Positive Psychology Interventions: Research Evidence, Practical Utility, and Future Steps


*Gratitude visit – 1 week to write a letter to someone who had been kind to them and then to deliver the letter

*Three good things in life – every night for a week, write down three things that went well that day and to provide a causal explanation for each

*You at your best – write about a time when they were at their best and to reflect on the personal strengths displayed in the story. Reflect on the story every day for a week

*Using signature strengths in a new way – identify their strengths and select one of the top 5 strengths to use in new ways every day for a week

*Identifying signature strengths – to take the survey and note their five highest strengths

*Placebo (early memories) – write about early memories every night for a week


Copied from Seligman et al. (2005)



Research by Seligman et al. (2006) provided additional support for the ability of PPIs to reduce depression by increasing positive emotion, engagement, and meaning as opposed to working directly on depressive symptoms. This research involved two studies, the first focusing on a group of individuals with mild to moderate symptoms of depression as measured by the BDI-II and the second study focusing on a group of individuals with unipolar depression who were seeking treatment at a psychology service provider (and needed to meet the inclusion criteria of having a major depressive disorder). The first study involved 40 students who were randomly assigned to either the positive psychotherapy (PPT) intervention or to a no treatment condition. The PPT intervention involved 2 h per week for 6 weeks of a group-based intervention program (two groups of 8–11 participants) and included activities such as using signature strengths, three blessings, writing an obituary, a gratitude visit, active-constructive responding, and savoring. See Table 15.2 for a description of these activities.


Table 15.2
Descriptions of interventions from Seligman et al.’s (2006) study




























Session
Description

1
Using your strengths: Take the VIA (values in action) strengths questionnaire to assess your top 5 strengths and think of ways to use those strengths more in your daily life

2
Three good things/blessings: Each evening, write down three good things that happened and why you think they happened

3
Obituary/biography: Imagine that you have passed away after living a fruitful and satisfying life. What would you want your obituary to say? Write a 1–2-page essay summarizing what you would like to be remembered for the most

4
Gratitude visit: Think of someone to whom you are very grateful, but who you have never properly thanked. Compose a letter to them describing your gratitude and read the letter to that person by phone or in person

5
Active/constructive responding: An active-constructive response is one where you react in a visibly positive and enthusiastic way to good news from someone else. At least once a day, respond actively and constructively to someone you know

6
Savoring: Once a day, take the time to enjoy something that you usually hurry through (e.g., eating a meal, taking a shower, walking to class). When it is over, write down what you did, how you did it differently, and how it felt compared to when you rush through it

After 1 year, the PPT group moved to the nondepressed range, whereas the control group stayed in the mild to moderate range. Satisfaction with life also increased for the PPT group; however, the control group also reported increases. In the second study involving 46 clients with unipolar depression, the PPT entailed 14 sessions addressing clients’ immediate clinical needs and included homework exercises (selected to suit the participant’s specific needs from a pool of 14 exercises). This intervention was compared with a treatment as usual and a treatment as usual plus medication group. Relative to the comparison groups, PPT participants experienced decreased depression and higher remission rates (i.e., absence of depressive symptoms), once again supporting the efficacy of PPT.

Numerous other intervention studies focusing on specific PPIs, such as forgiveness (Reed and Enright 2006), kindness (Otake et al. 2006), and gratitude (Sergeant and Mongrain 2011), have also been undertaken, with many showing favorable outcomes (such as increased hope, positive affect, satisfaction with life, and decreased depression). Emmons and McCullough (2003) examined the effects of a gratitude intervention on well-being over a series of three studies, with participants ranging from students to individuals with neuromuscular disease. Participants were randomly assigned to either the hassles, gratitude, or placebo control group (life events or social comparison). They were instructed to complete their assigned activity either daily or weekly for 2 or 3 weeks (this varied across the three studies). Refer to Table 15.3 for specific instructions. Participants reported their mood states, coping behaviors, health behaviors, physical symptoms, and global life appraisal pre- and post-intervention. In comparison to the placebo control groups, participants who were in the gratitude condition reported improved well-being (e.g., more optimistic appraisals of life, increased level of exercise, decreased reporting of physical symptoms, and increased positive affect). However, not all findings were consistent across the three studies, and not all the outcome variables included in the study demonstrated improvements. Others have also questioned the use of comparison groups which induce negative affect, such as the daily hassle condition (Froh et al. 2009).


Table 15.3
Descriptions of interventions from Emmons and McCullough’s (2003) study






















Condition
Instructions

Gratitude
There are many things in our lives, both large and small, that we might be grateful about. Think back over the past week and write down on the lines below up to five things in your life that you are grateful or thankful for (Emmons and McCullough 2003, p. 379)

Hassles
Hassles are irritants—things that annoy or bother you. They occur in various domains of life, including relationships, work, school, housing, finances, health, and so forth. Think back over today and, on the lines below, list up to five hassles that occurred in your life (Emmons and McCullough 2003, p. 379)

Life events
What were some of the events or circumstances that affected you in the past week? Think back over the past week and write down on the lines below the five events that had an impact on you (Emmons and McCullough 2003, p. 379)

Social comparison (downward)
It is human nature to compare ourselves to others. We may be better off than others in some ways and less fortunate than other people in other ways. Think about ways in which you are better off than others, things that you have that they do not have, and write these down in the spaces below (Emmons and McCullough 2003, p. 381)

Cheavens et al. (2006) designed a hope intervention involving 8 × 2-h group ­sessions. The hope intervention covered aspects such as setting realistic and meaningful goals, developing various pathways for achieving these goals, identifying motivational sources and counteracting motivational challenges, monitoring goal progress, and modifying goals and pathways, as required. Homework tasks were also assigned to intervention group participants. Examples of goals selected by study participants included exercising more often, working on interpersonal relationships, and changing jobs. Participants comprised 32 members from the community who were randomly assigned to either the hope condition or a wait-list control condition. Improvements from pre- to post-intervention and relative to the wait-list control group were found for agency hope (but not pathways hope), ­anxiety, self-esteem, and purpose in life.

Sin and Lyubomirksy’s (2009) meta-analysis provides an efficient overview of the efficacy of 51 different positive psychology interventions (N  =  4,266), including forgiveness (Freedman and Enright 1986; Reed and Enright 2006), positive writing (King 2001), and well-being therapy (Fava et al. 1998). Essentially, this meta-analysis found that PPIs are effective in increasing well-being and decreasing depression, with effect sizes of .29 and .31, respectively. While these results generally support the use of PPIs, at best, these effect sizes are moderate and should not be overestimated. Consequently, gaining insight into methods for improving the efficacy of PPIs is an important next step and will now be explored.



Which Positive Psychology Interventions Work, and for Whom?


With an increasing focus on evidence-based practice, cost-effectiveness, efficient distribution of limited resources, and treatment success, gaining an understanding of the underlying mechanisms behind PPIs—and not just the main effects on well-being—is imperative. This means that at least two fundamental criteria need to be met. First, that there is sound research (including RCTs and meta-analyses) supporting the efficacy of PPIs, and second, that there is sufficient ecological validity demonstrating that PPIs possess real world applicability for a variety of people and outcomes, as intended. Hence, the circumstances under which the interventions are beneficial need to be elucidated. This will enable the selection of appropriate interventions to suit individual needs while concurrently accommodating contextual factors. For example, there is little point in recommending online interventions to individuals who do not have computer access or who are not sufficiently skilled to use a computer.

Lyubomirsky (2008) refers to person-activity fit as being important for the selection of PPIs or volitional activities. Person-activity fit is believed to occur when the activity feels natural, enjoyable, and valuable. Ideally, the requirements (or nature) of the activity should align with the skill set, interests, needs, disposition, values, and personal resources of the individual. In addition, the context (or environmental) conditions should also fit the task at hand, in terms of time demands, special ­equipment, and level of support from significant others.

Research examining the direct effects of an intervention on well-being without considering any potential moderating or mediating factors, while important in the initial stages of determining the broad effects of an intervention, has limitations from a long-term perspective. Although not always consistent, evidence—including RCTs and meta-analyses supporting the efficacy of PPIs—is steadily accumulating, and thus more attention is being directed to understanding interaction effects. As a starting point, Sin and Lyubomirsky (2009), in their meta-analysis, examined interaction effects and found that higher levels of depression, increased age, one-on-one interventions (in contrast to group administration), and interventions of longer duration, heighten the efficacy of PPIs. This information provides some direction for exploring mediating and moderating factors. These types of factors can be divided into three broad categories: (1) participant characteristics, (2) nature of intervention, and (3) contextual factors.


Participant Characteristics


Numerous individual difference factors are plausible mediators or moderators of the efficacy of PPIs. An endless range of state and dispositional factors may be relevant, but some of the most obvious ones include personality, motivation levels, mental health status, character strengths, and sociodemographic factors. Some of these will now be discussed.


Motivation


Sheldon and Lyubomirsky (2006) found that self-concordant motivation, which refers to a commitment to pursue goals that are interesting and align with one’s core values, moderates the efficacy of PPIs. Study participants were assigned to either the counting blessings (CB), visualizing best possible selves (BPS), or life events (placebo control) condition. Descriptions of the counting blessings (gratitude) and life events activities were similar to those used in Emmons and McCullough’s (2003) study, as outlined in Table 15.2. BPS participants were asked to

[i]magine yourself in the future, after everything has gone as well as it possibly could. You have worked hard and succeeded at accomplishing all of your life goals. Think of this as the realization of your life dreams, and of your own best potentials. In all of these cases you are identifying the best possible way that things might turn out in your life, in order to help guide your decisions now. You may not have thought about yourself in this way before, but research suggests that doing so can have a strong positive effect on your mood and life satisfaction. So, we’d like to ask you to continue thinking in this way over the next few weeks, following up on the initial writing that you’re about to do. (p. 77)

Participants were asked to rate their level of engagement and motivation to continue with the assigned activity. They also reported on how often they did the assigned activity. Of the three groups, self-concordant motivation was found to be highest for the BPS group. Consistent with predictions that the intervention which aligned most closely with the participants’ interests and values would be the most effective in improving mood, the BPS participants reported greater increases in positive affect relative to the CB and life events participants. Interestingly, however, participants from all conditions, including life events, reported immediate decreases in negative affect. The most pertinent finding was that an individual’s motivational level to undertake an activity influenced the efficacy of the activity. Hence, the use of wait-list control groups would help balance out issues related to motivational factors and should be used where relevant and possible.


Wants Versus Needs


Schueller (2010) found that preference for undertaking a PPI is positively related to adherence to the activity. More recently, Schueller (2011) found no significant difference between participants assigned to activities based on preference compared to those who were randomly assigned an activity. It would seem, then, that determining person-activity fit based on preference is not always straightforward. Giannopoulos and Vella-Brodrick (2011) found that assigning individuals to an intervention which differed from, rather than matched, their dominant orientation to happiness (pleasure, engagement, and meaning) was most effective in enhancing well-being. In other words, participants with, for example, a high-pleasure orientation to happiness, who were assigned to either the three engaging or three meaningful things writing activity, rather than the three pleasurable things writing activity, reported greater well-being benefits. Similarly, Silberman (2007) found with 72 undergraduate psychology students that self-selection into four PPIs (three good things, you at your best, using signature strengths, and the gratitude visit) did not increase the benefits to be gained from undertaking the interventions. These study findings illuminate the situation, whereby activities may match needs but not preferences (wants), and raise the issue of which of these criteria should take precedence when determining person-activity fit. At present, there is insufficient evidence-based research to guide these decisions.


Positive Affect and Personality


Froh et al. (2009), in their study of 89 adolescents, explored positive affect as a moderator of the efficacy of the gratitude visit. As gratitude interventions have not shown consistent well-being benefits in comparison to control conditions, it was thought that the gratitude intervention may only benefit a subgroup of individuals with specific characteristics, such as low positive affect. It was predicted that those already high in positive affect may have experienced an emotional ceiling whereby additional emotional gains are unlikely. Hence, those lower in positive affect may have more scope to improve their positive emotions through the gratitude intervention. They found that adolescents low in positive affect in the gratitude condition reported higher levels of both gratitude and positive affect immediately after the intervention and positive affect at the 2-month follow-up, compared to adolescents in the daily event condition. Hence, positive affect did moderate the efficacy of the gratitude visit.

Personality is another participant characteristic that could influence how well PPIs work. Personality factors have received considerable research attention, with extroversion and emotional stability being particularly identified as strong correlates of well-being (See Diener et al. 1999). However, personality has seldom been examined as an individual difference factor potentially influencing the efficacy of specific PPIs. Yet, it is conceivable that personality may play a large role in determining what interventions will work for specific individuals. For example, do certain interventions, such as the gratitude visit, require high levels of extroversion or openness for them to be effective in enhancing well-being? One study, which has focused on the “depressive personality styles” of being self-critical and needy, found with 772 adults who were assigned to either a gratitude, music, or control exercise for 1 week that those in the gratitude and music conditions reported increased happiness over time in comparison to control participants (Sergeant and Mongrain 2011). Noteworthy in this study, however, is that self-critics reported the most favorable outcomes if they were assigned to a gratitude condition, whereas needy individuals did not benefit from the intervention and indeed decreased with regards to self-esteem. Clearly, the interactive role of personality in relation to PPIs is another area that warrants further investigation.


Mental Imagery


Given that many of the PPIs involve recalling situations (e.g., three good things) or imagining future events (e.g., BPS), there appears to be some reliance on mental imagery skills in the execution of these tasks. Mental imagery is defined as the occurrence of quasisensory or quasiperceptual experiences despite the absence of any real sensory stimuli (Richardson 1969). Mental imagery ability is evident when individuals can immerse themselves in and respond to the mental images, as if they were really occurring.

Researchers of PPIs are beginning to explore the role of mental imagery for increasing happiness and well-being. For example, Peters et al. (2010) examined whether a 15-min BPS condition followed by a further 5 min of mental imagery was more effective at increasing optimism than a control condition in which participants were asked to write about and imagine a typical day in their life. The BPS plus mental imagery condition was more effective at increasing optimism than the control condition. While it is not known whether mental imagery per se was the active ingredient of the PPI (particularly as there was no comparison group without the explicit mental imagery instructions), this finding is consistent with evidence that mental imagery activates emotional systems (more readily than verbal methods) and is therefore an effective tool for amplifying positive emotions (Holmes and Mathews 2010; Holmes et al. 2008).

Just as mental imagery training has been shown to enhance sporting performance (Martin et al. 1999), some competency with mental imagery may be helpful to participants when undertaking PPIs that involve the recall or reexperiencing of events and projecting into the future to imagine what life would be like. A study by Odou and Vella-Brodrick (2011) examined the influence of mental imagery prompts while undertaking the three good things and best possible self-interventions and found there was no difference in intervention efficacy for those with the mental imagery prompts compared to those without the prompts. However, mental imagery ability was positively correlated with well-being, suggesting that by improving mental imagery skills such as controllability and vividness, well-being may be enhanced (or well-being may improve mental imagery ability). Extending on this work, more targeted and controlled studies examining mental imagery ability as a possible moderator or mediator variable, rather than as a component of an intervention, are warranted.


Mindfulness


Mindfulness can be operationalized as both a trait and state and involves heightened awareness of, and attention to, stimuli as well as personal emotions, thoughts, and motives (Brown and Ryan 2003; Thomas 2006). Aspects of mindfulness also seem relevant to the successful undertaking of many PPIs. For example, high levels of awareness and attention are relevant to PPIs, such as savoring and three good things, as these interventions require individuals to be aware of positive events and experiences as they are occurring so that they can be recalled at a later point in time. Given that there are training programs to increase mindfulness (Kabat-Zinn 2003), determining which PPIs are optimized as a result of specific levels of mindfulness seems a worthwhile task. This means that individual’s mindfulness levels can be improved to suit the task, or PPIs can be selected to suit individuals based on whether or not they possess high levels of mindfulness. Higher levels of mindfulness practice have been associated with increased levels of positive affect and decreased levels of negative affect (Jha et al. 2010) and increased psychological well-being (Huppert and Johnson 2010). However, how mindfulness levels influence the efficacy of PPIs has not been the focus of research to date.


Socioeconomic Status and Demographics


Typically, research studies have relied on participants from high socioeconomic and westernized backgrounds. This middle class, white bias may impact significantly on the outcomes obtained on the efficacy of PPIs. It has been found that higher education and income levels are related to higher SWB (Cummins 2000). Hence, PPIs may not be as effective for individuals with lower levels of education and income or from different cultural backgrounds. Moreover, PPIs appear to be more effective for older people (Sin and Lyubomirsky 2009). These findings suggest that some ­consideration of the interaction effects of individuals’ socioeconomic status and demographic details is warranted when selecting PPIs, and greater effort is needed to recruit more diverse and representative samples in future research studies on PPIs so that more about the influence of individual difference and cultural factors on the efficacy of PPIs can be learned.

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Jun 29, 2017 | Posted by in PSYCHOLOGY | Comments Off on Positive Psychology Interventions: Research Evidence, Practical Utility, and Future Steps

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