Positive Psychotherapy Slides created by Barbara A Cubic

Positive Psychotherapy Slides created by Barbara A. Cubic, Ph. D. Professor Eastern Virginia Medical School To accompany Current Psychotherapies 10

Learning Objectives n This presentation will focus on: • Overview of positive psychotherapy • History of positive psychology • Applications of positive psychotherapy • Empirical evidence supporting positive psychotherapy

BASIC CONCEPTS

Flourishing Traditional psychotherapies focus on the negatives. n Positive psychotherapy (PPT) is built on the principles of positive psychology. n Flourishing is a state characterized by positive emotions, a strong sense of personal meaning, good work, and positive relationships. n

Positive Psychotherapy (PPT) Name does not suggest other psychotherapies are negative. n PPT not intended to replace traditional therapeutic approaches. n PPT is an approach that seeks to balance the attention given to negative and positive life events in psychotherapy. n

PPT n PPT focuses on the reorientation to a build-what’s-strong model that supplements the traditional fix-what’s-wrong approach.

Comparing Positive Psychotherapy to Other Therapies

Comparing PPT to Other Approaches PPT Other Approaches • Believes clients care about much more than simply relief from their distress. • Wants to explore, express, and enhance their strengths. • Aim to address basic human deficiencies. • Focus on negative thoughts, feelings, and behavior.

Psychoanalytic View n n n Arthur Schopenhauer and Sigmund Freud felt the best humans could ever achieve was minimizing their own misery. Freud posited that negatives were an indispensable element of human existence. Assumed defenses built to repress these conflicts and manage the unbearable anxiety they cause.

Psychotherapy Has Hit a Dead End

65% Barrier n Treatment of depression • CBT and Pharmacotherapy both hit a ceiling at 65%. – Placebo may account for 45 -55% of this effect. – More valid and realistic the placebo, the greater the placebo response.

Why a 65% Barrier? Behavioral change is difficult. n People lack motivation, have comorbid issues, or live in unhealthy environments that are not amenable to change. n Easier to continue to behave in maladaptive ways. n

Other Challenges Facing Psychotherapy About 40% of clients terminate therapy prematurely. n Clients only make superficial changes as a result of therapy. n Traditional psychotherapy takes a palliative approach. n • Has stopped looking for a cure. n Psychotherapy largely a science of victimology.

How PPT Challenges Traditions n n n Focuses on learning to function well in face of psychological distress. Trying to break the 65% barrier. Builds on research. • Presence of character strengths shown to make a significant incremental contribution toward recovery from depression. • Gratitude leads to lower levels of stress and depression.

HISTORY OF POSITIVE PSYCHOTHERAPY

Maslow’s Hierarchy of Needs Self-Actualization Self Esteem Love and Belonging Safety Physiological “Psychology has been far more successful on the negative than on the positive side … It has revealed to us little about his potentiates, his virtues, his achievable aspirations … It is as if psychology has voluntarily restricted itself to only half its rightful jurisdiction, and that, the darker, meaner half. ” Maslow

Early Beginnings of PPT Jahoda’s (1958) Current Concepts of Positive Mental Health argued well-being should be appreciated in its own right. n Frankl (1963) noted that the primary human drive was not pleasure, but the pursuit of meaning. n

Psychological Abstracts (since 1887) 14 -1 Negative to Positive Ratio

Limited Attention to Positives n Handbook of Psychotherapy and Change by Bergin and Garfield does not include well-being or happiness in the subject index. (Lambert, 2013) n Diagnostic Statistical Manuals have catalogued hundreds of psychiatric symptoms for disorders, but not a single and coherent classification of strengths until 2004.

Examples of Therapies Incorporating Positives n n Fordyce (1983) focused on increasing happiness for college students through 14 strategies. Well-being therapy (WBT) integrates CBT and well-being. • Is effective in treating affective and anxiety disorders. n Frisch’s quality-of-life therapy (QOLT) integrates CT with positive psychology and has been shown effective with depressed clients.

Positive Interventions Making Progress n n n Journal of Clinical Psychology (2009) focused exclusively on positive interventions for clinical disorders. Positive psychology interventions are being explored in clinical settings. Interventions focusing on one or two positive attributes have been conducted.

As APA President, Marty Seligman Urged n Psychology to supplement this historical goal with a new goal. • Exploring what makes life worth living and building the enabling conditions of a life worth living.

Current Status of PPT n 2000 -2010 — More than a 1000 articles related to positive psychology published in peerreviewed journals. • Peer-reviewed journals include the Journal of Positive Psychology, Journal of Happiness Studies, International Journal of Well-being and Applied Psychology: Health & Wellbeing.

Current Status of PPT Positive psychology taught internationally. n Programs on positive psychology developed in the United States. n Online positive psychology resources are available: n • • www. authentichappiness. com www. ppc. com www. viacharacter. org www. positivepsychologynews. com

Current Status of PPT Grants for Positive Psychology Center to explore longitudinal indicators of positive health, positive neuroscience, the mechanisms of self-regulation, and retention among college students. n International Positive Psychology Association founded in 2007. n

Current Status of PPT International level scientific gatherings on positive psychology. n Positive psychology exercises under the Comprehensive Soldier Fitness Program are now being taught within the U. S. Army. n Considerable popular press attention towards positive psychology. n

THEORY OF PERSONALITY FOR POSITIVE PSYCHOLOGY

Positive Psychology Asserts Notion that childhood determines adult personality is false. n Genes have a tremendous influence on adult personality. n Heritability does not determine how unchangeable a trait will be. n Happiness is a personality trait that can be changed. n

Formula for Happiness n. H • • =S+C+V H: Enduring level of happiness S: Personal set range C: Circumstances V: Factors under personal volitional control

Psychotherapy Can Be a Venue for Strength Building n Fixing weaknesses yields remediation. • Nurturing strengths produces growth and more well-being. n n Repairing or fixing weakness does not necessarily make clients stronger or happier. Using strengths increases clients’ self -efficacy and confidence in ways focusing on weakness cannot.

Psychotherapy Can Be a Venue for Strength Building Strengths offer ways to facilitate being good, being kind, humorous, industrious, curious, creative, and grateful. n Strengths essentially come from being good, not feeling good. n Six virtues with 24 character strengths identified. n

The Six Virtues 1. Wisdom and Knowledge § Cognitive strengths that involve acquiring and using knowledge. 2. Courage § Exercise of will to accomplish goals in the face of opposition, whether external or internal. 3. Humanity § Interpersonal strengths that involve tending and befriending others.

The Six Virtues 4. Justice § Strengths that underlie healthy community life. 5. Temperance § Protection against excess and vices. 6. Transcendence § Strengths that forge connections to the larger universe and provide meaning.

Wisdom and Knowledge: Character Strengths Creativity (ingenuity, originality) • Thinking of novel and productive ways to do things. n Curiosity (interest, novelty seeking, openness to experience) • Taking an interest in all of ongoing experience. n

Wisdom and Knowledge: Character Strengths Judgment (critical thinking) • Thinking things through and examining them from all sides. n Love of learning • Mastering new skills, topics, and bodies of knowledge. n Perspective (wisdom) • Providing wise counsel to others. • Taking the “big picture” view. n

Courage: Character Strengths Bravery (valor) • Facing threat, challenge, or pain. n Perseverance (persistence, industry, diligence) • Finishing what one starts. n

Courage: Character Strengths n Honesty (authenticity and integrity) • Speaking the truth and presenting oneself in a genuine way. n Zest (vitality) • Approaching life with excitement and energy. • Not doing things halfway or halfheartedly. • Living life as an adventure. • Feeling alive and activated.

Humanity: Character Strengths n Love (capacity to give/receive) • Valuing close relations with others, in particular those reciprocated. n Kindness (compassion, altruism, generosity, care) • n Doing favors/deeds for others. Social intelligence • Awareness of the motives and feelings of self and others. • Knowing what to do to fit into different social situations. • Knowing what makes other people tick.

Justice: Character Strengths n Teamwork (citizenship, social responsibility, loyalty) • n Working well as member of a group. Fairness (equity) • Treating people the same according to notions of fairness and justice. n Leadership • Encouraging a group one is a member of to get things done while maintaining good relations within the group.

Temperance: Character Strengths n Forgiveness (mercy) • Forgiving wrongs of others. • Accepting other’s shortcomings. n Humility (modesty) • Letting one’s accomplishments speak for themselves. • Not regarding oneself as more special than one is.

Temperance: Character Strengths n Prudence • Carefulness about one’s choices. • Not taking undue risks. • Avoiding regrets n Self-regulation (self-control) • Regulating what one feels and does. • Being disciplined.

Transcendence: Character Strengths n Appreciation of beauty and excellence (awe, wonder, elevation) • n Noticing and appreciating beauty, excellence, or skilled performance. Gratitude • Awareness of and thankfulness for good things. n Hope (optimism, future-mindedness) • Expecting the best in the future and working to achieve it. • Believing in a good future.

Transcendence: Character Strengths n Humor (playfulness) • Liking to laugh and tease. n Spirituality (sense of purpose, faith, meaning, religiousness) • Knowing where one fits within the larger scheme. • Having coherent beliefs about the higher purpose and meaning of life that shape conduct and provide comfort.

Chris Peterson’s Model for Evaluating Disorders 1. What psychological state or trait reflects absence of character strength? 2. What state or trait signifies its opposite? 3. What state or trait displays its exaggeration? A disorder may result from the absence of a given character strength, but it can also result from its presence in extreme forms.

Chris Peterson’s Model for Evaluating Disorders § If psychology as usual uses a lens of abnormality to view normality, “then why not use the lens of normality or even super normality to view abnormality? ”

Example: Psychology Disorders and Dysregulation of Strengths Disorder Symptoms Lack & Excess of Strengths Major depressive disorder Depressed mood, feeling sad, hopeless, helpless, slow, fidgety, bored Lack: Joy, amusement, hope, optimism, playfulness Excess: Eccentricity, pollyannaism, buffoonery Diminished pleasure Lack: Pursuing/appreciating positive experiences, sense of wonder Excess: Self-indulgence, sensation-seeking Fatigued, slow Lack: Alertness, diligence Excess: Overexcitement Indecision Lack: Determination, resolution, winnowing Excess: Overanalytical, inflexible

PPT is Based on 3 Primary Assumptions 1. Psychopathology results when inherent capacities for growth, fulfillment, and happiness are thwarted by sociocultural factors. 2. Positive emotions/strengths are authentic and real. 3. Effective therapeutic relationships can be built on exploration and analysis of positive personal characteristics and experiences.

Seligman’s Conceptualization of Happiness and Well-being n PPT is primarily based on Seligman’s deconstruction of “happiness” into three scientifically measurable and manageable components: • Positive emotion (the pleasant life) • Engagement (the engaged life) • Meaning (the meaningful life)

The Pleasant Life Dimension of human experience endorsed by hedonic theories of happiness. n Consists of experiencing positive emotions about the present, past, and future and learning new skills to amplify the intensity and duration of these emotions. n

The Pleasant Life n n n Positive emotions build resilience by “undoing” the effects of negative emotions. Depressed clients seeking psychotherapy experience a lower than 0. 5 to 1 ratio of positive to negative emotion. Fredrickson (2009) found that experiencing 3 positive emotions for every single negative emotion may be a threshold for flourishing.

The Engaged Life n n Relates to the pursuit of engagement, involvement, and absorption in work, intimate relations, and leisure. Stems from Csikszentmihalyi’s (1990) work on flow. • Psychological state brought about by intense concentration. • Flow typically results in temporal distortion (a lost sense of time).

The Engaged Life n Seligman (2002) proposes a way to enhance engagement: • Identify clients’ salient character strengths and then help clients find opportunities to use them more. n In PPT, clients learn about undertaking intentional activities that use their signature strengths to create engagement.

The Meaningful Life Meaning refers to using signature strengths to belong to and serve something bigger than oneself. n Frankl (1963) emphasized: n • Happiness cannot be attained by desiring happiness. • It must “ensue” as the unintended consequence of working for a goal greater than oneself.

The Meaningful Life PPT asserts a lack of meaning is not just a symptom, but a cause of psychological disorders. n Theory of happiness recently revised and two new elements added: n • Positive relationships • Accomplishment

The Full Life The full life entails happiness and life satisfaction. n Is much more than the sum of its components — pleasure, engagement, and meaning. n These components are neither exclusive nor exhaustive. n

The Psychotherapy Process PPT helps clients explore their strengths. n Therapist first focuses on building a congenial relationship by mindfully listening. n The positive introduction is discussed in detail and often runs as a dynamic narrative throughout the course of therapy. n

The Psychotherapy Process n n n Therapists encourage clients to describe strengths. Clients are provided a handout that briefly describes the core character strengths. Clients are asked to complete an online Values in Action – Inventory of Strengths (VIA-IS; Peterson & Seligman, 2004) to identify their signature strengths.

The Psychotherapy Process n Top 5 strengths identified on the Values in Action – Inventory of Strengths are generally considered client’s strengths: • PPT follows a comprehensive approach known as dynamic strength -assessment to be more comprehensive.

Dynamic Strength-Assessment Uses the Values in Action classification model. n Clients identify (but don’t rank) 5 strengths best illustrating their personality. n Identical collateral data is collected from a friend or family member. n Clients then complete an online self-report measure of strengths. n

Dynamic Strength-Assessment Clients are provided a worksheet to compute their strengths and create a composite score. n Clients share memories, experiences, real-life stories, anecdotes, accomplishments, and skills that illustrate development and use of these strengths. n

Strengths n Strengths are discussed as: • Tonic – Displayed in nearly all situations. • Phasic – Displayed only in some situations or with certain groups. n Clients also identify under- or overuse of strengths.

Overview of the 14 -Session Model of PPT Session Topic and Homework 1 Orientation to PPT; Positive introduction 2 Character strengths; Dynamic strengths; Assessment; Blessing journal 3 Signature strengths; Signature strength action plan 4 Good vs. bad memories; Writing memories

Overview of the 14 -Session Model of PPT Session Topic and Homework 5 Forgiveness; Forgiveness letter 6 Gratitude; Gratitude letter and visit 7 Midtherapy; Feedback session 8 Satisficing vs. maximizing satisficing 9 Hope, optimism, and posttraumatic growth; One door closes, one door opens

Overview of the 14 -Session Model of PPT Session Topic and Homework 10 Positive communication; Active constructive Signature strengths of others; Family strengths tree Savoring; Planned savoring activity Altruism; Gift of time The full life 11 12 13 14

Positive Themes in Other Therapy Models n n n Most therapists can incorporate strengths in therapy without significantly changing their therapeutic framework. Clients can be helped to devise personalized strength-based pathways to solve life’s problems. These pathways often are hidden from clients because of symptomatic distress.

Examples of PPT Strategies Positive reappraisal to help clients unpack bitter memories and place them in perspective. n Clients create psychological space between themselves and the negative memory. n Clients devise an inventory of both negative and positive aspects of the bitter memory. n

Examples of PPT Strategies n Clients recognize cues that activate the recall of a bitter memory. • n Then engage in an adaptive and alternative activity. Encourage clients to consider option of forgiveness.

Examples of PPT Strategies PPT does not deny negative emotions or encourage rosecolored glasses. n PPT aims to validate negative experiences. n • Simultaneously encourages clients to explore their effects. • Seek out potential positives from their difficult and traumatic experience.

Example of a PPT Exercise n Savoring teaches clients to slow down and enjoy experiences they would normally hurry through. • For example, eating while fully present and non-judgmentally aware, to stop the pattern of mindless eating. – Focus is on teaching client awareness of: • • Taste and texture of food. Thoughts experienced while eating. Physical sensations in the body. Tension in the body.

Mechanisms of Change in PPT Broadens and builds therapeutic resources. n Increases behavioral, cognitive, and affective flexibility. n Allows clients to develop their signature strengths. n Teaches clients to deal with problems head on. n Provides reeducation of attention. n

Applications of Positive Psychology

Who Won’t Benefit from PPT Some clients may feel that character has no place in therapeutic discourse because they may feel it will invoke judgment by therapist. n A client with deeply entrenched self-perception of being victim may not benefit from PPT initially. n

Who Won’t Benefit from PPT n n n Identification of character strengths may exaggerate the inflated self-view of someone with narcissistic characteristics. Clients who have experienced trauma may not benefit from a PPT approach initially. Clients expecting a linear progression of improvement may find PPT challenging.

PILOT STUDIES HAVE REPORTED PROMISING FINDINGS, BUT THESE SHOULD BE VIEWED CAUTIOUSLY UNTIL REPLICATED ON A LARGE SCALE. MORE NEEDS TO BE KNOWN ABOUT THE EFFICACY OF PPT WITH SPECIFIC CLINICAL CONDITION, ITS GENERALIZABILITY, OR THE ROLE OF POSSIBLE MEDIATING VARIABLES.

Applications of PPT n PPT can help clients with a wide range of psychological disorders. • Clients with depression appear to benefit most from PPT exercises. • Clients with co-occurring disorders (depression and anxiety, depression and adjustment issues, etc. ) can benefit from PPT exercises.

Applications of PPT n Group PPT has also been shown to be effective with a range of psychological disorders. • • n n Depression Addiction Borderline personality disorder Schizophrenia PPT exercises can also be adopted for other treatment modalities. PPT sequence can be altered as needed.

Applications of PPT n n n Core PPT exercises have been used with nonclinical samples in life and executive coaching, education, and organizations. RCTs completed online using PPT exercises have shown promising results. PPT offers tremendous potential for expanding the horizons of psychotherapy.

Evidence for PPT n Seligman, Steen, Park, and Peterson (2005) and Seligman, Rashid, and Parks (2006) • Both studies demonstrated that PPT exercises, delivered singularly or packaged into comprehensive treatment package, are effective in undoing symptoms of depression as well as in amplifying well-being.

Evidence for PPT n n Three studies have demonstrated the validity and reliability of the Positive Psychotherapy Inventory (PPTI). Rashid & Uliaszek (2012) integrated PPT with DBT for BPD in 12 -session group. • Compared to treatment as usual, participants in the intervention group (skills and strengths) improved more on measures of: – Well-being, emotional regulation, and overall symptom reduction.

Evidence for PPT n PPT exercises shown effective with adolescents seeking treatment for drug addiction and behavioral challenges. • Kingdom, Akhtar and Boniwell (2010) n RCT with 6 th graders found PPT exercises were effective in increasing well-being and improving social skills as reported by teachers and parents. • Rashid and Anjum (2008)

Evidence for PPT n Preference for one PPT exercise links to adherence to match exercises. • Schueller (2011) n n Findings about the effectiveness of PPT are encouraging. More research needed to evaluate PPT’s effectiveness with a variety of psychological disorders. • Including comparisons with traditional symptom-targeted treatments.

PPT in a Multicultural World Happiness, in Western culture, has been synonymous with pursuit of pleasure (hedonism). n PPT’s approach, largely based on the notion of pursuit of good life (eudemonia), is more conducive to multicultural clients because it includes a broader notion of happiness. n

PPT in a Multicultural World n PPT’s positive introduction; focus on stories, anecdotes, and resilience; and focus on meaning, relationship, engagement, and accomplishment appeals to the diverse. • These can all be examined and discussed within a cultural context. n Balancing negative with positive can make psychotherapy more empowering for diverse clients.

International Findings on PPT n n Strengths may manifest differently across cultures. Melanie Bay (2012), working in France, compared group PPT, CBT and medication: • Clients in PPT experienced greater therapeutic benefits. n In Iran, Moeenizadeh and Salagame (2010) found clients in well-being therapy fared better than CBT.