Linda Bolier

Positive psychology interventions: a meta-analysis of randomized controlled studies

BackgroundThe use of positive psychological interventions may be considered as a complementary strategy in mental health promotion and treatment. The present article constitutes a meta-analytical study of the effectiveness of positive psychology interventions for the general public and for individuals with specific psychosocial problems.MethodsWe conducted a systematic literature search using PubMed, PsychInfo, the Cochrane register, and manual searches. Forty articles, describing 39 studies, totaling 6,139 participants, met the criteria for inclusion. The outcome measures used were subjective well-being, psychological well-being and depression. Positive psychology interventions included self-help interventions, group training and individual therapy.ResultsThe standardized mean difference was 0.34 for subjective well-being, 0.20 for psychological well-being and 0.23 for depression indicating small effects for positive psychology interventions. At follow-up from three to six months, effect sizes are small, but still significant for subjective well-being and psychological well-being, indicating that effects are fairly sustainable. Heterogeneity was rather high, due to the wide diversity of the studies included. Several variables moderated the impact on depression: Interventions were more effective if they were of longer duration, if recruitment was conducted via referral or hospital, if interventions were delivered to people with certain psychosocial problems and on an individual basis, and if the study design was of low quality. Moreover, indications for publication bias were found, and the quality of the studies varied considerably.ConclusionsThe results of this meta-analysis show that positive psychology interventions can be effective in the enhancement of subjective well-being and psychological well-being, as well as in helping to reduce depressive symptoms. Additional high-quality peer-reviewed studies in diverse (clinical) populations are needed to strengthen the evidence-base for positive psychology interventions.

An Internet-Based Intervention to Promote Mental Fitness for Mildly Depressed Adults: Randomized Controlled Trial

Background Depression is a worldwide problem warranting global solutions to tackle it. Enhancing well-being has benefits in its own right and could be a good strategy for preventing depression. Providing well-being interventions via the Internet may have synergetic effects. Objective Psyfit (“mental fitness online”) is a fully automated self-help intervention to improve well-being based on positive psychology. This study examines the clinical effects of this intervention. Methods We conducted a 2-armed randomized controlled trial that compared the effects of access to Psyfit for 2 months (n=143) to a waiting-list control condition (n=141). Mild to moderately depressed adults in the general population seeking self-help were recruited. Primary outcome was well-being measured by Mental Health Continuum-Short Form (MHC-SF) and WHO Well-being Index (WHO-5); secondary outcomes were depressive symptoms, anxiety, vitality, and general health measured by Center for Epidemiological Studies Depression Scale (CES-D), Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), and Medical Outcomes Study-Short Form (MOS-SF) vitality and general health subscales, respectively. Online measurements were taken at baseline, 2 months, and 6 months after baseline. Results The dropout rate was 37.8% in the Psyfit group and 22.7% in the control group. At 2-month follow-up, Psyfit tended to be more effective in enhancing well-being (nonsignificantly for MHC-SF: Cohen’s d=0.27, P=.06; significantly for WHO-5: Cohen’s d=0.31, P=.01), compared to the waiting-list control group. For the secondary outcomes, small but significant effects were found for general health (Cohen’s d=0.14, P=.01), vitality (d=0.22, P=.02), anxiety symptoms (Cohen’s d=0.32, P=.001), and depressive symptoms (Cohen’s d=0.36, P=.02). At 6-month follow-up, there were no significant effects on well-being (MHC-SF: Cohen’s d=0.01, P=.90; WHO-5: Cohen’s d=0.26, P=.11), whereas depressive symptoms (Cohen’s d=0.35, P=.02) and anxiety symptoms (Cohen’s d=0.35, P=.001) were still significantly reduced compared to the control group. There was no clear dose–response relationship between adherence and effectiveness, although some significant differences appeared across most outcomes in favor of those completing at least 1 lesson in the intervention. Conclusions This study shows that an online well-being intervention can effectively enhance well-being (at least in the short-term and for 1 well-being measure) and can help to reduce anxiety and depression symptoms. Further research should focus on increasing adherence and motivation, reaching and serving lower-educated people, and widening the target group to include people with different levels of depressive symptoms. Trial Registration Netherlands Trial Register (NTR) number: NTR2126; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2126 (archived by WebCite at http://www.webcitation.org/6IIiVrLcO).

The impact of emotional well-being on long-term recovery and survival in physical illness: a meta-analysis

This meta-analysis synthesized studies on emotional well-being as predictor of the prognosis of physical illness, while in addition evaluating the impact of putative moderators, namely constructs of well-being, health-related outcome, year of publication, follow-up time and methodological quality of the included studies. The search in reference lists and electronic databases (Medline and PsycInfo) identified 17 eligible studies examining the impact of general well-being, positive affect and life satisfaction on recovery and survival in physically ill patients. Meta-analytically combining these studies revealed a Likelihood Ratio of 1.14, indicating a small but significant effect. Higher levels of emotional well-being are beneficial for recovery and survival in physically ill patients. The findings show that emotional well-being predicts long-term prognosis of physical illness. This suggests that enhancement of emotional well-being may improve the prognosis of physical illness, which should be investigated by future research.

Internet-Based Intervention to Promote Mental Fitness in Mildly Depressed Adults: Design of a Randomized Controlled Trial

Background Investing in mental well-being is considered a supplement to current mental health service delivery in which the treatment and prevention of mental disorders are core components. It may be possible for people to enhance their well-being by boosting their “mental fitness.” Objective Psyfit, an online, multi-component, fully automated self-help intervention, was developed with the aim of improving well-being and reducing depressive symptoms. The efficacy and cost-effectiveness of this intervention will be examined in a randomized controlled trial. Methods In this two-armed randomized controlled trial, a total of 290 participants will be assigned to use Psyfit (experimental condition) or to a 6-month waiting list (control condition). Adults with mild to moderate depressive symptoms interested in improving their mental fitness will be recruited from the general population through advertisements on the Internet and in newspapers. Online measurements by self-assessment will be made prior to randomization (pre-test), 2 months after baseline (post-test), and 6 months after baseline (follow-up). Results The primary outcome is well-being. Secondary outcomes are depressive symptoms, general health, vitality, and economic costs. Analysis will be conducted in accordance with the intention-to-treat principle. Conclusions This study will examine the efficacy and cost-effectiveness of an online intervention that aims to promote well-being in people with elevated levels of depressive symptoms. If shown to be effective, the intervention could prove to be an affordable and widely accessible intervention to improve well-being in the general population. Trial Registration The study is registered with the Netherlands Trial Register, part of the Dutch Cochrane Centre (NTR2126).

Cost-effectiveness of online positive psychology: Randomized controlled trial

As yet, no evidence is available about the cost-effectiveness of positive psychological interventions. When offered via the Internet, these interventions may be particularly cost-effective, because they are highly scalable and do not rely on scant resources such as therapists’ time. Alongside a randomized controlled trial of an online positive psychological intervention, a health-economic evaluation was conducted. Mild to moderately depressed adults seeking self-help and recruited in the general population were randomly assigned to the intervention group (n = 143) and a waitlisted usual care group (n = 141). Improved clinical outcomes were achieved in the intervention group (at least for depression) at higher costs. When outliers (the top 2.5%, n = 5 in intervention group, n = 2 in control group) were removed, cost-effectiveness was increased considerably. For positive psychology, economic evaluations may be a means to nudge policy decision-makers towards placing positive psychological interventions on the health agenda.

Validation of the Flourishing Scale in a sample of people with suboptimal levels of mental well-being

BackgroundThere is growing interest in measuring the eudaimonic perspective of mental well-being (social and psychological well-being) alongside existing measures of the hedonic perspective of mental well-being (subjective well-being). The Flourishing Scale (FS) assesses core aspects of social-psychological functioning and is now widely used in research in practice. However, the reliability and validity of eudaimonic measures such as the FS has not yet been tested in people with low or moderate levels of well-being. This group is at risk for developing mental disorders and, therefore, an important target group for public mental health.MethodsWe extensively evaluated the psychometric properties of the 8-item FS in a sample of adults with low or moderate levels of well-being in The Netherlands (N = 275) using confirmatory factor analysis (CFA), item response theory analysis and a multitrait matrix.ResultsThe unidimensional structure of the scale was confirmed with CFA and an adequate fit to the Rasch model. However, our sample showed positive skewness of the scale, but lacked measurement precision at the higher end of the social-psychological continuum. In general, the multitrait matrix demonstrated the convergent validity of the scale, with strong to weak correlations between the FS and (1) overall well-being, (2) social and psychological well-being (3) positive eudaimonic states, (4) hedonic states, (5) psychopathology and (6) personality traits. Nevertheless, relatively low correlations were found, specifically in comparison with the Mental Health Continuum-Short Form (MHC-SF).ConclusionsThe FS seems a reliable and valid instrument for measuring social-psychological functioning in adults with suboptimal well-being, but its use in intervention studies and clinical practice might be debatable. Therefore, the FS seems most suitable to include in epidemiological studies alongside existing hedonic measures to more fully capture mental well-being. Future research should examine the temporal stability of the FS and the consequences of the positive skewness and limited external validity of the scale found in the current study.

The home party: “Development of a low threshold intervention for ‘not yet reached’ parents in adolescent substance use prevention”

Aim: Parents of low socioeconomic status living in deprived areas, and also ethnic minority parents in general, are not reached by current family‐based approaches to addiction prevention. The aim of this project was to develop and pilot implement a low threshold intervention (the home party) aimed at these parents. The recruitment method of the home party intervention is based on the Tupperware formula. Home parties take place in the home of one of the parents, they are needs‐driven and they emphasise protective factors in parenting. The questions addressed by the present project were whether the home party technique is a suitable strategy for recruiting hard‐to‐reach parents, whether it is responsive to their needs, and what factors can impede or facilitate the implementation of the parties. The home party project: The intervention was developed and pilot‐tested in an iterative process. The project was accompanied by a process evaluation, including a post‐test of the participating parents. Results: In the 2000–2003 period, 22 parties were held, reaching a total of 177 parents. The parents expressed satisfaction with the content of the party and reported they had learned more about substance use and felt strengthened in their parenting efforts. Conclusion: The home party intervention is feasible for recruiting and engaging intended target groups. More research is needed on the aims and effectiveness of the home party intervention, and on implementation within a broad community approach.

Short web-based guided self-help intervention prevents the onset of a major depressive disorder in adults with subthreshold depression

ABSTRACT FROM: Buntrock C, Ebert DD, Lehr D, et al. Effect of a web-based guided self-help intervention for prevention of major depression in adults with subthreshold depression: a randomized clinical trial. JAMA 2016;315:1854–63.[OpenUrl][1][PubMed][2] The available treatments can only moderately reduce the enormous burden of disease associated with depression.1 Prevention of the transition from subthreshold depression to a full-blown disorder is therefore highly needed. Offering accessible and affordable preventive interventions at a large scale, such as web-based interventions, could be an indispensable strategy to reduce the global burden of depression. In the study by Buntrock and colleagues, 406 adults with subthreshold depression (Centre for Epidemiological Studies-Depression Scale score ≥16, but no current major depressive disorder (MDD) according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders , SCID) were randomly assigned between March 2013 and … [1]: {openurl}?query=rft.jtitle%253DJAMA%26rft.volume%253D315%26rft.spage%253D1854%26rft_id%253Dinfo%253Apmid%252F27139058%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=27139058&link_type=MED&atom=%2Febmental%2F20%2F1%2Fe4.atom

Online training voor het verbeteren van de mentale conditie

SamenvattingDe meeste mensen weten wel wat ze (zouden) moeten doen om gezond te blijven: iedere dag een half uurtje bewegen, gezond eten, niet roken en niet teveel alcohol drinken. Voor onze mentale gezondheid is dit minder duidelijk. Of niet? Psyfit.nl is een online zelfhulpcursus waarmee de mentale conditie wordt getraind. Via een zestal ‘mental fitness’ principes, zoals het richting geven aan je leven, stimuleren van positieve emoties en leven in het hier en nu, werken mensen aan hun welbevinden en veerkracht wat tezamen de mentale conditie bepaalt.1Door de oefeningen, tests en tips krijgen deelnemers inzicht in hun krachten en mogelijkheden om met het leven van alledag om te gaan (zie box 1 Onderdelen in Psyfit.nl en Figuur 1 Screenshot).AbstractOnline training to improve mental fitness - From effectiveness to impact Psyfit.nl (‘‘mental fitness online’’) is a fully automated self-help intervention aimed at improving well-being. The intervention is based on the emerging field of positive psychology in which tools aimed at flourishing and positive functioning are being developed and evaluated. The combination of positive psychology and technology offers synergetic opportunities: both intent to engage and empower large groups of people (‘positive technology’). In a randomized controlled trial, the intervention was found to be effective in the enhancement of wellbeing and reduction of depression and anxiety symptoms. Psyfit is currently being put into practice. Different ways to disseminate and implement the intervention in order to improve the uptake and adherence are being explored.