Experts are proposing a new, lower cost method to treat depression — teaching people to practice positive activities.
The naturopathic technique is an extension of decades of social psychology research.
Researchers at the University of California, Riverside and Duke University Medical Center proposed the new treatment approach, termed Positive Activity Interventions (PAI), in a paper published in the Journal of Alternative and Complementary Medicine.
PAIs are intentional activities such as performing acts of kindness, practicing optimism, and counting one’s blessings. The philosophy is based on extended research on how happy and unhappy people are different.
Researchers believe this new approach has the potential to benefit depressed individuals who don’t respond to pharmacotherapy or are not able or willing to obtain treatment.
The technique is less expensive to administer, is relatively less time-consuming and has yielded rapid improvement of mood symptoms, holds little to no stigma, and carries no side effects.
The discovery of a low-cost method to treat depression is timely as more than 16 million U.S. adults – about 8 percent of the population – suffer from either major or chronic depression.
Moreover, about 70 percent of reported cases either do not receive the recommended level of treatment or do not get treated at all, according to the National Institute of Mental Health. Globally, the World Health Organization estimates that depression affects more than 100 million people.
Medications for depression have been in existence for 50 years, with the first generation of tricyclic compounds such as imipramine now largely replaced in most parts of the world by newer antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
While these pharmaceuticals can be lifesaving for some individuals, initial drug therapy produces full benefits in only 30 percent to 40 percent of patients. Even after trying two to four different drugs, one-third of people will remain depressed.
The research team – led by Dr. Sonja Lyubomirsky, professor of psychology and director of the Positive Psychology Laboratory at University of California - Riverside; Lihong Wang, M.D., and P. Murali Doraiswamy, M.B.B.S., FRCP, of Duke University – conducted a rigorous review of previous studies of PAIs, including randomized, controlled interventions with thousands of normal men and women as well as functional MRI scans in people with depressive symptoms.
“Over the last several decades, social psychology studies of flourishing individuals who are happy, optimistic and grateful have produced a lot of new information about the benefits of positive activity interventions on mood and well-being,” Lyubomirsky said.
Despite the findings, utilization of the approach has not entered mainstream psychiatric practice.
“Very few psychiatrists collaborate with social scientists and no one in my field ever reads the journals where most happiness studies have been published. It was eye-opening for me as a psychopharmacologist to read this literature,” Doraiswamy said.
Lyubomirsky said that after she and Doraiswamy exchanged notes, “the obvious question that popped up was whether we can tap into the PAI research base to design interventions to galvanize clinically depressed people to move past the point of simply not feeling depressed to the point of flourishing.”
Although the paper found that positive activity interventions are effective in teaching individuals ways to increase their positive thinking, positive affect and positive behaviors, only two studies specifically tested these activities in individuals with mild depression.
In one of these studies, lasting improvements were found for six months. Effective PAIs used in the study included writing letters of gratitude, counting one’s blessings, practicing optimism, performing acts of kindness, meditating on positive feelings toward others, and using one’s signature strengths, all of which can be easily implemented into a daily routine at low cost.
People often underestimate the long-term impact of practicing brief, positive activities, Lyubomirsky said.
For example, if a person gets 15 minutes of positive emotions from counting her blessings, she may muster the energy to attend the art class she’d long considered attending, and, while in class, might meet a friend who becomes a companion and confidant for years to come. In this way, even momentary positive feelings can build long-term social, psychological, intellectual, and physical skills and reserves.
During the research a review of brain imaging studies led the investigators to theorize that PAIs may act to boost the dampened reward/pleasure circuit mechanisms and reverse apathy – a key benefit that does not usually arise from treatment with medication alone.
“The positive activities themselves aren’t really new,” said Kristin Layous, a graduate student and the paper’s lead author. “After all, humans have been counting their blessings, dreaming optimistically, writing thank-you notes, and doing acts of kindness for thousands of years. What’s new is the scientific rigor that researchers have applied to measuring benefits and understanding why they work.”
A major benefit of positive activities is that they are simple to practice and inexpensive to deliver.
“While PAIs appear to be a potentially promising therapy for mild forms of depression,” Doraiswamy cautioned, “they have not yet been fully studied in people with moderate to severe forms of depression. We need further studies before they can be applied to help such patients.”