If a patient has high cholesterol or sugar, the doctor may prescribe a drug to lower what is too high, but he/she generally adds some suggestions: for instance to avoid certain types of food, to do more physical activity, to refrain from smoking. What the patient does is defined as self-therapy or self-management and is at least as important as a drug that is prescribed. But if someone has a low mood and seeks medical help, the doctor–particularly if he or she is a psychiatrist–will likely just prescribe a drug and not encourage any “self-therapy.”
The problem with his approach to care is that psychiatric drugs, even when they are properly prescribed, may help very little in the long run and create a number of additional problems.(1)
In the 1990s, I became particularly concerned about the high risk of relapse in depression and its link with residual symptomatology (2). Other investigators became similarly concerned. It was not easy to help patients get better, but it was even more difficult to help them keep well. I was looking for a psychotherapeutic strategy that could increase the level of recovery, that could enhance self-therapy, that could build on a person’s resources. This was the setting where I developed a psychotherapeutic technique for increasing psychological well-being, which I dubbed Well-Being Therapy (WBT) (3).
This specific psychotherapeutic technique for increasing psychological well-being and resilience has been validated in a number of randomized controlled trials (4). It is a short-term strategy, that emphasizes self-observation, with the use of a structured diary, interaction between patients and therapists, and homework. Patients are encouraged to identify episodes of well-being in a diary and to set them into a situational context. Once the instances of well-being are properly recognized, the patient is encouraged to identify thoughts and beliefs leading to premature interruption of well-being (automatic thoughts), as is performed in cognitive therapy.
However, the trigger for self-observation is different, as it is based on well-being instead of distress. Cognitive restructuring along dimensions of psychological well-being may then take place; activities that are likely to elicit well-being and optimal experiences are encouraged. The findings from controlled studies indicate that flourishing and resilience can be promoted by specific interventions leading to a positive evaluation of one’s self, a sense of continued growth and development, the belief that life is purposeful and meaningful, the possession of quality relations with others, the capacity to manage affectively one’s life, and a sense of self-determination. A decreased vulnerability to depression and anxiety also has been demonstrated after well-being therapy in high-risk populations (5, 6).
I have written a manual for its use (4), with information that is useful for patients who want to pursue self-therapy that may help them obtain recovery. The book consists of 3 parts. The first describes how WBT was developed and how it was validated by a number of controlled trials. The second part outlines the type of assessment that is necessary for its application and provides the treatment manual, session by session, with descriptions of clinical cases. The third part deals with the current indications of WBT based on controlled studies and other potential applications: depression, mood swings, generalized anxiety disorder, panic and agoraphobia, post-traumatic stress disorder and the interventions in school settings. It is a detailed clinical account about how to use WBT in those settings. It is not a self-help book, but it includes information that pharmaceutical propaganda does not make easily available and may be crucial for the management of mood and anxiety disorders.
- Fava GA: Rational use of antidepressant drugs. Psychother Psychosom 2014;83:197-204
- Fava GA: The concept of recovery in affective disorders. Psychother Psychosom 1996; 65: 2-13.
- Fava GA: Well-being therapy: conceptual and technical issues: Psychother Psychosom 1999; 68: 171-179.
- Fava GA: Well-Being Therapy. Treatment Manual and Clinical Applications. Basel, Karger, 2016.
- Fava GA, Rafanelli C, Grandi S, Conti S, Belluardo P: Prevention of recurrent depression with cognitive behavioral therapy: preliminary findings. Arch Gen Psychiatry 1998; 55: 816–820.
- Fava GA, Ruini C, Rafanelli C, Finos L, Conti S, Grandi S: Six-year outcome of cognitive behavior therapy for prevention of recurrent depression. Am J Psychiatry 2004; 161: 1872–1876.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.