First wave and second PP
The field of positive psychology studies the subjective well-being, optimism, flow states and optimal functioning in human behaviour. It has brought with it a renewed interest in the benefits of introducing PPIs. Many researchers in the area of positive psychology have focused their science on what is ‘right’ in flourishing people (Seligman, 2011). The extensive research does far more than simply widen our understanding of ‘why’ some individuals are happy (Lyubomirsky, 2001), grateful (McCullough, Emmons, & Tsang, 2002) and optimistic (Seligman, Gillham, & Shatté et al., 2001) but actually provides a set of universal mechanisms packaged as evidence-based PPIs, of ‘how’ to amongst other benefits increase subjective wellbeing, psychological wellbeing and life satisfaction.
This can be termed as ‘first wave positive psychology’ (Wong, 2011). The original idea formulated in the first wave of positive psychology was to move away from the disease model. This focused on working to move people who fell between -8 to -3 on the medical model, or phrased a different way from the severely depressed, to the mildly depressed.
The usual psychological approaches provided to patients include cognitive or interpersonal therapy and pharmacotherapy. With often, both talking therapy and drug therapy administered in tandem. The positive psychology movement evolved to not only include positive affect, but also to explore negative affect. In doing so, ‘second wave positive psychology’ has achieved wider-reaching implications for ‘psychology as usual’ (Ivtzan, Lomas, & Hefferon, 2015). Second wave positive psychology considers both increasing positive emotions and decreasing mental illness and disorder. This will be discussed further in the essay when we introduce some theories and research from Keyes (2005).
Defining PPIs and the amelioration of depression
When considering the place for PPIs in ‘psychology as usual’ or mainstream psychology, it is important to define what is meant by a PPI. Sin and Lyubomirsky (2009) define PPIs as ‘treatment methods or intentional activities that aim to cultivate positive feelings, behaviours or cognitions’. To distinguish from psychology as usual, they explain that ‘programs, interventions, or treatments aimed at fixing, remedying, or healing something that is pathological or deficient – as opposed to building strengths – do not fit the definition of a PPI’.
This clear definition of what is and is not a PPI comes from meta-analytical work carried out by Sin and Lyubomirsky. It is notable that, when Seligman and others (2005) reviewed the available literature four years earlier they yielded more than one hundred PPIs. However, using a selection criterion which proposed twelve mechanisms underpinning a PPI that is appropriate enough to be included, Sin and Lyubomirsky found fifty-one available PPIs.
This definition and selection criteria led them to investigate the following: ‘Do positive psychology interventions – that is, treatment methods or intentional activities aimed at cultivating positive feelings, positive behaviours, or positive cognitions – enhance well-being and ameliorate depressive symptoms?’ (Sin & Lyubomirsky, 2009). Their meta-analysis of the evidence for the effectiveness of PPIs reviews 4,266 individuals using fifty-one different PPIs. The results showed the PPIs do significantly enhance psychological and subjective wellbeing (mean r=.29) and decrease depressive symptoms (mean r-.31).
Interestingly, the depression status influenced the results, with the individuals reporting higher levels of depression when measured before, actually showing the greatest reduction when measured post PPI. This evidence combats the widely-held assumption that positive psychology cannot help or is irrelevant to severe depression. Sin’s and Lyubomirsky’s results where expanded on by Boiler and others later (2013). The meta-analytical work broadened to articles which included self-help, group therapy and individual therapy PPIs. Again, the conclusion found evidence of both a reduction in depressive symptoms, and an increase in both psychological and subjective wellbeing.
One of the biggest criticisms of positive psychology is that it focuses too much on hedonic individual happiness (Van Deurzen, 2008). This evidence of efficacy indicates that PPIs could have a strong impact on ‘psychology as usual’, which up until now has not whole-heartedly recognised positive psychology. Despite this, Boiler and others say, ‘additional high-quality peer-reviewed studies in diverse (clinical) populations are needed to strengthen the evidence-base for positive psychology interventions’. Based on this statement, we cannot say with absolute confidence that PPIs can dispel the myths held against its efficacy just yet.
Some common PPIs include, practising optimism (Boehm & Lyubomirsky, 2006), utilising your signature strengths (Seligman et al., 2005; Biswas-Diener et al., 2010), counting your blessings (Emmons & McCullough, 2003; Lyubomirsky, et al., 2005; Froh, Sefick, & Emmons, 2008), Random acts of Kindness – ‘Happy people become happier through kindness: A counting kindnesses intervention’ (Sheldon & Lyubomirsky, 2004; Otake, Shimai, & Fredrickson et al., 2006; Dunn, Anik, & Aknin et al., 2009) expressive writing (Burton & King, 2004) best possible self (King, 2001; Sheldon & Lyubomirsky, 2006) and writing letters of gratitude to others (Seligman et al., 2005; Lyubomirsky et al., 2011; Toepfer, Cichy, & Peters, 2012).
Boehm & Lyubomirsky, declared ‘Randomised controlled longitudinal experiments have proved the efficacy of these interventions in increasing subjective wellbeing and reducing depressive symptoms’ in The Oxford Handbook of Positive Psychology (2009). With people who have suffered depression these PPIs serve as a vital tool to prevent a relapse into depression. Because these activities are taught to the patient and self-administered through practice by the patient the locus of control is intrinsic in its nature. The patient attributes a reduction in symptoms and improvement in mood to their doing and not to an anti-depressant or a therapist (Deci & Ryan, 2008). An internal locus of control directly correlates to a decrease in depression and reduces the potential of relapse (Benassi & Presson, 1996; 2003).
We will now broaden this discussion to mindfulness, and specifically mindfulness-based stress reduction (MBSR) (Kabat-Zinn, 2003). MBSR focuses on the reduction of pain and the management of psychological distress. It has even been found to reduce stress and depression similar to the effects of cognitive behavioural therapeutic methods (Kabat-Zinn, 2003). These results could demonstrate a place of inclusion for MBSR in mainstream treatment of depression or stress, with evidence of alterations in the brain structure following the practice of this intervention (Davidson, Kabat-Zinn, & Schumacher, 2003).
One of many studies looking at the direct effect of this PPI on coping with stress, depression, anger and sleep was conducted in Korea. ‘The findings in this study indicate that the MBSR is an effective program to decrease stress, depression and state trait anger in middle aged women’ (Park & Choi, 2016). Similar results can be found in the testing of loving-kindness meditation. Preliminary results have shown a significant increase in positive emotions and subsequent broadening of personal resources (Fredrickson et al., 2008).
Nevertheless, these PPIs may be few but they have been proven to demonstrate an added value to ‘psychology as usual’. They have been found to cultivate successful outcomes in many important and varied life domains, so not only relieving the suffering of depression but fostering success elsewhere in life. For example, better psychological health, increased pro-social behaviour, higher creativity and superior job performance (Lyubomirsky, King, & Diener, 2005).
There is a criticism that PP is a ‘happy–ology’, only focused on positive thinking, expressed by Barbara Ehrenreich in her book ‘Smile or Die’ (2010). While some critics comment on the damage of ‘positive thinking’, this, in the author’s opinion, is a misunderstanding of the principles and core tenets of positive psychology. The discussed research goes against the critics and a long way to prove that a healthy psychology means applying interventions that impact both the positive and negative, agreeing that modern day psychology reflects two sides of the same coin in this regard (Lazarus 2003).
What is especially relevant for sufferers of depression is the improved speed of recovery in the cardio-vascular effects of negative emotion, when the patient is practising a PPI which promotes positive emotion. Research into the famous broaden, build and undo theory (Fredrickson et al., 1998; 2001) demonstrated that the fostering of positive emotion improves broad-minded coping skills and builds a buffer against relapse. This move away from local and the narrowing of attention towards a more global and broad mind can create an upwards spiral towards increased resilience, physical health and psychological well-being (Gasper & Clore, 2002).
Seligman et al. (2005) provided a meaningful example of the broadening of positive psychology. They carried out an online experiment in which they randomly assigned 411 participants who were mildly depressed with an average score of 14.1 (CES-D) to engage for one week with one of five established PPIs designed to enhance well-being, compared to a placebo group. Participants in the placebo experiment were tasked to write down their early experiences each day. This group demonstrated a short term boost before returning to their baseline after a week.
Notably, the group tasked with using the PPI (practising gratitude, expressive writing, positive thinking, three good things or using one’s own strengths) demonstrated a boost in well-being and a reduction in depressive symptoms. These benefits were maintained after the practice ended. With two PPIs, namely noting ‘three good things’ and ‘using one’s signature strengths in a new way’ resulted in a lasting boost in wellbeing and reduction in depression for up to 6 months.
Interestingly, this study demonstrates the rapid decrease of depressive symptoms ‘after just one week or less of participation’. This shows that not only are PPIs effective in decreasing depressive symptoms, but results happen quickly too.
This rapid change is notable when compared with the prescription of anti-depressants, which can take time to be effective, or with cognitive therapy, which is administered through twelve sessions through the NHS in the UK. This is another example of a treatment that takes longer than these PPIs to show effect. One notable criticism is to say that not all participants experience the positive change; however, this could also be said for pharmacotherapy or cognitive therapies that have been studied as well.
In another study carried out by Seligman in 2005, this time focusing on severely depressed participants with an average CES-D of 33.9, they were given the daily activity of focusing on ‘three good things’. Within fifteen days, 94% experienced relief and the CES-D average decreased by 16.7, from severe depression to mild-moderate depression. Although the development and testing of PPIs is in its early stages, these interventions demonstrate promise in not only relieving depressive symptoms but doing so at a comparably rapid pace.