What kind of psychotherapy naturally produces it?
Posted Feb 03, 2015
Just because you’re not sick, doesn’t mean you’re healthy.
We are used to that idea in physical health. Being cancer free is not the same as being fit—you have to take the steps needed to develop your physical strength, endurance, and flexibility. Not having the flu is great, but vigor depends on eating well, exercising, and getting enough sleep. Physical health, we know, goes far beyond the absence of illness.
The clarity we have with physical health, however, vanishes once we get to our own emotional, psychological, and social life. For most of us it’s not even clear what prospering means in these areas, never mind how to produce it. If we aren’t depressed, or anxious, or addicted, we’re doing okay, right? If we have a good job, and people respect us, that’s about it, isn’t it?
Ah, no. It isn’t.
There is no doubt that depression, panic disorder, or addiction will interfere with an ability to live a rich and full life, but avoiding such things doesn’t mean we are flourishing. As with physical health, it is just the beginning.
Arianna Huffington details a perspective on what it means to thrive in her new book, Thrive.1 Thriving, she notes, involves well-being in multiple areas: physical, emotional, social, and psychological. It involves wisdom, appreciation of wonder, and being able to bring purpose and compassion into your life.
Arianna’s formula for promoting thriving includes both positive physical health practices (e.g., sleep), and positive behavioral health practices such as mindfulness, downtime, giving, and a renewed connection with your deepest values. It involves what she calls “evicting the obnoxious roommate in your head,” opening up to “intuition”—or experience that goes beyond words—and creating positive habits that can guide us when we are in auto-pilot. She teaches the importance of acceptance (not resignation!) and having the wisdom to know when control and change works and when it does not. She suggests facing our own finitude, and spending more time giving than getting.
But what if you are dealing with a notable psychological problem? What if you want to alleviate a serious behavioral health issue AND you want to flourish in the kind of positive sense she has laid out? Is any of this advice still relevant?
It turns that that it is.
Very much in line with the ideas in Thrive, new research shows there is particular benefit from an intervention that includes a central focus on mindfulness, emotional openness, and values. It turns out that that even just reading a self-help book to alleviate your psychological problems can help you both defeat the blues, and increase your ability to live a full, rich, and meaningful life—provided it is oriented toward these “thriving” processes.
More good stuff!
The study just published by a team of Dutch researchers in a prestigious scientific journal looked at 376 participants with depressive symptomatology who were randomly assigned to a wait list or to a book version of Acceptance and Commitment Therapy (ACT)2 plus email support.3 The impact of the intervention on depression had been presented earlier4—this was a re-analysis to examine its impact on flourishing.
ACT is a method of psychotherapy that attempts to increase emotional openness and mindful, non-judgmental awareness of thoughts; to increase flexible attention to the now and contact with a perspective-taking sense of self; and to foster values choices and building patterns of values-based living. Together these six processes are termed “psychological flexibility” and are the central target of ACT.5
ACT was the first and is still one of the only evidence-based forms of psychotherapy to include both mindfulness-based methods AND values-based methods, as Huffington advocates. It is focused both on how to deal with negative emotion and thought, AND how to pursue a positive life vision. It is about both alleviation of suffering AND flourishing.
Many of the specific ideas in Thrive are actually in ACT almost word for word. This includes work on healthy acceptance, compassion for others, and turning down the obnoxious voice within (in ACT this is done through what is called “defusion.”) New habits are grooved through committed, values-based action.
Previous studies have looked at accomplishment of the dual set of goals in ACT primarily by examining both psychological problems and quality of life. But this new study did a deeper dive into thriving, going well beyond traditional measures of life satisfaction.
ACT has been evaluated in more than 110 randomized controlled trials, and is on government and scientific society lists of evidence-based forms of psychotherapy, including for depression.6 Given that, it is not surprising that the intervention, even in book and email support form, produced major reductions in depression. What is new is the breadth and depth of the simultaneous impact on well-being and growth.
Flourishing was measured in 14 areas across three domains: emotional well-being (positive affect, happiness, and satisfaction with life); psychological well-being (autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, self-acceptance); and social well-being (social acceptance, social actualization, social contribution, social coherence, and social integration). Rates of flourishing were calculated using a well-established cut off in which the majority of these 14 specific areas reached very high levels.
The good news was this: After nine weeks spent reading a book on ACT, 24% of these participants with depressive symptomatology moved from “not flourishing” to “flourishing”. In the wait list group, only 10% did that, a statistically significant difference. The positive impact of ACT on flourishing showed no fall off over a three month follow up.
Not bad for reading a book and some emails!
The study even showed why flourishing increased. Some baseline differences predicted flourishing, but pragmatically the more important processes were the ones that changed due to treatment. It turns out that the key was an increase in psychological flexibility. If you become more accepting, are able to turn down the volume of the voice within, and become more mindful and values focused, you are on the road to success in a broad way.
There is a bottom line here that is worth taking to heart. Alleviation of suffering can go hand in hand with creating a rich, full, and meaningful life. Thriving isn’t something that is just within reach for those who are pretty healthy already. Even if you are dealing with significant psychological problems, you can start working toward it right here, and right now.
The formula for doing so is not fancy, and it’s not beyond normal people: learn how to open up; become more mindful, accepting, and aware; slow down the rush and link your behavior to your deepest sense of caring, both for yourself and others. It turns out that this will help a lot with your psychological problems. It will also help you thrive.
1 Huffington, A. (2014). Thrive: The third metric to redefining success and creating a life of well-being, wisdom, and wonder. New York: Harmony.
2 A translation is available under the slightly odd title of “A beginner’s guide to mindfulness”. Bohlmeijer, E. and Hulsbergen, M (2013). Open University Press.
3 Bohlmeijer, E. T., Lamers, S. M. A., & Fledderus, M. (2015). Flourishing in people with depressive symptomatology increases with Acceptance and Commitment Therapy. Post-hoc analyses of a randomized controlled trial. Behaviour Research and Therapy, 65, 101-106.
4 Fledderus, M., Bohlmeijer, E.T., Pieterse, M. E., & Schreurs, K. M. (2011) Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial. Psychological Medicine, 11, 1-11.
5 Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.