December 16, 2010

The Pursuit of Happiness

Psychologists and therapists have traditionally focused on alleviating misery–-making anxious people less anxious, angry people less angry, and psychotic people less psychotic–-and assumed that happiness was a byproduct. Researchers in a relatively new subfield of psychology believe that reducing suffering is not enough and that increasing happiness should be a separate and equally important objective.
Positive psychology is the study of positive emotion and human strengths, with the goal of identifying and building strengths, nurturing talent, and improving quality of life in relatively untroubled people. Positive psychology researchers study the traits and habits of happy people and, based on their findings, design interventions to increase happiness.
So what makes us happy?
·     Strong interpersonal relationships make us happy. The people in the highest percentiles of happiness are extremely social, have rich and meaningful friendships, are in a romantic relationship, and don’t spend a lot of time alone.

·     Knowing and using our personal strengths makes us happy. Positive psychology therapy clients complete questionnaires that identify their strengths and are assigned to, for example, use their key strengths in new ways three times per week. If your two greatest strengths are patience and teaching, things like helping your niece learn to read and showing your dad how to use HTML increase happiness. Likewise, couples in therapy with a positive psychologist are assigned to go on a “strengths date,” i.e., a date during which both partners get to use their strengths.

·     Meaning (using your strengths in the service of a greater good or to belong to a larger community) and engagement (the ability to get lost in what you’re doing, whether it’s stock trading, parenting, or making music) make us happy. Pleasure (the experience of positive emotion), on the other hand, is less relevant to happiness. 

The implications of positive psychology findings are considerable. People seeking happiness through pleasure can consider pursuing engagement and meaning instead. The known relationship between happiness and outcomes like better health and longer life can have a significant positive impact on larger systems such as health care and the economy. Finally, positive psychology is an exciting and validating option for future mental health professionals (ahem) who are less interested in severe mental illness and very interested in helping well people improve their quality of life.  

December 08, 2010

Personality Disorders

DSM personality disorders are fascinating and controversial because they suggest that a person’s personality--by nature multifaceted, unique, and shaped by experience--can be maladaptive and inappropriate to the point that it constitutes a disorder. According to the DSM, a personality disorder is an enduring, inflexible, and pervasive pattern of experience and behaviour that deviates markedly from the expectations of the person’s culture; is manifested in terms of cognition, emotion, interpersonal functioning, and impulse control and leads to significant distress or impairment. The ten DSM personality disorders are divided into three clusters.
Odd or Eccentric: A person with a schizoid personality is a loner, detached or aloof, with a restricted range of emotions. A person with a paranoid personality is distrustful and suspicious, and frequently and unjustifiably perceives others as deceitful or disloyal. A person with antisocial personality disorder is popularly known as a psychopath or sociopath: manipulative and lacking in empathy or conscience. A person with a schizotypal personality is odd or eccentric, with unusual or peculiar beliefs or behaviour.
Dramatic, Emotional, or ErraticBorderline personality disorder is characterized by emotional instability, poor self-image, dramatic shifts in mood, fear of abandonment, and tumultuous interpersonal relationships. A person with a narcissistic personality is grandiose, selfish, entitled, and intolerant, with a strong need for admiration. A person with a histrionic personality is theatrical, flashy, emotional, and uncomfortable when not the centre of attention.
Fearful or Avoidant: A person with an avoidant personality fears criticism, avoids social interaction, and is risk-adverse and sensitive to rejection. A person with a dependent personality is needy and submissive, very sensitive to criticism or disapproval, and needs a lot of reassurance and help making decisions. A person with an obsessive-compulsive personality is focused on efficiency and productivity, and may be considered a perfectionist or a workaholic.
Each personality disorder is described by 7 to 9 traits, most of which are not independently pathological. Lots of people people are, for example, impulsive and fail to plan ahead, or show restraint within intimate relationships out of fear of shame or ridicule, without having an antisocial or avoidant personality disorder, respectively. Further, a personality disorder is not necessarily immediately obvious. You could be dating someone for three months before you realize that he is intolerant of your opinions, expects special treatment from waiters and customer service representatives, and frequently and tangentially mentions his Harvard PhD in conversation with strangers–-helping explain why he has a hard time sustaining a relationship.
Therapists can use a strong or otherwise unusual personal reaction to a given client as a clue to the possibility of a personality disorder, and can convert the reaction into a therapeutic intervention by telling the client about it (e.g., “I feel personally responsible for your well-being to an unusual extent” or “I feel like nothing I could do would allow me to gain your trust”). If the client says it’s not the first time he or she has received that particular feedback, the therapist can ask something like, “What do you think it’s like for others to feel so much responsibility for you?” or “How has your difficulty with trust affected your marriage?” to help the client gain insight about how his or her personality impacts his or her relationships.
Personality disorders don’t come out of nowhere, and can constitute a valid response to a maladaptive early environment. If you were consistently misled and betrayed as a child, paranoia is a reasonable response. If you were an adored and overprotected child who was never criticized and who never faced a tough decision or problem on her own, dependence is to be expected. The emotional instability and fear of abandonment common among individuals with borderline personality disorder are the natural outcomes of alternating abuse, invalidation, and neglect. This developmental perspective on personality disorders can be validating for clients and helpful in maintaining patience and empathy in therapists who work with people with personality disorders. The therapist’s job is then to guide the client to an understanding of the impact of the behaviour pattern on the client’s current relationships and to help the client replace dysfunctional patterns with more adaptive and appropriate behaviour.

December 03, 2010

Activity Scheduling

When you’re sad, bored, lonely, or otherwise unhappy, people often suggest that you get out of the house, join a group, do something nice for yourself, or some variation on that theme. It’s intuitive that engaging outwardly or doing something that you enjoy feels good, but this type of activity has been found to be so effective in improving mood that psychologists working with depressed clients implement mandatory participation in rewarding and pleasurable activities or in activities that increase feelings of mastery. An empirically validated treatment for depression, activity scheduling was developed thirty years ago after research demonstrated that depressed people find fewer activities pleasant and engage in pleasant activities less frequently than do non-depressed people. 
Clients are provided with a blank weekly calendar and are asked to pencil in, for example, 15 minutes of rewarding or pleasurable activity twice per day. The activity has to be realistic: a severely depressed client is unlikely to suddenly join a sports team or redecorate the kitchen. A realistic pleasurable activity might be 15 minutes of reading a magazine and sipping a hot drink. An activity that promotes mastery might be as simple as watering the plants, completing a small errand, or merely showering and shaving. For a depressed client whose life is very busy (with unpleasant or unrewarding activities), a pleasurable activity might be an afternoon coffee break during which the client stops working and listens to his or her favourite music for 15 minutes. Clients are asked to monitor their mood on a graph so that they can observe the mood shifts that correspond with activity.
The non-depressed-person version of activity scheduling is personal projects. A personal project is a hobby, venture, or activity that makes you feel happy, fulfilled, or accomplished–-things like learning to knit, joining a pub ‘trivia night’ team, building a bookshelf, writing a blog, training for an athletic event, learning to play an instrument, designing a software program, and volunteering. The parallel between activity scheduling for depressed people and personal projects for well people is obvious, and provides an intriguing perspective on the role of personal projects in quality of life. Psychology research supports the prescription of enjoyable and rewarding activities as an anti-depressant for depressed clients; it doesn’t seem far-fetched to bet that personal projects increase fulfillment and improve quality of life in well people.