Disseminating Self-Help: Positive Psychology Exercises in an Online Trial

“Positive psychology focuses on factors that help promote optimal well-being and investigates the functional consequences of these states [7].”

“Consistent findings suggest that stronger social relationships reduce mortality and help us cope with life stressors [12].”

“Experimental and longitudinal studies have found that increased positive emotions lead to social, occupational, and health benefits [9].”

“” A signature strength is based on a classification of positive characteristics of individuals that are morally valued in general, that are fulfilling, and that are trait-like [21].”

“One study comparing five different positive psychology exercises head-to-head used two different gratitude-boosting strategies [20].”

“Indeed, this effect remained even when controlling for baseline levels of depressive symptoms, suggesting that positive mental health is different from merely the absence of psychological distress [16].”

“Furthermore, psychological well-being in general, and positive emotion in particular, appear to promote meaning-making in stressful situations, which in turn leads to more effective coping [13].”

“A further investigation of gratitude journaling found that participants benefited more when completing longer weekly entries as opposed to shorter more frequent entries [19].”

“Past research in positive psychology interventions has found that variety is an important moderator of intervention gains and that several techniques are more effective than a single technique [23,36].”

“As previously mentioned, higher levels of gratitude are linked to improved relationships and coping with stressors [10,14].”

“Costing an estimated US $43 billion per year in treatment, depression is the leading cause of disability and lost productivity worldwide [2].”

“Other programs that have combined content from individual exercises into longer and more involved intervention packages have been delivered in a variety of settings including schools and have also been delivered to military personnel [25,26].”

“Seligman et al, 2006 [24] Participants are instructed to take time to focus intently on a positive expe-”

“Gable et al, 2004 [32] Participants learn to respond positively to good news shared by others by lengthening the conversation and helping the sharer relive the experience.”

“Despite other research that has demonstrated a relationship between adherence to the intervention and efficacy [34,35], this study found that participants who received less content actually made larger gains than participants who received more content.”

“Furthermore, depression is a chronic disease; once an individual has experienced his or her first episode, he or she is 2 to 3 times more likely to experience subsequent episodes [3].”

“As previously mentioned, higher levels of gratitude are linked to improved relationships and coping with stressors [10,14].”

“One exercise designed to increase gratitude asks participants to reflect each day on three good things that happened by writing these things down in a journal [18].”

“Even more interestingly, a recent study showed that increased psychological well-being is a significant protective factor from the occurrence of future episodes of major depression [15].”

“Furthermore, subthreshold symptoms are a strong risk factor for developing major depression in the future [6].”

“Other programs that have combined content from individual exercises into longer and more involved intervention packages have been delivered in a variety of settings including schools and have also been delivered to military personnel [25,26].”

“Mild to moderate depressive symptoms are at least as prevalent as major depressive disorder, and many individuals with subthreshold depressive symptoms experience substantial functional impairment [4,5].”

“People who tended to reflect on the positive moments of their life reported increased ability to savor life and had higher levels of positive emotions [22].”

“A meta-analysis of the school-based Penn Resiliency Program found that only trials delivered by highly trained research team providers produced significant gains [27].”

“In one of the first empirical investigations of an intervention aimed to increase happiness, Fordyce provided college students with a course that taught participants to mimic the behaviors of happy people [17].”

“Mild to moderate depressive symptoms are at least as prevalent as major depressive disorder, and many individuals with subthreshold depressive symptoms experience substantial functional impairment [4,5].”

“Correlational evidence links higher reported focus on engaging and meaningful activities to greater occupational success and higher incomes [11].”

“In a study of an online body dissatisfaction intervention, participants who completed a gratitude diary were twice as likely to complete the intervention compared with a thought-monitoring and cognitive-restructuring group [31].”

“Despite other research that has demonstrated a relationship between adherence to the intervention and efficacy [34,35], this study found that participants who received less content actually made larger gains than participants who received more content.”

“People using the application on Facebook were roughly twice as likely to report good things compared with users of a three good things Facebook group, which is distinct from an application in that it is merely a place where people can post and has no features [29].”

“…participants in the naturalistic study reported performing almost eight different positive activities simultaneously (Parks et al., 2012), and participants in a Web-based study obtained the biggest benefits when practicing two or four positive activities concurrently (Schueller & Parks, 2012).”

“The potential exists to transport contemporary web-based delivery (e.g. Schueller and Parks 2012; Mitchell et al. 2010; Schueller 2010) to an even more accessible, cost-effective and user-friendly platform.”

“Burckhardt and colleagues (2015) suggested that more structured settings and dose effects may have contributed to their negative results, since other studies have found that the number of activities participants are required to do can reach a saturation point (77).”

“In addition, a number of online studies have effectively used PPT-based interventions with promising results (e.g. Parks, Della Porta, Pierce, Zilca, & Lyubomirsky, 2012; Mitchell, Stanimirovic, Klein, & Vella-Brodrick, 2009; Schueller & Parks, 2012).”

“…interventions, switching from one intervention to another throughout the intervention period (e.g., Ho, Yeung, & Kwok, 2014; Lambert D’raven, Moliver, & Thompson, 2015; Layous, Lee, Choi, & Lyubomirsky, 2013; Proyer, Gander, Wellenzohn, & Ruch, 2014; Schueller, 2010, 2011; Schueller & Parks, 2012).”

“…interventions may be effectively administered via the Internet (e.g., Abbott, Klein, Hamilton, & Rosenthal, 2009; Gander et al., 2013; Mitchell, Stanimirovic, Klein, & Vella-Brodrick, 2009; Mongrain & AnselmoMatthews, 2012; Schueller & Parks, 2012; Seligman et al., 2005; Shapira & Mongrain, 2010).”

“The Internet is also being used for positive psychology approaches [12].”

“Additional research also would be valuable to identify whether a smaller number of positive psychology exercises (e.g. Schueller & Parks, 2012) or allowing the participants to choose exercises (e.g. Schueller, Leykin, Perez-Stable, & Munoz, 2013) would improve the efficacy of PPT-S.”

“, by phone), and require minimal training of providers [34, 41, 42].”

“…from methodological limitations such as a relatively small sample size in group therapies (Page and VellaBrodrick, 2012; Rashid, 2014; Ruini et al., 2014) or a low adherence rate in (web-based) self-help interventions (Bolier et al., 2013b; Mitchell et al., 2010; Schueller and Parks, 2012).”

“This study distinguishes itself from former experimental research, which was limited to single-component interventions [27,29,30] or longer multiple and fixed-sequential interventions [26,28,33], in focusing on a multicomponent, flexible, online intervention.”

“…2011; Huffman et al., 2014; Meyer, Johnson, Parks, Iwanski, & Penn, 2012; Parks & Szanto, 2013), others due to lack of positive outcome measure (Schueller & Parks, 2012), some due to the preponderance of psychology student among their samples (Khramstova & Glascock, 2010; Layous, Katherine…”

“Online dissemination of positive psychology exercises has proven feasible and effective [102].”

“Second, individuals should engage in a handful of activities (between two and four; Schueller & Parks, 2012) to maximize the potential effect, while minimizing hassle.”

“There is robust evidence that moderators exist which contribute to the effectiveness of PPIs (e.g. Schueller, 2012; Schueller & Parks, 2012; Senf & Liau, 2013).”

“With the advance of the positive psychology movement, various exercises and interventions have been developed to increase the wellbeing of people, either delivered as single exercises (Seligman, Steen, Park & Peterson, 2005) or as a package (Schueller & Parks, 2012; Seligman, Rashid & Parks, 2006).”

“…new, unique populations (Froh, Kashdan, Ozimkowski, & Miller, 2009; Meyer, Johnson, Parks, Iwanski, & Penn, 2012), new settings (Huppert & Johnson, 2010; Reivich, Seligman, & McBride, 2011; Seligman, Rashid, & Parks, 2006), and new modes of delivery (Parks & Szanto, 2013; Schueller & Parks, 2012).”

“Data were drawn from a parent study designed to test the feasibility of disseminating a positive activities intervention online and to test whether the number of activities offered to participants (0, 2, 4, or 6) affected adherence and outcomes.(27) The online version of the intervention was adapted from an establishe…”

“…Seligman, Steen, Park, & Peterson, 2005; Sergeant & Mongrain, 2014; Shapira & Mongrain, 2010) and as packaged interventions (Cohn, Pietrucha, Saslow, Hult, & Moskowitz, 2014; Parks, Della Porta, Pierce, Zilca, & www.internationaljournalofwellbeing.org 43 Lyubomirsky, 2012; Schueller & Parks, 2012).”

“Other known predictors of greater effectiveness include enjoyment of the exercise (Schueller & Parks, 2012), sustained effort (Lyubomirsky et al., 2011; Sheldon et al., 2010), exercise variety (Schueller & Parks, 2012), and low to moderate exercise difficulty (Sheldon et al., 2010).”

“High attrition rates are a common feature in PPI studies (Bolier et al., 2015; Mongrain & Anselmo-Matthews, 2005; Schueller & Parks, 2012).”

“Taken together, our results will contribute to a new field of multicomponent PPIs for enhancing well-being and flourishing in the general population and highlight a new target population for mental health promotion.”

“Other research has found that in an online positive psychology intervention completing 2-4 exercises improved well-being but attempting to complete up to 6 exercises negated all benefits [32].”

“The imbedded nature of the UWP is likely to explain the low dropout rates observed in the current studies compared to the high attrition seen in stand-alone interventions which can be as high as 55% (Schueller and Parks 2012) or even 80% (Ouweneel, Le Blanc, and Schaufeli 2013).”

“Randomised controlled trials (RCTs) comparing PPT with no treatment show increased positive affect and life satisfaction and decreased depressive symptoms in undiagnosed students [16], in a self-referred online sample [8], in undiagnosed middle school students [17], and in students with a diagnosis of mild to moderate…”

“The growing number of studies examining online PIs have yielded promising results regarding their effectiveness (e.g., Bolier et al., 2013a; Layous, Nelson, & Lyubomirsky, 2012a; Schueller & Parks, 2012).”

“In line with previous work finding that Internet interventions are able to improve well-being effectively, we expected that users would exhibit higher well-being during periods in which they used the intervention more frequently [14,15].”

“Assigning multiple and different positive activities is better than engaging in only one activity (see e.g. Fordyce, 1977), although a certain number of activities should not be exceeded (Schueller & Parks, 2012).”

“…data to averages might result in a loss of information; for example, participant samples might be heterogeneous and contain several subgroups (Schueller & Parks, 2012; e.g., in terms of psychological distress; Parks et al., 2012), and adverse effects might not be taken into consideration…”

“…successfully via remote distribution option, e.g., automated websites, phone apps, among others, with a proven track record for efficacy and cost-effectiveness (Bolier et al., 2014; Drozd, Mork, Nielsen, Raeder, & Bjørkli, 2014; Gander, Proyer, Ruch, & Wyss, 2013; Schueller & Parks, 2012).”

“It has been suggested that disseminating a broad range of positive psychology interventions (PPIs) online, tends to increase their use and effectiveness [59,60].”

“Although the BPS group had higher person-activity fit, which was shown to be related to the continued use of PPI (Schueller and Parks 2012), the person-activity fit did not associate with the adherence in this study, perhaps due to the shorter duration of our intervention relative to Schueller and Parks (2012).”

“However, such programs often administer a range of PPIs to participants without adequately differentiating their distinct effects, contexts, and durations (Schueller & Parks, 2012).”

“…and practice is supported by research showing an association between well-being and improved functioning, increased resilience and life satisfaction (Fredrickson & Joiner, 2002), and suggesting its protective value against the onset or re-occurrence of mental illness (Schueller & Parks, 2012).”

“…PPT with no treatment show decreased depressive symptoms in students (Lü, Wang, & Liu, 2013; Parks-Sheiner, 2009; Rashid & Anjum, 2008; 4 Seligman et al., 2006) and other non-clinical, community samples (Schueller & Parks, 2012; Seligman et al., 2006; Seligman, Steen, Park, & Peterson, 2005).”

“In addition, they can be delivered remotely and require more limited provider training.(18,20,60) The focus of PP on wellness and strengths, rather than illness, is also highly patient-centered.”

“Given the growing popularity of evidence-based PPI, and their demonstrated efficacy (Bolier et al., 2013; Sin & Lyubormirsky, 2009), it becomes relevant to address their acceptability in order to tailor treatments to clients’ needs and expectations, as the person-activity model has proposed (Layous & Lyubomirsky, 2013…”

“…option for individuals with limited financial means, as technology become more common and affordable, there is also great potential for the use of web-based (e.g. Schueller & Parks, 2012) and smartphone-based (e.g. Parks et al., 2012) self-help programs using positive psychology content.”

“Attrition is a common problem in longitudinal studies and in research that focuses on online interventions with repeated measures.(27,30,47,56) A systematic review of available evidence was conducted by researchers in Australia”

“Schueller and Parks (2012), for example, reported group differences on average, but a cluster analysis of their baseline data (reported in Study 1 of Parks et al., 2012) revealed that the sample of online happiness seekers was heterogeneous.”

“The results of these discussions were used to set up and gradually refine the resulting intervention.”

“This finding accords with the central role of social relationships for positive mental health [42], and also with previous findings of the positive effect of having multiple exercises in an online positive psychological intervention [43].”

“The efficacy of such “shotgun” intervention approaches that incorporate multiple components, strategies and exercises are well-documented in the extant literature (Schueller & Parks, 2012; Seligman et al., 2005).”

“Performing a variety of positive activities concurrently also yields greater benefits than simply practicing one single activity (Parks et al. 2012; Schueller and Parks 2012).”

“34 The results of the professional views on engagement mostly corroborated earlier studies (e.g. 6,7,35 ) and the results of the interviews with health app users.”

“In particular, many participants in our study developed or endorsed content supporting positive thinking, relaxation, and self-care strategies that have become broadly popular as “self-help” [32,90,103], and that can be effective for managing less severe mental health concerns [53].”

“A second reason positive psychology interventions are deemed suitable for online dissemination is that they are viewed as inherently more appealing and may have fewer barriers to entry, compared to accessing traditional forms of therapy, or so-called problem-focused approaches (Layous et al., 2011; Schueller and Parks…”

“One of the most frequently used and well-validated positive psychology interventions is the “three good things”-interventions (Seligman, Steen, Park, & Peterson, 2005; see also Gander et al., 2013; Mongrain & Anselmo-Matthews, 2012; Proyer, Gander, Wellenzohn, & Ruch, 2014; Schueller & Parks, 2012).”

“Research on the implementation of web-based positive psychology exercises has also demonstrated high levels of feasibility, acceptability, and positive outcomes [31,32].”

“Aucune conclusion définitive n’a été tirée sur la relation entre le nombre d’exercices et l’efficacité, qui reste complexe et demanderait des études supplémentaires (Schueller & Parks, 2012).”

“…design is similar to how “self-help books” present activities to readers in an attempt to provide structured guidelines on how to enhance their wellbeing; without therapeutic input or active guidance from a professional (Schueller & Parks, 2012; Sin & Lyubomirsky, 2009; Van Zyl & Rothmann, 2014).”

“It was demonstrated that positive psychology interventions are effective in increasing subjective well-being and psychological well-Table being and in decreasing the depressive symptoms (Bolier et al., 2013; Schueller & Parks, 2012 Martínez-Martí et al., & World Health Organization, 2010).”

“Because there are individual differences in what makes people happy (e.g., Sin et al., 2011), allowing participants to choose their activities may maximize the benefits of the intervention (Schueller, 2011; Schueller & Parks, 2012) and increase task engagement (Schueller, 2010).”

“…many different positive psychology techniques and diverse activities target - ing the intervention’s main and secondary goals described above, which research suggests may be more effective as opposed to implementing a singular approach (Ng, 2015; Schueller & Parks, 2012; Sin & Lyubomirsky, 2009).”

“Participants will be asked if they completed the previous week’s activity.(113) Participants who report completing the activity will be asked to rate how much they felt they benefited, how much they enjoyed, and how difficult they found each exercise using a 7point Likert-type scale.”