title: Mediators and moderators of behavior change in patients with chronic cardiopulmonary disease: the impact of positive affect and self-affirmation.
abstract: Among patients with chronic cardiopulmonary disease, increasing healthy behaviors improves outcomes, but such behavior changes are difficult for patients to make and sustain over time. This study aims to demonstrate how positive affect and self-affirmation improve health behaviors compared with a patient education control group. The patient education (PE control) patients completed a behavioral contract, promising to increase their physical activity or their medication adherence and received an educational guide. In addition to the contract and guide, the positive affect/self-affirmation intervention (PA intervention) patients also learned to use positive affect and self-affirmation to facilitate behavior change. Follow-up was identical. In 756 patients, enrolled in three randomized trials, the PA intervention resulted in increased positive affect and more success in behavior change than the PE control (p < .01). Behavior-specific self-efficacy also predicted success (p < .01). Induction of positive affect played a critical role in buffering against the adverse behavioral consequences of stress. Patients who experienced either negative psychosocial changes (p < .05) or interval negative life events (p < .05) fared better with the PA intervention than without it. The PA intervention increased self-efficacy and promoted success in behavior change by buffering stress.
authors.affiliation: Center for Integrative Medicine and Division of Clinical Epidemiology and Evaluative Sciences Research, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065 USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Charlson
authors.affiliation: Department of Statistical Sciences, Cornell University, New York, NY USA.
authors.forename: Martin T
authors.initials: MT
authors.lastname: Wells
authors.affiliation: Center for Integrative Medicine and Division of Clinical Epidemiology and Evaluative Sciences Research, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065 USA.
authors.forename: Janey C
authors.initials: JC
authors.lastname: Peterson
authors.affiliation: Center for Integrative Medicine and Division of Clinical Epidemiology and Evaluative Sciences Research, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065 USA.
authors.forename: Carla
authors.initials: C
authors.lastname: Boutin-Foster
authors.affiliation: Center for Healthful Behavior Change, Division of General Medicine, Department of Medicine, New York University, New York, NY USA.
authors.forename: Gbenga O
authors.initials: GO
authors.lastname: Ogedegbe
authors.affiliation: Hospital for Special Surgery, Weill Cornell Medical College, New York, NY USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mancuso
authors.affiliation: Center for Integrative Medicine and Division of Clinical Epidemiology and Evaluative Sciences Research, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065 USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Hollenberg
authors.affiliation: Department of Health and Behavior Studies, Teachers College and Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Allegrante
authors.affiliation: Center for Integrative Medicine and Division of Clinical Epidemiology and Evaluative Sciences Research, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065 USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Jobe
authors.affiliation: Johnson Graduate School of Management, and Psychology Department, Cornell University, New York, NY USA.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Isen
keywords: Behavior change; Positive affect; Self-affirmation; Self-efficacy; Stress