An online positive affect skills intervention reduces depression in adults with type 2 diabetes

Abstract

Positive affect predicts improved glycemic control and longevity in adults with type 2 diabetes. We tested Developing Affective HeaLth to Improve Adherence (DAHLIA), a self-paced online intervention for type 2 diabetes that teaches positive affect skills such as savoring, gratitude, and acts of kindness. Participants (n = 49) were randomized to the five-week DAHLIA course or an emotion-reporting wait-list control. DAHLIA was understood and accepted by participants and showed good retention (78%). At post-intervention, DAHLIA participants showed a significantly greater decrease in depression than controls (−4.3 vs. +0.6 points on the CES-D, p = 0.05). Secondary analyses found that this effect was considerably stronger in intervention recipients recruited online than those recruited in person. Intervention recipients recruited online also showed significantly increased positive affect, reduced negative affect, and reduced perceived stress. There were no effects on measures of diabetes-specific efficacy or sense of burden, or preliminary measures of health behaviors. This successful feasibility and efficacy trial provides support for a larger trial focusing more specifically on health behavior.

Keywords:

• health
• intervention
• emotion
• online

Acknowledgments

We gratefully acknowledge the support of the following colleagues: Elizabeth Bartmess provided training and oversight in software user experience testing. Heather Coleman performed user experience testing and contributed to intervention development. Stephanie Maurer assisted with study protocol development. Marlene Bedrich and Gloria Yee at the UCSF Diabetes Education Center helped tailor the intervention for a type 2 diabetes population and permitted us to recruit participants at their classes.

Funding

This publication was supported by (1) NIMH K24 5K24MH093225-02 and (2) the National Center for Research Resources and the National Center for Advancing Translational Sciences, NIH, through UCSF-CTSI [grant number UL1 RR024131]. The sponsors had no role in the conduct of the research, analysis, or preparation of the manuscript.

Notes

1. We used fully random assignment based on a computerized random number generator. This led to a chance discrepancy in cell sizes: 29 participants were assigned to the intervention and 20 to the control condition.

2. The length of the emotion reporting period was based on our estimate of how long it would take intervention participants to complete the lessons. Average time to complete the intervention was lower than expected, leading to the slight mismatch between groups in time spent in the study.