BUILDING INNOVATIVE MODELS OF POSITIVE PSYCHOTHERAPY FOR PEOPLE LIVING WITH ACQUIRED
BRAIN INJURY
ASSOCIATE PROFESSOR ANDREW KEMP, PHD, FBPSS
ASSOCIATE PROFESSOR ZOE FISHER, PHD, DCLIN PSYCH
HEALTH AND WELLBEING
• OXFORD DICTIONARY: DEFINES “HEALTH” AS “THE STATE OF BEING FREE FROM ILLNESS OR
INJURY”
• WORLD HEALTH ORGANISATION (WHO) DEFINITION: COMPLETE PHYSICAL, MENTAL, AND
SOCIAL WELLBEING, NOT MERELY THE ABSENCE OF DISEASE AND INFIRMITY
• BUT…
GLOBAL CONTEXT: HEALTH IN THE 21ST CENTURY
• SHIFT IN THE ‘EPIDEMIOLOGICAL TRANSITION’: INCREASING BURDEN ATTRIBUTABLE TO
CHRONIC DISEASE BURDEN RELATIVE TO ACUTE DISEASE
• CAN WE OFFER THOSE WITH ABI AN OPPORTUNITY TO EXPERIENCE WELLBEING DESPITE
LIVING WITH A CHRONIC CONDITION?
LONELINESS DISTRESS MORTALITY
• ‘KODOKUSHI’
• IN U.K., MORE THAN 25% LIVE ALONE
• 60% TEENAGERS REPORT FEELING LONELY
• LONELINESS INCREASES DISTRESS RISK FOR
MORBIDITY, MORTALITY
Kemp et al., 2017. In book titled: Neuroscience and Social Science: The Missing Link
OVER 8YRS, MENTAL DISTRESS WAS LINKED TO:
RUSS ET AL., 2012, BMJ
MODELS OF HEALTHCARE
• ACUTE MEDICAL MODEL IS THE DOMINANT MODEL OF CARE
• ASSUMPTIONS INCLUDE:
• FOCUS ON PEOPLE WITH ACUTE CONDITIONS
• FIX & RETURN TO ‘PRE –INJURY STATE’
• THE PATIENT IS A PASSIVE RECIPIENT OF CARE
• HEALTH AND WELLBEING IS SYNONYMOUS WITH THE ABSENCE OF ILLNESS
MODELS OF HEALTH CARE HAVE NOT CHANGED TO REFLECT THE EPIDEMIOLOGICAL TRANSITION
NEURO-REHABILITATION
• NEUROREHABILITATION IS DEFINED AS ‘A COMPLEX MEDICAL PROCESS, WHICH AIMS TO AID
RECOVERY FROM NERVOUS SYSTEM INJURY, AND TO MINIMIZE AND/OR COMPENSATE FOR
EVERYDAY DIFFICULTIES RESULTING FROM IT’
• FOCUS ON REDUCING IMPAIRMENT AND PSYCHOLOGICAL DISTRESS
• TREMENDOUS SCOPE TO BROADEN THE EFFICACY OF NEUROREHABILITATION BY INCREASING
FOCUS ON BUILDING WELLBEING IN ADDITION TO REDUCING IMPAIRMENT AND DISTRESS
A BRIEF BACKGROUND TO PP
Hedonic
Wellbeing
Eudaimonic
Wellbeing
Hedonic Well-Being = happiness you get from
feeling pleasure in the moment, typically short lived,
we have to keep topping up our reserves to maintain
its effects.
Eudaimonic Well-Being = happiness gained from
having meaning and purpose in our life, fulfilling our
potential and feeling that we are part of something
bigger than ourselves.
A BRIEF BACKGROUND TO PP
Hedonic Theory of
Wellbeing
Integrated Theory
of Wellbeing Eudaimonia Theory
of Wellbeing
Subjective Wellbeing Theory
& Broaden & Build Model
PERMA Theory Six Factor Model of Psychological
Wellbeing (PWB)
Life
Satisfaction
Positive
Emotion
Negative
Emotion
Positive
Relationships
Engagement
Achievement
Meaning &
Purpose
Autonomy
Personal
Growth
Self-
Acceptance
Environmental
Mastery
PP & VAGAL FUNCTION
Kok et al (2013). Psych Sci
• INCREASES IN VAGAL FUNCTION
INCREASES IN POSITIVE EMOTIONS
INCREASES IN SOCIAL CONNECTEDNESS IN
AN UPWARD SPIRAL RELATIONSHIP
• THESE FINDINGS HAVE IMPORTANT
IMPLICATIONS FOR POSITIVE PSYCHOLOGY
VAGAL NERVE FUNCTION
• VAGAL FUNCTION IS AN INDEX OF:
• AUTONOMIC FLEXIBILITY
• EMOTIONAL FLEXIBILITY
• PHYSICAL HEALTH
• RESILIENCE
• VAGAL FUNCTION IS INDEXED BY HEART RATE
VARIABILITY (HRV)
• HRV IS DETERMINED FROM BEAT TO BEAT
VARIATION IN CONSECUTIVE HEART BEATS
WHY SHOULD HEART RATE BE VARIABLE?
Kashdan & Rottenberg, 2010; Kemp et al., 2017a,b
• RESPIRATORY SINUS ARRHYTHMIA
• VARIABILITY ALLOWS ONE TO BE
FLEXIBLE TO ENVIRONMENTAL STRESS
• FLEXIBILITY IS A FUNDAMENTAL
ASPECT OF HEALTH
• VAGAL FUNCTION RESILIENCE
HOW IS VAGAL FUNCTION ALTERED?
• VAGAL FUNCTION IS ADVERSELY AFFECTED BY:
• SMOKING
• PHYSICAL INACTIVITY
• DISTRESS
• WE CAN IMPROVE VAGAL FUNCTION THROUGH:
• POSITIVE PSYCHOLOGY
• POSITIVE HEALTH BEHAVIOURS
• POSITIVE SOCIAL TIES
• POSITIVE ENVIRONMENTS
Image from forthcoming review on neuroscience of sadness, Kemp et al., submitted
THEORETICAL UNDERPINNINGS – GENIAL 1.0
BUILDING WELLEBING MUST TARGET: -
- POSITIVE HEALTH BEHAVIOURS
- POSITIVE PSYCHOLOGICAL EXPERIENCES
- SOCIAL RELATIONSHIPS AND INTEGRATION
Kemp, Arias & Fisher., 2017. In book titled: Neuroscience and Social Science: The Missing Link
Individual Community
Environment
Mead, Fisher & Kemp & colleagues, 2019
BUILDING SERVICES THAT IMPROVE WELLBEING: THEORETICAL
UNDERPINNINGS – GENIAL 2.0
GENIAL 2.0:
Individual Community
Environment
Social
cohesion
Reconnecting
to nature
Health
behaviours
Health
behaviours
Social
cohesion
Reconnecting
to nature
Psychological
experience
Health behaviours
impact on wellbeing
Psychological experience
has implications for
individual, community &
the environment
Social cohesion has
important impacts on
individual wellbeing
Nature-based experience
has implications for
individual & community
wellbeing
Positive
Emotion
Engagement
Relationships Meaning
Achievement
Wellbeing = connection (underpinned by healthy vagal function)
Mead, Fisher & Kemp & colleagues, 2019
Prosociality
Sustainable
happiness
Meaning
Hope
Empathy
Love
Genetics
Social
harmony
Sumbiophilia
Volunteering
Resilience Engagement
Endemophilia
Social justice
Social
capital
Social
cohesion
Time in
nature
Self-
esteem
Diet
Sleep
Physical
activity
Family
Emotions
Life
satisfaction
Happiness
Positive
relationships
Comfort
Sustainable
behaviour Salutogenesis
Mental
health
Sense of
purpose
Mindfulness Acceptance
National
wellbeing
Opposite of
illbeing
Social
networks
Achievement Wellbeing = connection
(underpinned by healthy vagal function)
Relationships
Positive mind
Self-
acceptance
Self-
regulation
Autonomy
Soliphilia
Eutierria
Friends
Biophilia
Flourishing
GENIAL Science: A
transdisciplinary and life-
course research effort focused
on health & wellbeing
Gratitude
Community
Personal
growth
Psychological
flexibility
Active hope Psychological
wellbeing
Maturity
Joy
Spirituality
Optimism
Socio-
economic
status
Individual
Quality of
life
Equality Environment
Character
strengths
Environmental
mastery
Self-
actualisation
THE GENIAL DEFINITION OF WELLBEING
“POSITIVE PSYCHOLOGICAL EXPERIENCE, WHICH CAN BE IMPACTED ON BY POSITIVE HEALTH
BEHAVIOURS, AND IS PROMOTED THROUGH A SENSE OF CONNECTEDNESS TO OURSELVES AS
INDIVIDUALS, AS WELL AS TO THE COMMUNITIES AND ENVIRONMENT WITHIN WHICH WE
LIVE.”
BRAIN INJURY CAN AFFECT ALL ASPECTS OF WELLBEING
Health
Behaviour
Psychological
Experiences
Social
Connections
1. CHARACTER STRENGTHS
THEORY
• Y-SHAPED MODEL TO RECOVERY (GRACEY, 2009)
• NIEMIEC, R. (2017). CHARACTER STRENGTHS INTERVENTIONS:
A FIELD GUIDE FOR CLINICIANS
• ACTIVITIES:
• VIA 24 CHARACTER STRENGTHS QUESTIONNAIRE
• POSITIVE INTRODUCTIONS
• STRENGTHS MAPPING
https://www.viacharacter.org
2. MIND AND BODY CONNECTION
POLYVAGAL THEORY (STEPHEN PORGES, DEB DANA)
• NEUROCEPTION
• HIERACHY (CALM AND CONNECT; FLIGHT OR FIGHT; FREEZE)
• REGULATION AND CO-REGAULATION
ACTIVITIES:
• MAPPING ANS: THE AUTONOMIC LADDER
• TRIGGERS AND GLIMERS MAP
• THE REGULATION RESOURCE MAP (E.G. BREATHING,
MEDIATION, MUSIC, ART, MOVEMENT)
Psychophysiological flexibility is a fundamental
aspect of health
3. POSITIVE EMOTIONS & FLOW
• FLOW IS FUNDAMENTAL TO HAPPINESS:
CSIKSZENTMIHALYI
• POSITIVE EMOTION: BROADEN AND BUILD (FREDRICKSON,
1998, 2001, 2013)
• ACTIVITIES:
• BUILDING POSITIVE EMOTIONS – 3 GOOD THINGS,
• MEDIATION: LOVING KINDNESS
• SAVOURING EXERCISES
• OPTIMISM TRAINING – CBT
4. POSITIVE HEALTH BEHAVIOURS
• SLEEP, EXERCISE, DIET
• UPWARD SPIRAL THEORY OF LIFESTYLE CHANGE
• INFORMATION IS NOT TRANSFORMATION –
COMMON KNOWELDGE IS NOT COMMON ACTION
• ACTIVITIES:
• GOAL SETTING & BEHAVIOURAL CHANGE
• FACILITATING SOCIAL CONNECTION - GROUPS
• POSITIVE EMOTIONS SUSTAIN BEHAVIOURAL CHANGE
(CAPPELLEN, 2018)
Cappellen et al., 2018, Psychol Health
SWANS
5. SOCIAL RELATIONSHIPS & COMMUNITY
• SOCIAL IDENTITY THEORY – HASLAM
• PERMA – SELIGMAN
• POSITIVITY RESONANCE – FREDICKSON
• ACTIVITIES:
• GRATITUDE JOURNAL
• RANDOM ACTS OF KINDNESS
• LAUGHTER YOGA
• FACILITATE COMMUNITY INTERGRATION BASED ON
STRENGTHS, TALENTS AND VALUES
• GROUP ACTIVITIES
Laughter yoga session for Headway charity
@ Margam Abbey
BUILDING COMMUNITY
Positive Psychological Experiences
Positive Health Behaviours
Positive SocialConnections
Healthy Vagal
Function
Co-creating Health and Wellbeing
Community Connectors SWWBIG
ABMU, Rehabilitation
Engineering
6. RECONNECTING WITH NATURE
• GLEN ALBRECHT’S EARTH EMOTIONS (E.G.
BIOPHILA, TOPOPHILIA)
• ACTIVITIES:
• TIME SPENT IN NATURE (MINDFUL
PHOTOGRAPHY; SURFABILITY; FOREST BATHING)
• POS HEALTH BEH
• SUSTAINABLE BEHAVIOUR - MENOTR AND
VOLUNTEER ROLES
Taylor et al., 2015. Landscape and Urban Planning
7. MEANING AND PURPOSE
• KEY THEORISTS - VIKTOR FRANKL AND PAUL
WONG
• POST TRAUMATIC GROWTH
• LOSS OF SELF IDENTITY
• SYSTEM DISRUPTION – ‘LOSING ONES WAY’
(JUMISKO ET AL., 2006); ‘ EMPTINESS AND
DISCONNECTION’ (SOEKER, 2011)
ACTIVITIES:
• VALUES IDENTIFICATION AND GOAL SETTING
• INTEGRATION OF CHARACTER STRENGTHS – Y
SHAPED MODEL (GRACEY, 2009)
• OPPORTUNITIES FOR CONNECTION TO
SOMETHING BIGGER THAN ONES SELF
8. ACHIEVEMENT
• GRIT AND MINDSET (GROWTH VS FIXED) THEORIES
• ACTIVITIES:
• GTD – GOAL SETTING AND IDENTIFYING VALUES
(GET STUFF OUT HEAD AND ORGANISE)
• CO-PRODUCTION/CO-CREATION –
QUALIFICATIONS, AWARDS, MENTOR ROLES
• GOAL SETTING WITH CHARACTER STRENGTHS
Tulip, Fisher, Bankhead, Wilkie, Pridmore, Gracey, Tree and Kemp (2019). Building wellbeing in people with chronic conditions: A qualitative
evaluation of an 8-week positive psychotherapy intervention for people living with an acquired brain injury. Submitted to Frontiers in
Psychology
ACKNOWLEDGEMENTS
Add clinical team here