Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders

Well-being therapy and sleep hygiene in a non-clinical population of adults reporting poor sleep quality and distress: A remote pilot randomized controlled study

OBJECTIVES

This pilot randomized controlled study evaluates the feasibility and preliminary efficacy of a 7-week remote intervention combining well-being therapy and sleep hygiene to improve sleep and psychological outcomes among adults reporting poor sleep and distress.

METHODS

Thirty-one participants (81% women, 40.2 ± 13.0 y, 48% racial/ethnic minority) were recruited from the community during the COVID-19 pandemic through online and local advertisement, and randomized to well-being therapy+sleep hygiene or sleep hygiene-only. Study outcomes were evaluated by self-reported questionnaires administered at baseline and post-intervention and a daily sleep diary.

RESULTS

Compared to sleep hygiene-only, well-being therapy+sleep hygiene led to greater improvements in wake after sleep onset (time-by-group interaction: 3.6 ± 1.5 min, p = .017), personal growth (β -3.0, 95%CI -5.2, -0.8, p = .01), and purpose in life (β -3.5, 95%CI -6.1, -0.9, p = .009). Anxiety, perceived stress, sleep quality, and insomnia symptoms improved similarly in both groups (between-group differences, p > .05). Improvements in sleep quality, insomnia, and sleep duration were associated with reductions in multiple measures of psychological distress (all p < .05).

CONCLUSIONS

These findings suggest that, in a non-clinical setting of individuals suffering from combined poor sleep and psychological distress, the addition of well-being therapy to sleep hygiene may provide additional benefits for sleep by promoting sleep continuity and well-being.

First validation of the model of sustainable mental health: Structural model validity and the indirect role of adaptation

OBJECTIVES

There is a growing interest in mental well-being as a vital outcome in clinical practice in addition to mental illness. The model of sustainable mental health (SMH) was recently introduced to delineate how interventions can improve mental health by targeting barriers and resources of adaptation to life stressors, improving the ability to adapt and thereby reducing mental illness and improving mental well-being. The aim of the current study is to empirically validate the conceptual model of SMH as well as the assumed indirect role of ability to adapt.

METHODS

This study used an existing dataset of the general population with self-reported reduced well-being due to the corona crisis (n = 849, mean age 53 years, SD = 15). Measurements of mental illness (depression and anxiety), mental well-being, ability to adapt, a specific barrier for adaptation (i.e., repetitive negative thinking), and a specific resource for adaptation (i.e., positive reframing) were included. Structural equation modeling was used to assess both the structural validity of the model and the indirect effect of ability to adapt.

RESULTS

An acceptable to good fit was found for the model of SMH and all paths between the proposed elements of the model were significant and in the hypothesized direction. Ability to adapt served as an indirect pathway trough which repetitive negative thinking (B = 0.149, 95% confidence interval [CI] = 0.016-0.028) and positive reframing (B = 0.163, 95% CI = 0.065-0.123) were linked with mental illness and mental well-being.

CONCLUSION

The current study provides the first empirical support of the internal validity of the model of SMH in a sample of the general population with reduced well-being, suggesting that barriers and resources to adaptation have an effect on mental illness and mental well-being through the ability to adapt. The model of SMH may therefore be a good model to use in research and clinical practice for developing, implementing, and evaluating a balanced treatment approach targeting both barriers and resources for adaptation.

The Mental Illness-Health Matrix and the Mental State Space Matrix: Complementary meta-conceptual frameworks for evaluating psychological states

OBJECTIVE

It is increasingly appreciated that mental health may not just involve a relative absence of mental illness, but the active presence of positive psychological desiderata. However, research attention on mental illness and health has tended to remain siloed and disconnected-proceeding along parallel tracks-with their potential relationship underexplored and undertheorized. As such, we sought to develop theoretical models to help us better understand the interaction of these two domains of experience.

METHODS

Through extensive engagement with relevant literature, we created two complementary meta-conceptual frameworks to represent and evaluate states of mental illness and health.

RESULTS

The Mental Illness-Health Matrix allows different forms of mental illness and health to be situated and assessed within a common framework. The Mental State Space Matrix further enables these various forms to be conceptualized and appraised in terms of numerous common parameters (e.g., valence and arousal).

CONCLUSION

It is hoped that these frameworks will stimulate and support further research on the inter-relational dynamics of illness and health. Indeed, the matrices themselves are provisional works-in-progress, with their articulation here intended as a foundation for their further development as understanding of these topics evolves and improves.

Personalised app-based relapse prevention of depressive and anxiety disorders in remitted adolescents and young adults: a protocol of the StayFine RCT

INTRODUCTION

Youth in remission of depression or anxiety have high risks of relapse. Relapse prevention interventions may prevent chronicity. Aim of the study is therefore to (1) examine efficacy of the personalised StayFine app for remitted youth and (2) identify high-risk groups for relapse and resilience.

METHOD AND ANALYSIS

In this Dutch single-blind parallel-group randomised controlled trial, efficacy of app-based monitoring combined with guided app-based personalised StayFine intervention modules is assessed compared with monitoring only. In both conditions, care as usual is allowed. StayFine modules plus monitoring is hypothesised to be superior to monitoring only in preventing relapse over 36 months. Participants (N=254) are 13-21 years and in remission of depression or anxiety for >2 months. Randomisation (1:1) is stratified by previous treatment (no treatment vs treatment) and previous episodes (1, 2 or >3 episodes). Assessments include diagnostic interviews, online questionnaires and monitoring (ecological momentary assessment with optional wearable) after 0, 4, 12, 24 and 36 months. The StayFine modules are guided by certified experts by experience and based on preventive cognitive therapy and ingredients of cognitive behavioural therapy. Personalisation is based on shared decision-making informed by baseline assessments and individual symptom networks. Time to relapse (primary outcome) is assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia-lifetime version diagnostic interview. Intention-to-treat survival analyses will be used to examine the data. Secondary outcomes are symptoms of depression and anxiety, number and duration of relapses, global functioning, and quality of life. Mediators and moderators will be explored. Exploratory endpoints are monitoring and wearable outcomes.

ETHICS, FUNDING AND DISSEMINATION

The study was approved by METC Utrecht and is funded by the Netherlands Organisation for Health Research and Development (636310007). Results will be submitted to peer-reviewed scientific journals and presented at (inter)national conferences.

TRIAL REGISTRATION NUMBER

NCT05551468; NL8237.

Decreased Psychological Well-Being in Patients With Bipolar Disorder in Remission

BACKGROUND

The goals of this study were to introduce psychological well-being as an important subject of inquiry in bipolar disorder, to compare well-being in a cohort of patients with bipolar disorder with that of a normative sample, and to assess whether common measures of well-being and mood measure empirically distinct phenomena.

METHODS

Participants were outpatients with bipolar I disorder in remission (N=37) from the Enhancing Emotion Regulation in Bipolar Disorder (EERBD) study and a matched community normative sample from the Midlife in the United States (MIDUS) survey (N=6297). The Psychological Well-Being Scale (PWBS) was used to measure psychological well-being. We calculated means and SD of scores on the PWBS and evaluated the differences between the scores of the bipolar I and community samples. We also tested the association between raw and change scores in depression [Hamilton Rating Scale for Depression (HAM-D)] and eudaimonic well-being (PWBS) using Spearman correlation coefficients.

RESULTS

The MIDUS survey sample (N=6297) was 48% male, with a mean age of 47 years (SD=13 y). The EERBD sample (N=37) was 27% male, with a mean age of 41 years (SD=11 y). In the bipolar sample, the baseline mean score on the HAM-D was 12.7 (SD=6.0) and the mean score on the Young Mania Rating Scale was 6.1 (SD=6.2). The baseline mean sum score on the PWBS in the normative community MIDUS sample was 100 (SD=14), while that of the bipolar I EERBD sample was 79 (SD=15) at baseline, 84 (SD=13) posttreatment, and 84 (SD=12) at the 3-month follow-up assessment. The effect sizes of the differences at all timepoints were large (Hedges g=1.42 at baseline, 1.11 at the end of treatment, and 1.06 at the 3-mo follow-up). No association was found between the PWBS and depression scores.

CONCLUSIONS

Outpatients with bipolar disorder in remission demonstrated substantially impaired psychological well-being, despite low levels of depressive symptoms, compared with a normative community sample.

Psychometric evaluation of the Positive Mental Health (PMH) scale using item response theory

BACKGROUND

The investigation of patient-reported outcomes and psycho-oncological interventions mainly focuses on psychological distress or psychopathology. However, the recognition of the equal importance of positive mental health (PMH) has increased lately. The PMH-scale is a brief questionnaire allowing to assess well-being in individuals in the general population and in patients. Previous studies evaluated the psychometric properties of the PMH-scale using classical test theory (CTT). This study is the first to investigate the PMH-scale in patients with cancer using item analysis according to the Rasch model.

METHODS

In total, N = 357 cancer patients participated in the study. A Rasch analysis of the PMH-scale was conducted including testing of unidimensionality, local independence, homogeneity and differential item functioning (DIF) with regard to age, gender, type of cancer, the presence of metastases, psycho-oncological support, and duration of disease. Additionally, the ordering of the item thresholds as well as the targeting of the scale were investigated.

RESULTS

After excluding one misfitting item and accounting for local dependence by forming superitems, a satisfactory overall fit to the Rasch model was established (χ² = 30.34, p = 0.21). The new PMH-8 scale proved to be unidimensional, and homogeneity of the scale could be inferred. All items showed ordered thresholds, there was no further item misfit. DIF was found for age, but as the impact of DIF was not substantial, no adjustment related to the age-DIF had to be made. The Person Separation Index (PSI = 0.89) was excellent, indicating excellent discriminatory power between different levels of positive mental health. Overall, the targeting of the PMH-8 was good for the majority of the present sample. However, at both ends of the scale item thresholds are missing as indicated by a slight floor effect (1.4%) and a considerable ceiling effect (9.8%).

CONCLUSIONS

Overall, the results of the analysis according to the Rasch model support the use of the revised PMH-scale in a psycho-oncological context.

Dampening of positive affect and depression: A meta-analysis of cross-sectional and longitudinal relationships

Dampening responses to positive affect have been posited to confer vulnerability to depression, but longitudinal studies have not consistently shown dampening tendencies to predict follow-up depression. The cross-sectional, longitudinal, and cross-lagged relationships between dampening and depression were determined using meta-analytic methods. A systematic literature search of the PsycINFO and PubMed databases supplemented by Google Scholar yielded 60 samples suitable for inclusion in the cross-sectional analyses and 12 samples meeting criteria for the longitudinal analyses. In the first meta-analytic study to examine the relationship between dampening and depression, we found dampening to be associated with depression both cross-sectionally (r = .45) and prospectively (r = 0.34). Crucially, dampening at baseline remained a significant predictor of follow-up depression even after controlling for baseline levels of depression in cross-lagged analyses (β = .09). A bidirectional effect was also found, with baseline levels of depression predicting follow-up tendencies to engage in dampening (r = 0.36). This relationship was again diminished but remained significant after controlling for initial levels of dampening (β = .14). These results suggest that dampening responses to positive affect are a risk factor for the development of depression and highlight the importance of targeting dampening cognitions in treatment.

Staging of unipolar depression: systematic review and discussion of clinical implications

Staging has been increasingly used in unipolar depression since its introduction in the nineties. Several models are available, but their differential features and implications are not completely clear. We systematically reviewed: (a) staging models of longitudinal development of unipolar depression; (b) staging models of treatment-resistant unipolar depression; (c) their applications. MEDLINE, PsycINFO, EMBASE, and Web of Science were examined according to PRISMA guidelines from inception to December 2021. Search terms were: 'stage/staging', combined using the Boolean 'AND' operator with 'psychiatric disorder/mental disorder/depressive/mood disorder'. A total of 169 studies were identified for inclusion: 18 described staging models or applications, 151 described treatment-resistant staging models or applications. Staging models of longitudinal development were found to play a key role in formulating sequential treatment, with particular reference to the use of psychotherapy after pharmacotherapy. Staging methods based on treatment resistance played a crucial role in setting entry criteria for randomized clinical trials and neurobiological investigations. Staging is part of clinimetrics, the science of clinical measurements, and its role can be enhanced by its association with other clinimetric strategies, such as repeated assessments, organization of problematic areas, and evaluation of phenomena that may affect responsiveness. In research, it may allow to identify more homogeneous populations in terms of treatment history that may diminish the likelihood of spurious results in comparisons. In clinical practice, the use of staging in a clinimetric perspective allows clinicians to make full use of the information that is available for an individual patient at a specific time.

Response to TMS treatment for depression associated with higher levels of psychological well-being

Treatment resistant depression (TRD) is a complex condition associated with a great deal of disability and suffering. The relationship between TRD and psychological well-being (PWB) appears to be more complex than a simple antithesis. Transcranial magnetic stimulation (TMS) is a well-tolerated treatment for TRD. However successful, a drawback for TMS is that it has a lack of predictive biomarkers for treatment response. Our study focuses on the relationship between PWB and treatment resistant depression, and how PWB relates to TMS treatment response. We hypothesized that TMS treatment responders would have higher levels of PWB at baseline. In this study of 21 patients with TRD, we used the Ryff Scales of Psychological Well-Being and Patient Health Questionnaire-9 (PHQ-9). We found a significant relationship between environmental mastery, purpose in life, self-acceptance, and total PWB with baseline depression but no significant correlation between autonomy, personal growth, and positive relations with others and baseline PHQ-9 scores. No Ryff domain of PWB significantly predicted change in PHQ-9 score. Interestingly, however, we found that TMS responders had higher levels of autonomy (M(SD) = 62.10(10.46), p = 0.022) and personal growth (M(SD) = 65.00(11.04), p = 0.007) than non-responders at baseline. These specific aspects of well-being appear to be distinct from depression and particularly important in treatment response. This discovery suggests that assessing PWB might prove clinically useful when assessing future candidates for TMS treatment of TRD. Further research is necessary to evaluate the effects of TMS on PWB since these may be distinct from its effect on depression symptomology.

Meaning-Making in the Face of Intersecting Catastrophes: COVID-19 and the Plague of Inequality

Beyond the enormous toll in illness and death, the COVID-19 pandemic unleashed multiple additional problems (job loss, evictions, hunger) that are disproportionately borne by those who were already vulnerable. In this essay, I reflect about these intersecting catastrophes, which I see as undermining the capacities of many to live meaningful and fulfilling lives. Symptoms of these problems are growing "deaths of despair" due to suicide, drug and alcohol addictions. Drawing on multidisciplinary science, I suggest that these widespread problems cannot be ministered to by focusing only at the individual level. Structural factors, including unfair distributions of resources and opportunities demand attention as well because they are fueling growing disparities between the privileged and the disadvantaged segments of contemporary societies. I examine what meanings and emotions are relevant responses to these troubled times, giving emphasis to the legitimacy of anger and outrage in the face of suffering and injustice. Further insight is sought in historical accounts of longstanding tensions between self-interest and the social contract. Going forward, I suggest that these turbulent times call for greater engagement with and scientific understanding of the arts and humanities in activating the deepest corners of our humanity. Examples from past and current art dealing with human suffering, inequality, and plagues illustrate their possible role in nurturing human capacities to understand, to care, and to act.

Positive Psychology: Looking Back and Looking Forward

Envisioning the future of positive psychology (PP) requires looking at its past. To that end, I first review prior critiques of PP to underscore that certain early problems have persisted over time. I then selectively examine recent research to illustrate progress in certain areas as well as draw attention to recurrent problems. Key among them is promulgation of poorly constructed measures of well-being and reliance on homogeneous, privileged research samples. Another concern is the commercialization of PP, which points to the need for greater oversight and quality control in profit-seeking endeavors. Looking ahead, I advocate for future science tied to contemporary challenges, particularly ever-widening inequality and the pandemic. These constitute intersecting catastrophes that need scientific attention. Such problems bring into focus "neglected negatives" that may be fueling current difficulties, including greed, indifference, and stupidity. Anger, which defies easy characterization as positive or negative, also warrants greater scientific study. Going forward I advocate for greater study of domains that likely nurture good lives and just societies - namely, participation in the arts and encounters with nature, both currently under study. Overall, my entreaty to PP is to reckon with persistent problems from its past, while striving toward a future that is societally relevant and virtuous.

Outcomes of student trainee-delivered cognitive-behavioral therapy (CBT) on internalizing symptoms, CBT skills, and life satisfaction

Increased quality of life (QoL) is rated by patients as a primary factor in determining recovery from psychopathology. Cognitive-behavioral therapies (CBTs) are the most well-researched psychotherapies for internalizing disorders and appear effective at reducing symptoms even when delivered by trainees. Existing research suggests that the effects of CBTs on QoL are more modest than their effects on symptoms. However, little is known about the effects of trainee-delivered CBT on life satisfaction, a subjective measure of QoL. We analyzed data from 93 clients treated by students (n=23) in a graduate-level training clinic using an intent-to-treat approach, completers case analyses, and random forest imputation. Across methods of handling missing data, improvements in anxiety, depression, and CBT skills were more marked than improvements in QoL. Exploratory analyses suggested baseline life satisfaction was the strongest predictor of end-of-treatment life satisfaction. Future research should explore alternatives to "standard" CBT for clients with low life satisfaction.

21-Day Stress Detox: Open Trial of a Universal Well-Being Chatbot for Young Adults

There has been a lot of interest in digital mental health interventions but adherence to online programmes has been less than optimal. Chatbots that mimic brief conversations may be a more engaging and acceptable mode of delivery. We developed a chatbot, called 21-Day Stress Detox, to deliver stress management techniques for young adults. The purpose of the study was to explore the feasibility, acceptability, and potential efficacy of this low-intensity digital mental health intervention in a non-clinical population of young adults. The content was derived from cognitive behavioural therapy (CBT) and included evidence-informed elements such as mindfulness and gratitude journaling. It was delivered over 21 daily sessions using the Facebook Messenger platform. Each session was intended to last about 5–7 min and included text, animated GIFs, relaxation tracks and reflective exercises. We conducted an open single-arm trial collecting app usage through passive data collection as well as self-rated satisfaction and qualitative (open-ended) feedback. Efficacy was assessed via outcome measures of well-being (World Health Organisation (Five) Well-being Index; WHO-5; and Personal Well-being Measure; ONS4); stress (Perceived Stress Scale–10 item version; PSS-10); and anxiety (Generalized Anxiety Disorder 7-item scale; GAD-7). One hundred and ten of the 124 participants who completed baseline commenced the chatbot and 64 returned the post-intervention assessment. Eighty-one percent were female and 51% were first year students. Forty-five percent were NZ European and 41% were Asian. Mean engagement was 11 days out 21 days (SD = 7.8). Most (81%) found the chatbot easy to use. Sixty-three percent rated their satisfaction as 7 out of 10 or higher. Qualitative feedback revealed that convenience and relatable content were the most valued features. There was a statistically significant improvement on the WHO-5 of 7.38 (SD = 15.07; p < 0.001) and a mean reduction on the PSS-10 of 1.77 (SD = 4.69; p = 0.004) equating to effect sizes of 0.49 and 0.38, respectively. Those who were clinically anxious at baseline (n = 25) experienced a greater reduction of GAD-7 symptoms than those (n = 39) who started the study without clinical anxiety (−1.56, SD = 3.31 vs. 0.67, SD = 3.30; p = 0.011). Using a chatbot to deliver universal psychological support appears to be feasible, acceptable, have good levels of engagement, and lead to significant improvements in well-being and stress. Future iterations of the chatbot should involve a more personalised content.

Mindfulness-based positive psychology interventions: a systematic review

Background

There are hundreds of mindfulness-based interventions in the form of structured and unstructured therapies, trainings, and meditation programs, mostly utilized in a clinical rather than a well-being perspective. The number of empirical studies on positive potentials of mindfulness is comparatively less, and their known status in academia is ambiguous. Hence, the current paper aimed to review the studies where mindfulness-based interventions had integrated positive psychology variables, in order to produce positive functioning.

Methods

Data were obtained from the databases of PubMed, Scopus, and PsycNet and manual search in Google Scholar. From the 3831 articles, irrelevant or inaccessible studies were eliminated, reducing the number of final articles chosen for review to 21. Interventions that contribute to enhancement of eudaimonia, hedonia, and other positive variables are discussed.

Results

Findings include the potential positive qualities of MBIs in producing specific positive outcomes within limited circumstances, and ascendancy of hedonia and other positive variables over eudaimonic enhancement.

Conclusion

In conclusion, exigency of modifications in the existing MBIs to bring about exclusively positive outcomes was identified, and observed the necessity of novel interventions for eudaimonic enhancement and elevation of hedonia in a comprehensive manner.

The psychometric network structure of mental health in eating disorder patients

OBJECTIVE

Psychometric network analysis has led to new possibilities to assess the structure and dynamics of psychiatric disorders. The current study focuses on mental health networks in patients with anorexia nervosa, bulimia nervosa, binge eating disorder and other specified eating disorders (EDs).

METHOD

Network analyses were applied with five mental health domains (emotional, psychological and social well-being, and general and specific psychopathology) among 905 ED patients. Also, networks of 36 underlying symptoms related to the domains were estimated. The network stability, structure and (bridge) centrality of the nodes were assessed for the total group and each ED type. Network differences between the ED types were also examined.

RESULTS

ED psychopathology was only weakly connected with the well-being domains. Psychological well-being was the most central node in the domain network. The most central nodes in the symptom network were feeling depressed, feeling worthless, purpose in life and self-acceptance. Bridge symptoms between well-being and psychopathology were self-acceptance, environmental mastery, interested in life and feeling depressed. There were no network differences between the ED types in both the domain and symptom networks.

CONCLUSIONS

This study shows novel associations between well-being and psychopathology in ED patients. Central domains and their underlying symptoms may be especially important to consider in treatment for promoting mental health in ED patients.

The relationship between depressive symptoms, general psychopathology, and well-being in patients with major depressive disorder

OBJECTIVE

In mental health care, treatment effects are commonly monitored by symptom severity measures. This study aimed to investigate the relationship between symptom severity and well-being in the treatment of patients with major depressive disorder (MDD).

METHODS

Adult MDD outpatients (n = 77) were administered the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR), the Outcome Questionnaire (OQ-45), and the Mental Health Continuum-Short Form (MHC-SF) before treatment and 6 months later.

RESULTS

Symptom severity correlated moderately with well-being at baseline and strongly at follow-up. Reliable change index scores showed improvement on the QIDS-SR, OQ-45, and MHC-SF in 65%, 59%, and 40%, respectively. A quarter of patients improved in symptom severity but not well-being (Inventory of Depressive Symptomatology-Self-Report [IDS-SR]: 25%; OQ-45: 24%).

CONCLUSION

Findings suggest that symptom severity and subjective well-being are related, but distinct concepts. Several reasons for the stronger improvements in symptoms than in well-being are discussed.

When the Label Does Not Match the Content of a Trial: "Well-Being Therapy" in Posttraumatic Stress Disorder: Commentary on Radstaak et al. (2020)

Radstaak, Hüning, and Bohlmeijer (2020) reported on a randomized controlled trial (RCT) of well-being therapy (WBT) compared to treatment as usual (TAU) in the treatment of residual posttraumatic stress disorder (PTSD) symptoms. No significant differences emerged between treatment conditions. However, our view is that what the authors labeled as WBT did not match the manualized psychotherapeutic strategy, and what was defined as TAU was actually an active control group. Further methodological limitations hinder the interpretation of results and make it difficult to draw conclusions from the study. Radstaak et al. (2020) deserve credit for addressing the vexing and neglected problem of residual symptoms in PTSD. However, the role of WBT in PTSD treatment still needs to be explored via an effectively designed RCT. Given that WBT does not require exposure to a patient's index traumatic event as a means of alleviating PTSD symptoms, WBT may represent a promising alternative to current treatments of PTSD.

Internet-based acceptance and commitment therapy programme 'Happiness Mom' for well-being: a protocol for a randomised controlled trial

INTRODUCTION

This randomised controlled trial (RCT) aims to examine the effects of an internet-delivered acceptance and commitment therapy (iACT) programme ('Happiness Mom') on the psychological well-being of working mothers.

METHODS AND ANALYSIS

The target population of the RCT will be employed mothers with at least one preschool child. Participants who fulfil the study's eligibility criteria will be randomly assigned either to an iACT intervention group (n=200) or to a wait-list control group (n=200). Participants in the intervention groups will be asked to complete the programme within 12 weeks of the baseline survey. The intervention programme contains eight modules based on ACT. Primary outcomes are six components of psychological well-being, based on Ryff's theory. Secondary outcomes are intention to leave their job, work engagement, work performance, sick leave days, psychological distress, euthymia, positive emotions, job and life satisfaction, social support and parental burn-out.

ETHICS AND DISSEMINATION

Ethical approval for this study has been obtained from the Research Ethics Review Board of Graduate School of Medicine, the University of Tokyo (No. 2019134NI). If the intervention programmes are found to be significantly beneficial, the programmes can be made available for all working mothers with preschool children in Japan.

DISCUSSION

This study will contribute to the development of an internet-based self-care programme that is effective, feasible, low cost and accessible to improve the well-being of working mothers.

TRIAL REGISTRATION NUMBER

UMIN000039918.

Kellner's Symptom Questionnaire, a Highly Sensitive Patient-Reported Outcome Measure: Systematic Review of Clinimetric Properties

INTRODUCTION

Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric approach provides a viable framework for their assessment.

OBJECTIVE

The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being).

METHODS

The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included.

RESULTS

A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo.

CONCLUSIONS

The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.

Longitudinal Health Consequences of Childhood Adversity: The Mediating Role of Purpose in Life

Early life adversity has long-term detrimental effects on physical health. Although biological, behavioral, and social factors have been explored as intermediate mechanisms, little research has explored psychosocial factors as potential mediators. This study examined whether purpose in life longitudinally mediates the relationship between childhood adversity and two measures of adult health. Data were obtained from 3,871 participants in the Midlife in the United States (MIDUS) study. We tested a longitudinal mediation model from childhood adversity to adult health via purpose in life, controlling for baseline measures of health. Results indicated that childhood adversity is associated with poorer adult health through direct and mediated paths. Childhood adversity may restrict individuals' sense of purpose in life, and reduced purpose in life is subsequently associated with poorer subjective health and increased likelihood of functional limitations. The findings of this study can be used to inform the development of psychosocial and therapeutic intervention programs and services for adults with a history of childhood adversity.

Well-Being Therapy as Rehabilitation Therapy for Posttraumatic Stress Disorder Symptoms: A Randomized Controlled Trial

Many individuals with posttraumatic stress disorder (PTSD) continue to have substantial residual symptoms after completing psychological treatment. Well-being therapy (WBT) has been developed to treat the residual phase of mental disorders, prevent relapse, and promote a full recovery. The present study aimed to compare treatment as usual (TAU) with the long-term effects of WBT as a rehabilitation therapy in adults who successfully completed psychological treatment for PTSD. Participants who did not meet PTSD diagnostic criteria after completing treatment were randomized to WBT (n = 29) or TAU (n = 35) groups. Assessments of well-being, residual PTSD symptoms, and posttraumatic growth were conducted at baseline (T0) and again after 3 months (T1), 6 months (T2), and 1 year (T3). The results of the multilevel analysis revealed that WBT was not more effective than TAU in increasing levels of well-being, γ = 0.02 (SE = 0.11) or posttraumatic growth, γ = 0.10 (SE = 0.13) nor in decreasing PTSD symptoms, γ = -0.04 (SE = 0.05). However, for participants with low levels of well-being at baseline (Mental Health Continuum-Short Form score < 2.6), WBT was more effective than TAU in increasing ratings of well-being, γ = -0.41 (SE = 0.19) and posttraumatic growth, γ = -0.55 (SE = 0.24); this effect was most evident at T3 for posttraumatic growth, d = 1.23. Future research should assess clinically relevant individual characteristics that to optimize the effectiveness and utility of WBT.

Trajectories of change in well-being during cognitive behavioral therapies for anxiety disorders: Quantifying the impact and covariation with improvements in anxiety

Cognitive behavioral therapy (CBT) has been found to be very effective in reducing many forms of mental illness, but much less is known about whether CBT also promotes mental health or well-being. The goals of the present study were to (a) quantify the magnitude and timing of changes in overall well-being and specific facets of well-being during different CBTs for anxiety disorders, (b) determine whether these effects vary across transdiagnostic and disorder-specific CBT, and (c) examine how changes in well-being during treatment relate to changes in anxiety. A total of 223 adults (55.6% female, Mage = 31.1 years) were randomized to 1 of 5 CBT protocols for anxiety disorders at an outpatient clinic. Analyses included standardized mean gain effect sizes (ESsg) and latent growth curve modeling. Moderate-to-large increases in overall well-being and the 3 components of subjective, psychological, and social well-being were observed, mainly during the second half of CBT, and these increases were maintained at a 6-month follow-up. The magnitude of effects was comparable for transdiagnostic and disorder-specific CBT protocols and greater than in the waitlist condition. Parallel process latent growth curve models indicated that trajectories of change in well-being across treatment were strongly correlated with trajectories of change in clinician-rated and self-reported anxiety. Together, these findings suggest that different CBT protocols for anxiety consistently produce robust and lasting changes in well-being, and these changes are strongly linked to changes in anxiety during treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Understanding Psychosocial Wellbeing in the Context of Complex and Multidimensional Problems

This Special Issue deals with the topic of how people and social groups face problems in an increasingly complex and globalized society. The topics included in the call for papers were the interaction of psychosocial well-being and mental health with economic, gender, racial and ethnic inequalities, migration and demographic change and conflict and war, as well as the effects of stigma on people discriminated against because of their differential characteristics, whether they are of a sexual, disability or other minority. We made this proposal because we believed that, despite the introduction of the biopsychosocial model in the late 1970s as a paradigm of the integration of different disciplinary views, research in mental health and psychosocial well-being is still highly fragmented. For decades, we have tried to advance by emphasizing a part of the equation, with results that are at least modest. Therefore, in this Special Issue, we prioritized works aiming at disciplinary and methodological integration. The Special Issue was open to any subject area related to the impacts of social issues on mental health and psychosocial well-being. We were interested in empirical and theoretical enquiries at all ecological levels, from the psychosocial impact of social dynamics on individuals, to the analysis of how sociocultural and geopolitical factors influence health and collective psychosocial well-being.

Residual symptoms of depression: clinical and theoretical implications

Residual symptoms of variable intensity often persist following pharmaco/or psychotherapeutic interventions for treatment of major depression (MD). In several studies, such persistent symptoms have been clearly shown to be associated with a higher risk of relapse, chronicity and functional impairment, but their true nature is still controversial. Several authors consider that these symptoms belong to the range of depression proper and thus indicate that the current episode has been inadequately treated, a hypothesis reinforced by their frequent similarity with the symptoms preceding the full-blown picture of MD. However, in the current state of research, their connection with certain personality traits or comorbid disorders—notably anxiety disorders—cannot be completely ruled out. This article reviews the main data from the literature concerning residual symptoms and their treatment, as well as the issues related to their psychopathological meaning. In practice, once the state of a patient has been stabilized in partial remission of the depressive syndrome, the clinician should revise the current therapeutic strategy and seek to find how to return as fully as possible to the previous euthymic state.

Self-rated residual symptoms do not predict 1-year recurrence of depression

Background

Residual depressive symptoms are generally documented as a risk factor for recurrence. In the absence of a specific instrument for the assessment of residual symptoms, a new 25-item Depression Residual Symptom Scale (DRSS) was elaborated and tested for recurrence prediction over a 1-year follow-up.

Sampling and methods

Fifty-nine patients in remission after a major depressive episode (MDE) were recruited in two centres. They were assessed with the DRSS and the Montgomery-Asberg Depression Rating Scale (MADRS) at inclusion and followed for 1 year according to a seminaturalistic design. The DRSS included specific depressive symptoms and subjective symptoms of vulnerability, lack of return to usual self and premorbid level of functioning.

Results

Severity of residual symptoms was not significantly associated with increased risk of recurrence. However, DRSS score was significantly higher among patients with three or more episodes than one to two episodes. Number of previous episodes and treatment interruption were not identified as significant predictors of recurrence.

Conclusion

The proposed instrument is not predictive of depressive recurrence, but is sensitive to increased perception of vulnerability associated with consecutive episodes. Limitations include small sample size, seminaturalistic design (no standardisation of treatment) and content of the instrument.

Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Systematic Review and Meta-analysis

IMPORTANCE

Cognitive behavioral therapy is recommended for anxiety-related disorders, but evidence for its long-term outcome is limited.

OBJECTIVE

This systematic review and meta-analysis aimed to assess the long-term outcomes after cognitive behavioral therapy (compared with care as usual, relaxation, psychoeducation, pill placebo, supportive therapy, or waiting list) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).

DATA SOURCES

English-language publications were identified from PubMed, PsycINFO, Embase, Cochrane, OpenGrey (1980 to January 2019), and recent reviews. The search strategy included a combination of terms associated with anxiety disorders (eg, panic or phobi*) and study design (eg, clinical trial or randomized controlled trial).

STUDY SELECTION

Randomized clinical trials on posttreatment and at least 1-month follow-up effects of cognitive behavioral therapy compared with control conditions among adults with generalized anxiety disorder, panic disorder with or without agoraphobia, social anxiety disorder, specific phobia, PTSD, or OCD.

DATA EXTRACTION AND SYNTHESIS

Researchers independently screened records, extracted statistics, and assessed study quality. Data were pooled using a random-effects model.

MAIN OUTCOMES AND MEASURES

Hedges g was calculated for anxiety symptoms immediately after treatment and at 1 to 6 months, 6 to 12 months, and 12 months or more after treatment completion.

RESULTS

Of 69 randomized clinical trials (4118 outpatients) that were mainly of low quality, cognitive behavioral therapy compared with control conditions was associated with improved outcomes after treatment completion and at 1 to 6 months and at 6 to 12 months of follow-up for a generalized anxiety disorder (Hedges g, 0.07-0.40), panic disorder with or without agoraphobia (Hedges g, 0.22-0.35), social anxiety disorder (Hedges g, 0.34-0.60), specific phobia (Hedges g, 0.49-0.72), PTSD (Hedges g, 0.59-0.72), and OCD (Hedges g, 0.70-0.85). At a follow-up of 12 months or more, these associations were still significant for generalized anxiety disorder (Hedges g, 0.22; number of studies [k] = 10), social anxiety disorder (Hedges g, 0.42; k = 3), and PTSD (Hedges g, 0.84; k = 5), but not for panic disorder with or without agoraphobia (k = 5) and could not be calculated for specific phobia (k = 1) and OCD (k = 0). Relapse rates after 3 to 12 months were 0% to 14% but were reported in only 6 randomized clinical trials (predominantly for panic disorder with or without agoraphobia).

CONCLUSIONS AND RELEVANCE

The findings of this meta-analysis suggest that cognitive behavioral therapy for anxiety-related disorders is associated with improved outcomes compared with control conditions until 12 months after treatment completion. At a follow-up of 12 months or more, effects were small to medium for generalized anxiety disorder and social anxiety disorder, large for PTSD, and not significant or not available for other disorders. High-quality randomized clinical trials with 12 months or more of follow-up and reported relapse rates are needed.

Individual participant data (IPD) meta-analysis of psychological relapse prevention interventions versus control for patients in remission from depression: a protocol

INTRODUCTION

Psychological interventions and antidepressant medication can be effective interventions to prevent depressive relapse for patients currently in remission of depression. Less is known about overall factors that predict or moderate treatment response for patients receiving a psychological intervention for recurrent depression. This is a protocol for an individual participant data (IPD) meta-analysis which aims to assess predictors and moderators of relapse or recurrence for patients currently in remission from depression.

METHODS AND ANALYSIS

Searches of PubMed, PsycINFO, Embase and Cochrane Central Register of Controlled Trials were completed on 13 October 2019. Study extractions and risk of bias assessments have been completed. Study authors will be asked to contribute IPD. Standard aggregate meta-analysis and IPD analysis will be conducted, and the outcomes will be compared with assess whether results differ between studies supplying data and those that did not. IPD files of individual data will be merged and variables homogenised where possible for consistency. IPD will be analysed via Cox regression and one and two-stage analyses will be conducted.

ETHICS AND DISSEMINATION

The results will be published in peer review journals and shared in a policy briefing as well as accessible formats and shared with a range of stakeholders. The results will inform patients and clinicians and researchers about our current understanding of more personalised ways to prevent a depressive relapse. No local ethics approval was necessary following consultation with the legal department. Guidance on patient data storage and management will be adhered to.

PROSPERO REGISTRATION NUMBER

CRD42019127844.

The pursuit of euthymia

Psychiatrists often consider the positive characteristics displayed by a patient in their clinical judgment, yet current assessment and treatment strategies are shifted on the side of psychological dysfunction. Euthymia is a transdiagnostic construct referring to the presence of positive affects and psychological well-being, i.e., balance and integration of psychic forces (flexibility), a unifying outlook on life which guides actions and feelings for shaping future accordingly (consistency), and resistance to stress (resilience and tolerance to anxiety or frustration). There is increasing evidence that the evaluation of euthymia and its components has major clinical implications. Specific instruments (clinical interviews and questionnaires) may be included in a clinimetric assessment strategy encompassing macro-analysis and staging. The pursuit of euthymia cannot be conceived as a therapeutic intervention for specific mental disorders, but as a transdiagnostic strategy to be incorporated in an individualized therapeutic plan. A number of psychotherapeutic techniques aiming to enhance positive affects and psychological well-being (such as well-being therapy, mindfulness-based cognitive therapy, and acceptance and commitment therapy) have been developed and validated in randomized controlled clinical trials. The findings indicate that flourishing and resilience can be promoted by specific interventions leading to a positive evaluation of one's self, a sense of continuing growth and development, the belief that life is purposeful and meaningful, satisfaction with one's relations with others, the capacity to manage effectively one's life, and a sense of self-determination.

Beyond diagnosis in psychiatric practice

In psychiatry, the information conveyed by diagnosis (i.e., the "type" to which the individual patient is reconducted) is in itself insufficient for therapeutic and prognostic purposes. Hence the need for a more detailed characterization of the individual case, with a special focus on the assessment of low-order and high-order psychopathological dimensions, the evaluation of the severity of the clinical picture, the assessment of the stage of development of the disorder, and the exploration of a series of antecedent and concomitant variables. We should start to promote the construction and validation of tools guiding the clinician systematically in this characterization, trying to incorporate in this effort elements of the approaches that are currently presented as "alternative" to the ICD and DSM.

Predicting optimal interventions for clinical depression: Moderators of outcomes in a positive psychological intervention vs. cognitive-behavioral therapy

Identifying differences in the clinical response to specific interventions is an important challenge in the field of Clinical Psychology. This is especially true in the treatment of depression where many treatments appear to have comparable outcomes. In a controlled trial, we compared a positive psychology group intervention, the Integrative Positive Psychological Intervention for Depression (IPPI-D; n = 62) to a cognitive-behavioral therapy group intervention (CBT; n = 66) for depression. No statistically or clinically-significant differences between the treatments were found, but a slight advantage was observed, on average, for IPPI-D. The aim of the present study was to identify and combine moderators of the differential efficacy of these two psychological interventions for clinical depression. For this purpose, a secondary analysis using the Personalized Advantage Index (PAI) was performed to identify the intervention predicted to produce the better outcome for each patient. Six of the 21 potential moderators were found to predict differential efficacy between the treatments. IPPI-D was predicted to be the optimal treatment for 73% of the sample. Baseline features that characterized these individuals were: mental and physical comorbidity, prior antidepressant medication, higher levels of negative thoughts, and higher personal growth. The 27% who were predicted to achieve better outcomes in CBT than in IPPI-D tended to have these baseline features: no comorbidities, no prior antidepressant medication, lower levels of negative thoughts, and lower personal growth.

Randomized controlled trial of a well-being intervention in cardiac patients

OBJECTIVE

Positive psychological well-being interventions have demonstrated promise in improving both psychological and physical health-related outcomes in patients with coronary artery disease (CAD), but evidence of the efficacy of these interventions with individuals with CAD is limited. As such, we developed an eight-week group-based intervention targeting eudaimonic aspects of psychological well-being in a randomized pilot trial. The primary aims of the trial were feasibility and acceptability, and we also explored the intervention's effectiveness on psychological outcomes.

METHOD

Participants were 40 CAD outpatients randomly assigned to the intervention (n = 20) or an attention-matched control group (n = 20). Feasibility was measured by rates of group session attendance and homework completion, and acceptability was assessed through participant ratings of intervention activities. Additional study outcomes, compared between groups, included psychological well-being, optimism, depression, and positive and negative affect.

RESULTS

The intervention met a priori criteria for feasibility and acceptability. The intervention was also associated with greater improvements in psychological well-being (β = -16.90; 95% Confidence Interval [CI] = -23.36, -10.44; p < .001, ES = 1.65), optimism (β = -8.80; 95% CI = -11.17, -6.43; t = -7.41; p < .001; ES = 2.34), and depression (β = 26.45; 95% CI = 20.97, 31.93; p < .001) immediately post-intervention, with sustained effects six weeks later.

CONCLUSIONS

These results indicate that the intervention was feasible, well-accepted, and effective in improving clinically relevant psychological outcomes in individuals with CAD. Future work should seek to replicate this work and assess general health-related and cardiac health-specific outcomes.

Identifying key targets for interventions to improve psychological wellbeing: replicable results from four UK cohorts

BACKGROUND

An increasing importance is being placed on mental health and wellbeing at individual and population levels. While there are several interventions that have been proposed to improve wellbeing, more evidence is needed to understand which aspects of wellbeing are most influential. This study aimed to identify key items that signal improvement of mental health and wellbeing.

METHODS

Using network analysis, we identified the most central items in the graph network estimated from the well-established Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Results were compared across four major UK cohorts comprising a total of 47,578 individuals: the Neuroscience in Psychiatry Network, the Scottish Schools Adolescent Lifestyle and Substance Use Survey, the Northern Ireland Health Survey, and the National Child Development Study.

RESULTS

Regardless of gender, the three items most central in the network were related to positive self-perception and mood: 'I have been feeling good about myself'; 'I have been feeling confident'; and 'I have been feeling cheerful'. Results were consistent across all four cohorts.

CONCLUSIONS

Positive self-perception and positive mood are central to psychological wellbeing. Psychotherapeutic and public mental health interventions might best promote psychological wellbeing by prioritising the improvement of self-esteem, self-confidence and cheerfulness. However, empirical testing of interventions using these key targets is needed.

Routine Cognitive Behavioural Therapy for Anxiety and Depression is More Effective at Repairing Symptoms of Psychopathology than Enhancing Wellbeing

The primary focus of classic cognitive behavioural therapy (CBT) for depression and anxiety is on decreasing symptoms of psychopathology. However, there is increasing recognition that it is also important to enhance wellbeing during therapy. This study investigates the extent to which classic CBT for anxiety and depression leads to symptom relief versus wellbeing enhancement, analysing routine outcomes in patients receiving CBT in high intensity Improving Access to Psychological Therapy (IAPT) Services in the UK. At intake, there were marked symptoms of anxiety and depression (a majority of participants scoring in the severe range) and deficits in wellbeing (a majority of participants classified as languishing, relative to general population normative data). CBT was more effective at reducing symptoms of anxiety and depression than repairing wellbeing. As a result, at the end of treatment, a greater proportion of participants met recovery criteria for anxiety and depression than had moved from languishing into average or flourishing levels of wellbeing. Given the importance of wellbeing to client definitions of recovery, the present results suggest a greater emphasis should be placed on enhancing wellbeing in classic CBT.

Entrepreneurship and Eudaimonic Well-Being: Five Venues for New Science

Researchers in entrepreneurial studies are increasingly interested in the psychological well-being of entrepreneurs. Approaches to well-being tend to be partitioned into hedonic and eudaimonic formulations. Most entrepreneurial studies have focused on hedonic indicators (life satisfaction, happiness, positive affect). The central objective of this essay is to examine the relevance of eudaimonic well-being for understanding entrepreneurial experience. The theoretical background and key dimensions of eudaimonic well-being are described and their relevance for entrepreneurial studies is considered. Illustrative findings from prior well-being studies are examined, also with emphasis on possible extensions to entrepreneurship. Five key venues for the entrepreneurial field are then considered: (1) entrepreneurship and autonomy, viewed both as a motive (self-determination theory) and as an aspect of well-being (eudaimonic well-being theory); (2) varieties of entrepreneurship (opportunity versus necessity) and eudaimonic well-being; (3) eudaimonia in the entrepreneurial journey (beginning, middle, end); (4) entrepreneurship, well-being and health; and (5) entrepreneurs and the eudaimonia of others - contrasting virtuous and vicious types. In each topic, extant findings from entrepreneurial studies are considered and new research directions proposed. The overall aim is to be generative regarding the interplay between entrepreneurial experience and eudaimonic wellbeing.

Meta-analyses of positive psychology interventions: The effects are much smaller than previously reported

For at least four decades, researchers have studied the effectiveness of interventions designed to increase well-being. These interventions have become known as positive psychology interventions (PPIs). Two highly cited meta-analyses examined the effectiveness of PPIs on well-being and depression: Sin and Lyubomirsky (2009) and Bolier et al. (2013). Sin and Lyubomirsky reported larger effects of PPIs on well-being (r = .29) and depression (r = .31) than Bolier et al. reported for subjective well-being (r = .17), psychological well-being (r = .10), and depression (r = .11). A detailed examination of the two meta-analyses reveals that the authors employed different approaches, used different inclusion and exclusion criteria, analyzed different sets of studies, described their methods with insufficient detail to compare them clearly, and did not report or properly account for significant small sample size bias. The first objective of the current study was to reanalyze the studies selected in each of the published meta-analyses, while taking into account small sample size bias. The second objective was to replicate each meta-analysis by extracting relevant effect sizes directly from the primary studies included in the meta-analyses. The present study revealed three key findings: (1) many of the primary studies used a small sample size; (2) small sample size bias was pronounced in many of the analyses; and (3) when small sample size bias was taken into account, the effect of PPIs on well-being were small but significant (approximately r = .10), whereas the effect of PPIs on depression were variable, dependent on outliers, and generally not statistically significant. Future PPI research needs to focus on increasing sample sizes. A future meta-analyses of this research needs to assess cumulative effects from a comprehensive collection of primary studies while being mindful of issues such as small sample size bias.

Skills to Enhance Positivity in Suicidal Adolescents: Results from a Pilot Randomized Clinical Trial

The objective of this study was to examine the feasibility, acceptability, and preliminary effects of an intervention, Skills to Enhance Positivity (STEP) that aims to increase attention to positive emotions and experiences and to decrease suicidal events. STEP involves four in-person individual sessions delivered during an inpatient psychiatric admission, followed by one month of weekly phone calls and daily text messages with mood monitoring and skills practice. A pilot randomized controlled trial of STEP vs. enhanced treatment as usual (ETAU) was conducted with 52 adolescents. Results indicated that on average 83% of sessions were completed and that on 70% of days, participants engaged with the text-messaging component of the intervention. Acceptability for both in-person and text-messaging components were also high, with satisfaction ratings averaging between good and excellent. STEP participants reported fewer suicide events than ETAU participants (6 vs. 13) after six months of follow-up.

The Curious Neglect of High Functioning After Psychopathology: The Case of Depression

We address a key issue at the intersection of emotion, psychopathology, and public health-the startling lack of attention to people who experience benign outcomes, and even flourish, after recovering from depression. A rereading of the epidemiological literature suggests that the orthodox view of depression as chronic, recurrent, and lifelong is overstated. A significant subset of people recover and thrive after depression, yet research on such individuals has been rare. To facilitate work on this topic, we present a generative research framework. This framework includes (a) a proposed definition of healthy end-state functioning that goes beyond a reduction in clinical symptoms, (b) recommendations for specific measures to assess high functioning, and (c) a road map for a research agenda aimed at discovering how and why people flourish after emotional disturbance. Given that depression remains the most burdensome health condition worldwide, focus on what makes these excellent outcomes possible has enormous significance for the public health.

Having an Eating Disorder and Still Being Able to Flourish? Examination of Pathological Symptoms and Well-Being as Two Continua of Mental Health in a Clinical Sample

Introduction: Eating Disorders (EDs) are serious psychiatric disorders, impacting physical and psychosocial functioning, often with a chronic course and high mortality rates. The two continua model of mental health states that mental health is a complete state, that is, not merely the absence of mental illness, but also the presence of mental health. This model was studied among ED patients by examining the presence and correlates of well-being and psychopathology. In addition, the levels of well-being were compared to the Dutch general population. Method: A total of 468 female ED patients participated in this study during application and intake at a specialized ED treatment Center in the Netherlands. They filled out questionnaires about well-being (MHC-SF), general psychopathology (OQ-45), and ED psychopathology (EDE-Q). Categorical andmean well-being levels were calculated. Also, the relationships between these variables were examined with Pearson correlation and multiple hierarchical regression analysis. Results: ED patients showed lower levels of emotional, psychological, and social well-being on average compared to the general population. About 26% of the ED patients experienced low levels of well-being (languishing). However, also 13% experienced high levels of well-being (flourishing), varying between 9% in Anorexia Nervosa to 25% in Binge Eating Disorder. ED psychopathology and general well-being showed a moderate negative correlation. For patients with Bulimia Nervosa and Binge Eating Disorder however no such correlation was found. Lower general psychopathology, not having a history of hospitalization for the ED, and adaptive personal functioning were correlated with well-being among ED patients. Conclusion: This study shows initial support for the two continua model of mental health among ED patients. Psychopathology and well-being should be considered as related, but distinct dimensions of mental health in ED patients. Further research should focus on the possible reciprocal relationships between psychopathology and well-being during recovery. It is recommended to monitor well-being during treatment and to implement interventions for well-being to realize complete recovery for those patients with inadequate levels of well-being.

A positive psychology intervention for patients with bipolar depression: a randomized pilot trial

Background: There are few effective treatments for bipolar depression, a common and debilitating illness.Aims: We aimed to examine the feasibility and preliminary efficacy of a four-week, telephone-delivered positive psychology (PP) intervention for patients with bipolar depression.Methods: Twenty-five patients hospitalized for bipolar depression were randomized to receive a PP (n = 14) or control condition (CC; n = 11) intervention. Following discharge, participants completed weekly exercises and phone calls with a study trainer. PP intervention feasibility was assessed by the number of exercises completed, and acceptability was examined on five-point Likert-type scales of ease and utility. Between-group differences on psychological constructs at 4 and 8 weeks post-enrollment were assessed using mixed effects regression models.Results: Participants in the PP group completed an average of three out of four PP exercises and found PP exercises to be subjectively helpful, though neither easy nor difficult. Compared to CC, the PP intervention led to trends towards greater improvements in positive affect and optimism at follow-up, with large effect sizes (modified Cohen's d = 0.95-1.24). PP had variable, non-significant effects on negative psychological constructs.Conclusions: Larger, randomized trials are needed to further evaluate the efficacy of this intervention in this high-risk population.