Feasibility, Acceptability, and Preliminary Efficacy of a Positive Psychology Intervention in Patients With Coronary Heart Disease: A Randomized Controlled Trial

Abstract

BACKGROUND: Both positive (e.g., optimism, well-being) and negative (e.g., stress, depressive symptoms) psychological constructs are associated with cardiovascular health. Positive psychology interventions (PPIs), which involve the cultivation of well-being through systematic activities, have the potential to enhance positive constructs and reduce negative ones; however, there has been limited study of PPIs in individuals with coronary heart disease. OBJECTIVE AND METHODS: This 3-arm, randomized controlled pilot trial investigated the feasibility, acceptability, and preliminary efficacy of an 8-week, group-based PPI, compared with group-based cognitive-behavioral therapy and treatment as usual, in patients with coronary heart disease. Assessments were completed at baseline, 9 weeks postintervention, and 15-week follow-up, and outcomes included C-reactive protein, happiness, optimism, psychological distress, and depressive symptoms. RESULTS: Eighty-four patients with coronary heart disease were included (mean age = 57.6 ± 8.3; 13.1 female). Participants in the PPI group completed 6.8 (standard deviation 1.3) of 8 sessions (85), and the majority of PPI (96) participants completed ≥5 out of the 8 sessions. PPI exercises were rated as easy to complete and subjectively useful, and PPI participants reported a high likelihood of continuing them after the intervention. In preliminary efficacy analyses, there were no consistent treatment effects of the PPI on C-reactive protein levels compared with treatment as usual and cognitive-behavioral therapy. Finally, the PPI was associated with nonsignificant, small- to medium-sized greater improvements in psychological outcomes compared with treatment as usual and cognitive-behavioral therapy at 9 and 15 weeks. CONCLUSIONS: Among individuals with coronary heart disease, a group-based PPI was feasible, well-accepted, and associated with preliminary, nonsignificant, small- to medium-sized improvements in mental health compared with treatment as usual and cognitive-behavioral therapy.