AbstractLike many treatments for depression,the study aims to see whether mindfulness meditation or positive psychologyinterventions would have an effect on depressive symptoms, trait anxiety,positive affect and negative affect in a group of non-depressed individuals. 20participants were recruited with 12 of the participants being Caucasian, 7being Asian, and 1 being Hispanic.
The participants, ranging from ages of 20 to33 years old, with 7 being male and 13 being female, were assigned to either amindfulness intervention group of breathing exercises or a positive psychologyintervention group of keeping a gratitude journal. Prior to treatmentassignment, the participants were given anassessment that measured depression symptoms, trait anxiety, positive affectand negative affect using the Beck Depression Inventory (BDI-II), State-TraitAnxiety Inventory (STAI) and Positive Affect and Negative Affect Schedule (PANAS).At follow-up, after a 2 week period of interventions, the participants filledout the same initial assessment.
For both the BDI-II and the STAI scores, keepinga gratitude journal had a greater effect in the reduction of depressivesymptoms and trait anxiety. In regards to the PANAS scores, mindfulnessmeditation had a greater reduction in negative affect while positive psychologyshowed greater increase in positive affect. For both interventions, there was adifference between pre-treatment and post-treatment which suggests that bothinterventions did indeed have a significant effect. While behavioral activationhas been proven effective in depressed populations, it can be modified intopositive psychology and mindfulness interventions to improve the mental healthof a non-depressed population.
IntroductionMajor depressive disorder (MDD), alsoknown as depression, is a serious mental health illness, and an importantpublic health issue. According to the World Health Organization, more than 300million people of all ages suffer from depression globally (“Depression,” n.d.).Depression is the leading cause of disability in the United States for ages 15to 44 (“Anxiety and Depression Association of America: Depression,” n.
d.). Itaffects more than 16.1 million American adults, or about 6.7% of the U.S.
population of ages 18 and older in one given year. It is more prevalent in womenthan in men; and while it can develop at any age, the median age of onset isaround 32.5 years old (“Anxiety and Depression Association of America:Depression,” n.d.).
According to the DSM-5, five of more of the nine symptomslisted must be present during the same two-week period and present a changefrom previous functioning for a diagnosis. The nine symptoms include adepressed mood for most of the day and nearly every day, diminished pleasure inpreviously enjoyable activities, significant changes in weight and appetite, insomniaor hypersomnia, psychomotor agitation, fatigue or loss of energy, feelings ofworthlessness, diminished ability to think or concentrate, and recurrentthoughts of death or suicide (American Psychiatric Association, 2013).Thereis broad literature on the etiology of depression. Research states that thereare genetic, biological, environmental and interpersonal processes thatcontribute to depression (England, 2009, p.
56). More recent research promotesthe idea that the complex interactions and combinations of multiple factors areassociated with increased risk for depression (p. 56). For example, the diathesis-stress model focuses on the relationshipbetween potential causes of depression and individuals’ degree of vulnerabilityto react to those causes. The diathesis-stress model suggests that people have,to varying degrees, certain vulnerabilities or predispositions for developingdepression, where an interaction with stressful life events will prompt theonset of the illness (p. 57).
Biologicalfactors such as neurological and genetic mechanisms appear to play a role inthe development of major depression (England, 2009, p. 73). Researchers andscientists have identified many neurotransmitters related to the neurobiologyof depression with two being the monoamine neurotransmitters serotonin andnorepinephrine (Aan het Rot, Mathew, Charney, 2009, p. 305). The research focusingon these two neurotransmitters states that individuals with depression arelikely to have low levels of these neurotransmitters because various effectiveantidepressant drugs have been shown to acutely increase their levels (p. 306).
Ona genetic level, scientists have not identifieda specific gene or a series of genes that cause depression. Rather, “certainvariations in genes, called polymorphisms, may increase risk for depression” (Aanhet Rot et al., 2009, p. 306). Among these, are genes of the serotonin system(5-HT).
Studies investigating the role of genetic polymorphisms in theserotonin-related genes in the etiology of depression have revealed theserotonin transporter (5-HTTLPR) gene to be very of importance. Caspi et al.(2003) found that those with one or two copies of the short allele of 5-HTTLPRexperienced more depressive symptoms and presented with higher rates of depressionin response to stressful life events than individuals who are homozygous forthe long allele.Environmentalfactors play a large role in the studies of depression’s etiology. There is acommon understanding that depression may occur as reaction to negativeenvironmental circumstances, and etiological models are largely from adiathesis-stress perspective as mentioned earlier. Etiological literature tendsto focus on three main environmental stressors: acute negative life events,chronically stressful life circumstances, and exposure to adversity in childhood(England, 2009, p.
85).Thereare various different forms of treatment for depression. Health-care providersmay choose to offer psychological treatments (such as cognitive behavioraltherapy (CBT), interpersonal psychotherapy, and behavioral activation),antidepressant medication (such as selective serotonin reuptake inhibitors andtricyclic antidepressants) or somatic treatments (electroconvulsive therapy(ECT)) in more severe cases of depression. The effectiveness of each treatmentoften varies from person to person.Behavioralactivation (BA), a newer form of therapy treatment, often structured in 12 or24 sessions, is a formal therapy that focuses on scheduling activities toencourage patients to approach those that they are avoiding, and then analyzingthe function of the cognitive processes that serve as a form of avoidance(Veale, 2008, p. 29).
The main goals of BA are to “increase engagement inadaptive activities, decrease engagement in activities that maintain depressionor increase risk for depression, and solve problems that limit access to rewardor that maintain or increase aversive control” (Dimidjian, Barrera, Martell, Muñoz,and Lewinsohn, 2010, p. 3). With all the research into BA, many studies havebeen conducted regarding its efficacy as a treatment option. In a recent studyconducted by Richards et al.
(2016), 440 participants diagnosed with depressionwere recruited, where 221 participants were assigned to a full course of BA and219 participants were assigned to a full course of cognitive behavioral therapy(CBT). At follow-up, the researchers found that the BA treatment, a simplerpsychological treatment than CBT, had no lesser effect than CBT and wastherefore equally effective.BAhas shown to improve the mental health of those suffering from depression.Likewise, the activities and focus of BA should therefore also benefit thosewho do not suffer from depression. BA can thus be modified into activities thatwould improve the mental health of the average person not suffering fromdepression using both positive psychology and mindfulness as methods of BA.Positivepsychology, pioneered by Martin Seligman, is “the scientific study of thestrengths that enable individuals and communities to thrive; and is foundedon the belief that people want to lead meaningful and fulfilling lives, cultivatewhat is best within themselves, and enhance their experiences of love, work,and play” (Seligman, 2000). It focuses not only on well-being, but also onhappiness, where happiness is broken down into three domains: pleasure, engagement,and meaning (Seligman, 2000). In one study of positive psychology by Kyeong etal.
(2017), the neurobiological consequences of a gratitude meditationintervention and resentment intervention were assessed using the fMRI dataacquired during the interventions. The results showed that the average heartrate was significantly lower during the gratitude intervention than during theresentment intervention, indicating a resting-state of well-being. In anotherstudy, 119 women were randomly assigned to either a gratitude intervention groupor no treatment group for a duration of two weeks (Jacowska, 2016, p. 1). Atfollow-up, the treatment showed to improve subjective well-being through acorrelated increase in sleep quality and reduction in blood pressure (p. 8).Similarlyto positive psychology, mindfulness, pioneered by Jon Kabat-Zinn, focuses on astate of active and open attention on the present.
In cultivating mindfulness,there are seven attitudinal foundations that include: non-judging, patience,beginner’s mind, trust, non-striving, acceptance, and letting go (Kabat-Zinn, 2013,p. 18). Mindfulness is a sense that there is a way of being, a way of lookingat problems, and a way of coming to terms with catastrophe that can make lifemore joyful and rich (p. 19). In one study conducted by Stjernswärd and Hanssonin 2016, 97 participants were recruited from families living with a person withmental illness to undergo an 8-week web-based mindfulness intervention. At post-interventionfollow-up, there were significant improvements in levels of mindfulness, aswell as significant improvements in levels of perceived stress, caregiverburden, and self-compassion (Stjernswärd S.
, Hansson L., 2016). There has alsobeen research in regards to mindfulness and its relation to stress reduction.In one specific study, 109 random bachelor students of the University ofInnsbruck were recruited and assigned to either and intervention group of mindfulness-basedself-leadership training (MBSLT) or a control group. After the 10-weekintervention, results showed that while participants of the control groupshowed an increase in stress over time, the participants of the interventiongroup maintained constant stress levels over time. Furthermore, the MBSLT overtime led to a reduction of test anxiety in participants in the intervention group.
Researchon positive psychology and mindfulness have shown that both have positiveeffects on one’s well-being. In one study conducted by Leary and Dockray in2015, the efficacy of these two dual-component interventions on reducing depressionand stress and increasing happiness levels was assessed. In the study, 65 femaleparticipants were randomly assigned to a wait-list control condition or toeither a gratitude or a mindfulness intervention condition. After 3 weeks ofintervention, results showed that the outcome variables of depression, stressand happiness improved over time for both the gratitude and mindfulnessinterventions but not for the wait-list control group. These results show thatinterventions based on both positive psychology and mindfulness seem to providea useful way to enhance well-being.The current study therefore focuses on theefficacy of positive psychology and mindfulness as interventions for improvingthe mental health of a non-depressed participant group. Specifically, our studyutilizes gratitude journals and mindfulness breathing exercises as interventions,where the effectiveness of both will be assessed through the outcome variablesof reducing depression symptoms, decreasing anxiety, increasing positive affectand decreasing negative affect, measured using the Beck Depression Inventory(BDI), the State and Trait Anxiety Inventory (STA), and the Positive and NegativeAffect Scale (PANAS), respectively. While many studies have been conducted onthe efficacy of either positive psychology or mindfulness, or on the efficacyof both; there have been little studies that compare which one of the two seemto be more effective.
Therefore, rather than assessing whether both interventionswill be equally effective, our study aims to see whether one will be morebeneficial than the other. Despite research on the benefits of both positivepsychology and mindfulness, the hypothesis of this study is that writing agratitude journal will have a greater effect on reducingdepressive symptoms, reducing state trait anxiety, decreasing negative affectand increasing positive affect than practicing mindful breathing.MethodsParticipantsA total of 20 subjects were recruited for this study. The participants’ages ranged from 20 to 33 years old (M=21.85, SD= 2.92). 12 of the participantswere Caucasian, 7 were Asian and one participant was Hispanic.
Of the 20participants, there were 13 females and 7 males. MeasuresThe measures used in the study areused to measure the outcome variables of mindfulness breathing intervention andgratitude journal intervention. The measures include the Beck DepressionInventory-II (BDI-II), the State-Trait Anxiety Inventory (STAI), and the Positiveand Negative Affect Schedule (PANAS).The Beck Depression Inventory-II(BDI-II) (Beck et al.
1996), is a 21-question multiple choice self-report measureused to measure the severity of depression. When presented with the BDI-II, apatient is asked to consider each statement as it relates to the way they havefelt for the past two weeks, according to a scale from 0-3 (0 being least, 3being most). The total score of 0-13 is minimal range, 14-19 is mild, 20-28 ismoderate, and 29-63 is severe. The BDI-II has demonstrated good 1-week retest reliabilityand strong internal validity (r=0.
93, ? =.91).The State and Trait Anxiety Inventory (STAI) (Spielberger etal. 1983), is a self-report measure inventory that consists of 40 itemspertaining to anxiety. The STAI measures both state anxiety and trait anxiety.There is also a fairly strong retest-reliability and internal validity (r=0.65and 0.
75 over a 2 month period, ? =.86).The Positive and Negative Affect Schedule (PANAS) (Watson etal. 1988) is used to measure positive and negative affect. It is comprised oftwo mood scales, one that measures positive affect and the other which measuresnegative affect. This 20 item questionnaire consists of words that describedifferent feelings and emotions, where participants are required to respondusing a 5-point scale that ranges from very slight or not at all (1) toextremely (5).
It has also demonstrated an overall strong retest-reliability andinternal validity (positive: r=0.68, ?=0.86; negative:r=0.71, ? =0.87). ProcedureA group of 20 participants werechosen to take part in the study. Participants filled out measures of theBDI-II, STAI, and PANAS at baseline and two weeks later at follow-up. Eachparticipant was randomly assigned to either a mindfulness intervention group ora positive psychology intervention group for a total of 2 weeks.
Themindfulness intervention group had participants partake in mindfulnessbreathing exercises, while the positive psychology intervention group had theparticipants keep a gratitude journal. After the 2 week period of interventions,the participants were gathered and were required to fill out the sameassessment as the initial using each of the measures (BDI-II, STAI, PANAS). Thescores were used to assess which intervention was better at reducing depressionsymptoms, decreasing anxiety, increasing positive affect and decreasing negativeaffect.
ResultsIn order to assessthe significance of the data from our study, both an independent-samples t-testand a paired-samples t-test were conducted. The independent samples t-test wasconducted to assess mindfulness meditation or writing in a gratitude were moreeffective at decreasing scores on the Beck Depression Inventory-II, State-TraitAnxiety Inventory, and the Positive and Negative Affect Schedule. There was asignificant different in BDI-II scores between the mindfulness meditation intervention(M=-5.
10, SD=4.60) and positive psychology intervention (M=-9.80, SD=5.05)conditions; t(18)=-2.174, p < .05) There was a significant difference inSTAI scores between the mindfulness meditation intervention (M=-10.50, SD=3.
84) and positive psychology intervention (M=-4.60, SD=4.45); t(18)= 3.17, p< .01. There was also a significant difference in negative affect (NA)scores between the mindfulness meditation intervention (M=-6.
40, SD=2.46) andpositive psychology intervention (M=-3.60, SD=2.41); t(18)=2.57 and p < .
05.Mindfulness Meditation, with a mean difference of -6.40, had a greater effectin reducing negative affect in our participants as opposed to the PositivePsychology Intervention with a gratitude journal. Lastly, a significantdifference can be seen in the PANAS scores of Positive Affect for PositivePsychology (M=9.5, SD=2.46) and Mindfulness Meditation (M=1.
8, SD=3.43)conditions; t(18)=5.77, p < .01.Thepaired-samples t-test was run to assess whether the mindfulness meditationintervention and positive psychology intervention were effective.
There was asignificant difference in BDI-II scores from pre (M=17.85, SD=10.34) to post (M=10.40,SD=7.96); t(19)=6.30, p < .
01. There was a decrease in STAI scores from pre (M=49.75,SD=13.51) to post (M=42.20, SD=12.34); t(19)=6.68, p < .
01. There was also adecrease in NA from pre (M=25.15, SD=6.73) to post (M=20.15, SD=5.91);t(19)=8.07; p < .
01. Lastly, there was an increase in positive affect (PA)from pre (M=27.25, SD=6.
02) to post (M=32.90, SD=6.67); t(19)=-5.16, p <.01.DiscussionThe study examinesthe effect of mindfulness and positive psychology as an intervention forimproving the mental health of non-depressed college students. In our study,subjects are assigned to either a mindfulness breathing intervention or apositive psychology intervention where they keep a gratitude journal, in orderto see their effects on depressive symptoms, trait anxiety, and positive andnegative affect. The study hypothesizes that writing in a gratitude journalwould have a greater effect on reducingdepressive symptoms, reducing state trait anxiety, decreasing negative affectand increasing positive affect than practicing mindful breathing.
At follow-up afterconducting an independent samples t-test, the results showed that in our studyof 20 participants, the positive psychology intervention group had a largerreduction of depression symptoms and state trait anxiety and a larger increaseof positive affect, while the mindfulness intervention group showed a largerdecrease in negative affect. This shows that while our results support theaspects of the hypothesis that state that positive psychology will have agreater effect on reducing depressive symptoms, reducing state trait anxiety,and increasing positive affect, it did not however, support our hypothesis thatpositive psychology will have a greater effect on decreasing negative affect.Despite this, these results seem to suggest that overall, the positivepsychology intervention of keeping a gratitude journal is more effective in increasingthe mental well-being of our non-depressed participants.
Gratitude is oftenassociated with positive feelings, and thus it would only be logical thatkeeping a gratitude journal can increase positive affect and ultimately reducesymptoms of depression in both a depressed and non-depressed population.There have been manystudies that research the association between a grateful attitude and itsimpact on a psychological and physical well-being. In astudy conducted by Kwok et al., in 2016 in Hong Kong, they hypothesized “thatthe increase in hope, altered by the hope intervention, should predict lowerdepression and greater life satisfaction following intervention” (Kwok, 2016,p. 351). In their study, the efficacy of a positive psychology program forpreventive intervention as well as its efficacy specifically for depression inChinese children in Hong Kong was assessed.
The findings of that study suggestthat the intervention “enhanced human strengths of hope and gratitude, which inturn contribute to consequent decrease in depressive symptoms and increase inlife satisfaction” (p. 359). Furthermore, in their study, they also listed paststudies and research that were conducted in regards to positive psychology. Nineexperimental studies were cited in support of their own; with the studies includedbeing Berg et al., 2008; Cheavens, Feldman, Gum, Michael, & Snyder, 2006;Duggleby et al., 2007; Feldman & Dreher, 2012; Klausner, Synder, , 2000; MacLeod et al., 2008; Marques, Lopez, et al., 2011; Rustøen,Cooper, & Miaskowski, 2011 and Rustøen & Hanestad, 1998.
Overall, theresults of these studies also show that the experimental groups consisting ofpositive psychology interventions reported significant increases in hope and inother positive outcomes such as subjective well-being.Similarly to our study, ina study done by Emmons and McCullough in 2002, it was found that gratitudecorrelated with trait measures of positive affect, vitality, optimism, envy,depression, and anxiety. In hisstudy, participants were randomly assigned to 1 of 3 interventiongroups, these group conditions being hassles, gratitude listing, and eitherneutral life events or social comparison.Participants kept daily records of their moods, coping behaviors, health behaviors,physical symptoms, and overall life appraisals. The results of the studyshow that the gratitude-outlook groups demonstrated an overall heightenedwell-being across several of the outcome measures used. Ultimately this study’sresults “suggest that a conscious focus on blessings may have emotional andinterpersonal benefits”, which would support the hypothesis and result from ourstudy (Emmons & McCullough, 2003, p.
377).Withall the research in support of positive psychology beingan effective intervention to increase well-being and positive affect in both adepressed and non-depressed population, it seems to show that there is potentialfor positive psychology to become a more common treatment for depression.Despitethat fact that the results from our study overall support those of manyprevious studies, we did however, have certain limitations that need to beaddressed.
First, our sample was very small, only totaling 20 participants.Second, our sample was fairly racially and ethnically homogeneous, which is representativeof the general population. Third, there was no way to confirm that participantshad in fact completed the interventions at home.
To conclude, further research can be donein order to provide more support for positive psychology as a treatmentintervention for depression. While our study was conducted using anon-depressed population, similar studies can be done using the procedure fromour study but conducted with a depressed population of a larger sample size inorder for significant results to be produced.