June 13, 2017
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In a recent study published in the Journal of Consulting and Clinical Psychology, researchers evaluated two coping programs for patients recently diagnosed with HIV, and measured their relative impact on viral load and other health metrics. The intervention group received "positivity training," or facilitator-led instruction on gratitude, mindfulness, and other techniques designed to promote positive thinking. The second group met with the same facilitators for the same amount of time, but did not receive positivity training.
At the start of the study, 44% of the intervention group was on antiretroviral therapy (ART), which was similar to the 46% in the control group. Reporting any missed doses of ART was also similar for both groups at baseline, with 13% in the intervention group and 14% in the control.
After each patient completed the 15-month intervention, 91% of the "positivity" group had suppressed viral load, compared to only 76% of the control group. Additionally, both groups had the same percentage (86%) on ART, but only 13% of the "positivity" group reported any missed doses of ART, compared with 23% of the control group.
"Although the effect on viral load was not statistically significant ... from a public health perspective, this is huge," said lead author Judith Moskowitz, professor of medical social sciences and director of research at the Osher Center for Integrative Medicine at Northwestern University Feinberg School of Medicine.
"In addition, the control group went on antidepressants at a higher rate than the intervention group," said Moskowitz. Prior to any intervention, about 17% of all study participants said they used antidepressants. By the end of the study, 35% of the control group reported using antidepressants, compared to 17% in in the intervention group.
"That was really surprising to me," Moskowitz said. "I interpret that as the intervention group is using the positivity skills to control mental health."
But why would positive thinking techniques like mindfulness and gratitude directly impact viral load? That's something Moskowitz can only theorize about for now, but is planning to pursue that question in future studies.
"What I think is going on is that having positive emotion helps you better cope with stress," she said, but "when you get into the nitty gritty of the biological pathways affected, we haven't been able to pick it up in our data."
Moskowitz's interest in the power of positive thinking began in the 1990s. Back then, she recalled, HIV was essentially a death sentence, and she and her colleagues were studying coping mechanisms among the caregivers of AIDS patient, many of whom were partners, family and friends of the dying patient. Throughout her interviews with caregivers, Moskowitz was surprised to discover that they reported positive emotions during times of significant stress.
"That set me on a path of studying positive emotion during stress," Moskowitz said. "It seems to have an adaptive purpose." At the time, she explained, the field of psychology was moving away from an emphasis on reducing negative emotions and increasingly exploring how to improve positive emotions.
She began putting the positivity program together in 2007, creating a curriculum that borrowed from positive psychotherapy, clinical research and standard cognitive behavioral techniques.
"I really wanted to put together a buffet of skills, giving patients the option to try one of eight different techniques and see what works best for them," she said.
"It doesn't require a trained clinician to do these positivity interventions," she said. "I think it is like physical exercise: If you can make it a habit, it becomes an automatic way of thinking. A lot of these skills are about thinking about things different. And that doesn't take much time at all."
Future Positivity Research
Although Moskowitz's recent findings about positivity were impressive, the study failed to produce a statistically significant difference in viral load between the two groups, perhaps because the study recruited 159 participants, which was not a big enough number to tease out a meaningful difference. Moskowitz is currently applying for a grant that would allow her to conduct a larger study with the Chicago Department of Health.
In addition, Moskowitz is directing larger body of research into positivity training for diabetics, women with breast cancer, and other patient groups. Although her positivity training program is not commercially available, she is currently planning a study to assess whether the positivity training used in the HIV study can be effective if delivered through an online portal rather than by an in-person facilitator.
Making the positivity training techniques available via an online portal would eventually allow any interested patient to pursue the training and learn the positivity skills. In the meantime, Moskowitz recommends that patients curious about the power of positive thinking download commercially-available apps such as Happify, a happiness skill-building app that uses science-backed techniques.
Sony Salzman is a freelance journalist reporting on health care and medicine, who has won awards in both narrative writing and radio journalism. Follow Salzman on Twitter: @sonysalz.
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