Connectedness and positive psychology practice questions for the lifestyle medicine boards
Connectedness questions test the evidence linking relationships and positive emotion to health, and the interventions you can actually offer patients.
ABLM exam domain: Connectedness and Positive Psychology
8%of the ABLM exam
~12of 150 physician questions
~10of 120 health professional questions
127questions on this domain in the bank
What the exam expects you to know
ABLM builds the exam on the lifestyle medicine core competencies. For this domain they include:
Positive psychology in health behavior change counseling
How positive psychology strategies help patients sustain healthy behaviors
Eudaimonic and hedonic well-being, and their effects on health and longevity
Social connectedness, social networks, loneliness and health outcomes
Harmful and helpful effects of social media on well-being
Positive psychology activities that support flourishing
High-yield areas
Loneliness and social isolation as risk factors for mortality and disease
Gratitude, savoring, acts of kindness and other positive psychology interventions
Purpose in life and eudaimonic well-being
Social prescribing and connecting patients with community resources
Social media use and adolescent well-being
How to study it
This domain mixes research interpretation with counseling. Know the direction and rough size of the main associations, and be ready to pick a realistic intervention for the patient in the vignette.
Free practice questions: Connectedness and positive psychology
4 questions from the bank, with the full rationale and source. Pick your answer, then open the rationale.
Question 1 of 4 · moderateConnectedness and Positive Psychology
A geriatric practice is building a case for routinely addressing social isolation and loneliness as health risks. Which health-risk association matches the summary of the 2020 National Academies report Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System?
Social isolation was linked to about a 10% higher risk of dementia
Poor social relationships were linked to about double the risk of stroke
Loneliness in heart failure showed no link with hospitalization
Social isolation showed no link with premature all-cause mortality
Loneliness in heart failure was linked to nearly 4 times the risk of death
Show answer and rationale
Answer: E. Loneliness in heart failure was linked to nearly 4 times the risk of death
A (incorrect): Incorrect. Social isolation has been associated with an approximately 50% increased risk of developing dementia, not 10%.
B (incorrect): Incorrect. Poor social relationships (isolation or loneliness) have been associated with a 32% increased risk of stroke and a 29% increased risk of incident coronary heart disease, not a doubling.
C (incorrect): Incorrect. Loneliness among heart failure patients has been associated with a 68% increased risk of hospitalization and a 57% increased risk of emergency department visits.
D (incorrect): Incorrect. The summary states that social isolation has been associated with a significantly increased risk of premature mortality from all causes.
E (correct): Correct. The summary reports that loneliness among heart failure patients has been associated with a nearly fourfold increased risk of death, along with 68% more hospitalization and 57% more emergency department visits. The same summary notes that about 24% of community-dwelling adults aged 65 and older are socially isolated and 43% of adults aged 60 and older report loneliness.
Source: National Academies of Sciences, Engineering, and Medicine. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: National Academies Press; 2020. Summary, opening section (isolation linked to premature all-cause mortality; about 50% higher dementia risk; heart failure loneliness nearly 4 times death, 68% hospitalization, 57% ED visits; 29% CHD and 32% stroke; 24% of community-dwelling adults 65 and older isolated; 43% of 60 and older lonely). https://nap.nationalacademies.org/read/25663/chapter/2
Question 2 of 4 · moderateConnectedness and Positive Psychology
A 58-year-old man had a myocardial infarction 2 weeks ago. He scores low on perceived social support and has mild depressive symptoms. His cardiologist wonders whether a psychosocial program will improve his cardiac prognosis and reviews the ENRICHD randomized trial of cognitive behavior therapy, with SSRIs when indicated, in 2,481 post-MI patients. Which result is accurate?
Mood and support improved, but event-free survival did not
Death or recurrent MI fell by about one quarter with treatment
Social support scores did not change with the intervention
Event-free survival improved in the low-support subgroup alone
Therapy began about 6 months after the index infarction
Show answer and rationale
Answer: A. Mood and support improved, but event-free survival did not
A (correct): Correct. At 6 months, depression and social support scores improved more with the intervention, but after an average 29 months event-free survival was 75.8% with the intervention and 75.9% with usual care.
B (incorrect): Incorrect. There was no significant difference in the composite of death or recurrent MI between the arms.
C (incorrect): Incorrect. ESSI social support scores rose more in the intervention group (mean change 5.1 versus 3.4, P<.001).
D (incorrect): Incorrect. There were no survival differences between arms in any of the three psychosocial risk groups, including low perceived social support.
E (incorrect): Incorrect. Cognitive behavior therapy began at a median of 17 days after the MI and continued for about 6 months.
Source: Writing Committee for the ENRICHD Investigators (Berkman LF, et al). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the ENRICHD randomized trial. JAMA. 2003;289(23):3106-3116. Abstract Intervention (CBT started median 17 days after MI, median 11 sessions over 6 months, SSRIs when indicated) and Results (HRSD and ESSI improvements at 6 months, P<.001; event-free survival 75.9% usual care vs 75.8% intervention after mean 29 months; no differences in any psychosocial risk group). https://pubmed.ncbi.nlm.nih.gov/12813116/
Question 3 of 4 · moderateConnectedness and Positive Psychology
A 52-year-old woman in cardiac rehabilitation tells her husband that she has been promoted. He smiles, says quietly, "That's nice, I'm happy for you," and goes back to reading without asking anything more. Using the capitalization framework of Gable and colleagues (2004), which classification of his response and its association with relationship quality is correct?
Passive-constructive; associated with better relationship quality
Active-constructive; associated with better relationship quality
Active-destructive; associated with poorer relationship quality
Passive-constructive; associated with poorer relationship quality
Passive-destructive; associated with greater trust and commitment
Show answer and rationale
Answer: D. Passive-constructive; associated with poorer relationship quality
A (incorrect): Incorrect. The authors note that passive-constructive responses, which tend to be associated with desirable outcomes in accommodation research, were associated with undesirable outcomes in the capitalization data.
B (incorrect): Incorrect. Active-constructive responding is enthusiastic, with questions and genuine interest in the good event. His brief, quiet acknowledgment does not fit that category.
C (incorrect): Incorrect. Active-destructive responses actively diminish the event, for example by finding a problem with it or pointing out its downsides, which he did not do.
D (correct): Correct. Quiet, understated support ("says little, but I know he/she is happy for me") defines the passive-constructive category. In the couples study, passive-constructive, active-destructive and passive-destructive responses were negatively correlated with commitment, satisfaction, intimacy and trust.
E (incorrect): Incorrect. Passive-destructive responses ignore the event or show disinterest, and they were negatively, not positively, correlated with trust and commitment.
Source: Gable SL, Reis HT, Impett EA, Asher ER. What do you do when things go right? The intrapersonal and interpersonal benefits of sharing positive events. J Pers Soc Psychol. 2004;87(2):228-245. doi:10.1037/0022-3514.87.2.228. PMID 15301629. Study 2, Table 2 (Perceived Responses to Capitalization Attempts items, including passive-constructive 'My partner says little, but I know he/she is happy for me') and Study 2 and Study 3 results (only active-constructive responses positively associated with relationship quality; passive-constructive, active-destructive and passive-destructive negatively associated). https://pubmed.ncbi.nlm.nih.gov/15301629/
Question 4 of 4 · easyConnectedness and Positive Psychology
A health system wants primary care teams to identify older adults who are socially isolated or lonely. To save time, a quality team proposes that each clinic write its own two-question screen by combining one item from a loneliness scale with a question staff find useful. Which approach best follows the 2020 National Academies report on social isolation and loneliness in older adults?
Use the same validated tool or tools across the whole system
Let each clinic design a short screen that suits its workflow
Combine single items taken from several validated scales
Allow each clinic to select a different validated instrument
Wait to assess until patients raise loneliness on their own
Show answer and rationale
Answer: A. Use the same validated tool or tools across the whole system
A (correct): Correct. The report recommends that providers periodically assess older adults with one or more validated tools and emphasizes standardization, with all clinicians in a system using the same tool or set of tools.
B (incorrect): Incorrect. The committee advises refraining from creating new, unvalidated tools and stresses that clinicians in a system should use the same tool.
C (incorrect): Incorrect. The report advises against using partial versions of existing tools, which can undermine their validity.
D (incorrect): Incorrect. Standardization within a health system is described as an important aspect of tool selection, so clinics should not each choose separately.
E (incorrect): Incorrect. Recommendation 7-1 calls for periodic assessment to identify older adults experiencing social isolation and loneliness, rather than waiting for disclosure.
Source: National Academies of Sciences, Engineering, and Medicine. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: National Academies Press; 2020. Summary, Goal 2: Translate Current Research into Health Care Practices; Recommendation 7-1 (periodic assessment with one or more validated tools) and accompanying text (standardization: all clinicians in a system use the same tool or set of tools; use validated tools and refrain from using parts of existing tools or creating new, unvalidated tools). https://nap.nationalacademies.org/read/25663/chapter/2
For exam preparation only, not clinical advice.
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