Positive Interventions in Cognitive-Behavioural Psychotherapy


Published: Oct 15, 2020
Keywords:
Cognitive-Behavioural Psychotherapy Positive interventions Effectiveness
Πασχαλία Μυτσκίδου
Βλοντάκης Ιωάννης
Abstract

Cognitive-Behavioural Therapy (CBT) is a well-established, evidence-based psychotherapy. Although it is the therapy of choice for both depression and anxiety disorders, many patients remain symptomatic after termination of their treatment, while relapses are not uncommon in the long-term follow-ups. Over time, different techniques have been
proposed in order to enrich cognitive-behavioural psychotherapy and increase its effectiveness. From the field of Positive Psychology, three psychotherapeutic strategies, Well-Being Therapy, Hope Therapy and Quality of Life Therapy, have been applied as additional ingredients in cognitive-behavioral packages. They are applied either as relapse prevention or as therapeutic strategies, in patients with affective and anxiety disorders who failed to respond to standard psychotherapeutic treatments. This paper presents the clinical and conceptual framework, as well as the structure and application of each strategy. Their potential clinical usefulness and results of preliminary validation studies are presented. Finally, their contribution in enriching the effectiveness of CBT is discussed.

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References
American Psychiatric Association (2010). Practice
Guideline for the Treatment of patients with Major
Depressive Disorder. Retrieved September 27,
Guide.
Βαϊδάκης, Ν. (2008). Κατευθυντήριες θεραπευτικές
οδηγίες για τη Διαταραχή Πανικού. Hellenic
Psychiatry, General Hospital, 5(1), 21-27.
Barlow, D.H. (2002). Anxiety and its disorders: The
nature and treatment of anxiety and panic. New
York: Guilford.
Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G.
(1979). Cognitive therapy of depression. New
York: Guilford Press.
Beck, A.T., Steer, R.A., Ball, R., & Ranieri, W. (1996).
Comparison of Beck Depression Inventories -IA
and -II in psychiatric outpatients. Journal of
Personality Assessment, 67(3), 588-597.
Bruce, T., Spiegel, D., & Hegel, M. (1999). Cognitivebehavioral
therapy helps prevent relapse and
recurrence of panic disorder following alprazolam
discontinuation: a long-term follow-up of the
Peoria and Dartmouth studies. Journal of
Consulting and Clinical Psychology, 67, 151-156.
Butler, A.C., Chapman, J.E., Forman, E.M., & Beck,
A.T. (2006). The empirical status of cognitivebehavioral
therapy: A review of meta-analyses.
Clinical Psychology Review, 26, 17-31.
Campbell, A., Converse, P.E., & Rogers, W.L. (1976).
The quality of American life. New York: Russell
Stage.
Charney, D.S. (2004). Psychobiological mechanisms
of resilience and vulnerability. American Journal
of Psychiatry, 161, 195-216.
Cheavens, S.J., Feldman, D.B., Woodward, J.T. &
Snyder, C.R. (2006). Hope in cognitive psycho -
therapies: on working with client strengths.
Journal of Cognitive Psychotherapy, 20, 135-144.
Cheavens, J., Feldman, D.B., Gum, A., Michael, S.T.,
& Snyder, C.R. (2006). Hope Therapy in a
community sample: A pilot investigation. Social
Indicators Research, 77, 61-78.
Clark, D.M., Salkovskis, P.M., Hackmann, A., Wells,
A., Ludgate, J., Gelder, M. (1999). Brief cognitive
therapy for panic disorder: a randomized
controlled trial. Journal of Consulting and Clinical
Psychology, 67, 583-589.
Clinical Practice Guidelines: management of Anxiety
Disorders (2006). Canadian Journal of Psychiatry
(2), 23S-29S.
Cohn, M.A., Fredrickson, B.L., Brown, S.L., Mikels,
J.A., & Conway, A.M. (2009). Happiness un -
packed: Positive emotions increase life
Μυτσκίδου Πασχαλιά, PhD. και Βλοντάκης Ιωάννης
satisfaction by building resilience. Emotion, 9(3),
-368.
Diener, E., & Lucas, R. E. (2000). Subjective
emotional well-being. In M. Lewis & J.M. Haviland
(Eds.), Handbook of emotions (2nd ed.) (pp. 325-
. New York: Guilford.
Durham, R.C., Higgins, C., Chambers, J.A., Swan,
J.S., & Dow, M.G.T. (2012). Long-term outcome
of eight clinical trials of CBT for anxiety disorders:
Symptom profile of sustained recovery and
treatment-resistant groups. Journal of Affective
Disorders, 136(3), 875-881.
Fava, G.A. (1999). Well-being therapy. Psychotherapy
and Psychosomatics, 68, 171-178.
Fava, G.A., Savron, G., Grandis, S., & Rafanelli, C.
(1997). Cognitive Behavioral management of
drug - resistant major depressive disorder.
Journal of Clinical Psychiatry, 58, 278-282.
Fava, G.A., Rafanelli, C., Cazzarro, M., Conti, S., &
Grandi, S. (1998a). Well-being therapy: A novel
psychotherapeutic approach for residual
symptoms of affective disorders. Psychological
Medicine, 28, 475-480.
Fava, G.A., Rafanelli, C., Cazzaro, M., Conti, S., &
Grandi, S. (1998b). Prevention of recurrent
depression with cognitive behavioral therapy.
Archives of General Psychiatry, 55, 816-820.
Fava, G.A., Rafanelli, C., Grandi, S., Conti, S., Ruini,
C., Mangelli, L., & Belluardo, P. (2001). Long-term
outcome of panic disorder with agoraphobia
treated by exposure. Psychological Medicine, 31,
-898.
Fava, G.A., & Ruini, C. (2003). Management of
recurrent depression. Psychotherapy and Psycho -
somatics, 72, 3-9.
Fava, G.A, Ruini, C., Rafanelli, C., Finos, L., Conti, S.,
& Grandi, S. (2004). Six year outcome of
cognitive behavior therapy for prevention of
recurrent depression. American Journal of Psy -
chiatry, 161, 1872-1876.
Fava, G.A., Ruini, C., Rafanelli, C., Finos, L., Salmaso,
L., Mangelli, L., & Sirigatti, S. (2005). Well-Being
Therapy of Generalized Anxiety Disorder.
Psychotherapy and Psychosomatics, 74, 26-30.
Fava, G.A. & Tomba, E. (2009). Increasing Psycho -
logical well-being and resilience by psycho -
therapeutic methods. Journal of Perso nality 77(6),
-1934.
Fitzpatrick, M.R. & Stalikas, A. (2008). Integrating
positive emotions into theory, research, and
practice: a new challenge for psychotherapy.
Journal of Psychotherapy Integration, 18(2), 248–
Folkman, S. & Moskowitz, J.T. (2000). Positive affect
and the other side of coping. American
Psychologist, 55(6), 647-654.
Fredrickson, B.L. (1998). What good are positive
emotions? Review of General Psychology, 2, 300-
Fredrickson, B.L. (2001). The role of positive
emotions in positive psychology: The broadenand-
build theory of positive emotions. American
Psychologist, 56, 218-226.
Fredrickson, B.L. & Branigan, C. (2005). Positive
emotions broaden the scope of attention and
thought–action repertoires. Cognition and
Emotion, 19(3), 313-332.
Fredrickson, B.L. & Joiner, T. (2002). Positive emo -
tions trigger upward spirals toward emotional
well-being. Psychological Science, 13(2), 172–
Fredrickson, B.L., Mancuso, R.A., Braniganm C., &
Tugade, M.M. (2000). The undoing effect of
positive emotions. Motivation and Emotion, 24,
-258.
Fredrickson, B.L., Tugade, M.M., Waugh, C.E., &
Larkin, G.R. (2003). What good are positive
emotions in crises? A prospective study of
resilience and emotions following the terrorist
attacks on the United States on September 11th,
Journal of Personality and Social
Psychology, 84(2), 365-376.
Frisch, M.B. (1998). Quality of life therapy and
assessment in health care. Clinical Psychology:
Science and Practice, 5, 19-40
Frisch, M.B. (2006). Quality of Life Therapy. New
Jersey: John Wiley & Sons.
Frisch, M.B. (2009). Quality of Life Therapy and
Coaching (QOLTC). In S.J. Lopez (Ed.).
Encyclopedia of Positive Psychology (pp. 824-
. New York: Wiley-Blackwell.
Garland, E.L., Fredrickson, B., Kring, A.M., Johnson,
D.P., Meyer, P.S., & Penn, D.L. (2010). Upward
spirals of positive emotions counter downward
spirals of negativity: insights from the Broadenand-
Build Theory and Affective Neuroscience on
the treatment of emotion dysfunctions and
deficits in psychopathology. Clinical Psychology
Review, 30(7), 849-864.
Garland, E.L. & Howard, M.O. (2009). Neuroplasticity,
Θετικές παρεμβάσεις στη Γνωσιακή-Συμπεριφορική Ψυχοθεραπεία 309
psychosocial genomics, and the biopsychosocial
paradigm in the 21st Century. Health and Social
Work, 34(3), 191-199.
George, M.S., Ketter, T.A., Parekh, P.I., Horowitz, B.,
& Post, R.M. (1995). Brain activity during transient
sadness and happiness in healthy women.
American Journal of Psychiatry, 152, 341-351.
Goddard, A.W. & Charney, D.S. (1997). Toward an
integrated neurobiology of panic disorder.
Journal of Clinical Psychiatry, 58(2), 4-11.
Grant, G.M., Salcedo, V., Hynan, L.S., Frisch, M.B.,
& Puster, K. (1995). Effectiveness of quality of life
therapy for depression. Psychological Reports,
(3), 1203-1208.
Hofmann, S.G. & Smits, J.A J. (2008). Cognitive-
Behavioral Therapy for Adult Anxiety Disorders: A
meta-analysis of randomised placebo-controlled
trials. Journal of Clinical Psychiatry, 69(4), 621-
Hollon, S.D. & Ponniah, K. (2010). A review of
empirically supported psychological therapies for
mood disorders in adults. Depression and
Anxiety, 27, 891-932
Hollon, S.D., DeRubeis, R.J., Shelton, R.C.,
Amsterdam, J.D., Salomon, R.M., O’Reardon,
J.P., Lobett, M.L., Young, P.R., Haman, K.L.,
Freeman, B.B. & Gallop, R. (2005). Prevention of
relapse following cognitive therapy vs. medi -
cations in moderate to severe depression.
Archives of General Psychiatry, 62, 417-422.
Hunt, C. & Andrews, G. (1998). Long-term outcome of
panic disorder and social phobia. Journal of
Anxiety Disorders, 12, 395-406.
Johnson, J., Gooding, P.A., Wood, A.M. & Tarrier, N.
(2010). Resilience as positive coping appraisals:
Testing the schematic appraisals model of
suicide (SAMS). Behaviour Research and Therapy
, 179-186.
Kanter, J.W., Manos, R.C., Bowe, W.M., Baruch, D.E.,
Busch, A.M., & Rusch, L.C. (2010). What is
behavioral activation? A review of the empirical
literature. Clinical Psychology Review 30, 608-
Karimi, H., Doaltshahee, B., Momeni, K., Kho -
dabakhshi, A., Rezaei, M., & Kamrani, A.A. (2010).
Effectiveness of integrative and instrumental
reminiscence therapies on depression symptoms
reduction in institutionalized older adults: An
empirical study. Aging and Mental Health, 14(7),
-887.
Karwoski, L., Garratt, G.M., & Ilardi, S.S. (2006). On
the integration of Cognitive-Behavioral Therapy
for depression and positive psychology. Journal
of Cognitive Psychotherapy: An International
Quarterly, 20(2), 159-170.
Klausner, E J., Clarkin, J.F., Spielman, L., Pupo, C.,
Abrams, R., & Alexopoulos, G. S. (1998). Late-life
depression and functional disability: the role of
goal-focused group psychotherapy. International
Journal of Geriatric Psychiatry, 13(10), 707-16
Lopez, S.J., Snyder, C.R., Magyar-Moe, J.L., Edwards,
L.M,. Pedrotti, J.T., Janowski, K., Turner, J.L., &
Pressgrove, C. (2004). Strategies for accentuating
hope. In P. A., Linley, & S., Joseph (Eds.), Positive
Psychology in Practice (pp. 388-404). Hoboken,
NJ: John Wiley and Sons.
Martin, A.M. (2011). Recent advances in the treatment
of anxiety disorders. Canadian Psychology, 52(1),
-9.
Moeenizadeh, M. & Salagame, K. K. (2010). The
impact of Well-Being Therapy on Symptoms of
Depression. International Journal of Psychological
Studies, 2(2), 223-230.
National Institute for Clinical Excellence. (2004).
Anxiety: Management of anxiety (panic disorder,
with and without agoraphobia, and generalized
anxiety disorder) in adults in primary, secondary
and community care. Retrieved December 20,
from www.nice.or.uk/CG022quickrefguide.
Otte, C. (2011). Cognitive behavioural therapy in
anxiety disorders: current state of evidence.
Dialogues in Clinical NeuroSciences, 13, 413-421.
Paykel, E.S., Scott, J., Cornwall, P.L., Abbott, R.,
Crane, C., Pope, M., & Johnson, A.L. (2005).
Duration of relapse prevention after cognitive
therapy in residual depression: follow-up of
controlled trial. Psychological Medicine, 35(1),
-68.
Rafanelli, C., Park, S.K., Ruini, C., Ottolini, F.,
Cazzaro, M., & Fava, G.A. (2000). Rating wellbeing
and distress. Stress Medicine, 16, 55-61.
Rinskind, J.H. (2006). Links between Cognitive-
Behavioral Hope-Building and positive psycho -
logy: applications to a psychotic patient. Journal
of Cognitive Psychotherapy, 20, 171-182.
Rinskind, J.H., Sarampote, C., & Mercier, M.A. (1996).
For every malady as overeign cure: Optimism
training. Journal of Cognitive Psychotherapy, 10,
-117.
Rodrigue, J.R., Baz, M.A., Widows, M.R. & Ehlers,
Μυτσκίδου Πασχαλιά, PhD. και Βλοντάκης Ιωάννης
S.L. (2005). A randomized evaluation of Qualityof-
Life Therapy with patients awaiting lung
transplantation. American Journal of Tran -
splantation, 5, 2425-2432.
Rufer, M., Hand, I., Alsleben, H., Braatz, A., Ortmann,
J., Katenkamp, B., Fricke, S. & Peter, H. (2005).
Long-term course and outcome of obsessivecompulsive
patients after cognitive-behavioral
therapy in combination with either fluvoxamine or
placebo. A 7-year follow-up of a randomized
double-blind trial. European Archives of Psychiatry
and Clinical Neuroscience, 255(2), 121-128.
Ryff, C.D. (1989). Happiness is everything, or is it?
Explorations on the meaning of psychological
well-being. Journal of Personality and Social
Psychology, 57, 1069-1081.
Ryff, C.D., & Singer, B. (1998). The contours of
positive human health. Psychological Inquiry, 9,
-20.
Ryff, C.D., & Singer, B. (2000). Interpersonal
flourishing: a positive health agenda for the new
millennium. Personality and Social Psychology
Review, 4, 30-44.
Ryff, C.D., Singer, B., Dienberg Love, G., & Essex,
M.J. (1998). Resilience in adulthood and later life.
In J. Lomranz (Ed.), Handbook of aging and
mental health (pp. 69-96). New York: Plenum.
Seligman, M., & Csikszentmihalyi, M. (2000). Positive
psychology: An introduction. American Psych -
ologist, 55, 5-14.
Singer, B., Friedman, E., Seeman, T., Fava, G.A., &
Ryff, C.D. (2005). Protective environments and
health status: Cross-talk between human and
animal studies. Neurobiology of Aging, 26, s113-
s118.
Snyder, C.R. (1996). To hope, to lose, and hope
again. Journal of Personal and Interpersonal Loss,
, 3-16.
Sonino, N., & Fava, G. A. (2003). Tolerance to
antidepressant treatment may be overcome by
ketoconazole. Journal of Psychiatric Research,
, 171-173.
Σταλίκας, Α. & Μυτσκίδου Π. (2011). Εισαγωγή στη
Θετική Ψυχολογία. Αθήνα: Τόπος.
Stuart, G.L., Treat, T.A., & Wade, W.A. (2000).
Effectiveness of an empirically based treatment
for panic disorder delivered in a service clinic
setting: 1-year follow-up. Journal of Consulting
and Clinical Psychology, 67, 506-512.
Σωτηροπούλου, Π. (2005). Αξιολόγηση των παρεχό-
μενων υπηρεσιών μιας Μονάδας Εξωτερικών Ια-
τρείων Ψυχοθεραπείας Διαταραχών Παθολογικού
Άγχους και Ανάλυση Κόστους-Ωφέλειας. Διδα-
κτορική Διατριβή. Πάντειο Πανεπιστήμιο Κοινω-
νικών και Πολιτικών Επιστημών.
Vittengl, J.R., Clark, L.A., Dunn, T.W., & Jarrett, R.B.
(2007). Reducing relapse and recurrence in
unipolar depression: a comparative metaanalysis
of cognitive-behavioral therapy’s effects.
Journal of Consulting and Clinical Psychology,
(3), 475-88.
Wood, A.M. & Joseph, S. (2010). The absence of
positive psychological (eudemonic) well-being as
a risk factor for depression: A ten year cohort
study. Journal of Affective Disorders 122, 213-