Integrating Mental Health in Positive Psychology
Integrating mental health services into primary health care (PHC) is among the most viable means of closing the treatment gap and ensuring that people get the mental health care they need. It’s no surprise why the field of psychology has centered around mental health issues for so many years. Nearly one fifth (46.6 million) of U.S. adults lived with a mental illness at some point in 2017, and 42.6% of these adults received mental health services (“Mental Illness”, 2019). With so many people needing treatment, there is always a demand for new research on treatments that can restore a patient’s mental health or help give the right diagnosis. How could we focus on optimal human functioning when we still don’t fully understand how to alleviate the symptoms of mental illness?
Recent developments emerging from the field of psychology suggest that positive psychology, the study of flourishing or optimal functioning of individuals and groups of people, is not the opposite of the study of mental illness. Connecting these two branches of the field allows psychological practitioners to help people anywhere on the spectrum of mental well-being.
Understanding Positive Psychology
Positive psychology originated as a response to inequality in the field of psychology, where most of the research came from a clinical perspective and was intended to answer questions about mental illness. By the early 90s, psychologists were very knowledgeable about what goes wrong in individuals, groups, and institutions (Gable & Haidt, 2005). The benefits of understanding what contributes to positive mental conditions in people were left unexplored. Meanwhile, clinical psychology progressed in finding treatments in mental illness, social psychology progressed in understanding prejudice, and cognitive psychology progressed in understanding errors in human judgment (Gable & Haidt, 2005). As useful as these understanding are, they left psychologists in the dust when it came to understanding human virtues.
Psychology would have been more accurately defined as “the study of the broken mind.” Where was the study of the “peak” mind, or even the everyday mind? Psychology claims to be the study of all mental processes, but without positive psychology, a lot is missing.
To shift the focus of psychology to incorporate more investigation into the positives of the human condition, Martin Seligman introduced positive psychology to the American Psychological Association in 1998, during his APA Presidential Address.
Ever since then, the scientific study of human flourishing became a standard branch of psychological science. Psychology could now look at the other side of the coin. The goal of mental health studies is now not just how to achieve the absence of mental illness, but how mental strengths can be improved and practiced in daily life to boost happiness in ordinary people. The scope of psychology widened to include advice for everyone to experience less distress, whether they had a diagnosis or not.
Thanks to Seligman’s popularization of this incredible branch of psychology, anyone can get a positive psychology certificate and begin transforming not only their lives but the people around them.
This provides a helpful introduction to the Positive Psychology field for those who are new to the topic, including the main assumptions, goals, and theories.
Connecting Mental Health to Positive Psychology
While positive psychology evolved as a response to an overbearing focus on understanding poor mental health and established its place within the field of psychology, it is nowhere near separate from the other branches, not even the branch it responds to. Positive psychology more accurately intertwined itself into the field of psychology than stole the spotlight as an independent science.
Just because positive psychology doesn’t focus on symptoms, mental deficits, or a person’s weaknesses doesn’t mean that the interventions and theories positive psychology has provided can’t be applied to people with mental illness or poor mental health and assist in their management of symptoms. Instead of trying to understand negative affect, positive psychology seeks to boost positive affectivity, which can be very effective in helping to manage mood disorders (Lopez-Gomez et al., 2019).
Essentially, positive psychology treats happiness and satisfaction as a skill that anyone can learn. While it may seem like too drastic of a leap to treat poor mental health with positive psychology interventions, the benefits of positive psychology even to those with severe mental illness have been researched and documented many times. Those with severe mental illness would indeed need to experience multiple “in-between” phases from suffering from a disorder to achieving optimal functioning, but anyone can use positive psychology interventions to increase their happiness from whatever their baseline is and experience more moments of flourishing than they were before. Positive psychology is not “the next step” after recovering from mental illness; it can be integrated any step of the way.
In this video, Tal Ben-Shahar, an instructor of a popular positive psychology course at Harvard University, overviews some of the positive psychology’s applications to increasing happiness and reducing stress and other mental health issues.
The Research on Positive Psychology and Mental Illness
Research has shown that positive psychology interventions, which refer to actions that bring about changes in people, can reduce the symptoms of multiple mental illnesses, from depression to schizophrenia, as well as increase participant’s scores on measures of happiness and well-being. Positive psychology practices also serve as a buffer against the development of psychopathology (Trompetter, Kleine, & de Bohlmeijer, 2017).
A common and considerably effective treatment for depression is cognitive-behavioral therapy. One study compared the efficacy of the Integrative Positive Psychology Intervention for Depression (IPPI-D) to a cognitive-behavioral therapy group intervention also designed to treat depression. It was found that there was no statistically significant difference in the success of the treatments (Lopez-Gomez et al., 2019). Positive psychology worked just as well as a standard clinical intervention, with even a slight advantage on average for the IPPI-D (Lopez-Gomez et al., 2019).
In this study, multiple factors seemed to moderate which type of treatment worked better. For 73% of the sample, IPPI-D was predicted to be superior. (Lopez-Gomez et al., 2019). Therefore, while positive psychology interventions may not be worlds ahead of other treatments, they can be an option on the table for those seeking help. It appears that many people could benefit from that availability, as it is preferred for those with certain characteristics, like those with comorbidities, those who have already tried anti-depressants, and those who have higher levels of negative thought or higher personal growth (Lopez-Gomez et al., 2019).
Another study used positive writing as the psychological intervention. Suhr, Risch, & Wilz (2017) asked recently discharged psychiatric patients to write about positive aspects of their life, positive experiences, or individual strengths to improve mood, depressive symptoms, well-being, and coping. These patients had lower depression scores when measured 5 weeks after their discharge, and they also were more effective at emotional reappraisal, which helps people cope with negative situations. Positive writing is self-administered and does not take long to do, so it is promising that this study could apply to and help large groups of people (Suhr et al., 2017).
An optimism positive psychology intervention was also shown to reduce the symptoms of mental illness. Sergeant & Mongrain (2014) found that when given an optimism intervention, patients experienced an increase in happiness and psychological well-being, and a reduction in dysfunctional attitudes and depressive symptoms.
Group Positive Psychotherapy and Mental Health
Positive psychology doesn’t just focus on the individual, so neither does its treatments. The effects of a Positive Living group on participants with schizophrenia were tested, yielding positive results. The Positive Living group was adapted from group positive psychotherapy (Meyer, Johnson, Parks, Iwanski, & Penn, 2012). Participants completed weekly exercises, including identifying and using strengths, expressing gratitude for events of their day, and savoring (Meyer et al., 2012). In positive psychology, savoring refers to the prolonging of your appreciation of positive experiences by actively noticing and focusing your thoughts on them.
Results showed significant improvements in participants’ well-being, hope, savoring, and symptoms. The participants even experienced reductions in paranoid, psychotic, and depressive symptoms (Meyer et al., 2012). This suggests positive psychotherapy
can improve symptoms that are not just mood-based and can affect a wide range of mental health issues.
Gratitude and Mental Health
A huge component of the positive psychology field is the wealth of findings that suggest a positive effect of gratitude on well-being. One popular intervention is called Three Good Things (TGT). TGT involves recognizing and writing down three good things that happened in your day and what caused them (Odou & Vella-Brodrick, 2013). The benefits of gratitude include recognizing what you may take for granted and savoring your pleasurable experiences and therefore prolonging your enjoyment (Odou & Vella-Brodrick, 2013). Feelings of gratitude can also replace other negative emotions you might be feeling at the time you practice TGT. Participants who were instructed to use TGT show a reduction in negative affect and an increase in well-being (Odou & Vella-Brodrick, 2013).
Senf & Liau (2013) also demonstrated the effects of a gratitude-based intervention. When their participants used TGT and expressed gratitude for someone through a hand-delivered letter, they experienced a boost of happiness and a reduction of depressive symptoms one month later (Senf & Liau, 2013).
While not everyone experiences depressive symptoms, everyone could certainly benefit from the boost of happiness gratitude offers. Writing three positive experiences of your day before you go to the bed is a fantastic addition to your nightly routine and could significantly increase your mental well-being.
Mental Strengths and Mental Health
Positive psychology focuses on identifying and magnifying human strengths instead of fixing what is wrong (Senf & Liau, 2013). However, just knowing what strengths are present or available to us on an individual level can help us overcome weaknesses and cope with mental health issues. Senf & Liau (2013) tested a strength-based intervention in which participants were assisted in identifying their top five strengths through an online questionnaire. They were then instructed to use the strengths in new ways. This intervention had a positive effect on happiness and reduced depressive symptoms.
Another popular strength intervention is the Best Possible Selves (BPS) exercise. BPS involves conceptualizing and writing about the best possible version of your future self, who has achieved all your dreams and life goals (Odou & Vella-Brodrick, 2013). The point of this intervention is to identify goals and values and to provide insight into your motivations. Participants who completed the BPS intervention had lower negative affectivity and depressive symptoms and therefore increased well-being (Odou & Vella-Brodrick, 2013).
Beiller-Teichmann & Pomini (2015) created a strength profile assessment to help clinicians better identify patients’ strengths. Most clinical assessment tools are designed to measure patient weaknesses. However, evidence suggests that focusing on strengths buffers against psychopathology (Beiller-Teichmann & Pomini, 2015). Both the clinicians and the patients approved of the assessment. Clinicians stated that having strength profiles helped them identify objections and interventions that would promote well-being and recovery (Beiller-Teichmann & Pomini, 2015).
Positive Psychology and Well-Being Online
If positive psychology is your chosen path to optimal mental health and well-being, everything you need is at your fingerprints. Online positive psychology programs offer numerous benefits to those who choose to explore them. There are many advantages to taking a web-based positive psychology course. Information and resources can be delivered for lower cost, to many people at once, and can be done from anywhere. Web-based positive psychology interventions have been proven to increase happiness and improve depressive symptoms (Woodworth, O’Brien, Diamond, & Shcüz, 2017). One study revealed that an online positive psychology intervention used by graduate students led to higher resilience at the end of three weeks (Venieris, 2017).
In another study, a short online positive psychology intervention “nine beautiful things” improved depressive symptoms for a week and increased happiness for up to one month (Proyer, Gander, Wellenzohn & Ruch, 2016). Participants were instructed to write down 3 beautiful things in human behavior, 3 beautiful things in the environment, and 3 beautiful things in general (Proyer, Gander, Wellenzohn & Ruch, 2016). This small act of gratitude could easily be repeated weekly to sustain benefits.
Web-based positive psychology may apply to you if you feel strongly about the values of positive psychology and may be able to find your new passion for practicing it and helping others and yourself. In that case, high-quality and effective positive psychology certificate programs are conventionally available online. There are many more studies referenced previously and later in this article showing the efficacy of online positive psychology as it relates to different interventions and outcomes.
Positive Psychology and Mental Health 2020
With the deadly spread of COVID-19 and numerous other distressing events occurring in 2020, more and more people are experiencing poor mental health and stress in ways they never have before.
Savoring, a popular concept in positive psychology, might help mitigate the extra stress and anxiety that has arisen in the general population. Savoring positive emotions that can still be felt during this crisis can help calm the mind (Yamaguchi et al., 2020). Despite the ongoing physical distance, more and more effort has been put into sustaining positive emotional connections and social support systems. Prolonging the good feelings that come out of these positive experiences through staying mindful and savoring can help individuals recover from stress and mental disorders (Yamaguchi et al., 2020).
Other Traits for Well-Being
Strengths encompass a variety of individual traits, and gratitude exercises can be done by everyone. While both of these positive psychology topics help us understand how to promote flourishing in individuals with varying mental health conditions, research has also narrowed down more specific traits that directly contribute to recovery or prevent the development of a disorder. The best part is that these traits can be learned. One of these traits is self-compassion.
Research suggests that individuals in excellent mental health are more likely to demonstrate self-compassion skills that buffer against psychopathology (Trompetter et al., 2017). Self-compassion refers to an empathetic and accepting perspective of yourself when you are unsuccessful. It is known to reduce the suffering that accompanies failure. Self-compassion is also positively associated with positive affect, life satisfaction, optimism, and happiness (Trompetter et al., 2017).
Self-compassion can be broken down into 3 parts: self-kindness, which refers to being friendly and understanding to yourself during stressful times, common humanity, which refers to recognizing failure as a shared human experience, and mindfulness, which refers to attempts to view the situation nonjudgmentally from the outside (Trompetter et al., 2017).
Self-compassionate individuals use less maladaptive emotional regulation strategies found in psychopathologies, such as avoidance and rumination. Therefore, it was hypothesized that self-compassion serves as a moderator in the relationship between positive mental health and psychopathology, with self-compassion occurring with positive mental health contributing more to the absence of mental illness than positive mental health does alone (Trompetter et al., 2017).
A study confirmed that self-compassion did indeed partially mediate the negative relationship between positive mental well-being and the presence of mental disorders, meaning self-compassion in healthy people may be part of the reason why some don’t develop mental illness.
The reason for the success of self-compassionate people may be that they don’t try to change or escape from stressful situations, but just modify the context of the negative experience and shift away from viewing the experience as growing exclusively from personal fault and more towards a shared human experience (Trompetter et al., 2017).
Self-compassionate people can openly expose themselves to stressors while still feeling care and support for themselves and tolerating and calmly understanding the situation and any personal faults (Trompetter et al., 2017). Self-compassion helps people regulate their emotions and perform positive cognitive reappraisal, which refers to the positive subjective interpretation of a situation, and acceptance (Trompetter et al., 2017).
Self-compassion is just one example of a single positive trait having a large effect. High self-forgiveness is associated with less disordered eating (Peterson et al., 2017). Both of these traits can be practiced, offering hope that anyone can receive benefits from them, even if they start with little use of these traits.
This video provides more information about the role of self-forgiveness in positive psychology.
Positive Psychology and Mental Health in Children and Adolescents
Mental health problems manifest differently in children and adolescents, as they have different stressors. They may not have to worry about career success, but academic achievement is important to them. Parenting a child isn’t of their concern, but they have to fight for approval from their mother and father. They don’t need to work to maintain relationships with a spouse, but they may feel isolated from friends or bullied by peers.
Marques, Pais-Ribeiro, & Lopez (2011) investigated the relationship between common traits identified in positive psychology and mental health and academic achievement in Portuguese students. It was shown that students who reported higher measures of hope, life satisfaction and self-worth had better mental health and higher academic achievement (Marque et al., 2011). 2 years later, the students who reported higher positive characteristics were still happier and more successful (Marque et al., 2011). Hope was the strongest predictor of academic achievement, and life satisfaction was the strongest predictor of mental health (Marque et al., 2011). Hopefully, positive psychology can expand on factors that increase hope and life satisfaction in students so that every child may benefit from this relationship.
A 10-session positive psychology course implemented in a middle school provides insight in boosting other positive traits in students (Roth, Suldo, & Ferron, 2017). The sessions involved in-group activities and after school assignments to increase gratitude, kindness, use of strengths, savoring, optimism, and hope (Roth et al., 2017).
First, students completed a writing intervention to envision their best self. For the next two sessions, the students completed gratitude interventions by journaling about what they are grateful for and expressing appreciation to someone who enhances their life. In the fourth session, students were instructed to perform five acts of kindness in one day (Roth et al., 2017).
The next three interventions were designed to help students identify their signature strengths through an assessment called Values in Action Inventory of Strengths for Youth (Roth et al., 2017). The students then applied their signature strengths in new ways and were instructed to savor the positive emotions that came from using their strengths (Roth et al., 2017).
In the next session, students were introduced to an optimistic explanatory style, where positive events are viewed as permanent and resulting from positive personal efforts, and negative events are interpreted as temporary, external, and specific to the context (Roth et al., 2017). Finally, in the last two sessions, students facilitated hopeful thinking, goal setting, and attainment, and reviewed all of the previous strategies (Roth et al., 2017). This successful ten-session intervention provides many ideas for how kids can improve their subjective well-being. By the end of the sessions, the kids experienced increased positive affect and life satisfaction.
Another intervention, this time with first-year college students, had promising effects on thriving and negative emotions. The 90-minute, single-session, positive cognitive intervention focused on character strengths (Bu & Duan, 2019). The session started with Identifying Character Strengths which helps the participants understand the meaning of certain strengths. Begin to determine which strengths are associated with themselves (Bu & Duan, 2019). That activity was followed by Character Strengths 360°.
In this portion of the intervention, participants identified with strength labels through the help of outside observers. Participants could call their parents to talk to them about character strengths and receive feedback on what strengths their parents perceived in them (Bu & Duan, 2019).
The third activity, Signature Character Strengths helped participants to identify and confirm their signature strengths. Lastly, in the Nominate Goals section, participants contemplated the role of their strengths in the future (Bu & Duan, 2019). They prepared to start consciously using the strengths after the interventions. Participants set goals and made plans of action to utilize their strengths in the coming week (Bu & Duan, 2019).
After this intervention, the students experienced significant increases in thriving after the test and 1 week later, and signature decreases of negative emotions up to 3 months later (Bu & Duan, 2019). The more students grew in their strength knowledge the more likely they were to thrive after the session (Bu & Duan, 2019). Hopefully, positive psychology expands, even more, to help more children thrive and cope with mental health issues.
Positive Psychology and Mental Health in Seniors
Most positive psychology research skips over this age group, but there is evidence to suggest positive psychology interventions are just as effective for the older population as they are for others. One online positive psychology intervention found that a combination of four interventions could increase happiness and reduce depressive symptoms for older individuals. Online interventions might be ideal for elders who may not be able to easily travel.
The interventions that led to positive well-being effects in elders were three good things, which involves writing down 3 positive events in the day and why they happened, a gratitude visit, which is thanking a person who has not been thanked so far and reading the letter to the person, using signature strengths in a new way, which involves assessing strengths using a strength inventory and putting them in action, and three funny things, which is writing about the funniest events of your day and why they happened (Proyer, Grander, Wellenzohn, & Ruch, 2014).
Other programs based on autobiographical memory, forgiveness, and gratitude interventions also have shown positive results (Ramírez, Ortega, Chamorro, & Colmenero, 2014). The autobiographical memory intervention was based on life review therapy which helps elders retrieve and sort through their memories. It has been shown to improve mood and depression in the elderly (Ramírez et al., 2014).
In life review therapy, the focus is on positive and specific events found through structured interviews. This technique in conjugation with forgiveness and gratitude interventions decreased state anxiety and depression and increased life satisfaction and subjective happiness in an experimental group of elders (Ramírez et al., 2014). It is worth considering if all positive psychology principles can apply later in life.
Mental Health Books Influenced by Positive Psychology
Books are a great option for those looking to expand their knowledge of the field and its role in mental health. These five books are a great step towards an exceptional understanding of mental health and positive psychology.
1. Therapist’s Guide to Positive Psychology Interventions by Jeana L. Magyar-Moe (2009)
This guide describes the principles and theories of positive psychology as they relate and can be applied to counseling and psychotherapy. It covers the most well-research and effective positive psychology interventions for symptoms of mental illness and includes tools psychologists can use to carry out exercises or make assessments.
2. Positive Psychology for Overcoming Depression: Self-help Strategies for Happiness, Inner Strength and Well-being by Miriam Akhtar (2012)
This self-help book outlines multiple ways people can utilize positive psychology concepts to buffer against symptoms of depression, drawing on real-life case studies. Some of the concepts covered include savoring, gratitude, optimism, and resilience. While this book may be extremely useful, remember that it is often necessary to consult and get help from a certified counselor in real-time.
3. Wellbeing, Recovery, and Mental Health by Mike Slade, Lindsay Oades, and Aaron Jarden (2017)
This book is another great compilation of connections between wellbeing and positive approaches and mental illness recoveries. It includes information on wellness-based therapies, online positive psychology approaches, and recovery communities.
4. The Resilience Factor by Karen Reivich and Andrew Shatte (2002)
This book combines theory and research, offering seven practical strategies to help people overcome adversity, obstacles, and life-altering events.
5. Positivity: Groundbreaking Research Reveals How to Embrace the Hidden Strength of Positive Emotions, Overcome Negativity, and Thrive by Barbara L. Fredrickson (2009)
This book discusses the role of positivity in both enhancing life and relieving depression. It also c
