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Happy Despite Pain: A Randomized Controlled Trial of an 8-Week Internet-delivered Positive Psychology Intervention for Enhancing Well-being in Patients With Chronic Pain

Peters, Madelon L. PhD*; Smeets, Elke PhD*; Feijge, Marion MSc; van Breukelen, Gerard PhD; Andersson, Gerhard PhD§,∥; Buhrman, Monica PhD; Linton, Steven J. PhD#

doi: 10.1097/AJP.0000000000000494
Original Articles

Objectives: There is preliminary evidence for the efficacy of positive psychology interventions for pain management. The current study examined the effects of an internet-based positive psychology self-help program for patients with chronic musculoskeletal pain and compared it with an internet-based cognitive-behavioral program.

Materials and Methods: A randomized controlled trial was carried out with 3 conditions: an internet-delivered positive psychology program, an internet-delivered cognitive-behavioral program and waitlist control. A total of 276 patients were randomized to 1 of the 3 conditions and posttreatment data were obtained from 206 patients. Primary outcomes were happiness, depression, and physical impairments at posttreatment and at 6-month follow-up. Intention-to-treat analyses were carried out using mixed regression analyses.

Results: Both treatments led to significant increases in happiness and decreases in depression. Physical impairments did not significantly decrease compared with waitlist. Improvements in happiness and depression were maintained until 6-month follow-up. There were no overall differences in the efficacy of the 2 active interventions but effects seemed to be moderated by education. Patients with a higher level of education profited slightly more from the positive psychology intervention than from the cognitive-behavioral program.

Discussion: The results suggest that an internet-based positive psychology and cognitive-behavioral self-help interventions for the management of chronic pain are clinically useful. Because the self-help exercises as used in the current program do not require therapist involvement, dissemination potential is large. Further studies should examine whether it can best be used as stand-alone or add-on treatment combined with established pain treatment programs.

*Department of Clinical Psychological Science


Department of Methodology and Statistics, and CAPHRI School for Care and Public Health, Maastricht University, The Netherlands

§Department of Behavioural Sciences and Learning, Linköping University, Linköping

Department of Clinical Neuroscience, Karolinska Institute, Stockholm

Department of Psychology, Uppsala University, Uppsala

#Center for Health and Medical Psychology, Örebro University, Sweden

Supported by a VICI innovative research grant from the Netherlands Organization of Scientific Research (NWO) The Hague The Netherlands; and awarded to M.L.P. (grant #453-07-005). The remaining authors declare no conflict of interest.

Reprints: Madelon L. Peters, PhD, Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands (e-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Received October 7, 2016

Received in revised form January 26, 2017

Accepted February 17, 2017

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