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).”

“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).”

“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).”

“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).”

“…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…”

“…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…”

“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.”

“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).”

“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).”

“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).”

“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).”

“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…”

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

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

“…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).”

“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.”

“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.”

“…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…”

“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…”

“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.”

“…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).”

“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…”

“…(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…”

“…(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).”

“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…”

“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).”

“…(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).”

“…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…”

“…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).”

“…(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).”

“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…”

“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].”