Well-Being Therapy: starting with the good things

The term "well-being therapy" (WBT) sounds more like"positive thinking" than a serious therapy concept. Nevertheless, this approach appears to significantly reduce, for example, relapse rates in depression. Reason enough not to be deterred by the term and to consider it in current medical discussions.

The holistic clinical approach provides therapeutic focus to well-being episodes

The term "well-being therapy" (WBT) sounds more like"positive thinking" than a serious therapy concept. Nevertheless, therapy goals that cannot be achieved by psychoanalysis or behavioral therapy alone seem to be achieved with this approach. In particular, the relapse rate in depression seems to be significantly reduced. Reason enough not to be deterred by the term and to consider it in current medical discussions.

At this year's 9th World Congress of Behavioural and Cognitive Therapies 2019, which took place in Berlin in July, WBT was discussed in front of a large specialist audience. The most important representative and developer of the WBT, Giovanni Flava, psychiatrist and clinical psychologist at the University of Bologna, was invited. In his lecture, he explained the principles and functionalities while clearing up some prejudices against the approach.

The concept

WBT is a structured, guided and problem-oriented technique that was developed in the late 1990s when the treatment of depression with cognitive behavioral therapy did not show the desired results. WBT usually consists of eight to sixteen sessions. Depending on whether behavioral therapy has already been carried out, there may also be fewer sessions. The focus is on observing one's own well-being, using a structured diary. The patients receive concrete homework which they have to write down. In contrast to other forms of therapy, WBT does not start with observing the problem, but rather with remembering moments of well-being, naming them and only in the next step finding out when negative automatic thoughts and stress triggers occur.

According to Flava, this procedure often initially alienates patients: As a rule, they want to talk about their bad state of health and often do not spontaneously know how to name any positive events. Statements like "The diary will remain empty" or "I never feel well" are not correct, according to Flava. There are always - albeit short - moments of well-being, one only has to track them down. This monitoring of episodes of well-being happens in the first sessions. In the middle sessions, we try to identify the moments and thoughts that lead to an interruption of well-being. Finally, in the final sessions, the dysfunctional thoughts are discussed and modified according to the state of well-being.

Six dimensions

This is not about "positive thinking", but about achieving a balanced, functional state of health in various areas of life. The six dimensions for positive mental health, developed by Marie Jahoda as early as 1958, serve as a basis for this.

Environmental mastery

Personality growth

Purpose in life

Autonomy

Self-acceptance

Positive relationships with others

Summary

WBT is not a psychotherapeutic technique in its own right but is linked to further therapeutic measures and clinical prerequisites. Basically, it is an integrative clinical approach based on the monitoring of psychological well-being, which can be combined with any psychotherapeutic technique under appropriate indication. Thus, it should always be clarified in advance whether and how a patient can benefit from WBT. Since most patients in clinical practice suffer from complex and/or chronic disorders, a differentiated diagnosis and individual treatment strategy are indispensable.

Source: 
WCBCT2019, Berlin: Presentation by Giovanni A. Flava: The Clinical Role of Well-Being Therapy

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