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Well-being therapy in depression: New insights into the role of psychological well-being in the clinical process

23 important questions on Well-being therapy in depression: New insights into the role of psychological well-being in the clinical process

How can well-being therapy be characterized?

As a manualised, short-term psychotherapeutic strategy that emphasizes self-observation, with the use of a structured diary, homework and interaction between patients and therapists

What are the six criteria of to model (developed by Marie Jahoda) for positive mental health? (6)

1. Autonomy
2. Environmental mastery
3. Satisfactory interactions with other people and the milieu
4. The individual's style and degree of growth, development or self-actualization
5. The attitudes of an individual toward their own self (self-perception/acceptance)
6. The individual's balance and integration of psychic forces

What are the phases in WBT?

1. Initial: self-observation of psychological well-being
2. Intermediate: identifying thoughts, beliefs, and behaviors leading to premature interruption of well-being
3. Final phase: cognitive restructuring of dysfunctional dimensions of psychological well-being
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What are the features of WBT that are unique when compared to other positive interventions? (5)

1. Monitoring of psychological well-being in a diary
2. Identification of low tolerance to well-being by seeking automatic thoughts
3. Behavioral exposure
4. Cognitive restructuring using specific psychological well-being models
5. Individualized and balanced focus

What is the goal of monitoring psychological well-being in a diary?

Identifying episodes of well-being and setting them into a situational context

How does behavioral exposure take place in WBT? (2)

1. Reinforcement and encouraging of activities that may elicit well-being and optimal experiences
2. Grades task assignments, especially for feared/challenging situations that are otherwise avoided (can result in growth and self-improvement)

What is the goal of cognitive restructuring in WBT?

Identifying specific impairments of excessive levels in well-being dimensions can provide content for the therapist to explain thing and enable the client to apply WBT phases

In what way does WBT have a balanced focus?

Positive and negative characteristics are often on the same continuum and interact with each other. An optimal balance should be found for each patient. This balance can vary from illness to illness and from patient to patient

What is the significance of impairment in psychological well-being?

Quality-of-life measurement, and not symptomatic ratings, can predict recurrence

What is the importance of incorporating psychological well-being into the concept of recovery?

Residual symptomatology is often found in patients who are judged to be remitted according to the DSM, but these symptoms can easily become prodromes of relapse

What is the consequence of incorporating well-being into the concept of recovery?

Then full recovery can only be reached via interventions that facilitate progress towards enhancement of well-being

What are some relevant grounds for taking well-being as a target of treatment? (3)

1. Scales describing well-being are more sensitive to drug effects than scales with symptoms
2. Well-being is a crucial component of patient satisfaction and of perceived change in patients
3. Psychotherapy contributed more to well-being related outcomes than pharmacotherapy by increasing patient satisfaction

How does well-being change the conception of resilience?

Looking for well-being following adversity is a more demanding and rigorous conception of resilience than the avoidance of illness or negative behavioral outcomes

What is the opposite of resilience?

Subjective incompetence: feelings of being trapped or blocked because of a sense of inability to plan or start actions toward goals

How can subjective competence be overcome?

Means must be transformed and the assumptive world should be restructured (as is done in WBT)

In what way should WBT be used as a therapeutic tool?

It should be incorporated in a therapeutic plan: one course of treatment is not enough to yield lasting and satisfactory remission

In what way should WBT be prescribed?

It should be prescribed based on clinical reasoning, case formulation, and macro analysis

What are the findings of the effect of WBT on relapse prevention (2)

1. Sequential combination of CBT and WBT results in a decreased rate of relapse (however, also found in the combination of pharmacotherapy in the acute phase and psychotherapy in the residual phase)
2. For GAD a combination of CBT and WBT may also be better than only CBT

Why is a combination of CBT and WBT better than clinical management in the treatment of cyclothymic disorder?

WBT may address polarities of mood swings and is geared to a state of euthymia

How can WBT help in the face of treatment resistance?

1. Viable alternative when standard cognitive techniques do not yield improvement or even cause worsening
2. Working on dimensions such as purpose in life may counteract suicidal behavior, which is proven to be difficult to treat
3. May have a function in decreasing mental pain that is often present in suicidal clients
4. Anxious depression may be a source of treatment resistance, whereby WBT may help find the balance between euthymia and dysthymia

In what way can WBT (and CBT) help when antidepressants seem to have had a loss in efficacy?

Prescribing CBT/WBT over a dose increase may be associated with reduced relapse rates at a 1-year follow-up

How can WBT (and CBT) help in antidepressant drug continuation?

The discontinuation may cause forms of dependence with withdrawal symptoms that do not wane afterward. Patients assigned to CBT/WBT were less likely to experience relapse/recurrence, which shows that discontinuation is feasible when psychotherapy is provided

What are the main conclusions on WBT? (2)

1. WBT appears uniquely suited for addressing the residual phase of mood and anxiety disorders, as part of a planned sequence of therapeutic measures
2. Pursuit of euthymia is possible with a personalized approach that characterizes the treatment protocol and requires a comprehensive initial evaluation

The question on the page originate from the summary of the following study material:

Positive Clinical Psychology

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