Background
Methods
Sampling
Study setting
Exercise | Brief description |
---|---|
Positive Introduction | Write short story at your ‘best’ |
Identifying strengths | Person completes Values in Action Inventory of strengths (VIA-IS). Their family/ friend completes shorter version |
Strengths plan | Plan to use top strengths in daily life |
Blessings journal | Record three good things per day |
Writing memories | Write three bad memories and distress |
Forgiveness letter | Write to someone that want to forgive but do not deliver letter |
Gratitude letter | Write to someone never properly thanked and deliver letter |
Personal satisficing plan | Plan to settle for good enough compared to trying to find the ‘best’ option |
One door closes, one door opens | Write times when something important did not happen but other opportunities did |
ACR | Practice being enthusiastic and supportive of others’ meaningful and important news |
Family strengths tree | Each family member completes VIA-IS followed by group discussion |
Savoring activity | Attempt to make pleasure last |
Gift of time | Use strengths in the service of others |
Analysis
Author 1 SW | Author 2 JK | Author 3 ST | Author 4SP | |
---|---|---|---|---|
Professional role and credentials | Health services researcher, BSc | Health services researcher, MSc | Health services researcher and GP | Psychiatrist, psychotherapist, researcher |
Role in the research | Interviewer, lead analyst | Support data analysis | PhD supervisor | PhD supervisor |
Potential influence on interview conduct or analysis | Established relationships with interviewees Lead on project developing an online positive psychological intervention (PhD project) Familiarity with positive psychology and eHealth literature | Familiarity with mental health services research literature | Familiarity with eHealth literature | Familiarity with resource-oriented treatments and existing mental health service practice and literature |
Results
Participants
Themes
1. The fit between a positive psychological approach and context | 2. Balancing the social | 3. The role of support | 4. Persuasive design |
---|---|---|---|
1.1. Ability to identify positives 1.2. Feeling misunderstood 1.3. A complementary approach 1.4. Cultural fit | 2.1. Connecting to overcome self-absorption 2.2. Complexities in social relationships 2.3. Technology: promoting isolation or connection? | 3.1. Managing emotions 3.2. Promoting independence vs. motivation 3.3. Service capacity | 4.1. Appeal and accessibility 4.2. How much is expected 4.3. Credibility 4.4. Tailoring and targeting |
The fit between a positive psychological approach and context
‘This sounds really awful but people that are negative in general, even when they are well, tend to have quite a negative outlook on things – those are the people that are at more of a risk I think of not responding well to this treatment because their general…some people’s personality is negative.’ (Patient, 0504).
‘When you’re down automatically everything comes out negative. You’re never gonna say alright, I’m negative and I want to think about positive things because the mind won’t let it.’ (Patient, 0401).
That probably was the lowest point in my life, I think I probably would have found it really hard, ‘cos actually things weren’t going well at that time – actually […] I hadn’t found a job, relationship was in pieces, like things were pretty strained with my parents […] so I think it would be really hard [laughter] to like, like drawing blood out of stone… (Patient, 0502).
‘I think the biggest kick in the teeth when you’re feeling particularly depressed is when it almost feels like people are putting your feelings to one side and saying oh, shh, you know just stop it, whatever, feel good’, (Patient, 0503).
‘I mean that’s…I think when you’re suffering through a dark time, even the phrase positive thinking is enough to make you sick; it seems like you know a phrase with which people are refusing to understand you,’ (Patient, 0901).
I know it’s all about positivity, which is fantastic – we all need positive vibes […] but I’m wondering if […] you can look at where you don’t wanna go […]. So when you’re feeling really bad you know like self-medicating, self-harm, that’s where I don’t wanna go. (Patient, 0702).
‘If […] you’ve been, you know really depressed for six months or something like that, then you’d probably have to be medicated in order for you to kind of have the presence of mind in order to focus on the positive aspects.’ (Patient, 0506).
‘It might not be easy for them to do it immediately, but it’ll certainly make them think oh well this is stuff I can work towards and do and be positive about enjoying the positive emotions that come with it,’ (Psychological therapist, 1402).
‘A lot of the American terminology is […] construed by British people to be a bit over the top.’ (Clinical Psychologist, 1403).
‘You just need to word it differently and yeah. ‘Cos it sounds a bit kind of churchy and yeah, like happy-clappy yeah[h]. […] it needs to be a completely non-religious thing that you’re gonna do […] you want people of all different faiths and people that haven’t got faiths to be able to do it’(Patient, 0504).
‘I don’t even like the word ‘grateful’ because I’m like, well I am very grateful but I don’t really need to be told to be grateful unless you’re being like a spoilt brat – that’s different. So I’m just a bit like wary of that word because […] [its] very like ‘this is the way’ like gratitude, like that’s what you should be feeling’ (Patient, 0903).
Balancing the social
‘To make myself feel better like I do volunteer […] it’s just like a good thing to do to like get out of yourself, and to go do and then like come home and you’ve been out of the house but it’s for a purpose.’ (Patient, 0903).
‘I might be thinking very positive myself, I may not come out like that. You know so if it comes out like you know very sort of [pause] blurry and[…], slow or it doesn’t come out – my facial actions, my eye contact, stuff like that – if it’s not connecting then maybe words doesn’t make no difference’ (Patient, 0703).
‘The only thing that I am a bit hesitant or sceptical about is about the voluntary side of stuff – especially if you can’t give too much time or effort because actually maybe you’re actually in need of things yourself’ (Patient, 0902).
‘Something that’s…that encourages an open, alternative form of relationship – it’s about fostering relationships. So …and family is just one of those. And now you can have a family of friends, you know?’ (GP, 1401).
‘Where depression may relate to isolation, I think technology is inherently isolating, so I think you’d probably meet some resistance on that front’ (Patient, 0901).
‘We’re not saying it’s the be-all and end-all, but definitely has a place to get people understanding information or you know ideas. And it…one of the ideas could be this outside-in approach that’s on the app, so they know that it’s not just about the phone, it’s about doing things for friends and family’ (Psychological therapist, 1402).
‘If you want to speak to other people that are going through something similar, it’d be good to have that option but then I suppose on the negative side of that do you really want lots of negative people talking to other negative people, because it could end up putting you in a downward spiral.’ (Patient, 0704).
The role of support
‘How would the app say to you oh […] it wasn’t your fault, or this shouldn’t have happened, or it’s not that bad, or like it has happened but you’ve gotta put it in the past – an app can’t tell you that. That could be quite, that could be good and it could be very bad; that could trigger something off couldn’t it?’ (Patient, 0101).
‘Yeah, ‘cos I’m a terrible sort of procrastinator or whatever – I can put anything off, unless other people are involved and then, if you’re accountable then you do it.’ (Patient, 0501).
‘You know what if they give up then that’s their choice isn’t it? But I think if you say…and I check this [taps the table repeatedly] and you’d better do it because I will check it, then it’s not self-help anymore’ (GP, 1501).
‘And I think it needs support and I think this is where…. this is what is lacking in GP surgeries and all over the country, is the support. The support network, befriending network – like people like MIND [mental heath charity] who, you know do a fantastic job’ (Patient, 0505).
Persuasive design
Presented in a […] way where it’s softer round the edges […] so it looks a bit more like an app that you’d wanna kind of play with, but it’s actually helping as well, rather than being something that’s like medical and psychologically necessarily termed. (Psychological therapist, 1404).
‘Maybe not necessarily how it looks but how you actually use it would be quite important to me. I often notice things in apps that like are a bit ‘buggy’ or actually that’s a bit of a pain to do.’ (Patient, 0201).
I guess if you’re doing it [forgiveness letter] in the sense of an app I wouldn’t…like things which is like questionnaires and you know write three things positive about yourself and all that, like I think that sounds all good, because it’s like much more surface level, whereas a letter is much more, you know it’s getting to the nitty-gritty. So I probably wouldn’t…yeah I’d probably just skip over. (Patient, 0903).
I think you should have more than one because I think people lose interest quickly if it’s just one thing I think.’ (Patient, 0101).
I wouldn’t wanna be bombarded, because one a day is quite good, one at a time, and then you go on to a next level. Whereas if it’s all at once you don’t know what’s hitting you and you can get bored with that, and you give up, ‘cos it’s too much – overwhelming. (Patient, 0701).
It makes sense [to have the NHS logo] because then I think people trust this app more than when it’s just a commercial thing. Yeah, it’s like you know when they look on the Internet for advice, they always trust ‘NHS Choices’ or the NHS website more than any other website. (GP, 1501).
So somebody’s opinion that you trust whether that’s a person in position of authority or a person that you know has been through similar things. (Patient, 0506).
I think it’s gonna be hard to rely on somebody to log back in and look at the good things that they’ve said about themselves that day […] so it’d be good to have something to come up and say look, this is what you’ve said about yourself in the week – just to make you feel good. (Patient, 0704).
Cos that was something about ‘Beating the Blues’, that some of the examples are quite specific and they were quite difficult to relate to if you weren’t whatever, 44, you were an old man or whatever it was. (Clinical Psychologist, 1403).
You know there’s an algorithm that goes right they’re thinking about that thing so that kind of unlocks a different element about it […] you know if they are engaged in doing this exercise then having loads more unlock levels of that thing I suppose. (Psychological therapist, 1404).