Positive Psychology in a neuropsychology setting

I'm fairly early in my Psychology journey, with two years as an Assistant Psychologist under my belt. But I do have an MSc in Positive Psychology, which my colleagues seem to find intriguing. Two questions keep coming up: 'What exactly is positive psychology?' and 'What can we learn from it?'

I believe that Positive Psychology has helped me to see service users, therapy and colleagues in a wider, more holistic way. I'd like to share some observations on the valuable insights it provides into my psychology practice.

What is it?

Positive Psychology is the study of happiness and flourishing. Officially developed in the late 90's by Martin Seligman, it has roots in humanistic psychology, which Seligman believed lacked scientific evidence. Positive Psychology's unique take on what helps people flourish quickly gained momentum in the academic literature. It was developed for the general population with the aim of preventing mental health difficulties, but recent studies demonstrate considerable success from using Positive Psychology Interventions (PPI's) as treatment for a range of mental health difficulties such as depression, anxiety and social anxiety (see Carr et al., 2021).

The three areas I have found particularly helpful and accessible for service users are character strengths, wellbeing models and PPI's. The following sections will reflect on my experiences, mainly in a neuropsychology service.

Character strengths

Boniwell and Tunariu (2019) describe character strengths as those which we are good at, which energise us, which benefit us and others, that can be measured, and that we find enjoyable.

Character strengths should be generalisable across numerous situations, link to our moral values and we should feel good about ourselves when using them. In contrast, a learned skill, from which someone derives no pleasure, would not be considered a strength. For example, a manager who leads a successful team, but who feels deflated after a day's work, would not consider leadership (Peterson & Seligman, 2004) a character strength.

From my observations, there could be some simple ways that character strengths can inform wider psychology. These include incorporating strengths into formulation, supporting adjustment/acceptance work and supporting staff wellbeing.

Formulation: Recognising a service user's strengths in formulation isn't exactly a new phenomenon, but nevertheless, one that seems important to consider. They are simple and easily accessible for both service users and staff. By identifying character strengths as part of formulation and helping clients draw on these, I have seen patients gain a sense of accomplishment and mastery over their recovery (key components to several models of wellbeing).

Adjustment/acceptance: Identifying character strengths has helped some service users to recognise strengths which are independent of individual circumstances. This is particularly relevant in neurology, where physical and cognitive changes can result in long-term disability. For some service users, it can be the first time they have considered themselves to have personal strengths post-injury. Seeing them in black and white, generated by a scientifically developed tool, can have a profound impact on self-esteem and can act as an anchor during some of the low points of therapy.

For example, one service user found that turning her character strength of kindness inwards helped her face challenging emotions and build resilience in the therapy setting. Another patient found it helpful to draw on her strength of love of learning to help her research and understand more about her own difficulties. One service user couldn't use the online tool, but found that having family members highlight her strengths and achievements since her injury helped her to feel more connected to and valued by them. It helped her appreciate her progress and she began to consider how she could use her strengths to build a new life for herself.

Staff wellbeing: Working within a busy multidisciplinary team has helped me reflect on the role of character strengths for supporting ourselves, teams and wider systems. It seems a particularly prominent time for healthcare services to recognise and maintain our inner strengths following the stresses of the pandemic.

I use my own strengths to improve my wellbeing at work and to fall back on when things are tough. Starting my role in the height of Covid made it difficult to connect with colleagues and learn my role through natural processes (asking those 'have you got a minute' questions/shadowing staff). My love of learning strength helped me to research my role and organise training which helped build my confidence and connect with others (one of my values). Now I'm more settled, I try to use my strengths of creativity and perseverance when developing spreadsheets and writing information sheets.

Sharing strengths within teams could help to improve connection and wellbeing in our new hybrid-working worlds. Hearing my supervisor compliment my research skills and creativity helped me feel valued in my role. Consequently, receiving more tasks that used these skills increased my job satisfaction. Perhaps taking five minutes in meetings to recognise a team member's strengths could help to promote multi-disciplinary connection. Providing staff with more opportunities to use their character strengths might be a small step towards increased staff wellbeing.

Wellbeing models

Several wellbeing models have been developed over the years. These models aim to identify key areas that contribute to feelings of wellbeing and eudaimonic happiness (happiness derived from authenticity and values-based living rather than superficial pleasure seeking). Perhaps the most widely recognised is the PERMA model (Seligman, 2008). This focuses on: Positive emotions, Engagement, Relationships, Meaning and Accomplishment.

Two areas spring to mind for wider psychological use of wellbeing models: encouraging independence and supporting with discharge transitions.

Independence and discharge transitions: Working in a neuro service has highlighted some of the difficulties service users with long-term conditions can face such as a deterioration in symptoms. This can lead service users to need multiple episodes of care as their symptoms progress. A review by Harriman et al. (2021) found 16 per cent of their neuro-psych patients were repeat referrals. This made me wonder about the role of wellbeing models in helping some service users to promote independence after discharge. For example, service users with less complex conditions, in the earlier stages of their illness, or as a first-level stepped care approach outside of neuro services. This is of course if they were amenable this type of self-monitoring. I would not want to suggest that this approach should replace rehabilitation with qualified professionals or deter patients from seeking help. It should also not invalidate service users individual experiences and difficulties.

One suggestion could be introducing the chosen model at the start of therapy as a way to monitor their wellbeing: areas that are going well versus those that need some work. Then, as life changes occur or their illness progresses, the models may go some way in helping people stay independent for longer. For example, if a service user planned to move to a quieter area, they could recognise in advance that this might impact their relationships and plan ways to connect with others, join a group etc. This might also inspire a sense of Accomplishment, Meaning and Positive emotions.

Positive Psychology Interventions

Positive psychology interventions (PPI's) are intentional activities which are designed to foster positive emotions. They are similar in nature to behavioural activation (BA) interventions, as both use external activities to improve mood. However, PPI's were designed to cultivate happiness, rather than target depression. They build on character strengths and work with a model of good fit (choosing ones that work for you) to improve adherence, in contrast to BA's scheduling. Good fit can be measured using The Person-Activity Fit Diagnostic (Lyubomirsky, 2007).

Boniwell and Tunariu (2019) describe PPI's as falling into seven 'ACTIONS':

1. Active (physical activity)
2. Calming (mindfulness and meditation)
3. Thinking (processing past events)
4. Identity (personal strengths/self-understanding)
5. Optimisation (planning for the future)
6. Nourishing (self-soothing/self-care)
7. Social (PPI's with others)

According to Broaden and Build Theory (Fredrickson, 2001), when people are in a positive emotional state (e.g. when using PPIs), they are better able to broaden their minds and access a wider range of solutions, think more creatively and build resources and social networks. Including PPI's in therapy could help service users to take control of their recovery, boost mood and provide practical and adaptable tools to inspire independence.

Due to their nature, some may already be commonplace in therapy (e.g. mindfulness) making them easy to integrate. Being aware of the goal to broaden and build wellbeing in contrast to reducing distress can offer a refreshing, holistic view of the tools we use in practice. It also inspires me to use them myself when feeling doubt or uncertainty in my work.

Using calming and nourishing PPIs (e.g. compassionate meditations) helped a service user calm her racing thoughts. We did this together at the start of a session to help her focus on her session goals and gradually she started practicing them independently. Realising that she could calm herself was empowering, and inspired her to experiment. This resulted in her integrating calming music in her daily routine.

When combining PPIs with a wellbeing model, a woman from an older adult's service decided to take a mindful walk with a friend to build her relationships, incorporate more calmness and use her strength of appreciation of beauty and excellence. These were strategies she felt confident in continuing after therapy and which fit well with her personal values.

Final reflections

I have introduced a few ideas from Positive Psychology which might be helpful to apply to practice. Character strengths and PPIs might overlap with current practices, so could be integrated easily. Wellbeing models might require a little more effort as they are not currently commonplace; but they could provide a valuable tool to help service users manage their wellbeing independently and smooth discharge transitions.

Whatever way some of these concepts might apply to your own area of work, I hope I have at least provided you a few positive psychology nuggets to reflect on. Applying positive psychology in a wider psychological context can be a rewarding experience for psychologists and service users alike.

Key sources

Boniwell, I., & Tunariu, A. D. (2019). Positive psychology: Theory, research and application. London: Open University Press.

Carr, A., Cullen, K., Keeney, C., Canning, C., Mooney, O., Chinseallaigh, E., & O'Dowd, A. (2021). Effectiveness of positive psychology interventions: A systematic review and meta-analysis. The Journal of Positive Psychology, 16(6), 749-769.

Fredrickson. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. The American Psychologist, 56(3), 218–226.

Harriman, E., Poh, J., & Steverson, T. (2021). A clinical psychology service in stroke rehabilitation: A review of five years of referrals and an evaluation of a matched care model. The Neuropsychologist, 11, 38-46.

Lyubomirsky, S. (2007). The how of happiness: A scientific approach to getting the life you want. New York: Penguin Press.

Peterson, Christopher & Seligman, M.E.P. (2004). Character strengths and virtues: A handbook and classification. Washington, D.C.: APA Press and Oxford University Press.

Seligman, M. (2011). Flourish. Boston: Nicholas Brealey Publishing.

Tedeschi, R.G. & Calhoun, L.G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma.Journal of Traumatic Stress, 9, 455–471.

Yu, Y., Chotipanvithayakul, R., Wichaidit, W., & Cai, W. (2022). Effects of character strength-based intervention vs group counselling on post-traumatic growth, well-being, and depression among university students during the COVID-19 pandemic in Guangdong, China: a non-inferiority trial. Psychology Research and Behaviour Management, 1517-1529.