Cite as: Schrank B, Brownell T, Tylee A, Slade M (2014) Positive psychology: An approach
to supporting recovery in mental illness, East Asian Archives of Psychiatry, 24, 95-103.
Positive psychology: an approach to supporting recovery in mental illness
Running title: Positive psychology and mental illness
Authors: Beate Schrank, MD1,2; Tamsin Brownell, MSc1; Andre Tylee, PhD1; Mike Slade,
PhD1
Affiliations:
1
King’s College London, Institute of Psychiatry
2
Medical University of Vienna, Department of Psychiatry and Psychotherapy
Corresponding author:
Beate Schrank
Health Service and Population Research Department (Box P029), King's College London,
Institute of Psychiatry, Denmark Hill, London SE5 8AF
Email: beate.schrank@kcl.ac.uk
Phone: 020 7848 0704
Fax: 020 7848 5056
1
Abstract
Objectives: This paper reviews the literature on positive psychology with a specific focus on
people with mental illness. It describes the characteristics, critiques and roots of positive
psychology (PP) and positive psychotherapy (PPT), and summarises the existing evidence
on PPT.
Results: PP aims to re-focus psychological research and practice on the positive aspects of
experience, strengths and resources. Despite a number of conceptual and applied research
challenges the field has rapidly developed since its introduction at the turn of the century and
today serves as an umbrella term to accommodate research investigating positive emotions
and other positive aspects, such as creativity, optimism, resilience, empathy, compassion,
humour, or life satisfaction. PPT is a therapeutic intervention that evolved from this research.
It shows promising results for reducing depression and increasing wellbeing in healthy
people and those with depression. PP and PPT are increasingly being applied in mental
health settings, but research evidence involving people with severe mental illness is still
scarce.
Conclusions: The focus on strengths and resources in PP and PPT may be a promising
way to support recovery in people with mental illness, such as depression, substance abuse
disorders and psychosis. More research is needed to adapt and establish these approaches
and
provide
an
evidence
base
for
their
application.
Key Words: rehabilitation, psychiatry, psychology, psychotherapy, health services
2
What is Positive Psychology?
The academic discipline of Positive Psychology (PP) developed from Martin Seligman’s 1998
Presidential Address to the American Psychological Association1. He maintained that
psychology so far had mostly addressed only one of its original aims, i.e. curing mental
illness, whilst largely neglecting the two other aims, i.e. helping people to lead more
productive and fulfilling lives; and identifying and nurturing high talent. Consequently,
Seligman dedicated his presidency at the American Psychology Association to initiating a
shift in psychology’s focus towards the positive aspects of human experience, positive
individual traits, and more generally the positive features which make life worth living 2. In this
context, the term “positive” was only ambiguously defined as what “promises to improve the
quality of life and also to prevent the various pathologies that arise when life is barren and
meaningless” (p.5).
Seligman and Csikszentmihalyi2 originally conceptualised Positive Psychology as a “new
movement” (p. 5) in psychology. This notion of a movement was considered necessary in
order to counteract the perceived powerful focus of psychology on the negative aspects of
life and on ill health. A number of definitions of PP have since been proposed but no clear
boundaries defined for the field. A systematic review conducted in 2011 found 53 published
definitions of PP spanning six core domains: (i) virtues and character strengths, (ii)
happiness, (iii) growth, fulfilment of capacities, development of highest self, (iv) good life, (v)
thriving and flourishing, and (vi) positive functioning under conditions of stress3.
Since its introduction, a wealth of research and opinion papers, books, and journal special
issues have been published and a dedicated PP journal has been established. Networks,
courses and research centres have been created, and sizeable amounts of money have
been allocated to PP research, education, and training by various funders4. PP has also
received broad and international media coverage.
3
Along with the rapid evolution of Positive Psychology and the extensive publicity, PP also
generated some criticism which falls into five overlapping domains. First, PP was criticised
for denying or openly devaluing closely related prior work 5. Early stage publications were met
with strong disapproval due to their implicit or explicit assumption that PP had newly created
its constituent topics of interest6. In fact, there is a long history of movements and
psychological schools that also attended to the positive aspects of life. However, whilst many
of the research topics examined in PP have been studied before (e.g. attachment, optimism,
love, and emotional intelligence), others topics in PP were less popular before and boosted
through the introduction of PP, e.g. gratitude, forgiveness, awe, inspiration, hope, curiosity,
or laughter7.
A second concern was that PP rhetoric was polarising and created a false dichotomy of a
new ‘positive’ and an old ‘negative’ or ‘usual’ psychology8,9. In reality, the large majority of
academic work in psychology may be considered neither positive nor negative, but neutral 7.
In clinical practice, an exclusive focus on the positive was criticised for creating a “tyranny of
positive attitude” preventing people from expressing negative emotions9, and helping people
to avoid difficult but necessary therapeutic processes10.
A third criticism concerns the feasibility of discriminating positive and negative variables. This
criticism pertains to two areas: (i) the processes by which variables have a positive or
negative effect; and (ii) the measurement of variables as either positive or negative.
Variables may not be invariably positive or negative8,11. For example, research showed that
dispositional pessimism can have debilitating motivational effects while defensive pessimism
can help people deal with anxiety, adapt and perform better than strategic optimists 12. A PP
intervention helping defensive pessimists to be more optimistic might deprive them of a
useful coping strategy12, because a pessimistic attitude can in some circumstances be more
adaptive than an optimistic attitude. Automatically assigning any variable of interest,
especially emotions, to a positive or negative valences without regard for wider context may
create research results of questionable value and generalizability8.
4
The fourth criticism is that PP concepts neglect the cultural context of human activity, and
reflect the individualism ethic of American society13. Identity, virtue, or a ‘good life’ may have
different meanings in different cultures, so it may be difficult to arrive at one universal
definition of such concepts6. The same issue has been explored in relation to recovery14.
Applying a narrow set of values may lead to research results that are not generalizable or to
the development of interventions which are not applicable across populations.
Finally, from a more philosophical perspective, PP has been criticised for its lack of a
developed framework for investigating complex topics such as character, virtues, or
happiness9,15. Despite the repeated reference to Aristotle, ethical considerations were found
largely missing16. This relative lack of attention to conceptualisation and theoretical
underpinnings may arise from the emphasis within PP research on empiricism.
PP has come a long way in response to these criticisms. Pre-existing resource oriented
psychological approaches and research on positively framed topics are now acknowledged17.
PP is argued to have developed as a result of a different perspective on these topics, namely
to challenge the traditional focus of psychology on negative issues. Whilst it may be the case
that it is often negative emotions which reflect more immediate problems to be addressed
and are hence the focus of more traditional psychological principles, PP broadens this
perspective. Instead of focussing on responding to problems, PP focusses on the need to
identify the positive qualities that help individuals to not only overcome problems, but also to
go forward and flourish2. Furthermore, positive psychology focuses on the development of a
quantitative evidence base for its constituent topics, on which there has been less emphasis
in antecedent resource oriented approaches.
Statements on the perspective of PP have been adjusted to be less polarising, by redressing
what is still perceived as an imbalance but focussing on “understanding the entire breadth of
human experience, from loss, suffering, illness, and distress through connection, fulfilment,
5
health, and wellbeing.”4. The potentially over-simplified division of positive and negative
remains largely unresolved. More research is needed to explore why variables may be
perceived as positive or negative, and to develop measures allowing a more flexible
assignment of valence. Contextual factors now receive increasing attention, especially when
it comes to creating a supportive context for interventions18. However, empirical research
considering the complexities of cultural diversity and societal problems is still scarce, and an
increased emphasis on ethics and complex philosophically informed frameworks is so far
merely stated as a future goal of PP17. The increasing acknowledgement and inclusion of
earlier works, especially from humanistic approaches, may be a first step towards creating a
more differentiated and theoretically informed picture of positive emotions and states in PP6.
Historical developments and predecessors of Positive Psychology
A number of researchers and therapists have framed their approach as positive, strengths or
resource-oriented, providing a rich knowledge base for PP to build on. Examples of earlier
‘positive’ approaches within mental health systems include New Thought, Mental Hygiene,
Individual Psychology, or Humanistic Psychology, as well as a range of psychotherapy
methods.
New Thought is one of the early but still well-known movements that emphasised the
transformational power of positive thinking. It became popular in the late 19th century
together with other mind cure movements promising happiness, material success and good
health, provided people focus on and practice positive mental suggestions19. PP
interventions today also include exercises that aim to re-focus attention towards the
positive20.
The Mental Hygiene movement had widespread influence from the beginning of the 20th
century until the 1940s, particularly in the United States. Its aim was to facilitate the
attainment of physical and mental health through perfect adjustment to society by developing
and preserving those human values and achievements which contribute to a balanced
6
mental life for the individual19. The attainment of perfect health, adjustment, achievement,
and balance is reminiscent of the early conceptual framing of PP, as is the fact that the
mental hygiene movement also focussed on education and postulated the importance of
scientific studies in their field.
More complex and comprehensive schools of thought attending to the positive were to follow
in the middle and later parts of the 20th century. Alfred Adler founded the school of Individual
Psychology which emphasises the healthy functions of the person. He considered the three
“tasks of life” to be occupation, social relationships, and love. Similar to PP, Adlerian
Psychology acknowledged human strength and the potential for higher levels of mental
health and wellbeing. However, in comparison with PP it more strongly stressed the social
embeddedness and connectedness of the individual21.
Similar to Martin Seligman, Abraham Maslow, who founded Humanistic Psychology in the
1950’s, criticised the fact that psychology had focussed too much on negatives, illnesses and
sins, instead of potentials, virtues, aspirations and psychological height22. He proposed that
humanistic psychology should be based on the study of healthy, creative individuals and
empirically investigate the lives and patterns of self-actualised persons. Maslow even used
the term ‘positive psychology’. Of all predecessors, humanistic psychology bears most
resemblance with PP in that they both aim to focus on what is healthy and growth oriented
within people23.
Carl Rogers developed person-centred psychotherapy, one of the best known humanistic
psychotherapy approaches. Rogers’ theory assumes that people have an inherent tendency
towards growth, development, and optimal functioning. In his therapy a non-judgmental and
unconditionally positive regard is adopted towards clients in order to help them realise their
true positive potential24. Further contemporary resource oriented therapeutic approaches
include systemic family therapy; solution focussed therapy; socio-therapy and therapeutic
communities; music therapy; self-help groups and mutual support groups; peer support and
7
consumer led services; and befriending25. All of these approaches share at least some
possible therapeutic strategies with PP interventions. Examples include using the family as a
resource (e.g. family therapy), focussing on strengths (e.g. solution focussed therapy), or on
social relationships (e.g. befriending).
Research evidence in PP
Positive Psychology was originally conceptualised as a discipline strongly based on high
quality quantitative research, such as observational studies or randomised controlled trials.
This should allow the methods of natural sciences and evidence based medicine to be
applied to the study of wellbeing2,26. The reliance on quantitative scientific methods was
initially also used to set the Positive Psychology movement apart from earlier approaches to
human flourishing, which may arguably have placed more emphasis on qualitative
research23,27.
In terms of content, today Positive Psychology serves as an umbrella term to accommodate
research endeavours which started both before and after the introduction of the movement
by Seligman and Csikszentmihalyi. Related research spans a diverse range of disciplines,
such as education28, organizational behaviour management29, sport psychology30, family
medicine31, cancer care32 and brain injury rehabilitation33. For example, cross-sectional and
observational studies have investigated various positive emotions, such as joy, contentment,
love, and gratitude, as well as other positive aspects, such as creativity, self-efficacy,
optimism resilience, empathy and altruism, compassion, humour, and life satisfaction34.
These have informed the creation of systematic measures of character strength and
virtues26. This variety of topics and areas makes it difficult to place specific research within or
outside the spectrum of PP.
Among the areas of work in positive psychology research is the development and
8
investigation of strategies that would make people permanently happier. A range of
approaches intended to promote wellbeing have been tested in intervention research, such
as mindfulness therapy, forgiveness therapy, gratitude therapy and various forms of
wellbeing therapy35. Some of the most promising amongst the strategies have been
combined into one overall intervention manual named Positive Psychotherapy (PPT)26.
Positive psychology in (mental) health services
Public health activities aim to prevent disease, premature death and disability in the
population. Mental health problems strongly contribute to the burden of morbidity, mortality
and impairment in the population and are hence an important field for public health
specialists36. Indeed, recent public health literature reflects an increased focus on
psychological health and wellbeing in addition to disorder and disability37. Reasons why such
a shift may be beneficial include the high prevalence of mental health problems and the
possible preventive value of fostering wellbeing for health behaviours.
In mental health services research, the strong focus on illness, symptoms, and deficits as the
target for change has begun to shift towards strengths and resources only in recent decades.
The World Psychiatric Association remarks in its official journal that “psychiatry has failed to
improve the average levels of happiness and wellbeing in the general population”38 (p.71),
suggesting that the promotion of wellbeing is among the goals of the mental health system.
This shift in the mental health field somewhat coincides with the consumer led recovery
movement, which has evolved since the 1980s and argues for a focus on wellbeing
regardless of the presence of mental illness. Recovery in this context refers not to symptom
remission but to people (re-)engaging in their life on the basis of their own goals and
strengths, and finding meaning and purpose through constructing and reclaiming a valued
identity and valued social roles39. These goals of the recovery movement appear highly
congruent with those of PP. The two movements, recovery and PP, are complementary39,40.
9
They share a similar focus, but the former has so far been largely built on personal accounts,
theories, and opinions with empirical research lagging behind41, while the latter offers a
quantitative research focus in need of defensible theories and contextual knowledge on
which to base its application.
While PP was originally associated with the scientific study of optimal human functioning and
with refocusing psychology away from adversity and illness towards understanding – “how
normal people flourish under more benign conditions”2 (p.5) – PP approaches have since
been successfully expanded to various populations including people with disorders and in
adverse conditions.
Positive Psychotherapy
One therapeutic approach to evolve from Positive Psychology is Positive Psychotherapy
(PPT)20,26, which aims to increase wellbeing in its recipients20. It has to be distinguished from
two other groups of therapeutic interventions: (i) those which share the same name, and (ii)
those which share the same aim.
First, several authors proposed therapeutic interventions which they called ‘positive
psychotherapy’. For example, Nossrat Peseschkian founded one positive psychotherapy
approach in the 1970s which assumes that people have two basic capacities: to love and to
know. It is a conflict-centred and resource-oriented psychotherapy that also works with the
unconscious42,43. Further examples are Milton Erickson’s hypnotherapy approach which he
framed in a positive way, causing some authors to call his methods positive psychotherapy44,
and positive group therapy for cancer patients, focussing on post-traumatic growth45.
Second, other therapies have aims similar to Positive Psychotherapy, i.e. to attain wellbeing,
happiness, or a good life, but they use different strategies to reach these aims. Examples
10
include Fordyce’s (1977)46 “happiness intervention”, Fava et al’s (1998)47 “wellbeing therapy”
and Frisch’s (2006)48 “quality of life therapy”. These all offer a wellbeing or life satisfaction
component but attend to troublesome issues and problems first and treat wellbeing as an
add-on. This distinguishes them from PPT which has as its primary focus personal strengths,
positive emotions and other positive resources to indirectly target symptoms and deficits.
PPT was developed originally for people with depressive symptoms following the hypothesis
that depression cannot only be treated effectively by reducing its negative symptoms but also
by directly and primarily building positive emotions, character strengths, and meaning 20,49.
The intervention is based on Seligman’s early theory of authentic happiness, in which a good
life consists of three components: (i) positive emotions (the pleasant life), (ii) engagement
(the engaged life), and (iii) meaning (the meaningful life).
Similar to cognitive behavioural therapy (CBT) for depression50, PPT assumes a cognitive
bias towards the negative in humans and uses techniques aiming to shift attention, memory,
and expectations away from the negative and the catastrophic toward the positive and the
hopeful20. However, in contrast to CBT the focus of PPT exercises is on training and
experience, i.e. external and behavioural, and less on cognitive insight. A fundamental
assumption of PPT is that people have both an inherent capacity for happiness and a
susceptibility to psychopathology. Clients are perceived as autonomous, growth-oriented
individuals. Distressing, unpleasant, or negative states and experiences are not denied51, in
part they are even explicitly elicited, but in doing so clients are encouraged to focus on
positive aspects of such experiences.
There are five fundamental principles of PPT52. First, PPT broadens and builds therapeutic
resources, similar to other psychotherapies. PPT broadens the client’s perspective by
encouraging him to undertake exercises which can elicit positive emotions, help generate
11
new ideas and more positively frame difficult situations. Second, PPT exercises use specific
strategies to help clients think about negative situations by conducting careful positive
reappraisals. Third, PPT also includes experiential and skills-building exercises, which focus
on clients’ identification and development of key strengths to increase their confidence and
motivation. Fourth, PPT deals with problems by teaching clients to actively think about their
positive qualities and helping them realise they can use these to solve their problems.
Finally, PPT helps clients by re-educating their attention, memory and expectations away
from the negative and towards a more positive mindset.
PPT can be applied in group and individual formats. It exists in a 6-session and a 14-session
version with all exercises designed to address one or more of the three components of
authentic happiness20,51. Exercises include, for example, identifying character strengths and
using them more in daily life, keeping a blessings journal, focusing on good instead of bad
memories, savouring moments and activities, using forgiveness and gratitude to create
positive emotions, or helping others52. Apart from using specific exercises, PPT relies on a
skilled and knowledgeable therapist to specifically look and probe for clients’ strengths, and
help them realise how these strengths can be associated with their personality, goals, values
and intra- and inter- personal life.
Research evidence on Positive Psychotherapy
A meta-analysis of 51 studies of positive interventions, including therapies focusing on
mindfulness, positive writing, gratitude, forgiveness, or kindness, demonstrated significantly
improved wellbeing and decreased depressive symptoms for people with depression53. A
more recent meta-analysis of 39 positive psychology randomised studies involving a total of
6,139 participants also concluded that positive psychology interventions can be effective in
enhancing subjective and psychological wellbeing and reducing depressive symptoms54.
Several of the included interventions successfully used single components of PPT. For
12
example, undergraduate students writing about “one’s best possible self” showed increased
wellbeing55; students writing about intensely positive experiences each day for only three
days enhanced positive mood and decreased health centre visits for up to three months56;
and students and people with neuromuscular disease keeping a blessings journal for 10
week also showed increased wellbeing57. Individual PPT exercises were also tested in RCTs
with self-referred general population samples
58-60
and including mildly depressed people61
against no-treatment control and placebo (e.g. recording childhood memories) showing
significantly positive effects of PPT exercises on happiness and reduction in depression for
most exercises and for a follow-up period of up to 6 months. Individual exercises also
produced an increase in self-esteem and decrease in physical symptoms in a community
sample with low wellbeing and high self-criticism, especially when doing active as compared
to passive exercises62. However, while individual exercises may produce benefits, there is
also evidence for a dose response relationship. An RCT assigning healthy individuals to
receiving two, four, or six exercises over six weeks or a no-treatment control showed that
those receiving two or four exercises experienced significant decreases in depressive
symptoms61. Meta-analysis confirmed that assigning multiple and different positive activities
in general is more effective than employing just one63.
PPT as a package has so far been tested in at least 14 published studies involving healthy
participants as well as participants with physical or mental illnesses, as summarised in Table
1.
--- Table 1 here –
Published studies on PPT have a number of limitations including potential selection bias, lack
of diagnostic assessments, small sample sizes, lack of randomisation or lack of blinding.
Moreover, the cultural background of clients is usually not considered although there is
evidence for its differential effect on benefits64. Hence, overall, research evidence for the
efficacy of PPT has to be rated as preliminary but promising.
13
Positive Psychotherapy for people with severe mental illness
There is strong evidence that subjective wellbeing is not only a desirable outcome in its own
right, but also a significant predictor of symptomatic response in the treatment of people with
schizophrenia78,79 and is strongly associated with medication compliance in this group15.
However, no established structured intervention exists for increasing the subjective wellbeing
of people with severe mental illnesses.
Given the evidence from other client groups outlined in Table 1, including depression20,72,74,75,
those with suicidal ideation75 and suffering from substance abuse disorders73, PPT appears
to be a promising approach for also increasing wellbeing in people with severe mental
illness. Furthermore, preliminary evidence exists for its feasibility and potential usefulness in
people with psychosis. A small uncontrolled study of six-session PPT over 10 weeks showed
significant increases in wellbeing, savouring beliefs, hope, self-esteem, and personal
recovery scores as well as a decrease in paranoid, psychotic, and depressive symptoms77.
However, despite aiming to adapt the intervention for people with cognitive impairments,
feedback indicated that most participants found it difficult to understand77. The study did not
elicit any specific modifications to the intervention for the client group and did not attempt to
account for the social-cultural context.
To deal with the challenge of culture and context, 14-session PPT was adapted for clients
with severe mental illness in a multicultural European city, i.e. South London. This involved a
systematic review on wellbeing80, a qualitative study exploring the processes of improving
wellbeing in people with psychosis81, and a qualitative study and expert consultation to adapt
PPT for the new client group82. Evidence from a pilot RCT83 testing the adapted PPT
intervention, i.e. WELLFOCUS PPT, appears promising, particularly in terms of symptom
reduction. Wellbeing remains a difficult to target domain. This may be due to conceptual
14
problems, measurement issues, or intervention variables such as timing and follow-up.
Overall, positive psychotherapy can be seen as a promising intervention to support recovery
in people with common mental illness, and preliminary evidence suggests it can also be
helpful for people with more severe mental illness such as psychosis. Fully supporting
recovery requires a focus on wellbeing in addition to standard service outcome variables
such as symptoms or service use. More conceptual work may be needed in this client group
to define and conceptualise wellbeing, and to identify shared and distinguishing features
compared to other concepts such as quality of life or happiness84 and recovery85. A
theoretically defensible conceptual underpinning may help address the problems of
measuring such a highly complex and individual construct. Finally, further optimisation of
PPT and evaluation in a definitive randomised controlled trial will generate the evidence base
for how PPT can support wellbeing – and through that recovery – in people with severe
mental illness.
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22
Table 1: Evidence on PPT in healthy people and people with somatic and mental illnesses
Reference
Design
Population
Recruitment
from
N
Control
Group(s)
PPT Intervention
Assessment
Times
Results
Healthy individuals and community samples
Lü 201365
RCT
College students College
with high and low psychology
trait positive affect class
34
No treatment
adapted from 6Baseline, postsession PPT, for 16 treatment
weeks
Parks-Sheiner
2009 66
RCT
University
students with
mild-moderate
depression
Mass
university
email
110
No treatment
6-session PPT, for
6 weeks
Baseline, post
intervention, 3,
6 and 12 month
follow-ups
Study 2:
RCT
Community
sample
Internet selfreferral
361
No treatment
6-session PPT, for
6 weeks
Baseline, post
intervention, 1,
3, 6, 12 month
follow-ups
No significant results for depression,
life satisfaction or positive emotion
Study 3:
RCT
Community
sample
Internet selfreferral
267
No treatment
6-session PPT, for
6 weeks
Baseline, post
intervention, 1
and 3 month
follow-ups
Significant decrease in depressive
symptoms in PPT group post-intervention,
not maintained at follow-up.
Significant increase in life satisfaction in
PPT group post-intervention, maintained at
1 month follow up.
No significant result for positive emotions
Rashid 2004 67
RCT
Not stated
Not stated
65
Not stated
RCT
Middle school
students
Not stated –
abstract only
22
None
Study 1:
abstract only
Rashid 2008 68
PPT group showed a significant increase in
positive trait affect
Significantly improved depression in
intervention group post-treatment,
maintained until 6-months follow-up.
Significant increase in life satisfaction in
both groups post-treatment
Readings, watching Not stated
assigned films on
character strengths,
writing reaction
papers weekly,
class room
discussions and
out-of-class
exercises
Significant increase in character strength in
intervention compared to control group
Not stated –
abstract only
Limited description. “Substantial” change in
happiness reported for the intervention
group compared to control group.
Not stated –
abstract only
23
Ouweneel 2013
69
Goodwin 2011
70
Community
Controlled
trial with self- sample
selection to
intervention
or control
Website selfreferrals
311
No treatment
25 online
Baseline, postassignments over 8 intervention
weeks, covering
three areas:
happiness, goalsetting and
resource-building
significantly stronger increase in self-efficacy
levels and positive emotions in intervention
compared to control group
Uncontrolled Community
study
sample with high
anxiety scores
Internet,
flyers,
11
None
adapted from 6Baseline, postsession PPT, with 5 treatment
additional
exercises, for 10
weeks
No significant changes in relationship
functioning, relationship satisfaction, stress
or anxiety
Professional
referrals
Somatic disorders
Huffman 2011
RCT
71
Acute
cardiovascular
disease
Three
inpatient
cardiac units
30
Active control,
i.e. meditation.
8 weekly exercises, Baseline, postwith weekly
intervention
telephone calls: (1)
Attentional
three good things,
control, i.e.
(2) gratitude, (3)
recalling events best possible self
from past week (health), (4) best
possible self
(relationships), (5)
and (6) three acts of
kindness and (7)
and (8) a repeat of
one component
The PPT group showed greater
improvement in depressive symptoms,
anxiety, happiness and health-related quality
of life compared to the two control conditions
post-intervention
Mental disorders
Asgharipoor
201272
RCT
Out-patients with
major
depressive
disorder
Referral by
therapists
18
CBT
12 weekly sessions, Baseline, postunclear use of
intervention
exercises focusing
on the three
domains of a good
life
Significant increases in happiness in both
groups.
24
Seligman 2006
RCT
Mild to
moderatelydepressed
students
University
attended –
method
unclear
40
Placebo
therapy, i.e.
recording
earliest
memories
6 session PPT, 6
weeks
Baseline, post
intervention, 3,
6, 12 month
follow up
The intervention group showed a significant
decrease in depressive symptoms at 6 and
12 month follow up compared to control
group.
No significant changes in life satisfaction.
RCT
Severely
depressed
students
Referred from
Counselling
and
Psychological
Services at
University of
Pennsylvania
46
Two control
groups:
treatment as
usual with or
without antidepressant
medication
14 session PPT, 12 Baseline, post
weeks
intervention
The intervention group showed less
depressive symptoms, better overall
functioning, higher life satisfaction and
happiness compared to both control groups
post-intervention.
20
Study 1:
Study 2:
Study 3:
Uncontrolled Community
study
sample with
depression
Website selfreferrals
50
None
Exercises from 14session PPT: 1
exercise a month
for a userdetermined number
of months
Baseline, postintervention
(tested after
each exercise)
Limited description. In the first month, 50
subscribers had baseline score indicating
severe depression. After each completed
the three blessings task and returned to the
website approx. 14 days later, 94% were
less depressed (mild-moderate depression)
Akhtar 2010 73
Controlled
trial – not
stated if
randomised
Alcohol and
drug
treatment
service for
young people
20
No treatment
8 weekly sessions
including savouring,
gratitude, strengths,
relaxation, goalsetting,
relationships,
nutrition and
resilience.
Baseline, postintervention, 6
and 12- week
follow-ups
Significant increase in happiness, optimism
and positive emotions post-intervention in
intervention group, and decrease in
happiness, optimism and positive emotions
in control group.
Young adults (1420 years) with
substance abuse
issues
Cuadra-Peralta
2010 74
QuasiOutpatients with
experimental, depression
comparing
PPT to
existing CBT
group.
Mental health
clinic in Chile
18
CBT
9 weekly sessions
adapted from 14session PPT
Baseline, post
intervention
Positive psychology was more effective than
behavioural therapy in decreasing
depressive symptoms
Huffman 2014
Uncontrolled People with
suicidal ideation
study
or behaviours
Inpatient
psychiatric
unit
61
None
9 exercises, 1 each
day: gratitude,
strengths, acts of
kindness,
meaningful
Pre and post
each exercise
All exercises were associated with
significant improvements in hopelessness
and optimism, except for optimism following
the forgiveness exercise (which saw a small
improvement)
75
25
activities, counting
blessings, best
possible self,
forgiveness and
behavioural
commitment
Kahler 2013 76
Uncontrolled Community
study
sample wanting to
stop smoking
and with low
positive affect
self-referral
from
newspaper
advert, radio,
TV, facebook,
community
events
19
None
Adapted from 6session PPT, 7
weeks, plus
transdermal
nicotine patch for 8
weeks
Baseline, after
each session,
postintervention, 5,
13, 23 week
follow-ups
Inferential statistics not calculated. 6
participants ceased smoking and were
abstinent at 23 week follow-up. No
substantial mood changes during or after the
intervention
Meyer 2012 77
Uncontrolled People with
schizophrenia
study
Mental health
services in the
US
16
None
adapted from 6session PPT, for 10
weeks, plus booster
session after 16
weeks
Baseline, postintervention,
post booster
session
Significant increase in wellbeing, savouring
beliefs, hope, self-esteem and personal
recovery scores, and significant decrease in
symptom severity post-intervention.
Results maintained at 16-week follow-up
except for self-esteem
26