national center for chronic disease prevention and health promotion, division of adult and community...
TRANSCRIPT
National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health, State
Support, Arthritis, Epilepsy & Quality of Life Branch
August 10, 2011
Rosemarie Kobau, MPH, MAPP
ACHMA Webinar
Moving Toward Health Through Well-being and Positive Mental Health
Disclaimer
Statements made in this presentation do not necessarily represent the views of the Centers for Disease Control and Prevention, the US Department of Health and Human Services or the US Government.
Agenda
I. Well-being and Federal initiatives
II. Well-being models
III. Benefits of positive emotions and positive mental health
IV. Cultivating positive emotions
V. Population mental health promotion examples
VI. Discussion
“This FOA provides support to address the five “Strategic Directions” outlined in the CTG program: tobacco-free living, active living and healthy eating, clinical and other preventative services, social and emotional wellness, and healthy and safe physical environment.
Prevention and Public Health Fund: Community Transformation Grants
Well-being/Wellness, Health & Health Promotion
DHHS (2011) National Prevention Strategy
“ …move the nation away from a health care system focused on sickness and disease to
one focused on wellness and prevention.”
Healthy People 2020 Foundation Health Measures: HRQOL & Well-Being
Disease Health
• Prevent or minimize disease, disability, injury
Disease model vs. Salutogenic model
(Deficits vs. Assets)
• Build resources, reserves, function, & competencies to promote & protect physical and mental assets for health
• Promote conditions that foster healthy development; satisfying and productive lives
• Implies greater attention to “positive health/mental health”
Breslow, 2006; Antonovsky, 1979; Keyes, 2007
(ill-being vs. well-being)
Most public health activities
More public health + other stakeholder activities
Health: a state of complete physical, mental and social well-being, not merely the absence of disease and infirmity” ; and “a resource for everyday life (WHO, 1948; Ottawa Charter, 1986)
Definitions and models
Well-being: either of two sets of related, but distinct subjective or psychological attributes:
Subjective well-being: Life satisfaction, high positive/low negative affect, by self-assessment
Psychological well-being: Personal growth, autonomy, self-acceptance, life purpose, mastery, positive relations….
Also: Preference/satisfaction (economics); Objective lists (e.g., education, income) (NEF 2011)
Positive Mental Health is an empowering resource, broadly inclusive of psychological assets and skills essential to human fulfillment and well-being (Herrman et al. 2005)
• Criticisms exist (Huber et al. 2011)
Well-Being Models (con’t.)
“Well-Being is a dynamic state where one maximizes his or her physical, mental, and social functioning in supportive environments to live a full, satisfying and productive life.” (CDC Well-
being Work group 2010)
*For public health practice: physical well-being too
Integrates psychological notions of well-being with positive physical health for greater health impact
Links health with the places where people live, learn, work and play
Points to the roles and opportunities for multiple social sectors to affect well-being
Grounded in health equity & social justice: disadvantaged individuals may face more unfair obstacles in maximizing well-being
Positive Emotions & Well-Being(Diener & Chan, 2011; Pressman & Cohen, 2005; Chida & Steptoe 2008)
Absence of negative emotions ≠ presence of positive emotions; are generally independent; influenced by different causes (illness vs. social interactions)
Growing research indicates that positive and negative emotions have distinct biomarkers (e.g., neuroendocrine & cardiovascular)
Associated with ↓ risk of disease, illness, injury; ↑ immune functioning, ↓cortisol, pain
Emotional vitality & optimism associated with reduced incidence of coronary heart disease (after controlling for depressive symptoms)
Associated with speedier recovery from stress & illness
More productive at work & less burnout at work
Moving Toward Health: Population mental health promotion
· Employment opportunities· Safe, affordable housing· Social inclusion & anti-discriminatory
policies· Positive parenting/early childhood
development interventions· Active living· Public transportation· Parks to encourage social
connectedness, access to nature and physical activity
· Taxation of addictive substances· Healthy school environments
Cultivating Positive Emotions
Are fleeting/fragile
Feelings can’t be “willed”—must be prompted with thoughts (e.g., “What went well for me today?”), actions (e.g., physical activity), healthy physical and social environments (e.g., friends; employment )
Fostering and sustaining positive emotions (combating negativity bias) requires effort—like for maintaining physical health
Heritability/biological set-points? Personality traits? Can still help people function well within their set-point range
Supportive environments (good working conditions; social support)
Similar to weight/height (heritable, but environment & life circumstances matter)
Joy, Gratitude, Serenity, Hope, Interest
Inspiration; Awe; Love; Pride; Amusement
*Does not negate value of negative emotions on human development, coping, creativity, personal growth
Moving Toward Health: Individual health promotion for positive mental health
• Gratitude • Meaningful Activity/Flow• Learned optimism• Savoring• Mindfulness• Signature Strengths• Hope• Acts of Kindness • Social support • Connect with nature• Physical activity• “Satisficing “ vs. “Maximizing”
Multiple paths to well-being (King, 2008)
Gratitude (Emmons & McCullough, 2003; Emmons, 2007)
- Journaling three blessings/three good things at least once a week shown to improve well-being
Increasing positive emotions
“A felt sense of wonder, thankfulness, and appreciation for life.”
Signals being treated in a pro-social fashion
Expressing and experiencing gratitude associated with more satisfying social relationships and well-being
May minimize hedonic adaptation
• Focus on what you’re good at; what you like about where you live; vary domains of life to consider—friends, family, work, health & why you think good thing happened
Increasing resiliency
Learned Optimism & Resilience Skills
Shown to prevent depressive symptoms and reduce moderate & severe depression in children (Penn Resilience Program-PRP)
· Target Explanatory Style (Me/Always/Everything)· Challenging Beliefs/ABC Model (Self-talk)· Thinking Errors (e.g. All-or-nothing thinking)· Putting it in Perspective
Can regulate explanatory style and dispute negative thoughts routinely (Seligman, 2002)
U.S. Army Comprehensive Soldier Fitness Program
A population-wide approach to improving resiliency and positive mental health in all enlisted staff, interested family members, and civilian staff working with the U.S. Army.
(Peterson & Seligman 2004)
Values in Action (VIA Classification of Strengths of Character)
Based on review of historical, philosophical, religious texts and popular culture to identify common positive dispositions and characteristics to help young people realize their full potential
Increasing positive emotions
http://www.viastrengths.org
Criteria: 1. Is ubiquitous: is widely recognized across cultures 2. Is fulfilling: contributes to individual fulfillment, satisfaction, and happiness 3. Is morally valued: is valued in its own right and not for tangible outcomes it may produce4. Does not diminish others: elevates others who witness it 5. Has a nonfelicitous opposite: has antonyms that are negative 6. Is trait-like: is an individual difference with demonstrable generality and stability7. Is measureable: successfully measured by researchers as an individual difference8. Is distinct: is not redundant (conceptually or empirically) with other character strengths9. Has paragons: is strikingly embodied in some individuals 10. Has prodigies: is precociously shown by some children or youth11. Can be selectively absent: is missing altogether in some individuals12. Has enabling institutions: is deliberate target of societal practices and rituals that try to cultivate it.
Core strength Components1. Wisdom and Knowledge – cognitive strengths that entail the acquisition of knowledge
Creativity; Curiosity; Judgment & Open-Mindedness; Love of Learning; Perspective
2. Courage – emotional strengths that involve the exercise of will to accomplish goals in the face of opposition, external or internal
Bravery; Perseverance; Honesty; Zest
3. Humanity – interpersonal strengths that involve tending and befriending
Capacity to love and be loved; Kindness; Social intelligence
4. Justice – civic strengths that underlie healthy community life
Teamwork; Fairness; Leadership
5. Temperance – strengths that protect against excess
Forgiveness and mercy; Modesty; Prudence; Self-regulation
6. Transcendence – strengths that forge connections to the larger universe and provide meaning
Appreciation of beauty and excellence; Gratitude; Hope; Humor; Religiousness & Spirituality
Values in Action (VIA) Classification of Strengths of Character
· Using signature strengths in a new and different way every day for a week was shown to increase happiness & decrease depressive symptoms (Seligman et al. 2005)
· Mental Illness & Recovery (VA Clinic) (Resnick & Rosenheck, 2006)
Applying Signature Strengths: Positive Communication
Positive Introduction in clinic or in support groups—
“Tell me a story of you at your best….”
Identity apart from illness/label & strengths-based
Example: Seize Your Strengths: A workshop to promote positive functioning in people with epilepsy
Part I: Introductions Understanding and
exploring your character Strengths Inquiring into your
character strengths Sharing our discoveries
Part II: Explore challenges of
epilepsy Strengths-based future Wrap-up
N=20 (9 women)Mean age: 40 yrs.
80% believed material “very helpful” in coping with epilepsy
Almost all enjoyed learning about their character strengths “very much”
87% were “very confident” could practice character strengths in next two weeks
All would recommend workshop to another person with epilepsy
“This workshop made me think to live more positively with epilepsy”“I learned I wasn’t alone”“It was fun! I liked it a bundle!”
Participants’ comments:
Process outcome evaluation (AES, 2009)
Patient check-list for well-being
___I frequently feel happy and contented.___There are many things that bring me joy.___I am satisfied with my life.___I feel sad infrequently.___I feel angry infrequently.___I feel stressed infrequently.___I often feel grateful, forgiving, and trusting.___I have friends and family members I can count on.___I am an optimistic person.___I am very happy with my social relationships.
Opportunity to discuss mental health without stigma of mental illness; bridge to mental illness symptoms
Diener, 2008
(in addition to standard symptom/function/MI checklists….)
Learned Optimism
Gratitude “Hunt the Good Stuff” (Seligman, 2011)
Character Strengths
Building Strong Relationships
Global Assessment Tool
Master Resilience Trainers
Comprehensive Resilience Modules
Institutional Training
Components:
Strategies:
http://www.neweconomics.org/sites/neweconomics.org/files/Five_Ways_to_Wellbeing.pdf
UK Government’s Foresight Project on Mental Capital and Well-being (2008)
Connect - with the people around you…Be Active – go for a run or walk; step outside…Take Notice – be curious; notice natural beauty; be mindful; savor events… Keep Learning - learn/try something new… Give – do something nice for a friend; volunteer….
Aim was to identify a set of evidence-based actions (and public health messages) to improve well-being, which individuals would be encouraged to build into their daily lives
Five Ways to Well-being
“Five-Ways is used to think about how to transition from managing illness to supporting a non-medical service focused on recovery, wellness andparticipation. Mersey Care NHS trust has developed a wellness planningtool which uses the Five Ways to Wellbeing to connect people leaving itsservice with community activities….”
Measurement of Well-Being
Multiple validated and extensively used measures exist
Healthy People 2020
Preference-based measures (e.g., Quality of Well-Being Scale) Psychometric measures (e.g., Flourishing [Keyes 2007]; Satisfaction with
life [Diener et al., 1985]) Single-item measures (e.g. global Life Satisfaction [Strine et al. 2007] Individual + social indicators (e.g., Australian Well-Being Index; New
Economics Foundation)
Health Status and QOL(NIH PROMIS Global Health; CDC HRQOL-4)Participation measuresWell-being
**Expanding WB work group members—please contact me if interested
Satisfaction with Life (Diener et al 1985) Meaning in Life (Steger, et al. 2006) Autonomy, Competence, & Relatedness (Ryan & Deci, 2000) Global Life Satisfaction Global Happiness Domain specific LS (education; work; spiritual, religious/philosophical
beliefs; housing; family life; health; friends & social life; neighborhood; ability to help others; achievement of goals; leisure; physical safety; energy level)
CDC HRQOL-4
Porter Novelli HealthStyles 2008, 20102010 BRFSS (Satisfaction with Life Scale +
happiness + 4 domain specific LS) in NH, WA, OROpportunities to collaborate
CDC Well-Being 2008-2011 Pilot Testing
Conclusions Moving Toward Health Through Well-Being and Positive Mental Health
Positive mental health and well-being comprise an asset-based approach to health promotion, elevating health to a positive state, inclusive of resources to help promote and protect health
Public health practice might supplement psychological notions of well-being with physical domain for greater health impact
Promoting positive mental health might be an effective prevention strategy to delay onset of disease and improve its management
Evidence-based positive mental health interventions are available for use, but require more evaluation in diverse populations
Validated measures of well-being exist to monitor well-being
HP2020 will begin to track well-being, and may set goals to improve well-being—we need your help!
CDC Health-Related Quality of Life and Well-Being Website & Resources: http://www.cdc.gov/
hrqol
Disease Health
Assets for full, productive, satisfying lifePrevention
“…avoid or minimize pathological conditions.”
Disease model vs. Salutogenic model(Mental Illness vs. Mental Health) (Keyes, 2005, 2007)
• Positive emotions• Meaning/fulfillment• Satisfying relationships• Autonomy, mastery,• Achievement • Physical vitality • Community supports (e.g., employment; access to care; housing; parks)
“PERMA” (Seligman 2011)
“FLOURISHING” (Keyes, 2007)
“Positive Mental Health” (WHO, 2005, 2009; Barry & Jenkins 2007)
Population Mental HealthFosters individual competencies, resources, and psychological strengths, and strengthens community assets to prevent mental disorder and enhance well-being and QOL (Herrmann et al. 2005; Barry & Jenkins 2007; Friedli, 2009)
? Health is the ability to adapt and self-manage in the face of social, physical, and emotional challenges (Huber et al., 2011)