Tuesday, October 20, 2009

"Positive Psychotherapy" (PPT) for depression

This post is a continuation of my earlier post on the psychology of happiness. I'm trying to look at each of the references in more detail.

PPT (positive psychotherapy) is a technique described in a paper by Seligman et al. Here's a reference, from American Psychologist in 2006:

In this paper the technique was tested on two groups. The more important finding concerns the application of PPT with severely depressed adults. PPT was compared with "treatment as usual" (mainly supportive therapy), and "treatment as usual plus antidepressant". The trial lasted 12 weeks, and there was follow-up over 1 year.

The PPT group showed significant improvement in depression scores, and significantly increased happiness, compared to the two control groups.

More controlled studies need to be done on the technique, but in the meantime, the ideas are simple, valuable, potentially enjoyable, and easily incorporated into other therapy styles such as CBT. Here are some of the exercises recommended in PPT, as described in the paper mentioned above:

1) Write a 300-word positive autobiographical introduction, which includes a concrete story illustrating character strengths
2) Identify "signature strengths" based on exercise (1), and discuss situations in which these have helped. Consider ways to use these strengths more in daily life
3) Write a journal describing 3 good things (large or small) that happen each day
4) Describe 3 bad memories, associated anger, and their impact on maintaining depression (this exercise to be done just once or a few times, not every day)
5) Write a letter of forgiveness describing a transgression from the past, with a pledge to forgive (the letter need not be actually sent)
6) Write a letter of gratitude to someone who was never properly thanked
7) Avoiding an attitude of "maximizing" as a goal, rather focusing on meaningfully engaging with what is enough (i.e. avoiding addictive hedonism, in terms of materialism or achievement). The authors use the term "satisficing", which led me to look this word up--here's a good article I found: http://en.wikipedia.org/wiki/Satisficing). I think this idea is really important for those of us who are very perfectionistic or who have very specific, fixed standards for the way they believe life should be, and who therefore feel that real life is always lagging behind these expectations or requirements, or that real life could at any moment crash into a state of failure.
8) Identification of 3 negative life events ("doors closed") which led to 3 positives ("doors opened").
9) Identification of the "signature strengths" of a significant other.
10) Give enthusiastic positive feedback to positive events reported by others, at least once per day
11) Arrange a date to celebrate the strengths of oneself and of a significant other
12) Analyze "signature strengths" among family members
13) Plan and engage with a "savoring" activity, in which something pleasurable is done, with conscious attention given to how pleasurable it is, and with plenty of time reserved to do it
14) "Giving a gift of time" by contributing to another person, or to the community, a substantial amount of time, using one of your signature strengths. This could include volunteering.

Here's a link to a blog devoted to positive psychology techniques:
This blog is connected to a site in which they want you to sign up and pay for a membership. I'm always a bit jarred when an altruistic psychotherapeutic system is marketed for financial profit. Would it not be more satisfying to everyone to offer this for free? Also I think the photograph of an ecstatic woman in a flowery meadow is a bit over-the-top as advertising for the site. I find the marketing excessively aggressive, it looks like an infomercial. Some of this stuff could really be off-putting to weary, understandably cynical individuals with chronic depression who have tried many other types of therapy already. And there can be a sort of religious fervor among enthusiastic adherents of a new technique, which can skew reason.

Yet, these ideas are worth looking at. And I certainly agree that in psychiatry, and in therapy, we often focus excessively on the negative side of things, and do not attend enough to nurturing the positive.


Anonymous said...

I have not read a lot about positive psychology. However, whenever I try to read more I always begin to feel irritated. This is what bothers me:

1) I do not understand what is wrong with focusing on "pathology". I do not understand what is wrong to focus on "weaknesses" versus strengths. I guess what bothers me about this
is that I am always being told (through the media, etc) that mental health disorders are just as "real" as physical disorders. But in physical medicine the focus seems to be on pathology, e.g., figuring out what is wrong, attempting to treat symptoms, etc. So why is this approach considered wrong in psychiatry (or psychology)?

2) I feel like there is a kind of moralizing that underlies "positive psychology". I understand that positive psychologists discuss the importance of "negative emotions", but I still get the message that there is something wrong with embracing these negative emotions. I feel like there is a kind of judgment attached to being a "negative" person, focusing on the "negative", etc. It seems to me that our culture is extremely critical of people who possess a "negative attitude". I think that this is an attitude that people who suffer from depression or similar illness deal with on a regular basis. Popular media tells us to ditch friends who are negative, who drain energy from us...we're exhorted to "think positively"...it seems selfish and rude to display a negative attitude. Sometimes the language of positive psychology seems like a kind of groupthink to me. It seems sometimes that the purpose of adopting this attitude is because this is a culturally acceptable attitude, this is the "healthy" way to think. Sometimes it seems like a kind of bullying to me. It also reminds me of this idea within some religions that despair or hopelessness is a sin. It seems very judgmental. It's as though individuals who are "happy" have somehow managed to figure out this basic truth (that focusing on strengths, positive emotions, positive experiences, etc etc etc is the path to a satisfying and happy life)-- it somehow seems dismissive of the entire experience of psychiatric illness (depression, etc).

I also find it very hard to separate "positive psychology" from the kind of "positive thinking" books that are so popular. I know that positive psychologists argue that their brand of positive psychology is different, but sometimes it seems hard not to see some overlap. Focus on positive emotions and positive experiences, and good things will happen for you! It seems gimmicky and like a kind of salesmanship. (You have used the term "salesmanship" in reference to a certain type of CBT, and positive psychology seems very similar to me).

3) I think about depressive realism. It makes me wonder what the underlying message of "positive psychology" is. Is the goal of "positive psychology" to see things as they are, or as things "should be" in order to encourage positive emotions, positive experiences, etc etc? It seems like there is a kind of illusive (or delusive?) thinking behind this.

I have read a comment by one psychologist who says that there is an "epistemic double-standard" within positive psychology. She says that, on the one hand, there is an underlying bias towards the "positive", e.g. positive interpretations of experiences or I guess of life generally. But science in general does not support this kind of "positive bias" of data. Therefore, it is interesting that there is so much emphasis on quantifying the benefits of "positive psychology" through experiments, etc.

4) Some of the positive psychology experiments sound very very very very suspect to me. I might be misremembering this, but I remember once reading about one study that measured "happiness" by how wide and authentic smiles in yearbook photos were (?). Sometimes it seems like bad research is being abused to support a certain ideology.

GK said...

I've written a separate, newer post, in response to the above comment.