Treating Depression With Online Optimism Intervention

03 Apr 2018

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Does proneness to flow states affect effectiveness?

Researchers of depression have often focused on the role of negative future-oriented cognitions in the development and maintenance of the disorder (e.g., Beck, Rush, Shaw, & Emery, 1979; Abramson, Alloy, & Metalsky, 1989). Beck (1967, 1976) asserted that depressed people possess a negative cognitive triad consisting of negative views of the self, world, and the future. Extensive research on depressed people revealed that they have more dysfunctional attitudes, report more negative automatic thoughts and hopelessness and adopt a more pessimistic explanatory style than people who are not depressed (Beck, Riskind, Brown, & Steer, 1988; Hollon, Kendall, & Lumry, 1986; Peterson & Seligman, 1984). In addition, Gotlib, Krasnoperova, Yue, and Joormann (2004) found that depressed people process negative information more completely and efficiently than non-depressed controls.

Over the last decade, proponents of positive psychology have highlighted that rather than focusing solely on negative painful experiences, we should also empirically study positive emotional well-being and human strengths (Seligman & Csikszentmihalyi, 2000; Seligman, Steen, Park, & Peterson, 2005). This gave rise to many positive psychology interventions (PPIs) which sought to promote positive cognitions, behaviours, or emotions to help depressed individuals. A recent meta-analysis of 49 studies of PPIs by Sin and Lyubomirsky (2009) revealed that these interventions are effective in reducing depressive symptoms and increasing well-being.

One positive trait which PPIs have targeted is optimism. Current research demonstrate that some PPIs seeking to cultivate optimism in both depressed and non-depressed populations have reported some success at improving psychological well-being (Peters, Flink, Boersma, & Linton, 2010; Layous et al., 2013; Sergeant & Mongrain, 2014).

Carver, Scheier, and Segerstrom (2010) define optimism as a positive outlook on life (both during times of success and adversity) and having positive expectations about the future. It has been widely shown that optimism is positively correlated with engaging coping strategies (Carver et al., 2010), mental health outcomes (Kawachi & Berkman, 2001; Lench, 2011), better social relationships (Carver, Kus, & Scheier, 1994), and a range of positive physical health outcomes (Rasmussen, Scheier, & Greenhouse, 2009).

Sharot (2011) pointed out that optimists possess the optimism bias- the phenomenon where individuals believe that they are less likely to experience a negative event compared to others even when their optimistic beliefs are challenged. On the other hand, other studies have shown that the optimism bias is absent in depressed people (Strunk, Lopez, & DeRubeis, 2006). In addition, individuals with severe depression not only lack this bias but also have a tendency to view future outcomes more negatively than what they really are (Strunk et al., 2006). Achat, Kawachi, Spiro, DeMolles and Sparrow (2000) argue that if we uncover the mechanisms of this optimism bias, it can provide us with powerful insight into the development of depression.

One of the most up to date studies by Sergeant and Mongrain (2014) tried to shed more light on the mechanisms of the optimism bias. They designed an online PPI to cultivate optimism and included pessimism as a trait moderator. The results supported their hypothesis that pessimistic individuals would gain more out of the intervention and report fewer depressive symptoms. Sergeant and Mongrain’s (2014) findings draw attention to the impact of individual differences (pessimism) on the success of the online PPI.

In addition, other findings suggest that PPIs are most effective when there is a good fit between the activity and the individual characteristics of the user (Lyubomirsky, Sheldon, & Schkade, 2005; Dickerhoof, 2007; Mongrain, 2009). For example, Lyubomirsky et al. (2005) pointed out PPIs that emphasize social interaction may benefit people with high social needs to a greater extent. Therefore, it would be informative to look at how other individual differences traits play a part in the success of the PPI. This could possibly help us match PPIs to individuals according to their individual characteristics to gain the most out of the intervention.

One other area which positive psychology focused on is the concept of flow. Csikszentmihalyi and Csikszentmihalyi (1988) described psychological flow as an experience of low self-awareness, full concentration and enjoyment of the task at hand. In addition, there is a positive channelling of emotions associated with learning and performing into the task one is doing (Csikszentmihalyi & Csikszentmihalyi, 1988). Asakawa (2010) found positive associations between flow proneness and active coping strategies as well as better mental health. As such, Csikszentmihalyi & Csikszentmihalyi (1988) called for a better understanding of flow states to assist development of PPIs.

De Manzano, Cervenka, Jucaite, Hellenas, Farde, and Ullen (2013) looked at neuropsychological evidence underlying individual differences in flow proneness and found a positive correlation between dorsal striatum dopamine availability and flow propensity. Similarly, it was found that dopamine plays a role in the optimism bias, affecting belief formation by reducing negative beliefs about the future (Sharot, Guitart-Masip, Korn, Chowdhury, & Dolan, 2012). As such, it seems that optimism and flow proneness could possibly be related quite closely.

However, no research so far has looked at proneness to flow states being a mediating mechanism for the outcomes of an online optimism PPI. As such, this study would like to investigate that by following up on Sergeant and Mongrain’s (2014) experiment. The findings would have important implications in two key areas which were discussed earlier: 1) helping us better understand the mechanisms of the optimism bias and 2) helping us better match PPIs according to client characteristics so as to treat depression more effectively.

The present study has two hypotheses: (1) Following the completion of the exercise period, participants in the optimism condition were expected to report significantly greater and longer lasting improvements in psychological well-being than the control condition. Psychological well-being was dependent on a few measures- the endorsement of having an enjoyable, purposeful, and engaging life and low levels of dysfunctional beliefs and depressive symptoms.

(2) Dispositional proneness to flow states was expected to be a significant moderator of the relationship between exercise condition and psychological well-being over time. Individuals who were most prone to flow states were expected to gain the most benefit from the optimism intervention. This is because if the individual is more prone to experience flow, he is therefore more likely to get absorbed in the intervention and gain more out of it.

2 A possible Method

Include: research question, IV, DV, overview of stimuli, design & procedure

Exclude: method-style description for replication, specific hypotheses

Overview of procedure

Psychology undergraduate students will participate in the study for course credit. The whole study will be conducted online. Participants will receive a specific link through their email to sign up for the study. After obtaining their consent, they were then asked to provide demographic information such as age, gender, ethnicity, history of psychopathology and treatment with psychotherapy. After that, participants completed the Swedish Flow Proneness Questionnaire and a series of baseline psychological well-being measures (OTH, CES-D and DAS-14- see below for more details). They then undergo a 3-week intervention period (optimism PPI or control intervention) before completing another set of psychological well-being measures. Participants were followed-up 1 and 2 months later to assess their psychological well-being using the same measures to check for any enduring effects of the intervention.

Nature of study

This leads to a 2 (exercise condition: optimism, control) x 2 (flow proneness: low, high) mixed within and between participants experimental design.

Independent Variable

Participants were randomly assigned to either the optimism PPI condition or a control condition. The optimism PPI condition used two alternating exercises to train participants in two key components of optimism. One exercise sought to train participants to view one’s goals as feasible and meaningful while the other exercise sought to train participants to focus on and recollect positive experiences in one’s life (Segerstrom, 2006).

On the other hand, the control condition consisted of two alternating neutral diary-writing activities. The first exercise asked participants to describe their experience of the last day. The second exercise asked participants to describe what they thought the next day would be like.

Participants engaged in the exercises for a 3 week period. Owing to the length constraint, please refer to Sergeant and Mongrain’s (2014) study for full details of the activities.

Dependent Variables

Swedish Flow Proneness Questionnaire, SFPQ, (Ullen et al., 2012).

The SFPQ is a 21-item self-report measure of proneness to flow states measuring flow during work, during maintenance and during leisure activities. Subsequently, data will be split for analysis into two groups, high or low flow proneness.

Orientations to Happiness, OTH, (Peterson, Park, & Seligman, 2005).

The OTH is an 18-item self-report measure of endorsement of three ways to be happy: pleasure (minimizing pain and maximizing pleasant feelings), engagement (taking part in engaging activities that produce flow), and meaning (use of valued skills and talents to achieve success).

Centre for Epidemiological Studies Depression Scale, CES-D, (Radloff, 1977).

The CES-D is a 20-item measure developed to identify depressed mood and depressive symptoms in the general population.

Dysfunctional Attitude Scale–14, DAS-14, (Mongrain & Zuroff, 1989).

The DAS-14 is an abbreviated version of the Dysfunctional Attitude Scale (Weissman & Beck, 1978). The DAS is a well-validated self-report measure of maladaptive beliefs which are characteristic of depressed individuals.

Ethical considerations

Informed consent will be obtained from participants. Participants would be fully debriefed after the experiment. At any point of the experiment, participants possess the right to withdraw their participation and/or data without incurring any penalties. All data will be maintained confidential.

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