Critical Thinking

Abstract Like many treatments for depression, the study

Abstract

Like many treatments for depression,
the study aims to see whether mindfulness meditation or positive psychology
interventions would have an effect on depressive symptoms, trait anxiety,
positive affect and negative affect in a group of non-depressed individuals. 20
participants were recruited with 12 of the participants being Caucasian, 7
being Asian, and 1 being Hispanic. The participants, ranging from ages of 20 to
33 years old, with 7 being male and 13 being female, were assigned to either a
mindfulness intervention group of breathing exercises or a positive psychology
intervention group of keeping a gratitude journal. Prior to treatment
assignment, the participants were given an
assessment that measured depression symptoms, trait anxiety, positive affect
and negative affect using the Beck Depression Inventory (BDI-II), State-Trait
Anxiety Inventory (STAI) and Positive Affect and Negative Affect Schedule (PANAS).
At follow-up, after a 2 week period of interventions, the participants filled
out the same initial assessment. For both the BDI-II and the STAI scores, keeping
a gratitude journal had a greater effect in the reduction of depressive
symptoms and trait anxiety. In regards to the PANAS scores, mindfulness
meditation had a greater reduction in negative affect while positive psychology
showed greater increase in positive affect. For both interventions, there was a
difference between pre-treatment and post-treatment which suggests that both
interventions did indeed have a significant effect. While behavioral activation
has been proven effective in depressed populations, it can be modified into
positive psychology and mindfulness interventions to improve the mental health
of a non-depressed population.

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Introduction

Major depressive disorder (MDD), also
known as depression, is a serious mental health illness, and an important
public health issue. According to the World Health Organization, more than 300
million people of all ages suffer from depression globally (“Depression,” n.d.).
Depression is the leading cause of disability in the United States for ages 15
to 44 (“Anxiety and Depression Association of America: Depression,” n.d.). It
affects 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 women
than in men; and while it can develop at any age, the median age of onset is
around 32.5 years old (“Anxiety and Depression Association of America:
Depression,” n.d.). According to the DSM-5, five of more of the nine symptoms
listed must be present during the same two-week period and present a change
from previous functioning for a diagnosis. The nine symptoms include a
depressed mood for most of the day and nearly every day, diminished pleasure in
previously enjoyable activities, significant changes in weight and appetite, insomnia
or hypersomnia, psychomotor agitation, fatigue or loss of energy, feelings of
worthlessness, diminished ability to think or concentrate, and recurrent
thoughts of death or suicide (American Psychiatric Association, 2013).

There
is broad literature on the etiology of depression. Research states that there
are genetic, biological, environmental and interpersonal processes that
contribute to depression (England, 2009, p. 56). More recent research promotes
the idea that the complex interactions and combinations of multiple factors are
associated with increased risk for depression (p. 56). For example, the diathesis-stress model focuses on the relationship
between potential causes of depression and individuals’ degree of vulnerability
to react to those causes. The diathesis-stress model suggests that people have,
to varying degrees, certain vulnerabilities or predispositions for developing
depression, where an interaction with stressful life events will prompt the
onset of the illness (p. 57).

Biological
factors such as neurological and genetic mechanisms appear to play a role in
the development of major depression (England, 2009, p. 73). Researchers and
scientists have identified many neurotransmitters related to the neurobiology
of depression with two being the monoamine neurotransmitters serotonin and
norepinephrine (Aan het Rot, Mathew, Charney, 2009, p. 305). The research focusing
on these two neurotransmitters states that individuals with depression are
likely to have low levels of these neurotransmitters because various effective
antidepressant drugs have been shown to acutely increase their levels (p. 306).

On
a genetic level, scientists have not identified
a specific gene or a series of genes that cause depression. Rather, “certain
variations in genes, called polymorphisms, may increase risk for depression” (Aan
het Rot et al., 2009, p. 306). Among these, are genes of the serotonin system
(5-HT). Studies investigating the role of genetic polymorphisms in the
serotonin-related genes in the etiology of depression have revealed the
serotonin 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-HTTLPR
experienced more depressive symptoms and presented with higher rates of depression
in response to stressful life events than individuals who are homozygous for
the long allele.

Environmental
factors play a large role in the studies of depression’s etiology. There is a
common understanding that depression may occur as reaction to negative
environmental circumstances, and etiological models are largely from a
diathesis-stress perspective as mentioned earlier. Etiological literature tends
to focus on three main environmental stressors: acute negative life events,
chronically stressful life circumstances, and exposure to adversity in childhood
(England, 2009, p. 85).

There
are various different forms of treatment for depression. Health-care providers
may choose to offer psychological treatments (such as cognitive behavioral
therapy (CBT), interpersonal psychotherapy, and behavioral activation),
antidepressant medication (such as selective serotonin reuptake inhibitors and
tricyclic antidepressants) or somatic treatments (electroconvulsive therapy
(ECT)) in more severe cases of depression. The effectiveness of each treatment
often varies from person to person.

Behavioral
activation (BA), a newer form of therapy treatment, often structured in 12 or
24 sessions, is a formal therapy that focuses on scheduling activities to
encourage patients to approach those that they are avoiding, and then analyzing
the 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 in
adaptive activities, decrease engagement in activities that maintain depression
or increase risk for depression, and solve problems that limit access to reward
or that maintain or increase aversive control” (Dimidjian, Barrera, Martell, Muñoz,
and Lewinsohn, 2010, p. 3). With all the research into BA, many studies have
been conducted regarding its efficacy as a treatment option. In a recent study
conducted by Richards et al. (2016), 440 participants diagnosed with depression
were recruited, where 221 participants were assigned to a full course of BA and
219 participants were assigned to a full course of cognitive behavioral therapy
(CBT). At follow-up, the researchers found that the BA treatment, a simpler
psychological treatment than CBT, had no lesser effect than CBT and was
therefore equally effective.

BA
has shown to improve the mental health of those suffering from depression.
Likewise, the activities and focus of BA should therefore also benefit those
who do not suffer from depression. BA can thus be modified into activities that
would improve the mental health of the average person not suffering from
depression using both positive psychology and mindfulness as methods of BA.

Positive
psychology, pioneered by Martin Seligman, is “the scientific study of the
strengths that enable individuals and communities to thrive; and is founded
on the belief that people want to lead meaningful and fulfilling lives, cultivate
what is best within themselves, and enhance their experiences of love, work,
and play” (Seligman, 2000). It focuses not only on well-being, but also on
happiness, where happiness is broken down into three domains: pleasure, engagement,
and meaning (Seligman, 2000). In one study of positive psychology by Kyeong et
al. (2017), the neurobiological consequences of a gratitude meditation
intervention and resentment intervention were assessed using the fMRI data
acquired during the interventions. The results showed that the average heart
rate was significantly lower during the gratitude intervention than during the
resentment intervention, indicating a resting-state of well-being. In another
study, 119 women were randomly assigned to either a gratitude intervention group
or no treatment group for a duration of two weeks (Jacowska, 2016, p. 1). At
follow-up, the treatment showed to improve subjective well-being through a
correlated increase in sleep quality and reduction in blood pressure (p. 8).

Similarly
to positive psychology, mindfulness, pioneered by Jon Kabat-Zinn, focuses on a
state 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 looking
at problems, and a way of coming to terms with catastrophe that can make life
more joyful and rich (p. 19). In one study conducted by Stjernswärd and Hansson
in 2016, 97 participants were recruited from families living with a person with
mental illness to undergo an 8-week web-based mindfulness intervention. At post-intervention
follow-up, there were significant improvements in levels of mindfulness, as
well as significant improvements in levels of perceived stress, caregiver
burden, and self-compassion (Stjernswärd S., Hansson L., 2016). There has also
been research in regards to mindfulness and its relation to stress reduction.
In one specific study, 109 random bachelor students of the University of
Innsbruck were recruited and assigned to either and intervention group of mindfulness-based
self-leadership training (MBSLT) or a control group. After the 10-week
intervention, results showed that while participants of the control group
showed an increase in stress over time, the participants of the intervention
group maintained constant stress levels over time. Furthermore, the MBSLT over
time led to a reduction of test anxiety in participants in the intervention group.

Research
on positive psychology and mindfulness have shown that both have positive
effects on one’s well-being. In one study conducted by Leary and Dockray in
2015, the efficacy of these two dual-component interventions on reducing depression
and stress and increasing happiness levels was assessed. In the study, 65 female
participants were randomly assigned to a wait-list control condition or to
either a gratitude or a mindfulness intervention condition. After 3 weeks of
intervention, results showed that the outcome variables of depression, stress
and happiness improved over time for both the gratitude and mindfulness
interventions but not for the wait-list control group. These results show that
interventions based on both positive psychology and mindfulness seem to provide
a useful way to enhance well-being.

The current study therefore focuses on the
efficacy of positive psychology and mindfulness as interventions for improving
the mental health of a non-depressed participant group. Specifically, our study
utilizes gratitude journals and mindfulness breathing exercises as interventions,
where the effectiveness of both will be assessed through the outcome variables
of reducing depression symptoms, decreasing anxiety, increasing positive affect
and decreasing negative affect, measured using the Beck Depression Inventory
(BDI), the State and Trait Anxiety Inventory (STA), and the Positive and Negative
Affect Scale (PANAS), respectively. While many studies have been conducted on
the efficacy of either positive psychology or mindfulness, or on the efficacy
of both; there have been little studies that compare which one of the two seem
to be more effective. Therefore, rather than assessing whether both interventions
will be equally effective, our study aims to see whether one will be more
beneficial than the other. Despite research on the benefits of both positive
psychology and mindfulness, the hypothesis of this study is that writing a
gratitude journal will have a greater effect on reducing
depressive symptoms, reducing state trait anxiety, decreasing negative affect
and increasing positive affect than practicing mindful breathing.

Methods

Participants

A 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 participants
were Caucasian, 7 were Asian and one participant was Hispanic. Of the 20
participants, there were 13 females and 7 males.

 

Measures

The measures used in the study are
used to measure the outcome variables of mindfulness breathing intervention and
gratitude journal intervention. The measures include the Beck Depression
Inventory-II (BDI-II), the State-Trait Anxiety Inventory (STAI), and the Positive
and Negative Affect Schedule (PANAS).

The Beck Depression Inventory-II
(BDI-II) (Beck et al. 1996), is a 21-question multiple choice self-report measure
used to measure the severity of depression. When presented with the BDI-II, a
patient is asked to consider each statement as it relates to the way they have
felt for the past two weeks, according to a scale from 0-3 (0 being least, 3
being most). The total score of 0-13 is minimal range, 14-19 is mild, 20-28 is
moderate, and 29-63 is severe. The BDI-II has demonstrated good 1-week retest reliability
and strong internal validity (r=0.93, ? =.91).

The State and Trait Anxiety Inventory (STAI) (Spielberger et
al. 1983), is a self-report measure inventory that consists of 40 items
pertaining to anxiety. The STAI measures both state anxiety and trait anxiety.
There is also a fairly strong retest-reliability and internal validity (r=0.65
and 0.75 over a 2 month period, ? =.86).

The Positive and Negative Affect Schedule (PANAS) (Watson et
al. 1988) is used to measure positive and negative affect. It is comprised of
two mood scales, one that measures positive affect and the other which measures
negative affect. This 20 item questionnaire consists of words that describe
different feelings and emotions, where participants are required to respond
using a 5-point scale that ranges from very slight or not at all (1) to
extremely (5). It has also demonstrated an overall strong retest-reliability and
internal validity (positive: r=0.68, ?=0.86; negative:
r=0.71, ? =0.87).

 

Procedure

A group of 20 participants were
chosen to take part in the study. Participants filled out measures of the
BDI-II, STAI, and PANAS at baseline and two weeks later at follow-up. Each
participant was randomly assigned to either a mindfulness intervention group or
a positive psychology intervention group for a total of 2 weeks. The
mindfulness intervention group had participants partake in mindfulness
breathing exercises, while the positive psychology intervention group had the
participants keep a gratitude journal. After the 2 week period of interventions,
the participants were gathered and were required to fill out the same
assessment as the initial using each of the measures (BDI-II, STAI, PANAS). The
scores were used to assess which intervention was better at reducing depression
symptoms, decreasing anxiety, increasing positive affect and decreasing negative
affect.

Results

In order to assess
the significance of the data from our study, both an independent-samples t-test
and a paired-samples t-test were conducted. The independent samples t-test was
conducted to assess mindfulness meditation or writing in a gratitude were more
effective at decreasing scores on the Beck Depression Inventory-II, State-Trait
Anxiety Inventory, and the Positive and Negative Affect Schedule. There was a
significant 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

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