Accentuate the positive!

Michael C. LaFerney | 06/02/2014

Research in positive psychology provides much of value to nurses.

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Janet Smith, a patient with a dysthymic disorder, is working on treatment goals with her nurse therapist. For both her short-term and long-term goals, she states, “I want to be happy.” Her therapist asks, “How would I know you are happy?” Janet cannot say, and her therapist replies, “I can help you become less depressed, but I can’t make you happy.”
Michael LaFerney author imageJanet is chronically depressed and has been this way for more than two years. She functions at a minimal level but doesn’t enjoy life, has few friends, is angry toward those she feels have slighted her in some way, and thinks in ways that create a depressed and anxious mood. Janet’s therapist has been working with her to change her negative thought patterns, and Janet is on antidepressant medication.
Psychopathology vs. positive psychology
In the past, most mental health treatment has focused on psychopathology. Psychopathology is the study of mental disorders—what is abnormal about people. There was little concern about what made people better adjusted, more adaptive, and resilient—about what would make life emotionally rewarding for them.
This has changed in recent years with the emerging field of positive psychology. Humanistic and cognitive therapies led the way. Research in positive psychology provides much of value to nurses, who have also been leaders in this area through holistic nursing approaches.
What can the nurse therapist do to help Janet in her pursuit of happiness? What do we know about what makes people happy? While there are many aspects to happiness and ways to increase it, I will identify only a few.

First, we can teach Janet about positive psychology. We know that people who are most happy spend the least time alone (Elias, 2012). Janet isolates herself from others. To become happier, she needs to spend more time with others, engage in more social events, and be more intimate in relationships. Janet gets more depressed during the holidays, secondary to family emphasis during this time of the year. She is invited to family gatherings but doesn’t go.
Milieu therapy
Inpatient psychiatric units have milieu therapy because therapists know that social support helps decrease depression. To be happy, Janet needs to design a therapeutic milieu in her life, finding some activity or interest that gets her out of the house and involved with others. Here’s a behavioral assignment that her therapist can give her: Go to your family gathering.
Janet spends a lot of time thinking of things she doesn’t have. “I don’t have enough money. If I did, I’d be happy,” she thinks. Studies show that correlation between having money and emotional health is weak. While wealth may eliminate some worries and increase overall satisfaction, pursuit of wealth for its own sake can cause circumstances that reduce happiness, such as neglect of family and health (Hershfield, 2013).
Janet has some things going for her. She has a job, is in relatively good health, and has family that cares for her. Yet, she rarely thinks of these assets. She dislikes her job but stays there. Studies show that people who like what they are doing and have a reason to get up in the morning do best. Flow is important. People are often most happy when they are immersed in work or hobbies they enjoy.
Purpose needed
People need purpose in life. If a person is disabled or unemployed, he or she can volunteer, engage in some meaningful activity, or get a pet to take care of. Janet feels her health is poor, but her physician thinks her symptoms are somatic, due to depression rather than a “real illness.” People who subjectively view their health as poor are less happy than those who have a positive outlook, even when they have serious medical issues.
Janet’s therapist asks her to take a daily inventory of things she can be grateful for. Some studies suggest that the happiest people are those who are thankful for even little things in daily life (Elias, 2012). Forgiving those who have slighted us—whether real or imagined—can reduce our anger and help us let go of negative thoughts and feelings that hinder happiness.
Therapists can also aid people who are unhappy by teaching them to become more optimistic and less pessimistic, find meaning in life through spiritual experiences, use and enjoy humor, do physical exercise, engage in mindfulness training, do something for others, and live in the here and now. Happiness is not just the absence of depression. Events can make us happy, but only for a short time. Happiness is a process best enjoyed by the living of routine days. Happiness includes working, enjoying friends and family, and being thankful for what we have. It is called “being in flow.”

Abnormal psychology is a required course in many nursing programs. Perhaps it is time to incorporate positive psychology into the curriculum. Nurses can use these principles to increase happiness in their own lives. While nursing can be stressful, it can also provide many of the processes needed for happiness. These include purpose, friends, decent income and standard of living, and ability to see gratitude firsthand from patients and their families for the important role we play in restoring health.

Michael C. LaFerney,PhD, RN, PMHCNS-BC, is a psychiatric clinical nurse specialist at Arbour SeniorCare in Haverhill, Massachusetts, USA.
Elias, M. (2002.) Psychologists now know what makes people happy. USA Today.
Hershfield, H.E. (2013). Savoring: Explaining the happiness-wealth relationship. Psychology Today.
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