title: A randomized pilot trial of a positive affect skill intervention (lessons in linking affect and coping) for women with metastatic breast cancer.
abstract: BACKGROUND
  We conducted a randomized pilot trial to examine the feasibility, acceptability, and preliminary efficacy of a 5 week positive affect skills intervention (LILAC: lessons in linking affect and coping) for women with metastatic breast cancer. Additionally, we examined whether online delivery of the intervention would offer comparable benefits as in-person delivery.
  
  
  METHODS
  Women with metastatic breast cancer (N = 39) were randomized to an in-person intervention, online intervention, or in-person attention-matched control. Psychological well-being (depression [Center for Epidemiologic Studies Depression Scale], positive and negative affect [Differential Emotions Scale], cancer-specific quality of life [Multidimensional Quality of Life Scale-Cancer Version]), and positive coping (mindfulness, positive-affect skill use, and self-compassion [Self-Compassion Scale: Short-Form]) were assessed at baseline, 1 week post-intervention, and 1 month post-intervention follow-up.
  
  
  RESULTS
  The LILAC intervention showed good feasibility, acceptability, and retention. Although the study was not adequately powered to detect between-group differences in change on preliminary efficacy outcomes, within-group comparisons revealed that LILAC participants (in-person and online combined) showed reductions in depression and negative affect by the 1 month follow-up (d = -0.81). Notably, LILAC participants fell below the clinical threshold for depression (Center for Epidemiologic Studies Depression Scale = 16) by the 1 month follow-up (t[17] = -2.22, P = .04, d = -0.52), whereas control participants did not differ from threshold (t[9] = 0.45, P = .66, d = 0.14).
  
  
  CONCLUSIONS
  The LILAC intervention, regardless of delivery method, shows feasibility, acceptability, and preliminary efficacy for promoting psychological well-being in women with metastatic breast cancer. This research provides support for a larger randomized trial to test more definitively the potential benefits of LILAC. A strength of the LILAC intervention includes its innovative focus on positive affect. The efficacy of the online delivery suggests the potential for widespread Internet dissemination.
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Elaine O
authors.initials: EO
authors.lastname: Cheung
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Cohn
authors.affiliation: Stanford Medicine, Stanford, CA, USA.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Dunn
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Melisko
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Stefana
authors.initials: S
authors.lastname: Morgan
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Penedo
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Salsman
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Dianne M
authors.initials: DM
authors.lastname: Shumay
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Judith T
authors.initials: JT
authors.lastname: Moskowitz
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications* / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D003863:Depression / Q000523:psychology; D004644:Emotions; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008875:Middle Aged; D064866:Mindfulness; D009362:Neoplasm Metastasis; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011788:Quality of Life; D016896:Treatment Outcome
keywords: cancer; metastatic breast cancer; oncology; online; positive Affect; well-being