CEP Workshop Series 2013

Module 2: Well-being & Recovery

Fraser Todd and Michelle Fowler
2013
Workshop Introduction
Workshop Agenda
Mihi and Introductions
Housekeeping & Workshop overview
Review of Introductory Workshop Information
Exercise 1 The Case of Rachel
What is Recovery?
Dimensions of Well-being
Determinants of Well-being
Enabling and Enhancing Well-being
The Case of Rachel Bringing Well-being into CEP Practice
Action Planning
Thinking About CEP
Simple-Complicated-Complex:
Learning About CEP:
Thinking About CEP
Three Dimensions of CEP Practice
Spirit Principles - Techniques:
SpiriL
7 Key Principles
Techniques
1. Cultural Considerations
2. Recovery & Well-being
3. Engagement
4. Motivation
5. Assessment
6. Management
7. Integrated Care
Person-focused care
Well-being orientated care Integrated care
Walk the Talk
Wellbeing & Recovery Across the Three
Dimensions
SpiriL
Principles
Techniques
Well-being & Recovery
Overarching goal of treatment
Personal definition and pathways to wellbeing
Care integrated by planning interventions to enhance wellbeing
Treatment of dysfunction and disability only as indicated
by wellbeing goals
Support personal autonomy towards recovery goals
Well-being & recovery strategies (next slide)
Central place of the definition of wellbeing to ensure
care is person-centred
Wellbeing & Recovery Across the Three
Dimensions
SpiriL
Principles
Techniques
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ldenufy values values card sorL, paper card sorL, schlzophrenla/Leen
verslons
ldenufy CharacLer SLrengLhs CharacLer sLrengLhs 72, vlA slgnaLure sLrengLhs
ldenufy Wellbelng 8esL posslble selves
ldenufy meanlng & purpose lasL forward (reuremenL) exerclse, Walklng Lowards yourself
Pope & Cpumlsm CrauLude vlslL, CounL your blesslngs, besL posslble selves
lmprovlng soclal
relauonshlps
8andom acLs of klndness, osluve Communlcauon
Lnhance posluve emouons Savorlng, Lhree good Lhlngs, counL your blesslngs
LngagemenL wlLh llfe llow acuvlues
AccompllshmenLs new skllls and hobbles (apply key sLrengLhs)
Low self-esLeem Lovlng klndness medlLauon
asL Lrauma lorglveness
Sense of Coherence CrauLude acuvlues,
AppreclaLe Lhe posluve Savorlng, grauLude acuvlues
Self-esLeem Lovlng klndness MedlLauon and Self-compasslon
Barriers to Well-being
Finances
Accommodation
Unemployment
Mental Illness
Family tensions
etc
Relationships
Substance Use
Pathways to Well-being
Pleasure Character
Strengths
+ve Activities
Enabling
Institutions
+ve Relationships
Optimism
etc
Well-being & Recovery & the 7 Key Principles
Well-being
1. CulLural
values and denluons of well-
belng vary ln dlerenL culLures
CollecuvlsL v lndlvldual
CLher mlnorlLy culLures
e.g. gay, youLh, drug uslng
Well-belng
3. LngagemenL
LngagemenL by expllclL focus
on person's denluon of well-
belng
eople engage wlLh Lhlngs LhaL
have meanlng for Lhelr llfe as a
whole
4. Mouvauon
use values, hopes and
asplrauons as Lhe rauonale for
LreaLmenL
eople are mouvaLed by Lhose
Lhlngs LhaL have mosL meanlng
Lo Lhem
Well-belng goals are more
mouvaung LhaL healLh
goals
3. AssessmenL
8egln assessmenL by lncludlng
fuLure hopes and asplrauons
roblems placed ln Lhe conLexL
of values, sLrengLhs & vlslon of
well-belng
lormulauon as narrauve
of Lhe person's llfe
6. ManagemenL
Coals & ouLcomes clearly
aruculaLe quallLy of llfe as Lhe
key ouLcome soughL
lncorporauon of posluve
lnLervenuons lnLo LreaLmenL
plan
7. lnL. Care
lnLegraLe care be placlng well-
belng of LangaLa whalora aL Lhe
cenLre
llL LreaLmenLs around needs of
LangaLa whalora
Lecuve collaborauon Lo
meeL needs
Exercise 2: The Case of Rachel
Small Group Recovery and Wellbeing exercise
See Handbook for details
1. What is Recovery & Well-being?
What is Recovery & Well-being?
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Muluple unlque paLh Lo recovery
Pope
Self-responslblllLy
Meanlng as a valuable member of socleLy
ldenuLy dlsuncL from LhaL of 'pauenL' or 'consumer'
llndlng a valuable nlche
What is Recovery?
Key Aspects of Recovery:
What is Well-being?
Overview of Well-being
Terms and Definitions :
Happiness - Hedonic & Eudaimonic
Subjective Well-being (Diener)
Life Satisfaction + Emotional (Positive and
Negative Affect)
Psychological Well-being (Ryff)
Quality of Life (WHOQOL)
Flourishing (Keyes)
Flourishing (Seligman) - PERMA
What is Well-being?
Dimensions of Well-being :
Ryff - Psychological Well-being
self-acceptance
positive relations with others
autonomy
environmental mastery
purpose in life
personal growth
Quality of Life (WHOQOL)
Social
Psychological
Environmental
Physical
Flourishing (Seligman) PERMA
Flourishing (Keyes)
What is Well-being?
Complete State Model of Mental Health (Keyes):
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keyes CLM:
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What is Well-being?
Flourishing (Keyes) :
Pedonla (of Lhe followlng Lwo Lo a hlgh level):
1. osluve AecL - pasL 30 days
2. Avowed happlness or avowed llfe sausfacuon
osluve luncuonlng (slx of Lhe followlng Lo a hlgh level):
3. Self-accepLance
4. Soclal accepLance
3. ersonal growLh
6. Soclal acLuallzauon
7. urpose and meanlng ln llfe
8. Soclal conLrlbuuon
9. LnvlronmenLal masLery
10. Soclal coherence
11. AuLonomy
12. osluve relauons wlLh oLhers
13. Soclal lnLegrauon
What is Well-being?
Flourishing - Hedonia (1 of 2) :
1. osluve aecL:
8egularly cheerful, ln good splrlLs, happy, calm and peaceful, saused, and full of llfe
(pasL 30 days))
2. Avowed happlness and llfe sausfacuon:
leels happy or saused wlLh llfe overall or domalns of llfe
What is Well-being?
Flourishing - Positive Functioning (six of 3-13) :
1. Self accepLance:
Polds posluve amLudes Loward oneself & pasL llfe, accepLs varled aspecLs of self
2. Soclal accepLance:
Pas posluve amLude Lowards oLhers whlle acknowledglng & accepung peoples dlerences &
complexlLy
3. ersonal growLh:
Shows lnslghL lnLo own poLenual, sense of developmenL, & open Lo new and challenglng
experlences
4. Soclal acLuallzauon:
8elleves LhaL people, soclal groups, & socleLy have poLenual & can evolve or grow posluvely
3. urpose and meanlng ln llfe:
Polds goals & bellefs LhaL amrm sense of dlrecuon ln llfe, feels LhaL llfe has a purpose & meanlng
6. Soclal conLrlbuuon:
leels LhaL ones llfe ls useful Lo socleLy & Lhe ouLpuL of hls or her own acuvlues are valued or
valuable
What is Well-being?
Flourishing - Positive Functioning (six of 3-13) :
7. LnvlronmenLal masLery:
LxhlblLs capablllLy Lo manage complex envlronmenL, & can choose or manage and mold
envlronmenLs Lo sulL needs
8. Soclal coherence:
lnLeresLed ln socleLy or soclal llfe: feels socleLy & culLure are lnLelllglble, somewhaL loglcal,
predlcLable & meanlngful
9. AuLonomy:
LxhlblLs self-dlrecuon LhaL ls oen gulded by hls or hr own soclally accepLed &
convenuonal lnLernal sLandards & reslsLs unsavory soclal pressures
10. osluve relauons wlLh oLher:
Pas warm, sausfylng, Lrusung personal relauonshlps & ls capable of empaLhy and lnumacy
11. Soclal lnLegrauon:
Pas a sense of belonglng Lo a communlLy & derlves comforL & supporL from communlLy
What is Well-being?
Languishing (Keyes) :
Pedonla (1 of 2 Lo a low level)
osluve luncuonlng (slx of 3-13 low level)
What is Well-being?
Keyes Sample of US Adults:
0
10
20
30
40
30
60
70
80
90
100
MenLal lllness no MenLal lllness
37
17
12
llourlshlng
Langulshlng
Mod MenLal PealLh
keyes, C. 1he !ournal of PealLh and Soclal 8ehavlor (2002) 43(2) 207-222
Rachel Flourishing or Languishing?
Flourishing or Languishing? :
<928.92:3 E24EG /:? :9 H I3.789=/J
1 osluve aecL low
2 Llfe sausfacuon 0
3 Self-accepLance low
4 Soclal accepLance low
3 ersonal growLh low
6 Soclal acLuallzauon 0
7 urpose and meanlng ln llfe 0
8 Soclal conLrlbuuon 0
9 LnvlronmenLal masLery 0
10 Soclal coherence 0
11 AuLonomy 0
12 osluve relauons wlLh oLhers low
13 Soclal lnLegrauon 0
2. Determinants of Well-being
Determinants of Well-being
Social The Big 7:
(E. K24 L F=68:95 #>.6M34 ,-KN
1. lamlly relauonshlps - @":2=8' =*)'-
2. llnanclal slLuauon - relauve lncome, soclal comparlson
3. Work - unemploymenL
4. CommunlLy and frlends - +':'+ 2> )=5-), 0'06'=-$"1 2> (2(M='+"#"25- 2=#*("N*92(-
3. PealLh
6. ersonal freedom OP5*+")/ 2> Q2:'=(0'()R
M rule of law, vlolence, corrupuon, eecuveness of governmenL servlces, opporLunlLy
7. ersonal values - care abouL oLhers v care abouL self, bellef ln Cod
ST1+*"(- LCU 2> :*="*(8' "( .;V 6')4''( 825()="'-
ST1+*"(- DFU 2> :*="*(8' "( -5"8"@' =*)'- 6')4''( 825()="'-
Determinants of Well-being
Social Well-being :
nauonal lncome
SLandard of llvlng
Change ln Cender 8oles
1elevlslon
Soclal order
Crlme
CrowLh of lndlvlduallsm
Cllnlcal depresslon
SubsLance use
Determinants of Well-being
Factors that Influence Individual SWB :
Zero to Small Moderate Large
Age Number of friends Gratitude
Gender Being married Optimism
Education Religiousness Being employed
Social class Level of leisure activity Frequency of sexual intercourse
Income Physical health % time experiencing positive affect
Having children Conscientiousness Happiness of identical twins
Ethnicity (majority v minority) Extraversion Self-esteem
Intelligence Neuroticism (negative correlation)
Physical attractiveness Internal locus of control
osluve Correlauons wlLh Papplness and Llfe Sausfacuon
eLerson, C. A prlmer ln posluve psychology (2006) pg 92
Exercise 3: Personal Responsibility
Take a minute or two to reflect on the socal determinants of well-being.
How do you act in your daily interactions with friends, family and
tangata whaiora to enable their well-being?
3. Enabling & Enhancing Well-being
Enabling and Enhancing Well-being
Well-being and Change :
lnLenuonal
AcuvlLy
40
SeL olnL
30
ClrcumsLances
10
Enabling and Enhancing Well-being
Well-being Strategies and Positive Interventions :
A loL of research, buL Lhe eld ls sull lmmaLure
Cauuon: many suggesLed lnLervenuons LhaL have no evldence base
Powever, many do.
lor a descrlpuon of a large number of evldence based lnLervenuons.
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,82( V22X- OYZR BC[C
Enabling and Enhancing Well-being
General Comments :
lor a descrlpuon of a large number of evldence based lnLervenuons.
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'ShoLgun approach' may be beuer (prescrlbed several lnLervenuons aL once)
Mouvauon & durauon
1hose who chose/self-selecL and who conunue Lo use lnLervenuons do much beuer
llL
noL all lnLervenuons sulL everybody. llL Lhe persons preference Lo Lhe lnLervenuon.
1hree clusLers of preference (l.e. people Lend Lo prefer one clusLer):
l. Acuve-consLrucung and savorlng
ll. 8lesslngs and llfe summary
lll. CrauLude and sLrengLhs
negauve eecLs
lor some, posluve lnLervenuons may worsen well-belng:
! Low llfe sLress + valulng happlness hlghly
! needy people may experlence lowered self-esLeem on lndependenL and solo Lasks
Enabling and Enhancing Well-being
Strategies to Enhance Well-being - Lyubomirsky:
Enabling and Enhancing Well-being
Seligmans PERMA Pathways to Flourishing :
O:52M@. )P:M:35
Savorlng pasL achlevemenLs and successes
CrauLude - counL your blesslngs, Lhree good Lhlngs
Losada 8auo: + Lo - emouons 3:1
)ngagemenL
llow acuvlues
*elauonshlps
8andom acLs of klndness
osluve communlcauon - Acuve ConsLrucuve (demonsLraLe enLhuslasm ln
responses, oer supporL) cf passlve consLrucuve or acuve/passlve desLrucuve responses
Qeanlng and purpose
lasL lorward Lxerclse - fasL forward Lo Lhe end of your llfe, noLe whaL you wanL
Lo be remembered for, by whom, and whaL accompllshmenLs and sLrengLhs
would you wanL oLhers Lo Lalk abouL
#ccompllshmenLs
Savor pasL accompllshmenLs
Work Lo develop masLery over new skllls and hobbles (use sLrengLhs)
Positive lnterventions for Specific Purposes
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ldenufy values values card sorL, paper card sorL, schlzophrenla/Leen verslons
ldenufy CharacLer SLrengLhs CharacLer sLrengLhs 72, vlA slgnaLure sLrengLhs
ldenufy Wellbelng 8esL posslble selves
ldenufy meanlng and purpose lasL forward (reuremenL) exerclse, Walklng Lowards yourself
Pope & Cpumlsm CrauLude vlslL, CounL your blesslngs, besL posslble selves, open mlndseL
lmprovlng soclal relauonshlps 8andom acLs of klndness, osluve Communlcauon
Lnhance posluve emouons Savorlng, Lhree good Lhlngs, counL your blesslngs, Losada rauo
LngagemenL wlLh llfe llow acuvlues
Lnhanclng accompllshmenLs new skllls and hobbles (apply key sLrengLhs)
Low self-esLeem Lovlng klndness medlLauon
asL Lrauma, lnLerpersonal
sensluvlLy
lorglveness
Sense of Coherence CrauLude acuvlues,
AppreclaLe Lhe posluve Savorlng, grauLude acuvlues
Self-esLeem Lovlng klndness MedlLauon and Self-compasslon
Sesslon 1: AssessmenL
Sesslon2: 1reaLmenL lannlng and negouauon
Sesslons 3-10: 8+ SLrucLured Sesslons 30-60 mlnuLes
SLrucLured Sesslon:
1. Lnhance mouvauon and seL agenda (3 mln)
2. 8evlew goals, pasL week, sympLoms, homework, adherence
3a. Speclc lnLervenuon (10-20 mln)
3b. Speclc lnLervenuon (10-20 mln)
4. 8evlew sesslon, relnforce CommlLmenL 1alk and Well-belng vlslon (10
mln)
Bringing Well-being into CEP Practice
Structured Sessions:
lnLegraLe key sLraLegles lnLo follow-up/Lherapy sesslons
Bringing Well-being into CEP Practice
Structured Follow-up Session:
1
1ake opporLunlues Lo reecL and summarlse
Change Lalk
CommlLmenL Lalk
Well-belng Lalk
3a
2
3b 4
Bringing Well-being into CEP Practice
Structured Follow-up Session Planning Template:
4: The Case of Rachel
Exercise 4: The Case of Rachel
Small Croup Lxerclse
See Pandbook for deLalls
Rachel
Opinion :
#R25 SN
Ma[or uepresslve ulsorder
1Su
Alcohol dependence wlLh physlologlcal dependence
Cannabls dependence wlLh physlologlcal dependence
nlcoune dependence wlLh physlologlcal dependence
B.A #.M:/:426=/ O9:1/.P5N
negauve emouonallLy
negauve rumlnauons
Pyper-arousal and lnLruslve memorles from rape
oor auenuon conLrol
negauve urgency
lmpulslvlLy
AvoldanL coplng sLyle
SLressful relauonshlp wlLh parLner
SLress of carlng for young chlld
Lack of asseruveness ln relauonshlps (dependenL LralLs)
Exercise 4a: The Case of Rachel
\')5=( )2 /25= -0*++ #=251-
W112"() * -8="6' *(@ 1'=-2( )2 >''@6*8X
\':"'4 )$' ?*-' 2> \*8$'+
1hlnk abouL LreaLmenL ln Lerms of sLrucLured sesslons
1. AssessmenL
2. 1reaLmenL lannlng and negouauon
3. 8+ SLrucLured Sesslons
,.552:3 SN #55.55P.38
WhaL wlll you do Lo brlng wellbelng lnLo Lhe assessmenL process?
When would you do lL?
Rachel
Personal Values and Character Strengths :
(:C T <E=9=68.9 ,89.348E5N
1. lalrness
2. klndness
3. CurloslLy
O.95:3=/ +=/7.5 )R.9625.
1. lamlly
2. Self-accepLance
3. urpose
Rachel
WHOQOL-BREF :
Pow would you raLe your quallLy of llfe = 3 (nelLher poor nor good
Pow saused are you wlLh your healLh = 2 (ulssaused)
(ouL of 3)
uomaln 1: hyslcal PealLh 36
uomaln 2: sychologlcal 31
uomaln 3: Soclal relauonshlps 44
uomaln 4: LnvlronmenL 30
(ouL of 100) - norms around 70, sd's around 12-13
Rachel
Vision of Well-being :
K.58 O:5521/. ,./D IU V.=95J
Close relauonshlp wlLh her daughLer, avallable as a supporuve lovlng moLher
Pave a happy supporuve lovlng famlly
leellng relaxed and generally overall wlLhln myself
Mood sLable, good sleep, healLhy llfesLyle
Worklng ln a [ob LhaL was sausfylng and had purpose
Smokefree, cannabls free, Lo be drlnklng less and ln conLrol of Lhls
llnanclally sLable
SLable relauonshlp wlLh a lovlng, supporuve and communlcauve parLner
ComforLable ln soclal slLuauons
Pobbles LhaL l en[oy
Supporuve frlends
Rachel Flourishing or Languishing?
Flourishing or Languishing? :
<928.92:3 E24EG /:? :9 H I3.789=/J
1 osluve aecL low
2 Llfe sausfacuon 0
3 Self-accepLance low
4 Soclal accepLance low
3 ersonal growLh low
6 Soclal acLuallzauon 0
7 urpose and meanlng ln llfe 0
8 Soclal conLrlbuuon 0
9 LnvlronmenLal masLery 0
10 Soclal coherence 0
11 AuLonomy 0
12 osluve relauons wlLh oLhers low
13 Soclal lnLegrauon 0
Exercise 4b: The Case of Rachel
,( /25= -0*++ #=251-H
Sesslon 2: 1reaLmenL lannlng
ulscuss Lhe speclc posluve lnLervenuons you mlghL use.
Why would you plck Lhese ones?
Rachel
Standard Treatments:
Q.;26=M:3
SS8l, 8lsperldone aL nlghL for 1Su, conslder nalLrexone for alcohol
O5A6E:/:426=/ &38.9@.3M:35
Coplng skllls lncludlng mlndfulness, dlsLress Lolerance
8elapse prevenuon
lmaglnal densluzauon
"8E.9
lamlly educauon and supporL
Exercise 4c: The Case of Rachel
)R.9625. W6 *=6E./N F://:?07C ,.552:3 ,8976879.
,( /25= -0*++ #=251-
Sesslons 3-8 AssessmenL:
uslng Lhe LemplaLe below, dlscuss when you would use Lhe speclc lnLervenuons
across Lhe sesslons 3-8.
ln column 3a brley enLer Lhe sLandard LreaLmenLs you would plan
ln column 3b enLer Lhe posluve lnLervenuons you would plan
(spend conslderably more ume on Lhe posluve lnLervenuons
Rachel
Further Interventions for Rachel :
racuce AC responses - daughLer, parLner, famlly, frlends
Meanlng and urpose ln Llfe -lasL lorward Lxerclse
CharacLer SLrengLhs
apply your sLrengLh of curloslLy ln a new way, each day for a week
8andom AcLs of klndness
each day for a week, Lake Lhe opporLunlLy Lo do someLhlng klnd for anoLher
person wlLhouL expecung lL Lo be reclprocaLed
Lovlng klndness MedlLauon
lorglveness (lncludlng self-forglveness)
Exercise 5: Enabling Institutions
Take a minute or two to reflect on the principles of well-
being and recovery how they might apply the institution
or service you work in.
How well does this institution or service enable well-being
in its staff? In its tangata whaiora?
Action Plans