title: The Positive Emotions after Acute Coronary Events behavioral health intervention: Design, rationale, and preliminary feasibility of a factorial design study.
abstract: BACKGROUND
  Positive psychological constructs, such as optimism, are associated with greater participation in cardiac health behaviors and improved cardiac outcomes. Positive psychology interventions, which target psychological well-being, may represent a promising approach to improving health behaviors in high-risk cardiac patients. However, no study has assessed whether a positive psychology intervention can promote physical activity following an acute coronary syndrome.
  
  
  OBJECTIVE
  In this article we will describe the methods of a novel factorial design study to aid the development of a positive psychology-based intervention for acute coronary syndrome patients and aim to provide preliminary feasibility data on study implementation.
  
  
  METHODS
  The Positive Emotions after Acute Coronary Events III study is an optimization study (planned N = 128), subsumed within a larger multiphase optimization strategy iterative treatment development project. The goal of Positive Emotions after Acute Coronary Events III is to identify the ideal components of a positive psychology-based intervention to improve post-acute coronary syndrome physical activity. Using a 2 × 2 × 2 factorial design, Positive Emotions after Acute Coronary Events III aims to: (1) evaluate the relative merits of using positive psychology exercises alone or combined with motivational interviewing, (2) assess whether weekly or daily positive psychology exercise completion is optimal, and (3) determine the utility of booster sessions. The study's primary outcome measure is moderate-to-vigorous physical activity at 16 weeks, measured via accelerometer. Secondary outcome measures include psychological, functional, and adherence-related behavioral outcomes, along with metrics of feasibility and acceptability. For the primary study outcome, we will use a mixed-effects model with a random intercept (to account for repeated measures) to assess the main effects of each component (inclusion of motivational interviewing in the exercises, duration of the intervention, and inclusion of booster sessions) from a full factorial model controlling for baseline activity. Similar analyses will be performed on self-report measures and objectively-measured medication adherence over 16 weeks. We hypothesize that the combined positive psychology and motivational interviewing intervention, weekly exercises, and booster sessions will be associated with superior physical activity.
  
  
  RESULTS
  Thus far, 78 participants have enrolled, with 72% of all possible exercises fully completed by participants.
  
  
  CONCLUSIONS
  The Positive Emotions after Acute Coronary Events III study will help to determine the optimal content, intensity, and duration of a positive psychology intervention in post-acute coronary syndrome patients prior to testing in a randomized trial. This study is novel in its use of a factorial design within the multiphase optimization strategy framework to optimize a behavioral intervention and the use of a positive psychology intervention to promote physical activity in high-risk cardiac patients.
authors.affiliation: 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jeffery C
authors.initials: JC
authors.lastname: Huffman
authors.affiliation: 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Ariana M
authors.initials: AM
authors.lastname: Albanese
authors.affiliation: 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Kirsti A
authors.initials: KA
authors.lastname: Campbell
authors.affiliation: 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Celano
authors.affiliation: 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Millstein
authors.affiliation: 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mastromauro
authors.affiliation: 2 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Healy
authors.affiliation: 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Wei-Jean
authors.initials: WJ
authors.lastname: Chung
authors.affiliation: 3 Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.affiliation: 4 The Methodology Center, Penn State, University Park, PA, USA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Collins
authors.affiliation: 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Park
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology / Q000534:rehabilitation*; D004644:Emotions; D005240:Feasibility Studies; D015438:Health Behavior; D006801:Humans; D008603:Mental Health; D062405:Motivational Interviewing; D000067656:Optimism; D017063:Outcome Assessment, Health Care; D012107:Research Design; D013689:Telephone
keywords: Positive psychology; factorial design study; multiphase optimization strategy