Measuring Positive Emotion Outcomes in Positive Psychology Interventions: A Literature Review

Abstract

Accumulating evidence for the unique social, behavioral, and physical health benefits of positive emotion and related well-being constructs has led to the development and testing of positive psychological interventions (PPIs) to increase emotional well-being and enhance health promotion and disease prevention. PPIs are specifically aimed at improving emotional well-being and consist of practices such as gratitude, savoring, and acts of kindness. The purpose of this narrative review was to examine the literature on PPIs with a particular focus on positive emotion outcomes. We evaluated the evidence on the effects of PPIs on positive emotion specifically, and discussed the range of evidence regarding the relative responsiveness of emotion measures to PPIs in order to gain a better understanding of the specific emotional pathways through which PPIs influence psychological and physical well-being. We conclude with recommendations for best evaluating effects of PPIs on positive emotion outcomes.

Keywords

positive emotion positive psychology interventions

With some early exceptions (Fordyce, 1977, 1983; Lichter et al., 1980), historically, the emphasis in psychology has been on reducing depression, anxiety, or other negative affective constructs. Starting in the late 1990s, interest in positive emotion burgeoned with the rise of positive psychology (Seligman & Csikszentmihalyi, 2000), and with theoretical and empirical work by Folkman (1997) and Fredrickson (1998) bringing more attention to positive emotions as uniquely beneficial for health and well-being, independent of the effect of negative emotions. Accumulating evidence for social, behavioral, and physical health benefits of positive emotion and related constructs (e.g., optimism, life satisfaction; Lyubomirsky et al., 2005; Pressman & Cohen, 2005) has led to the development and testing of positive psychology interventions (PPIs). PPIs are made up of practices such as gratitude, savoring, and acts of kindness and are specifically aimed at improving well-being (Schueller et al., 2014). Some PPIs focus on a single skill and others are multicomponent interventions that teach a collection of positive skills. Various delivery modes have been tested including in person delivered to individuals (e.g., Moskowitz et al., 2017) or groups (e.g., Chaves et al., 2017), and self-guided via Internet (e.g., Addington et al., 2019; Peters et al., 2017) or with telephone support (e.g., Hausmann et al., 2018; Huffman et al., 2016).

Across several meta-analyses (Bolier et al., 2013; Chakhssi et al., 2018; Curry et al., 2018; Davis et al., 2016; Dickens, 2017; Hendriks et al., 2019; Kirby et al., 2017; Sin & Lyubomirsky, 2009; Zeng et al., 2015), PPIs have small to medium effects on well-being. However, the broad category of well-being is inconsistently operationalized across studies, making it difficult to determine whether PPIs have stronger effects on particular aspects of well-being compared to others. For example, decreases in depression are frequently used as one indicator of well-being (Bolier et al., 2013; Hendriks et al., 2019; Sin & Lyubomirsky, 2009), consistent with the field’s historical focus on negative emotions. Diverse positive constructs are usually grouped together, combining positive emotion with outcomes such as meaning and purpose, life satisfaction, and optimism (Chakhssi et al., 2018; Sin & Lyubomirsky, 2009), or with other cognitive and affective appraisals of one’s life as a whole (Bolier et al., 2013; Hendriks et al., 2019).

What cannot be gleaned from most of these prior meta-analyses is the extent to which PPIs influence positive emotion specifically, apart from other positive constructs. We define positive emotions as subjective positively valenced feelings that range from happy, calm, and satisfied to excited and thrilled, and differentiate them from other positively valenced constructs like optimism, life satisfaction, and meaning. These effects are critical to distinguish, given that positive emotion is one of the primary pathways through which PPIs are thought to benefit health and well-being (Lyubomirsky & Layous, 2013; Schueller et al., 2014).

The positive pathways to health theoretical model (Moskowitz, Addington, & Cheung, 2019) posits that engaging in the positive activities in PPIs increases the frequency of positive emotion which, in turn, has a range of proximal effects such as providing a timeout from stress (Lazarus et al., 1980); prompting more adaptive coping strategies (Folkman, 1997); broadened attention and cognition and increased behavioral action tendencies (Fredrickson, 1998); reduced emotional reactivity to daily stress and strengthened social relationships, which all lead to reduced stress. In turn, this reduction in stress predicts better physiological functioning (e.g., quicker autonomic recovery after a stressful event; Fredrickson, 1998; Pressman & Cohen, 2005; Pressman et al., 2019) and greater engagement in preventive health behaviors (Bassett, Schuette, et al., 2019; Hoogwegt et al., 2013), which ultimately lead to improved physical and psychological well-being such as less depression and anxiety, more life satisfaction, and increased meaning and purpose. The effects flowing from increased positive emotion—proximal effects, reduced stress, improved physiological function, and improved health behaviors—are hypothesized mediators of the effects of PPIs on physical health. Individual characteristics such as type of stress, baseline levels of depression and well-being, sociodemographic characteristics, and dispositional or personality factors constitute one class of potential moderators. Other potential moderators include dosage and frequency of activities (Lyubomirsky & Layous, 2013), the particular positive activity and match to individual (Schueller, 2012), and delivery mode.

The purpose of the present article is to review the literature on PPIs, with a particular focus on positive emotion outcomes. We seek to evaluate the evidence on the effects of PPIs on positive emotion specifically, and to gauge the range of evidence regarding the relative responsiveness of emotion measures to PPIs in order to gain a better understanding of the specific emotional pathways through which PPIs influence psychological and physical well-being. Although our focus is on positive emotion, we include effects on negative emotion to explore the extent to which PPIs, as theorized, have larger effects on positive emotion than on negative emotion. A number of variables will likely influence whether a PPI affects emotion, including sample demographics and other characteristics, type of control condition, and emotion assessment methods and operationalization. We discuss each of these in more detail in what follows.

Methods

Review Approach

To select studies for this review, a medical librarian searched Ovid MEDLINE, Embase, PsycInfo, and Scopus in November 2019. Keywords and subject headings (when available) were used to locate English language publications on positive psychology interventions and positive emotion. The full list of search terms is in the supplemental material. Positive emotion terms included both specific positive emotions as well as scales or measures used to assess those emotions. After deduplication in EndNote, a total of 737 records remained for review. In addition, we reviewed studies included in previous meta-analyses (Bolier et al., 2013; Chakhssi et al., 2018; Curry et al., 2018; Sin & Lyubomirsky, 2009) and narrative reviews of PPIs (Hernandez et al., 2018; Pressman et al., 2019). The authors reviewed the titles and abstracts, selected 55 for full text review, and retained 31 studies for inclusion to represent a range of samples (e.g., clinical, student, general population), self-reported positive emotion outcome measures, PPI activities (e.g., multicomponent, single component), and delivery modes (e.g., in person [individual and group], telephone, online).

Emotion outcomes

We focus and organize our review around the emotion measures that appeared most frequently in our search, grouping them in three categories: (a) dimensional measures (e.g., PANAS; Watson et al., 1988); (b) discrete emotion measures (e.g., Differential Emotions Scale; Izard, 1977); and (c) measures that are “blended” in that they incorporate a broader set of affective constructs like meaning and purpose in addition to emotion items (e.g., Subjective Happiness Inventory; Seligman & Csikszentmihalyi, 2000).

According to dimensional models (Larsen & Diener, 1992; Russell, 1980), emotion can be classified along two orthogonal axes: valence and activation. The valence dimension captures the continuum of how pleasant versus unpleasant an emotion is, from negative to positive. The activation dimension captures the continuum of how arousing or energizing an emotion is, from low activation (e.g., drowsy, lethargic) to high activation (e.g., alert, frenetic). These two dimensions can be conceptualized as a circumplex (Larsen & Diener, 1992) which captures a majority of the variance in subjective emotional experience. Watson and Tellegen (1985) proposed that the best way to view the two dimensions of valence and activation is to rotate the dominant poles so they range from high activation pleasant to low activation unpleasant. According to this approach, each emotion can be understood as a combination of these two dimensions, resulting in the following four quadrants of emotion: high-activation positive emotion (e.g., excited, elated), high-activation negative emotion (e.g., nervous, angry), low-activation positive emotion (e.g., calm, content), and low-activation negative emotion (e.g., sad, bored).

In contrast, discrete measures of emotion rest on the assumption that there is a fundamental set of basic emotions that can be differentiated based on their physiological, behavioral, and subjective experience components (Izard & Buechler, 1980). Discrete emotion measures tap a set of theorized basic states thought to be fundamental to the subjective experience. These basic emotions are thought to be consistent across cultures (Ekman, 1992) and include emotions such as interest, joy, surprise, sadness, anger, disgust, contempt, fear, shame, and guilt (Izard, 1977).

At the broader level of well-being, positive psychology research has distinguished between hedonic and eudaimonic outcomes. Positive emotion falls in the hedonic category, whereas eudaimonic well-being includes meaning and purpose, a sense of mastery, and fulfillment (Ryan & Deci, 2001; Ryff, 1989). A number of outcome measures in PPIs combine both hedonic (high positive emotion, low negative emotion, and life satisfaction) and eudaimonic (meaning and purpose) constructs, and as these are frequently the primary outcome in PPI studies, we include a brief review of these combined measures in addition to our focus on measures that tap only emotions. Examination of the effects of PPIs on these blended measures allows us to differentiate the effects of PPIs on positive emotion alone versus the effects of PPIs on hedonic and eudaimonic well-being more generally.

In addition to information on the emotion measures, we also include information about the time frame over which participants are asked to retrospectively report their emotional experience. These range from current state to past day, past week, and past month. Finally, our review contains information on the operationalization of emotion scores, as some studies use cut point or the balance of positive to negative affect instead of assessing aggregate (sum or average) positive and negative emotion scores separately as dependent variables.

Other Study Characteristics

In addition to the emotion outcome, we also collected information about characteristics of each study that likely play a role in efficacy of the PPIs. These variables include sample characteristics, whether participants were randomly assigned to the PPI, as well as size and the strength of the control condition. Strength of the control condition is a particularly important consideration in interpretation of intervention effects (Freedland et al., 2019). No treatment or waitlist control conditions are used to determine whether an intervention works at all—does engaging in the PPI improve emotion outcomes better than not engaging in any intervention? “Treatment as usual” determines whether an intervention works compared to a clinically relevant comparison—does the PPI have a bigger effect on emotion change when compared to a standard treatment (e.g., antidepressants)? The most rigorous controls for PPIs are attention and time matched, which address questions of mechanism—how or why an intervention works—and account for nonspecific effects such as facilitator contact and social support. For example, comparison to other activities that have the same amount of contact with study staff but do not include the hypothesized active ingredients (positive activities) of the program would be included in this most stringent group (Freedland et al., 2019).

Results

Dimensional Measures of Emotion

The PANAS (Watson et al., 1988) captures high-activation positive and negative emotions and is one of the most frequently used emotion measures in both observational and intervention studies. It consists of 10 high-activation positively valenced items (interested, excited, strong, enthusiastic, proud, alert, inspired, determined, attentive, and active) and 10 high-activation negatively valenced items (distressed, upset, guilty, scared, hostile, irritable, ashamed, nervous, jittery, afraid). Most PPI studies using the PANAS operationalize positive affect (PA) as the sum or average of the positive emotion items and the sum or average of negative emotion items, and examine positive and negative affect separately.

Details of 14 PPIs with PANAS as the emotion outcome are shown in Table 1. Overall, it appears that PPIs are associated with increased PANAS PA (e.g., Huffman et al., 2016; Shao et al., 2016) if the intervention is compared to minimal control—a waitlist or treatment-as-usual condition—but not if the control is more active or attention-matched (e.g., Hausmann et al., 2017; Mohammadi et al., 2018; Müller et al., 2016). For instance, Chaves et al. (2017) used a very active time- and attention-matched condition—cognitive behavioral therapy (CBT)—and found that whereas both the intervention and the active CBT control demonstrated significant increases on PANAS positive emotion, effects did not differ between PPI and the active CBT control condition. This suggests that for improving PA as measured with the PANAS, PPIs are superior to not engaging in any intervention, but may not be more effective when compared to more active control activities. There is a similar pattern for effects on PANAS negative affect such that in comparison to waitlist, treatment-as-usual, or assessment-only controls, PPIs have a significant impact on negative affect as well, but again, not if the control condition is more active or attention-matched.

Table 1.

Selected Positive Psychological Intervention Studies with Self-Reported Positive Emotion Outcome.

First author, year	Sample	n	Intervention type	Intervention length	Delivery format	Randomized	Control group	Timing of assessments	Time frame for emotion recall	Between-group effects on PA?	Within-group effects on PA?	Effect on negative emotion?
PANAS
Huffman, 2016	Acute coronary syndrome enrolled as inpatients with suboptimal adherence to health behaviors (40% female)	48	Multi	8 weekly sessions	Phone	No	TAU	Pre- and post-intervention	Past week	Yes	Yes on PANAS past week	NR
Chaves, 2017	Women with major depression or dysthymia	96	Multi	10 weekly sessions	Group in person	Yes	CBT	Pre- and post-intervention	Past week	No	Yes, both groups improved on PANAS past week	Yes, within group but not between. Both groups decreased on NA
Muller, 2016	Chronic pain secondary to physical disability (70% female)	96	Multi (select 4 of 10)	1 day per week for 8 weeks	Self-administered (PDF instructions sent by email)	Yes	Write about 3 events or activities	Pre-, post-, 2.5mo FU	Past week	No	Yes	No
Celano, 2018	Acute coronary syndrome enrolled as inpatients with suboptimal adherence to health behaviors (59% female)	128	Multi	8 weekly sessions	Phone	No - factorial trial where all received PPI	None	Baseline (pre), 8 weeks (post), 16 weeks	Past week	N/A	Yes – all groups increased on PANAS past week	Yes
Hausmann, 2017	Veterans age >=50 with knee or hip osteoarthritis and elevated pain (17% female)	42	Multi	6 weekly sessions	Workbook plus brief weekly phone calls	Yes	Neutral activities	1,3, and 6 months after the end of the program	Past week	No	NR	Yes
Auyeung, 2018	University students in Hong Kong (73% female)	100	Best possible selves	6 days	Self-guided online	Yes	Neutral writing exercises	Baseline, day 7	Past week	Yes	NR	NR
Machado, 2019	Medical students in Brazil (53% female)	69	Multi	7 weekly sessions	Group in person	No	Conventional medical psychology class	Baseline, 7 weeks	Not specified	NR	Yes	No
Shao, 2016	Chinese speaking pts with cervical cancer (stage 0-III) 1-week post-surgery	120	Gratitude and mindful breathing	4 weekly session	1 instruction phone call, then self-guided (manual/audio)	Yes	Waitlist control	Pre- and post-intervention	Not specified	Yes	NR	Yes
Mohammadi, 2018	Coronary heart disease patients (>=6 mo. post-acute event) (23% female)	62	Multi	8 sessions weekly, 2-hours each	Group in person	Yes	Cardiac education	Pre-, post- 2mo FU	Not specified	No	NR	No
Ivtzan, 2018	Adults from Hong Kong and Great Britain (53% female)	115	Multi	8 weeks	Self-guided online	Yes	Waitlist control	Pre- and post- intervention	Not specified	No	NR	Yes
PANAS affect balance
first author, year	sample	n	intervention type	intervention length	delivery format	randomized	control group	timing of assessments	Time frame for emotion recall	between-group effects on PA?	within-group effects on PA?	effect on negative emotion?
Drozd, 2014	Adults (75% female)	206	Multi	13 10-minute sessions over 4 weeks	Self-guided online	Yes	Waitlist control	Baseline, 1, 2, and 6 months	Past week	Yes	Yes	NR separate from affect balance
Hausmann, 2018	VA patients with osteoarthritis (24% female)	360	Multi	6 weekly sessions	Phone	Yes	Neutral activities	1,3, and 6 months after the end of the program	Past week	No	No	NR separate from affect balance
Kerr, 2015	Adults on a waitlist for outpatient therapy (75% female)	48	Daily gratitude diary or daily kindness diary	14 days	Workbook	Yes	Daily mood-monitoring	Pre- and post-intervention	Past day	No	No	NR separate from affect balance
PANAS - cut off scores
first author, year	sample	n	intervention type	intervention length	delivery format	randomized	control group	timing of assessments	Time frame for emotion recall	between-group effects on PA?	within-group effects on PA?	effect on negative emotion?
Boutin-Foster, 2016	African Americans with hypertension (70% female)	238	Self-affirmation, small gifts, motivational interviewing	Bimonthly for 12 months	Phone and self-guided workbook	Yes	Education	Baseline, 12 months	Not specified	No	No	No
Differential Emotions Scale (DES)
first author, year	sample	n	intervention type	intervention length	delivery format	randomized	control group	timing of assessments	Time frame for emotion recall	between-group effects on PA?	within-group effects on PA?	effect on negative emotion?
Moskowitz, 2019	Dementia caregivers (84% female)	170	Multi	6 weekly 1-hour sessions	Facilitated remotely via tablet	Yes	Daily emotion reporting	Post intervention (6 weeks)	Past week	Yes	Yes, marginal increase for intervention; significant decrease for control	Both groups decrease
Bassett, 2019	People living with HIV and elevated depression (10% female)	21	Multi	6 weeks	Self-guided online	Yes	Daily emotion reporting	Baseline, post intervention (6-8 weeks later)	Past week	No (p=.07)	Yes	No
Carrico, 2019	Men living with HIV	110	Multi	6 weekly 1-hour sessions	In person, individually delivered	Yes	Neutral writing exercises	Screening, baseline, 3-, 6-, 12- and 15-months	Past week	No (p=.051)	NR	No
Cohn, 2014	People with type 2 diabetes (51% female)	49	Multi	6 weeks, 1-2 15-minute sessions	Self-guided online	Yes	Daily emotion reporting	Baseline, post intervention (6-8 weeks later)	Past week	No	No	No
Cheung, 2016	Women with metastatic breast cancer	39	Multi	6 weeks	In person and online	Yes	In person attention control	Baseline, 1 week and 1- month post-intervention	Past week	No	No	No
Moskowitz, 2017	People newly diagnosed with HIV (8% female)	159	Multi	6 weeks	In person, individually delivered	Yes	In person attention control	Baseline, then 5, 10, and 15 months post diagnosis	Past week	No	No	No
Fredrickson, 2008	Employees of a computer company (60% female)	139	Loving kindness	9 weeks	Group in person	Yes	Waitlist control	Daily during the intervention period	Past day	Yes	Yes	No
Moskowitz, 2017	People newly diagnosed with HIV (8% female)	159	Multi	6 weeks	In person, individually delivered	Yes	In person attention control	5, 10, and 15 months post diagnosis	Past day	Yes	Yes	No
Cohn, 2014	People with type 2 diabetes (51% female)	49	Multi	6 weeks, 1 or 2 15-minute sessions	Self-guided online	Yes	Daily emotion reporting	Baseline, post intervention (6-8 weeks later)	Past day	No	No	No
Bassett, 2019	People living with HIV and elevated depression (10% female)	21	Multi	6 weeks	Self-guided online	Yes	Daily emotion reporting	4 times per day, 2 days per week over the course of the study	Past day	No	No	No
Other Discrete Emotion
first author, year	sample	n	intervention type	intervention length	delivery format	randomized	control group	timing of assessments	Time frame for emotion recall	between-group effects on PA?	within-group effects on PA?	effect on negative emotion?
Hwang, 2017	University students with elevated depression in Korea (75% female)	32 (24 completed post)	Multi	5 weeks, 2 sessions per week	In person, individually delivered	Yes	Neurofeedback-aided meditation and no treatment	Baseline, post (6-weeks), 4 months post- (PPI and active control only)	Past month	No on SPANE	Yes	Yes, decrease in NA compared to no treatment control
Schotanus-Dijkstra, 2019	Adults with suboptimal mental health (low or moderate well-being) (86% female)	275	Multi	9 weeks	Self-guided (book) with email support	Yes	Waitlist control	Baseline, 3, 6, and 12 months	Past week	Yes - Significant interaction effect on short version of the mDES (8 positive items)	NR	NR
Nelson, 2016	Community, students, and mTurk (60% female)	472	Acts of kindness (for others, the world, or self)	4 weeks	Self-guided online	Yes	Tracking activities	Weekly during the 4-week intervention and a 2-week follow up (resulting in 6 total assessment points)	Past week	Yes significant between group difference on the Affect Adjective Scale	Yes- marginally-significant effect of prosocial conditions (acts of kindness to others and the world combined) on quadratic within-group change in positive emotion (but no linear within-group change in positive emotion)	Yes - significant between-group effect on NA at post
Peters, 2017	Adults with chronic musculoskeletal pain (85% female)	276	Multi	7 to 16 weeks	Self-guided online with weekly phone or email support	Yes	CBT and waitlist	Baseline, post, 6 months	Current moment	Yes PPI vs waitlist; No PPI vs CBT on current moment Brief Mood Introspection Scale	NR	Yes PPI vs waitlist; No PPI vs CBT
Other Discrete Emotion affect balance
first author, year	sample	n	intervention type	intervention length	delivery format	randomized	control group	timing of assessments	Time frame for emotion recall	between-group effects on PA?	within-group effects on PA?	effect on negative emotion?
Lambert, 2019	University students in Dubai (56% female)	268	Multi	14 weeks	In person, classroom delivered	No	Psychology class w/o PPI content	Baseline, post (14 weeks), 3 months post	Not specified	Yes to SPANE affect balance	Yes affect balance increased significantly within intervention at post and follow-up	NR
Blended Hedonic-Eudaimonic Measures
first author, year	sample	n	intervention type	intervention length	delivery format	randomized	control group	timing of assessments	Time frame for emotion recall	between-group effects on PA?	within-group effects on PA?	effect on negative emotion?
Nikrahan, 2016	Heart surgery patients (24% female)	55	Multi	6 weeks	Group in person	Yes	Waitlist control	Post (7 weeks) and 15 weeks	Not specified	Yes - baseline to 15 weeks on Oxford Happiness Inventory	Yes	N/A
Mohammadi, 2018	Outpatients with chronic coronary heart disease (23% female)	61	Multi -optimism intervention	8 weeks	Group in person	Yes	Cardiac education	Post (8 weeks) and 16 weeks	Not specified	Yes baseline to 8 weeks Oxford Happiness Inventory	NR	(Described above)
Drozd, 2014	Adults (75% female)	206	Multi	4 weeks	Self-guided online	Yes	Waitlist control	Baseline, post (4 weeks),2 months, and 6 months	Not specified	N/A (Subjective Happiness Inventory only assessed in intervention group)	Yes	N/A
Ramirez, 2014	Older adults (63% female)	46	Multi	9 weeks	Group in person	Yes	Placebo	Baseline, post- intervention, and 4 months post	Not specified	Yes on Subjective Happiness Inventory	Yes	Yes – significant decrease in anxiety and depression
Mongrain, 2011	Adults (82% female)	719	Compassion activities	1 week	Self-guided online	Yes	Writing about early childhood memories	Baseline, post (1 week), 1 month, 3 months, and 6 months	Past week	Yes on Steen Happiness Index/Authentic Happiness Index	NR	N/A
Proyer,2016	Adults (90% female)	113	9 beautiful things	1 week	Self-guided online	Yes	Writing about early childhood memories	Baseline, post-intervention (1 week), 1 month, 3 months, and 6 months	Past week	Yes (one-tailed) from baseline to post, one-week, and one-month follow-ups on Steen Happiness Index/Authentic Happiness Index	NR	N/A
Chaves, 2017	Women with elevated depression	96	Multi	10 weeks	Group in person	No (blind allocation, but not randomized)	CBT	Baseline, post (10 weeks)	Not specified	No on Pemberton Happiness Index	Yes, both positive psychology and CBT groups showed increased PA from baseline to post	Both groups decreased on PANAS NA

CBT = cognitive behavioral therapy; FU = follow-up; HIV = human immunodeficiency virus; mDES = modified Differential Emotions Scale; NR = not reported; PA = positive affect; PANAS = Positive and Negative Affect Schedule; PPI = positive psychological intervention; NA = negative affect; SPANE = Scale of Positive and Negative Experience; TAU = treatment as usual; VA = Veteran’s Administration

Rather than looking at a sum or average score on positive and negative affect separately, some researchers calculate “affect balance” based on the ratio of positive to negative affect on the PANAS (Drozd et al., 2014; Hausmann et al., 2018). Similar to the results reported before, effect of the PPI appears to depend on the strength of the control condition. In one study comparing a multicomponent self-guided online-delivered PPI to a waitlist control, intervention participants showed significant increases in PANAS positive to negative affect balance (Drozd et al., 2014). In contrast, in another study that relied on a more stringent attention-matched control condition, there were no between-group differences in PANAS affect balance of a phone-delivered PPI compared to a neutral activities control (Hausmann et al., 2018).

In summary, a number of PPI studies report significant improvements on PANAS positive affect within the intervention group (Celano et al., 2018; Chaves et al., 2017; Müller et al., 2016), but few show significantly greater improvements compared to attention-matched controls. Effects are generally the same for negative emotion, that is, PPIs reduce PANAS negative within the intervention, but the effects do not differ significantly from more active controls (e.g., Hausmann et al., 2018). The studies that have the PANAS as a primary emotion outcome differ on other important factors such as delivery mode (e.g., self-guided with telephone support, in-person group delivery, self-guided workbook), gender make-up of the sample, and normative trajectories of change in affect in the sample (e.g., women with cervical cancer, community participants, acute coronary syndrome, chronic pain), but it is not yet clear the extent to which any of these variables moderate the effect of PPIs on the PANAS.

Discrete emotion measures

Examples of discrete emotion measures used as outcomes in PPIs are the Differential Emotions Scale (Izard, 1977), the Affect-Adjective Scale (Diener & Emmons, 1984), the Scale of Positive and Negative Emotion (Diener et al., 2010), and the Brief Mood Introspection Scale (Mayer & Gaschke, 1988), which, in contrast to the PANAS, tap both high- and low-activation positive and negative affect (e.g., happy, pleased, joyful, contented, calm, worried, angry, frustrated, sad).

Details of 12 PPI studies that use a discrete emotion outcome measure are shown in Table 1. Note that three of the studies are listed twice in this section (Basset, Cohn et al., 2019; Cohn et al., 2014; Moskowitz et al., 2017) because they included multiple retrospective time frames for reporting emotion—assessing both past day emotion and past week emotion.

Similar to the PANAS findings, studies that have tested the effects of PPIs on discrete emotion measures have shown effects on positive emotion when compared with waitlist or treatment-as-usual controls (Fredrickson et al., 2008; Moskowitz, Cheung et al., 2019; Nelson et al., 2016; Schotanus-Dijkstra et al., 2019), but not when compared with more active conditions (Cheung et al., 2016; Hwang et al., 2017; Moskowitz et al., 2017) that control for time spent on activities and attention from facilitators. Interestingly, unlike the PANAS findings, the effects of PPIs seem to be limited primarily to increasing positive emotion, and there do not seem to be comparable decreases in negative emotion as assessed with discrete emotion measures.

In addition, interesting differences emerge when comparing the time frame of assessment using discrete emotion measures. There is some suggestion that intervention effects are more likely on discrete measures of positive emotion when using shorter time frames (e.g., past day or current moment; Fredrickson et al., 2008; Peters et al., 2017), but less so for longer time frames (e.g., past month; Hwang et al., 2017). For example, one of first studies to test effects of a PPI on a discrete emotion measure was done by Fredrickson and colleagues in a test of loving kindness meditation (Fredrickson et al., 2008). The modified Differential Emotions Scale (mDES), which augments the original DES with additional positive items (e.g., amusement, gratitude, love, pride; Fredrickson, 2013), was used to assess emotion daily for the 9 weeks of the program, and responses were aggregated to form weekly averages of positive and negative emotion. Participants in the loving kindness condition had significant increases on positive emotion with the past day retrospective time frame compared to the waitlist control. There were no significant effects of the loving kindness intervention on negative emotion.

In a study that assessed both past day and past week on the mDES, 159 people newly diagnosed with HIV were randomized to a multicomponent PPI or to an attention-matched interview and questionnaire condition (Moskowitz et al., 2017). Although there was no difference between intervention and control on mDES positive (or negative) emotion assessed over the past week, participants in the intervention showed higher levels of positive emotion over the past day assessed using the Day Reconstruction Method (Kahneman et al., 2004). There were no significant effects on either past week or past day negative emotion.

Summary for discrete emotion measures

As in the studies that have PANAS as the emotion outcome, the PPIs that report effects on discrete emotion measures differ on a number of factors including sample, delivery mode, and strength of control condition, so it is premature to draw definitive conclusions. However, there is some indication that, in adequately powered studies, PPIs are likely to significantly influence positive emotion, particularly when compared to minimal control conditions (e.g., Moskowitz, Cheung et al., 2019; Schotanus-Dijkstra et al., 2019). In contrast to findings with the PANAS, few studies that use discrete emotion outcomes find effects of PPIs on negative emotion, supporting the notion that PPIs may have specific, targeted effects on positive but not negative emotion, as assessed by discrete emotion measures.

Measures that combine hedonic and eudaimonic well-being

Table 1 includes details of seven studies that use blended hedonic–eudaimonic outcome measures.

The Steen Happiness Index

The Steen Happiness Index (Seligman et al., 2005), later updated with additional items and renamed the Authentic Happiness Index, was explicitly designed to be sensitive to influence of PPIs and assesses pleasure, engagement, and meaning. Participants are asked to select the statement from each group that best describes the way they have been feeling for the past week, including today. Emotion items include bipolar emotion terms such as sorrow/joy, boredom/fascination, shame/pride, and bad/unbelievably great mood, but the scale also includes additional constructs such as social engagement as well as meaning and purpose. Studies that use the Authentic Happiness Index as an outcome usually find significant effects of the PPI. Mongrain et al. (2011) randomized 719 adults to compassionate activities for 1 week or to an early childhood memory control. Participants in the compassion condition experienced greater increases on the Steen Happiness Index compared to the control over the 6-month follow-up period. Similarly, Proyer et al. (2016) randomized 113 adults to write about nine beautiful things (three in human behavior, three in nature or the environment, and three beauty in general) every evening for a week or to a control condition in which they wrote about early memories. Assessments showed significant increases on the Authentic Happiness Inventory in the intervention condition at all follow-up points. Neither study assessed negative emotion specifically but Proyer et al. (2016) reported that post-intervention participants had decreased depression at post and 1 week follow-up.

The Oxford Happiness Inventory

The Oxford Happiness Inventory (Argyle et al., 1989) is a dispositional measure that also mixes a number of constructs including life satisfaction, optimism, and sense of control, as well as some items that particularly reflect hedonic (e.g., “I am very happy,” “I often experience joy and elation”) and eudaimonic affect (e.g., “I don’t have a particular sense of meaning and purpose in my life [reverse coded]” “I feel that life is very rewarding”). In a randomized trial in patients who had recent heart surgery, Nikrahan et al. (2016) tested three versions of a group PPI compared to a waitlist control condition. When the three intervention arms were combined for analysis, there were no differences on the Oxford Happiness Inventory from baseline to 7 weeks. However, by the 15-week assessment, the intervention participants reported increases compared to a waitlist control. Mohammadi et al. (2018) tested a group PPI in 62 cardiac patients. The control condition was an attention-matched cardiac education class. Results showed significant between-group differences in improvements from pre to postintervention on the Oxford Happiness Inventory. In contrast, the authors found no group differences on the PANAS, suggesting the possibility that effects on the Oxford Happiness Inventory were driven by the eudaimonic content instead of the hedonic (high-activation positive emotion) items captured by the PANAS.

Hedonic–eudaimonic measures summary

Measures such as the Oxford Happiness Inventory or the Steen Hapiness Index combine hedonic and eudaimonic components so it is not possible to distinguish PPI effects on emotion from effects on other facets of well-being. In addition, this group of measures also includes some that are more dispositionally focused (e.g., Oxford Happiness Inventory), that is, they ask participants how they are generally, without a specific time frame referenced. In theory, we would expect less change in dispositional well-being and for eudaimonic well-being to change more slowly in response to a relatively brief PPI. Explicit exploration of effects of PPIs on hedonic compared to eudaimonic measures is an important area for future research focus.

Discussion

Positive emotion is one of the key mechanisms through which positive psychology interventions (PPIs) are hypothesized to influence psychological and physical health (Moskowitz, Addington, and Cheung, 2019; Schueller et al., 2014). Although a number of meta-analyses have demonstrated that PPIs have broadly beneficial effects, most do not differentiate positive emotion specifically or tease apart effects on positive emotion from those on other theorized pathways (Bolier et al., 2013; Chakhssi et al., 2018; Curry et al., 2018; Sin & Lyubomirsky, 2009). In one exception, Curry et al. (2018) conducted a meta-analysis of acts of kindness interventions and, in a subanalysis of individual measures, found that across five studies that used the PANAS, the effect sizes varied widely from −.46 to .70. This wide variability highlights the fact that even if studies deliver the same type of intervention and use the same outcome measure, there are likely many other factors that drive the efficacy of the intervention.

Our goal in this review was to provide an overview of types of emotion outcomes used in tests of PPIs, evaluate the evidence on the effects of PPIs on positive emotion specifically, and examine whether there is sufficient evidence to determine whether different measures were more or less responsive to PPIs. Based on this review, we can draw several conclusions regarding emotion outcomes in PPIs. First, PPIs often have a significant influence on positive emotion, especially when looking at change within the intervention group or when evaluating the intervention versus a minimal control condition such as a treatment-as-usual or waitlist. One of the most frequently used measures to evaluate the efficacy of PPIs is the PANAS, which assesses higher activation emotions. Specific PPIs such as loving kindness, for example, might be expected to impact lower activation positive emotions in particular (“peaceful positive emotions”; Zeng et al., 2015), and exclusive reliance on the PANAS may be missing important effects on lower activation emotions that are not tapped by the measure. On the other hand, some measures may be overly inclusive in that they combine hedonic (emotion) and eudaimonic (meaning and purpose) items, obscuring effects on either type of well-being individually. For example, Mohammadi et al. (2018) tested effects of a PPI on the Oxford Happiness Inventory and the PANAS. Whereas they found significant improvements on a measure that combines emotion and eudaimonic items—the Oxford Happiness Inventory—there were no group differences on the PANAS, perhaps suggesting that eudaimonic items were driving the effects of the intervention. It is important for researchers to select measures that can precisely assess the outcome that is targeted by the PPI, to add to our understanding of whether interventions can improve these different aspects of psychological well-being. Although there are a number of interventions that specifically target meaning and purpose (Breitbart et al., 2015; Westerhof et al., 2010), few have measured both positive emotion and meaning and purpose separately to begin to parse out any differential effects on emotion.

Another source of variability in PPI outcomes and research that utilizes self-reported emotion measures more generally is the time frame for retrospective reporting. The emotion assessments reviewed here vary on a spectrum from measuring momentary emotion (e.g., “How happy are you feeling right now”) or past day emotion (e.g., “How happy did you feel in the past day”), to assessing emotions experienced over longer durations, such as past week emotion (e.g., “How happy did you feel over the past week”). Furthermore, emotion measures vary in terms of whether they capture the individual’s state levels of emotion versus more trait/dispositional tendencies to experience emotion (e.g., “I consider myself a happy person”). Ecological momentary assessment (EMA) or daily diary measures of emotion allow for more fine-grained examination of emotion processes such as intraindividual variability (Ong & Ram, 2017) or responsivity to daily stress (Mroczek et al., 2015) that may better capture the emotion changes in response to PPIs. For example, using a daily diary assessment, Mroczek et al. (2015) demonstrated that lower levels of positive emotional reactivity in response to a daily stressful event are predictive of a lower risk of mortality. These findings suggest that reactivity or other operationalizations of daily emotional experience calculated from daily diaries or ecological momentary assessment (Ong & Ram, 2017) may be an important focus of measurement of PPI effects for future studies, particularly if physical health is one of the more distal outcomes of interest.

This is not to say that broader time frames for self-reported emotion are not useful. There is evidence that shorter retrospective time frames for self-reported emotion may rely more on emotion experience, whereas for longer recall periods participants rely more on their beliefs about what they likely felt based on context rather than the actual emotion experienced (Robinson & Clore, 2002). This review suggests that there is evidence for PPIs’ influence on shorter (e.g., Fredrickson et al., 2003; Moskowitz et al., 2017; Peters et al., 2017) as well as longer time frames (e.g., past week; e.g., Auyeung & Mo, 2019; Huffman et al., 2016; Moskowitz, Cheung et al., 2019). So not only do PPIs influence emotional experience, they influence an individual’s beliefs and expectations as well as awareness about the experience of PPIs (“I just completed this program that taught me how to have more positive emotion, therefore I must be experiencing more positive emotion”). As with many interventions or treatments, effect of PPIs on self-reported emotion outcomes may be at least partially driven by these expectancy effects (Kirsch, 1997). PPIs often explicitly aim to increase positive emotion, so it is perhaps surprising that effects on self-reported positive emotion outcomes are not even stronger. Both emotional experiences and beliefs are likely to have an important impact on psychological and physical health. Investigators need to be cognizant of what memory processes may be at play with measures using different retrospective time frames and understand that these differences lead to distinctive types of information regarding impact of an intervention.

This review makes clear that it is critically important for researchers to begin with a theoretical model to guide the selection of emotion measure and decisions about how best to operationalize emotion. What are the hypothesized mechanisms of effect of the PPI under study? Which affective states, specifically, would be expected to change in response to the intervention? For example, results from a large population-based observational study demonstrate that PANAS PA, and in particular the item “active,” predicts lower risk of mortality (Petrie et al., 2018). Based on these findings, researchers testing PPIs that include a physical activity component (e.g., Celano et al., 2018), or other activities hypothesized to increase higher activation positive emotions, may consider including the PANAS to be sure to capture these increases. Similarly, in observational studies, optimism is a significant predictor of better health behaviors in patients following acute coronary syndrome (Millstein et al., 2016). Researchers who are particularly interested in how PPIs can improve such health behaviors should make sure to include measures of optimism to best capture the hypothesized mechanisms for beneficial health effects in this population (e.g., Duque et al., 2019; Huffman et al., 2016).

Researchers should also take characteristics of their population into account in selecting emotion measures. In a recent study that reported on the preliminary efficacy of a PPI tailored specifically for people with bipolar disorder, the authors gave careful thought to the selection of outcomes most appropriate for this population—differentiating between high- and low-activation emotions as well as how much participants valued different emotional states (Painter et al., 2019). The intervention content focused on low-activation positive emotions in particular (e.g., calm, rested, relaxed, peaceful, serene), because high-activation positive emotions may be a symptom of, or trigger for, mania.

Other potential measures of emotion include psychophysiology (e.g., skin conductance), behavioral observation of facial expression or posture, vocal pitch, and neuroimaging. These non-self-reported measures of emotion also have drawbacks such as imprecise match to subjective experience (Cacioppo et al., 2000), low convergence among the measures (Mauss & Robinson, 2009), and high participant burden. Indirect measures of emotion—those that do not require direct verbal self-report of an internal emotional state such as the affect misattribution procedure (Lee et al., 2019) or the Implicit Positive and Negative Affect Test (IPANAT; Quirin et al., 2009)—hold promise in laboratory studies but are untested in the field in response to PPIs. For example, in-lab manipulation of affect based on film clips results in changes on the IPANAT not reflected in self-report that correlated with cardiovascular reactivity (van der Ploeg et al., 2016). New approaches to emotion assessment using passive sensors in smartphones (e.g., accelerometer, microphone, calls, location, SMS) are showing reasonable correlation with self-reported mood (Servia-Rodríguez et al., 2017), but also have not yet been tested in response to PPIs and may provide an important new avenue for investigation of PPI effects on emotion.

Schueller et al. (2014) suggest that PPIs have effects through increases in positive emotion, positive cognitions, and/or positive behaviors, so in addition to specifying which type of positive emotion is hypothesized to improve for a given PPI, researchers should consider which cognitions and behaviors may be influenced and measure these outcomes as well. Beyond the measure and operationalization of self-reported emotion, the studies reviewed here also vary on a number of other characteristics that likely influenced the effect of the PPI, such as demographic characteristics of the sample, the type of stress they were experiencing, length and content of the intervention, make-up of the control conditions, and length of follow-up. Careful theoretically based selection and reporting of the emotion outcome measures in PPI research will move the field to a place where we can start looking at these potential moderators of intervention effects and toward answers to the question of which PPIs have the biggest impact on emotional well-being and for whom.

Supplemental Material

Appendix_-_Search_Terms_for_Moskowitz_Measuring_Positive_Emotion_Outcomes_in_Positive_Psychology_Interventions – Supplemental material for Measuring Positive Emotion Outcomes in Positive Psychology Interventions: A Literature Review

Supplemental material, Appendix_-_Search_Terms_for_Moskowitz_Measuring_Positive_Emotion_Outcomes_in_Positive_Psychology_Interventions for Measuring Positive Emotion Outcomes in Positive Psychology Interventions: A Literature Review by Judith T. Moskowitz, Elaine O. Cheung, Melanie Freedman, Christa Fernando, Madelynn W. Zhang, Jeff C. Huffman and Elizabeth L. Addington in Emotion Review

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Judith T. Moskowitz

Elizabeth L. Addington

Supplemental Material

Supplemental material for this article is available online.

References

Addington

Cheung

E. O.

Bassett

Kwok

Schuette

Shiu

Yang

Cohn

M. A.

Leykin

Saslow

L. R.

Moskowitz

J. T.

(2019). The MARIGOLD study: Feasibility and enhancement of an online intervention to improve emotion regulation in people with elevated depressive symptoms. Journal of Affective Disorders, 257, 352–364.

Argyle

Martin

Crossland

(1989). Happiness as a function of personality and social encounters. In Recent advances in social psychology: An international perspective (1st ed., pp. 189–203). Elsevier.

Auyeung

P. K. H.

(2019). The efficacy and mechanism of online positive psychological intervention (PPI) on improving well-being among Chinese university students: A pilot study of the best possible self (BPS) intervention. Journal of Happiness Studies, 20(8), 2525–2550.

Bassett

S. M.

Cohn

Cotten

Kwok

Moskowitz

J. T.

(2019). Feasibility and acceptability of an online positive affect intervention for those living with comorbid HIV depression. AIDS and Behavior, 23(3), 753–764.

Bassett

S. M.

Schuette

S. A.

O’Dwyer

L. C.

Moskowitz

J. T.

(2019). Positive affect and medication adherence in chronic conditions: A systematic review. Health Psychology, 38(11), 960–974.

Bolier

Haverman

Westerhof

G. J.

Riper

Smit

Bohlmeijer

(2013). Positive psychology interventions: A meta-analysis of randomized controlled studies. BMC Public Health, 13, Article 119. https://doi.org/10.1186/1471-2458-13-119

Breitbart

Rosenfeld

Pessin

Applebaum

Kulikowski

Lichtenthal

W. G.

(2015). Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology, 33(7), 749–754.

Cacioppo

J. T.

Berntson

G. G.

Larsen

J. T.

Poehlmann

K. M.

Ito

T. A.

(2000). The psychophysiology of emotion. In Lewis

Haviland-Jones

J. M.

(Eds.), Handbook of emotions (pp. 173–191). Guilford Press.

Celano

C. M.

Albanese

A. M.

Millstein

R. A.

Mastromauro

C. A.

Chung

W.-J.

Campbell

K. A.

Legler

S. R.

Park

E. R.

Healy

B. C.

Collins

L. M.

Januzzi

J. L.

Huffman

J. C.

(2018). Optimizing a positive psychology intervention to promote health behaviors after an acute coronary syndrome: The Positive Emotions After Acute Coronary Events III (PEACE-III) Randomized Factorial Trial. Psychosomatic Medicine, 80(6), 526–534.

10.

Chakhssi

Kraiss

J. T.

Sommers-Spijkerman

Bohlmeijer

E. T.

(2018). The effect of positive psychology interventions on well-being and distress in clinical samples with psychiatric or somatic disorders: A systematic review and meta-analysis. BMC Psychiatry, 18(1), 211.

11.

Chaves

Lopez-Gomez

Hervas

Vazquez

(2017). A comparative study on the efficacy of a positive psychology intervention and a cognitive behavioral therapy for clinical depression. Cognitive Therapy and Research, 41(3), 417–433.

12.

Cheung

E. O.

Cohn

M. A.

Dunn

L. B.

Melisko

M. E.

Morgan

Penedo

F. J.

Salsman

J. M.

Shumay

D. M.

Moskowitz

J. T.

(2016). A randomized pilot trial of a positive affect skill intervention (lessons in linking affect and coping) for women with metastatic breast cancer. Psycho-Oncology. Advance online publication. https://doi.org/10.1002/pon.4312

13.

Cohn

M. A.

Pietrucha

M. E.

Saslow

L. R.

Hult

J. R.

Moskowitz

J. T.

(2014). An online positive affect skills intervention reduces depression in adults with Type 2 diabetes. The Journal of Positive Psychology, 9(6), 523–534.

14.

Curry

O. S.

Rowland

L. A.

van Lissa

C. J.

Zlotowitz

McAlaney

Whitehouse

(2018). Happy to help? A systematic review and meta-analysis of the effects of performing acts of kindness on the well-being of the actor. Journal of Experimental Social Psychology, 76, 320–329.

15.

Davis

D. E.

Choe

Meyers

Wade

Varjas

Gifford

Quinn

Hook

J. N.

van Tongeren

D. R.

Griffin

B. J.

Worthington

E. L.

(2016). Thankful for the little things: A meta-analysis of gratitude interventions. Journal of Counseling Psychology, 63(1), 20–31.

16.

Dickens

L. R.

(2017). Using gratitude to promote positive change: A series of meta-analyses investigating the effectiveness of gratitude interventions. Basic and Applied Social Psychology, 39(4), 193–208.

17.

Diener

Emmons

R. A.

(1984). The independence of positive and negative affect. Journal of Personality and Social Psychology, 47, 1105–1117.

18.

Diener

Wirtz

Tov

Kim-Prieto

Choi

D.-w.

Oishi

Biswas-Diener

(2010). New well-being measures: Short scales to assess flourishing and positive and negative feelings. Social Indicators Research, 97(2), 143–156.

19.

Drozd

Mork

Nielsen

Raeder

Bjørkli

C. A.

(2014). Better days – A randomized controlled trial of an Internet-based positive psychology intervention. The Journal of Positive Psychology, 9(5), 377–388.

20.

Duque

Brown

Celano

C. M.

Healy

Huffman

J. C.

(2019). Is it better to cultivate positive affect or optimism? Predicting improvements in medical adherence following a positive psychology intervention in patients with acute coronary syndrome. General Hospital Psychiatry, 61, 125–129.

21.

Ekman

(1992). An argument for basic emotions. Cognition and Emotion, 6(3–4), 169–200.

22.

Folkman

(1997). Positive psychological states and coping with severe stress. Social Science and Medicine, 45, 1207–1221.

23.

Fordyce

M. W.

(1977). Development of a program to increase personal happiness. Journal of Counseling Psychology, 24(6), 511–521.

24.

Fordyce

M. W.

(1983). A program to increase happiness: Further studies. Journal of Counseling Psychology, 30, 483–498.

25.

Fredrickson

B. L.

(1998). What good are positive emotions? Review of General Psychology, 2, 300–319.

26.

Fredrickson

B. L.

(2013). Positive emotions broaden and build. In Devine

Plant

(Eds.), Advances in experimental social psychology (Vol. 47, pp. 1–53). Elsevier.

27.

Fredrickson

B. L.

Cohn

M. A.

Coffey

K. A.

Pek

Finkel

S. M.

(2008). Open hearts build lives: Positive emotions, induced through meditation, build consequential personal resources. Journal of Personality and Social Psychology, 95, 1045–1062.

28.

Fredrickson

B. L.

Tugade

M. M.

Waugh

C. E.

Larkin

G. R.

(2003). What good are positive emotions in crises? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. Journal of Personality and Social Psychology, 84, 365–376.

29.

Freedland

K. E.

King

A. C.

Ambrosius

W. T.

Mayo-Wilson

Mohr

D. C.

Czajkowski

S. M.

Thabane

Collins

L. M.

Rebok

G. W.

Treweek

S. P.

Cook

T. D.

Edinger

J. D.

Stoney

C. M.

Campo

R. A.

Young-Hyman

Riley

W. T.

, & National Institutes of Health Office of Behavioral and Social Sciences Research Expert Panel on Comparator Selection in Behavioral and Social Science Clinical Trials. (2019). The selection of comparators for randomized controlled trials of health-related behavioral interventions: Recommendations of an NIH expert panel. Journal of Clinical Epidemiology, 110, 74–81.

30.

Hausmann

L. R.

Youk

Kwoh

C. K.

Gallagher

R. M.

Weiner

D. K.

Vina

E. R.

Obrosky

D. S.

Mauro

G. T.

McInnes

Ibrahim

S. A.

(2018). Effect of a positive psychological intervention on pain and functional difficulty among adults with osteoarthritis: A randomized clinical trial. JAMA Network Open, 1(5), Article e182533. https://doi.org/10.1001/jamanetworkopen.2018.2533

31.

Hausmann

L. R.

Youk

Kwoh

C. K.

Ibrahim

S. A.

Hannon

M. J.

Weiner

D. K.

Gallagher

R. M.

Parks

(2017). Testing a positive psychological intervention for osteoarthritis. Pain Medicine, 18(10), 1908–1920.

32.

Hendriks

Schotanus-Dijkstra

Hassankhan

de Jong

Bohlmeijer

(2019). The efficacy of multi-component positive psychology interventions: A systematic review and meta-analysis of randomized controlled trials. Journal of Happiness Studies. Advance online publication. https://doi.org/10.1007/s10902-019-00082-1

33.

Hernandez

Bassett

S. M.

Boughton

S. W.

Schuette

S. A.

Shiu

E. W.

Moskowitz

J. T.

(2018). Psychological well-being and physical health: Associations, mechanisms, and future directions. Emotion Review, 10, 18–29.

34.

Hoogwegt

M. T.

Versteeg

Hansen

T. B.

Thygesen

L. C.

Pedersen

S. S.

Zwisler

A.-D.

(2013). Exercise mediates the association between positive affect and 5-year mortality in patients with ischemic heart disease. Circulation: Cardiovascular Quality and Outcomes, 6(5), 559–566.

35.

Huffman

J. C.

Millstein

R. A.

Mastromauro

C. A.

Moore

S. V.

Celano

C. M.

Bedoya

C. A.

Suarez

Boehm

J. K.

Januzzi

J. L.

(2016). A positive psychology intervention for patients with an acute coronary syndrome: Treatment development and proof-of-concept trial. Journal of Happiness Studies, 17(5), 1985–2006.

36.

Hwang

Kwon

Hong

(2017). A preliminary study of new positive psychology interventions: Neurofeedback-aided meditation therapy and modified positive psychotherapy. Current Psychology, 36(3), 683–695.

37.

Izard

C. E.

(1977). Human emotions. Plenum.

38.

Izard

C. E.

Buechler

. (1980). Aspects of consciousness and personality in terms of differential emotions theory. In Plutchik

Kellerman

(Eds.), Theories of emotion (pp. 165–187) New York: Academic Press.

39.

Kahneman

Krueger

A. B.

Schkade

D. A.

Schwarz

Stone

A. A.

(2004). A survey method for characterizing daily life experience: The day reconstruction method. Science, 306(5702), 1776–1780. https://doi.org/10.1126/science.1103572

40.

Kirby

J. N.

Tellegen

C. L.

Steindl

S. R.

(2017). A meta-analysis of compassion-based interventions: Current state of knowledge and future directions. Behavior Therapy, 48(6), 778–792.

41.

Kirsch

(1997). Response expectancy theory and application: A decennial review. Applied and Preventive Psychology, 6(2), 69–79.

42.

Larsen

R. J.

Diener

. (1992). Promises and problems with the circumplex model of emotion. In Clark

M. S.

(Ed.), Review of Personality and Social Psychology: Vol. 14. Emotional and Social Behavior (pp. 25–59). Newbury Park, CA: SAGE.

43.

Lazarus

R. S.

Kanner

A. D.

Folkman

(1980). Emotions: A cognitive-phenomenological analysis. In Plutchik

Kellerman

(Eds.), Theories of emotion (pp. 189–217). Academic Press.

44.

Lee

Lindquist

Arbuckle

Mowrer

Payne

(2019). An indirect measure of discrete emotions. Emotion. Advance online publication. https://doi.org/10.1037/emo0000577

45.

Lichter

Haye

Kammann

(1980). Increasing happiness through cognitive retraining. New Zealand Psychologist, 9, 57–64.

46.

Lyubomirsky

King

Diener

(2005). The benefits of frequent positive affect: Does happiness lead to success? Psychological Bulletin, 131(6), 803–855. https://doi.org/10.1037/0033-2909.131.6.803

47.

Lyubomirsky

Layous

(2013). How do simple positive activities increase well-being? Current Directions in Psychological Science, 22(1), 57–62.

48.

Mauss

I. B.

Robinson

M. D.

(2009). Measures of emotion: A review. Cognition and Emotion, 23(2), 209–237.

49.

Mayer

J. D.

Gaschke

Y. N

. (1988). The experience and meta-experience of mood. Journal of Personality and Social Psychology, 55, 102–111.

50.

Millstein

R. A.

Celano

C. M.

Beale

E. E.

Beach

S. R.

Suarez

Belcher

A. M.

Januzzi

J. L.

Huffman

J. C.

(2016). The effects of optimism and gratitude on adherence, functioning and mental health following an acute coronary syndrome. General Hospital Psychiatry, 43, 17–22.

51.

Mohammadi

Aghayousefi

Nikrahan

G. R.

Adams

C. N.

Alipour

Sadeghi

Roohafza

Celano

C. M.

Huffman

J. C.

(2018). A randomized trial of an optimism training intervention in patients with heart disease. General Hospital Psychiatry, 51, 46–53.

52.

Mongrain

Chin

J. M.

Shapira

L. B.

(2011). Practicing compassion increases happiness and self-esteem. Journal of Happiness Studies, 12(6), 963–981.

53.

Moskowitz

J. T.

Addington

E. A.

Cheung

E. O.

(2019). Positive pathways to health. General Hospital Psychiatry, 61, 136–138.

54.

Moskowitz

J. T.

Carrico

A. W.

Duncan

L. G.

Cohn

M. A.

Cheung

E. O.

Batchelder

Martinez

Segawa

Acree

Folkman

(2017). Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV. Journal of Consulting and Clinical Psychology, 85(5), 409–423.

55.

Moskowitz

J. T.

Cheung

E. O.

Snowberg

K. E.

Verstaen

Merrilees

Salsman

J. M.

Dowling

G. A.

(2019). Randomized controlled trial of a facilitated online positive emotion regulation intervention for dementia caregivers. Health Psychology, 38(5), 391–402.

56.

Mroczek

D. K.

Stawski

R. S.

Turiano

N. A.

Chan

Almeida

D. M.

Neupert

S. D.

Spiro

(2015). Emotional reactivity and mortality: Longitudinal findings from the VA Normative Aging Study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 70(3), 398–406.

57.

Müller

Gertz

K. J.

Molton

I. R.

Terrill

A. L.

Bombardier

C. H.

Ehde

D. M.

Jensen

M. P.

(2016). Effects of a tailored positive psychology intervention on well-being and pain in individuals with chronic pain and a physical disability: A feasibility trial. The Clinical Journal of Pain, 32(1), 32–44.

58.

Nelson

S. K.

Layous

Cole

S. W.

Lyubomirsky

(2016). Do unto others or treat yourself? The effects of prosocial and self-focused behavior on psychological flourishing. Emotion, 16(6), 850–861.

59.

Nikrahan

G. R.

Suarez

Asgari

Beach

S. R.

Celano

C. M.

Kalantari

Reza Abedi

Etesampour

Abbas

Huffman

J. C.

(2016). Positive psychology interventions for patients with heart disease: A preliminary randomized trial. Psychosomatics, 57(4), 348–358.

60.

Ong

A. D.

Ram

(2017). Fragile and enduring positive affect: Implications for adaptive aging. Gerontology, 63(3), 263–269.

61.

Painter

J. M.

Mote

Peckham

A. D.

Lee

E. H.

Campellone

T. R.

Pearlstein

J. G.

Morgan

Kring

A. M.

Johnson

S. L.

Moskowitz

J. T.

(2019). A positive emotion regulation intervention for Bipolar I disorder: Treatment development and initial outcomes. General Hospital Psychiatry, 61, 96–103.

62.

Peters

M. L.

Smeets

Feijge

van Breukelen

Andersson

Buhrman

Linton

S. J.

(2017). Happy despite pain: A randomized controlled trial of an 8-week Internet-delivered positive psychology intervention for enhancing well-being in patients with chronic pain. The Clinical Journal of Pain, 33(11), 962–975.

63.

Petrie

K. J.

Pressman

S. D.

Pennebaker

J. W.

Øverland

Tell

G. S.

Sivertsen

(2018). Which aspects of positive affect are related to mortality? Results from a general population longitudinal study. Annals of Behavioral Medicine, 52(7), 571–581.

64.

Pressman

S. D.

Cohen

(2005). Does positive affect influence health? Psychological Bulletin, 131(6), 925–971. https://doi.org/10.1037/0033-2909.131.6.925

65.

Pressman

S. D.

Jenkins

B. N.

Moskowitz

J. T.

(2019). Positive affect and health: What do we know and where next should we go? Annual Review of Psychology, 70, 627–650.

66.

Proyer

R. T.

Gander

Wellenzohn

Ruch

(2016). Nine beautiful things: A self-administered online positive psychology intervention on the beauty in nature, arts, and behaviors increases happiness and ameliorates depressive symptoms. Personality and Individual Differences, 94, 189–193.

67.

Quirin

Kazén

Kuhl

(2009). When nonsense sounds happy or helpless: The Implicit Positive and Negative Affect Test (IPANAT). Journal of Personality and Social Psychology, 97(3), 500–516.

68.

Robinson

M. D.

Clore

G. L.

(2002). Belief and feeling: Evidence for an accessibility model of emotional self-report. Psychological Bulletin, 128(6), 934–960.

69.

Russell

J. A.

(1980). A circumplex model of affect. Journal of Personality and Social Psychology, 39, 1161–1178.

70.

Ryan

R. M.

Deci

E. L.

(2001). On happiness and human potentials: A review of research on hedonic and eudaimonic well-being. Annual Review of Psychology, 52(1), 141–166.

71.

Ryff

C. D.

(1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57, 1069–1081.

72.

Schotanus-Dijkstra

Pieterse

M. E.

Drossaert

C. H.

Walburg

J. A.

Bohlmeijer

E. T. J.

(2019). Possible mechanisms in a multicomponent email guided positive psychology intervention to improve mental well-being, anxiety and depression: A multiple mediation model. The Journal of Positive Psychology, 14(2), 141–155.

73.

Schueller

S. M.

(2012). Personality fit and positive interventions: Extraverted and introverted individuals benefit from different happiness increasing strategies. Psychology, 3(12A), 1166–1173.

74.

Schueller

Kashdan

Parks

(2014). Synthesizing positive psychological interventions: Suggestions for conducting and interpreting meta-analyses. International Journal of Wellbeing, 4(1), 91–98.

75.

Seligman

M. E. P.

Csikszentmihalyi

(2000). Positive psychology: An introduction. American Psychologist, 55, 5–14.

76.

Seligman

M. E. P.

Steen

T. A.

Park

Peterson

(2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60, 410–421.

77.

Servia-Rodríguez

Rachuri

K. K.

Mascolo

Rentfrow

P. J.

Lathia

Sandstrom

G. M.

(2017). Mobile sensing at the service of mental well-being: A large-scale longitudinal study. Paper presented at the Proceedings of the 26th International Conference on World Wide Web, Perth, Australia.

78.

Shao

Gao

Cao

F.-L.

(2016). Brief psychological intervention in patients with cervical cancer: A randomized controlled trial. Health Psychology, 35(12), 1383–1391.

79.

Sin

N. L.

Lyubomirsky

(2009). Enhancing well-being and alleviating depressive symptoms with positive psychology intervention: A practice-friendly meta-analysis. Journal of Clinical Psychology, 65, 467–487.

80.

Van der Ploeg

M. M.

Brosschot

J. F.

Thayer

J. F.

Verkuil

. (2016). The Implicit Positive and Negative Affect Test: Validity and relationship with cardiovascular stress-responses. Frontiers in Psychology, 7, 425. https://doi.org/10.3389/fpsyg.2016.00425

81.

Watson

Clark

L. A.

Tellegen

(1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.

82.

Watson

Tellegen

(1985). Toward a consensual structure of mood. Psychological Bulletin, 98, 219–235.

83.

Westerhof

G. J.

Bohlmeijer

E. T.

van Beljouw

I. M.

Pot

A. M.

(2010). Improvement in personal meaning mediates the effects of a life review intervention on depressive symptoms in a randomized controlled trial. The Gerontologist, 50(4), 541–549.

84.

Zeng

Chiu

C. P.

Wang

Oei

T. P.

Leung

F. Y.

(2015). The effect of loving-kindness meditation on positive emotions: A meta-analytic review. Frontiers in Psychology, 6, Article 1693. https://doi.org/10.3389/fpsyg.2015.01693

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB