Clinical Applications - Are there any?

Overview

- Positive Psychology Interventions
- Well-Being Therapy
- Interventions derived from mindfulness meditation

Positive Psychology Interventions (PPIs)

Table 1: PPIs covered in this section include:

Signature Strengths – Increase general well-being and life-satisfaction

Patients are asked to consider their various strengths and try to identify the top five in their repertoire using the Values in Action Inventory of Strengths (VIA-IS), which identifies 24 strengths that can be divided into six core traits (see Farmer, 2011) for the complete explanation of each strength):Wisdom; Courage; Humanity; Justice; Temperance; Transcendence.

As such, patients can learn which strengths work in specific situations and learn to better incorporate them into their daily lives, both creatively and industriously, improving daily functioning. This intervention could teach individuals to associate the usual stress of daily tasks with their strengths allowing them to feel a sense of control and agency. Over time, stress might become connected with these feelings of agency, which is assumed to be a key determinant of physiological toughness.

Three Blessings/Good Things – Increases happiness levels and well-being

The patient should write down three things that have gone well each day and why, in the evening for a week.

It's easy to ruminate on the things that didn't go well; we are usually much more unpracticed at remembering the good things and savoring them. Therefore, taking the time to think about what has gone well, shifts our cognitions from negative to positive.

Writing a positive obituary – Promotes positive emotions

The newly developed Broad Minded Affective Coping (BMAC) technique (Tarrier, 2010a) is designed to promote positive emotions through the recall of positive autobiographical memories, as happiness and hope expand thought-action repertoires and support the building of resources and resilience to a variety of psychological disorders.

Gratitude – Increases happiness levels

This exercise involves the patient thinking of someone to whom they are very grateful but have never properly thanked. They are directed to write a letter describing their gratitude and are urged to give it to the person. This is because when we are grateful for what is good in our lives, we appreciate them more.

Empirical Results for these PPIs

Using PPIs in group therapy

Other Interventions: Well-Being Therapy

Interventions using mindfulness developed from meditation

These interventions are different from PPIs as they are derived from the mindfulness component of meditiation.

Meta-analysis

However, both of these studies combined PPIs with CBT-thus, how can one be confident that the beneficial gains were the result of the PPIs and not of the CBT which is a more traditional and well-established intervention (Fava et al., 2005; Zautra, Davis, Reich, et al., 2008). In order to substantiate and ascertain the significance of PPIs when applied to clinical populations, studies have to be carried out where PPIs are compared against other types of interventions such as psychoanalysis, CBT, and medication.

A meta-analysis showed that the positive-psychology interventions are less effective when compared against the control groups than when compared to the no-treatment groups, which suggests that part of the effectiveness of the interventions is due to demand effects or the general therapeutic expectations of taking part in any intervention (Wampold, 2007).

Whilst the studies discussed above provide evidence of successful clinical application of PPIs in a variety of cases, Sin et al.’s (2009) meta-analysis provides an excellent quantitative picture of how effective PPIs have been in enhancing well-being and alleviating depressive symptoms, compared with traditional interventions.

Results: Essentially the study showed that PPIs were more successful than control interventions both in alleviating depressive symptoms and in enhancing well-being. Furthermore, clinical populations experienced a larger effect size than non-clinical populations, which goes some way to dispelling the notion that PPIs are more suited to non-clinical populations.

It was noted, however, that the efficacy of PPIs was reduced in patients who scored low on motivation and so one way to maximise the gains of PPIs would be for the therapist to work on increasing the client’s motivation to be treated this way, prior to the beginning of therapy.

General conclusion of the effectiveness of Positive Psychology Interventions in clinical populations

See Table 2 for a Summary of the different Positive Psychology Interventions.

Overall, the empirical evidence seems to support the usefulness of PPIs. However, is it important to remember that the field of positive psychology is at a rather immature stage in its development and thus not many long-term follow-up studies have been carried out.

Although there is supportive empirical evidence, many studies can be criticised on the grounds of methodological issues - the empirical nature of the field can be enhanced if the subjective self-report measures of happiness are replaced by neuropsychological, behavioural and experimental measures, which are more objective and indisputable.

From the studies described above it is evident that PPIs have been applied in a variety of clinical settings and, in at least some cases their efficacy matches or exceeds that of the traditional interventions. Given such findings Woods and Tarrier (2010) recommend that Positive Psychology is integrated into mainstream clinical psychology so that clinicians have a wider range of intervention techniques to offer patients. Further rigorous evaluation of PPIs should be carried out, but initial findings suggest that such treatments have strong potential for clinical application.

Table 2: Summary of the Interventions