on-one treatment to promote positive emotions and coping reported increased positive affect and decreased negative affect (Moskowitz et al., 2011).”

“Lastly, seven positive affect skills (Moskowitz et al., 2012) were adopted for PATH and delivered chronologically.”

“, 2006), others find the ideas overwhelming and irrelevant to helping them cope with their depression, as has also been suggested (La Torre, 2007; Moskowitz et al., 2012).”

“Positive activity interventions, such as daily positive reflection, using gratitude journals, and conducting acts of kindness, have been used in the management of heart disease, cancer, diabetes, and chronic pain [26-29].”

“There has been promising preliminary work suggesting that systematic positive psychological interventions are well-accepted and may reduce distress and improve outcomes in patients with chronic medical illnesses [103, 104], including patients with heart disease [105-107].”

“More specifically, positive and negative affect were measured with a modified Differential Emotions Scale used in positive emotion studies (e.g., Moskowitz et al., 2012).”

“We also provided participants with strategies to increase day-to-day positive emotions, mindfulness, and mindful eating [24-28]; a coach (the first author), who answered the participants’ questions via email or phone [29]; encouragement to be physically active [30] and get sufficient sleep [31]; information about web-…”

“Studies have shown that positive affect [47,48] and other mental skills training interventions [40,49,50] are feasible and effective; thus, future studies should determine if more positive affect and optimistic traits can be cultivated in these trainees to improve course”

“…that target multiple different PPWB aspects—hedonic, eudaimonic, and otherwise—over the course of the program, and such programs do appear to boost well-being and some health behaviors (Moskowitz et al., 2012; Moskowitz et al., 2017; Moskowitz, Cheung, et al., 2019; Huffman et al., 2019, 2021).”

“…and has been widely tested by her team in multiple studies with more than 1,000 participants (ages 16–78) coping with various life stressors—from diagnosis with a serious illness to normative daily stress (Carrico & Moskowitz, 2014; Cheung et al., 2017; Moskowitz et al., 2012, 2014, 2017).”

“Details on development of the positive affect skills intervention are published elsewhere.(61)‘(63)‘(65) Table 1 provides an overview of the intervention sessions and home practice.”

“Studies also indicate that various skills-based training improves positive affect (e.g. noticing minor positive events, mindfulness, positive reappraisal, acts of kindness) (Moskowitz et al., 2012).”

“Positive psychology techniques have been shown to increase positive affect and decrease negative affect (Moskowitz et al., 2012; Sin and Lyubomirsky, 2009), and these findings have led to the assumption that positive focus influences both positive and negative affect.”

“…Health” research (Seligman, 2008) as well as a burgeoning area of research trying to improve health via Positive Psychology Clinical Psychology in Europe 2020, Vol.2(4), Article e3103 https://doi.org/10.32872/cpe.v2i4.3103 interventions (e.g., Huffman et al., 2011; Moskowitz et al., 2017, 2012).”

“of a PP intervention in patients with HIV [21].”

“41,42 Savoring, planning positive activities, and pursuing meaningful goals are examples of positive psychology approaches that can help improve coping with life stressors, including major illnesses and caregiving.”

“The PA skills intervention on which LARKSPUR is based was developed by J. Moskowitz and has been widely tested by her team in 13 studies with > 300 participants (ages 16 to 78) coping with various life stressors — from diagnosis with a serious illness to normative daily stress [36 – 38].”

“The included skills are the same as LEAF 1 [26] and other previous versions of the intervention [25, 28, 29] with the exception of self-compassion, which was substituted for acts of kindness.”

“Series of exercises based on the review of the scientific literature (Moskowitz, 2011; Moskowitz et al., 2012; Seligman, 2011) that have shown to have a major impact on the wellbeing, and for the optimal development DOI: 10.4236/psych.2018.915169 2919 Psychology of the people, were carried out.”

“…con las implicaciones que eso puede tener sobre el sentido de control interno, así como sobre las emociones, el esfuerzo y la persistencia para el logro de los objetivos personales (Ar- tistico, Cervone y Pezzuti, 2003; Löffler et al., 2012; Moskowitz et al., 2012; Schwarzer y Renner, 2000).”

“The main psychological outcome was positive affect, measured using the positive affect items of the Positive and Negative Affect Schedule (PANAS) (Watson, Clark, & Tellegen, 1988), given that it was a proximal target for the intervention, is sensitive to change, and has been linked to health outcomes (Moskowitz et al.…”

“Positive affect has received less attention in caregiving studies, overshadowed by the negative aspects of caregiving; although, in the past decade, a growing interest in the benefits of caregiving has been noted (Carbonneau, Caron, & Desrosiers, 2010; Moskowitz et al., 2012; Roff et al., 2004; Roth, DilworthAnderson,…”

“One such intervention developed by Moskowitz et al. has been successfully implemented in patients with HIV, breast cancer, and caregivers (Cheung et al., 2017; Moskowitz et al., 2012, 2019).”

“, 2012), has been shown to bolster intrinsic motivation and lead to positive behavioral outcomes (Moskowitz et al., 2012).”

“Interest is part of positive affect and a growing body of research suggests that positive affect could play an important part in psychological and physical well-being [41].”

“…with heart disease (Huffman et al., 2011), cancer (Casellas-Grau et al., 2014; Raque-Bogdan et al., 2020), diabetes (Cohn et al., 2014), chronic pain (Braunwalder et al., 2022; Hausmann et al., 2014), health-related stress (Moskowitz et al., 2012), and depression (Sin and Lyubomirsky, 2009).”