Whenever I’ve looked for depression treatment, I’ve always wanted help with one basic thing: Stop the pain! And that’s what most therapies for depression try to do. They focus on what’s wrong and try to get those symptoms into remission. If it works, and you feel a lot better, the good stuff of living takes care of itself. In other words, health is defined as the absence of illness rather than the presence of well-being.
There’s a lot of research, however, pointing to a big problem with the symptom remission strategy. Only a minority of patients fully recover from a major depressive episode. The rest don’t quite get rid of all the symptoms, and it turns out that these leftovers are an excellent predictor of recurrence. Relapse is a huge issue, as so many of us know, but it’s only in the last 15 years or so that new therapies have been developed specifically to deal with it.
One of these is Well-Being Therapy (WBT), and it turns the usual treatment approach on its head. Instead of starting with everything that’s wrong, it starts with everything that’s right. Though it falls under the general heading of Positive Psychology, WBT is quite different from any approach based on thinking positively and banishing negative feelings. The idea of well-being that underlies the therapy is not just about feeling good. It’s primarily about strengthening the capacity to lead a fulfilling life.
WBT uses six major dimensions to define well-being, each ranging along a spectrum from completely positive to completely negative.
Environmental mastery: Having a sense of competence in managing everyday life as opposed to feeling that everything around you is beyond your control.
Personal growth: Open to new opportunities and feeling steady development in your life, as opposed to feeling like you’re stagnating and unable to change.
Purpose in life: Having goals, a sense of direction and purpose in your present life as well as your past, as opposed to believing your life has no meaning and lacks direction or goals.
Autonomy: Independent, self-motivated and able to resist social pressures, as opposed to depending on others for approval and relying on their judgment instead of your own.
Self-acceptance: Feeling good about who you are and accepting of both good and bad qualities, as opposed to always being dissatisfied with yourself and wanting to be different than you are.
Positive relationships: Able to form warm and trusting relationships and feel empathy and affection for others, as opposed to being isolated from people and frustrated in most relationships.
What I like about characterizing well-being in this way is the recognition that a fulfilling life is a complicated thing. This approach doesn’t try to fit you into a preconceived norm of ”happiness.” It’s flexible enough to allow you to work in your own way on those dimensions that you most want to improve.
Well-Being Therapy is a short-term strategy, designed to be completed in 8 weekly sessions. If you put yourself into this picture, the therapist would work with you through three phases of two or three sessions each. But the process doesn’t start with a lecture about the six dimensions and all the characteristics of each one. Those can be introduced later, one at a time, as you identify more clearly what you’re going through.
