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Well-Being After Psychopathology: A Transformational Research Agenda

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Abstract

If one struggles with depression, anxiety, or suicidal impulses, what is the best outcome that one can hope for? Can psychopathology be a bridge to a better place where people operate with autonomy and self-mastery, enjoy healthy relationships, experience frequent positive emotions, and view life as meaningful and purposeful? Studies of national samples have revealed that a substantial number of people with depression, panic disorder, and suicidal impulses go on to achieve high levels of psychological well-being. We consider the practical and theoretical implications of these findings and call for a transformational mental-health agenda that focuses on good outcomes.

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Objective: This paper presents a systematic review and meta-analysis of available evidence on remission rates for substance use disorders (SUDs), providing weighted mean estimates of SUD remission rates. The review also explores study-level characteristics that may explain variations in remission rates across studies. Methods: A comprehensive search strategy identified studies published between 2000 and 2015 with follow-up periods of at least three years or reported lifetime remission outcomes for potential inclusion in the review. Remission was defined as not meeting diagnostic criteria for abuse or dependence for a minimum period of six months, as of final follow-up. A single-group summary meta-analysis was performed. Pooled estimated annual remission rates (PEARRs) were calculated. Meta-regression techniques and subgroup analyses were used to explore the association between study remission rates and key selected variables. Results: Of 8855 studies identified, 21 met the eligibility criteria. The results suggested that 35.0% to 54.4% of individuals with SUDs achieved remission, and this occurred after a mean follow-up period of 17 years. The PEARRs projected few cases of SUD remission, between 6.8% and 9.1% in any given year. Studies that reported higher remission rates had longer follow-up periods, and lower sample retention rates. Conclusions: Results support the contention that SUDs are more likely to be "chronic" or long term disorders than acute disorders for a substantial number of individuals. However, more longitudinal research is required. Treatment geared to chronicity, such as assertive community treatment and intensive case management, needs to be more readily available for SUD populations.
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Drawing from the author's psychological research on especially generative (that is, caring and productive) midlife American adults and on a reading of American cultural history and literature, this book identifies a prototypical story of the good life that many Americans employ to make sense of who they are, who they have been, and who they will be in the future. The central theme in this story is redemption - the deliverance from suffering to a positive status or outcome. Empirical research suggests that highly generative American adults are much more likely than their less generative counterparts to construe their lives as tales of redemption. Redemptive life stories promote psychological well-being, physical health, and the adult's commitment to making a positive contribution to society. But stories of redemption are as much cultural texts as they are individual psychological constructions. From the spiritual autobiographies composed by the Massachusetts Bay Puritans to the most recent episodes of the Oprah Winfrey Show, common scripts for the redemptive self may be found in religious accounts of conversion and atonement, the rags-to-riches stories of the American dream, and canonical cultural narratives about personal liberation, freedom, and recovery. The book examines the psychological and cultural dynamics of redemptive life narratives, including the role of American religion and self-help as sources for the construction of life stories and the broad similarities, as well as the striking differences in how African-American and Euro-American adults construct redemptive stories of the self. For all their psychological and cultural power, redemptive life stories sometimes reveal important limitations in American identity. For example, some versions of the redemptive self underscore the naïve expectation that suffering will always be overcome and the arrogance of seeing one's own life as the living out of a personal manifest destiny.
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Researchers and clinicians assume a strong, positive correlation between anxiety symptoms and functional impairment. That assumption may be well-justified since diagnostic criteria typically include functional impairment. Still, the relationship remains largely unavailable in any systematic review. Our aim with this paper was to provide empirical evidence for this assumed relationship and to document the observed correlations between anxiety symptom measures and functional impairment measures. Correlations existed for symptoms of six anxiety disorders (Panic Disorder, Agoraphobia, Social Anxiety Disorder, Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder) across four functional domains (global, social, occupational, and physical). Overall, the mean of 497 correlations across all disorders and functional domains was modest (r=.34); since the variability between disorders and functional domains tended to be rather large, we explored these correlations further. We presented these results and the potential explanations for unexpected findings along with the clinical and research implications.
Article
A large international sample was used to test whether hedonia (the experience of positive emotional states and satisfaction of desires) and eudaimonia (the presence of meaning and development of one's potentials) represent 1 overarching well-being construct or 2 related dimensions. A latent correlation of .96 presents negligible evidence for the discriminant validity between Diener's (1984) subjective well-being model of hedonia and Ryff's (1989) psychological well-being model of eudaimonia. When compared with known correlates of well-being (e.g., curiosity, gratitude), eudaimonia and hedonia showed very similar relationships, save goal-directed will and ways (i.e., hope), a meaning orientation to happiness, and grit. Identical analyses in subsamples of 7 geographical world regions revealed similar results around the globe. A single overarching construct more accurately reflects hedonia and eudaimonia when measured as self-reported subjective and psychological well-being. Nevertheless, measures of eudaimonia may contain aspects of meaningful goal-directedness unique from hedonia. (PsycINFO Database Record
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This target article focuses on the construct of post-traumatic growth—positive psychological change experienced as a result of the struggle with highly challenging life circumstances. Prominent theories of post-traumatic growth define it in terms of personality change, and as a result, this area of research should be of great interest to personality psychologists. Despite this fact, most of the research on this topic has not been sufficiently informed by relevant research in personality psychology, and much of the extant research suffers from significant methodological limitations. We review the literature on post-traumatic growth, with a particular focus on how researchers have conceptualized it and the specific methodological issues associated with these conceptualizations. We outline some ways in which personality science can both be enriched by the study of this phenomenon and inform rigorous research on post-traumatic growth and provide a series of guidelines for future research of post-traumatic growth as positive personality change. Copyright © 2014 European Association of Personality Psychology
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Until recently, resilience among adults exposed to potentially traumatic events was thought to occur rarely and in either pathological or exceptionally healthy individuals. Recent research indicates, however, that the most common reaction among adults exposed to such events is a relatively stable pattern of healthy functioning coupled with the enduring capacity for positive emotion and generative experiences. A surprising finding is that there is no single resilient type. Rather, there appear to be multiple and sometimes unexpected ways to be resilient, and sometimes resilience is achieved by means that are not fully adaptive under normal circumstances. For example, people who characteristically use self-enhancing biases often incur social liabilities but show resilient outcomes when confronted with extreme adversity. Directions for further research are considered.
Article
There is insufficient research on rating psychological well-being and distress in clinical populations. The aim of this study was to evaluate the differential characteristics of instruments assessing well-being and distress in 20 remitted patients with affective (mood and anxiety) disorders and 20 healthy control subjects matched for sociodemographic variables. Remitted patients displayed significantly higher levels of psychological distress—as measured by Paykel's Clinical Interview for Depression (CID), Van Praag's Scale for Personality Disturbances and Kellner's Symptom Questionnaire (SQ)—and significantly less well-being—as measured by Ryff's Scales of Psychological Well-Being (PWB) and the SQ—than control subjects. The correlations between scales of psychological distress and well-being were found to be complex in both patients and controls. Psychotherapeutic treatment of residual symptomatology in patients disclosed a differential sensitivity of the scales to changes. The results thus suggest that well-being cannot be equated to lack of distress (as implicitly endorsed by current psychiatric paradigms), and the need for a multidimensional assessment in stress medicine. Copyright © 2000 John Wiley & Sons, Ltd.
Article
Social anxiety is associated with low positive affect (PA), a factor that can significantly affect psychological well-being and adaptive functioning. Despite suggestions that individuals with high levels of social anxiety would benefit from PA enhancement, the feasibility of doing so remains an unanswered question. Accordingly, in the current study, individuals with high levels of social anxiety (N = 142) were randomly assigned to conditions designed to enhance PA (Kind Acts), reduce negative affect (NA; Behavioral Experiments), or a neutral control (Activity Monitoring). All participants engaged in the required activities for 4 weeks and completed prepost questionnaires measuring mood and social goals, as well as weekly email ratings of mood, anxiety, and social activities. Both the prepost and weekly mood ratings revealed that participants who engaged in kind acts displayed significant increases in PA that were sustained over the 4 weeks of the study. No significant changes in PA were observed in the other conditions. The increase in hedonic functioning was not due to differential compliance, frequency of social activities, or an indirect effect of NA reduction. In addition, participants who engaged in kind acts displayed an increase in relationship satisfaction and a decrease in social avoidance goals, whereas no significant changes in these variables were observed in the other conditions. This study is the first to demonstrate that positive affect can be increased in individuals with high levels of social anxiety and that PA enhancement strategies may result in wider social benefits. The role of PA in producing those benefits requires further study. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Article
Theoretical conceptualizations of generalized anxiety disorder (GAD) continue to undergo scrutiny and refinement. The current paper critiques five contemporary models of GAD: the Avoidance Model of Worry and GAD [Borkovec, T. D. (1994). The nature, functions, and origins of worry. In: G. Davey & F. Tallis (Eds.), Worrying: perspectives on theory assessment and treatment (pp. 5–33). Sussex, England: Wiley & Sons; Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In: R. Heimberg, C. Turk, & D. Mennin (Eds.), Generalized anxiety disorder: advances in research and practice (pp. 77–108). New York, NY, US: Guilford Press]; the Intolerance of Uncertainty Model [Dugas, M. J., Letarte, H., Rheaume, J., Freeston, M. H., & Ladouceur, R. (1995). Worry and problem solving: evidence of a specific relationship. Cognitive Therapy and Research, 19, 109–120; Freeston, M. H., Rheaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791–802]; the Metacognitive Model [Wells, A. (1995). Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301–320]; the Emotion Dysregulation Model [Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9, 85–90]; and the Acceptance-based Model of GAD [Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: integrating mindfulness/acceptance-based approaches with existing cognitive behavioral models. Clinical Psychology: Science and Practice, 9, 54–68]. Evidence in support of each model is critically reviewed, and each model's corresponding evidence-based therapeutic interventions are discussed. Generally speaking, the models share an emphasis on avoidance of internal affective experiences (i.e., thoughts, beliefs, and emotions). The models cluster into three types: cognitive models (i.e., IUM, MCM), emotional/experiential (i.e., EDM, ABM), and an integrated model (AMW). This clustering offers directions for future research and new treatment strategies.
Article
Unconditional and conditional trajectories of posttraumatic stress disorder (PTSD) symptomatology were examined using a sample of U.S. soldiers deployed on a NATO-led peacekeeping mission to Kosovo. Data were collected at 4 time points, ranging from the weeks leading up to deployment to 9-months post deployment. Latent class growth analysis revealed 4 unique symptom trajectories: resilience, recovery, delayed, and unrealized anxiety. Variables identified as significant predictors of trajectory class included previous traumatic events, combat exposure, peacekeeping daily hassles, depression, alcohol use, aggressive behavior, stress reactivity, and military rank. Results from this study add to the literature detailing the variability in PTSD course, as well as to the literature pertaining to predictors of PTSD onset and course.
Article
Outcomes in depression treatment research include both changes in symptom severity and functional impairment. Symptom measures tend to be the standard outcome but we argue that there are benefits to considering functional outcomes. An exhaustive literature review shows that the relationship between symptoms and functioning remains unexpectedly weak and often bidirectional. Changes in functioning often lag symptom changes. As a result, functional outcomes might offer depression researchers more critical feedback and better guidance when studying depression treatment outcomes. The paper presents a case for the necessity of both functional and symptom outcomes in depression treatment research by addressing three aims-1) review the research relating symptoms and functioning, 2) provide a rationale for measuring both outcomes, and 3) discuss potential artifacts in measuring functional outcomes. The three aims are supported by an empirical review of the treatment outcome and epidemiological literatures.
Article
Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
Non-traditional measures of subjective well-being and their validity: A review
  • C N Scollon
Scollon, C. N. (2018). Non-traditional measures of subjective well-being and their validity: A review. In E. Diener, S. Oishi, & L. Tay (Eds.), Handbook of well-being. DEF Publishers. https://nobascholar.com/chapters/13