Can positive psychology help to treat dual diagnosis?

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Katalin Ujhelyi, Jerome Carson and Ioanna Melidou share results of a new study.

People with dual diagnosis – co-occurring substance misuse and mental health issues – have complex needs. The duality of their disorders gives augmented symptoms, leaving clients particularly vulnerable and with poorer treatment outcomes. They require the most support, but in fact receive the least, according to Turning Point’s recent Dual dilemma report.

The unmet need of those with coexisting problems was the reason for developing a new treatment programme, within the scope of a PhD research project conducted at the University of Bolton, in collaboration with Lifeline Project. The project involved a group of participants with dual diagnosis issues who attended the Bolton Integrated Drugs and Alcohol Service (BIDAS). 

Traditionally, psychology has been preoccupied with what is wrong with us and concentrated on trying to repair it. Positive psychology, on the other hand, is the science of positive aspects of human life and looks for what is right with people. It explores positive experience, positive individual traits, and positive institutions (Seligman & Csikszentmihalyi, 2000).

The field is not intended to replace traditional approaches, but to draw on the findings and methodologies of psychology in general and make it more representative of the human experience (Seligman et al, 2005). According to Seligman’s PERMA Model of positive psychology, wellbeing or flourishing stands on five pillars: positive emotions, engagement, relationships, meaning, and accomplishment (Seligman, 2011).

Positive psychology has been successfully applied in addiction recovery, as well as in the treatment of mental illnesses. However, there is a lack of research relating to dual diagnosis.

Applied to addiction, it can be seen in three areas associated with ‘the pleasant life’ (positive emotions about the past, present, and future); ‘the engaged life’ (having positive traits that are necessary for full engagement, such as hope); and ‘the meaningful life’ (service to, and membership of, positive entities such as family, workplace, Alcoholics Anonymous).

Positive interventions aim to increase positive feelings, behaviours, and cognitions rather than working on pathology and maladaptive thoughts and behaviours (Sin & Lyubomirsky, 2009). According to positive psychology, a lack of mental illness does not automatically mean you have a happy life. While the aim of traditional psychology is to treat mental illness, positive psychology gives a hand to this traditional approach but in addition helps people move beyond survival to achieve their full potential and flourish.

The new programme – developed by the University of Bolton and Lifeline Project, within the scope of a PhD research project – is providing dual diagnosis clients with an opportunity to increase their wellbeing. It has been shown that individuals with dual diagnosis are less hopeful about their future, struggle more to cope with whatever life throws at them, and therefore experience lower levels of wellbeing (Ujhelyi et al, 2016). The aim of the current intervention is to increase levels of hope, resilience and mental wellbeing through a positive psychology approach.

In a group, participants were introduced to several different positive psychology concepts and learned how these can be integrated into their lives to make them more resilient, more hopeful and happier. In collaboration with the Psychosocial Interventions Service (PSI) at Lifeline Project, participants already engaging in treatment were identified as having a mental health diagnosis and a relative level of stability in regard to substance misuse. The PSI service provided the group with a space and equipment to deliver the sessions, and a member of staff attended to observe and provide support if necessary.

Positive psychology does not equate with a ‘smiley face’ – it is much more than that. It considers concepts that are deep-rooted in different cultures all around the world, but may have been forgotten in terms of benefit to our everyday lives. It also seeks to provide robust empirical evidence as to how these aspects can benefit our wellbeing.

The new positive psychology Intervention consists of 12 two-hour sessions run on a weekly basis, delivered using a psycho-educational approach. Participants are encouraged to engage in group exercises and work in between sessions, acquiring skills and psychological resources that will help them with their recovery.

For people with addictions the work must begin by restoring character strengths. Taking the VIA strengths test – available to anyone at www.viastrengths.org – enables them to discover their top five signature strengths to follow specific objectives. A goal-oriented mindset can then be facilitated through increasing people’s willpower or motivation, as well as their ‘waypower’ – their ability to set and achieve realistic goals while being able to deal with challenges.

What is needed is a radical change in the attitude people have towards life, taking responsibility to find the right solutions to whatever comes up. People need empowerment through increasing their resilience to take control over their own lives, and be given the freedom to accept or reject the opportunities life presents.

Finding what makes life worth living through the deeper appreciation of gratitude, learning about how generating positive emotions in one’s life can build an upward spiral, and recognising the importance of compassion towards oneself and others, are all psychological resources that can provide us with tremendous support during hardship.

Focusing intentionally on our immediate experience and becoming grounded in the present moment through the formal and informal practices of mindfulness will help with the integration of the aforementioned aspects into our lives. And last but not least, we can use mindfulness to put basic nutrition into action to keep ourselves healthy. The end product of learned skills and acquired resources is resilience – the ability to cope with adversity by replacing maladaptive coping strategies.

Although it is too early to draw conclusions, the results of the first pilot study are promising. People’s lives in the group have changed significantly. Based on participants’ feedback, nothing had made them think as much as this intervention before. One participant said: ‘I feel like I have just woken up! I see life in a totally different light!’ Another said: ‘This intervention has changed my way of thinking about myself. I think I shall give myself a little more credit from now on.’ They also felt that the intervention taught them to rely more on themselves: ‘I don’t want to go to the recovery services for the rest of my life,’ and were empowered by the skills and resources they acquired.

The main themes arising from the feedback were ‘I can do this!’ ‘I am capable’, and ‘life is worth living’. Based on the results of the study questionnaires, participants have become more mindful, their dependence on substances has decreased, their wellbeing has increased and they feel more resilient and more hopeful. They have become less anxious and less depressed, and finally, they have more positive emotions and positive experiences. We intend to start a second pilot study in January 2017, which will test an improved version of the intervention.

The authors would like to thank the clients who participated in the programme and Lifeline Project Bolton for their cooperation, and Alcohol Research UK for funding the pilot study. This project would not have been possible without their support.

Katalin Ujhelyi is a PhD student at the University of Bolton, Jerome Carson is professor of psychology at the University of Bolton, and Ioanna Melidou is psychosocial interventions team manager for Lifeline Project.

For further details of this work contact: K.Ujhelyi@bolton.ac.uk

References

Sin, N.L. & Lyubomirsky, S. (2009). Enhancing Well-Being and Alleviating Depressive Symptoms with Positive Psychology Interventions: A practice-friendly meta-analysis. Journal of Clinical Psychology (65)5, 467-487.

Seligman, M.E.P., Steen, T.A., Park, N., and Peterson, C. (2004). American Psychologist, 60(5), 410-421.

Seligman, M.E.P. (2011). Flourish: A New Understanding of Happiness and Well-Being. Ney York: Free Press.

Seligman, M.E.P. and Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55(1), 5-14.

Turning Point (2016). Dual Dilemma: The impact of living with mental health issues combined with drug and alcohol misuse. Turning Point UK: London.

Ujhelyi, K., Carson, J., and Holland, M. (2016). Positive Psychology in Dual Diagnosis. A preliminary investigation. Advances in Dual Diagnosis, 9(4), 1-15.