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Given the lack of biomedical treatments, we developed the \u201cRelaxation Response Resiliency for NF\u201d (3RP\u2010NF) program to improve psychosocial outcomes among adults with NF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To move toward\u00a0effectiveness testing, we must understand mechanisms that explained treatment effects. We tested whether our hypothesized mechanisms of change\u2014mindfulness, coping, and optimism\u2014mediated improvements in quality of life, depression, and anxiety among adults in the 3RP\u2010NF program (<jats:italic>N<\/jats:italic>\u2009=\u2009114; ages 18\u201370; 72.80% female; 81.58% White).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted mixed\u2010effects models to assess whether these mechanisms uniquely mediated outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Improvements in quality of life were most explained by coping, (<jats:italic>b<\/jats:italic>\u2009=\u20090.97, SE\u2009=\u20090.28, CI [0.45, 1.56]), followed by mindfulness (<jats:italic>b<\/jats:italic>\u2009=\u20090.46, SE\u2009=\u20090.17, CI [0.15, 0.82]) and optimism (<jats:italic>b<\/jats:italic>\u2009=\u20090.39, SE\u2009=\u20090.12, CI [0.17, 0.65]). Improvements in depression and anxiety were most explained by mindfulness (<jats:italic>b<\/jats:italic>\u2009=\u2009\u22121.52, SE\u2009=\u20090.38, CI [\u22122.32, \u22120.85], CSIE\u2009=\u2009\u22120.26; <jats:italic>b<\/jats:italic>\u2009=\u2009\u22121.29, SE\u2009=\u20090.35, CI [\u22122.04, \u22120.67], CSIE\u2009=\u2009\u22120.23), followed by optimism (<jats:italic>b<\/jats:italic>\u2009=\u20090.39, SE\u2009=\u20090.12, CI [0.17, 0.65]; <jats:italic>b<\/jats:italic>\u2009=\u2009\u22120.49, SE\u2009=\u20090.20, CI [\u22120.91, \u22120.13]), but were not explained by coping (<jats:italic>b<\/jats:italic>\u2009=\u20090.22, SE\u2009=\u20090.43, CI [\u22120.62, 1.07]; <jats:italic>b<\/jats:italic>\u2009=\u20090.06, SE\u2009=\u20090.46, CI [\u22120.84, 0.97]), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Targeting mindfulness, coping, and optimism in psychosocial interventions may be a promising way to improve the lives of adults with NF.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jclp.23623","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T23:58:02Z","timestamp":1701129482000},"page":"456-470","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Mindfulness, coping, and optimism as mechanisms of change in the 3RP\u2010NF intervention"],"prefix":"10.1002","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3229-5504","authenticated-orcid":false,"given":"Victoria A.","family":"Grunberg","sequence":"first","affiliation":[{"name":"Center for Health Outcomes and Interdisciplinary Research Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Harvard Medical School Boston Massachusetts USA"},{"name":"Division of Newborn Medicine MassGeneral for Children Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jafar","family":"Bakhshaie","sequence":"additional","affiliation":[{"name":"Center for Health Outcomes and Interdisciplinary Research Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heena","family":"Manglani","sequence":"additional","affiliation":[{"name":"Center for Health Outcomes and Interdisciplinary Research Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Hooker","sequence":"additional","affiliation":[{"name":"Center for Health Outcomes and Interdisciplinary Research Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A.","family":"Rochon","sequence":"additional","affiliation":[{"name":"Center for Health Outcomes and Interdisciplinary Research Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana\u2010Maria","family":"Vranceanu","sequence":"additional","affiliation":[{"name":"Center for Health Outcomes and Interdisciplinary Research Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,11,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/17437199.2020.1716383"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60259-2"},{"key":"e_1_2_10_4_1","unstructured":"Carver C. 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