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Person-centred care requires improved documentation of nursing home resident wellbeing, e.g. by nursing staff proxy assessments. Previous studies mainly focused on proxy self-report agreement of quality of life of people with dementia, using lengthy questionnaires. This is the first study to investigate how well nursing staff assess residents’ wellbeing after training, using a single-question assessment method of happiness and engagement. We conducted a cross-sectional mixed-method study, including proxy assessments from 49 nursing staff, and self-reports from 49 nursing home residents without dementia (mean age 85). We explored agreement between colleagues, and between proxy assessments and self-reports, and potential nursing staff characteristics associated to this (age, experience, hours worked per week). Brief written motivations were evaluated on nursing staffs’ understanding of the happiness and engagement concepts. The results showed low agreement between colleagues, and low agreement between proxy assessments and self-reports. Nursing staff assessed happiness and engagement substantially higher than residents’ self-reports. Hours worked per week was related to happiness proxy assessments, but none of the included nursing staff characteristics were related to proxy self-report agreement. Nursing staff interpreted the concepts in diverse ways. Overestimating resident wellbeing when using this single-assessment method may undermine subsequent efforts to improve wellbeing. We could not identify which nursing staff could best provide wellbeing assessments. For now, proxy wellbeing assessments should always be combined with regular self-reports whenever possible.

Background The Life-Chart Method (LCM) is an effective self-management treatment option in bipolar disorder (BD). There is insufficient knowledge about the consumers’ needs and desires for an e-monitoring solution. The first step towards a new mood monitoring application is an extended inventory among consumers and professionals. Methods The aim of the current study was: to identify opinions about online mood monitoring of patients with BD and professionals and to identify preferences on design, technical features and options facilitating optimal use and implementation of online mood monitoring. This study used a qualitative design with focus-groups. Participants were recruited among patients and care providers. Three focus-groups were held with eight consumers and five professionals. Results The focus-group meetings reveal a shared consciousness of the importance of using the Life-Chart Method for online mood monitoring. There is a need for personalization, adjustability, a strict privacy concept, an adjustable graphic report, and a link to early intervention strategies in the design. Due to the fact that this is a qualitative study with a relative small number of participants, so it remains unclear whether the results are fully generalizable. We can’t rule out a selection bias. Conclusions This study demonstrates the importance of involving stakeholders in identifying a smartphone-based mood charting applications’ requirements. Personalization, adjustability, privacy, an adjustable graphic report, and a direct link to early intervention strategies are necessary requirements for a successful design. The results of this value specification are included in the follow-up of this project.

In the current study, a Dutch whole school Positive Education Programme (PEP) was investigated. PEP is a bottom-up programme, aimed at shifting teacher’s attention from solely focusing on learning outcomes towards a more comprehensive approach that takes the wellbeing and engagement of students during classes into account. PEP was investigated through a clustered quasi-experimental trial. Four primary schools, 639 pupils, were included, of which two were allocated to PEP. Multilevel analyses showed no significant differences on any of the outcomes. However, the data indicated a trend towards more engagement in the intervention schools (p =.09). Also, at post-measurement, the proportion of sufficiently engaged students was significantly higher in the intervention schools. Although it seems too premature to draw conclusions regarding the effectiveness of such a whole school approach, the findings on engagement are promising and have the potential to engender a wide range of other beneficial outcomes.

Purpose To evaluate the effectiveness of two versions (personal or automated feedback) of a psychological Web-based self-help intervention targeting partners of cancer patients. The intervention was based on acceptance and commitment therapy (ACT) and self-compassion training. Participants’ adherence and their satisfaction were also studied. Methods Two hundred three partners of patients with heterogeneous entities of cancer were randomized into three conditions: personal feedback (PF) (n = 67), automated feedback (AF) (n = 70), or waiting list (WL) control (n = 66). Participants completed measures at baseline (T0) and post-intervention (T1; 3 months after baseline) to assess psychological distress (HADS; primary outcome), positive mental health, caregiver strain, general health (secondary outcomes), posttraumatic growth, resilience, self-compassion, psychological flexibility, sense of mastery, and relational communication style (process measures). Participants in the two experimental conditions also completed these measures at follow-up (T2; 6 months after baseline). Results There was no significant difference in change in psychological distress, positive mental health, caregiver strain and general health from T0 to T1 for either of the experimental conditions compared with the WL-condition. However, when compared to a WL-condition, the PF-condition was effective in increasing psychological flexibility (effect size d = 0.49) and resilience (d = 0.12) and decreasing overprotection (d = 0.25), and the AF-condition was effective in reducing overprotection (d = 0.36) and improving protective buffering (d = 0.36). At follow-up, the PF-condition was more effective than the AF-condition for improving mental health (d = 0.36), psychological flexibility (d = 0.60), mastery (d = 0.48), and protective buffering (d = 0.24). Participants positively appreciated the intervention and 69% participants were adherent. Conclusion This study demonstrates that a Web-based intervention based on ACT and self-compassion training with automated or personal feedback does not seem to improve psychological distress; however, it may have the potential to support partners of cancer patients to cope with the difficult situation they are facing. The condition with personal feedback seemed to be more beneficial.

Objective Psychometric network analysis has led to new possibilities to assess the structure and dynamics of psychiatric disorders. The current study focuses on mental health networks in patients with anorexia nervosa, bulimia nervosa, binge eating disorder and other specified eating disorders (EDs). Method Network analyses were applied with five mental health domains (emotional, psychological and social well‐being, and general and specific psychopathology) among 905 ED patients. Also, networks of 36 underlying symptoms related to the domains were estimated. The network stability, structure and (bridge) centrality of the nodes were assessed for the total group and each ED type. Network differences between the ED types were also examined. Results ED psychopathology was only weakly connected with the well‐being domains. Psychological well‐being was the most central node in the domain network. The most central nodes in the symptom network were feeling depressed, feeling worthless, purpose in life and self‐acceptance. Bridge symptoms between well‐being and psychopathology were self‐acceptance, environmental mastery, interested in life and feeling depressed. There were no network differences between the ED types in both the domain and symptom networks. Conclusions This study shows novel associations between well‐being and psychopathology in ED patients. Central domains and their underlying symptoms may be especially important to consider in treatment for promoting mental health in ED patients., Highlights Psychometric network analysis shows novel associations between well‐being and psychopathology in eating disorder (ED) patients.The most central mental health domain and underlying symptoms were psychological well‐being, feeling depressed feeling worthless, purpose in life and self‐acceptance.A transdiagnostic approach to ED treatment, focusing on central mental health symptoms may be warranted.

Purpose Investigate whether Life Review Therapy and Memory Specificity Training (LRT-MST) targeting incurably ill cancer patients may also have a beneficial effect on caregiving burden, symptoms of anxiety and depression, and posttraumatic growth of the informal caregivers. Methods Data was collected in the context of a randomized controlled trial (RCT) (secondary analyses) on the effect of LRT-MST among incurably cancer patients. Informal caregivers of participating patients were asked to complete outcome measures at baseline (T0), post-intervention (T1), and 1-month follow-up (T2): caregiver burden (caregivers reaction assessment scale (CRA)), symptoms of anxiety and depression (hospital anxiety and depression scale), and posttraumatic growth (posttraumatic growth inventory). Linear mixed models (intention to treat) were used to assess group differences in changes over time. Effect size and independent samples t tests were used to assess group differences at T1 and T2. Results In total, 64 caregivers participated. At baseline, 56% of the caregivers experienced anxiety and 30% depression. No significant effect was found on these symptoms nor on posttraumatic growth or most aspects of caregiver burden. There was a significant effect of LRT-MST on the course of self-esteem (subscale CRA) (p = 0.013). Effect size was moderate post-intervention (ES = − 0.38, p = 0.23) and at 3-month follow-up (ES = 0.53, p = 0.083). Conclusions Many caregivers of incurably ill cancer patients experience symptoms of anxiety and depression. LRT-MST does not improve symptoms of depression and anxiety, negative aspects of caregiver burden, or posttraumatic growth. LRT-MST may have a protective effect on self-esteem of informal caregivers (positive aspect of caregiver burden). Trial registration number Netherlands Trial Register (NTR 2256), registered on 23-3-2010.

Person-centered care (PCC) interventions have the potential to improve resident well-being in nursing homes, but can be difficult to implement. This study investigates perceived facilitators and barriers reported by nursing staff to using a PCC intervention consisting of three components: assessment of resident well-being, planning of well-being support, and behavioral changes in care to support resident well-being. Our explorative mixed method study combined interviews (n = 11) with a longitudinal survey (n = 132) to examine which determinants were most prevalent and predictive for intention to use the intervention and actual implementation 3 months later (n = 63). Results showed that perceived barriers and facilitators were dependent on the components of the intervention. Assessment of resident well-being required a stable nursing home context and a detailed implementation plan, while planning of well-being support was impeded by knowledge. Behavioral changes in nursing care required easy integration in daily caring tasks and social support. (C) 2020 The Author(s). Published by Elsevier Inc.

Many individuals with posttraumatic stress disorder (PTSD) continue to have substantial residual symptoms after completing psychological treatment. Well-being therapy (WBT) has been developed to treat the residual phase of mental disorders, prevent relapse, and promote a full recovery. The present study aimed to compare treatment as usual (TAU) with the long-term effects of WBT as a rehabilitation therapy in adults who successfully completed psychological treatment for PTSD. Participants who did not meet PTSD diagnostic criteria after completing treatment were randomized to WBT (n = 29) or TAU (n = 35) groups. Assessments of well-being, residual PTSD symptoms, and posttraumatic growth were conducted at baseline (T0) and again after 3 months (T1), 6 months (T2), and 1 year (T3). The results of the multilevel analysis revealed that WBT was not more effective than TAU in increasing levels of well-being, γ = 0.02 (SE = 0.11) or posttraumatic growth, γ = 0.10 (SE = 0.13) nor in decreasing PTSD symptoms, γ = -0.04 (SE = 0.05). However, for participants with low levels of well-being at baseline (Mental Health Continuum-Short Form score < 2.6), WBT was more effective than TAU in increasing ratings of well-being, γ = -0.41 (SE = 0.19) and posttraumatic growth, γ = -0.55 (SE = 0.24); this effect was most evident at T3 for posttraumatic growth, d = 1.23. Future research should assess clinically relevant individual characteristics that to optimize the effectiveness and utility of WBT.

We examined mediators of a multi-component positive psychology intervention for healthy employees. We analyzed data from a randomized controlled trial involving 158 participants who were assigned to a six-session intervention program or a wait-list control group. In total, 144 participants completed baseline and post-test assessment. The mediating effects of positive emotions and psychological flexibility on treatment outcomes mental well-being and resilience at post-test assessment were examined. We also examined the influence of a range of moderators on the relationship between the intervention and the outcomes. Mediator analyses showed that these improvements possibly and partially work through increasing positive emotions. Psychological flexibility could not be considered a mediator. However, due to inability to infer causality, definite conclusions on the mediating effect of positive emotions cannot be drawn. In relation to mental well-being, a significant moderating effect for ethnicity was found in the intervention group.

People with reduced levels of mental well-being might be at risk for developing future mental illness. Although several positive psychology interventions successfully improve mental well-being and psychological distress, less is known about their efficacy in a sample at risk for mental disorders. A Dutch sample of 289 participants with low or moderate levels of well-being were randomly assigned to other-focused kindness with reflection, other-focused kindness without reflection, self-focused kindness, or waitlist control (Trial register: NTR6786). Results of multilevel growth curve analyses revealed that other-focused kindness, but not self-focused kindness, led to improvements in the primary outcome mental well-being relative to waitlist control up to 6-week follow-up. By contrast, only other-focused kindness without reflection led to improvements in psychological distress. The three kindness conditions mainly did not differ from one another, and mainly no differences were found up to 6-months follow-up. An exception was that perceived stress was significantly more reduced up to 6-week and 6-months follow-up when people practiced other-focused kindness without reflection then when participants had practiced self-focused kindness. These findings point to the benefits of practicing kindness for others when people might be at risk for future mental illness. The study also indicates that reflecting about practicing kindness does not seem to have added value.

The job demands-resources (JD-R) model has hardly been studied in volunteer organizations and there is a scarcity of studies evaluating self-compassion as a personal resource within the JD-R model. The present study addresses these gaps in current knowledge, first by examining the applicability of the JD-R model in a crisis line volunteer organization. Second, self-compassion is examined, both in terms of its moderating role on the exhaustion process as well as its role on the motivation process. Structural equation modelling was used for the analyses. The influence on the organizational outcome ‘compassion towards others’ was examined using a multiple regression analysis. The results showed that the JD-R model has an acceptable fit on this sample and supports the central assumption that exhaustion and motivation are two independent but related processes. This study provides evidence that self-compassion is a valuable addition to the JD-R model, as it has an indirect effect on both processes, and increases the explained variance in compassion towards others by 7% through the exhaustion process and by 3% through the motivational process. These findings point to the importance of focusing on self-compassion in training and supervision in volunteer organizations.

There is a growing number of studies evaluating the impact of positive psychology interventions (PPI’s) in people with severe mental illnesses (SMI). The results of these studies have not been quantitatively reviewed yet. In this study, we conduct a meta-analysis on the effects of PPI’s on mental health in people with SMI across studies. Sixteen studies are included (nine RCTs), representing 729 patients. Meta-analyses were performed for well-being as the primary outcome at post-treatment. We found no significant effects on both well-being en psychopathology for the PPI’s in comparison with the control conditions. Within-group effects revealed a moderate effect (Hedge’s g = 0.40) on well-being and a large effect on psychopathology (g = 0.70). Though there is at present no evidence that PPIs are more effective in comparison with other active interventions, our findings demonstrated that people with SMI do benefit from PPIs in terms of enhancement of mental health.

Objectives To evaluate the psychometric properties of the Responses to Positive Affect (RPA) questionnaire in a sample of persons with bipolar disorder (BD). Method Cross‐sectional survey study with 107 persons with BD. The original 3‐factor model of the RPA was compared with a 2‐factor model. Construct validity was determined with measures of well‐being, personal recovery, social role participation, and psychopathology and incremental validity was evaluated. Results The fit of the 3‐factor model was acceptable for most fit indices. Subscores of the RPA revealed a significant relationship with aspects of well‐being, personal recovery, and psychopathology. Dampening and self‐focused positive rumination explained additional variance in personal recovery above and beyond well‐being. Conclusions The RPA is an internally consistent and valid tool to assess positive emotion regulation processes in persons with BD. Specifically, the processes of dampening and emotion‐focused positive rumination seem to play an important role in BD.

The relevance of personal recovery receives increasing attention in mental health care and is also important for people with bipolar disorder (BD). There is a need for reliable and valid instruments measuring personal recovery. Therefore, the current study evaluated the psychometric properties of a Dutch translation of the Questionnaire about the Process of Recovery (QPR) in a sample of people with BD and explored the relationship with constructs of well-being, social role participation and psychopathology. A cross-sectional survey study was conducted, in which 102 people diagnosed with BD completed the QPR. Factor structure of the QPR was evaluated by conducting confirmatory factor analyses (CFA) and internal consistency was assessed by calculating reliability coefficients. Convergent validation measures assessed well-being, social role participation and symptomatology. Incremental validity was determined by evaluating the ability of the QPR to explain variance in symptomatology above and beyond measures of well-being and social role participation. Findings of the CFA supported a unidimensional factor structure and internal consistency estimates were excellent. Scores of the QPR showed strong correlations with convergent measures, but were only weakly associated with manic symptomatology. Moreover, personal recovery explained additional variance in symptoms of depression and anxiety above and beyond well-being, indicating incremental validity. The QPR appears to be a reliable and valid tool to assess personal recovery in people with BD. Our findings underline the importance of personal recovery in the context of treatment of BD. Personal recovery demonstrates a substantial overlap with well-being.

Background There is a need to regularly update the evidence base on the effectiveness of online mindfulness-based interventions (MBIs), especially considering how fast this field is growing and developing. Objective This study presents an updated meta-analysis of randomized controlled trials assessing the effects of online MBIs on mental health and the potential moderators of these effects. Methods We conducted a systematic literature search in PsycINFO, PubMed, and Web of Science up to December 4, 2020, and included 97 trials, totaling 125 comparisons. Pre-to-post and pre-to-follow-up between-group effect sizes (Hedges g) were calculated for depression, anxiety, stress, well-being, and mindfulness using a random effects model. Results The findings revealed statistically significant moderate pre-to-post effects on depression (g=0.34, 95% CI 0.18-0.50; P Conclusions Our findings not only demonstrate that online MBIs are booming but also corroborate previous findings that online MBIs are beneficial for improving mental health outcomes in a broad range of populations. To advance the field of online MBIs, future trials should pay specific attention to methodological quality, adherence, and long-term follow-up measurements.

Background:Crisis line services, run by volunteers, offer a listening ear 24/7 to people who cannot or do not want to use professional help. Although previous studies have identified various potential stressors crisis line volunteers face, as yet a comprehensive assessment is lacking with regards to the frequency and perceived stressfulness of work- and organization-related demands, and their relationship with distress and a volunteer's intention to leave.Objective:To identify the frequency and impact of particular stressful situations (demands). In addition, to examine the extent to which these demands are associated with volunteers' demographics, distress and intention to leave the crisis line service.Method:In a cross-sectional study among 543 volunteers of a Dutch crisis line service the participants filled out a questionnaire about their experience of a large number of work- and organization-related demands and their perceived stressfulness. To calculate the impact of demands, the occurrence and stressfulness were multiplied. In addition, work-related distress, intention to leave the crisis line service as well as a number of demographics and work-related characteristics were assessed.Results:Work-related demands with the highest impact on volunteers were calls from people with psychiatric problems and suicidal intentions. “Having no time for a break” was the organization-related demand with the highest impact on volunteers. Eighteen percentage of the volunteers scored moderate or high on distress and 4% had the intention to leave the crisis line service within 1 year. Most work- and organization-related demands were positively associated with volunteers' distress and intention to leave the organization. Being older, being male and spending more hours per week volunteering were significantly, positively correlated with work-related demands. The total explained variance for distress was 16% and for intention to leave 13%.Conclusion:Although most crisis line volunteers experienced low impact from work- and organization-related demands, these demands were significantly related to experienced distress and the intention to leave crisis line service. For volunteers with moderate to high distress it can be useful to implement interventions aimed at increasing personal resources to help them deal with the challenges of the work at the crisis line.

Adolescents with depression who participate in behavioral activation therapy may find it hard to be motivated to perform tasks at home that their therapists recommend. We describe the initial design and usability evaluation of a home device (“PlantBot”) that could be used to remind young adults with depression at home of their behavioral activation therapy-related tasks. The prototype features electronics in a two-layer base, with a fake plant on top and supported using the Amazon Echo voice agent. We use an online panel study to evaluate the usability of our system with youth with past depression ( N = 30). Initial findings highlight the device’s usability, potential benefit, and attractiveness of the plant component, as well as multiple improvements to be made.

Background: Personal recovery is increasingly recognized as important outcome for people with bipolar disorder (BD), but research addressing associated factors of personal recovery in this group remains scarce. This study aimed to explore the association of sociodemographic variables, social participation, psychopathology, and positive emotion regulation with personal recovery in BD. Methods: Baseline data from a randomized controlled trial and survey data were combined (N = 209) and split into a training (n = 149) and test sample (n = 60). Block-wise regression analyses and model training were used to determine the most relevant predictors. The final parsimonious model was cross-validated in the test sample. Results: In the final parsimonious model, satisfaction with social roles (β =.442, p 2 =.561) and performed well in predicting personal recovery in the independent test sample (adjusted R2 =.491). Conclusions: Our findings suggest that especially social participation, anxiety and positive rumination might be relevant treatment targets when aiming to improve personal recovery. Practitioner points: Personal recovery is considered an increasingly important outcome for people with chronic mental health conditions, including bipolar disorder. We found that anxiety and manic symptoms as well as positive rumination and social participation were independently associated with personal recovery in bipolar disorder. Therefore, these outcomes might be relevant treatment targets when aiming to improve personal recovery in bipolar disorder. Possible interventions to improve these outcomes are discussed, including supported employment and vocational rehabilitation for social participation and exercising with savoring strategies to increase positive rumination.

This systematic review and meta-analysis compared prevalence rates for subthreshold anxiety and anxiety disorders in adults aged 55+ and examined if these rates were associated with age. A systematic search and screening procedure resulted in 46 included articles. First, prevalence rates for subthreshold anxiety and anxiety disorders were statistically compared. Subthreshold panic, generalized anxiety and specific phobia were significantly more prevalent than the corresponding clinical disorders. In general, subthreshold anxiety appeared to be at least similarly prevalent to anxiety disorders, although firm conclusions are precluded due to the small number of samples that could be included in the analyses and the large heterogeneity between the reported prevalence rates. Second, using subgroup analyses, pooled prevalence rates for four age groups of older adults (55-64, 65-74, 75-84, 85+) were compared. For specific phobia, the 75-84 and 85+ groups had significantly lower prevalence rates than the 55-64 and 65-74 groups. Posttraumatic stress disorder was significantly more prevalent in the 55-64 group than in the other age groups, and lowest in the 85+ group. No other significant differences between age groups were found. The association between later life subthreshold anxiety and age could not be examined due to a lack of reported information. The main limitation of this study is the small number of samples in the analyses, which limits their power and generalizability. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective. Compassion-based interventions show promise in enhancing well-being and reducing distress, however little is known about their applications for people with long-term physical conditions. The current study investigates compassion-based interventions for this population: what are their differing elements (content, structure, tailoring, use of technology), feasibility and acceptability, effects and experienced benefits? Methods. A mixed-methods systematic review was conducted. Four bibliographic databases were searched without time or study design restrictions. Meta-synthesis was used to integrate quantitative results of effects, and qualitative results of experienced benefits. Results. Twenty studies met the inclusion criteria, of which most targeted people with cancer or persistent pain. Interventions were either comprehensive with 6-12 face-to-face sessions, or brief based on a single compassion exercise. Participants highly rated feasibility and accessibility. Amongst a plethora of outcomes, reductions in depression and anxiety were the most common findings. Our qualitative synthesis yielded participants’ perceived benefits of (1) acceptance of the condition; (2) improved emotion regulation skills; (3) reduced feelings of isolation. Little overlap was found between quantitative and qualitative outcomes. Conclusion. While the field is still in its infancy, this review highlights the potential benefits of compassion-based interventions for people with long-term physical conditions and discusses recommendations for further intervention research and development.

Purpose Personality functioning is strongly linked to well-being in the general population. Yet, there is a lack of scientific knowledge about the pathways between personality trait facets and emotional, psychological and social well-being in ED patients. The general aim was to examine potential associations between maladaptive personality trait facets and the three main dimensions of well-being. Methods Participants were 1187 female eating disorder patients who were referred for specialized treatment. Patients were diagnosed with anorexia nervosa (31.7%), bulimia nervosa (21.7%), binge eating disorder (11%) and other specified eating disorders (35.5%). The Personality Inventory for the DSM 5 (PID-5) was used to measure 25 trait facets, and well-being was measured with the Mental Health Continuum Short Form (MHC-SF). Multiple hierarchical regression analyses were applied to examine potential associations between personality and well-being while controlling for background and illness characteristics. Results Personality trait facets led to a statistically significant increase of the explained variance in emotional (38%), psychological (39%), and social well-being (26%) in addition to the background and illness characteristics. The personality trait facets anhedonia and depression were strongly associated with all three well-being dimensions. Conclusion Personality traits may play an essential role in the experience of well-being among patients with EDs. To promote overall mental health, it may be critical for clinicians to address relevant personality trait facets, such as anhedonia and depression, associated with well-being in treatment. Level of evidence Level V, cross-sectional descriptive study.

Until recently clinical psychology has been mainly concerned with what is defined as deviant and/or maladaptive mental states. In this chapter, we present a new model for sustainable mental health that allows for balanced psychological treatment. The model is based on a growing body of research demonstrating that mental illness and mental well-being are related but distinct dimensions of mental health. Further research shows that well-being actually reduces the risk of mental illness. An important component in the model is that sustainable mental health incorporates well-being as an essential mental health outcome in addition to and alongside mental illness. The model also proposes adaptation processes that are essential in the regulation of mental well-being and mental illness. Psychological treatments and interventions are placed on a spectrum targeting either barriers or resources for successful adaptation or a combination of both. Evidence of the impact of psychological treatments that fit well with the model such as Acceptance and Commitment Therapy and Life-review therapy in the context of public mental health is presented. The advantages of the model are twofold. Firstly, it surpasses a simplistic dichotomy of ‘positive’ versus ‘negative’ approaches, and secondly, it offers an integrative perspective for practitioners.

Background Our objective was to evaluate the effectiveness and cost-effectiveness of the positive psychology intervention ‘Happiness Route’ compared to an active control condition in a vulnerable population with an accumulation of health and psychosocial problems. Methods We conducted a randomized, single-blind, actively-controlled, parallel group study in seven municipalities in the Netherlands. To be eligible, participants had to experience loneliness, health problems and low socio-economic status. Each group received several home visits by a counsellor (two in the control condition, two to six in the experimental condition). In the Happiness Route, a happiness-based approach was used, whereas the control condition used a traditional problem-based approach. The primary outcome was well-being, measured with the Mental Health Continuum-Short Form (MHC-SF). Results Fifty-eight participants were randomized to the Happiness Route, 50 to the control condition. Participants were severely lonely, had on average three health problems and less than 5% had paid work. The total MHC-SF score, emotional and social well-being, depression and loneliness improved significantly over the nine-month period in both conditions (p Conclusions Mental health status of both groups improved considerably. However, we could not demonstrate that the Happiness Route yielded better health outcomes compared to the control condition. Nevertheless, the results of the cost-effectiveness analysis suggested that the Happiness Route is an acceptable intervention from a health-economic point of view. Our results should be viewed in light of the fact that we could not include the planned number of participants. Trial registration Netherlands Trial Register: NTR3377. Registered 2 Apr 2012.

The aim of the current study was to evaluate the impact of a 6-week gratitude intervention for people with low to moderate well-being and moderate symptomatology of depression and anxiety up to 6 months follow-up. 217 Dutch adults were randomly assigned to one of three conditions: a 6-week gratitude intervention, a 6-week self-kindness intervention as an active control condition and a waitlist control condition. Participants completed online assessments on well-being, depression, anxiety and gratitude at baseline, post-test, 6 weeks and 6 months follow-up. Changes in outcome measures over time were examined using multilevel growth curve modeling in R to account for repeated measures nested within individuals. The gratitude intervention was more effective in improving mental well-being in comparison to the self-kindness intervention (d = .63 at post-intervention andd = .40 at 6 weeks follow-up) and waitlist control (d = .93 at post-intervention andd = .66 at 6 weeks follow-up). The data also demonstrated that the gratitude intervention was superior to waitlist control and practicing self-kindness on various measures of gratitude but not on distress. The results of this study suggest that a 6-week gratitude intervention is an effective, low-intensity intervention for enhancing mental well-being but not distress among people with low to moderate levels of well-being and moderate distress, at least in higher-educated women. The sustained effects on various measures of gratitude up to 6 months follow-up suggest that it is possible to promote a lasting appreciative perspective on life.

There is growing evidence that positive psychology interventions (PPIs) are effective in enhancing mental well-being and reducing depressive symptoms. However, there is a knowledge gap regarding the motives of people to seek such PPIs. This study qualitatively identifies help-seeking motives and quantitatively examines which motives relate to client satisfaction, adherence and an impact on mental well-being, anxiety and depressive symptoms. We analyzed 123 introductory emails of people with suboptimal levels of mental well-being who assigned to a comprehensive 9-week PPI with email support, of which its efficacy was investigated in a randomized controlled trial. Results showed that 49% mentioned mainly suffering-related motives (i.e. distress and stressful events/circumstances) and 51% mentioned mainly growth-related motives (i.e. mental well-being and developing resources). Hardly any motive was significantly related to beneficial outcomes, albeit developing resources and suffering were positively—though weak—correlated with adherence. The present study indicates that this PPI was effective for a broad audience, namely for those with suffering-related and with growth-related motives. This finding underscores the great relevance of PPIs to reach people who might be at risk for future mental disorders who otherwise do not seek help.

Background Alcohol use is associated with an automatic tendency to approach alcohol, and the retraining of this tendency (cognitive bias modification [CBM]) shows therapeutic promise in clinical settings. To improve access to training and to enhance participant engagement, a mobile version of alcohol avoidance training was developed. Objective The aims of this pilot study were to assess (1) adherence to a mobile health (mHealth) app; (2) changes in weekly alcohol use from before to after training; and (3) user experience with regard to the mHealth app. Methods A self-selected nonclinical sample of 1082 participants, who were experiencing problems associated with alcohol, signed up to use the alcohol avoidance training app Breindebaas for 3 weeks with at least two training sessions per week. In each training session, 100 pictures (50 of alcoholic beverages and 50 of nonalcoholic beverages) were presented consecutively in a random order at the center of a touchscreen. Alcoholic beverages were swiped upward (away from the body), whereas nonalcoholic beverages were swiped downward (toward the body). During approach responses, the picture size increased to mimic an approach movement, and conversely, during avoidance responses, the picture size decreased to mimic avoidance. At baseline, we assessed sociodemographic characteristics, alcohol consumption, alcohol-related problems, use of other substances, self-efficacy, and craving. After 3 weeks, 37.89% (410/1082) of the participants (posttest responders) completed an online questionnaire evaluating adherence, alcohol consumption, and user satisfaction. Three months later, 19.03% (206/1082) of the participants (follow-up responders) filled in a follow-up questionnaire examining adherence and alcohol consumption. Results The 410 posttest responders were older, were more commonly female, and had a higher education as compared with posttest dropouts. Among those who completed the study, 79.0% (324/410) were considered adherent as they completed four or more sessions, whereas 58.0% (238/410) performed the advised six or more training sessions. The study identified a significant reduction in alcohol consumption of 7.8 units per week after 3 weeks (95% CI 6.2-9.4, P Conclusions This is one of the first studies to employ alcohol avoidance training in a mobile app for problem drinkers. Preliminary findings suggest that a mobile CBM app fulfils a need for problem drinkers and may contribute to a reduction in alcohol use. Replicating these findings in a controlled study is warranted.

The PlantBot is a home device that shows iconographic or simple lights to depict actions that it requests a young person (its user) to do as part of Behavioral Activation therapy. In this initial proto- type, a separate conversational speech agent (i.e., Amazon Alexa) is wizarded to act as a second system the user can interact with.

This article presents findings from a meta-analysis which sought to determine the effectiveness of interventions adopting a whole school approach to enhancing children and young people’s social and emotional development. Whole school interventions were included if they involved a coordinated set of activities across curriculum teaching, school ethos and environment, and family and community partnerships. A total of 45 studies (30 interventions) involving 496,299 participants were included in the analysis. Post-intervention outcomes demonstrated significant but small improvements in participants’ social and emotional adjustment (d = 0.220), behavioural adjustment (d = 0.134), and internalising symptoms (d = 0.109). Interventions were not shown to impact on academic achievement. Origin of study and the inclusion of a community component as part of a whole school approach were found to be significant moderators for social and emotional outcomes. Further research is required to determine the active ingredients of whole school interventions that we can better understand the components necessary to achieve successful outcomes.

Recently, there has been a sharply incremental number of studies of positive psychology interventions (PPIs) from non-western countries. The aim of this study is to review and evaluate the efficacy of these PPIs. Databases, including PubMed, PsycInfo, and Scopus, were searched up to December 2017. In addition, we performed hand searches and reference checks. After removal of duplicates, 7,516 studies were screened and finally 28 randomized controlled trials (RCTs) were included in the meta-analysis. A random effects model was used to calculate between group effect-sizes at post-test. Results showed that PPIs from non-western countries have a moderate effect on subjective well-being ( g = 0.48) and psychological well-being ( g = 0.40), and a large effect on depression ( g = 0.62) and anxiety ( g = 0.95). The overall low study quality of the studies indicates the possibility of biases, which may explain why PPIs from non-western countries report larger effect sizes than PPIs from western countries. However, PPIs could also be more effective in non-western countries due to a better cultural fit.

Objective The growing evidence for the dual continua model of psychopathology and well‐being has important implications for measuring outcomes in mental health care. The aim of the current study is to validate a measure of well‐being as well as the dual continua model in adults with mood, anxiety, personality, and developmental disorders. Methods 472 adult psychiatric outpatients filled out the Mental Health Continuum‐Short Form (MHC‐SF) and the Outcome Questionnaire before start of treatment. Results Confirmatory factor analyses (CFA) confirmed the three‐factor structure of emotional, psychological, and social well‐being of the MHC‐SF. The dual continua model had the best fit in the complete sample and the different diagnostic groups. Conclusion The MHC‐SF is a reliable and valid instrument to measure well‐being in the psychiatric population. Although relatively high correlations between psychopathology and well‐being exist, the results underline the importance to measure well‐being in addition to psychopathology in mental health care.

Background Although positive psychology interventions (PPIs) show beneficial effects on mental health in non-clinical populations, the current literature is inconclusive regarding its effectiveness in clinical settings. We aimed to examine the effects of PPIs on well-being (primary outcome), depression, anxiety, and stress (secondary outcomes) in clinical samples with psychiatric or somatic disorders. Methods A systematic review and meta-analysis was conducted following PRISMA guidelines. PsycINFO, PubMed, and Scopus were searched for controlled studies of PPIs in clinical samples between Jan 1, 1998 and May 31, 2017. Methodological quality of each study was rated. We used Hedges’ adjusted g to calculate effect sizes and pooled results using random-effect models. Results Thirty studies were included, representing 1864 patients with clinical disorders. At post-intervention, PPIs showed significant, small effect sizes for well-being (Hedges’ g = 0.24) and depression (g = 0.23) compared to control conditions when omitting outliers. Significant moderate improvements were observed for anxiety (g = 0.36). Effect sizes for stress were not significant. Follow-up effects (8–12 weeks), when available, yielded similar effect sizes. Quality of the studies was low to moderate. Conclusion These findings indicate that PPIs, wherein the focus is on eliciting positive feelings, cognitions or behaviors, not only have the potential to improve well-being, but can also reduce distress in populations with clinical disorders. Given the growing interest for PPIs in clinical settings, more high quality research is warranted as to determine the effectiveness of PPIs in clinical samples. Trial registration PROSPERO CRD42016037451 Electronic supplementary material The online version of this article (10.1186/s12888-018-1739-2) contains supplementary material, which is available to authorized users.

The results of our study on the effects of well‐being therapy (WBT) compared with a treatment‐as‐usual (TAU) control condition among individuals with residual symptoms of posttraumatic stress disorder (PTSD) were recently published in the Journal of Traumatic Stress (Radstaak et al., 2020). In a subsequent commentary, Fava and Guidi (2020) raised several conceptual and methodological issues that they asserted potentially limited the interpretation of the results. In this response, we aim to clarify these issues, thus contributing to the optimal interpretation of the findings.

Background and ObjectivesAs proposed by the self-determination theory, satisfying nursing home residents’ needs for autonomy, relatedness, and competence may improve their well-being. This is the first study to test the longitudinal relations of the satisfaction of these three basic psychological needs to the subjective well-being of nursing home residents and to determine whether a balance among the satisfaction of the three needs is important for well-being.Research Design and MethodsParticipants in this longitudinal survey study included 128 physically frail residents (mean age 85 years) at four Dutch nursing homes. Satisfaction of the three basic psychological needs was measured at baseline, and depressive feelings and life satisfaction 5–8 months later. Absolute differences between the three basic need satisfaction scores were summed to create a score of need satisfaction balance.ResultsAll three needs were related to both well-being measures over time, although autonomy had the strongest relationships. Only autonomy and competence were uniquely associated with depressive feelings, and only autonomy was uniquely associated with life satisfaction. The need satisfaction balance score was related to well-being independent of the autonomy and relatedness scores.Discussion and ImplicationsThese results confirm that all three basic psychological needs are important for nursing home residents’ well-being, with autonomy having the strongest and most consistent relationship to their well-being. Additionally, high satisfaction of one need does not compensate for low satisfaction of another. Supporting residents’ needs for autonomy, relatedness, and competence should, therefore, have a central role in nursing home culture-change interventions.

Studies investigating the effectiveness of compassion-focused therapy (CFT) are growing rapidly. As CFT is oriented toward helping people deal with internal processes of self-to-self-relating, having instruments to measure these processes is important. The 22-item Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS) has been found a useful measure. In the present study, a 14-item short form of the FSCRS (FSCRS-SF) suited to studies requiring brief measures was developed and tested in a Dutch community sample (N = 363), and cross-validated in a sample consisting of participants in a study on the effectiveness of a guided self-help compassion training (N = 243). Confirmatory factor analysis (CFA) indicated acceptable to good fit of the FSCRS-SF items to a three-factor model. Findings regarding internal consistency were inconsistent, with Study 1 showing adequate internal consistency for all subscale scores and Study 2 demonstrating satisfactory internal consistency only for the reassured self (RS) subscale score. Furthermore, the results showed that the FSCRS-SF subscale scores had adequate test-retest reliability and satisfactory convergent validity estimates with theoretically related constructs. In addition, the FSCRS-SF subscale scores were found to be sensitive to changes in self-to-self relating over time. Despite mixed findings regarding its reliability requiring further investigation, the FSCRS-SF offers a valid and sensitive measure which shows promise as a complimentary shorter version to the original FSCRS suited to nonclinical populations. Given that the FSCRS is increasingly used as a process and outcome measure, further research on this short form in nonclinical and clinical populations is warranted. (PsycINFO Database Record

Objectives: This study assesses the effects of an autobiographical memory intervention on the prevention and reduction of depressive symptoms in older persons in residential care. Trained volunteers delivered the intervention. Methods: A randomized controlled trial was carried out with depressive symptoms as the primary outcome. The experimental condition received the intervention Precious Memories one-on-one, whereas the control condition had individual unstructured contacts with a volunteer. Participants were 86 older persons living in residential care. There were three measurements: pre-intervention, post-intervention (2 months after the first measurement), and follow-up (8 months after the first measurement). Besides depressive symptoms, the retrieval of specific positive memories was measured as a process variable. Anxiety, loneliness, well-being, and mastery were assessed as secondary outcomes. Results: Depressive symptoms improved equally in the intervention and the control condition at post-measurement. Participants with clinically relevant depressive symptoms also maintained the effects at follow-up in both conditions. The retrieval of specific positive memories improved more in the autobiographical memory intervention, although this was not maintained at follow-up. Anxiety and loneliness improved equally well in both conditions, but no effects were found for well-being or mastery. Conclusion: It is concluded that volunteers can deliver the intervention and contribute to the mental health of this highly vulnerable group of older adults.

Background: Resilience can be described as the capacity to deal with adversity and traumatic events. The current economic situation in Suriname and its social economic consequences may demand a great amount of resilience for people living in Suriname. In this explorative study, we examined the relation between strengths and resilience among the three major ethnic groups in Suriname. Method: Semi-structured interviews were conducted with 25 participants. We sought to gather viewpoints from community representatives, health care professionals and academic scholars about the personal resources used by people in Suriname to help them deal with the consequences of the current socio-economic crisis. Results: We identified major five strengths that were associated with resilience: religiousness, hope, harmony, acceptance and perseverance. While these strengths contribute to the development of resilience, they can under certain circumstances have an ambiguous influence. Conclusion: Our findings suggest that religiousness is the bedrock strength for the development of resilience in Suriname. We recommend that future positive psychological interventions in non-Western countries integrate positive activities with religious elements into program interventions to achieve a better cultural fit.

The efficacy of several multicomponent positive psychology interventions (PPIs) have been demonstrated, but little is known about its possible mechanisms of change. We examined (1) the efficacy of an email guided self-help PPI on six core well-being processes (positive emotion, use of strengths, optimism, self-compassion, resilience and positive relations) and (2) the mediating role of these processes on mental well-being, anxiety and depressive symptoms. Adults ≥ 18 years were recruited in the general population and randomized into the intervention (n = 137) or wait-list control group (n = 138). Repeated measures analyses showed that the intervention group improved significantly more than the control group on all six processes. Improvement (t0–t1) on each process statistically mediated improvement (t0–t2) on mental well-being, anxiety and depressive symptoms. Simple-mediation analyses revealed small to moderate effect sizes. Multiple-mediation analyses revealed most pronounced results for positive relations and self-compassion, suggesting that these processes might be key mechanisms in promoting well-being.

Objectives: Solution-focused support (SFS) is an upcoming approach to support people with intellectual disabilities (ID). However, while research shows that clients appreciate this approach, insight into professionals’ experiences and their application of SFS is lacking. This article describes a qualitative study aimed at understanding how professionals make sense of learning and applying SFS, specifically, Cauffman’s Solution Cube. Methods: Logbook files in which professionals reported their experiences with SFS for a full year were qualitatively analyzed in two steps: (1) identification of how professionals assigned successful and unsuccessful applications of SFS, and reflected on what worked and dilemmas arising during this application process, (2) identification of patterns over time in how professionals learned how to deal with the encountered dilemmas. Results: The main dilemma experienced by professionals concerns ‘doing what works’ in conjunction with other dimensions of the Solution Cube. Three overall patterns were identified to address how professionals made sense of learning how to apply SFS over time and deal with ambiguities of ‘doing what works’ in practice: (1) a focus on caring, (2) a focus on empowering, and (3) a focus on balancing between the two. Conclusions: Understanding how professionals deal with SFS over time enables researchers to identify different ways professionals learn SFS, along with the ambiguities they experience about the approach and unintended applications. Implications for implementing SFS and learning facilitators that might help promote a balance between caring and empowerment, specifically for people with ID, are provided.

Unemployment is associated with a diminished mental health. Interventions to improve mental health for the unemployed exist. However, there is no clear overview with respect to the content and effectiveness of these interventions. A systematic search was conducted and, included studies that targeted unemployed adults, described an intervention and reported mental health as an outcome measure. After screening, 24 studies remained, which contained 21 different interventions. These interventions could be classified into three categories: occupational skills training interventions, psychological interventions and combined interventions. The majority of the studies reported significant short-term effects on mental health, but in most cases evidence of sustained effects was lacking or not assessed. There is promising evidence that interventions combining occupational skills and resilience training are effective in promoting mental health. However, there is a need for high-quality research on the intervention effects on the mental health of the (long-term) unemployed.

In this article, we bring the study of meaning together with the emerging field of study focusing on the emotions of wonder: wonder, enchantment, awe, and being moved. It is in meaningful moments that these two meet, and in our empirical study, we used the emotions of wonder as a lens to investigate meaningful moments. We applied a novel intervention, the Wonderful Life question, to elicit narratives of meaningful moments from 100 participants varying in age, profession, and social status. Using characteristics of wonder retrieved from the wonder literature to qualitatively analyze these narratives, we identified five types of meaningful moments: opening up to life, facing the precarity of life, celebrations, countering the negative, and familiar routines. The study deepens insight in the way meaning is discovered in different types of meaningful moments. It supports the premise that there is potential meaning in any moment in life, and the mind-set of wonder enabling the discovery of meaning. Finally, it pleads for the use of the Wonderful Life question as a means to elicit a wide spectrum of meaningful moments.

Crisis line services, operated by volunteers, have been proven to be effective in decreasing psychological pain and preventing suicidality. Although working at the crisis line may be rewarding, for some the confrontation with highly complex topics (i.e., suicidality, abuse, and loneliness) in combination with inappropriate calls (i.e., sexually abusive calls), may lead to distress or vicarious trauma. The aim of this paper is to systematically review the studies that have examined mental wellbeing of crisis line volunteers and the factors associated with it. Thirteen published empirical studies on the topic were found. These showed that crisis line volunteers are at increased risk of declined mental wellbeing. However, a wide range of operationalizations were used and most studies did not use validated instruments. On the other hand, studies showed that many volunteers experience satisfaction and gratification from their work. This review gives insight into some of the work-related, organization-related, and volunteer-related factors that may be associated with the decrease of mental wellbeing. More high quality, comprehensive, and quantitative research using validated instruments is urgently needed to assess the impact of the work on mental wellbeing and the relative impact of influencing factors.

Background: The importance of both specific emotion regulation strategies and overall deficits in emotion regulation in the context of psychopathology is widely recognized. Besides alleviating psychological symptoms, improving mental well-being is increasingly considered important in treatment of people with mental disorders. However, no comprehensive meta-analysis on the relationship between emotion regulation and well-being in people with mental disorders has been conducted yet. Objective: The aim of the current study was to synthesize and meta-analyze evidence regarding the relationship between emotion regulation and well-being in clinical samples across studies. Method: A systematic literature search was conducted in PsycINFO, PubMed and Scopus and 94 cross-sectional effect sizes from 35 studies were meta-analyzed to explore this relationship. To be eligible for the meta-analysis, studies had to include a clinical sample, assess at least one specific emotion regulation strategy or overall deficits in emotion regulation and include well-being as outcome. Results: The findings showed significant small to moderate negative relationships with well-being for the strategies avoidance (r = −0.31) and rumination (r = −0.19) and positive relationships with reappraisal (r = 0.19) and acceptance (r = 0.42). Grouping together putative adaptive and maladaptive strategies revealed similar sized relationships with well-being in the expected direction. Overall deficits in emotion regulation showed a negative moderate correlation with well-being (r = −0.47). No substantial difference in relationships was found when clustering studies into hedonic and eudaimonic well-being. Conclusion: Our findings suggest that emotion regulation is not merely related with psychopathology, but also with well-being in general as well as hedonic and eudaimonic well-being. Therefore, it might also be important to improve emotion regulation when aiming to improve well-being in people with mental disorders.

Background Nursing staff in nursing homes is at risk for stress-related problems. Positive psychology interventions have been shown to effectively improve well-being and decrease depressive symptoms, and may be beneficial for nursing staff. However, controlled studies with nursing staff are missing. Objectives and design This is the first study to test the effectiveness and acceptability of an online multi-component positive psychology intervention in nursing home staff. This study used a cluster-randomized controlled design, with an intervention group and a control group, and measurements at baseline (T0) and following the training period (T1). We hypothesized that the intervention would improve general well-being, job satisfaction and work engagement, especially for people with low initial well-being, satisfaction or engagement. Furthermore, we explored the acceptability of such an intervention for nursing home staff. Settings and Participants All nursing staff of the units for physically frail older adults of four Dutch nursing homes belonging to one care organization were invited to participate in this study. A sample of 128 nursing staff completed T0, and 107 nursing staff completed T1, mostly licensed practical nurses with a mean age of 42 years. Methods The 8-week online intervention concerned information and evidence-based exercises of six topics of Positive Psychology, which were completed individually at home. General well-being, job satisfaction and work engagement were measured, and participants evaluated the intervention. Results No time by group interaction effect was found on general well-being nor on work engagement, but there was a small effect on job satisfaction. No moderation effects of baseline outcome measures were found. The evaluation of the intervention varied: a majority positively valued the intervention, in particular the topics “positive emotions” and “strengths”, but most agreed that there was too much text and too many exercises. Conclusions The online multi-component positive psychology intervention had only very limited effectiveness, as the decrease in job satisfaction in the control group may reflect a regression to the mean. The high baseline levels of well-being and engagement, intervention content, obligatory character of the intervention, and individuality are discussed as possible reasons for these results. Opportunities lie in creating a concise, work focused positive psychology intervention for nursing staff, including some form of autonomy support.

BackgroundPatients with borderline personality disorder experience great difficulties in regulating their emotions. They often are unable to effectively detect their emotional arousal and struggle to timely apply learned techniques for emotion regulation. Although the use of continuous wearable biofeedback has been repeatedly suggested as an option to improve patients’ emotional awareness, this type of app is not yet available for clinical use. Therefore, we developed an ambulatory biofeedback app named Sense-IT that can be integrated in mental health care.ObjectiveThe aim of the study was to develop an ambulatory biofeedback app for mental health care that helps with learning to better recognize changes in personal emotional arousal and increases emotional awareness.MethodsUsing several methods in a tailored User Centred Design (UCD) framework, we tested the app’s usability and user experience (UX) via a cyclic developmental process with multiple user groups (patients, therapists, and UCD experts; 3-5 per group, per cycle).ResultsThe process resulted in a stable prototype of the app that meets most of the identified user requirements. The app was valued as useful and usable by involved patients, therapists, and UCD experts. On the Subjective Usability Scale (SUS), the patients rated the app as “Good” (average score of 78.8), whereas the therapists rated the app as “OK” (average score of 59.4). The UCD experts judged the app’s overall usability as between “OK” and “acceptable” (average score of 0.87 on a cognitive walkthrough). As most critical usability problems were identified and addressed in the first cycle of the prototyping process, subsequent cycles were mainly about implementing new or extending existing functions, and other adjustments to improve UX.ConclusionsmHealth development within a clinical mental health setting is challenging, yet feasible and welcomed by targeted users. This paper shows how new mHealth interventions for mental health care can be met with enthusiasm and openness by user groups that are known to be reluctant to embrace technological innovations. The use of the UCD framework, involving multiple user groups, proved to be of added value during design and realization as evidenced by the complementary requirements and perspectives. Future directions on studying clinical effectiveness of the app, appliance of the app in other fields, and the implications of integration of the app for daily practice in mental health are discussed.

Purpose: Life review therapy combined with memory specificity training (LRT-MST) is effective in cancer patients in palliative care, but the effect size is moderate. The aim of this qualitative study was to obtain more in-depth knowledge on motivation to start with LRT-MST, experiences with LRT-MST, and perceived outcomes of LRT-MST. Methods: Semi-structured interviews were conducted with 20 cancer patients in palliative care who participated in a randomized controlled trial investigating the effect of LRT-MST. All interviews were digitally recorded and transcribed verbatim. Data were analyzed by means of thematic analysis independently by two coders and coded into key issues and themes. Results: Patients started LRT-MST for intrinsic (e.g., potential benefit for personal well-being) and extrinsic reasons (e.g., potential benefit for future patients). Patients indicated mainly positive experiences with the intervention. They appreciated sharing their memories and regaining memories with a specific focus on retrieving positive memories. Some disliked the fact that negative memories could not be addressed. Most patients perceived positive outcomes of the intervention belonging to the overarching themes “ego-integrity” and “psychological well-being” in the here and now, as well as in the nearby future (including end-of-life). Conclusions: LRT-MST is of added value as a psychological intervention in palliative care. This study provided in-depth insight into reasons to start the intervention, and the experiences and outcomes, which are important to further tailor LRT-MST and for development or improvement of other psychological interventions targeting cancer patients in palliative care.

Background Bipolar disorder (BD) is associated with substantial societal burden. Therefore, economic studies in BD are becoming increasingly important. The goal of the current study is three-fold: (1) summarize the evidence regarding economic evaluations (EEs) of non-pharmacological interventions for BD, (2) summarize cost-of-illness studies (COIs) for BD published 2012 or later and (3) assess the quality of the identified studies. Methods A systematic search was conducted in MedLine, EMBASE and PsycINFO. For both EEs and COIs, quality assessments were conducted and general and methodological characteristics of the studies were extracted. Outcomes included incremental-cost-effectiveness ratios for EEs and direct and indirect costs for COIs. Results Eight EEs and ten COIs were identified. The included studies revealed high heterogeneity in general and methodological characteristics and study quality. All interventions resulted in improved clinical outcomes. Five studies additionally concluded decreased total costs. For COIs, we found a wide range of direct ($881-$27,617) and indirect cost estimates per capita per year ($1,568-$116,062). Limitations High heterogeneity in terms of interventions, study design and outcomes made it difficult to compare results across studies. Conclusions Interventions improved clinical outcomes in all studies and led to cost-savings in five studies. Findings suggest that non-pharmacological intervention for BD might be cost-effective. Studies on the costs of BD revealed that BD has a substantial economic burden. However, we also found that the number of EEs was relatively low and methodology was heterogenous and therefore encourage future research to widen the body of knowledge in this research field and use standardized methodology.

The past two decades have witnessed a rapid rise in well-being research, and a profusion of empirical studies on positive psychology interventions (PPIs). This bibliometric analysis quantifies the extent to which rigorous research on PPIs that employ randomized controlled trials (RCTs) reaches beyond Western Educated Industrialized Rich Democratic (WEIRD) populations. A search was conducted through databases including PubMed, PsycINFO, and Scopus for studies from 1998 to 2017. In total, we found 187 full-text articles that included 188 RCTs from 24 countries. We found that RCTs on the efficacy of PPIs are still predominately conducted in western countries, which accounted for 78.2% of the studies. All these countries are highly industrialized and democratic, and study populations are often highly educated and have a high income. However, there has been a strong and steady increase in publications from non-Western countries since 2012, indicating a trend towards globalization of positive psychology research.

Background Anxiety symptoms in older adults are prevalent and disabling but often go untreated. Most trials on psychological interventions for anxiety in later life have examined the effectiveness of face-to-face cognitive behavioral therapy (CBT). To bridge the current treatment gap, other treatment approaches and delivery formats should also be evaluated. Objective This study is the first to examine the effectiveness of a brief blended acceptance and commitment therapy (ACT) intervention for older adults with anxiety symptoms, compared with a face-to-face CBT intervention. Methods Adults aged between 55-75 years (n=314) with mild to moderately severe anxiety symptoms were recruited from general practices and cluster randomized to either blended ACT or face-to-face CBT. Assessments were performed at baseline (T0), posttreatment (T1), and at 6- and 12-month follow-ups (T2 and T3, respectively). The primary outcome was anxiety symptom severity (Generalized Anxiety Disorder-7). Secondary outcomes were positive mental health, depression symptom severity, functional impairment, presence of Diagnostic and Statistical Manual of Mental Disorders V anxiety disorders, and treatment satisfaction. Results Conditions did not differ significantly regarding changes in anxiety symptom severity during the study period (T0-T1: B=.18, P=.73; T1-T2: B=−.63, P=.26; T1-T3: B=−.33, P=.59). Large reductions in anxiety symptom severity (Cohen d≥0.96) were found in both conditions post treatment, and these were maintained at the 12-month follow-up. The rates of clinically significant changes in anxiety symptoms were also not different for the blended ACT group and CBT group (χ21=0.2, P=.68). Regarding secondary outcomes, long-term effects on positive mental health were significantly stronger in the blended ACT group (B=.27, P=.03, Cohen d=0.29), and treatment satisfaction was significantly higher for blended ACT than CBT (B=3.19, P Conclusions The results show that blended ACT is a valuable treatment alternative to CBT for anxiety in later life. Trial Registration Netherlands Trial Register TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131

We examined whether sustained vs. transient spatial attention differentially affect the processing of electrical nociceptive stimuli. Cued nociceptive stimuli of a relevant intensity (low or high) on the left or right forearm required a foot pedal press. The cued side varied trial wise in the transient attention condition, while it remained constant during a series of trials in the sustained attention condition. The orienting phase preceding the nociceptive stimuli was examined by focusing on lateralized EEG activity. ERPs were computed to examine the influence of spatial attention on the processing of the nociceptive stimuli. Results for the orienting phase showed increased ipsilateral alpha and beta power above somatosensory areas in both the transient and the sustained attention conditions, which may reflect inhibition of ipsilateral and/or disinhibition of contralateral somatosensory areas. Cued nociceptive stimuli evoked a larger N130 than uncued stimuli, both in the transient and the sustained attention conditions. Support for increased efficiency of spatial attention in the sustained attention condition was obtained for the N180 and the P540 component. We concluded that spatial attention is more efficient in the case of sustained than in the case of transient spatial attention.