psychotherapy positive psychology James Hawkins Independent Practice

psychotherapy & positive psychology James Hawkins, Independent Practice Edinburgh

key points of this workshop a) what is “positive psychology” & how has it developed? b) why is it relevant for psychotherapy? c) assessment issues d) some initial “tastes” i. Deci & Ryan ii. Fredrickson iii. Gilbert & Neff

what is positive psychology and how has it developed? interest in the good life & what helps people thrive goes back millennia through Ryff, Deci & Ryan, Maslow, Rogers, Bugental, Jahoda, Allport, Jung & James to Aquinas & Aristotle 5 yr old Nikki & 1996 gardening grouch story “the single most important contribution of positive psychology has been to provide a collective identity – a common voice and language for researchers & practitioners” Linley & Joseph

key points of this workshop ü what is “positive psychology” & how has it developed? b) why is it relevant for psychotherapy? c) assessment issues d) some initial “tastes” i. Deci & Ryan ii. Fredrickson iii. Gilbert & Neff

the spectrum of mental health full mental health & flourishing are typically present in only 15 -20% of the population – this is important for 1. ) overall enjoyment of life. 2. ) risk of relapse into full diagnostic criteria or subsyndromal disorder. 3. ) overall level of functioning in work & relationships

evidence from meta-analyses recent research shows significant benefits of positive psychology interventions on reducing psychological symptoms and associations with improved mortality ³ Sin, N. L. and S. Lyubomirsky (2009). "Enhancing well-being and alleviating depressive ³ symptoms with positive psychology interventions: a practice-friendly meta-analysis. " Journal of Clinical Psychology 65(5): 467 -487. Do positive psychology interventions that is, treatment methods or intentional activities aimed at cultivating positive feelings, positive behaviors, or positive cognitions - enhance well-being and ameliorate depressive symptoms? A meta-analysis of 51 such interventions with 4, 266 individuals was conducted to address this question and to provide practical guidance to clinicians. The results revealed that positive psychology interventions do indeed significantly enhance well-being (mean r=. 29) and decrease depressive symptoms (mean r=. 31). Chida, Y. and A. Steptoe (2008). "Positive Psychological Well-Being and Mortality: A Quantitative Review of Prospective Observational Studies. " Psychosom Med 70(7): 741756. Objective: To review systematically prospective, observational, cohort studies of the association between positive well-being and mortality using meta-analytic methods. Results: There were 35 studies (26 articles) investigating mortality in initially healthy populations and 35 studies (28 articles) of disease populations. The meta-analyses showed that positive psychological well-being was associated with reduced mortality in both the healthy population (combined hazard ratio (HR) = 0. 82 ; p <. 001) and the disease population (combined HR = 0. 98; p =. 030) studies. Intriguingly, meta-analysis of studies that controlled for negative affect showed that the protective effects of positive psychological well-being were independent of negative affect.

evidence from smiles research smile intensity protects against divorce ³ Hertenstein, M. , C. Hansel, et al. (2009). "Smile intensity in photographs predicts divorce later in life. " Motivation and Emotion 33(2): 99 -105. Abstract: Based on social–functional accounts of emotion, we conducted two studies examining whether the degree to which people smiled in photographs predicts the likelihood of divorce. Along with other theorists, we posited that smiling behavior in photographs is potentially indicative of underlying emotional dispositions that have direct and indirect life consequences. In the first study, we examined participants’ positive expressive behavior in college yearbook photos and in Study 2 we examined a variety of participants’ photos from childhood through early adulthood. In both studies, divorce was predicted by the degree to which subjects smiled in their photos. smile intensity predicts a longer life ³ Abel, E. L. and M. L. Kruger (2010). "Smile intensity in photographs predicts longevity. " Psychol Sci 21(4): 542 -544. Five people rate the smile intensity of 230 baseball players according to photos featured in the 1952 Baseball Register. The researchers used a three-point smile scale: no smile, half smile (mouth only), and genuine 'Duchenne' smile (muscles contracted around the mouth and corners of the eyes). Focusing on the 150 players who'd died by the time of the study and controlling for extraneous factors such as BMI and marital status, the researchers found that those who were flashing a genuine 'Duchenne Smile' were half as likely to die in any given year compared with non-smilers. Indeed, the average life-span of the 63 deceased nonsmilers was 72. 9 years compared with 75 years for the 64 partial smilers and 79. 9 years for the 23 Duchenne smilers.

why is positive psychology relevant for psychotherapists? Ø positive psychology can be add-on therapy as client recovers to reduce relapse risk Ø positive psychology can effect every aspect of therapy right from the very 1 st session Ø positive psychology is highly relevant for ourselves personally to improve both our own lives & our effectiveness as therapists

time to reflect!

key points of this workshop ü what is “positive psychology” & how has it developed? ü why is it relevant for psychotherapy? c) assessment issues d) some initial “tastes” i. Deci & Ryan ii. Fredrickson iii. Gilbert & Neff

wellbeing assessment dashboard positive emotions flourishing variants ² happiness scales ² panas ² fredrickson ratio ² diener spane ² self-determination ² ryff & keyes ² diener, seligman ² huppert, etc life satisfaction other aspects ² life overall ² life domains: work, relationships, etc ² strengths variants ² optimism, gratitude, compassion, etc see blog post at www. stressedtozest. com

wellbeing assessment today positive emotions flourishing variants ² happiness scales ² panas ² fredrickson ratio ² diener spane ² self-determination ² ryff & keyes ² diener, seligman ² huppert, etc life satisfaction other aspects ² life overall ² life domains: work, relationships, etc ² strengths variants ² optimism, gratitude, compassion, etc

key points of this workshop ü what is “positive psychology” & how has it developed? ü why is it relevant for psychotherapy? ü assessment issues d) some initial “tastes” i. Deci & Ryan ii. Fredrickson iii. Gilbert & Neff

self-determination theory (SDT) looking at wellbeing through the lens of selfdetermination theory – www. psych. rochester. edu/SDT is a general theory of motivation & personality that has evolved over the past three plus decades ¶ SDT suggests humans, like plants or other animals, intrinsically strive for need satisfaction & flourishing ¶ social contexts can support or thwart this need striving with major effects for health & wellbeing ¶ Deci, E. L. and R. M. Ryan (1985). Intrinsic motivation and self-determination in human behavior. New York, Plenum. Deci, E. L. and R. M. Ryan (2000). The "what" and "why" of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry 11: 227 -268.

three key psychological needs v a basic need (whether physiological or psychological) is defined as an energizing state that, if satisfied, promotes health & wellbeing but, if not satisfied, contributes to pathology and ill-being v autonomy, competence & relatedness are 3 key basic psychological needs – how they can best be satisfied will vary with individual strengths, life stage, social context, and culture v personal goals that lead to satisfaction of these 3 basic needs will promote well-being, but individuals – due to broad societal conditioning and personal life history – may well strive for goals that do not satisfy these needs or enhance their well-being Ryan, R. M. and E. L. Deci (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 55(1): 68 -78.

three key psychological needs autonomy: personal choice not compulsion by outside forces competence v competence: capable & effective autonomy not incompetent & inefficient v relatedness: regular emotional relatedness intimacy & shared activities not isolation & loneliness v Reis, H. T. , K. M. Sheldon, et al. (2000). Daily well-being: the role of autonomy, competence, and relatedness. Pers Soc Psychol Bull 26(4): 419 -435. Sheldon, K. M. , A. J. Elliot, et al. (2001). What is satisfying about satisfying events? Testing 10 candidate psychological needs. J Pers Soc Psychol 80(2): 325 -39.

what makes for a good day? v people whose needs for autonomy, competence & relatedness are more satisfied experience greater well-being than those whose needs are less satisfied v at the same time, for each individual, days when these basic needs are more satisfied are experienced as better than days when the needs are less satisfied v it’s not just the total amount of need satisfaction, it’s also the balance that optimises well-being Sheldon, K. M. , R. Ryan, et al. (1996). What makes for a good day? Competence and autonomy in the day and in the person. Pers Soc Psychol Bull 22(12): 1270 -1279. Sheldon, K. M. and C. P. Niemiec (2006). It's not just the amount that counts: balanced need satisfaction also affects well-being. J Pers Soc Psychol 91(2): 331 -41.

goals, motivations & well-being wellbeing “intrinsic” goals wellbeing “autonomous” motivations “controlled” motivations wellbeing “extrinsic” goals

now for some active involvement

wellbeing assessment today positive emotions flourishing variants ² happiness scales ² panas ² fredrickson ratio ² diener spane ² self-determination ² ryff & keyes ² diener, seligman ² huppert, etc life satisfaction other aspects ² life overall ² life domains: work, relationships, etc ² strengths variants ² optimism, gratitude, compassion, etc

goal setting & need satisfaction Sheldon, K. , N. Abad, et al. (2010). "Persistent pursuit of need-satisfying goals leads to increased happiness: A 6 -month experimental longitudinal study. " Motivation and Emotion 34(1): 39 -48. University-based community members (N=181) participated in a four-wave, 6 month longitudinal experiment designed to increase treatment participants’ happiness levels. Participants were randomly assigned to set goals either to improve their life circumstances (comparison condition) or to increase their feelings of autonomy, competence, or relatedness in life (treatment conditions). We hypothesized that sustained gains in happiness would be observed only in the three treatment conditions, and that even these gains would last only when there was continuing goal engagement. Results supported these predictions and the sustainable happiness model on which they were based (Lyubomirsky et al. in Rev Gen Psychol 9: 111– 131, 2005). Furthermore, participants with initial positive attitudes regarding happiness change obtained larger benefits. We conclude that maintained happiness gains are possible, but that they require both “a will and a proper way” (Lyubomirsky et al. in Becoming happier takes both a will and a proper way: two experimental longitudinal interventions to boost well-being, 2009).

goal setting & need satisfaction Here is an extract from the article giving more detail of the procedures used: "“For the next six months, we would like you to give special attention to a psychological need – namely, the need for (autonomy, competence, or relatedness). ” Autonomy was defined as occurring when “you make your own decisions and choices, so that what you do is interesting, meaningful, and valuable to you. ” Competence was defined as occurring when “you feel effective and capable in life, and that you are doing things that you are good at. ” Relatedness was defined as occurring when “you feel a sense of connection with important others – you understand care for these others, just as those others understand care for you. ” Comparison condition participants were told that “We would like you to try to change some important circumstances in your life. ” Circumstances were defined as “facts about your life, such as where you live, what you own, what you look like. ” Listed examples included changing where or who you live with, re-arranging your house, or changing your hairstyle, wardrobe, or look via cosmetic surgery. After hearing the examples, comparison group participants were told that all of them involved “making a one-time change regarding your life-circumstances that will have a positive effect in your life. ”

goal setting & need satisfaction Participants then brainstormed “some ways in which your (autonomy, competence, relatedness) need is not currently being met, ” or brainstormed “some life circumstances you could change. ” After this open-ended task, treatment participants were asked, on the next page, to list “four goals you can pursue, over the next six months, to better satisfy your (autonomy, competence, relatedness) need, ” while comparison participants were asked to list four goals they could pursue in order to change their life circumstances. " Ø autonomy: make your own decisions/choices so that what you do is interesting, meaningful & valuable to you Ø competence: strengthen your effectiveness & capability (domains include work/study, ‘administration’ & health) Ø relatedness: increase connection with important others (domains include shared activity, intimacy & conflict)

key points of this workshop ü what is “positive psychology” & how has it developed? ü why is it relevant for psychotherapy? ü assessment issues d) some initial “tastes” ü Deci & Ryan ii. Fredrickson iii. Gilbert & Neff

flourishing involves more than 3: 1 research by Fredrickson, Gottman, Losada & others strongly suggests that ‘flourishing’ individuals, couples & organizations are characterized by positive to negative interaction ratios that are between about 3: 1 and 11: 1 high positive: negative emotion ratios goodness optimal generativity functioning growth & resilience

positive emotions build resources physical resources speed recovery from stress, promote fitness, boost immunity, reduce mortality intellectual resources broaden attention focus promote flexibility, intuition, & creative problem-solving social resources build relationships encourage empathy, connections & support psychological resources increase happiness, promote resilience to stress & psychological growth

‘positive emotions’ include. . . amusement awe compassion contentment gratitude hope interest & curiosity sexual desire joy ‘pride’ love forgiveness, ‘elevation’ Fredrickson B L & Losada M F. Positive affect and the complex dynamics of human flourishing. Am Psychol 2005; 60(7): 678 -86.

fredrickson’s positivity ratio positive emotions flourishing variants ² happiness scales ² panas ² fredrickson ratio ² diener spane ² self-determination ² ryff & keyes ² diener, seligman ² huppert, etc life satisfaction other aspects ² life overall ² life domains: work, relationships, etc ² strengths variants ² optimism, gratitude, compassion, etc

how to nourish ‘positive’ emotions respect the importance of ‘positive’ emotions: notice, schedule in & look forward to helpful activities that might involve friends, exercise, music, nature, etc; self-chosen healthy goals; learn to ‘reframe’, to learn from, to appreciate calming skills (meditation, imagery, etc) can be powerful inducers of contentment, savouring, peacefulness noticing and acting from spontaneous intuitions, impulses, kindness, appreciations, humour bubbling up from positive emotional states often promotes wellbeing even more

savouring, mindfulness & flow deliberate, nonjudgemental attention to what is happening in the present moment savouring focus on the positive mindfulness focus on the present focus on positive experiences in past, present or future full immersion in what one is doing with loss of selfconsciousness flow focus on the activity

misguidedly we think that happiness depends on major successes “If we pull this off, we’ll eat like kings”

small is beautiful ü subjects monitored for six weeks ü reminder beeper ü record kept of whether felt positive & if so how positive ü overall happiness depends on how often we feel good ü brief peaks are relatively unimportant Larsen RJ, Diener E & Cropanzano RS Cognitive operations associated with individual differences in affect intensity J Personal Soc Psychol 1987; 53: 767 -74

effects of gratitude on wellbeing ü 3 research studies with a total of 314 participants ü the first 2 studies involved students, the 3 rd involved sufferers from a neuromuscular disease clinic ü participants were randomized to several different groups ü the groups were each asked to record different things, for example personal hassles, experiences they were grateful for, social comparisons, and life events ü the groups were compared on several measures including mood, physical symptoms, relationships, life satisfaction

improved mood & enjoyment ¶ remembering this exercise only took a very few minutes per day, the results were impressively worthwhile ¶ participants asked to note experiences they were grateful for did better than the social comparisons group and much better than the noting hassles group ¶ these benefits involved improvements over simply noting neutral life events in mood (9. 8%), overall life satisfaction (13. 8%), optimism about the future (5. 4%), and feeling more connected with others (11. 7%) Emmons, R. A. & Mc. Cullough, M. E. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Personal Soc Psychol 2003; 84(2): 377 -389.

gratitude & appreciation record People deal too much with the negative, with what is wrong. . . Why not try and see positive things, to just touch those things and make them bloom? Thich Nhat Hanh what’s the point of keeping the record? It seems to be normal for us to take many of the good things about our lives for granted – unless they are threatened or we no longer have them. Examples include our health; our ability to use our sense of vision, touch, smell, hearing; our ability to walk; being able to live a day without pain; having energy; not living in fear of political oppression; having friends we can talk to; being able to appreciate nature; having enough to eat; even being able to breathe. It seems for evolutionary, cultural, and personal reasons we simply become blind to so many of the precious aspects of life. In fact much of what we strive for is worth very little compared with gifts like health, our senses, nature, friends, even simply being alive. We can however teach ourselves to regain appreciation and gratitude for these incredible aspects of our lives. How much better to savour them while we have them, rather than take them for granted when they’re there and then miss them terribly when they go. And all these gifts will go. We’re only on this earth for a short time. Reminding ourselves to savour these simple, incredible aspects of our lives and the many other good things we can so easily take for granted makes huge sense and has been shown (Emmons and Mc. Cullough 2003) to improve our mood, health, relationships, and overall well-being. how to keep the record: Each day take a few minutes to jot down things you’ve experienced in the previous 24 hours that you’re grateful for and appreciate. They can be very simple things or huge blessings – often simple things are the biggest blessings. If you don’t have enough space, you can always continue on the back of the sheet. You may find that during the day you start to notice things that you could put down later on the record sheet. At the end of day, maybe lying in bed, try recalling some of the ‘special’ experiences in sensory detail. What did they look, feel, sound, smell like? You can re-run and re-taste the experiences in your mind. You may find it fun and helpful to start sharing what you have noticed and written down with your partner, family, or friends. The aim is to encourage us to be more aware and appreciative of our lives. Probably you’ll find it easier to keep this record if you choose a regular time of day when you usually fill it in. You may just want to try it for a week, or several weeks. You may want to keep the record for a while, then pause, and then use it again – maybe for a week every month as I tend to do. Whatever helps you most is what it’s right for you!

key points of this workshop ü what is “positive psychology” & how has it developed? ü why is it relevant for psychotherapy? ü assessment issues d) some initial “tastes” ü Deci & Ryan ü Fredrickson iii. Gilbert & Neff

self-compassion scale (short) positive emotions flourishing variants ² happiness scales ² panas ² fredrickson ratio ² diener spane ² self-determination ² ryff & keyes ² diener, seligman ² huppert, etc life satisfaction other aspects ² life overall ² life domains: work, relationships, etc ² strengths variants ² optimism, gratitude, compassion, etc

compassion for others & ourselves If you want others to be happy, practice compassion. If you want to be happy, practice compassion. Dalai Lama ¶ ¶ ¶ early family environment school teachers & other kids work place couple relationships friendship & other supports therapeutic relationships

huge amounts of evidence seeing more clearly – so much scientific research supports this understanding; this slide focuses on some of the ways early life experience affects us ³ ³ ³ ³ Bond L, Carlin JB, Thomas L, et al. Does bullying cause emotional problems? A prospective study of young teenagers. BMJ 2001; 323: 480 -4. Brewin CR, Firth-Cozens J, Furnham A, et al. Self-criticism in adulthood and recalled childhood experience. J Abnorm Psychol 1992; 101: 561 -6. Besser A, et al. The apple does not fall far from the tree: attachment styles & personality vul-nerabilities to depression in 3 generations of women. Pers Soc Psychol Bull 2005; 31: 1052 -73. Irons C, Gilbert P. Evolved mechanisms in adolescent anxiety and depression symptoms: the role of the attachment and social rank systems. J Adolesc 2005; 28: 325 -41. Teicher MH, Samson JA, Polcari A, et al. Sticks, stones, and hurtful words: relative effects of various forms of childhood maltreatment. Am J Psychiatry 2006; 163: 993 -1000. Johnson JG, Cohen P, Chen H, et al. Parenting behaviors associated with risk for offspring personality disorder during adulthood. Arch Gen Psychiatry 2006; 63: 579 -87. Reti IM, Samuels JF, Eaton WW, et al. Influences of parenting on normal personality traits. Psychiatry Res 2002; 111: 55 -64.

normal human responses attractive potential mate bullying, rejection forms of abuse sight & smell of food care, understanding & encouragement salivation, gastric secretion soothing, self-esteem courage & hope sexual arousal humiliation, defeat hopelessness

. . . become internalized dialogues sexual fantasy food images salivation, gastric secretion sexual arousal internal self-attack internal self-caring humiliation, defeat hopelessness the challenge is to reduce selfattacking & to nourish the ability to self-care internally soothing, self-esteem courage & hope

12 ways to boost self-compassion 7. Write yourself reminder messages on a card you carry, on your phone, or your computer: There are several research studies showing important benefits from using this kind of writing (Kelly, Zuroff et al. 2009; Shapira & Mongrain 2010). Typical instructions might involve visualising a "compassion- ate image characterized by warmth, acceptance, reassurance, and a desire to soothe distress. This image was also to possess qualities of wisdom, empathy, forgiveness and non-judgment. Participants were asked to spend 30 seconds visualizing this image, focusing on the compassionate other's tone of voice, body language, size, and emotions" and then to write from the perspective of this compassionate, soothing image "five statements to themselves. . . onto cue cards. . . participants were. . . told to repeat their compassionate selfstatements three times per day (morning, midday, and evening), over the next two weeks, while engaging in compassionate imagery. They were told to spend approximately one minute visualizing their warm, accepting image and up to four minutes reading their self-statements repeatedly out loud with emotion and warmth". Other successful research interventions have used variants on this kind of theme, encouraging participants to try to make the experience vivid and emotion-eliciting.

key points & reflection exercise ü what is “positive psychology” & how has it developed? ü why is it relevant for psychotherapy? ü assessment issues ü some initial “tastes” ü Deci & Ryan ü Fredrickson ü Gilbert & Neff

time to reflect!

the universe is full of magical things patiently waiting for our wits to grow sharper Eden Phillpotts