Varieties of suffering in the clinical setting: re-envisioning mental health beyond the medical model

In this paper, we argue for the need to rethink mental health beyond the medical model because much of human suffering cannot be diagnosed by the DSM-5. During the pandemic and post-pandemic, people have learned to accept the fact that no one is immune from suffering. Given the universality and complexity of human suffering, it is natural for people to wrestle with existential questions such as "Why struggle when all life end in death?" and "How can one flourish when life is so hard?" Existential positive psychology (EPP or PP2.0) was developed to address these existential concerns. After explaining the inherent limitations of the medical model and the need for EPP as an alternative vision for mental health, we provide illustrative clinical cases to demonstrate the advantages of this broader existential framework for both case conceptualization and interventions. According to EPP, mental illness is reconceptualized as both deficiency in knowledge and skills in coping with the demands of life and deficiency in meeting the basic needs for livelihood and mental health, the Soul's yearnings for faith, hope, and love. Finally, we introduce integrative meaning therapy as a therapeutic framework which can equip people with the needed skills to achieve healing, wholeness, and total wellbeing.

Cross-Cultural Psychometric Analysis of the Mature Happiness Scale-Revised: Mature Happiness, Psychological Inflexibility, and the PERMA Model

The present study aimed to evaluate the psychometric properties of the Mature Happiness Scale, a measure focused on inner harmony. Mature happiness is achieved when a person can live in balance between both positive and negative aspects of their life. A total sample of 2,130 participants from five countries (Canada: n = 390, United States: n = 223, United Kingdom: n = 512, Spain: n = 724, and Hungary: n = 281) responded to an online survey including the original Mature Happiness Scale, the PERMA-Profiler, and the Acceptance and Action Questionnaire-II. Exploratory and confirmatory factor analyses yielded a one-factor solution with seven positive items (non-reversed). We called this new version of the questionnaire the Mature Happiness Scale-Revised (MHS-R). Measurement invariance was found across countries, age groups, gender, and mental disorder diagnosis. Internal consistency and test-retest reliability were high. Older people, males, and people without a mental disorder diagnosis scored higher in mature happiness than younger ones, females, and those with a mental health disorder diagnosis, respectively. Mature happiness showed strong positive associations with various subscales of the PERMA-Profiler, specifically with positive emotions and meaning in life. In addition, mature happiness was strongly correlated with less negative affect and inner conflict and lower psychological inflexibility, whereas it was moderately correlated with lower loneliness. This validity evidence supports the cross-cultural use of the MHS-R in the aforementioned countries to reliably measure happiness among adults. With its holistic approach, the MHS-R may be a unique complement to other well-being measures, particularly to better predict mental health problems.

The meaning of love and its bittersweet nature

Love is the core of human experience and central to our meaning in life and wellbeing, yet it is also a complex concept full of ambiguity and contradiction. The main purpose of this paper is fourfold: Firstly, we want to clarify questions such as 'What is the meaning of love?' and 'Why is meaning of love so important to us?' Secondly, we want to explain why love is both suffering and essential for our happiness and mental health. Thirdly, we identify the major types of love and clarify which types are constructive and which are destructive. We also identify the key dimensions of true love. Finally, we emphasise that love does not always mean happiness; rather, it is meant to be a school to teach us important lessons and to make us complete. Therefore, we need to embrace suffering and at the same time cultivate the constructive types of love to improve our mental health and to make the world a more compassionate place.

Accelerating the science and practice of psychology beyond WEIRD biases: Enriching the landscape through Asian psychology

More than a decade has passed since major concerns emerged about the WEIRD-centric focus of mainstream psychological science. Since then, many calls have been made for the discipline of psychology (and other disciplines within the social sciences) to become more broadly representative of the human species. However, recent evidence suggests that progress toward improving the inclusivity and generalizability of psychological science has been slow, and that the dominance of WEIRD psychology has persisted. To build a more comprehensive psychological science that truly represents the global population, we need strategies that can facilitate more rapid expansion of empirical evidence in psychology beyond WEIRD biases. In this paper, we draw on several examples (i.e., non-duality and dialectical interaction, Wu-Wei, Zhong Yong) to illustrate how principles of Asian psychology could contribute to reshaping mainstream psychology. We discuss some strategies for advancing a global psychological science, along with some complementary practical suggestions that could enrich the WEIRD-centric landscape of current psychological science.

Suffering, psychological distress, and well-being in Indonesia: A prospective cohort study

Research on the subjective experience of suffering has typically focussed on older clinical samples living in Western, educated, industrialised, rich, and democratic (WEIRD) countries. To further extend the existing body of empirical research on suffering to less WEIRD contexts, we use three waves of data (Wave 1: December 2020; Wave 2: January 2021; Wave 3: February 2021) from a sample of nonclinical Indonesian adults (n = 594) to examine associations between suffering, two indices of psychological distress, and 10 facets of well-being. In our primary analysis, we estimated a series of multiple regression models that adjusted for a range of sociodemographic characteristics, financial and material stability, religious/spiritual factors, prior values of overall suffering, and prior values of each outcome assessed in Wave 1. Results indicated that overall suffering assessed in Wave 2 was associated with an increase in both indices of psychological distress and a decrease in eight facets of well-being assessed in Wave 3. Using a similar analytic approach, results from a secondary analysis indicated that higher scores on both indices of psychological distress and lower scores on seven of the well-being facets assessed in Wave 2 were associated with worse subsequent overall suffering assessed in Wave 3. These findings contribute to empirical literature on the implications of suffering for well-being.

Review of The Evolution of Life Worth Living: Why we choose to live

Soper’s pain-brain theory, based on evolutionary biology, represents a provocative breakthrough for both suicidology and positive psychology. The main thesis of the book is that the evolved way of choosing to live rather than to die in the face of unbearable suffering is to develop a zest for happiness and meaning. His new theory can be summed up by a two-by-two matrix of “pain-type” versus “brain-type” of reducing pain, and the “keeper” versus “fender” levels of protecting us from suicide. My main critique is that the brain versus pain distinction is confusing because the brain is the center for all the functions needed for to reduce pain and keep us alive. Similarly, his football metaphor of two levels of defense(“keeper” and “fender”) is incomplete because the best defense is offence, when a good last line of defense can be quickly turned into offence. Therefore, a more fluid way of conceptualizing this distinction may be the dialectically interactive dual systems of life protection (Yin) and life expansion strategies (Yang) (Wong, 2012). Soper’s pain-brain theory is similar to Wong’s general existential positive psychology theory of flourishing through suffering (Wong, 2020a, 2021a). Both approaches emphasize the centrality of suffering and posit that whether suffering results in mental illness and suicide or mental health and flourishing depends on whether we have the wisdom of the soul and the necessary social support.

Spanish Version of the Death Attitude Profile-Revised. Translation and Validation Into Spanish

The Death Attitude Profile-Revised (DAP-R) was developed in English-speaking cultures with the aim of measuring attitudes towards death. This measure consists of 32 items, grouped into five factors (Fear of Death, Avoidance of Death, Neutral Acceptance, Approach Acceptance, and Escape Acceptance). The DAP-R was translated and adapted to Spanish (DAP-RSp), and the psychometric properties were analyzed accross a general sample. The face validity was evaluated by 20 experts in palliative care. N = 417 (X = 39.06 years) took part in the validation. DAP-RSp showed adequate internal consistency (Cronbach's alpha ranging from 0.67 for Neutral Acceptance to 0.95 for Escape a Acceptance, and 0.88 for the total), a multitrait scaling analysis and a confirmatory factor analysis reproduced the five dimensions of the original scale. The Spanish version of the DAP-R can be used as a valid scale to assess attitudes towards death in Spanish speaking population.

Meaningful living, resilience, affective balance, and psychological health problems among Turkish young adults during coronavirus pandemic

The present study sought to investigate the mediating effect of the affective balance and resilience on the association between meaningful living and psychological health problems among Turkish young adults in the context of COVID-19. The participants were 359 Turkish young adults, comprising of primarily female (68.2%), and their age ranged between 18 to 43 (age M = 20.67, SD = 3.62). Findings from this study indicated that meaningful living had a positive predictive effect on resilience and positive affect, as well as a negative predicative on psychological health challenges and negative affect. Resilience and affective balance also mediated the effect of meaningful living on psychological health of young adults. These results suggest that resilience and affective balance are important aspects of meaning-focused preventions and interventions designed to build up resilience, positive affectivity, and psychological health.

Self-Transcendence as a Buffer Against COVID-19 Suffering: The Development and Validation of the Self-Transcendence Measure-B

The age of COVID-19 calls for a different approach toward global well-being and flourishing through the transcendence suffering as advocated by existential positive psychology. In the present study, we primarily explained what self-transcendence is and why it represents the most promising path for human beings to flourish through the transformation of suffering in a difficult and uncertain world. After reviewing the literature on self-transcendence experiences, we concluded that the model of self-transcendence presented by Frankl is able to integrate both of the characteristics associated with self-transcendence. Afterward, we discussed how the self-transcendence paradigm proposed by Wong, an extension of the model by Frankl, may help awaken our innate capacity for connections with the true self, with others, and with God or something larger than oneself. We presented self-transcendence as a less-traveled but more promising route to achieve personal growth and mental health in troubled times. Finally, we presented the history of the development and psychometrics of the Self-Transcendence Measure-Brief (STM-B) and reported the empirical evidence that self-transcendence served as a buffer against COVID-19 suffering. The presented data in the current study suggested that the best way to overcome pandemic suffering and mental health crises is to cultivate self-transcendence.

Tragic Optimism as a Buffer Against COVID-19 Suffering and the Psychometric Properties of a Brief Version of the Life Attitudes Scale

The Life Attitudes Scale (LAS) was designed to measure tragic optimism (TO)-a distinct type of optimism that could generate hopeless hope even in dire situations according to existential positive psychology (PP 2.0). This study explains why only a faith-based TO could serve as a buffer against suffering at the Nazi death camps as well as the global coronavirus disease 2019 (COVID-19) pandemic. In study 1, the results showed that the factorial structure of a 15-item LAS-Brief (LAS-B), which is a short measure of TO, replicated the original structure of the 32-item long version. The five factors (i.e., affirmation, acceptance, courage, faith, and self-transcendence) provided a good data model fit statistics for LAS-B; the measure had adequate-to-strong internal and latent construct reliability estimates. In study 2, the buffering effect of TO on the association between suffering experiences during COVID-19 and life satisfaction in adults was examined. The results of the studies were consistent with our hypothesis that TO as measured by LAS-B serves as a buffer against the impact of COVID-19 suffering on life satisfaction.

Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective

The COVID-19 pandemic has exposed the inadequacies of the current healthcare system and needs a paradigm change to one that is holistic and community based, illustrated by the healing wheel. The present paper proposes that existential positive psychology (PP 2.0) represents a promising approach to meet the rising needs in palliative care. This framework has a twofold emphasis on (a) how to transcend and transform suffering as the foundation for wellbeing and (b) how to cultivate our spiritual and existential capabilities to achieve personal growth and flourishing. We propose that these objectives can be achieved simultaneously through dialectical palliative counselling, as illustrated by Wong's integrative meaning therapy and the Conceptual Model of CALM Therapy in palliative care. We then outline the treatment objectives and the intervention strategies of IMT in providing palliative counselling for palliative care and hospice patients. Based on our review of recent literature, as well as our own research and practice, we discover that existential suffering in general and at the last stage of life in particular is indeed the foundation for healing and wellbeing as hypothesized by PP 2.0. We can also conclude that best palliative care is holistic-in addition to cultivating the inner spiritual resources of patients, it needs to be supported by the family, staff, and community, as symbolized by the healing wheel.

Protectors of Wellbeing During the COVID-19 Pandemic: Key Roles for Gratitude and Tragic Optimism in a UK-Based Cohort

The COVID-19 pandemic has presented a global threat to physical and mental health worldwide. Research has highlighted adverse impacts of COVID-19 on wellbeing but has yet to offer insights as to how wellbeing may be protected. Inspired by developments in wellbeing science and guided by our own theoretical framework (the GENIAL model), we examined the role of various potentially protective factors in a sample of 138 participants from the United Kingdom. Protective factors included physical activity (i.e., a health behaviour that helps to build psychological wellbeing), tragic optimism (optimism in the face of tragedy), gratitude (a prosocial emotion), social support (the perception or experience of being loved, cared for, and valued by others), and nature connectedness (physical and psychological connection to nature). Initial analysis involved the application of one-sample t-tests, which confirmed that wellbeing (measured by the Warwick-Edinburgh Mental Well-being scale) in the current sample (N = 138; M = 46.08, SD = 9.22) was significantly lower compared to previous samples (d = -0.36 and d = -0.41). Protective factors were observed to account for up to 50% of variance in wellbeing in a hierarchical linear regression that controlled for a range of sociostructural factors including age, gender, and subjective social status, which impact on wellbeing but lie beyond individual control. Gratitude and tragic optimism emerged as significant contributors to the model. Our results identify key psychological attributes that may be harnessed through various positive psychology strategies to mitigate the adverse impacts of hardship and suffering, consistent with an existential positive psychology of suffering.

Existential positive psychology and integrative meaning therapy

The unprecedented changes in our society because of COVID-19 and the fourth industrial revolution (4IR) shows that our healthcare system and the medical approach to psychotherapy can no longer meet the mental health needs of society. This paper first described the negative impact of COVID-19 and 4IR on our mental health. Then, following a brief critique of the medical model, this paper proposes that the future of psychotherapy needs to be based on the more inclusive and integrative framework of existential positive psychology (PP 2.0), which emphasizes flourishing through suffering. Finally, the paper emphasizes Viktor Frankl's cure and Wong's integrative meaning therapy. It concludes that integrative meaning therapy represents the future of psychotherapy, because it is situated in the area of interactions of at least three traditions: Clinical psychology, existential psychology, and positive psychology. This integrative model is holistic, recognising humans as bio-psycho-social-spiritual beings and considers several theoretical perspectives in both diagnosis and treatment.

The Unheard Cry of a Successful Asian Psychologist

This paper addresses the important issues of making it as an Asian psychologist in an overwhelmingly white academic field. Based on my professional and personal struggle to achieve success as a psychologist in both academia and clinical practice, I want to (a) expose the naked truth of being an Asian psychologist within a white academic field with regard to racial trauma, careerism, and expediency; (b) chart a course of maintaining personal and ethnic authenticity in truth-seeking in spite of all the visible and invisible obstacles in a foreign country; and (c) propose ways to fully recognize indigenous psychology and integrate Asian minorities in mainstream psychology.

Does Delay of Reinforcement Produce Durable Persistence?

In a foru-phase experiment, phase I was runway training under four different reinforcement conditions: partial reinforcement (PRF), partial delayed reinforcement (PDR), constant delayed reinforcement (CDR), and consistent reinforcement (CRF). During phase 2 extinction, PRF and PDR groups did not differ; both groups were more persistent than group CDR, which was in turn superior to the CRF control. Phase 3 was CRF reacquisition for all groups. During phase 4 extinction, PRF group was more presistent than the other three groups which did not differ. A Pavlovian counter-conditioning hypothesis was proposed to account for the absence of durable persistence following PDR training.

What Helps and What Hinders in Cross-Cultural Clinical Supervision

This study investigated what helped and what hindered in cross-cultural supervision. The participants were 25 visible minority graduate students and early counseling professionals. They were individually interviewed according to an expanded version of Flanagan’s critical incident technique. The most frequently cited positive themes were subsumed in five key areas: (a) personal attributes of the supervisor, (b) supervision competencies, (c) mentoring, (d) relationship, and (e) multicultural supervision competencies. The most frequently reported negative themes were grouped into five areas: (a) personal difficulties as a visible minority, (b) negative personal attributes of the supervisor, (c) lack of a safe and trusting relationship, (d) lack of multicultural supervision competencies, and (e) lack of supervision competencies. The results support a person-centered mentoring model of effective supervision.

Reclaiming Positive Psychology

The future of humanistic psychology lies in reclaiming themes of personal growth, self-actualization, authentic happiness, optimal functioning, and human flourishing. This article proposes that a meaning-centered holistic approach within the larger context of existential givens complements the molecular approach of research on specific components of positive psychology.

Death Attitudes across the Life-Span: The Development and Validation of the Death Attitude Profile (DAP)

Four orthogonal factors were identified by principal component factor analysis: Fear of Death/Dying, Approach-Oriented Death Acceptance, Escape-Oriented Death Acceptance, and Neutral Death Acceptance. Theta estimates of the internal consistency of the factor scales ranged from fair (.60) to good (.89). An elderly sample ( n = 50) showed less fear of death and more acceptance (all three kinds of acceptance) than the middle age ( n = 50) and the young ( n = 50) samples. As predicted, Fear of Death/Dying was negatively related to happiness, but positively related to hopelessness, whereas Escape-Oriented Death Acceptance was positively related to hopelessness, thus providing some evidence of concurrent validity of the DAP.

Social Support Functions of Group Reminiscence

This paper integrates two major domains of gerontological research, namely, social support and reminiscence, within the conceptual framework of social resources. It reviews the health benefits of informal social support in the elderly and then examines the social support functions of group reminiscence. Although the literature on the social support benefits of group reminiscence is very scanty, available data show it is an effective means of expanding social resources and facilitating socialization, which are essential to the mental health of the aging population.