POSITIVE PSYCHOLOGY AND GOAL-ACHIEVING PSYCHOTHERAPY (GAP)

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POSITIVE PSYCHOLOGY AND GOAL-ACHIEVING
PSYCHOTHERAPY (GAP)

• Ronald S. Kaiser, Ph.D., ABPP
• Licensed Psychologist
• Clinical Associate Professor, Department of
  Neurology,
• Thomas Jefferson University
• Jefferson Headache Center

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POSITIVE PSYCHOLOGY DEFINED

• Positive psychology is that branch of psychology
  that involves the study and promotion of
  well-being.
• The gold standard for measuring well-being is
  flourishing.
• The goal of positive psychology is the increase
  of flourishing.
• 
  Seligman, 2011

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POSITIVE PSYCHOLOGY DEFINED (2)

• Psychology is not just the study of pathology,
  weakness, and damage. It is also the study of
  strength and virtue.
• Treatment is not just fixing what is broken. It
  is nurturing what is best.
• Seligman
  Csikszentmihalyi (2000)
• Positive Psychology can be incorporated into
  other approaches to treatment.

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WHAT DETERMINES HAPPINESS?Lyubomirsky, 2007

• 
  
• 
  
• 
  

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PSYCHOTHERAPY COMES FROM A DISEASE REDUCTION MODEL

• Historical definition of health Absence of
  disease.
• Psychoanalytic goal of tension-reduction.
• CBT focuses on irrational beliefs, automatic
  negative thoughts, etc.
• DSM gold standard is No Diagnosis.
• Reportable scales on the MMPI are the elevated
  ones.
• NIMH funding is granted for disease research.

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WHO DEFINITIONS OF HEALTH AND MENTAL HEALTH HAVE
CHANGED

• Health is a state of complete physical, mental
  and social well-being, and not merely the absence
  of disease or infirmity.
• Mental Health is a state of well-being in which
  an individual realizes his or her own abilities,
  can cope with the normal stresses of life, can
  work productively, and is able to make a
  contribution to his or her community.

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PSYCHOLGYS CONTRIBUTIONS TO LEARNING HAVE
IMPACTED ON

• Schools
• Parenting
• Sports
• Industry
• But not necessarily on the conduct of
  psychotherapy

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PSYCHOLOGY AND INDUSTRY

• Often co-opted by other disciplines
• Effectiveness trumps credentials
• Laid the groundwork for the coaching profession
• Are you familiar with?
• Seth Godin
• Brian Tracey
• Jim Rohm
• Stephen Hovey
• Napoleon Hill
• Tony Robbins

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MORE MOTIVATING THAN MONEY(AFTER A CERTAIN
POINT)

• Autonomy
• Mastery
• Purpose

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LETS START WITH A BIT OF SELF-DISCLOSURE

• The influence of Jim Murray
• The influence of Don Meredith
• The influence of Dr. Benjamin Shimberg
• The influence of the gym
• The role of context
• The arrival of positive psychology
• The internet

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SOME NEW DEVELOPMENTS THAT AFFECT THEORY BUILDING

• Brain Plasticity
• Mindfulness
• The role of physical exercise
• The role of mental exercise
• Health Psychology
• Biofeedback/Neurofeedback
• The early work in positive psychology
• The internet

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THE SPECIAL ROLE OF BRAIN PLASTICITY

• The historical belief was that after childhood
  the brain could only change in one direction
  Decline.
• Hardwiring the concept that the brain was more
  like a computer than a muscle.
• Research has dramatically changed this thinking

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RESEARCH ON THE CHANGING BRAIN

• Taubs Constraint Induced (CI) Movement Therapy.
• Competitive plasticity and Merzenichs brain
  mapping.
• The role of mental rehearsal (Pascal-Leones
  piano students Sharanskys imprisonment).
• Maguires research on the posterior hippocampuses
  of London taxi drivers (Maguire, Current Biology,
  2011).
• Mirror neurons (Iacoboni, 2009)

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THE ROLE OF PHYSICAL EXERCISE

• What did Freud, Rogers, Skinner, Ellis, etc. have
  to say about exercise?
• What have Seligman, Achor, and other positive
  psychologists said about exercise?
• MacArthur Foundation studies demonstrate 3 ways
  of reducing cognitive decline (normal weight,
  lifelong learning, exercise)
• Studies demonstrate that if you are middle-age
  and sedentary and you start a regular exercise
  program, you can delay the onset of cognitive
  decline by 10-15 years (Ratey Kramer).
• Naperville, IL, 8th graders finished 1 in the
  world in science 6th in math after being
  involved in a comprehensive daily PE program.

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THE BRAIN AND POSITIVE PSYCHOLOGY
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POSITIVE PSYCHOLOGY EMERGES IN AN AGE OF SCIENCE

• Commitment to research
• Criticisms of humanistic psychology for
  insufficient research base.
• Unlike Freud, Rogers, Ellis, Positive Psychology
  was largely developed by academics rather than
  clinicians

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THE SEMINAL ARTICLE

• Seligman, M., Csikszentmihalyi, M. (2000).
  Positive psychology An introduction. American
  Psychologist, 55 (1), 5-14.

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PIONEERS OF THE POSITIVE PSYCHOLOGY MOVEMENT

• Ed Diener (Dr Happiness Subjective well-being)
• George Vaillant (longitudinal study of successful
  aging)
• MIHALYI CSIKSZENTMIHALYI
• MARTIN SELIGMAN
• Barbara Fredrickson (Broaden and Build
  Positivity Ratio)
• Christopher Peterson (Values in Action project)

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THE NEXT GENERATION OF LEADERS IN POSITIVE
PSYCHOLOGY

• Sonja Lyubomirsky (Happiness)
• Todd Kashian (Curiosity)
• Karen Reivich (Resilience)
• Angela Duckworth (Grit)
• Robert Vallarand (Passion)
• Tal Ben-Shahar (General student body teaching)
• Shawn Achor (Consulting)

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THE CONTRIBUTIONS OF CAROL DWECK

• Mindset The view that you adopt for yourself.
• Fixed Mindset The belief that your qualities
  are unchangeable and you have to keep proving
  yourself over and over.
• Related to being praised for your
  attributes.
• Growth Mindset The belief that your basic
  qualities can be changed by your efforts.
• Related to being praised for
  your efforts.
• Substantial research supports the benefits of the
  growth mindset.

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CSIKSZENTMIHALY

• As World War II approached in Europe, he observed
  how some adults became helpless as social
  supports decayed while others maintained their
  integrity.
• His work in the U.S. led to his development of
  the concept of Flow and its role in the
  development of Positive Psychology.

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FLOW

• The optimal experience.
• It does not just happen passively, but you
  cant force yourself into flow.
• It involves being fully focused, motivated,
  energized, and involved in an activity.
• You cant be depressed or anxious and able to be
  in a state of flow.
• Contrary to popular belief, lifes best moments
  are when we are stretched to physical and/or
  mental limits rather than relaxed.
• Our best moments may not necessarily be pleasant
  at the time.
• Experiences that result in flow for us are not
  universal.

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THE CONDITIONS OF FLOW

• Goals are clear
• Feedback is immediate
• There is a balance between opportunity and
  capacity
• Concentration is deep
• The sense of time is altered

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TRAITS OF THE AUTOTELIC PERSONALITY

• Curiosity
• Persistence
• Low self-centeredness
• Oriented toward performing activities for
  intrinsic reasons only.

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SELIGMAN

• His journey went from Learned Helplessness to
  Learned Optimism to Authentic Happiness to
  Flourish - and the psychology of well-being.
• Developed the MAPP program at Penn.
• Instrumental in developing major positive
  psychology concepts including Signature
  Strengths and PERMA.
• Collaborated with Chris Peterson in researching
  and writing Character Strengths and Virtues.

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PERMA

• Positive Emotion
• Engagement
• Relationships
• Meaning
• Accomplishment

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CHARACTER STRENGTHS AND VIRTUES

• Positive Psychologys answer to the DSM and ICD
  A Manual for the Sanities.
• The focus is on what is right about people rather
  than what is wrong.
• Based on substantial research across cultures.
• 6 Virtues encompass 24 Character Strengths.

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STRENGTHS OF WISDOM AND KNOWLEDGE

• Creativity (Originality, Ingenuity)
• Curiosity (Interest, Novelty-seeking, Openness to
  Experience)
• Open-mindedness (Judgment, Critical Thinking)
• Love of Learning
• Perspective (Wisdom)

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STRENGTHS OF HUMANITY

• Love
• Kindness (Generosity, Nurturance, Care
  Compassion, Altruistic Love, Niceness)
• Social Intelligence (Emotional Intelligence,
  Personal Intelligence)

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STRENGTHS OF JUSTICE

• Citizenship (Social Responsibility, Loyalty,
  Teamwork)
• Fairness
• Leadership

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STRENGTHS OF TEMPERANCE

• Forgiveness and Mercy
• Humility and Modesty
• Prudence
• Self-Regulation (Self-Control)

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STRENGTHS OF TRANSCENDENCE

• Appreciation of Beauty and Excellence (Awe,
  Wonder, Elevation)
• Gratitude
• Hope (Optimism, Future-Mindedness, Future
  Orientation)
• Humor (Playfulness)
• Spirituality (Religiousness, Faith, Purpose)

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STRENGTHS OF COURAGE

• Bravery
• Persistence (Perseverance, Industriousness)
• Integrity (Authenticity, Honesty)
• Vitality (Zest, Enthusiasm, Vigor, Energy)

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ASSESSING SIGNATURE STRENGTHS

• Go to www.authentichappiness.org
• VIA Survey of Character strengths (240 items)
• Brief Strengths Test (24 items)
• Several other tests
• Test results are used for research as well as
  your own benefit/

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OTHER INDICATORS OF STRENGTHS

• Resilience
• Savoring
• Grit
• Posttraumatic Growth

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FREDRICKSONS 10 TOP POSITIVE EMOTIONS

• Joy
• Gratitude
• Serenity
• Interest
• Hope

• Pride
• Amusement
• Inspiration
• Awe
• Love

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MEASURES OF POSITIVE INTERACTIONS

• The Losada Line and Ratio
• The Fredrickson Positivity Ratio

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RESEARCH SUPPORTIVE OF POSITIVE PSYCHOLOGY
CONCEPTS

• Education
• Health
• Aging
• Work-related
• The Military

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POSITIVE PSYCHOLOGY AND HEALTH

• Positive psychological well-being is associated
  with
• Fewer colds
• Reduced mortality in both healthy
  ill populations
• Reduced cardio-vascular disease
• Reduced mortality from CVD , renal
  failure, HIV
• Findings with respect to cancer are more
  equivocal
• No study has demonstrated a relationship between
  pessimism and better health or reduced mortality.

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THE IMPORTANCE OF THE SOCIAL NETWORK

• Strength of social relationships is the major
  distinguishing characteristic of the happiest 10
  of the population.
• 
  (Diener Seligman, 2002)
• There are 70 years of evidence that our
  relationships with others matter, and matter more
  than anything else in the world.
  (Vaillant, 2009)
• The concepts of social capital and reciprocity

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THE IMPORTANCE OF A SOCIAL NETWORK

• You should always go to other peoples funerals
  otherwise they wont come to yours.
• 
  Yogi Berra

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POSITIVE PSYCHOLOGY EXERCISES

• The What-Went-Well (or 3 Good Things or 3
  Blessings) Exercise
• The Gratitude Visit
• The 21 day rule for positive behavior change
• The 20 second rule
• The Reverse 20 second rule
• The Modified Presidential Campaign Assessment

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SELIGMANS ABCD EXERCISE

• Adversity
• Belief
• Consequences
• Disputation
• Energization

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CRITICISMS OF POSITIVE PSYCHOLOGY

• The scientists and philosophers
• The generalizers and over-simplifiers
• The anti-military
• Barbara Ehrenreich

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INTERNATIONAL POSITIVE PSYCHOLOGY ASSOCIATION

• For information or to join
• www.ippanetwork.org
• 3rd Annual World Congress was held in Los Angeles
  on June 23-27, 2013

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GOAL-ACHIEVING PSYCHOTHERAPY A MODEL FOR
POSITIVE PRACTICE

• GAP builds upon the research orientation and
  philosophy of positive psychology.
• GAP builds upon effective techniques of practice
  from several approaches, primarily CBT.
• GAP introduces unique concepts involving the role
  of the therapist, the purpose of psychotherapy,
  history, the goals of treatment, and the process.

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GOAL-ACHIEVING PSYCHOTHERAPY (GAP)

• Bridges the GAPs between
• Thinking and doing
• Gaining and maintaining
• The past and the future
• Science and practice

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PRINCIPLES AND PRACTICES OF GAP (1)

• The approach is forward looking and positive.
• The approach is geared toward building personal
  strengths to manage change and growth.
• The focus is primarily on the solution, not the
  problem.
• The past is meaningful especially as it relates
  to character strengths and achievements.
• The therapist is active, directive, supportive
  and a cheerleader for growth and change.

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PRINCIPLES AND PRACTICES OF GAP (2)

• The patient/client is active in preparing a
  Mission Statement and setting an achieving goals.
• Goal setting is designed to ensure maximum
  success by utilizing small and measureable
  forward steps.
• Wallowing is avoided.
• Activity is the default.
• Once positive commitment and direction is
  implemented, other forms of therapy can be
  incorporated.
• Positive personality change can take place
  throughout the life span.

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PRINCIPLES AND PRACTICES OF GAP (3)

• The Type P Personality is the model of the
  healthy personality.
• Emotional health is always a work in progress.
• GAP principles can be pursued on a do-it-yourself
  basis, in therapy, or through coaching
  depending upon your needs at any specific time.
• GAP-specific materials are available to aid in
  the implementation and maintenance of progress.
• www.thementalhealthgym.com is the ongoing source
  of GAP resources and information.

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THE GYM AS A MODEL

• Wellness is a central concept
• Open to all shapes and sizes
• Individual measureable goals
• Diagnosis is descriptive, not prescriptive.

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GAP ASSESSMENT ALTERNATIVES TO TRADITIONAL
DIAGNOSIS

• Competent Persons Disease the addiction to
  2nd place
• The Too Excuse
• Over-thinking
• Under-rating (A/Fail thinking Ascribing
  unimportance to achievements Luck)
• Waiting for an A

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THE TYPE P PERSONALITY

• The ultimate goal
• Assessment is done throughout the process
• Roughly comparable to PERMA

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TYPE P PERSONALITY

• Personal goal-directed
• Proactive
• Positive
• Persistent
• Playful

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THE INTRODUCTORY SESSION

• Understanding the reason for treatment
• Expression of therapist gratitude as part of
  informed consent
• Explanation of process and philosophy
• History-taking within the context of
  strength-building
• Introduction to the role of activity level and
  homework

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THE ROLE OF HISTORY

• Establish early the importance of moving forward
  to develop strengths.
• Identify unhappy aspects of history to
  primarily use in the future.
• Identify positive aspects of history.
• When was the best time in your life?
• What things do you like most about
  yourself?
• What makes you so resilient?
• Be prepared to revisit history from a position of
  strength.

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GETTING UNSTUCK THE CRITICAL QUESTIONS

• Are you a fortune teller?
• What can go right?
• What does this have to do with you?
• How is this getting you where you want to go?
• What will you do now to maintain your success?

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THE TECHNIQUES OF GAP (1)

• Vision without execution is hallucination.
• 
  Thomas Edison

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THE TECHNIQUES OF GAP (2)

• The Mission Statement
• The current goals
• Benefits
• Impediments
• Strengths to overcome impediments
• Areas for change and growth
• Health and fitness
• Cognitive functioning
• Social

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THE TECHNIQUES OF GAP (3)

• Exercise Cards
• Create Your Proactive Positive Explosion Form
• Type P Personality Development Form
• DEFAULTS ARE ACTIVE

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THERAPEUTIC CONSIDERATIONS

• The therapist as a role model
• Phone calls
• No shows
• Suicidal ideation or threats
• Patient sabotage
• Session intensity

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HOW DO YOU KNOW WHEN YOU ARE DONE?

• Does the person conform to the mission statement?
• How well does s/he meet the criteria for Type P
  Personality?
• Has the personal tipping point (Proactive
  Positive Explosion) been achieved?
• Has a maintenance program been put in place?
• Are conditions right for continued flourishing?

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SUCCESSFUL APPLICATIONS OF GAPTO SPECIAL
POPULATIONS

• Some Axis II populations
• Habit control
• Depression
• PTSD
• Headache patients

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WHY DOESNT IT WORK FOR EVERYONE?

• Nothing does.
• Expectancy of therapy as a place to wallow may
  not be met.
• Using the gym as a model, it is notable that
  people who drop out may successfully return in
  the future.
• Intensity and/or homework turn some people off.
• Its still a work in progress without a lot of
  external input.

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THE CHALLENGE

• The incidence of depression has risen every year
  since the early 20th century.
• Depression is the leading cause of disability in
  the U.S. for individuals between the ages of
  15-44.
• The average age of initial diagnosis is getting
  younger.
• Depression is the most costly disease in he world
  although up to half of the cases that meet the
  criteria for depression at any one time go
  untreated.
• IT IS HARD TO BE POSITIVE AND DEPRESSED AT THE
  SAME TIME.

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THANK YOU!

• Your comments are important to me.
• Please feel free to contact me at
• ronald.kaiser_at_jefferson.edu
• 215-955-2743
• Or
• ron.kaiser_at_thementalhealthgym.com
• 215-704-0983