Positive psychotherapy: A strength-based approach

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DOI: 10.1080/17439760.2014.920411
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Positive psychotherapy (PPT) is a therapeutic approach broadly based on the principles of positive psychology. Rooted in Chris Peterson’s groundbreaking work on character strengths, PPT integrates symptoms with strengths, resources with risks, weaknesses with values, and hopes with regrets in order to understand the inherent complexities of human experiences in a way that is more balanced than the traditional deficit-oriented approach to psychotherapy. This paper makes the case of an alternative approach to psychotherapy that pays equal attention and effort to negatives and positives. It discusses PPT’s assumptions and describes in detail how PPT exercises work in clinical settings. The paper summarizes results of pilot studies using this approach, discusses caveats in conducting PPT, and suggests potential directions.
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Positive psychotherapy: A strength-based approach
Tayyab Rashid*
Health & Wellness Centre, University of Toronto Scarborough, Toronto, Ontario, Canada
(Received 15 March 2014; accepted 8 April 2014)
Positive psychotherapy (PPT) is a therapeutic approach broadly based on the principles of positive psychology. Rooted
in Chris Petersons groundbreaking work on character strengths, PPT integrates symptoms with strengths, resources with
risks, weaknesses with values, and hopes with regrets in order to understand the inherent complexities of human experi-
ences in a way that is more balanced than the traditional decit-oriented approach to psychotherapy. This paper makes
the case of an alternative approach to psychotherapy that pays equal attention and effort to negatives and positives. It
discusses PPTs assumptions and describes in detail how PPT exercises work in clinical settings. The paper summarizes
results of pilot studies using this approach, discusses caveats in conducting PPT, and suggests potential directions.
Keywords: positive psychotherapy; character strengths in clinical practice; strength-based therapy/counseling; positive
emotions; engagement; meaning; PERMA
Positive psychotherapy (PPT) is a therapeutic approach
based on a premise, articulated and empirically explored
by Chris Peterson, who emphasized that psychology
ought to be concerned with strength as with weakness;
as interested in building the best things in life as in
repairing the worst; and as concerned with making lives
of normal people fullling as with healing pathology
(Peterson, 2006a). Strongly inuenced by Petersons
seminal work Classication of Virtues and Strengths
(CVS; Peterson & Seligman, 2004), PPT which inte-
grates symptoms with strengths, resources with risks,
weaknesses with values, and hopes with regrets in order
to understand inherent complexities of human experi-
ences in a balanced way. Clients seeking therapy are nei-
ther mere conglomerate of symptoms nor embodiments
of strengths. PPT systematically amplies their positive
resources; specically, positive emotions, character
strengths, meaning, positive relationships, and intrinsi-
cally motivated accomplishments. PPT neither suggests
that other psychotherapies are negative nor aims to
replace well-established practices. PPT is refocusing
rather than revamping therapeutic regimens. It is not
meant to be paradigm shift; it is an incremental change
to balance therapeutic focus on strengths and weak-
An improvement of psychotherapy via an alternative
Psychotherapys focus on alleviation of symptoms is
understandable. The human mind defaults towards nega-
tivity such that it responds more strongly to negatives
than to positives (Rozin & Royzman, 2001). Negative
impressions and stereotypes are quicker to form and
harder to undo (Baumeister, Bratslavsky, Finkenauer, &
Vohs, 2001). In the clinical context, negatives, because
of their apparent greater informational value, typically
receive more attention and form more complex cognitive
representations (Peeters & Czapinski, 1990).
Psychotherapy, responding to discernible psychologi-
cal distress of clients, has done well. It signicantly out-
performs placebo and in many cases, psychotherapy
fares better in the long run than medications
(Castonguay, 2013; Leykin & DeRubeis, 2009). How-
ever, effectiveness of psychotherapy can be improved.
First, clinical psychology and psychotherapy have tradi-
tionally been about decits and remediations (Maddux,
2008). Watkins has noted, It [psychotherapy] can also
be about optimization and transformation(2010,
p. 198). Petersons seminal work on character strengths
offers psychotherapy a tremendous opportunity to expand
its scope, making it more inclusive and balanced. Doing
so may be necessary because the use of psychotherapy
declined from 15.9 to 10.5% from 1998 to 2008,
whereas during the same period, the use of psychotropic
medications increased from 44.1 to 57.4% (Olfson &
Marcus, 2010). Some individuals, especially those who
could benet more from psychotherapy, avoid it due to
the stigma of being labeled with a psychiatric diagnosis
(Corrigan, 2004). Integration of strengths within the
complex and often negatively skewed narrative may
resocialize potential clients to perceive that psychother-
apy is not only about untwisting their distorted thinking
or restoring their troubled relationships; it is also about
*Corresponding author. Email: trashid@utsc.utoronto.ca
© 2014 Taylor & Francis
The Journal of Positive Psychology, 2015
Vol. 10, No. 1, 2540, http://dx.doi.org/10.1080/17439760.2014.920411
learning to use ones strengths, skills, talents, and abili-
ties to face challenges. Even before the current move-
ment of positive psychology, researchers recognized the
important of assessing and using clientsstrengths of to
gain their cooperation and acceptance of therapy
(Conoley, Padular, Payton, & Daniels, 1994). Second,
the effectiveness of psychotherapy is primarily assessed
by symptom remittance, while variables such as quality
of life or personal recovery are not commonly considered
as part recovery (Rapaport, Clary, Fayyad, & Endicott,
2005). In recent years, the concept of recovery has been
expanded to include hope, a meaningful and fullling
life, a positive sense of identity, and taking responsibility
for ones own wellbeing (Slade, 2010). Strengths-Based
Case Management (SBCM; Rapp & Goscha, 2006)isan
illustration. Studies of SBCM, including a number of
randomized controlled trials (RCTs) and quasi-experi-
mental designs, have reported a range of positive out-
comes including reduced hospitalization and increased
social support (Rapp & Goscha, 2006). Third, psycho-
therapists have inherent vulnerability to burnout, which
is characterized by emotional exhaustion, depersonaliza-
tion, and lack of personal accomplishment. These harm-
ful consequences adversely impact the quality of their
therapeutic work (Rosenberg & Pace, 2006). Burnout
could occur due to multiple reasons. One of them is
when available resources are too limited to meet the
demand of work (Hobfoll, 1989). Understanding clients
challenges, decits, dysfunction, and disorders in tandem
with their assets, strengths, skills, and abilities may not
only offer clients additional therapeutic possibilities, it
also helps psychotherapists to be more effective and have
a greater sense of accomplishment, which could buffer
against burnout. In a psychotherapy study, Flückiger and
Grosse Holtforth (2008) primed therapistsattention on
clientsstrengths (resource priming) before each of ve
therapy sessions. Results showed that resource activation,
as perceived by independent observers, improved therapy
outcome at session 20. Cheavens, Strunk, Sophie
Lazarus, and Goldstein (2012) found that personalizing
Cognitive Behaviour Therapy (CBT) to clients relative
strengths led to better outcome than CBT personalized to
clientsrelative decits.
Assumptions & theory
PPT has three assumptions about the nature, cause,
course, and treatment of specic behavioral patterns.
First,psychopathology results when clientsinherent
capacities for growth, fulllment, and wellbeing are
thwarted by psychological and sociocultural factors.
Well-being and psychopathology do not reside entirely
inside clients, but derive from a complex interaction
between clients and their environment. When this inter-
action becomes dysfunctional, clientsgrowth is thwarted
and they experience symptoms of psychiatric distress. In
other words, psychopathology surfaces when growth and
wellbeing are diminished. Psychotherapy offers a unique
opportunity to realize or revitalize potential and growth
of clients. Reection about negative aspects of ones life
is important, but growth happens through assessing,
acknowledging, and building strengths. Evidence shows
that strengths can play a key role in growth even in dire
life circumstances (Seery, Holman, & Silver, 2010).
Second, PPT considers positive emotions and strengths
to be as authentic and as real as symptoms and disor-
ders, and they are valued in their own right. Strengths
are neither defenses nor Pollyannaish illusions. Attributes
such as honesty, co-operation, gratitude, and kindness
are as real as deception, competition, grudge, greed, and
worry. The absence of mental illness does not necessarily
mean the presence of well-being (Keyes & Eduardo,
2012). Amelioration of symptoms will not engender
well-being per se. However, amplications of strengths
may make lives of clients satisfying and fullling and
which in turn, may buffer against future recurrence of
The third and nal assumption is that effective thera-
peutic relationships can be formed through the discus-
sion of positive personal characteristics and experiences.
Not all clients need or will benet from deep and pro-
tracted analysis and discussions of their troubles. The
media portrayal of psychotherapy has reinforced the
belief that therapy exclusively entails talking about trou-
bles, ventilating bottled-up emotions, and recovering
self-esteem. It not only maintains an unhelpful stigma
about mental health, it also reinforces a belief in clients
that they are somehow deeply awed or fragile. It is not
that troubles are not worth discussing, but powerful ther-
apeutic bonds can also be built by deeply discussing
positive emotions and experiences (Burton & King,
2004). Scheel, Davis, and Henderson (2012), through a
qualitative study examining therapistsuse of client
strengths, found that a strength-based approach helped
therapists in building trusting relationships and motivated
clients by instilling hope.
PPT is primarily based on Seligmans conceptualiza-
tion of happiness and well-being (Seligman, 2002,
2011). Seligman sorts highly subjective notions of happi-
ness and well-being into ve scientically measurable
and manageable components: (i) Positive emotion, (ii)
Engagement, (iii) Relationships, (iv) Meaning and (v)
Accomplishment, with the rst letters of each component
forming the mnemonic PERMA (Seligman, 2011). This
list of elements is neither exhaustive nor exclusive, but it
has been shown that fulllment in these elements and is
associated with lower rates of depression and higher life
satisfaction (Bertisch, Rath, Long, Ashman, & Rashid,
2014; Headey, Schupp, Tucci, & Wagner, 2010; Lamont,
2011; Sirgy & Wu, 2009). It should also be noted that
26 T. Rashid
Peseschkian in Germany has also worked on Positive
Psychotherapy for more than 20 years and is distinct
from PPT discussed in this article. Peseschkians
approach to therapy is inherently and systematically inte-
grative, incorporating cross-cultural, multidisciplinary,
therapeutically, and psychologically intertheoretic
(Peseschkian, 2000). PPT on the other hand is rooted in
the current movement of positive psychology.
How does PPT work?
The following section describes operationalization of
PERMA in concrete PPT exercises and explains the pro-
cess of conducting these exercises. PPT exercises and
their relationship with various character strengths, postu-
lated by Chris Peterson and Seligman (2004), are pre-
sented in Table 1.Denitions of these character strengths
are given in Table 2. PPT was initially validated with cli-
ents experiencing moderate to severe symptoms of
depression in individual and group settings (Seligman,
Rashid, & Parks, 2006). PPT can be a standalone treat-
ment, its protocol can be adapted to meet specic needs
or its exercises can be incorporated in other treatment
approaches. Pilot studies listed in Table 3, have applied
PPT to treat symptoms of depression, anxiety, psychosis,
borderline personality disorder, and to support smoking
PPT can be divided into three phases. The rst phase
focuses on exploring a balanced narrative of the client
and exploration of her/his signature strengths from multi-
ple perspectives. These signature strengths are operation-
alized into personally meaningful goals. The middle
phase focuses on cultivating positive emotions and adap-
tively dealing with negative memories. The nal phase
include exercises on fostering positive relationships and
meaning and purpose.
The therapeutic relationship is one of the most cura-
tive factors of psychotherapy (Norcross, 2002). From the
onset, the therapist empathically listens to clientscon-
cerns to build and maintain a trusting therapeutic relation-
ship. Meanwhile, the therapist searches for opportunities
to help clients identify and own their strengths. Through-
out PPT, negatives are balanced with positives; for
instance, a discussion of some perceived offense or per-
sonal injustice is balanced with recall of recent acts of
kindness shown to clients. Pain associated with trauma is
empathetically attended, but potential for growth from
trauma is also explored, whenever appropriate. Exploring
and amplifying strengths doesnt come at the cost of dis-
missing or minimizing problems and weaknesses.
Recall of positive memories plays an important role
in mood regulation (Joormann, Dkane, & Gotlib, 2006).
Such a recall allows individuals to savorthese positive
emotions (Bryant & Veroff, 2006). Fitzpatrick and
Stalikas (2008) posit that positive emotions, especially in
the early phase of therapeutic process, powerfully predict
therapeutic change by enabling clients to consider new
ideas and perspective and can build long-term cumula-
tive resources. If such a recall is initiated at the onset of
the therapy, positive emotions are likely to be generated.
To facilitate this process, after empathically attending to
clientspresenting concerns, they are encouraged to
introduce themselves through a real-life story that called
for the best in their lives in order to accomplish some-
thing personally meaningful, or through a story of over-
coming a signicant challenge or adversity (Rashid &
Ostermann, 2009). The exercise, known as the Positive
Introduction, in the group setting is found to be motivat-
ing for others and also builds trust among group mem-
bers. Clients often start this exercise in the session but
then complete it as homework using a more structured
worksheet. Clients are encouraged to draw parallels from
the story to their current life situations. Without provid-
ing any list of strengths, they are asked to think about
strengths depicted in their stories. The goal is to help cli-
ents have a narrative that encapsulates their complexities
of decits and of strengths. Through Positive Introduc-
tion clients not only are able to tell and retell their sto-
ries; with the therapists guidance, they may also be able
to integrate parts of the self that might have slipped from
their awareness due to cognitive rigidities, emotional
instability, or relational insecurities. Clients are encour-
aged to make the narrative more personally meaningful
and somewhat relevant to their current challenges. This
is facilitated through several multimedia illustrations, sto-
ries and case illustrations.
After the Positive Introduction, PPT focuses on char-
acter strengths. Rather than a simple and straightforward
approach of identifying and using more of top ve
strengths, PPT adapts a comprehensive strength assess-
ment approach. Clients rst read brief descriptions of 24
strengths, without their titles/names, and select (not rank )
ve that best describe their personality. Clients also ask
to have two signicant others (a family member and/or a
friend) to condentially complete a similar measure and
return the worksheet to clients in sealed envelopes. Cli-
ents then complete the online self-report measure Values
in Action Inventory of Strengths (VIA; Peterson &
Seligman, 2004), which upon completion offers feedback
about their top ve strengths. Data from all these sources
is aggregated to determine clients signature strengths.
Therapists encourage clients to share memories, experi-
ences, real-life stories, anecdotes, accomplishments, and
skills, which illustrate their signature strengths. At the
same time, therapists invite clients to conceptualize their
presenting issues as lack or excess of strengths (Table 2).
In doing so, clients are encouraged to develop a key
strength, psychological exibility which is an ability to
adapt to uctuating situational demands, reconguring
mental resources including strengths, shifting perspective,
The Journal of Positive Psychology 27
Table 1. PPT: An overview of PPT model.
Session & topic Description Character strength
1 Orientation to PPT. Psychological distress is discussed as lack of or diminished positive
resources such as Positive emotions, Engagement, Relationships,
Meaning, and Accomplishment (PERMA)
Emotional Intelligence,
Authenticity, Courage,
Lack of positive
Exercise: Positive Introduction: Clients write one page real-life
story which called for the best in them and which ends positively,
not tragically
2 Character strengths Character strengths are introduced. Notion of engagement and ow
is discussed
Emotional Intelligence, Perspective
Exercise: Clients identify their signature strengths in-session and
complete an online self-report measure at home
Two others (a family member and a friend) also identify (not rank)
their ve most salient signature strengths
3 Signature strengths
and positive
Signature strengths are discussed. Clients compile their signature
strengths prole incorporating various perspectives
Creativity, Hope and Optimism,
Exercise: Clients devise specic, measurable and achievable goals
targeting specic problems. The benets of positive emotion are
Exercise: Blessing Journal: Clients starts a journal to record three
good things every night (big or small )
4 Good vs. bad
The role of negative memories is discussed in terms of how they
perpetuate psychological symptoms. The role of good memories is
also highlighted
Gratitude, Appreciation of Beauty
and Excellence
Exercise: Clients write about feelings of anger and bitterness and
their impact in perpetuating distress
5 Forgiveness Forgiveness is introduced as a tool to transform anger and
bitterness and to cultivate neutral or positive emotions
Forgiveness and Mercy, Kindness,
Social intelligence, Self-regulation
Exercise: Clients describe a transgression, its related emotions and
pledge to forgive the transgressor. Letter is not necessarily delivered
6 Gratitude Gratitude is discussed as an enduring thankfulness. The roles of
good and bad memories are discussed again, with an emphasis on
Gratitude, Love, Social and
Emotional Intelligence,
Exercise: Clients write and delivers in person a gratitude letter to
someone he/she never properly thanked
7 Mid-therapy check The forgiveness and gratitude assignments are followed up.
Experiences related to the signature strengths and Blessing Journal
activities discussed
Perseverance, Perspective,
Clients and therapist discuss therapeutic gains and hurdle and ways
to overcome these hurdles
Exercise: Clients complete the Forgiveness and Gratitude
8 Satiscing vs.
Concepts of satiscing (good enough) and maximizing are
Self-regulation, Gratitude
Exercise: Clients devise ways to increase satiscing
9 Hope and optimism Optimism and hope are discussed in detail. Clients think of times
when important things were lost but other opportunities opened up
Hope & Optimism
Exercise: One Door Close, One Door Opened: Clients think of
three doors that closed and then ask, What doors opened?
10 Positive
Active-Constructive a technique of positive communication is
Love, Kindness, Curiosity, Social
Exercise: Active-Constructive Responding: Clients to look for
active-constructive opportunities
11 Signature strengths
of others
The signicance of recognizing and associating through character
strengths of family members is discussed
Love, Social Intelligence
Exercise: Family Strengths Tree: Clients ask family members to
take the complete signature strength measure. A family tree of
strengths is drawn up and discussed at a gathering
12 Savoring Savoring is discussed, along with techniques and strategies to
safeguard against adaptation
Appreciation of Beauty and
Excellence, Gratitude
Exercise: Savoring Activity: Clients plan a savoring activity using
specic techniques
28 T. Rashid
and balancing competing desires, needs, and life domains
(Kashdan & Rottenberg, 2010). In PPT, the psychothera-
pist helps clients to carefully re-conceptualize that certain
challenges could be due to competing demands of two
strengths (such as should one to honest or kind with a
close friend who may be involved in unethical behavior);
self-regulation in one domain of life (e.g. eating or exer-
cise) may be associated with weak interpersonal relation-
ships; fear of failure or giving up may lead to persisting
with goals which may be unrealistic; forgiving loved ones
for their transgression without a concrete behavior change
may be compromised fairness (see Table 1for more
examples). These characteristic are adapted from Christ
Petersons notion of conceptualizing psychopathology as
Access (A), Opposite (O), and Exaggeration (E)
(together, AOE) of character strengths (Peterson, 2006b).
One common features of psychological disorders is
the inability to effectively regulate emotions and self-
evaluations in different contexts (American Psychiatric
Association, 2013; Kashdan & Rottenberg, 2010). PPT
helps clients to regulate emotions and enhance self-
evaluation in various contexts by teaching them nuanced,
calibrated and contextualized use of both positives and
negatives. For example, clients may be motivated to
experience or even reinforce negative emotions because
these may more useful than positive ones. Anger, frustra-
tion, or disappointment in close relationship may signal
wrongdoing by the other person. Condence about com-
pleting an important task, without optimal level of anxi-
ety may turn into procrastination. Avoiding the
acknowledgment of loss and grief and resorting to
unhealthy coping means (e.g. drugs, sex, and shopping)
may prevent clients from comprehending the meaning of
loss and contemplating a revised personal narrative that
may be necessary for adaptive coping. PPT does not nec-
essarily ask clients to use specic strengths more; rather,
it engages clients in deeper reection of when and how
expression of specic strengths could be adaptive or
maladaptive (Biswas-Diener, Kashdan, & Minhas, 2011;
Kashdan & Rottenberg, 2010).
Following the assessment of signature strengths, cli-
ents and therapist collaborate to set personally meaning-
ful goals. Typically these are linked directly to reducing
psychiatric distress, increasing well-being, and improving
daily functioning. Clients and therapist agree to monitor
progress and modify according to situational needs, and
they regularly discuss an adaptive, calibrated, contextu-
alized, and exible use of signature strengths so that cli-
ents gradually learn skills to meet the varying needs of a
diverse situations. Therapists continue to highlights that
symptoms could also be explained either through lack or
excess of strengths. Due to limitations of space, instead
of brief clinical vignettes, following are some illustra-
tions from authorsrst hand clinical experience of help-
ing clients to conceptualize symptoms. Feeling hopeless
or slow as a result of lack of zest and playfulness; wor-
rying excessively due to a lack of gratitude or inability
to let go; indecision from lack of determination; repeti-
tive intrusive thoughts due to lack of mindfulness; nar-
cissism due to lack of modesty; feeling inadequate as
lack of self-efcacy; and difculty making decisions
because of an excess of prudence. Furthermore, thera-
pists also point out that sometimes clients get into trou-
ble for overuse of love and forgiveness (being taken for
granted), underuse of self-regulation in a specic domain
of life (indulgence), or fairness only in few situations or
teamwork only with preferred groups (bias and discrimi-
nation). Throughout the course of therapy, clients and
therapists monitor progress towards goals and make nec-
essary changes as well as continuously explore the nuan-
ces and subtleties of strengths, especially about
encountering their challenges through strengths. Clients
learn to identify their troubling emotions and memories
by harnessing their social intelligence; to tone down
grudges by accessing positive memories of specic situa-
tions, individuals, or experiences; and that instead of
avoiding difcult situations, they need to muster courage
and self-regulation to face them.
Whereas personalized goals using signature strengths
aim to reduce symptomatic distress, a number of PPT
exercises explicitly focus on cultivating positive emotions
such as gratitude, savoring, and playfulness. Whereas
negative emotions narrow cognitive, attentional, and
physiological resources to deal with an immediate threat,
Table 1. (Continued).
Session & topic Description Character strength
13 Positive Legacy &
Gift of Time
Clients visualize what would be positive legacy; therapeutic benets
of helping others are discussed. Exercises: Positive Legacy: Clients
write how they would like to be remembered. Gift of Time: Clients
Write How they would like to be remembers and also make plans
to give the gift of time doing something that also use their
signature strengths
Teamwork, Kindness
14 The Full Life Full life is discussed as the integration of Pleasure, Engagement,
and Meaning
Therapeutic gains and experiences are discussed and ways to
sustain positive changes are devised
The Journal of Positive Psychology 29
Table 2. Character strengths: denitions and usage (lacking/excess).
Character strengths Description
use Excess/over use
1 Appreciation of beauty
and excellence
Being moved deeply by beauty in nature, in art
(painting, music, theatre, etc.) or in excellence in any
eld of life
Oblivion Snobbery
2 Authenticity and honesty Not pretending to be someone one is not; coming across
as a genuine and honest person
3 Bravery and valor Overcoming fears to do what needs to be done; not give
up in face of a hardship or challenge
Fears, easily
Foolhardiness, risk-
4 Creativity and originality Thinking of new and better ways of doing things; not
being content with doing things in conventional ways
Conformity Eccentricity
5 Curiosity, interest in the
world and openness to
Being driven to explore things; asking questions, not
tolerating ambiguity easily; being open to different
experiences and activities
6 Fairness, equity and
Standing up for others when they are treated unfairly,
bullied or ridiculed; day-to-day actions show a sense of
7 Forgiveness and mercy Forgiving easily those who offend; not holding grudges Mercilessness Permissiveness
8 Gratitude Expressing thankfulness for good things through words
and actions; not take things for granted
Entitlement Ingratiation
9 Hope, optimism and
Hoping and believing that more good things will happen
than bad ones; recovering from setbacks and taking steps
to overcome them
10 Humor and playfulness Being playful, funny and uses humor to connect with
Humourlessness Buffoonery
11 Kindness and generosity Doing kind deeds for others, often without asking;
helping others regularly; being known as a kind person
Indifference Intrusiveness
12 Leadership Organizing activities that include others; being someone
others like to follow; being often chosen to lead by peers
Compliance Despotism
13 Capacity to love and be
Having warm and caring relationships with family and
friends; showing genuine love and affection through
actions regularly
Emotional promiscuity
14 Love of learning Loving to learn many things, concepts, ideas, facts in
school or on ones own
15 Modesty and humility Not liking to be the center of attention; not acting as
being special; admitting shortcomings readily; knowing
what one can and cannot do
Footless self-
16 Open-mindedness and
critical thinking
Thinking through and examining all sides before
deciding; consulting with others; being exible to change
ones mind when necessary
Unreective Cynicism, skepticism
17 Perseverance, diligence
and industry
Finishing most things; being able to refocus when
distracted and completing the task without complaining;
overcoming challenges to complete the task
xation, pursuit of
unattainable goals
18 Perspective (wisdom) Putting things together to understand underlying
meaning; settling disputes among friends; learning from
Superciality Ivory tower, arcane
and pedantic thinking
19 Prudence, caution and
Being careful and cautious; avoid taking undue risks; not
easily yielding to external pressures
Recklessness Prudishness, stufness
20 Religiousness and
Believing in God or higher power; liking to participate in
religious or spiritual practices e.g. prayer, meditation
Anomie Fanaticism
21 Self-regulation and self-
Managing feelings and behavior well most of the time;
following gladly rules and routines
Self-indulgence Inhibition
22 Social intelligence Easily understanding othersfeelings; managing oneself
well in social situations; displaying excellent
interpersonal skills
23 Teamwork, citizenship
and loyalty
Relating well with teammates or group members;
contributing to the success of the group
Selshness and
Mindless and
automatic obedience
24 Zest, enthusiasm and
Being energetic, cheerful and full of life; being liked by
others to hang out
Adapted from Peterson (2006b).
30 T. Rashid
Table 3. PPT: overview of pilot studies.
Authors and
publication status
Intervention description and
sample characteristics Primary outcome measures Key ndings
1 Seligman et al.
(2006); published
Individual PPT; n= 11), 1214
sessions, with clients diagnosed
with Major Depressive Disorder
(MDD), compared with
Treatment as Usual (TAU; n=9)
& Treatment as Usual plus
medication (TAUMED; n= 12);
under & postgraduate students-
seeking treatment at a university
counseling center
Depression (ZDRS &Hamilton),
Overall psychiatric distress
(OQ-45), Life Satisfaction
(SWLS) & Well-being (PPTI)
Post, Depression PPT < TAU
(ZDRS & Hamilton,d= 1.12 &
1.14) & PPT < TAUMED (ZDRS
d= 1.22) & Overall psychiatric
distress (OQ-45 d = 1.13); Post Well-
being PPT > TAU & TAUMED
(d=1.26 & 1.03)
2 Seligman et al.
(2006), published
Group PPT (n= 21) with clients
experiencing mild-to-moderate
depressive symptoms compared
with no-treatment control
(n= 21) in six sessions;
undergraduate students at a
Depression (BDI-II) & Life
Satisfaction (SWLS)
Post, Depression PPT < Control
(BDI-II,d= 0.48), and at 3, 6 & 12
month follow ups (d= 0.67, 0.77 &
0.57, respectively) with a reduction
of 0.96 points per week (p<.003), a
rate of change that was signicantly
greater than that of the control group
3 Parks-Schiener
(2009), dissertation
Individual (n= 52) completing
six PPT exercises online,
compared with no treatment
control group (n= 69), Online
Depression (CES-D), Life
Satisfaction (SWLS) & Positive
and Negative affect (PANAS)
Post, Depression (CES-Dd= 0.21, at
the six-month follow-up); Post, PPT
> Positive & Negative Affect
(d=0.16, 0.33 & 0.55 at three and
six month follow-up,respectively)
4 Lü, Wang, and Liu
(2013), published
Group PPT (n= 16), (2 h for 16
weekly sessions), compared with
a no treatment control group
(n= 18), exploring the impact of
positive affect on vagal tone in
handling environmental
Positive and negative affect
(PANAS) & Respiratory Sinus
Arrhythmia (RSA)
Depression, PPT < Control, at the
six-month follow-up (d= 0.21);
Positive & Negative Affect, PPT >
control, at the post-intervention,
three and six month follow-ups
(d= 0.16, 0.33 & 0.55, respectively)
5 Rashid, Anjum
et al. (2013),
Group PPT (n= 9), 8 sessions,
with grade 6 & 7 students
compared with no treatment
control (n= 9) at a public
middle school
Social Skills (SSRS), Student
Satisfaction (SLSS),Well-being
(PPTI-C) & Depression (CDI)
Post, PPT > Social Skills (SSRS-
Composite-parent version (d= 1.88)
and also on PPTI-C(d=0.90)
6 Reinsch (2012),
Group PPT clients (n= 9), six
sessions with clients seeking
psychotherapy through
Employee Assistance Program,
compared with no treatment
control group (n=8)
Depression (CES-D) & Well-
being (PPTI)
Post, Depression (CES-Dd= 0.84).
Therapeutic gains maintained one
month post-intervention while no
treatment control with depression
decreasing a statistically signicant
rate of 45%
7 Rashid, Uliaszek
et al. (2013),
Group PPT (n= 6) compared
group Dialectical Behavior
Therapy (DBT; n= 10) with
clients diagnosed with
Borderline Personality Disorder
at a university health center
Depression (SCID), Psychiatric
Symptoms (SCL-90), Emotion
Regulation (DER), Distress
Tolerance (DTS), Mindfulness
(KIMS), Well-being (PPTI)&
Life Satisfaction (SWLS)
Both PPT & DBT differed
signicantly from pre- topost-
treatment on most measures with an
average effect size of d= 1.15 &
1.18, respectively; DBT > PPT
(DERS d = 1.44)
8 Asgharipoor, Farid,
Arshadi, and
Sahebi (2010),
Group PPT (n= 9) for 12-weeks,
with clients diagnosed with
MDD, compared with Cognitive
Behavior Therapy (CBT), also
for 12 weeks, in a hospital
afliated psychological centre in
Mashhad, in Iran
Depression (SCID &BDI-II),
Happiness (OTS), Life
Satisfaction (SWLS)&
Psychological Well-being (SWS)
Post, Happiness, PPT > CBT (OTS;
(d =1.86). On most measures both
treatments did not differ
9 Cuadra-Peralta
et al. (2010),
Group PPT (n= 8) in nine
sessions with clients diagnosed
with depression, compared with
behavioral therapy (n= 10) at a
community center in Chile
Depression (BDI-II &CES-D),
Happiness (AHI)
Post, Happiness (AHI, PPT >
Behaviour Therapy (d= 0.72); PPT
group < on Depression, from pre-
topost-treatment (BDI-II;d= 0.90 &
CES-Dd= 0.93)
The Journal of Positive Psychology 31
positive emotions not only undo effects of negative emo-
tions but also expand cognitive researches resources
(Fredrickson, 2001,2009). Emerging evidence supports
this assertion (Jislin-Goldberg, Tanay, & Bernstein,
2012). Therefore, throughout the course of PPT, thera-
pists not only help clients to observe, acknowledge and
label positive emotions but also discuss with clients new
possibilities of generating alternative ways of solving
their problems when clients experience positive emotions.
PPT exercises such as Positive Introduction, Gratitude
Journal, Gratitude Letter & Visit, One Door Close, and
One Door Open facilitate cultivation of positive emotions
throughout the course of therapy. In the Gratitude Journal,
clients, just before going to bed, write three good things
small or big that happened during the course of the day.
Most clients nd this helpful not only in coping with nega-
tive experiences but also in cementing relationships
through explicitly noticing the kind acts and gestures of
friends and family. Kashdan, Julian, Merritt, and Uswatte
(2006) in a diary study with the Vietnam War veterans
diagnosed with Post-traumatic Stress Disorder (PTSD),
found that gratitude related to more daily self-esteem and
positive affect, above the effects of symptomatology. In
addition to gratitude, through PPT exercises such as
Satiscing versus Maximizing (Schwartz, Ward et al.,
2002) and Savoring (Bryant & Veroff, 2006) clients learn
to deliberately slow down and enjoy experiences they
would normally hurry through (e.g. eating a meal). When
the experience is over, clients reect and write down what
they did, and how they felt differently compared to when
they rushed through it.
Flourishing individuals, according to Fredricksons
positivity ratio (2009), experience three positives for every
one negative. Depressed individuals seeking therapy expe-
rience lower than one positive for every one negative
(Schwartz et al., 2002). Inevitably clients presenting for
therapy report a range of negative emotions. After helping
clients to actively and authentically cultivating positive
emotions, which relieve acute psychiatric distress, in the
middle phase of the therapy clients are encouraged to write
down grudges, bitter memories, or resentment and then
discuss in therapy the effects of holding onto them.
Through positive reappraisal, PPT aims to help clients
unpack their grudges and resentments through what it calls
Positive Appraisal (Rashid & Seligman, 2013). It includes
four strategies: (i) psychological space: write a bitter mem-
ory from a third persons perspective; (ii) reconsolidation:
recall ner and subtle aspects of a bitter memory in a
relaxed state; (iii) mindful focus: observe a negative mem-
ory rather than reacting; and (iv) diversion: intentionally
Table 3. (Continued).
Authors and
publication status
Intervention description and
sample characteristics Primary outcome measures Key ndings
10 Bay and Csillic
(2012), dissertation
Group PPT (n= 10) compared
with Group Cognitive Behavior
Therapy (n= 8) & medication
(n= 8) with client experiencing
symptoms of depression at the
le Centre de la Dépression and
le Centre Stress Anxiété et
Dépression, in France
Depression (BDI-Shortened),
Depression & Anxiety (HADS),
Happiness (SHS), Emotional
Inventory (EQ-I), Life
Satisfaction (SWLS) & Positive
and Negative Affect (PANAS)
Post, Depression, PPT < CBT
(d=0.66), Happiness (SHS;
d= 0.81), Life Satisfaction (SWLS;
d=0.66), Optimism (LOT-R,
d= 1.62) & Emotional Intelligence
(EQ-I, d = 1.04). On most measures
both PPT and CBT faired better than
medication group
11 Meyer, Johnson,
Parks, Iwanski,
and Penn (2012),
Group PPT in ten sessions, with
six exercises was adapted for
clients (n= 16) experiencing
symptoms of schizophrenia at a
hospital afliated clinic, with
baseline, post-intervention, three
month follow-up assessment
Psychological Well-being
(SWS), Savoring (SBI), Hope
(DHS), Recovery (RAS),
Symptoms (BSI) & Social
Functioning (SFS)
Post, PPT < CBT, Depression (BDI
d= 0.66), Happiness (SHS, d= 0.81),
Life Satisfaction (SWLS d = 0.66),
Optimism (LOT-Rd= 1.62) & EQ-I
(d = 1.04). In most cases both PPT
and CBT faired better than
medication group
12 Kahler et al.
(2014), published
Individual PPT (n= 19), in eight
sessions was integrated with
smoking cessation counseling
and nicotine patch with at a
community medical center
Depression (SCID, CES-D),
Nicotine Dependence (FTND),
Positive and Negative Affect
(PANAS) & Client Satisfaction
Rate of session attendance and
satisfaction with treatment were
high, with most participants reported
using and benetting from PPT
exercises. Almost one-third (31.6%)
of the sample sustained smoking
abstinence for six months after their
quit date
13 Goodwin (2010)
Group PPT (n= 11), in ten
sessions explore if treatment
increased relationship
satisfaction among anxious and
stressed individuals with a
community sample at a training
Anxiety (BAI), Stress (PSS),
relationship adjustment (DAS)
Post, PPT <, Anxiety (BAI d = 1.48),
Stress < (PSS d = 1.22), no changes
on relationship satisfaction (DAS)
32 T. Rashid
engage behaviorally in an unrelated or playful task. Clients
are also invited to consider the process of forgiveness.
However, PPT spends one session each on positive apprai-
sal and forgiveness, as the goal here is to support clients
strength-based well-being. It is not uncommon for exer-
cises employed in PPT to generate negative and uncom-
fortable emotions, some of which could be associated with
trauma. Much like any psychotherapy, PPT attends to all
varieties of emotional experiences. However, while empa-
thetically attending to pain associated with traumatic expe-
riences, PPT gently encourages clients to also explore
meaning and psychological growth (Bonanno & Mancini,
2012) through exercises such as One Door Closes, One
Door Opens Writing a Positive Legacy. Therapists are to
avoid too quickly pointing out the positive outcomes from
trauma, loss, or adversity. Incorporating strengths with
symptoms helps clients to learn how to encounter negative
experiences with a more positive mindset, and to reframe
those experiences in ways that are adaptable and helpful.
The third and nal phase of PPT exercises continues
to use clients strengths, but focus is on placed meaning
and purpose and ways signature strengths can be used to
serve something meaningful and bigger than oneself.
One exercise, positive communication, teaches clients
ways to validate and capitalize on precious moments
when their partners share good news with them (Gable,
Reis, Impett, & Asher, 2004). Others such as Gift of
Time help clients to pursue meaning and purpose by
using their strengths, such as strengthening close inter-
personal and communal relationships or pursuing artistic,
intellectual, or scientic innovations or philosophical or
religious contemplation (Stillman & Baumeister, 2009;
Wrzesniewski, McCauley, Rozin, & Schwartz, 1997).
There is solid evidence that having a sense of meaning
and purpose helps individuals to recover or rebound
quickly from adversity and buffer against feelings of
hopelessness and uncontrollability (Graham, Lobel,
Glass, & Lokshina, 2008; Lightsey, 2006).
Some caveats are in order. Despite its title and
emphasis on cultivation of strengths, PPT is not prescrip-
tive. Rather, it is descriptive in the sense that converging
scientic evidence indicates that certain benets accrue
when individuals attend to the positive aspects of their
experience. Wood and Tarrier (2010), in a longitudinal
study of 5500 individuals, have shown that people who
were low on characteristics such as self-acceptance,
autonomy, purpose in life, positive relationships with
others, environmental mastery, and personal growth were
up to seven times more likely to meet the cut-off for
clinical depression 10 years later. Much like CBT, which
shows that clientsdistorted thinking causes and main-
tains depression and then counsels them to change it,
PPT states that experiencing certain emotions is detri-
mental or benecial to ones well-being.
Second, PPT is not a panacea and will not be appro-
priate for all clients in all situations. Clinical judgment is
needed to determine the suitability of PPT for individual
clients. For example, a client with an inated self-per-
ception may use strengths to further support his/her nar-
cissism. Likewise, a client with a deeply entrenched
sense of being a victim may feel too comfortable in that
role, and may benet from an insight oriented approach
to ascertain the emotional pro and cons of this role rst
and then could perhaps benet from PPT exercises. For
some disorders, elimination of symptoms is much more
needed than cultivation of strengths. For example, a cli-
ent with symptoms of panic disorder needs an immediate
relieve from exposure or a client with symptoms of eat-
ing disorder may need structured therapeutic interven-
tions that address acuteness of symptoms rst. A client
experiencing grief and acute trauma would benet from
interventions that help him/her to cope with sadness and
Third, a therapist using PPT also should not expect
a linear progression of improvement, because the moti-
vation to change longstanding behavioral and emotional
patterns uctuates during the course of therapy. The
progress of one client should not bias therapists about
the likely progress (or lack of ) of another client. The
mechanism of change in PPT has not been explored
systematically, but inferring from the change of mecha-
nism uncovered by Lyubomirsky and Layous (2013)
about positive interventions, it can be argued that
change brought by positive interventions could be mod-
erated by level of symptom severity, individual person-
ality variables (motivation, effort), exibility in
completing and practicing the exercises and skills, and
overall client intervention t. Nonetheless, the therapist
must also be aware that change is not due to expec-
tancy effect. Finally, it is important to be aware of cul-
tural sensitivities in assessing strengths. An emotive
style of communication, interdependence on extended
family members, and avoiding direct eye contact may
convey zest, love, and respect (Pedrotti, 2011).
Positive psychology has been criticized for not
exploring peoples troubles deeply enough and steering
people quickly towards well-being and strengths without
comprehending the contextual features of the presenting
situations (Coyne & Tennen, 2010; Ehrenreich, 2009;
McNulty, & Fincham, 2012). As underscored throughout
this paper, PPT, does not deny negative emotions, nor
does it encourage clients to search for positives all too
quickly through rose-colored glasses. It is a scientic
endeavor to encourage clients to explore their intact
resources and learn contextual, nuanced and calibrated
use of these resources to overcome their challenges in
increments but never at the cost of denying, dismissing
or avoiding negatives.
The Journal of Positive Psychology 33
Empirical evidence, caveats, and future directions
PPTs empirical support has been found in several (albeit
pilot) studies.
In a 6-group, random-assignment, placebo controlled
Internet study, Seligman, Steen, Park, and Peterson (2005)
found that of 5 purported happiness interventions and 1
plausible control exercise, three exercises (using signature
strengths in a new way, three good things & gratitude
visit) increased happiness and decreased depressive symp-
toms. These ndings have since been independently repli-
cated with somewhat similar results (Giannopoulos &
Vella-Brodrick, 2011; Mongrain & Anselmo-Matthews,
2012). Exploring the ner aspects of PPT exercises,
Schueller (2010) has found that it is a persons internal
characteristics that make a particular positive psychology
intervention more or less benecial. Table 3lists thirteen
pilot and feasibility studies, with small samples. All have
explicitly used the PPT manual (Rashid & Seligman, in
press; Seligman et al., 2006) as a packaged treatment.
Most have offered PPT as a group intervention, with eight
randomized controlled pilot studies, nine published in peer
reviewed journals, and three dissertations. Seven of these
studies treated community samples (outpatients in hospital
settings, community mental health clinics) from Canada,
China, Chile, France, Iran, and the United States, address-
ing clinical concerns including depression, anxiety, bor-
derline personality disorder, psychosis, and nicotine
dependence. Four studies have compared PPT with two
other treatments, Dialectical Behavior Therapy (DBT) and
Cognitive Behavior Therapy (CBT). Due to space limita-
tion, only salient studies are summarized. The rst ran-
domized controlled pilot (Seligman et al., 2006) included
two studies, a six-session controlled group therapy for par-
ticipants experiencing mild to moderate symptoms of
depression and 1214 session individual therapy for a clin-
ical sample experiencing severe symptoms of depression.
The individual therapy compared PPT with Treatment as
Usual (TAU) and clients who received TAU, as well as
antidepressant medication (TAUMED). These clients
sought counseling services at a large urban university for
symptoms of severe depression. PPT took place over up to
14 sessions, mostly weekly, to individual clients in 1214
sessions. It was custom tailored to meet their circum-
stances and the feasibility of completing the exercises. The
TAU received an integrative and eclectic approach admin-
istered by licensed psychologists, two licensed social
workers, and two graduate-level interns. Overall, results
indicated that PPT did better than two active treatments,
with large effect size. These initial results were highly pre-
liminary with small sample sizes, and treatment was
offered by some intrinsically interested and trained in PPT.
More recently, Asgharipoor and colleagues (2012) com-
pared PPT with CBT (Registration ID in IRCT:
201201268829NI). Eighteen outpatients diagnosed met
the inclusion criteria, which included having major depres-
sive disorder as identied by SCID (Axis I. DSM-IV),
BDI-II (Beck, Steer, & Brown, 1996; a Persian validated
version), Subjective Units of Distress Scale (SUDS),
Oxford Happiness Scale, and Subjective Wellbeing Scale.
The PPT (n= 9) and CBT (n= 9) were offered in 12 two-
hour sessions at a community counseling center in Mash-
had, Iran. Results showed that the two treatments did not
differ in reducing symptoms of depression, but PPT was
found more effective in increasing happiness. These
results are somewhat consist with the ongoing study in
which PPT is compared with DBT. Participants are identi-
ed after completing SCID and multiple measures of psy-
chiatric distress and emotional dysregulation (see Table 3).
Results of the rst phase show that both PPT (n= 6) and
DBT (n= 10) worked equally well on most measure, but
DBT performed better on measured distress tolerance.
However, due to small sample size, these results are highly
preliminary. Lü, Wang, and Liu (2013) compared PPT
with a control group. PPT (n= 16) offered in 16 two hour
weekly sessions was compared with no treatment control
(n= 18). The outcome was impact of positive affect on
vagal tone in handling environmental challenges. PPT did
signicantly better than the control group at post-interven-
tion, three-, and six-month follow-up with medium effect
sizes. Reinsch (2012) offered PPT (n= 9) in six sessions to
clients seeking psychotherapy through Employee Assis-
tance Program and compared it with no treatment (n= 8).
Results indicated that signicant decrease in depression at
the post-intervention and therapeutic gains were main-
tained one month post-treatment with a statistically signi-
cant 45% decrease in depression. PPT has also been
adapted for various disorders and clinical conditions.
Kahler et al. (2014) adapted PPT for smoking cessation
(PPT-S). Treatment was offered through individual ses-
sions. Results show that rates of session attendance and
satisfaction with treatment were high, and most partici-
pants reported using and beneting from the PPT exer-
cises. Almost one-third of the participants (31.6%)
sustained smoking abstinence for six months after their
quit date. A manualized adaptation of standard 14-session
PPT called WELLFOCUS PPT has been developed at
Kings College, London. It aims to increase well-being in
service users with an experience of psychosis. The adapta-
tion process synthesized systematic review evidence and
qualitative research involving people with a psychosis
diagnosis who use mental health services (Schrank et al.,
2013). The evaluation of WELLFOCUS PPT in an RCT
with 11 groups has been completed (ISRCTN 04199273)
and the manuscript is in submission. PPT pilot studies,
listed in Table 3, overall, report decrease in depression and
increase in well-being compared to control or pre-treat-
ment scores, with medium to large effect sizes. All effect
sizes Cohensd(Cohen, 1992) are given in Table 3. When
34 T. Rashid
compared to another treatment such as CBT or DBT, PPT
performed equally well or exceeded notably on well-being
measures (e.g. Asgharipoor, Farid, Arshadi, & Sahebi,
2010; Cuadra-Peralta, Veloso-Besio, Pérez, & Zúñiga,
2010). One important caution in reviewing these studies is
their small sample sizes. The study at the Kings College,
London with 11 randomized groups will have with the
largest sample administering PPT to date.
Positive interventions typically are one or more posi-
tive psychology exercises, often, but not always, used
with non-clinical and randomized online samples.
Typical illustration of positive interventions would be
Seligman et al. (2005), Vella-Brodrick, Park, and
Peterson (2009), Mongrain and Anselmo-Mathews
(2012) and Schueller & Parks (2012). Two meta-analyses
of positive interventions have been published. The rst
meta-analysis of 51 positive interventions including both
clinical and non-clinical samples, conducted by Sin and
Lyubomirsky (2009), found that positive interventions
are effective, with moderate effect sizes in signicantly
decreasing symptoms of depression (mean r= 0.31) and
enhancing well-being (mean r= 0.29). The second meta-
analysis, by Bolier and her colleagues (2013), reviewing
39 randomized heterogeneous published studies, totaling
6139 participants. Of these only seven included clinical
samples. Authors found that positive interventions
reduced depression (mean r= 0.23) with small effect size
but enhanced well-being with moderate effect sizes
(r= 0.34). Compared to more structured, manualized,
sequential PPT that is used with clinical samples, posi-
tive interventions could benet non-clinical patrons as
well-being enhancing strategies that could prevent or
reduce risk of future psychological disorders.
Empirical foundations of PPT are critical, but equally
essential is establishing a repertoire of case studies, vign-
ettes and illustrations of PPT exercises conducted as a
packaged treatment, stand alone interventions, and incor-
porated with established treatments. This will help clini-
cians to understand day-to-day implementation of PPT.
Few developments in this regard are worth noting. Jour-
nal of Clinical PsychologysMay, 2009 issue exclusively
focused on positive interventions for clinical disorders
with rich case illustrations. Burns (2010) has compiled a
27-chapter casebook, written by a leading practitioner of
positive psychology. Each chapter provides a detailed
case illustration regarding the clinical use of positive
psychology, including PPT exercises with clients in dis-
tress. Most of the chapters offer step-by-step strategies.
In addition to protocolled treatment packages, single
positive interventions have also been applied to examine
their effectiveness for specic clinical conditions, such
as gratitude in undoing symptoms of depression (Wood,
Maltby, Gillett, Linley, & Joseph, 2008), best possible
self and three good things for depression (Pietrowsky,
2012), hope as a treatment of PTSD (Gilman, Schumm,
& Chard, 2012), the therapeutic role of spirituality and
meaning in psychotherapy (Steger & Shin, 2010), posi-
tive psychology interventions to treat drug abuse (Akthar
& Boniwell, 2010), cultivation of positive emotions in
treating symptoms of schizophrenia (Johnson et al.,
2009), and forgiveness as a way of slowly letting go of
anger (Harris et al., 2006). The role of positive interven-
tions to supplement traditional clinical work is also being
explored (e.g. Frisch, 2006; Harris, Thoresen, & Lopez,
2007; Karwoski, Garratt, & Ilardi, 2006; Ruini & Fava,
2009). Links between specic clinical conditions and
strengths also been explored, including creativity and
bipolar disorder (Murray & Johnson, 2010), positive
psychology and brain injury (Evans, 2011), positive
emotions and social anxiety (Kashdan et al., 2006),
social relationships and depression (Oksanen, Kouvonen,
Vahtera, Virtanen, & Kivimäki, 2010), various aspects of
well-being and psychosis (Schrank et al., 2013), positive
psychology and war trauma (Al-Krenawi et al., 2011),
school-based positive psychology interventions (Waters,
2011), and character strengths and mindfulness (Niemiec,
Rashid, & Spinella, 2012). In addition, a number of
online studies have effectively used PPT-based interven-
tions with promising results (e.g. Parks, Della Porta, Pierce,
Zilca, & Lyubomirsky, 2012; Mitchell, Stanimirovic, Klein,
& Vella-Brodrick, 2009; Schueller & Parks, 2012). This
could be a relatively cost effective way of offering mental
health services to nonclinical patrons as a preventative strat-
egy. To help psychotherapists incorporate positive interven-
tions in their clinical practice, a few books are available
(e.g. Bannink, 2012; Conoley & Conoley, 2009; Flückiger,
Wusten, Zinbarg, & Wampold, 2010; Joseph & Linley,
2006; Levak, Siegel, & Nichols, 2011; Linley & Joseph,
2004; Magyar-Moe, 2009; Proctor & Linley, 2013). Journal
articles on theoretical foundation of strengths in the clinical
practice have also been published (e.g. Dick-Niederhauser,
2009;Lent,2004;Slade,2010; Smith, 2006; Wong, 2006).
An outcome measure, Positive Psychotherapy Inventory
ents of PPT including positive emotions, engagement,
meaning, and relationships, has been devised and validated
(Bertisch et al., 2014; Guney, 2011; Rashid, 2008).
Establishing efcacy or effectiveness of interven-
tions takes decades of research, including open trial,
case reports, then controlled pilots, and nally multisite
studies. PPT has made a tentative but promising start.
It has shown effectiveness, and requires discovering
and identifying the mechanism of change. It is yet to
establish its incremental effectiveness over and
beyond the traditional approach and more clearly
delineate outcomes that are theoretically and empiri-
cally related to its content. So far, PPT has mostly
been used in group settings. There is dearth of studies,
which have used it in individual settings. Moving
forward, longitudinal and multimethod (e.g. experiential
The Journal of Positive Psychology 35
sampling, physiological, and neurological indices)
research designs may uncover effectiveness of PPT for
specic disorders. There is a lack of coherent theory
that explains the epistemology of well-being, especially
in clinical settings. Clinical practice often runs ahead
of evidence. Yet evidence is keeps practice alive
through, well dened and rened studies. PPT, without
competing, complements the rich repertoire of thera-
peutic approaches to enrich the eld.
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Outcome Measures (in alphabetical order)
Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown,
1996); Beck Depression Inventory-II -Short Form (BDI-SF:
Chibnall & Tait, 1994); Beck Anxiety Inventory, (BAI, Beck,
Epstein, Brown, & Steer, 1988); Brief Symptom Inventory (BSI:
Derogatis, 1993); Centre for Epidemiological Studies for
Depression (CES-D; Radloff, 1977); Children Depression
Inventory (CDI; Kovacs, 1992); Client Satisfaction Question-
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1979); Difculties in Emotion Regulation (DERS: Gratz &
Roemer, 2004); Distress Tolerance Scale (DTS; Simons &
Gaher, 2005); Dyadic Adjustment Scale (DAS; Spanier, 1976);
Emotional Quotient inventory (EQ-I; Dawda & Hart, 2000);
Fagerstrom Test for Nicotine Dependence (FTND; Heatherton,
Kozlowski, Frecker, & Fagerström, 1991); Hamilton Rating
Scale for Depression (HRSD; Hamilton, 1960); Hospital Anxi-
ety and Depression Scale.(HADS; Bjelland, Dahl, Haug, &
Neckelmann, 2002); Kentucky Inventory of Mindfulness Skills;
(KIMS; Baer, Smith, & Allen, 2004); Orientations to happiness
(Peterson, Park, & Seligman 2005); Life Orientation Test-
Revised (LOT-R; Scheier, Carver, & Bridges, 1994). Outcome
Questionnaire-45 (OQ-45; Lambert et al., 1996); Positive and
negative Affect Schedule (PANAS; Watson, Clark, & Tellegen,
1988), Positive Psychotherapy Inventory (PPTI; Rashid, 2005);
Positive Psychotherapy Inventory-Children Version (PPTI-C;
Rashid & Anjum, 2008); Recovery Assessment Scale (RAS;
Corrigan, Salzer, Ralph, Sangster, & Keck, 2004); Respiratory
sinus arrhythmia (RSA; Berntson et al., 1997; measures the
degree of respiration-linked variability in the heart rate);
Satisfaction with Life Scale (SWLS; Diener, Emmons, Larsen,
& Grifn, 1985); Savoring Beliefs Inventory (SBI; Bryant,
2003); Scales of Well-being (SWB; Ryff, 1989); Social Skills
Rating System (SSRS; Gresham & Elliot, 1990); Structured
Clinical Interview for DSM-IV-Axis I (SCID; First, Spitzer,
Gibbon, & Williams, 2007); StudentsLife Satisfaction Scale
(SLSS; Huebner, 1991); Symptom Checklist090-Revised (SCL-
90-R; Derogatis, 1994); The social functioning scale (SFS;
Birchwood, Smith, Cochrane, & Wetton, 1990); Values in
Action (VIA-Youth; Park & Peterson, 2006); Zung Self-Rating
Depression Scale (ZSRS; Zung, 1965).
40 T. Rashid
  • ... A strengths-based PP approach may help achieve a more balanced outlook (Bird et al., 2012) enabling substance use practitioners to gain a more positive view of their clients. This, in turn, may help them be more effective in providing support through guiding clients toward flourishing and have 40 a greater sense of accomplishment buffering against burnout (Rashid, 2015). 'Personal practice' through personal therapy enables direct experience and conscious reflection on such experience (Kolb, 1984), which are important for professional development and 45 improving psychological well-being and resilience to work more effectively and safely in a stressful profession (Wigg et al., 2011). ...
    Background: In traditional dual diagnosis treatment, the primary aim is to attend the substance use problem and tackle the mental health issues with little attention to the positive aspects of clients’ lives. This deficit-based approach, however, may bring about an ignorance of clients’ potentials. The present study primarily aimed at investigating practitioners’ views of their clients; acquiring information on how to improve a previously designed positive psychology intervention for dual diagnosis, and finding ways of integrating positive psychology with current approaches. Methods: A positive psychology intervention developed for dual diagnosis individuals was delivered to two groups of psychosocial intervention workers (n = 17) at a drug and alcohol service. The study employed a mixed methods approach with a quantitative and a qualitative element (focus group). Results: Participants reported a number of personal and professional benefits gained from the intervention, but also discussed the structure of the intervention, practitioner qualities, and difficulties of incorporation into existing treatment as challenges that may arise in terms of feasibility with this client group. Conclusions: Through a strengths-based positive approach, a more balanced treatment would enable the recognition and appreciation of both the vulnerabilities and the emerging potential of clients. This would lead to better outcomes with clients achieved by a healthier workforce.
  • ... This perspective emphasizes paying attention to strengths, improving the positives, and creating meaningful normal life as much as attending to weaknesses, addressing the negatives, and treating pathology [8]. Positive psychotherapy systematically amplifies positive individual resources such as character strengths, meaning, and intrinsically motivated accomplishments [9], and is effective in treating psychiatric disorders and improving subjective wellbeing [10,11]. For example, multiple sessions on topics associated with strengths can make people optimistic by identifying and devising their strength profiles [12], and subjective well-being can be enhanced through visualizing best possible selves, exploring wishes, and processing positive life experiences [13,14]. ...
    Full-text available
    Background Enhancing subjective well-being is an effective way to improve mental health and virtual reality is useful as an intervention tool for cultivating well-being. This preliminary study aimed to probe the usefulness of a virtual reality-based interactive feedback program as an intervention tool for promoting subjective well-being. Methods In the experiment, 36 males participated in this program, consisting of three tasks constructed based on the theories of positive psychology: ‘Experience-based problem recognition task’, ‘Future self-based success story expression task’, and ‘Strength expression task’. Participants rated visual analog scores associated with each of the tasks' contents. The concurrent validity of task scores was evaluated by correlations with scores of the psychological scales, such as the Mental Health Continuum-Short Form, Rosenberg’s Self-Esteem Scale, Dispositional Hope Scale, and Life Orientation Test Revised. Results The total task score was positively correlated with the scores of Mental Health Continuum-Short Form emotional well-being ( r = 0.492, p < 0.001) and psychological well-being ( r = 0.501, p < 0.001), Rosenberg’s Self-Esteem Scale ( r = 0.435, p < 0.001), Dispositional Hope Scale agency dimension ( r = 0.601, p < 0.001) and pathways dimension ( r = 0.451, p < 0.001), and Life Orientation Test Revised ( r = 0.378, p < 0.05), but not with the MHC-SF social well-being scores. After controlling the effects of the other task scores, the task scores had linear relationships with certain psychological assessments. Conclusion The results showed that the total task score was significantly correlated with indicators of well-being, self-esteem, hope, and optimism. The task scores obtained from the individual tasks were closely related to the indicators, depending on the nature of the task. These findings suggest that the program contents are well associated with certain aspects of subjective well-being and thus may be available for training that improves subjective well-being through interactive feedback.
  • ... An increased interest in PP interventions that focus on the development of strengths has emerged in recent years. The concept of a PP intervention refers to a series of intentional activities, such as a psychoeducational programme, aimed at fostering positive thoughts, feelings and behaviours (Biswas-Diener, 2010;Rashid, 2015). ...
    Full-text available
    More South African research is needed that examines the application of positive psychology to assist students in navigating the stressful first‑year experience by identifying, developing and applying signature strengths. This article reports on a mixed methods study that investigated the efficacy of a strengths-based development programme presented to a sample of 55 first‑year university students (mean age = 19.77, SD = 1.50, female = 60%). Quantitative data were collected in a pre- and post-intervention manner using the Personal Growth Initiative Scale, the Subjective Happiness Scale, the Satisfaction with Life Scale and the Strengths Use and Deficit Improvement Questionnaire. Qualitative data were collected in individual semi-structured interviews (n = 12, age range = 18‑22). Significant changes between the pre- and post‑test scores emerged when comparing the quantitative data. The qualitative analysis pointed to aspects that participants regarded as beneficial to the efficacy of the strengths-based programme. Collectively, the data integration suggested that the intervention had a positive impact on participants’ sense of well‑being and contributed to enhancing the first‑year experience. Limitations and areas for further research conclude the discussion.
  • ... Strength theory focuses on clients' capacities and skills internally and externally at the same time (Rashid, 2015). Clients are no longer viewed as a person who needs help. ...
    Full-text available
    Refugees are a group of people who has been leaved their own countries and could not be able to return their own countries safely, which is the result of various reasons, including war, race, religion, nationality, membership of a specific social group as well as political opinion (Dalton-Greyling and Campus, 2008). Due to their miserable and torturous experience, they are viewed as a specific group of people with high incidence of trauma. Therefore, this essay will explain the reasons of examining their experience, find out some factors that contribute to their trauma as well as clarify some issues which should be considered when working with them. Meanwhile, possible intervention approaches and clear reflection will be provided.
  • ... Compared to the other two models, the third model offers an advantage in the clinical context, since an individual's resources and problems can be contemplated simultaneously. In this vein, previous research has already indicated that a sole focus on problems does not necessarily lead to therapy goals being reached; combining problem activation with resource activation strategies, however, allows the potential of psychotherapy to unfold and enables problems to be solved more effectively (Flückiger, 2015;Gassmann & Grawe, 2006;Rashid, 2015). ...
    Full-text available
    Objectives: The current study compared resource realization and psychological distress in patients with different psychiatric diagnoses and healthy individuals and examined the moderating effect of intrapersonal resources (personal strengths) and interpersonal resources (relationships) on the association between incongruence (unsatisfactory realization of personal goals) and psychological distress. Method: In total, 218 participants (45.87% female, mean age = 39.83 years) completed standardized questionnaires at one measurement point. Results: Healthy individuals (n = 56) reported the most resources, followed by patients with psychotic (n = 53), substance use (n = 53), and depressive disorders (n = 56). While patients with psychotic disorders benefited from intra- and interpersonal resources, patients with depression only benefitted from intrapersonal resources. Patients with substance use disorders did not benefit from resources at all. Conclusions: Depending on the diagnosis, patients evaluated their level of resources differently and benefitted in different ways. The results suggest that within psychotherapy, it might be useful to strengthen resources, especially for patients with depressive and substance use disorders.
  • Psychological well-being is one of the constructs studied in positive psychology that is considered as one of the main components of public health. The present study aimed to compare the effectiveness of positive psychology and emotion regulation training interventions in promoting the psychological well-being in Nar-Anon group (Anonymous addicts’ family group) of Omidiyeh County. The research method was experimental with a pretest-posttest design and a control group. The statistical population of the study consisted of all families of drug abusers who participated in sessions of anonymous addicts’ family group (Nar-Anon) in Omidiyeh County in 2018. Sixty participants were randomly selected from the volunteer population and were randomly assigned to two experimental and one control groups (n = 20 per group). The first experimental group received positive psychotherapy intervention, and the second experimental group received emotion regulation training intervention, but the third (control) group did not receive any training. Follow-up was performed 2 months later. The research instrument included Ryff’s scale of psychological well-being (SPWB). Data analysis was done using the analysis of covariance (ANCOVA) and SPSS version 24.0. The results indicated that positive psychology (p = 0.0001) and emotion regulation training (p = 0.0001) interventions had a significant effect in promoting the psychological well-being. Results of the follow-up stage indicated that changes and the increase continued in participants’ psychological well-being. The difference between the positive psychology and emotion regulation training was not significant (p = 0.09). In other words, both training methods had equal effects on psychological well-being. Given the effectiveness of the interventions, they can be used to promote the psychological well-being of addicts and their families.
  • Article
    Full-text available
    The aim of the present study was to compare the effectiveness of group positive psychotherapy and psychodrama on spiritual attitude of women with chronic pain. The study was a semi-experimental research with pre-test, post-test and follow-up design with control group, and the statistical population included all women suffering from chronic pain who visited Pars Royal Clinic in Tehran, from among whom a sample of 45 women were selected using convenience sampling method and were assigned to three groups of 15 people. Research tools included Spiritual Attitude Scale, Group Positive Psychotherapy Protocol and Therapeutic Psychodrama Package. For analyzing the data, analysis of covariance (AN-COVA) was utilized. Research findings indicated that group positive psychotherapy was more effective than psychodrama on improving the spiritual attitude of women suffering from chronic pain (p<0.01). Based on the results, compared to psychodrama, group positive psychotherapy is more effective on strenghtening the spiritual attitude of women with chronic pain in using adaptive strategies to cope with chronic pain and thereby improving their quality of life.
  • Article
    Objectives This randomized controlled trial evaluated the effects of a psychosocial intervention developed based on the Integrative Body-Mind-Spirit (IBMS) model that aimed to enhance the well-being of parents of children with eczema. Methods Ninety-one families were randomly allocated to either the six-session intervention group ( n = 48) or the wait-list control group ( n = 43) and completed the randomized trial. For both groups, a range of psychosocial outcome measures were taken before the intervention (T 0 ), postintervention (T 1 ), and 6 weeks after the intervention (T 2 ). Results Relative to the control group, the intervention group was significantly improved over time in their levels of perceived stress, depression, and a number of holistic well-being measures, including nonattachment, afflictive ideation, and general vitality. Discussion The results provided empirical support for an IBMS-informed psychosocial intervention in reducing stress and depression and enhancing well-being among parents of children with eczema.
  • Article
    This study investigated the effects of a character strength focused positive psychology course on student well-being. The Values in Action character strengths were each presented as ways to increase both individual and community well-being. There were 112 undergraduate students in the positive psychology course and a comparison group of 176 undergraduates who took other psychology courses. They all completed the PERMA-Profiler (Butler and Kern in Int J Wellbeing 6:1–48, 2016) during the first and last week of the semester. This questionnaire assessed the five elements of positive emotion, engagement, relationships, meaning, accomplishment (PERMA) plus happiness, health, loneliness, and negative emotion. The hypotheses were that (1) the positive psychology students would have significant improvements in each of the measures during the semester and (2) these changes would be significantly greater in the desired direction than the changes for the students in other psychology courses. The first hypothesis was supported in that the positive psychology students had significant improvements in all of the measures, including the total PERMA score. The second hypothesis was also strongly supported in that these improvements were significantly greater relative to the students taking other psychology courses. The effect sizes for the difference between the groups were large for the total PERMA score (d = .846) and the element of meaning; medium-to-large for positive emotion and relationships; medium for happiness, accomplishment, and negative emotion (decrease); and small-to-medium for engagement, health, and loneliness (decrease).
  • Chapter
    Julius ist Mitte 30 und seit rund zwei Jahren in der Finanzdienstleitungsbranche tätig. Sein starkes Engagement hat ihm zu schnellem Aufstieg verholfen, sodass er schließlich von einem konkurrierenden Unternehmen abgeworben wurde. Ziel war es hierbei, sein umfangreiches Wissen lukrativ für das neue Unternehmen zum Einsatz zu bringen. Um schnell auf Anerkennung zu stoßen, hat er sich bemüht, seine Innovationen bestmöglich in das Team zu implementieren. Die anfängliche Ablehnungshaltung seiner neuen Kollegen mutierte schnell zu Spott und führte schließlich dazu, dass über die Hälfte seiner Mitarbeiter begann, ihn zu boykottieren.
  • Article
    This article describes the development of a brief research instrument to measure global life satisfaction in children, the Student's Life Satisfaction Scale (SLSS). A preliminary version of the SLSS was administered to a sample of 254 children age 7-14 from the Midwestern United States. The scale demonstrated acceptable internal consistency and a unidimensional factor structure. Satisfaction scores did not differ as a function of age, grade or gender. Analyses of individual items as well as total scale scores indicated a high degree of overall life satisfaction, which is consistent with findings reported for adults. A cross-validation study with a more heterogeneous sample of 329 children age 8-14 from the Midwest yielded similar results, including adequate temporal stability. A revised version correlated predictably with criterion measures. The revised SLSS appears useful for research purposes with students as early as age 8. Implications for future research are discussed.
  • Article
    Given recent attention to emotion regulation as a potentially unifying function of diverse symptom presentations, there is a need for comprehensive measures that adequately assess difficulties in emotion regulation among adults. This paper (a) proposes an integrative conceptualization of emotion regulation as involving not just the modulation of emotional arousal, but also the awareness, understanding, and acceptance of emotions, and the ability to act in desired ways regardless of emotional state; and (b) begins to explore the factor structure and psychometric properties of a new measure, the Difficulties in Emotion Regulation Scale (DERS). Two samples of undergraduate students completed questionnaire packets. Preliminary findings suggest that the DERS has high internal consistency, good test–retest reliability, and adequate construct and predictive validity.
  • Article
    The goal of this study was to evaluate the effects of a 6-week forgiveness intervention on three outcomes: (a) offense-specific forgiveness, (b) forgiveness-likelihood in new situations, and (c) health-related psychosocial variables, such as perceived stress and trait-anger. Participants were 259 adults who had experienced a hurtful interpersonal transgression from which they still felt negative consequences. They were randomized to a forgiveness-training program or a no-treatment control group. The intervention reduced negative thoughts and feelings about the target transgression 2 to 3 times more effectively than the control condition, and it produced significantly greater increases in positive thoughts and feelings toward the transgressor. Significant treatment effects were also found for forgiveness self-efficacy, forgiveness generalized to new situations, perceived stress, and trait-anger. © 2006 Wiley Periodicals, Inc. J Clin Psychol 62: 715–733, 2006.
  • Book
    Positive psychology - essentially the scientific study of the strengths that enable individuals and communities to thrive - is a relatively new discipline that has experienced substantial growth in the last 5-10 years. Research suggests that the principles and theories from this area of study are highly relevant to the practice of counseling and psychotherapy, and positive psychology presents clinicians and patients with a much needed balance to the more traditional focus on pathology and the disease model of mental health. This book provides a comprehensive introduction to the best-researched positive psychological interventions. It emphasizes clinical application, providing a detailed view of how the research can be applied to patients. Covering the broaden-and-build theory, strengths-based therapy, mentoring modalities and more, the volume will provide numerous assessment tools, exercises and worksheets for use throughout the counseling and psychotherapy process. - Summarizes the applications of research from positive psychology to the practice of counseling and psychotherapy - Provides clinician a variety of assessments, worksheets, handouts, and take home and in-session exercises to utilize in the process of conducting therapy from a positive psychological perspective - Provides general treatment planning guidelines for the appropriate use of such assessments, worksheets, handouts, and exercises - Bibliography of positive psychology references to compliment the information provided in this book.
  • Article
    Research has begun to explore the nature of strong experiences of music listening, identifying a number of individual components from physiological through to psychological (Gabrielsson & Lindström Wik, 2003), but this has not yet been considered in relation to mainstream theories of happiness. Drawing on positive psychology, Seligman's (2002) framework for achieving balanced wellbeing includes the components of pleasure, engagement, and meaning. In the current study, 46 university students (median age 21) gave free reports of their strongest, most intense experiences of music listening. Accounts were analysed thematically using an idiographic approach, exploring the relevance of Seligman's framework. Most strong experiences were positive, and occurred at live events with others. A wide range of mainly familiar music was associated with reported strong experiences, from classical through jazz and folk to old and new pop music, and experiences lasted for varying time periods from seconds to hours. Unexpected musical or non-musical events were sometimes associated with strong experiences. None of the accounts could be characterized by a single route to happiness: in addition to hedonism, engagement and meaning (particularly in terms of identity) were present in every description, and the findings thus emphasize the power of music to evoke a state of authentic happiness. The importance of taking account of the music, the listener, and the situation in order to fully understand these experiences is underlined. © 2011, European Society for the Cognitive Sciences of Music. All rights reserved.
  • Article
    Full-text available
    A sizable portion of the population experiences subthreshold depressive symptoms, and these symptoms can lead to substantial functional impairment. However, there is little research on psychological interventions for depressive symptoms in nonclinical populations. In a series of three studies, I examine the efficacy of Positive Psychotherapy (PPT)—an intervention designed to decrease depressive symptoms in mild-moderately depressed individuals by increasing pleasure, engagement, and meaning—both in-person and over the web. I also explore the mechanism by which PPT decreases symptoms without ever targeting depression directly. ^ In Study 1, I piloted a 6-week group PPT intervention. Participants randomly assigned to receive group PPT experienced fewer depressive symptoms and greater life satisfaction than did no-intervention controls. Decreases in depressive symptoms were mediated by increases in life satisfaction, but only partially. In Study 2, I examined the effects of the techniques used in PPT when administered individually. I randomly assigned participants to complete one of the six PPT exercises or a placebo control exercise. When analyzed as one group, PPT exercises led to significant improvement in depressive symptoms while the Control exercise did not. Both PPT exercises and the Control exercise increased life satisfaction. However, the PPT exercises did not significantly differ from the Control exercise on either outcome. In Study 3, I piloted an online version of PPT. Compared to assessment-only controls, online PPT participants experienced significantly fewer depressive symptoms. However, there were no significant effects on life satisfaction, nor on another potential mediator: positive emotion. There was substantial variation in rates of compliance and continued use for each exercise; however, three months later, 91% of those who completed the follow-up assessment were still practicing at least one of the six exercises, with the average participant continuing to use between 2 and 3 exercises. ^ Despite limitations, which include high dropout rates and structural rigidities due to the automated design of online PPT, this series of studies provides an important first step in developing a low-cost, acceptable intervention for decreasing mild-moderate depressive symptoms in nonclinical populations.