How Positive Psychology Interventions in the Workplace Have Improved Outcomes for Depression - Case Study Example

How Positive Psychology Interventions in the Work Place Have Improved Outcomes for Depression in the Community Name Institution Date of submission Abstract This paper discusses how positive psychology interventions have contributed to advances in the work place. Besides, the paper describes the use of Acceptance Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) in improving outcomes for depressed individuals in the community. The paper provides examples of each intervention and the evidence of the success of CBT and ACT in the work environment. Keywords: Positive Psychology Interventions; ACT; CBT; Depression Introduction According to McLaughlin (2011), depression is a major health problem that mostly affects adults in their working age. It is a mood disorder, which usually results to loss of interest and feeling of sadness at all times. Depression affects an individual’s way of thinking, feeling and behaviors, and leads to various physical and emotional difficulties. Positive psychology includes a scientific study of processes and features that guarantee an individual a worthwhile life, which is purposeful and satisfying. Acceptance Commitment Therapy (ACT) refers to a type of physiotherapy, which enables an individual to accept and cope with challenges and difficulties that arise during his/ her lifetime. Cognitive Behavioral Therapy (CBT) refers to a short-term physiotherapy treatment aimed at solving a particular psychological problem using practical and hands-on approach. Sources of evidence Acceptance Commitment Therapy enables an individual to accept and cope with challenges and difficulties that arise during his/ her lifetime. According to Cohn and Fredrickson, (2006), ACT is based on mindfulness of individuals and suggests that overcoming negative feelings and thoughts can help the individual to attain greater well-being. It examines the behaviors and character traits of an individual, in order to help him/her reduce avoidant survival styles. Furthermore, it addresses the commitment of an individual to make changes to their goals and various ways they can stick to their goals. Cognitive Behavioral Therapy (CBT) is a short-term treatment aimed at solving a particular psychological problem using practical and hands-on approach. The major aim of CBT is to change the way individuals think about their feelings and the reasons for their difficulties. Psychologists use CBT to treat various issues in an individual’s life like addiction to drugs and sleep disorders. CBT enables individuals to change their behaviors and attitude by concentrating on attitudes, beliefs and thoughts they hold and the way these cognitive processes relate to their emotional behaviors. The merit associated with CBT is that, it is a short-term therapy and takes three to seven months with one session per week to solve emotional problems (McLaughlin, 2011). Positive psychology includes the study of processes and factors, which enhance an individual’s meaningful and purposeful life. It includes a number of themes aimed at mental health, subjective experiences, and positive virtues. Positive psychology aims at establishing the right and not the wrong. It enables an individual to avoid dysfunctional behaviors, thoughts and emotions. Besides, the intervention provides an individual with the ability and skills to address the challenges inherent in their lives. Positive psychology helps individuals in maintaining and fostering ideal states of wellbeing with the best ratio of negative to positive experiences (Cohn and Fredrickson, 2006). Positive psychology aims at investigating the correlates, backgrounds, facilitators and outcomes of an individual’s well-lived life. It also establishes positive and practical interventions necessary to enhance an individual’s wellbeing. However, critics of positive psychology argue that, the intervention is subject to Pollyanna mentality whose objective is to realize constant happiness (Henricksen and Stephens, 2013). Positive psychology interventions at work place Glozier (2000) is of the view that, mental health and depression disorders are the main factors that cause sickness among workers and contribute to employee absenteeism and poor performance. However, most organizations have ignored depression and mental health of workers in their workplace health programs. Psychologists predict that by 2020, depression might be the major cause of poor job outcomes and work disability (Mathers and Loncar, 2006). This suggests that, it is essential for organizations to establish evidence-based workplace depression and mental health interventions to assist their employees cope with their challenges. Workplaces psychology interventions can help prevent most of the mental health challenges and the onset of depression disorders (Limm, Gündel and colleagues 2011). Conversely, most work-based interventions in use currently only respond when the employee exhibits symptoms of depression and when he/she is on a sick leave. Currently, the consensus on effectiveness of preventive programs and interventions is very regardless of the appeal for positive psychology interventions at the workplace. Mykletun and Harvey (2008) recommend that, workplace is the optimum place to offer prevention programs because more than 60% of individuals are employed and spent about 60% of their hours at the workplace. Hence, the interventions at the workplace are likely to reach a wider population. Additionally, the hostile psychosocial work setting is a risk factor for individuals with mental disorders. Thus, work-based strategies to alleviate depression reduce the risk factors at the workplace and facilitate an individual’s self-reliance and coping skills (Nieuwenhuijsen, Bültmann and colleagues, 2008). Furthermore, private and health sectors can share the cost of depression and mental health interventions offered at the workplace. Therefore, depression and mental health prevention programs and strategies reduce the organization’s expenditure and boosts financial returns on its investment. Psychologists can direct their prevention programs at only those at risk, at an entire population, or only at those developing early symptoms. However, studies reveal that interventions aimed at entire population are the best since they can reach more individuals at the workplace and selected groups without screening requirements, which is usually an expensive exercise. Besides, universal interventions at the workplace can reach people who may be coy of disclosing their symptoms and seeking treatment for worries of stigmatization and effects of negative perceptions at their workplace (Glozier, 2000). Effective workplace psychological interventions also include strategies to boost the individual’s happiness. In his study on happiness utility program, Fordyce (1993) remarked that happiness leads to successful outcomes in an individual’s work and relationship. He developed the program called 14 fundamentals of happiness to examine the effect of happiness on depressed individuals. Individuals exposed to the happiness program 14 principles, which included close relationships, significance of a busy life, plausible expectations, social interactions, optimistic thinking, maintaining integrity and adaptation to the present. Participants experienced of the happiness program experienced increased happiness and reduced depression compared to the control groups. The positive outcomes include increased quality and productivity of an individual’s work, creativity and strong social support. Besides, Danner, Snowdon, & Friesen (2001) suggest that, happy individuals at the workplace can regulate themselves, live longer and manage their adversities effectively than the unhappy individuals. In addition, individuals who are happier at their workplace tend to be more sociable, charitable and cooperative than those with less happiness (Williams & Shiaw, 1999). Therefore, positive psychology initiatives to alleviate employees’ depression and mental disorders should involve improving happiness among the employees (Henricksen and Stephens, 2013). Psychologists and organizations use various depression preventive programs to mitigate the onset of depression among workers (Limm, Gündel and colleagues 2011). Selective prevention that targets only those at risk and indicated prevention aimed at individuals with emerging symptoms usually result to positive outcomes at the workplace. However, universal CBT interventions aimed at an entire workplace population reduced the levels depression among the employees considerably (Leona Tan, Min-Jung Wang, 2012). Hence, prevention of the onset of depression among workers should involve suitable evidence-based programs at the workplace. The study by Leona Tan, Min-Jung Wang on the effectiveness of CBT-based interventions provides enough and reliable evidence since it involves search strategies that are more detailed and systematic. Besides, the study boasts of clear and distinct inclusion criteria and includes a clear assessment of its methodological consistency (Leona Tan, Min-Jung Wang, 2012). The ideal location to administer mental health and depression prevention programs to individuals is at their place of work (Leona Tan, Min-Jung Wang and colleagues, 2007). Leona and colleagues argue that, a workplace offers an ideal site to assemble a larger population of the working-age individuals. In their study to establish the effectiveness of universal CBT-based programs, Leona and colleagues offered the CBT intervention to an entire population in the organization. The participants demonstrated reduced levels of depression than the control groups who were exposed to indicative and selective CBT programs. Most private organizations fund positive psychology interventions in order to alleviate reduced work performance and sickness absenteeism accruing from depression among their employees (Glozier, 2000). Nonetheless, inadequate access finances and enough time restrict the large-scale implementation of the interventions. According to Christensen and Petrie (2013), psychologists and organizations should adopt e-health technology in order to help them overcome the challenges facing them in the implementation of the prevention programs especially those arising from time limitations. The e-health technology may include Internet-based CBT, which has demonstrated significant effectiveness in reducing anxiety and depression and improving mental health in the community (Powell, Hamborg and colleagues, 2010; Christensen and Griffiths, 2004). However, limitations and shortcomings are inevitable in this research evidence. The study could not identify the type of psychological that is the most effective since it identified a limited number of related studies. The inability to access enough evidence also challenged the study in establishing whether preventive programs based on psychosocial instruction were more appropriate than the interventions based on participatory programs. Another drawback of the study by Leona and colleagues on the effectiveness of universal CBT-based intervention is that, it based its results on randomized population samples. Thus, the researchers conducted their meta-analysis based on the assumptions of equal depression scores between the treatment and the control groups. In their meta-analysis assessment, Leona and colleagues found that both pre-test and present scores lacked statistically significant differences. Moreover, the research evidence from the study by Leona and colleagues limited its conclusions to self-report measures that involved reduction in signs and symptoms of depression instead of basing the conclusions on clinical diagnosis. Consequently, the self-report symptoms may have introduced biasness in the study through the Hawthorn effect since some individuals had prejudice to their types of psychological interventions (Leona, Min-Jung, Wang and colleagues, 2007). Another, pitfall of the research by Leona and colleagues is that, its studies included both the symptoms of anxiety and depression. Different studies of the research evidence should have focused on specifically on either anxiety or depression symptoms in order to the impacts of the interventions on anxiety and depression disorders separately. Lastly, Leona and colleagues used a search strategy that involved English publications only (Leona, Min-Jung and colleagues, 2007). Therefore, there is likelihood that the research might not have included universal psychological interventions available in non-English publications. Analysis of the research methodology Leona, Min-Jung, Wang and colleagues used a systemic search from various sources to identify appropriate randomized controlled samples on which they administered the workplace psychology interventions. They used the Downs and Black specification to assess the quality of their research. Leona and colleagues then performed the meta-analysis of their study using findings from studies with adequate methodological approach. They further used EMBASE, MEDLINE and PsycINFO electronic databases to identify relevant literature from recent articles. The search included a combination of the keywords depression, workplace, interventions, prevention and depression. Besides, they used the Cochrane Central Register of Controlled Trials to maximize the coverage of their sources of evidence (Olivo, Macedo, Gadotti and colleagues 2008). The inclusion criteria of the Leona and colleagues study on the effectiveness of CBT-based interventions involved identification of all the randomized controlled trials regarding interventions at workplace to determine the outcomes of the mental health and depression prevention programs. The interventions had to focus at collective prevention of depression in the entire working population before it to be included in the review. Besides, there was a general requirement for the studies to associate at least two different intervention groups allocated randomly of which one had to be a control group. The research study also required the participants of the viable studies to be adults within the working age who could fit in a workgroup (Limm, Gündel, 2011). The Leona and colleagues study’s inclusion criteria also involved the utilization of established and authenticated measures depression signs in order to avoid the limitations most studies, which focus on self-reports to examine reduction in depression levels. However, researchers of the evidence excluded the study articles that involved unemployed participants, volunteer work, aimed at indicated prevention, and those that considered non- English publications (Leona, Wang and colleagues, 2013). Leona and colleagues used the Downs and Black list to assess the quality of the study’s RCTs. The Downs and Black scale was suitable for this study the researchers developed it particularly for the field of public health. The checklist exhibit a stronger criterion validity of r = 0.91 and a suitable inter-rater reliability of r = 0.76. The study used Downs and Black specification to exclude studies that had a power below 0.8 with a 0.05 alpha. Moreover, Leona and colleagues designed data extraction sheet to record their findings. The extracted variables involved clustered RCT research design, sample characteristics, outcome indicators and intervention implementation characteristics. They recorded the data relevant to the evaluation of effect sizes in the R v.2.15 numerical programming language. Analysis of the results According to Leona, Wang and colleagues (2013), the comprehensive literature from the database found 1,023 titles upon elimination of duplicates. Two of the researchers identified 45 research articles as applicable to the research problem after examining the abstract and title of each article. The researchers further used the CENTRAL strategy to analyze the references of the studies and identified two extra articles. However, neither of the studies involved the use of clinical diagnostic tool to diagnose mental health disorders. Besides, none of the found articles involving the use of authenticated self-reported depression measures included non-depressed trial at their baseline. Consequently, the evidence was limited research articles that did not exclude diagnoses or individuals with high depression symptoms. Assessment of the quality of the 17 studies of revealed a 0.6 inter-rater reliability and excluded five from the meta-analysis since they had a poor quality. Leona and colleagues used the data from eight of the research articles to calculate the effect sizes of the intervention. They calculated the effective sample and the design effect using the techniques in the Cochrane Handbook since the analysis using clustered RCTs was not effective. Researchers also conducted for authors for missing information via the email of which three authors responded and provided the necessary data (Olivo, Macedo and Gadotti, 2008). Five of the identified studies were based on CBT, one on exercise-based programs, two on mental health prevention programs and one focused on hands-on intervention. The CBT-based interventions involved inoculation-training, psycho-education, stress management behavioral modification, and ACT techniques. The objective of these techniques was to resolve stressful circumstances inherent at the workplace and to enhance career management among the working individuals. Further analysis of the effectiveness of CBT-based intervention study by Wang, Leona and colleagues (2013) indicate a general mean difference of 0.16 (96% CI: 0.07, 0.24, and P=0.0002) between the control groups and that subjected to the intervention. However, the analysis did not detect any heterogeneity i.e. Q = 6.56; I2 = 0%; and P = 0.68. we also notice from the analysis that, at least 50 of the studies i.e. n =5 investigated of the psychology interventions based on the Cognitive Behavioral Therapy. The meta-analysis involving only CBT-based depression prevention programs revealed a mean difference of 0.12 (95% CI: 0.02, 0.22, P = 0.01) between the control groups and the psychology interventions based on CBT. The analysis however had no evidence of heterogeneity i.e. (Q = 5; I2 = 0%; and P = 0.93) (Leona, Wang and colleagues, 2013). Leona and colleagues conducted a sensitivity analysis that excluded the reports based on clustered RCTs research design. Nonetheless, there was no significant effect on the size of the pooled effect upon exclusion of the studies. There was also no change in the mean effect (d = 0.17, 95% CI: 0.09, 0.24) when theycarried out another sensitivity analysis by combining the intervention and control groups make a collective comparison (Olivo, Macedo and Gadotti, 2008). Analysis of the Conclusions and implications The current research evidence by Leona and colleagues suggests that universal mental health and depression interventions can generally mitigate the symptoms and onset of depression and mental health disorders among individuals in the workplace. The study also reveals that, workplace cognitive behavioral therapy interventions are the most effective at alleviating symptoms of stress and depression at the workplace. However, there is need for more research to establish degree to which the CBT-based interventions can inhibit the onset of new depression cases at the workplace. Implications of the study The study by Leona and colleagues on the efficiency universal interventions confirms the findings of other research studies that organizations should not ignore the depression prevention interventions in their health and promotion programs. The study recommends that individuals at the work place and their employers should develop a code of norms and ethics in order to prevent the onset of depression cases. Results of the study also imply that there is a need for organizations to improve the training standards and opportunities among the employees. Effective training will enable the workers to carry out their duties effectively without straining and prevents them from a feeling of incompetency (Seligman, Steen, Park and Peterson, 2005). Additionally, work based psychology interventions should involve a collaboration between experienced psychologists and experts from various disciplines. The cooperation will enhance an understanding of the mechanisms that underlie the effectiveness of positive psychology interventions. Positive psychology interventions should focus on other goals like examining the individual difference factors, effects of interaction and the mechanisms underlying effective prevention programs. This will help the interventions to maximize their range of outcomes (McLaughlin, 2011) The study also suggests that, health professionals and psychologists should enhance the benefits of positive psychology to their clients by forming coalitions to establish effective mental health and depression prevention strategies (Nieuwenhuijsen, Bültmann and colleagues, 2008). References Mathers CD, Loncar D: Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006. Limm H, Gündel H, Heinmüller M, Marten-Mittag B, Nater UM, Siegrist J, Angerer P: Stress management interventions in the workplace improve stress reactivity: a randomised controlled trial.Occup Environ Med 2011, 68:126-133. PubMed McLaughlin KA: The public health impact of major depression: a call for interdisciplinary prevention efforts.Prev Sci 2011, 12:361-371. PubMed. Glozier N: Workplace effects of the stigmatization of depression. J Occup Environ Med 2000, 40:793-800. PubMed. Muñoz RF, Cuijpers P, Smit F, Barrera AZ, Leykin Y: Prevention of major depression. Annual Rev Clin Psychol 2010, 6:181-212. PubMed. Olivo SA, Macedo LG, Gadotti IC, Fuentes J, Stanton T, Magee DJ: Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther 2008, 88:156-175. PubMed. Bernardo, A. B. J. (2010). Extending hope theory: Internal and external locus of trait hope.Personality and Individual Differences, 49, 944-949. Mykletun A, Harvey SB: Prevention of mental disorders: a new era for workplace mental health. Occup Environ Med 2012, 69:868-869. PubMed. Bryant, F. B. (1989). A four-factor model of perceived control: Avoiding, coping, obtaining, and savoring.Journal of Personality, 57, 773-797. Cohn, M. A., & Fredrickson, B. L. (2006). Beyond the moment, beyond the self: shared ground between selective investment theory and the broaden-and-build theory of positive emotions. Psychological Inquiry, 17, 39-44. Henricksen, A., & Stephens, C. (2013). The happiness-enhancing activities and positive practices inventory (HAPPI): Development and validation. Journal of Happiness Studies, 14, 81- 98. Littman-Ovadia, H., & Steger, M. (2010). Character strengths and well-being among volunteers and employees: Toward an integrative model. Journal of Positive Psychology, 5, 419 - 430. Louis, M. C. (2011). Strengths interventions in higher education: The effect of identification versus development approaches on implicit self-theory. Journal of Positive Psychology, 6, 204-215 Seligman, M. E. P., Steen, T. A., Park, N. P., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions.American Psychologist, 60, 410-421. Sergeant, S., & Mongrain, M. (2011). Are positive psychology exercises helpful for people with depressive personalitystyles? Journal of Positive Psychology, 6, 260-272. Shapira, L. B., & Mongrain, M. (2010). The benefits of self-compassion and optimism exercises for individuals vulnerable to depression. Journal of Positive Psychology, 5, 377-389 Nieuwenhuijsen K, Bültmann U, Neumeyer-Gromen A, Verhoeven AC, Verbeek JH, van der Feltz-Cornelis CM: Interventions to improve occupational health in depressed people. Cochrane Database Syst Rev 2008, CD006237. Heaney CA, Price RH, Rafferty J: Increasing coping resources at work: a field experiment to increase social support, improve work team functioning, and enhance employee mental health. Bond FW, Bunce D: Mediators of change in emotion-focused and problem-focused worksite stress management interventions.J Occup Health Psychol 2000, 5:156-163. PubMed Lyubomirsky, S. (2013). What is the optimal way to deliver a positive activity intervention? The case of writing about one?s best possible selves. Journal of Happiness Studies, 14, 635- 654 Christensen H, Petrie K: Information technology as the key to accelerating advances in mental health care.Aust N Z J Psychiatry 2013, 47:114-116. PubMed Powell J, Hamborg T, Stallard N, Burls A, McSorley J, Bennett K, Griffiths KM, Christensen H: Effectiveness of a web-based cognitive-behavioral tool to improve mental well-being in the general population: randomized controlled trial. Christensen H, Griffiths KM, Jorm AF: Delivering interventions for depression by using the internet: randomised controlled trial. BMJ 2004, 328:265. PubMed Read More

The merit associated with CBT is that, it is a short-term therapy and takes three to seven months with one session per week to solve emotional problems (McLaughlin, 2011). Positive psychology includes the study of processes and factors, which enhance an individual’s meaningful and purposeful life. It includes a number of themes aimed at mental health, subjective experiences, and positive virtues. Positive psychology aims at establishing the right and not the wrong. It enables an individual to avoid dysfunctional behaviors, thoughts and emotions.

Besides, the intervention provides an individual with the ability and skills to address the challenges inherent in their lives. Positive psychology helps individuals in maintaining and fostering ideal states of wellbeing with the best ratio of negative to positive experiences (Cohn and Fredrickson, 2006). Positive psychology aims at investigating the correlates, backgrounds, facilitators and outcomes of an individual’s well-lived life. It also establishes positive and practical interventions necessary to enhance an individual’s wellbeing.

However, critics of positive psychology argue that, the intervention is subject to Pollyanna mentality whose objective is to realize constant happiness (Henricksen and Stephens, 2013). Positive psychology interventions at work place Glozier (2000) is of the view that, mental health and depression disorders are the main factors that cause sickness among workers and contribute to employee absenteeism and poor performance. However, most organizations have ignored depression and mental health of workers in their workplace health programs.

Psychologists predict that by 2020, depression might be the major cause of poor job outcomes and work disability (Mathers and Loncar, 2006). This suggests that, it is essential for organizations to establish evidence-based workplace depression and mental health interventions to assist their employees cope with their challenges. Workplaces psychology interventions can help prevent most of the mental health challenges and the onset of depression disorders (Limm, Gündel and colleagues 2011). Conversely, most work-based interventions in use currently only respond when the employee exhibits symptoms of depression and when he/she is on a sick leave.

Currently, the consensus on effectiveness of preventive programs and interventions is very regardless of the appeal for positive psychology interventions at the workplace. Mykletun and Harvey (2008) recommend that, workplace is the optimum place to offer prevention programs because more than 60% of individuals are employed and spent about 60% of their hours at the workplace. Hence, the interventions at the workplace are likely to reach a wider population. Additionally, the hostile psychosocial work setting is a risk factor for individuals with mental disorders.

Thus, work-based strategies to alleviate depression reduce the risk factors at the workplace and facilitate an individual’s self-reliance and coping skills (Nieuwenhuijsen, Bültmann and colleagues, 2008). Furthermore, private and health sectors can share the cost of depression and mental health interventions offered at the workplace. Therefore, depression and mental health prevention programs and strategies reduce the organization’s expenditure and boosts financial returns on its investment.

Psychologists can direct their prevention programs at only those at risk, at an entire population, or only at those developing early symptoms. However, studies reveal that interventions aimed at entire population are the best since they can reach more individuals at the workplace and selected groups without screening requirements, which is usually an expensive exercise. Besides, universal interventions at the workplace can reach people who may be coy of disclosing their symptoms and seeking treatment for worries of stigmatization and effects of negative perceptions at their workplace (Glozier, 2000).

Effective workplace psychological interventions also include strategies to boost the individual’s happiness.

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