title: Effects of Positive Psychology Interventions on Risk Biomarkers in Coronary Patients: A Randomized, Wait-List Controlled Pilot Trial.
abstract: Among cardiac patients, positive psychologic factors are consistently linked with superior clinical outcomes and improvement in key markers of inflammation and hypothalamic-pituitary-adrenal axis functioning. Further, positive psychology interventions (PPI) have effectively increased psychologic well-being in a wide variety of populations. However, there has been minimal study of PPIs in cardiac patients, and no prior study has evaluated their effect on key prognostic biomarkers of cardiac outcome. Accordingly, we investigated the effect of 3 distinct PPIs on risk biomarkers in cardiac patients.
  
  
  
  In an exploratory trial, 69 patients with recent coronary artery bypass graft surgery or percutaneous intervention were randomized to (1) one of three 6-week in-person PPIs (based on the work of Seligman, Lyubomirsky, or Fordyce) or (2) a wait-list control group. Risk biomarkers were assessed at baseline, postintervention (7 weeks), and at 15-week follow-up. Between-group differences in change from baseline biomarker levels were examined via random effects models.
  
  
  
  Compared with the control group, participants randomized to the Seligman (B = -2.06; p = 0.02) and Fordyce PPI (B = -1.54; p = 0.04) had significantly lower high-sensitivity C-reactive protein levels at 7 weeks. Further, the Lyubomirsky PPI (B = -245.86; p = 0.04) was associated with a significantly lower cortisol awakening response at 7 weeks when compared with control participants. There were no other significant between-group differences.
  
  
  
  Despite being an exploratory pilot study with multiple between-group comparisons, this initial trial offers the first suggestion that PPIs might be effective in reducing risk biomarkers in high-risk cardiac patients.
authors.affiliation: Department of Psychology, University of Isfahan, Isfahan, Iran; Department of Psychology, Islamic Azad University of Borujen, Borujen, Iran. Electronic address: rezanikrahan@yahoo.com.
authors.forename: Gholam Reza
authors.initials: GR
authors.lastname: Nikrahan
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
authors.forename: Johannes A C
authors.initials: JA
authors.lastname: Laferton
authors.affiliation: Department of Psychology, University of Isfahan, Isfahan, Iran.
authors.forename: Karim
authors.initials: K
authors.lastname: Asgari
authors.affiliation: Department of Psychology, University of Isfahan, Isfahan, Iran.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Kalantari
authors.affiliation: Department of Consulting, University of Isfahan, Isfahan, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Abedi
authors.affiliation: Department of Internal Medicine, Najafabad Islamic Azad University, Najafabad, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Etesampour
authors.affiliation: Department of Immunology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Rezaei
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General HospitalBoston, MA.
authors.forename: Laura
authors.initials: L
authors.lastname: Suarez
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General HospitalBoston, MA.
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Huffman
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000378:metabolism / Q000523:psychology* / Q000601:surgery; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System; D007375:Interleukin-1 / Q000378:metabolism*; D015850:Interleukin-6 / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010865:Pilot Projects; D010913:Pituitary-Adrenal System; D012306:Risk; D012463:Saliva / Q000737:chemistry; D014850:Waiting Lists
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D007375:Interleukin-1; D015850:Interleukin-6; D002097:C-Reactive Protein; D006854:Hydrocortisone
keywords: HPA-axis functioning; coronary artery disease; inflammation; intervention; positive psychology; randomized controlled trial