Practical Exercises
Practical Exercises for the Reader
Exercise 1:
'Identify 3 Good things' exercise: Identify three good things that have happened during the day and write them down. E.g. That you stumbled across some flowers that reminded you that spring is just around the corner.
Exercise 2
Try to fill out the table on your own to make your own study ‘cheat sheet’ for an exam question on the use of Positive psychology to treat clinical populations.
| What kind of intervention is it? | What does it do? | Why it works | Evidence | Limitations | Compared to other interventions? | Improvements that can be made? |
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| Three blessings | |||||||
| Writing a positive obituary | |||||||
| Signature strengths | |||||||
| Gratitude | |||||||
| Best future self | |||||||
| Loving-kindness meditation | |||||||
| Mindfulness based stress reduction | |||||||
| Well-being therapy | |||||||
| Positive psychology couples therapy |
Exercise 3:
To prepare for the practical exam try to design an experiment which asses the use of any of the above interventions in a clinical population
Example: Design of experiment
| Intervention to be assessed | Well-being therapy Aimed at reducing relapse rates (important for well-being in clinical populations). |
| Clinical population | Obsessive Compulsive Disorder (OCD) |
| Assessed against | Cogntive Behavioural Therapy (CBT) Chosen as CBT has been shown to be effective in the treatment of all anxiety disorders. |
| Hypothesis | Both WBT and CBT will reduce residual symptoms in the patients, but only WBT will increase PWB scores after treatment. |
| Participants | 30 participants in each group (central limit theorem) Participants must meet the following criteria:
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Design |
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| Between subjects design | Patients will be randomly assigned to one of two treatment groups:
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| Measures | Residual symptoms measured by Ryff's (1989) Scales of Psychological Well-Being (PWB) (self-report). an 84-item inventory that covers six areas of well-being. Subjects respond with a six-point format ranging from strongly disagree to strongly agree. |
| Independent variable (IV) | Treatment type - 1 Factor 2 levels - (WBT & CBT) |
| Dependent variable (DV) | PWB score |
| Treatment | In both cases treatment will consist of eight 40 min sessions once every other week for 3-5 months. The same psychiatrist will be involved in both treatment groups. WBT patients will be asked to report only the episodes of well-being, rated on a 0-100 scale, in a diary. The initial 2 sessions will be concerned with identifying and setting into a situational context such episodes, not matter how short lived they were. After treatment, all patients will be assessed on the PWB by the same clinical psychologist who evaluated them on intake, but who did not take part in the treatment and was blind as to treatment assigned (double-blind study). Follow-up studies will be conducted at 3-, 6-, and 12-month intervals. |
| Statistics | A non-parametric method, the permutation test, adapted by Pesarin (1990), will be used to evaluate differences between groups. This test is analogue of two-tailed student's t test and parametric analysis of variance and covariance, without, however, being conditioned by normal distrubition hypotheses. The method is based on a simulation or resampling procedure, conditional on the data, which provides a simulated estimate of the permutation distribution of any statistic. It is particularly suitable for multi-dimensional (multivariate and/or multiparametric) cases, since it allows a combination procedure to control for multiple testing. |
| Implication of results | Assuming that the results demonstrate a decrease in residual symptoms in both treatments at the second assessment, but only a significant effect in increase of PWB well-being for WBT but not CBT then WBT can be used to to reduce residual symptoms in patients with anxiety disorders. It has been suggested that treatments that are effective in the acute phase of anxiety disorders may not be the most suitable for their residual stage or for preventive purposes (Fava, 1996). Modifications of current cognitive-behavioural strategies with WBT may target just such issues. |
| Validity, reliability, etc. | The PWB has been extensively validated in non-clinical populations (Ryff & Singer, 1996) and this study has ecological validity. |
| Limitations | Preliminary study. The characteristics of the simple are quite heterogeneous. Semi-naturalistic design, since patients were initially treated with the of different, even though standardised, methods. |
Exercise 4:
As a therapist, which of the intervention(s) would you pick to treat patient X? Justify your reasoning.
Case history:
A 16-year-old female presented with a 3-year diagnosis of Anorexia Nervosa. At age 13, the client began to diet because she was slightly overweight and dissatisfied with her body, immediately assuming hypo-caloric eating behavior ("Being thin makes me happy"). She has constant doubt about her intellectual ability, self-deprecating thoughts about her image, and a desire to die or leave school ("It is too late, it is very difficult"; "Therapy cannot help"; "I want to die"). she dwells on painful family and personal matters, past and present. she devotes 15 hrs daily to homework, and expects everything to be perfect. She receives constant criticism and no sign of affection from her parents.
Example: The author's choice and reasoning:
As PPIs have been found to be useful in combination with tradition treatments I would choose to use the Positive Psychotherapies (signature strengths, 3 blessings and best future self) along with CBT and Loving Kindness Meditation (LKM |
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3 blessings | Increases patient X’s general well-being and happiness by making her think of the positive events in her life rather than focusing on the negative aspects (e.g. “It is too late, it is very difficult” and “Therapy cannot help”). Can also help her to remove the focus from the personal and family matters that she spends so much time dwelling on, helping her to remember good time that they have spent together. |
Best future self | Increases her optimism, targeting her negative thoughts, such as “I want to die”. This exercise can allow her to understand that there is more to live for than her grades. Similarly, it should help her come to terms with her family situation and that things will not stay the same forever. By identifying coping strategies for future issues, she may learn how to identify ones that may be useful for dealing with current difficult situations. Importantly, this may also allow her to view herself in a future without the pathology (excess fear of weight gain), where her desire to die or leave school no longer exist and understand how the ‘future’ alternative is much more appealing than her current contemplations. |
Loving Kindness Meditation | Develop love and kind thoughts towards herself, targeting her self-doubt and body-image dissatisfaction as well as the irrational fear of gaining weight. This mindfulness component, central to all the ‘third wave therapies’, would not necessarily seek relaxation or a state of happiness in and of itself; rather, it allows a form of freedom, that is, of being able to act more comfortably in difficult situations. This is not as directly experienced in LKM as it is in e.g. MBSR so this should be taken into consideration when applying the interventions. As LKM also directs love and acceptance towards others and as such should increase positive emotions or at least tolerance towards her parents, despite their criticisms. |
Along this line of thought, these exercises and the Socratic dialogue around them, rather than being “a correct way of thinking,” are therapeutic activities that could enable the patient’s thinking to become more flexible, enabling her to focus on the content of her thoughts from the necessary objective distance, thereby reducing cognitive diffusion, as well as emphasising more positive cognitions. |
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