Design and evaluation of a positive intervention to cultivate mental health: preliminary findings

Abstract The past two decades have witnessed a proliferation of positive psychological interventions for clinical and nonclinical populations, and recent research, including meta-analyses, is providing evidence of its effectiveness. Most interventions have focused on increasing life satisfaction, positive affect, and psychological well-being. Manualized, multi-component interventions based on a comprehensive theory are scarce. Keyes' concept of mental health and flourishing (subjective, psychological, and social well-being) is an overarching theoretical framework to guide the design of a multi-component psychological intervention to cultivate well-being and personal development. Therefore, the purpose of this study was to design a theory-driven positive intervention and to pilot test the intervention. The manual presents an 8-week group program that includes homework activities. A sample of 56 young adults completed the intervention. Participants were assessed at base line, after termination, and at a 6-month follow-up session. Standardized instruments were used to assess the dimensions of mental health proposed by Keyes. Pre- and post-test measures of subjective, psychological, and social well-being showed significant differences, as did the total mental health scores. At 6-month follow-up, differences remained in subjective and psychological well-being and in positive mental health, with smaller effect sizes. Limitations of these preliminary findings as well as future lines of research and improvements in this manualized intervention are proposed in the light of current research on positive interventions.

Síntomas psicopatológicos en personas con fibromialgia: Una reflexión / Psychopathological symptoms in people with fibromyalgia: A reflection

El estudio realizado tuvo como objetivos comparar si existen diferencias en diversos síntomas psicopatológicos entre personas con y sin Fibro­mialgia (FM) de ambos sexos y analizar el inicio de los síntomas en la biografía de las personas con FM. Participaron 190 sujetos españoles: 140 con FM y 50 sin FM (10 varones, 180 mujeres). Con un diseño descriptivo y comparativo de corte transversal, se administró el Cuestionario de 90 Síntomas-Revisado (SCL-90-R). Los ANOVAs confirmaron que: (1) las personas con FM de ambos sexos comparadas con las que no tienen FM muestran puntuaciones medias significativamente más altas en todos los síntomas psicopatológicos (somatización, obsesión-compulsión, sensibilidad interpersonal, depresión, ansiedad, hostilidad, ansiedad fóbica, ideación paranoide, psicoticismo) y en los tres índices. Los síntomas más frecuentes fueron los de somatización, obsesión-compulsión, depresión y ansiedad, (2) las personas con FM comparadas con la muestra no-clínica del test tenían puntuaciones percentilares mayores o iguales a 95 en muchos síntomas (somatización, obsesión-compulsión, sensibilidad interpersonal, depresión, ansiedad) y en todos los índices. En el Índice Sintomático General (GSI) el 94.3% obtuvo percentiles mayores o iguales a 80. Sin embargo, comparadas con la muestra clínica del test (pacientes psiquiátricos), únicamente tuvieron percentiles altos (≥ 90) en somatización, y en el GSI solo el 30.7% tuvo percentiles mayores o iguales a 80 y (3) únicamente el 23.6% de las personas con FM presentó antecedentes psicopatológicos / psiquiátricos previos, lo que sugiere que la psicopatología en muchos pacientes se desarrolla después de la FM. El estudio realizado tiene importantes implicaciones para el tratamiento de la FM.

Fibromyalgia (FM) is a chronic syndrome of unknown etiology, complex and variable evolution, provoking generalized pain that can become incapacitating. It affects the biological, psychological, and social spheres, and is an important health problem due to its prevalence, morbidity, and high rates of use and consumption of health resources. FM is described as the existence of generalized pain of more than three months' duration, absence of other causal pathology, and comorbidity with other syndromes and symptoms, such as chronic fatigue, nonremedial sleep, cognitive deficit, and numerous somatic and emotional symptoms, such as anxiety and depression. In 1992, FM was recognized by the World Health Organization and typified in the International Classification of Diseases (CIE-10) within rheumtological diseases. The prevalence of FM in developed countries is between 1 and 4%, and in Spanish population, it is 2.4%, with 4.2% infemales and .2% in males. Although many studies agree about the presence of psychopathology in FM, its frequency and intensity are variable and there is little evidence about the premorbid situation of the affected people, and therefore, about role of psychopathology in its pathogenesis. It is known that many people with FM have psychopathological symptoms (anxiety, depression), but the studies differ about whether psychopathology is the origin of FM or whether all people with FM have psychopathological disorders. The goals of the study were to determine possible differences in diverse psychopathological symptoms in people of both sexes with and without FM and to analyze the onset of the symptoms in the biography of people with FM. The study was performed with 190 Spanish participants, 140 with FM (73.7%) and 50 without FM (26.3%). The participants were aged between 28 and 75 years (M = 52.16; SD ­= 9.18), 10 were male (5.3%) and 180 female (94.7%). A descriptive, comparative, cross-sectional design was used and the 90-Symptoms Checklist Revised (SCL-90-R - Derogatis,1983 /2002) was administered. The ANOVAs confirmed that: (1) compared with people who did not have FM, people with FM of both sexes obtained significantly higher mean scores in all the psychopathological symptoms (somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism) and in all three indices. The most frequent symptoms were somatization, obsession-compulsion, depression, and anxiety; (2) compared with the nonclinical sample of the test, people with FM had percentile scores greater than or equal many symptoms (somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety) and in all the indices. In the Global Severity Index (GSI), 94.3% of FM patients obtained percentiles of greater than or equal 80. However, compared with the clinical sample of the test (psychiatric patients), FM patients only obtained high percentiles (≥ 90) in somatization, and in the GSI, only 30.7% obtained percentiles greater than or equal 80; and (3) only 23.6% of the people with FM presented prior psychiatric / psychopathological antecedents, suggesting that, in many patients, psychopathology develops after FM. To conclude, we confirm the emotional suffering undergone by most people with FM, and the psychologist's importance in the multidisciplinary treatment of this disease. Beyond the debate about whether psychopathological symptoms are the cause or the effect of FM, empirical evidence reveals a high level of psychopathological symptoms (especially somatization, obsession-compulsion, anxiety, and depression) in a large part of the people with FM, which allows us to emphasize the great support that mental health professionals can provide to these patients. The study has important implications for the treatment of FM.