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“A cheerful heart is good medicine”, Proverbs 17.22




Seligman believed that positive psychology was not only for thoseseeking to improve an already generally happy state but that it could be used for those seeking clinical benefits. Click

to a video on the topic.







Positive Psychology for Clinical Benefits


History of Positive Psychology

Positive Psychology For Clinical Predictions

- depression

- self harm and suicidal thinking

Positive Psychotherapy for Depression

Positive Psychology Exercises for Depression

Wild Uncritical Claims

Cultural Information



The field of psychology was first proposed as a discipline to try and combat the great unbalance in psychological research. While a lot was being discovered about mental illness far less was known about mental health, wellbeing and happiness. A vast body of research focused on depression, anxiety, trauma and how to correct these, yet far less was being devoted to studying and understanding the majority of human beings who were not affected by these things. Therefore positive psychology began as a discipline to try and gain knowledge of what is necessary for a fulfilled, happy and optimum life. There is an illusion within psychology that the creation of this field was a rebellion, betrayal or revolution against psychology and its massive clinical influence. However, when we look at the explanations from the key players in positive psychology this does not appear to be the case.

"We see Positive Psychology as a mere change in focus for psychology, from the study of some of the worst things in life to the study of what makes life worth living. We do not see Positive Psychology as a replacement for what has gone before, but just as a supplement and extension of it." Seligman (2002)

So, rather than turning its back on mainstream psychology, positive psychology's aim is to try and develop and add to the existing knowledge, albeit from a different perspective. Whether this is a good move or not is often debated.

None the less, when we look at the consistent attention given to well-being and how to achieve it throughout culture and history its importance soon becomes apparent. Buddhism acknowledges that all human beings (and animals) wish for happiness and not to suffer- thus the purpose of their lives is to avoid suffering, and maximise happiness. Most religions have something to say about the value of gratitude, humility and self-fulfilment whether it is for yourself, creating it for others, or being rewarded with it eternally. Similarly philosophers have been debating from the earliest times on which factors make life meaningful.

This pervasive interest in the pursuit of happiness, wellbeing and the good life truly does validate the aims and existence of positive psychology. It is fair to say that everyone - including the mentally ill - has an interest in creating and experiencing these attributes.

This article seeks to highlight the ways in which positive psychology ideas and results can benefit the clinical field both in diagnosing and treating mental illness. By focusing on what creates and maintains a fulfilled and optimal life we can gain a much more comprehensive idea of the aetiology, prevention and treatment of mental illness.

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History of Positive Psychology

Although positive psychology as a field of psychology has established primal over the last twenty years its roots go back to the earliest times of human history. Within living memory the „good life“ has been the subject of philosophical and religious inquiry. Regarding the three great world philosophies of China, South Asia (mostly India) and the West you find many ideas about how to behave to make the lives of all people more productive and fulfilling as well as about identifying and nurturing high talent (see Cultural Connections).

Those missions were also part of the field of psychology over the eighteenth and nineteenth centuries in all of the great psychological traditions—psychoanalysis, behaviourism, cognitive therapy, humanistic psychology, and existential psychology. There is to name the influence of Freud's (1933/1977) notion of the pleasure principle, Jung's (1955) ideas about personal and spiritual wholeness, Adler's (1979) conceptualization of “healthy” individual strivings as motivated by social interest, and Frankl’s (1984) work on finding meaning under the most dire human circumstances. The early focus on positive psychology in particular is exemplified by work such as Terman's studies of giftedness (Terman, 1939) and marital happiness (Terman, Buttenwieser, Ferguson, Johnson, & Wilson, 1938), Watson's writings on effective parenting (Watson, 1928), and Jung' s work concerning the search for and discovery of meaning in life (Jung, 1933).

After World War II Psychology´s empirical locus shifted to assessing and curing mental illness. Two events contributed to this change: The foundation of the Veterans Administration (now Veterans Affairs) in 1946 and the one of the National Institute of Mental Health in 1947. From these points on practitioners engaged in treating mental illnesses and research concentrated on psychological disorders.

A decade later, the academic humanist psychology movement heralded by Abraham Maslow, Carl Rogers, Henry Murray, Gordon Allport, and Rollo May promised to add a new perspective to the entrenched clinical and behaviourist approaches. They dealt with the same questions positive psychologists pose. Humanist psychology had a strong effect on the field however did not attract much of a empirical base. Positive psychology is distinguished from humanistic psychology of the 1960s and 1970s and from the positive thinking movement through its reliance on empirical research.

Positive psychology aims to broaden the focus of the field of psychology in recent years. They don´t want to abandon a psychology that deals with human problems but to supplement to the traditional “fix-what’s-wrong” approach the “ the build-what’s-strong” approach .

What also foregrounds this approach is the issue of prevention which became more and more important during the last years, and in line with this was the presidental theme of the 1998 American Psychological Association convention in San Francisco. Psychologists recognized that the disease model doesn´t move psychology closer to the prevention of serious problems however a perspective focused on building competency does.

Altogether the contribution of positive psychology over the last years has been to campaign for positive emotion or well-being or good character as worthy of mainstream scientific investigation, to bring them to the attention of various foundations and funding agencies, to help raise money for their study, and perhaps to provide an overarching conceptual structure.

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Positive Psychology for Clinical Predictions

It is believed that positive psychology is not only useful for maintaining or improving happiness but that is also has a predictive value in relation to diagnosis.

Below are two example where positivity has a predictive value.

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Positive Psychology For Clinical Predictions-Depression

The authors begin by making a distinction between subjective well-being (SWB) and psychological well-being (PWB). Subjective Well Being involves an individual's subjective evaluation of their life. This includes high positive affect, low negative affect, and high satisfaction with life. Psychological well being involves the way the individual interacts with the world, including self-acceptance, autonomy, purpose in life, positive relationships with others, environmental mastery, and personal growth.

Recent research has shown that SWB and PWB load on separate factors in a factor analysis (Keyes et al 2002) showing that they are distinct from one another, i.e., SWB (positive affect, often feeling happy) does not necessarily lead to PWB (positive relationships and personal growth).

Recently, PWB has been implicated in treatment of depression (Fava 1998,1999) However it has not been used as a predictor or in preventative measures. This dissociation leads Wood and Joseph to believe that PWB could be used as an additional or alternative predictor of who is likely to develop depression. They also want to know whether low PWB is a consequence of depression or whether it is an actual cause of depression.

This study was longitudinal. In 1992–1993, 6875 people (aging population ages 51-56) completed several detailed questionaires including

Centre for Epidemiologic Studies Depression (CES-D)-a measure to identify depression

18-item version of the Scales of Psychological Well-being which provides an overall PWB score, as well as six sub-scales comprising self-acceptance, autonomy, purpose in life, positive relationships with others, environmental mastery, and personal growth.

Demographic and economic information were also collected including: sex, marriage status, years of education, economic status (household assets, combined personal and partner income, home ownership, vehicle ownership), current employment or retirement status.

Personality was measured via the Big 5 personality questionnaire. A health questionnaire was used to see whether the participants had any serious health problems. Participants were contacted 10 years later (at ages 61-65) and 5778 responded again. Logistic regressions were performed on the data.

Logistic regression is used for making a prediction of the probability of occurrence of an event (such as developing depression). Regression analysis determines the relationship between the independent variable (depressed/not depressed) and many dependent variables. From the strength of the all these relationships it determines which dependent variable is the best predictor. It displays its results as an odds ratio, for example someone who is high in neuroticism is 1.6 times more likely to be depressed than someone whose low in neuroticism. Regression also allows you to mark out variables as covariates (possible confounding variables) Wood and Joseph picked out medical, demographic and economic factors as co-variates due to their know links to depression. Presence of depression 10 years ago was also included as a co-variate.


Low PWB in 1992 was found to be the best predictor of developing depression 10 years later, in all the regression analyses performed. Having depression in 1992 came second. When they didn’t control for confounding variables people with low PBW in 1992 were 7.16 times more likely to be depressed 10 years later. Even when PWB was slightly impaired in 1993 subjects were still 2.3 times more likely to be depressed.

When the covariates were included low PWB in 1992 meant depression was 2.23 times more likely after 10 years. Slightly impaired PWB meant 1.5 times more likely.

To sumarise: this study shows that the absence of PWB strongly predicts depression, even after controlling for the presence of neuroticism, medical conditions, and economic status. It was also notable that PWB predicted depression above the personality trait of agreeableness. As agreeableness is associated with positive affect this again highlights the superiority of PWB as a predictor of depression over SWB.

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Positive Psychology For Clinical Predictions - Self Harm and Suicidal Thinking

“A comparison of specific positive future expectancies and global hopelessness as predictors of suicidal ideation in a prospective study of repeat self-harmers.” O’Conner, Fraser, Whyte, MacHale?, Masterton (2008)

The aim of this study was to investigate which construct best predicts suicidal ideation, ‘specific positive expectancies’ or ‘global hopelessness attitudes’. Global hopelessness is characterised as a pessimistic outlook regarding the future. It has been identified consistently in research as a reliable predictor for suicidal behaviour. Researchers refined this idea by asking whether it was the lack of hope for the future, or the presence of negative expectations which was the most important element of global hopelessness. The findings showed that it was the lack of positive expectation that was the determining factor. The Cry of Pain model (Williams et al 2001) proposes that suicidal intent is a reaction to feeling trapped in a hopeless situation, an attempt to escape. Lack of hope for the future enhances feeling trapped, whereas those who have some positive affect for their futures as well as negative may feel less claustrophobic in the present moment.


144 repeating self-harm patients (who had suicidal intent), within one day of attempting a self-harm act, completed clinical and psychological measures. Follow-up was tested at approximately 2.5 months. Participants were excluded if they had self-harmed only once, if they had no suicidal intent, or were psychotic.


Future Thinking Task (FTT)

Suicide Probability Scale (SPS) – suicidal ideation subscale, at T1 and T2

Beck Hopelessness Scale (BHS)

Beck’s Suicidal Intent Scale (BSIS)

Hospital Anxiety and Depression Scale (HADS)


Suicidal thinking at both testing times was positively correlated with depression, anxiety, and hopelessness. Baseline hopelessness was found to negatively correlate with positive future thinking, but was unrelated to negative future thinking. Positive future thinking negative correlated with suicidal thinking at time two, and with hopelessness and depression.

Positive future thinking was found to be a more accurate method of predicting suicidal intention at follow-up, regardless of age, sex, baseline mood, and suicidal ideation, in comparison to global hopelessness. Negative future thinking did not have a significant effect alone. These findings support the Cry of Pain Model.


The data suggests that positive future expectancies mediate suicidal intention. If this is the case, this knowledge could be used to develop a cognitive-behavioural intervention for self-harmers, for example, an exercise which focuses the patient’s mind on positive aspects of the future. O’Connor et. al. also draw attention to autobiographical memory bias. These researchers believe that by addressing negative bias in autobiographic memory, changes in positive future thinking may be induced. Perhaps most importantly, the measure of positive cognitions (or the lack of them) may be incredibly important in accurately predicting self-harm behaviours, in addition to the measure of negative cognitions.

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Positive Psychotherapy for Depression

STUDY 3: Positive Psychology Exercises for Depression“Positive Psychotherapy”, Seligman, Rashid, and Parks (2006)

At present, there is a lack of experimental studies of positive psychology interventions used with clinical populations in the literature. However, this study conducted by Seligman et. al. (2006) compares the efficacy of positive psychotherapy (designed by Seligman et. al.) with a more generic form of psychotherapy, and generic psychotherapy plus medication, for people with severe depression.

Positive Psychotherapy (PPT) N=11

PPT attempts to balance the focus on positive and negative aspects of the client’s thought processes and behaviours. Seligman et. al. elected to retain some focus on ‘negative’ issues, as they believed that clients expect this of psychotherapy, and a lack of this would compromise the client’s faith in the integrity of the therapy. However, the researchers hoped that complementing this more traditional style with a ‘positive psychology’ attitude would cement the therapist-client relationship in a way which would deter clients from dropping out of the study. In PPT the therapist is meant to act more as a witness to the client’s positive traits rather than an authoritative figure who draws attention to flaws in their cognitions or behaviours. PPT treatment was custom-tailored to the individual needs of each client, and the homework exercises (and the order in which they were handed out) were selected with these factors in mind. All clients in this treatment condition had the same therapist.

The (general) course of PPT

1. The therapist asks the client to introduce him/herself by telling a story from their life which shows them in a positive light, to provide a positive basis for the therapeutic relationship.

2. Clients identify their ‘signature strengths’. The therapist coaches the client, to help them find ways of utilising their strengths in their day-to-day lives.

3. Setting goals to use and enhance signature strengths using exercises.

4. The therapist coaches the client in re-education of attention and memory, focusing on the positive, in an attempt to redress the balance (counter-acting their depressive tendencies).

Treatment As Usual (TAU) N=9

An ‘integrative and eclectic approach’ was taken with the psychotherapy administered to this group of clients. There were several different therapists for the TAU condition. Therapists provided whatever treatment they deemed appropriate for the individual client. Type of treatment varied across the client base.

Treatment As Usual Plus Medication (TAUMED) N=12

Participants were independently sourced for this condition, as random allocation to a pharmacotherapy treatment would be unethical. This group received psychotherapy (similar to the TAU group), alongside antidepressant medication.


Clients in all groups completed the following measures before and after 10-12 weeks of therapy/therapy and medication:

  • Zung Self-Rating Scale (ZSRS)
  • Hamilton Rating Scale of Depression (HRSD)
  • Global Assessment of Functioning (GAF)
  • Outcomes Questionnaire (OQ)
  • Positive Psychotherapy Inventory (PPTI)
  • Satisfaction With Life Scale (SWLS)


The findings showed that PPT group showed significant improvement compared to TAU group on the HRSD, GAD, and PPTI measures. PPT showed significant improvement on the TAUMED group on the ZSRS, OQ and PPTI measures. There were no differences between groups on the SWLS. ‘Remission’ was defined by Seligman et. al. as a combination of the ZSRS score (less than 50), HRSD score (less than 7), a minimum of a 15-point difference between pre- and post-treatment fall in OQ score (post-treatment score less than 63), and GAF (less than or equal to ). 7/11 PPT participants, 1/9 TAU participants, and 1/12 TAUMED met this criteria; the PPT group had a larger remission rate, and seemed to show more improvement on the various scales than TAU and TAUMED clients. PPT was deemed to be a more successful therapy for individuals who qualify for Major Depressive Disorder (DSM-IV).


The findings of this study are limited because of the relatively small numbers of clients in each group. The fact that these clients were actively seeking treatment for their depression means that they were all motivated to improve their condition. This may compromise any inferences about low drop-out rates. The fact that the clients were given details of the PPT and TAU conditions before they were assigned to groups may have compromised the integrity of the separate therapies. Most clinically depressed people have co-morbid disorders – further study of the efficacy of positive interventions for people with more than one disorder may be useful. In addition the results be more applicable to the wider clinical population. Overall, however, as preliminary data, this study indicates that positive interventions may be particularly helpful in the treatment of clinical depression. Also the PPT group all had the same therapist, however those in the TAU and TAUMED group had different therapists.

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Positive psychology exercises for depression.

Another study by Seligman et al (2005) has shown the effectiveness of positive psychology exercises in aiding depression and increasing happiness over the long term, even when these exercises are only performed for a week. Participants completed positive psychology exercises and were followed for 6 months to see the effects. This study was conducted over the internet and its participants were registered members of Seligman’s website Participants who signed up to participate answered a series of demographic questions and then answered two questionnaires; one measured levels of depression (The Centre for Epidemiological Studies-Depression questionnaire), the other questionnaire was designed to measure happiness. The happiness questionnaire was devised specifically by the researchers as they believed that existing happiness scales did not cover the full three forms of happiness as they defined it (positive emotion, engagement and meaning). Their questionnaire contained items measuring each of these qualities and contained 20 items. Each item had 5 statements and participants had to answer with which statement they felt applied most to them. For example:

Most of the time I am bored (1)

Most of the time I am neither bored not interested in what I am doing (2)

Most of the time I am interested in what I am doing (3)

Most of the time I am quite interested in what I am doing (4)

Most of the time I am fascinated by what I am doing (5)

Despite the moving away from the format and content of traditional happiness questionnaires, participants scores of this new happiness scale correlated well (r=0.79) with scores on existing happiness questionnaires. This shows that the questionnaire is as reliable a measure of happiness as any other.

After completing these questionnaires, participants were then randomly assigned one of 6 exercises- 5 genuine positive interventions and 1 control exercise. Instructions of how to complete these exercises were emailed to the participant. They were sent 2 reminder emails throughout the week repeating the instructions for their exercise. In addition they were sent emails asking them to complete the happiness and depression questionnaires at follow up periods of 1 week, 1 month, 3 months and 6 months.

Subjects were not required to continue doing the exercise after one week.

The exercises were:

Placebo control exercise : Participants wrote about their early memories every night for 1 week.

Gratitude visit: Participants were given one week to write and deliver a letter expressing their gratitude to a person they felt had especially helped them but had never properly been thanked.

Three good things in life: Every night participants wrote down three things that had gone well over the course of the day. They were asked to think of what caused these things to go well.

You at your best: Participants wrote about a time when they were at their best. They re-read this story every night and reflected on the personal strengths that it highlighted.

Identifying signature strengths: Participants took the inventory of character strengths on the website and received information on their top 5 strengths. They were then told to use these strengths more often in the following week.

Using signature strengths in a new way: Again participants took the strengths questionnaire. They were told to use one of these strengths in a “new and different way” every day for a week.

Results indicate that two of the exercises increased happiness scores and decreased depression scores over the 6-month period. These were the Using signature strengths in a new way exercise and Three good things. In addition the Gratitude visit caused a large increase in happiness for one month then a return to baseline. The placebo, you at your best and Identifying signature strengths had a positive influence on happiness and depression but these effects were transient.

Although participants were explicitly told to perform the exercise for only one week Seligman and others did make sure to ask at the follow ups whether they had been continuing it on their own. They did find that some subjects had indeed been doing the exercise regularly. When they factored this into their statistics they found that those who had been continuing the exercise were the happiest and also had the lowest level of depression symptoms in this sample.

The authors of this study believe their results are important for the future of these positive intervention exercises particularly as clinical interventions for treating depression. However, they do acknowledge and address several weaknesses of their method. As this study was conducted over the internet this raises concerns of how seriously the participants were taking the exercises and questionnaires, whether they were doing them properly and how much effort was put in. The experimenters had little control over these factors and no way of verifying this other than trust. Yet, they cite the study of Gosling, Vazire, Srivastava and John (2004) to address these concerns. This study compared survey data collected from internet based questionnaires to data collected through traditional means. Their results show that:

1) Internet data is just as diverse as data collected through traditional methods

2) Participants who volunteer and take internet-based questionnaires are no more psychologically disturbed than traditional participants

3) Participants in internet studies are no less likely to take the study seriously or provide accurate information than those in traditional samples.

On the basis of this they believe that their results are valid however they do concede that their sample may be biased as those joining generally want to be happier. Therefore these results cannot not be generalised to the general population. Yet this is less important when we consider that people who want to be happier and make changes in their lives are the very target of these interventions. Therefore the sample is biased but “in a relevant direction.” (Seligman 2005)

The Future of Positive Clinical Interventions

The authors also point out that in retrospect one week may not have been enough time for subjects to become familiar with the exercise and be skilled enough to use it properly. The participants identifying key strengths and thinking about how to use them, may have needed some extra time to reflect on this e.g. whether they agreed with the results, were they surprised by them, perhaps they may have not have previously recognised or valued some of these features as strengths. However, they believe that with the help of a therapist and the benefit of a safe and therapeutic relationship the effects from these exercises could be even more beneficial. In addition, in light of the fact that the gratitude visit had a large but temporary positive effect, they believe that a positive therapeutic package should include a mixture of long lasting interventions along with exercises that give an immediate boost. Seligman and others are also currently trying to examine through further research whether there is an optimum sequence for these effective interventions and whether there are certain personality types for which specific exercises take and others do not.

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Wild Uncritical Claims

On some levels it appear that positive psychology has been consumed by the self help movement who then use the empirical basis of positive psychology to make quite extraordinary claims.

One such claim is that thinking positively can help you to live longer. A study by Danner, Snowdon & Freisen (2001) states that people who report more positive emotions in early adulthood tend to live longer lives. This contrasts with another study (Pressman and Cohen 2005) that states that those who are very positive in younger life tend to have a decreased life span as they are more likely to take part in risky behaviours. It states that it is positivity in older life that contributes to longer lifespan.

One thing to be wary of is that some people have taken positive psychology to the extreme and have rejected other forms of intervention as unnecessary. Christian science ,which is influenced by a philosophical idealism, rejects all medical intervention with the belief that any illness can be cured through the mind

Positive psychology suggests that being positive is the ideal state in life but there are many situations where unbridled positivity would not be appropriate, such as an on duty policeman or a juror in a law trial (Fineman 2006).

Abraham Lincoln (Abrham Lincoln quotes) said that most people are as happy as they make up their minds to be, and from a common sense point of view this would indeed ring true, but this view ignores that fact that we all encounter events in life that have an impact on us that we cannot mitigate.

Positive Psychology is about increasing happiness but even people who follow this tradition do not believe that everyone can be made equally happy. Sonja Lyubomirsky states that 50% of happiness is genetically determined and 10% is determined by life circumstances so positive psychology should be concerned with the 40% that is open to influence.

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Cultural Connections

Positive psychology has a short history but a long past, much like psychology as a tradition its self. All of the great world philosophies of China, South Asia and the West posed the question how to reach well-being or good character whereat some focused more on individual positive emotions (like Buddhism or Hinduism) and others on a collective well-being (like Confucianism and Athenian). In the following some of them will be regarded more closely.

Confucius (551-479 B.C.E.), who built up one of the main indigenous traditions of China, gave many instructions for having a good life which people could gain through education and experience. He named several central virtues that makes a life worth living. For gaining e.g. the virtue of humanity (defined by "Love people", the Analects 12:22) you have to act humanly ("If you want to make a stand, help others to make a stand, and if you want to reach your goal, help others reach their goal. Consider yourself and treat others accordingly: this is the method of humanity", the Analects 6:29). Acting with humanity was instrumental to get the similar treatment from others and therefore being one step closer to the ideal manifestation of human nature. In line with this he defined other strengths which should lead to a happy life.

Buddhism, with its origins in South Asia, approaches the happy life the other way around. Buddha (563? - 483? B.C.E.) preaches that life is suffering. The cause of suffering is the human´s innate sin of craving which ceases only upon nirvana. The nirvana can just be achieved by following the Holy Eightfold Path which will be accomplished by perfection in one´s understanding, thinking, speech, action, livelihood, effort, mindfulness, and concentration (see M. Flower, 1999). There are several virtue catalogues that guide people the path to enlightenment. Either way in the end they all teaches people how to improve personally and to live a positive life.

Athenian philosophers like Socrates (469-399 B.C.E.), Plato (427-327 B.C.E.) or Aristotle (384-322 B.C.E.) were the first philosophers of the West who posed the the question „What is the good of a person?“. After examining character they enumerated several virtues as traits of character that make someone a good person i.e. courage, justice, temperance, wisdom and later also generosity, wit, friendliness, truthfulness, magnificence and greatness of soul. All of those strengths should lead people to be good humans and citizens and thus having a good life and building up the ideal human society.

Moral philosophy changed with the growing influence of Judeo-Christianity (and later Islam), which saw God as the giver of laws by which one should live. That shifted the focus of Western discourse on morality from that of inner character to observable actions. The guiding questions changed from "What is the good of a person?" to "What are the right things to do?". Within the Old Testament two sections especially deal with the rules of right conduct: the account of the ten Commandments as a list of "thou shalt's" and "thou shalt not's" received by Moses in Exodus and two books of Proverbs that specifically instruct on the consequences of virtual and vices. The Commandments forbid polytheism, idolatry, taking God´s name in vain, murder, adultery, theft, lying, and covetousness, while commanding that the Sabbath be kept holy, and parents honoured (Exodus 20:1-17, Revised Standard Version). Books II (10:1-22:16) and IV (25:1-29:27) of Proverbs are attributed to Solomon and deal specifically with recommendations for virtuous behaviour (like integrity, trustworthiness, love, hope, knowledge) as well as prohibitions against vice. In Summary both the ten Commandments and the verses of Proverbs give instructions how to live a good live.

Another piece of evidence for the long past of the field of positive psychology, which stems from the Greek mythology, is the story of Pandora's Box. In this story it is told that the Greek gods made a women from the earth and entrusted her with a box that contained all of the plagues that we now suffer. Knowing that she would not be able to resist opening the box hope was also there as a remedy to the plagues. In so doing Zeus gave the people something good for negotiating their sorrow. Similarly positive psychology in clinical application aims to overcome human distress by building competencies.

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Abraham Lincoln Quotes Last accessed 28/10/10

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