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Outline

Positive Psychology
Positive Psychology Assessments
Positive psychology Interventions
Application to CLP settings
Literature Evidence
Criticisms
References

POSITIVE PSYCHOLOGY
Positive psychology is the study of how human beings prosper in the face of adversity
(Seligman & Csikszentmihalyi, 2000).Its goals are to identify and enhance the human strengths
and virtues that make life worth living, and allow individuals and communities to thrive.
According to Martin Seligman, before World War II, Psychology had three missions:
curing mental illness, making the lives of all people more fulfilling, and identifying and
nurturing high talent. We have made huge strides in the understanding of and therapy for mental
illness. But the downside was that the other two fundamental missions of psychology-making
the lives of all people better and nurturing "genius"-were all but forgotten. Thus Psychology
was essentially focused on treating mental disorders and paid little attention to transforming
the good in us to better.
But why has psychology been so focused on the negative? Why has it adopted the
premisewithout a shred of evidence that negative motivations are authentic and positive
emotions are derivative? There are several possible explanations according to Seligman.
Negative emotions and experiences may be more urgent and therefore override positive ones.
This would make evolutionary sense. Because negative emotions often reflect immediate
problems or objective dangers, they should be powerful enough to force us to stop, increase
vigilance, reflect on our behavior, and change our actions if necessary. (Of course, in some
dangerous situations, it will be most adaptive to respond without taking a great deal of time to
reflect.) In contrast, when we are adapting well to the world, no such alarm is needed.
Experiences that promote happiness often seem to pass effortlessly. So, on one level,
psychologys focus on the negative may reflect differences in the survival value of negative
versus positive emotions.
Peterson and Seligman (2004) developed a list of 24 strengths organized under six
virtues: wisdom and knowledge, courage, humanity and love, justice, temperance,
transcendence. And the character strengths they organize include curiosity, open-mindedness,
perspective, kindness and generosity, loyalty, duty, fairness, leadership, self-control, caution,
humility, bravery, perseverance, honesty, gratitude, optimism, zest. What is important to note
about the classification for our purposes is that the virtues are treated as logically independent
of each other, as are the strengths. Whether they are correlated is, of course, an empirical
question, but there is no normative suggestion that they should be correlated that they should
all be nurtured nor is there a claim that it is very difficult to exercise one strength effectively
without many of the others.
As envisioned by Seligman (1998b, 1998c), positive psychology has three primary
goals. The first is to delineate and measure positive traits that transcend particular cultures and
politics and approach universality, thus putting us in a position to begin building human
strengths, civic virtues, and the good life. The second goal is to promote positive experiences
and emotions. The third is to create more positive communities and institutions that will
embody and promote these strengths and experiences.
With the advance of research in Positive Psychology, various therapeutic interventions
as well as assessment tools have emerged. These assessments and therapeutic interventions are
applicable to a wide range of population. Some of the assessment tools that are available are as
follows:













Assessment Measures
Attributional Style Questionnaire (ASQ)
Curiosity and Exploration Inventory (CEI-II)
Gratitude Questionnaire - 6 (GQ-6)
Hope Scale (HS)
Inspiration Scale (IS)
Meaning in Life Questionnaire (MLQ)
Mindful Attention Awareness Scale (MAAS)
Older Adults' Attributional Style Questionnaire (OAASQ)
Personal Growth Initiative Scale (PGIS)
Psychological Well-Being Scales
Quality of Life Inventory (QOLI)
Satisfaction with Life Scale
Silver Lining Questionnaire (SLQ)
State-Trait-Cheerfulness Inventory (STCI)
Subjective Happiness Scale (SHS)
Transgression-Related Interpersonal Motivations Inventory (TRIM)
VIA Inventory of Strengths (VIA-IS)
(The questionnaires are available for download at
http://www.ppc.sas.upenn.edu/ppquestionnaires.htm#CEI

POSITIVE PSYCHOLOGY INTERVENTIONS
There is no single form of therapy exclusively focusing on Positive Psychology. However
various brief therapeutic interventions have been suggested that focus on enhancing the 24
character strengths mentioned earlier.
Some of these interventions are as follows:
Strengths Based Counseling
Strengths-Based Counseling is a model for conducting therapy based on the premises
of counseling psychology, prevention, positive psychology, positive youth development, social
work, solution-focused therapy, and narrative therapy (Smith, 2006).
The first three stages of Strengths-Based Counseling (i.e., building a therapeutic
alliance, identifying strengths, and assessing presenting problems) are focused on the creation
of a strong therapeutic alliance via helping clients to identify and use their strengths and
competencies to confront their struggles. At the same time, a thorough assessment of client
perceptions of their problems should occur.
In stage four, therapists set out to encourage and instill a sense of hope in clients by
focusing on and providing feedback to clients based upon their efforts or improvements, rather
than the outcomes of their efforts. In stage five, therapists help clients to frame solutions to
their problems via solution-building conversations. The focus of such conversations is on how
clients are addressing their problems rather than on the problems themselves. Stage six,
building strength and competence, fosters the development of internal and external client assets
by helping clients to realize that they have the power to effect important changes in their lives.
This is accomplished via building upon and fostering personal strengths and environmental
resources throughout the therapeutic process.
Stages seven through nine, empowering, changing, and building resilience, are
designed to promote agency and facilitate goal pursuits. Major components of these stages are:
(a) to help clients develop an awareness of how their problems do not necessarily reside within
them; (b) to help them see that change is a process, not an isolated event; (c) to utilize strengths
to facilitate change; and (d) to view mistakes that occur en route to change as opportunities for
learning, rather than as failures. During these stages, clients are also encouraged to realize
that they have the ability to choose how they will view their adversities in life. This is important
in a CLP setting. Finally, stage ten, evaluating and terminating, allows the therapist and client
to identify the strengths that were most valuable to the change process and
to honor the progress that has been made.
Savoring assignment
One way to increase positive emotions is to savor the pleasures in life. The clients are
asked to plan and implement at least one pleasurable activity while intentionally engaging in
savoring techniques (Rashid, 2008). Savoring entails being aware of pleasures and
purposefully paying attention to the experience of pleasure (Bryant and Veroff, 2002).
In order to savor an event or activity, the following techniques can be utilized
Share the experience with others tell others about the pleasurable experience before it takes
place, engage in the experience with others if possible, and reminisce about the positive
experience with others after it is over.
Memory-building Make mental notes of the event as it is happening and later reminisce about
the event once it is over. If possible, the clients might also take photos or purchase souvenirs
that represent the positive event.
Self-congratulation the clients are asked to congratulate oneself or take pride in what has
happened. They are instructed to sharpen their perceptions Be mindful of important elements
of the event while blocking out distractions or kill-joy thinking. (Kill-joy thinking is one way
to kill savoring. This type of thinking occurs when one begins to think about how the positive
event is not as good as someone elses or how it could be better, when one begins to think of
things you could/should be doing instead, or when you get distracted by thoughts unrelated to
the pleasurable experience.)
Absorption Let oneself get totally absorbed in the event.
Forgiveness Exercises
Forgiveness involves letting go of the emotional grudges one has towards a transgressor.
Forgiveness can be both for somebody else as well as oneself. One of the most common way
of letting go is a forgiveness letter. The instructions for the same are given below.

Forgiveness letter instructions
Think of a person from your past who you are holding a grudge against or have been in
conflict with. How is this grudge affecting you? How is it affecting the other person? Those
who study forgiveness have discovered that forgiving does not mean forgetting, condoning,
pardoning, or excusing the transgression and the goal of forgiveness is not necessarily
reconciliation (Enright and Coyle, 1998; McCullough and Witvliet, 2002; Seligman,
2002). Rather, forgiveness is something you do for yourself in order to reduce your level of
psychological distress through the release of toxic negative emotions. To help get you started
down the path of forgiveness, you are being asked to write a letter in which you describe a
transgression that has been committed against you and the emotions related to that
transgression.
There are a number of exercises that can be used to foster forgiveness in addition to the
writing of forgiveness letters. More specifically, therapists can help clients work toward
forgiveness by engaging them in emotional storytelling, finding benefits in adversity, and
letting go of grudges.

Finding Benefits in Adversity
King and Miner (2000) suggest that an alternative to Pennebakers emotional storytelling
entails having clients write about the benefits that have resulted from their traumatic
experiences.

Gratitude journals
Many people find it easier to think about the things that did not go well throughout their days
rather than the many things that did go well. This tendency to focus on the negative while
overlooking the positive is a bias in human thinking referred to as the fundamental negative
bias. The clients are asked to keep a journal for the next several weeks in which they will write
down three good things that happened to them each day in order to manually override the
fundamental negative bias. In addition to keeping an individual daily gratitude journal, some
clients may find it useful to engage in gratitude activities that involve their significant others
or family members such as keeping a couple gratitude journal.

Mindfulness meditation
Mindfulness refers to being in the here and now. Another dimension to it is the non-
judgemental attitude that is practiced. Thus, it refers to focusing attention on the current
situation, using all the sensory organs to experience the moment with an attitude of acceptance
and non-criticality. Mindfulness meditation is found to be helpful in many anxiety and mood
disorders.





ABCDE disputation
There are several key differences between how pessimistic and optimistic people tend
to think about the bad and good things that happen to them (Seligman, 1991, 1998; Seligman
et al., 1995). More specifically, people who are optimistic make external, variable, and specific
attributions for failure-like events rather than the internal, stable, and global attributions made
by pessimists. Learning to consider alternative explanations for adverse events and to choose
the one that is most variable and specific (rather than stable and global) is key to increasing
optimism. The ABCDE technique involves the client effectively disputing his or her thoughts
in a variety of situations and finding out concrete evidence that the beliefs are faulty. In this
exercise clients are asked to pay attention to any Adverse experiences that they have over the
course of the next few weeks that lead them to think like a pessimist. Next, they are asked to
write down their Beliefs about the adverse events and the Consquences of these pessimistic
beliefs. Then they are asked to vigorously Dispute their current beliefs in order to feel more
Energized and optimistic about the adversities.

Thus although most of these techniques are self-explanatory and can be practiced
without the help of a therapist, it should be noted that these techniques are no substitute for
psychotherapy. It is important to reiterate the need to begin therapy by completing the process
of positive psychological assessment Once such information has been gathered, the next
essential step in the therapy process is to share the findings of this thorough assessment process
directly with clients and to collaboratively work toward developing treatment plans that will
help them move toward experiencing complete mental health.








Application to a Consultation Liaison Psychiatry setting
Liaison psychiatry, also known as consultative psychiatry or consultation-liaison
psychiatry specialises in the interface between medicine and psychiatry, usually taking place
in a hospital or medical setting. The role of the consultation-liaison specialist is to see patients
with comorbid medical conditions at the request of the treating medical or surgical consultant
or team. Liaison psychiatry has areas of overlap with other disciplines including psychosomatic
medicine, health psychology and neuropsychiatry. Very often in a CLP setting, the focus is on
the here and now. However these exercises can be taught to the clients as home-work
exercises.
One of the most common Axis 1 disorders in a CLP setting is depression. Various
studies have shown the improvement of depressive symptoms using positive psychology
interventions (Sin et all, 2009). One another common concern in a CLP setting is pain- eg
Cancer pain, pain after surgery etc. Various mindfulness based interventions can help in the
reduction of pain. In a department like Physical Medicine and Rehabilitation, these techniques
can be incorporated into the strengths based approach that is typically followed. Exercises such
as gratitude letters or forgiveness create a surge of positive emotions that can be therapeutic.
However, while applying them to an Indian setting, the literacy levels of the client, their cultural
background and their physical ability to practice them should be taken into consideration. For
example the gratitude letter can be modified into a prayer that suits the cultural beliefs of the
client. Thus these techniques, like any other psychotherapy techniques should be tailor made
and not applied at a generic scale.

Research Evidence
Indeed, a variety of researchers have found positive relationships between finding
meaning in traumatic experiences and effective coping, psychological adjustment, higher self-
esteem, and fewer symptoms of depression (J anoff-Bulman, 1992; Taylor, 1983; Tennen et al.,
1991a,b; Freedman and Enright, 1996). King and Miner (2000) found that individuals
who were instructed to write about only the positive aspects of negative or traumatic events
(i.e., writing about the positive aspects of and how one has grown or benefited as a result of a
negative event) for 20 minutes a day for three days showed the same health benefits as those
who were instructed to write about their most traumatic life experiences. Hence, having clients
write about the perceived benefits of their negative experiences may be a great alternative to
having them experience or re-experience the pain of their past traumas through emotional
storytelling.
A meta-analysis of 39 studies by Bolier et al (2013) suggested that positive psychology
interventions can be effective in the enhancement of subjective well-being and psychological
well-being, as well as in helping to reduce depressive symptoms.

In another meta analysis of 16 studies by Grau et al (2013) on positive psychological
interventions among breast cancer patients, five groups of therapies were found: mindfulness-
based approaches, expression of positive emotions, spiritual interventions, hope therapy, and
meaning-making interventions. These specific interventions promoted positive changes in
breast cancer participants, such as enhanced quality of life, well-being, hope, benefit finding,
or optimism. However, the disparity of the interventions and some methodological issues limit
the outcomes.
Sin et al (2009) conducted a meta-analysis of 51 interventions (intentional activities
aimed at cultivating positive feelings, positive behaviors, or positive cognitions) with 4,266
individuals. The results revealed that positive psychology interventions do indeed significantly
enhance well-being (mean r=5.29) and decrease depressive symptoms (mean r=5.31). In
addition, several factors were found to impact the effectiveness of positive psychology
interventions, including the depression status, self-selection, and age of participants, as well as
the format and duration of the interventions.
A summary of studies of self administered positive psychology interventions over
control conditions by Layous et al (2011)is given in the following table. Thus research seems
to suggest that positive psychology interventions enhance wellbeing, if they are used
appropriately.

Criticisms
Like other branches of Psychology, Positive Psychology is also not without its
criticisms. One legitimate criticism of positive intervention research is that it is difficult to
determine what actually counts as a positive intervention. Another common criticism of
positive psychology is that it adopts a Pollyanna' mentality where everything in life is seen
through rose coloured glasses and the aim is to achieve constant happiness. Another criticism
is that positive psychology was more focused on the positive, and therefore didnt want
anything to do with the negative, and therefore it would do the same things as traditional
psychology had done, by just looking at one end of the spectrum.
However, the intent of positive psychology is not to create a positive and negative
dichotomy or a hierarchy where positive phenomena are always viewed as being superior to
negative ones, but rather to recognise and appreciate the complementary roles of both negative
and positive experiences and to pursue the ideal ratio of positive to negative experiences for
optimal health.

















References

Bolier et al.(2013). Positive psychology interventions: a meta-analysis of randomized
controlled studies. BioMedCentral Public Health. 13:119

Cowen E L., Kilmer R. (2002) Positive psychology: Some plusses and some Open issues.
J ournal of Community Psychology, Vol. 30, No. 4, 449460

Csikszentmihalyi M.(1990). Flow: The Psychology of Optimal Experience. New York: Harper
and Row

Froh, J .J . (2004) The History of Positive Psychology: Truth Be Told. NYS Psychologist.
Retrieved from
http://people.hofstra.edu/J effrey_J _Froh/Froh,J .J ._The%20History%20of%20Pos%20
Psych%282004%29.pdf

Grau, A.C.,Font, A.,Vives, J . (2014).Positive psychology interventions in breast cancer: A
systematic review. Psycho-Oncology 23: 919 DOI: 10.1002/pon

Layous, et al. (2011). Delivering Happiness: Translating Positive Psychology Intervention
Research for Treating Major and Minor Depressive Disorders The Journal Of
Alternative And Complementary Medicine. Volume 17, pp. 19

Leigh, H. & Streltzer, J . (2008). Handbook of Consultation-Liaison Psychiatry.New York:
Springer Publications

Lewis hall, Langer R, Mcmartin J . (2010). The role of suffering in human flourishing:
contributions from Positive psychology, Theology,and Philosophy. Journal of
Psychology and Theology Vol. 38, No. 2, 111-121

Lopez S. J & Magyar-Moe J . L.(2006). A Positive Psychology That Matters. The Counseling
Psychologist 2006 34: 323 DOI: 10.1177/0011000005284392

Lopez SJ , Floyd RK, Ulven J C, Snyder CR (2000). Hope therapy: helping clients build a house
of hope. In: Snyder CR, ed. Handbook of Hope. New York: Academic Press; 123150.

Rathunde K.(2001). Toward a Psychology of Optimal Human Functioning: What Positive
Psychology Can Learn from the ''Experiential Turns'' of J ames, Dewey, and Maslow.
Journal of Humanistic Psychology, Vol. 41 No. 1, 135-153DOI:
10.1177/0022167801411008
Seligman MEP (2000), Csikszentmihalyi M. Positive psychology: an introduction. American
Psychologist. ;55:514.

Seligman, M. (1991). Learned optimism. NY: Knopf.

Sin et al (2009). Enhancing Well-Being and Alleviating Depressive Symptoms With Positive
Psychology Interventions: A Practice-Friendly Meta-Analysis. Journal Of Clinical
Psychology: In Session, Vol. 65(5), 467487.

Snyder C. R., Ingram . E.(2006). Blending the Good With the Bad: Integrating Positive
Psychology and Cognitive Psychotherapy. Journal of Cognitive Psychotherapy: An
International Quarterly Volume 20, Number 2

Snyder C.R., Lopez S.J .(2002) Handbook of Positive Psychology, Oxford university Press.

Strumpfer, D. J . W. (2005). Standing on the shoulders of giants: Notes on early positive
psychology (Psychofortology). South African J ournal of Psychology, 35(1), 2145
Positive Psychology Interventions
in a CLP setting
























"Psychology is not just the study of weakness and damage; it is also the
study of strength and virtue. Treatment is not just fixing what is broken; it is
nurturing what is best within ourselves." - Martin Seligman

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