1 Introduction
2 Background
2.1 Positive Psychology and Increasing Well-Being
2.2 Positive Psychology vs. Other Active Interventions
3 The Present Study
4 Methods
4.1 Search Strategy
4.2 Selection of Studies
4.2.1 Study Design
4.2.2 Participants
4.2.3 Outcomes
4.2.4 Language
4.3 Data Management
4.4 Data Extraction
4.5 Risk of Bias
4.6 Data Analysis
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I2 = 0–40%: might not be important;
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I2 = 30–60%: may represent moderate heterogeneity;
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I2 = 50–90%: may represent substantial heterogeneity;
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I2 = 75–100%: considerable heterogeneity.
5 Results
5.1 Study Selection
5.2 Study Characteristics
Study | Country | Sample size | Participants | Depression status | Depression assessment | Intervention | Comparator | Outcome measures |
---|---|---|---|---|---|---|---|---|
Asgharipoor et al. (2012) | Iran | 18 | 13 female 5 male Mean age 26.44 (SD 6.10) 9 Intervention 9 Comparator | Major depression | SCID | Group positive-oriented psychotherapy 2 h per week for 12 weeks | Group CBT 2 h per week for 12 weeks | Happiness (OHI, SWBS) Depression (BDI-II, SUDS) |
Celano et al. (2017) | USA | 65 | 45 female 20 male Mean age 44.0 (SD 16.6) 32 Intervention 33 Comparator | Primary diagnosis of major depressive disorder | MINI | Telephone positive psychology intervention 6 weeks One exercise per week | Cognitive-focused intervention 6 weeks One exercise per week | Hopelessness (BHS) Suicide Ideation (CHRTS) Depression (QIDS) Optimism (LOT-R) Gratitude (GQ) Positive Affect (PANAS) |
Chaves et al. (2017) | Spain | 96 Women | 47 Intervention Mean age = 52..57 (SD = 9.38) 49 Comparator Mean age = 50.73 (SD = 11.34) | Major depression or dysthymia | SCID | Group PPI 2 h per week for 10 weeks | Group CBT 2 h per week for 10 weeks | Depression (BDI-II) Cognitive functioning (ATQ-30, RRS, WBSI) Emotional functioning (PANAS, BAI, RPA, DERS) Behavioural functioning (BIS/BAS) Well-Being (PHI, PWBS, SWLS, LOT-R, EOS) |
Furchtlehner et al.( 2019) | Austria | 92 | 59 female 33 male Mean age = 40.66 (SD = 12.4) 46 Intervention 46 Comparator | Mild to moderate depression Major depression in partial remission Dysthymia | SCID | Group manualised PPT (6 – 7 per group) 2 h per week for 14 weeks | Group manualized CBT 2 h per week for 14 weeks | Depression (BDI-II, DHS, MADRS) Overall psychological distress level (BSI) |
Hanson (2019) | UK | 115 | 100 female 15 male Mean age = 39.48 (SD = 11.32) 56 Intervention 59 Comparator | Symptoms of depression | BDI-II | Positive psychology self-help book Read 1 chapter per week for 8 weeks | CBT self-help book Read 1 chapter per week for 8 weeks | Depression (BDI-II) Well-Being (SHS, SWLS, PANAS, PWBS) |
Mongrain et al. (2016) | Canada | 741 globally diverse sample | 478 female 263 male Mean age = 32.64 (SD 11.39) 265 Intervention 235 Comparator 241 Control | Mild to moderate depression | CES-D | Online positive activity Three weeks (practice 10 emotions, one emotion to be practiced every other day) | 10-min online mindfulness meditation Three weeks (instructions delivered every other day) | Depression (CES-D) Subjective well-being (SWLS, OTH) |
O’Leary and Dockray (2015) | Ireland | 61 women | Mean age = 28.35 (SD = 6.65) 29 Intervention 22 Comparator 10 Control | Mild to major depression | EDS | Online gratitude exercises Four times per week for three weeks | Online Mindfulness exercise Four times per week for three weeks | Stress (PSS) Depression (EDS) Happiness (SHS) |
Seligman et al. (2006) | US | 32 | 22 female 10 male Age = 18 – 55 11 Intervention 9 Comparator 1 12 Comparator 2 | Major Depression | DSM-IV | PPT 14 individual sessions over 12 weeks | Comparator 1 = TAU Comparator 2 = TAU + medications | Depression (ZSRS, HRSD) Global Improvement (OQ, GAF) Well-Being (PPTI, SWLS, self-created PPT outcome measure) Remission (ZSRS, HRSD, OQ, GAF) |
Uliaszek et al. (2016) | Canada | 35 women | Mean age before drop out (n = 54) = 22.17 (SD = 5.05) 13 Intervention 22 Comparator | A range of symptoms of psychopathology including major depression | SCID-I and SCID-II | 12-week group PPT | 12-week group DBT | Psychopathology symptoms (SCL-90R, LPI) Adaptive and maladaptive skills (DERS, DTS, KIMS, WOCCL) Well-Being (PPTI, SWLS) |
Walker and Lampropoulos (2014) | US | 86 | 59 female 27 male Mean age = 20.67 (SD = 2.49) 21 Intervention 21 Comparator 1 22 Comparator 2 22 Control | At least mild depression | CES-D | Positive psychology homework assignments 2 weeks Min 4 h per assignment/activity | Comparator 1 = CBT without interpersonal element Comparator 2 = CBT with interpersonal element 2 weeks Min 4 h per assignment/activity | Mental health symptoms (CES-D, OQ) Positive state (BADS, MHC-SF, PANAS) |
5.3 Risk of Bias
Random sequence generation (selection bias) | Allocation concealment (selection bias) | Blinding of participants and personnel (performance bias) | Blinding of outcome assessment (detection bias) | Incomplete outcome data (attrition bias) | Selective reporting (reporting bias) | Other bias | |
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Asgharipoor et al. (2012) | Low | Unclear | Unclear | Low | Low | Unclear | Low |
Celano et al. (2017) | Low | Low | Unclear | Low | Low | Unclear | Low |
Chaves et al. (2017) | Low | Low | Unclear | Low | Low | Unclear | Low |
Furchtlehner et al. (2019) | Low | Unclear | Unclear | Low | Low | High | Low |
Hanson (2019) | Low | Unclear | Unclear | Low | Low | Unclear | High |
Mongrain et al. (2016) | Low | Unclear | Unclear | Low | Unclear | Unclear | Unclear |
O’Leary and Dockray (2015) | Low | Unclear | Unclear | Low | High | Unclear | Unclear |
Seligman et al. (2006) | Low | Unclear | Unclear | Low | Unclear | Unclear | Low |
Uliaszek et al. (2016) | Low | Unclear | Unclear | Low | Low | Unclear | Low |
Walker and Lampropoulos (2014) | Low | Unclear | Unclear | Low | Low | Unclear | Low |
5.4 Selection of Outcome Measures
5.5 Meta-Analysis
5.5.1 Post-Intervention Effects
Outcome | Number of studies | Intervention sample size | Comparator sample size | Hedge’s g (95% CI) | Heterogeneity | Test for overall effect | |
---|---|---|---|---|---|---|---|
Q | I2 | ||||||
Depression | 10 | 494 | 462 | 0.15 (−0.19, 0.49) | 42.53 df = 9 (p = 0.00001) | 79% | Z = 0.86 (p = 0.39) |
Happiness | 9 | 467 | 435 | 0.20 (−0.12, 0.53) | 30.40 df = 8 (p = 0.002) | 74% | Z = 1.22 (p = 0.22) |