Strengths Assessments as Clinical Interventions

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Within those psychiatric facilities, there is very little research about how positive psychology might be used since the deficit model is still firmly in place, and perhaps rightly so. Presumably, residential treatment is reserved for only those patients with the most severe symptoms. In those cases, can positive psychology still be of benefit?

A passing mention in a public health article on positive psychology is made to the use of the VIA in a Department of Veteran Affairs psychiatric rehabilitation program. According to this reference, simply taking the assessment, and nothing more, was an intervention with positive outcomes in and of itself. The researchers then encouraged the veterans to carry a strengths card with them as a daily reminder of their positive attributes to help in their recovery (Kobau, et. al., 2011).

The only true study I could find that evaluated a specific positive psychology intervention, in this case the strengths assessment, in an inpatient setting, was small, preliminary, and primarily designed to test the feasibility of such a study and only secondarily to examine the actual impact of the intervention. Participants were inpatients in a psychiatric unit following admission for self-injury or suicide attempt, with a mean duration of stay of 9 days. Huffman, et. al. (2014) used several positive psychology exercises for the study, with the strengths assessment exercise including the brief survey, and then selection of a strength to be used deliberately for the following 24 hours. Participants then wrote about how they used the strength and the outcome.

Perhaps most importantly, the study found that the exercises were feasible and well accepted with 90% of assigned exercises being completed. This was notable given the crisis nature of the unit. The investigators did find a small subset of the population that may have been too ill or distressed to engage in even these simple interventions. The study also found that the exercises had moderate effects in reducing hopelessness and increasing optimism, two key variables in suicidal thinking and behaviors. Of the nine different types of exercises, the strengths exercise had the third largest effects on both hopelessness and optimism, behind acts of kindness and gratitude letters. Whether these changes lasted post-discharge is not known, but a measurable effect in this high-risk group in such a short-term setting is a notable achievement (Huffman, et. al., 2014).

What I find most interesting about this final study is that these interventions were administered safely and effectively in the most high-risk inpatient population imaginable, with positive outcomes. The interventions that were not effective were those that asked patients to tackle the past or big issues such as life purpose. Other more straightforward, less introspective exercises seemed to work best (Huffman, et. al., 2014).

As I transition to working in a residential treatment center for adolescents and young adults with anxiety and mood disorders, I have to ask if these interventions can be used effectively with them. I know of one young adult transition program that has been using the StrengthsFinder among other interventions for the last two years with great outcomes. My facility has a more clinically complex population, but our environment is one that is focused on recovery and has a positive coaching model overlaid onto the mental health treatment. All of the pieces are in place for many of these exercises to be added into our recovery program. We all incorporate some pieces of positive psychology into our work and into the treatment programs, whether it be mindfulness, meditation, perhaps articulations of gratitude, and attempts at healthy living. However, to thoughtfully, and deliberately, develop a treatment and recovery plan based on evidence-based (however limited currently) positive psychology interventions, exercises and models, integrated with the evidence-based practices already in place such as DBT and other cognitive therapies, would be a transformation in the way we understand mental health treatment. For adolescents and young adults, who often view therapy and treatment with such skepticism, and often come to us with anger and defensiveness after years of being labeled and seen only for their weaknesses and faults and disorders, a focus on their strengths, the positive and their wellbeing may be the key to engaging them in their own purposeful recovery.

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References:

Huffman, J. C., DuBois, C. M., Healy, B. C., Boehm, J. K., Kashdan, T. B., Celano, C. M., Denninger, J. W., & Lyubomirsky, S. (2014). Feasibility and utility of positive psychology exercises for suicidal inpatients. General hospital psychiatry, 36, 88-94.

Kobau, R., Seligman, M. E. P., Peterson, C., Diener, E., Zack, M. M., Chapman, D., & Thompson, W. (2011). Mental health promotion in pubic health: Perspectives and strategies from positive psychology. American Journal of Public Health, 101(8), e1-e9.

Mongrain, M. & Anselmo-Matthews, T. (2012). Do positive psychology exercises work? A replication os Seligman et al. (2005). Journal of Clinical Psychology, 68(4), 382-389.

Seligman, M. E. P., Steen, T. A., Park, N., & Peterson C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60, 410-421.