Who benefits most from positive psychological interventions? Predictors and moderators of well-being outcomes in severe mental health conditions

Abstract

Background/Objectives: Positive psychology interventions (PPIs) may enhance well-being in individuals with severe psychiatric conditions (SPCs), yet little is known about individual differences in treatment response. Methods: We conducted a secondary analysis of a single-blind, parallel-group randomized controlled trial. A total of 119 adults receiving outpatient mental health care were randomized to an 11-week multicomponent PPI plus treatment as usual (PPI + TAU) or TAU alone. A priori demographic and baseline clinical variables (e.g., age, gender, education, diagnosis, symptom severity) were tested as predictors and moderators of six well-being outcomes. Moderation analyses were conducted using the PROCESS macro (version 4.1) for SPSS version 29.0, with simple slopes explored for significant interactions. Analyses followed an intention-to-treat approach. Results: Individuals who were unemployed, had a diagnosis within the psychosis spectrum, or exhibited high interpersonal sensitivity showed improvements in well-being irrespective of the treatment modality received. Older patients, those attending more weekly therapy sessions, and individuals with less somatization, hostility, or life satisfaction levels responded particularly well to the specialized PPI + TAU treatment. While several interactions were significant at p < 0.01, none remained significant after Bonferroni–Holm correction. Nevertheless, the patterns were consistent and theoretically grounded. Conclusions: Individual characteristics may influence the effectiveness of PPIs in SPC populations. Identifying predictors and moderators can inform more personalized interventions. The findings warrant replication. Trial registration: ClinicalTrials.gov, NCT01436331.