Experts Are Positive That Positive Psychiatry Works

Positive psychiatry, a term coined by past APA President Dilip Jeste, M.D., takes an approach to mental health that builds on the patient’s strengths and promotes well-being through the enhancement of positive psychosocial factors such as social relationships, wisdom, optimism, and resilience. In a session at APA’s Annual Meeting, Jeste and his fellow speakers presented evidence supporting the use of positive psychiatry and discussed myriad ways psychiatrists can engage in positive psychiatry with their patients.

Jeste, the director of the Global Research Network on Social Determinants of Health and Exposomics and the president-elect of the World Federation of Psychotherapy, began the session with a discussion of how positive psychosocial traits are known to increase longevity and improve outcomes across a range of disease states, including cardiovascular disease and cancer. He said focusing on a patient’s personal strengths lends itself readily to psychiatry, although such an approach is not widespread.

“We usually ask patients to tell us what is wrong with them and what they want to fix, and not what is right with them or what they like about themselves,” Jeste said. “We’ll ask them what caused the condition to relapse, and not what prevented it from relapsing for three years straight.”

Jeste said that positive psychiatry starts with an assessment of the patient’s personal strengths, perceived stresses, and lifestyle. He said that given the time constraints of office visits, patients can answer questions online or at home ahead of time, and that nonmedical clinic staff may assist patients with assessments in person. From there, psychiatrists can identify treatment targets and interventions that tap into the patient’s strengths.

Jeste also addressed the belief that certain positive psychosocial traits are fixed and cannot change.

“People will say that wisdom is like intelligence, and you’re [either] born with it [or not] and can’t change it, but that’s not true,” Jeste said. “Wisdom is much more than intelligence. It includes empathy, compassion, self-reflection, emotional regulation, and so on.”

Samantha V. Boardman, M.D., a clinical assistant professor of psychiatry at Weill Cornell Medical College, discussed wellness as patients see it, citing a 2018 survey of more than 6,000 people with mental illness.

“People cared a lot about treatment and having an understanding of their illness, but what they cared about most was having a sense of purpose and a better connection with others. Put simply, they cared about having better days,” Boardman said. “Patients don’t only want to feel less bad, they want to feel good. But what does traditional treatment focus on? Diagnosis of illness, alleviating suffering, and symptom management.”

She added that treatment that exclusively focuses on alleviating symptoms and suffering does not address quality of life and that even when the symptoms of mental illness are under control, a patient may not be thriving.

“There’s a great deal of evidence that there’s therapeutic benefit to emphasizing and exploring their positive emotions, experiences, and aspirations because … not only do positive emotions balance negative ones, they create enduring positive feelings,” Boardman said.

Boardman noted that she asks patients what they are like at their best, and asks them to explore ways of using their strengths to help them navigate their way through challenging situations.

“With strength-based interventions, treatment becomes more fun and more personally meaningful for patients. It resonates with them,” she said. Session chair Erick Messias, M.D., Ph.D., M.P.H., chair of the Department of Psychiatry and Behavioral Neurosciences at St. Louis University School of Medicine, addressed misconceptions about positive psychiatry.

“One of the most common misconceptions is that we have rose-tinted glasses and we see everything as positive,” he said. “No, no, no. Life has a lot of negative stuff. It has a lot of pain and suffering and loss, and we psychiatrists know this better than most people because we lose patients to suicide. The point is … about resilience and what happens to you during the hard days and hard times.” ■