research on positive psychology

• Research article
• Open access
• Published: 08 February 2013

Positive psychology interventions: a meta-analysis of randomized controlled studies

• Linda Bolier 1 ,
• Merel Haverman 2 ,
• Gerben J Westerhof 3 ,
• Heleen Riper 4 , 5 ,
• Filip Smit 1 , 6 &
• Ernst Bohlmeijer 3  

BMC Public Health volume  13 , Article number:  119 ( 2013 ) Cite this article

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The use of positive psychological interventions may be considered as a complementary strategy in mental health promotion and treatment. The present article constitutes a meta-analytical study of the effectiveness of positive psychology interventions for the general public and for individuals with specific psychosocial problems.

We conducted a systematic literature search using PubMed, PsychInfo, the Cochrane register, and manual searches. Forty articles, describing 39 studies, totaling 6,139 participants, met the criteria for inclusion. The outcome measures used were subjective well-being, psychological well-being and depression. Positive psychology interventions included self-help interventions, group training and individual therapy.

The standardized mean difference was 0.34 for subjective well-being, 0.20 for psychological well-being and 0.23 for depression indicating small effects for positive psychology interventions. At follow-up from three to six months, effect sizes are small, but still significant for subjective well-being and psychological well-being, indicating that effects are fairly sustainable. Heterogeneity was rather high, due to the wide diversity of the studies included. Several variables moderated the impact on depression: Interventions were more effective if they were of longer duration, if recruitment was conducted via referral or hospital, if interventions were delivered to people with certain psychosocial problems and on an individual basis, and if the study design was of low quality. Moreover, indications for publication bias were found, and the quality of the studies varied considerably.

Conclusions

The results of this meta-analysis show that positive psychology interventions can be effective in the enhancement of subjective well-being and psychological well-being, as well as in helping to reduce depressive symptoms. Additional high-quality peer-reviewed studies in diverse (clinical) populations are needed to strengthen the evidence-base for positive psychology interventions.

Peer Review reports

Over the past few decades, many psychological treatments have been developed for common mental problems and disorders such as depression and anxiety. Effectiveness has been established for cognitive behavioral therapy [ 1 , 2 ], problem-solving therapy [ 3 ] and interpersonal therapy [ 4 ]. Preventive and early interventions, such as the Coping with Depression course [ 5 ], the Don’t Panic course [ 6 ] and Living Life to the Full [ 7 , 8 ] are also available. The existing evidence shows that the mental health care system has traditionally focused more on treatment of mental disorders than on prevention. However, it is recognized that mental health is more than just the absence of mental illness, as expressed in the World Health Organization’s definition of mental health:

Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community [ 9 ].

Under this definition well-being and positive functioning are core elements of mental health. It underscores that people can be free of mental illness and at the same time be unhappy and exhibit a high level of dysfunction in daily life [ 10 ]. Likewise, people with mental disorders, can be happy by coping well with their illness and enjoy a satisfactory quality of life [ 11 ]. Subjective well-being refers to a cognitive and/or affective appraisal of one’s own life as a whole [ 12 ]. Psychological well-being focuses on the optimal functioning of the individual and includes concepts such as mastery, hope and purpose in life [ 13 , 14 ]. The benefits of well-being are recorded both in cross-sectional and longitudinal research and include improved productivity at work, having more meaningful relationships and less health care uptake [ 15 , 16 ]. Well-being is also positively associated with better physical health [ 17 – 19 ]. It is possible that this association is mediated by a healthy lifestyle and a healthier immune system, which buffers the adverse influence of stress [ 20 ]. In addition, the available evidence suggests that well-being reduces the risk of developing mental symptoms and disorders [ 21 , 22 ] and helps reduce mortality risks in people with physical disease [ 23 ].

Seligman and Csikszentmihaly’s (2000) pioneered these principles of positive psychology in their well-known article entitled ‘Positive psychology: An introduction’, published in a special issue of the American Psychologist. They argued that a negative bias prevailed in psychology research, where the main focus was on negative emotions and treating mental health problems and disorders [ 24 ]. Although the basic concepts of well-being, happiness and human flourishing have been studied for some decades [ 12 , 25 – 27 ], there was a lack of evidence-based interventions [ 24 ]. Since the publication of Seligman and Csikszentmihaly’s seminal article, the positive psychology movement has grown rapidly. The ever-expanding International Positive Psychology Association is among the most extensive research networks in the world [ 28 ] and many clinicians and coaches embrace the body of thought that positive psychology has to offer.

Consequently, the number of evaluation studies has greatly increased over the past decade. Many of these studies demonstrated the efficacy of positive psychology interventions such as counting your blessings [ 29 , 30 ], practicing kindness [ 31 ], setting personal goals [ 32 , 33 ], expressing gratitude [ 30 , 34 ] and using personal strengths [ 30 ] to enhance well-being, and, in some cases, to alleviate depressive symptoms [ 30 ]. Many of these interventions are delivered in a self-help format. Sin and Lyubomirsky (2009) conducted a meta-analytical review of the evidence for the effectiveness of positive psychology interventions (PPIs). Their results show that PPIs can indeed be effective in enhancing well-being (r = 0.29, standardized mean difference Cohen’s d = 0.61) and help to reduce depressive symptom levels in clinical populations (r = 0.31, Cohen’s d = 0.65). However, this meta-analysis had some important limitations. First, the meta-analysis included both randomized studies and quasi-experimental studies. Second, study quality was not addressed as a potential effect moderator. In recent meta-analyses, it has been shown that the treatment effects of psychotherapy have been overestimated in lower quality studies [ 35 , 36 ]. The lack of clarity in the inclusion criteria constitutes a third limitation. Intervention studies, although related to positive psychology but not strictly developed within this new framework (e.g. mindfulness, life-review) were included in the meta-analysis. However, inclusion of these studies reduces the robustness of the results for pure positive psychology interventions.

Present study

The aim of the present study is to conduct a meta-analysis of the effects of specific positive psychology interventions in the general public and in people with specific psychosocial problems. Subjective well-being, psychological well-being and depressive symptoms were the outcome measures. Potential variables moderating the effectiveness of the interventions, such as intervention type, duration and quality of the research design, were also examined. This study will add to the existing literature and the above meta-analytical review [ 37 ] by 1) only including randomized controlled studies, 2) taking the methodological quality of the primary studies into account, 3) including the most recent studies (2009 – 2012), 4) analyzing not only post-test effects but also long-term effects at follow up, and 5) applying clear inclusion criteria for the type of interventions and study design.

Search strategy

A systematic literature search was carried out in PsychInfo, PubMed and the Cochrane Central Register of Controlled Trials, covering the period from 1998 (the start of the positive psychology movement) to November 2012. The search strategy was based on two key components: there should be a) a specific positive psychology intervention, and b) an outcome evaluation. The following MeSH terms and text words were used: “well-being” or “happiness” or “happy*”, “optimism”, “positive psychology” in combination with “intervention”, “treatment”, “therapy” and “prevention”. This was combined with terms related to outcome research: “effect*”, or “effic*”, or “outcome*”, or “evaluat*”. We also cross-checked the references from the studies retrieved, the earlier meta-analysis of Sin & Lyubomirsky (2009) and two other reviews of positive psychological interventions [ 38 , 39 ]. The search was restricted to peer-reviewed studies in the English language.

Selection of studies

Two reviewers (LB and MH) independently selected potentially eligible studies in two phases. At the first phase, selection was based on title and abstract, and at the second phase on the full-text article. All studies identified as potentially eligible by at least one of the reviewers during the first selection phase, were re-assessed at the second selection phase. During the second phase, disagreements between the reviewers were resolved by consensus. The inter-rater reliability (kappa) was 0.90.

The inclusion criteria were as follows:

Examination of the effects of a positive psychology intervention. A positive psychology intervention (PPI) was defined in accordance with Sin and Lyubomirsky’s (2009) article as a psychological intervention (training, exercise, therapy) primarily aimed at raising positive feelings, positive cognitions or positive behavior as opposed to interventions aiming to reduce symptoms, problems or disorders. The intervention should have been explicitly developed in line with the theoretical tradition of positive psychology (usually reported in the introduction section of an article).

Randomization of the study subjects (randomizing individuals, not groups) and the presence of a comparator condition (no intervention, placebo, care as usual).

Publication in a peer-reviewed journal.

At least one of the following are measured as outcomes: well-being (subjective well-being and/or psychological well-being) or depression (diagnosis or symptoms).

Sufficient statistics are reported to enable the calculation of standardized effect sizes.

If necessary, authors were contacted for supplementary data. We excluded studies that involved physical exercises aimed at the improvement of well-being, as well as mindfulness or meditation interventions, forgiveness therapy, life-review and reminiscence interventions. Furthermore, well-being interventions in diseased populations not explicitly grounded in positive psychology theory (‘coping with disease courses’) were excluded. Apart from being beyond the scope of this meta-analysis, extensive meta-analyses have already been published for these types of intervention [ 40 – 42 ]. This does not imply that these interventions do not have positive effects on well-being, a point which will be elaborated on in the discussion section of this paper.

Data extraction

Data extraction and study quality assessment were performed by one reviewer (LB) and independently checked by a second reviewer (MH). Disagreements were resolved by consensus. Data were collected on design, intervention characteristics, target group, recruitment methods, delivery mode, number of sessions, attrition rates, control group, outcome measures and effect sizes (post-test and at follow up of at least 3 months). The primary outcomes in our meta-analysis were subjective well-being (SWB), psychological well-being (PWB) and depressive symptoms/depression.

The methodological quality of the included studies was assessed using a short scale of six criteria tailored to those studies and based on criteria established by the Cochrane collaboration [ 43 ]: 1) Adequacy of randomization concealment, 2) Blinding of subjects to the condition (blinding of assessors was not applicable in most cases), 3) Baseline comparability: were study groups comparable at the beginning of the study and was this explicitly assessed? (Or were adjustments made to correct for baseline imbalance using appropriate covariates), 4) Power analysis: is there an adequate power analysis and/or are there at least 50 participants in the analysis?, 5) Completeness of follow up data: clear attrition analysis and loss to follow up < 50%, 6) Handling of missing data: the use of intention-to-treat analysis (as opposed to a completers-only analysis). Each criterion was rated as 0 (study does not meet criterion) or 1 (study meets criterion). The inter-rater reliability (kappa) was 0.91. The quality of a study was assessed as high when five or six criteria were met, medium when three or four criteria were met, and low when zero, one or two criteria were met. Along with a summary score, the aspects relating to quality were also considered individually, as results based on composite quality scales can be equivocal [ 44 ]. Table  1 shows the quality assessment for each study. The quality of the studies was scored from 1 to 5 (M = 2.56; SD = 1.25). Twenty studies were rated as low, 18 were of medium quality and one study was of high quality. None of the studies met all quality criteria. The average number of participants in the analysis was rather high (17 out of 39 studies scored positive on this criterion), although none of the studies reported an adequate power analysis. Also, baseline comparability was frequently reported (26/39 studies). On the other hand, independence in the randomization procedure was seldom reported (7/39 studies) and an intention-to-treat analysis was rarely conducted (3/39 studies).

• Meta-analysis

In a meta-analysis, the effects found in the primary studies are converted into a standardized effect size, which is no longer placed on the original measurement scale, and can therefore be compared with measures from other scales. For each study, we calculated effect sizes (Cohen’s d ) by subtracting the average score of the experimental group (Me) from the average score of the control group (Mc), and dividing the result by the pooled standard deviations of both groups. This was done at post-test because randomization usually results in comparable groups across conditions at baseline. However, if baseline differences on outcome variables did exist despite the randomization, d’s were calculated on the basis of pre- post-test differences: by calculating the standardized pre- post change score for the experimental group (de) and the control group (dc) and subsequently calculating their difference as Δd= de – dc. For example, an effect size of 0.5 indicates that the mean of the experimental group is half a standard unit (standard deviation) larger than the mean of the control group. From a clinical perspective, effect sizes of 0.56 – 1.2 can be interpreted as large, while effect sizes of 0.33 – 0.55 are of medium size, and effects of 0 – 0.32 are small [ 45 ].

In the calculation of effect sizes for depression, we used instruments that explicitly measure depression (e.g. the Beck Depression Inventory, or the Center for Epidemiological Studies Depression Scale). For subjective and psychological well-being, we also used instruments related to the construct of well-being (such as positive affect for SWB and hope for PWB). If more than one measure was used for SWB, PWB or depression, the mean of the effect sizes was calculated, so that each study outcome had one effect size. If more than one experimental group was compared with a control condition in a particular study, the number of subjects in the control groups was evenly divided across the experimental groups so that each subject was used only once in the meta-analysis.

To calculate pooled mean effect sizes, we used Comprehensive Meta-Analysis (CMA, Version 2.2.064). Due to the diversity of studies and populations, a common effect size was not assumed and we expected considerable heterogeneity. Therefore, it was decided a priori to use the ‘random effects model’. Effect sizes may differ under this model, not only because of random error within studies (as in the fixed effects model), but also as a result of true variation in effect sizes between studies. The outcomes of the random effects model are conservative in that their 95% Confidence Intervals (CIs) are often broad, thus reducing the likelihood of type-II errors.

We tested for the presence of heterogeneity with two indicators. First, we calculated the Q-statistic. A significant Q rejects the null-hypothesis of homogeneity and indicates that the true effect size probably does vary from study to study. Second, the I 2 -statistic was calculated. This is a percentage indicating the study-to-study dispersion due to real differences, over and above random sampling error. A value of 0% indicates an absence of dispersion, and larger values show increasing levels of heterogeneity where 25% can be considered as low, 50% as moderate and 75% as a high level of heterogeneity [ 46 ].

Owing to the expected high level of heterogeneity, all studies were taken into account. Outliers were considered, but not automatically removed from the meta-analysis. The procedure of removing outliers which are outside the confidence interval of the pooled effect size is advised when a common effect size is assumed. However, in our meta-analysis, high dispersion was expected and therefore only the exclusion of Cohen’s d > 2.5 from the final sample was planned.

Subgroup analyses were performed by testing differences in Cohen’s d’s between subgroups. Six potential moderators were determined based on previous research and the characteristics of the investigated interventions and studies: 1) Self-selected sample/not self-selected: did the participants know that the aim of the intervention was to make them feel better?; 2) Duration: less than four weeks, four to eight weeks, or more than eight weeks; 3) Type of intervention: self-help, group intervention, or individual therapy; 4) Recruitment method: community (in a community center, local newspapers), internet, by referral/hospital, at university; 5) Psychosocial problems (Yes/none): was the data based on a group with certain psychosocial problems or was the study open to everyone?; 6) Quality rating: low (score 1 or 2), medium (score 3 or 4) or high (score 5 or 6). The impact of the duration and quality ratings was also assessed using meta-regression.

Results of meta-analysis may be biased due to the fact that studies with non-significant or negative results are less likely to be published in peer-reviewed journals [ 47 ]. In order to address this issue, we used three indices: funnel plots, the Orwin’s fail-safe number and the Trim and Fill method. A funnel plot is a graph of effect size against study size. When publication bias is absent, the observed studies are expected to be distributed symmetrically around the pooled effect size. The Orwin’s fail-safe number indicates the number of non-significant unpublished studies needed to reduce the overall significant effect to non-significance (according to a self-stated criterium) [ 48 ]. The effect size can be considered to be robust if the number of studies required to reduce the overall effect size to a non-significant level exceeds 5 K + 10, where K is the number of studies included. If asymmetry is found in the funnel plot, the Trim and Fill method adjusts the pooled effect size for the outcomes of missing studies [ 49 ]. Imputing missing studies restores the symmetry in the funnel plot and an adjusted effect size can be calculated.

For the reporting of the results of this meta-analysis, we applied Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 50 ].

Description of studies

The selection process is illustrated in Figure  1 . First, 5,335 titles were retrieved from databases and 55 titles were identified through searching the reference list accompanying the meta-analysis by Sin and Lyubomirsky (2009) [ 37 ] as well as two other literature reviews of positive psychological interventions [ 38 , 39 ]. After reviewing the titles and abstracts and removing duplicates, 84 articles were identified as being potentially eligible for inclusion in our study. Of these 84 articles, 40 articles in which 39 studies were described, met our inclusion criteria (of these, 17 articles describing 19 studies were also included in the meta-analysis by Sin and Lyubomirsky, 2009). In two articles [ 29 , 51 ] two studies were described, and one study [ 52 – 55 ] was published in four articles.

Flow diagram.

The characteristics of the studies included are described in Table  2 . The studies evaluated 6,139 subjects, 4,043 in PPI groups and 2,096 in control groups. Ten studies compared a PPI with a no-intervention control group [ 29 , 51 , 56 – 63 ], 17 studies compared a PPI with a placebo intervention [ 29 , 30 , 32 , 34 , 52 – 55 , 64 – 75 ], seven studies with a waiting list control group [ 33 , 76 – 81 ] and five studies with another active intervention (care as usual) [ 51 , 82 – 85 ]. A minority of seven studies [ 51 , 57 , 76 , 77 , 82 , 83 ] applied inclusion criteria to target a specific group with psychosocial problems such as depression and anxiety symptoms. Half of the studies, 19 in total, recruited the subjects (not necessarily students) through university [ 29 , 32 , 34 , 51 , 56 , 58 – 61 , 64 – 68 , 70 , 72 , 75 , 80 , 85 ]. In seven studies subjects were recruited in the community [ 33 , 57 , 71 , 73 , 76 , 77 , 81 ], in four studies by referral from a practitioner or hospital [ 29 , 51 , 82 , 83 ], in three studies in an organization [ 62 , 78 , 79 ] and six studies recruited through the internet [ 30 , 52 – 55 , 63 , 69 , 74 , 84 ]. Twenty-eight studies measured subjective well-being, 20 studied psychological well-being and 14 studied depressive symptoms. Half of the studies (20) were aimed at adult populations [ 29 , 30 , 33 , 51 – 56 , 62 , 63 , 65 , 69 , 71 , 73 , 74 , 76 , 78 , 79 , 81 – 84 ]. A substantial number of studies (17) were aimed at college students [ 29 , 32 , 34 , 51 , 58 – 61 , 64 , 66 – 68 , 70 , 72 , 75 , 80 , 85 ] and two studies were aimed at older subjects [ 57 , 77 ]. In most studies (26) the PPI was delivered in the form of self-help [ 29 , 30 , 34 , 52 – 56 , 58 , 59 , 61 , 63 – 71 , 73 – 75 , 77 , 78 , 80 , 84 , 85 ]. Eight studies used group PPIs [ 32 , 33 , 51 , 57 , 60 , 62 , 72 , 76 ] and five used individual PPIs [ 51 , 79 , 81 – 83 ]. Intensity varied considerably across studies, ranging from a short one-day exercise [ 70 ] and a two-week self-help intervention [ 65 ] to intensive therapy [ 51 , 82 , 83 ] and coaching [ 33 , 81 ].

Post-test effects

The random effect model showed that the PPIs were effective for all three outcomes. Results are presented in Table  3 . The effect sizes of the individual studies at post-test are plotted in Figures  2 , 3 and 4 .

Post-test effects of positive psychology interventions on subjective well-being. The square boxes show effect size and sample size (the larger the box, the larger the sample size) in each study, and the line the 95% confidence interval. The diamond reflects the pooled effect size and the width of the 95% confidence interval.

Post-test effects of positive psychology interventions on psychological well-being. The square boxes show effect size and sample size (the larger the box, the larger the sample size) in each study, and the line the 95% confidence interval. The diamond reflects the pooled effect size and the width of the 95% confidence interval.

Post-test effects of positive psychology interventions on depressive symptoms. The square boxes show effect size and sample size (the larger the box, the larger the sample size) in each study, and the line the 95% confidence interval. The diamond reflects the pooled effect size and the width of the 95% confidence interval.

A composite moderate and statistically significant effect size (Cohen’s d ) was observed for subjective well-being d = 0.34 (95% CI [0.22, 0.45], p<.01). For psychological well-being, Cohen’s d was 0.20 (95% CI [0.09, 0.30], p<.01) and for depression d = 0.23 (95% CI [0.09, 0.38], p<.01), which can be considered as small.

Heterogeneity was moderate for subjective well-being (I 2 = 49.5%) and depression (I 2 = 47.0%), and low for psychological well-being (I 2 = 29.0%). Effect sizes ranged from −0.09 [ 66 ] to 1.30 [ 64 ] for subjective well-being, -0.06 [ 78 ] to 2.4 [ 83 ] for psychological well-being and −0.17 [ 69 ] to 1.75 [ 83 ] for depression.

Removing outliers reduced effect sizes for all three outcomes: 0.26 (95% CI [0.18, 0.33], Z=6.43, p<.01) for subjective well-being (Burton & King, 2004 and Peters et al., 2010 removed) [ 64 , 70 ], 0.17 (95% CI [0.09, 0.25], Z=4.18, p<.01) for psychological well-being (Fava et al. (2005) removed) [ 83 ] and 0.18 (95% CI [0.07, 0.28], Z=3.33, p<.01) for depression (Fava, 2005 and Seligman, 2006 study 2, removed) [ 51 , 83 ]. Removing the outliers reduced heterogeneity substantially (to a non-significant level).

Follow-up effects

Ten studies examined follow-up effects after at least three months and up to 12 months (Table  3 ). For the purposes of interpretation, we used only those studies examining effects from three to six months (short-term follow-up), thus excluding Fava et al. (2005) [ 83 ] which had a follow-up at one year. The random-effects model demonstrated small but significant effects in comparison with the control groups for subjective well-being (Cohen’s d 0.22, 95% CI [0.05, 0.38], p<.01) and for psychological well-being (0.16, 95% CI [0.02, 0.30], p = .03). The effect was not significant for depression (0.17, 95% CI [−0.06, 0.39], p = .15). Heterogeneity was low for subjective well-being (I 2 = 1.1%) and psychological well-being (I 2 = 26.0%), and high for depression (I 2 = 63.9%).

Subgroup analyses

Subgroup analyses are presented in Table  4 . We looked at self-selection, duration of the intervention, type of intervention, recruitment method, application of inclusion criteria related to certain psychosocial problems, and quality rating.

For depression, five out of six subgroups of studies resulted in significantly higher effect sizes. Higher effect sizes were found for 1) interventions of a longer duration (only in the meta regression analysis), 2) individual interventions, 3) studies involving referral from a health care practitioner or hospital, 4) studies which applied inclusion criteria based on psychosocial problems and 5) lower quality studies. For subjective well-being and psychological well-being, there were no significant differences between subgroups, although for the latter there was a recognizable trend in the same direction and on the same moderators, except for quality rating.

Twenty-six out of 39 studies were self-help interventions for which we conducted a separate subgroup analysis. However, there was little diversity within the self-help subgroup: only six studies examined intensive self-help for longer than four weeks, self-help was offered to people with specific psychosocial problems in only one study and more than half of the self-help studies (n=14) recruited their participants via university. Consequently, there were no significant differences between subgroups for self-help interventions.

Publication bias

Indications for publication bias were found for all outcome measures, but to a lesser extent for subjective well-being. Funnel plots were asymmetrically distributed in such a way that the smaller studies often showed the more positive results (in other words, there is a certain lack of small insignificant studies). Orwin’s fail-safe numbers based on a criterium effect size of 0.10 for subjective well-being (59), psychological well-being (16) and depression (13) were lower than required (respectively 150, 110 and 80). Egger’s regression intercept also suggests that publication bias exists for psychological well-being (intercept=1.18, t=2.26, df=18, p=.04) and depression (intercept=1.45, t=2.26, df=12, p=.03), but not for subjective well-being (intercept=1.20, t=1.55, df=26, p=0.13). The mean effect sizes of psychological well-being and depression were therefore recalculated by imputing missing studies using the Trim and Fill method. For psychological well-being, three studies were imputed and the effect size was adjusted to 0.16 (95% CI 0.03-0.29). For depression, five studies were imputed and the adjusted effect size was 0.16 (95% CI 0.00-0.32).

Main findings

This meta-analysis synthesized effectiveness studies on positive psychology interventions. Following a systematic literature search, 40 articles describing 39 studies were included. Results showed that positive psychology interventions significantly enhance subjective and psychological well-being and reduce depressive symptoms. Effect sizes were in the small to moderate range. The mean effect size on subjective well-being was 0.34, 0.20 on psychological well-being, and 0.23 on depression. Effect sizes varied a great deal between studies, ranging from below 0 (indicating a negative effect) to 2.4 (indicating a very large effect). Moreover, at follow-up from three to six months, small but still significant effects were found for subjective well-being and psychological well-being, indicating that effects were partly sustained over time. These follow-up results should be treated with caution because of the small number of studies and the high attrition rates at follow-up.

Remarkably, effect sizes in the current meta-analysis are around 0.3 points lower than the effect sizes in the meta-analysis by Sin and Lyubomirsky (2009) [ 37 ]. We included a different set of studies in which the design quality was assured using randomized controlled trials only. Effectiveness research in psychotherapy shows that effect sizes are relatively small in high-quality studies compared with low-quality studies [ 35 ] and this might also be true for positive psychology interventions. In addition, we applied stricter inclusion criteria than those used by Sin and Lyubomirsky (2009) and therefore did not include studies on any related areas such as mindfulness and life review therapy. These types of interventions stem from long-standing independent research traditions for which effectiveness has already been established in several meta-analyses [ 40 , 41 ]. Also, the most recent studies were included. This might explain the overestimation of effect sizes in the meta-analysis by Sin and Lyubomirsky (2009).

Several characteristics of the study moderated the effect on depressive symptoms. Larger effects were found in interventions with a longer duration, in individual interventions (compared with self-help), when the interventions were offered to people with certain psychosocial problems and when recruitment was carried out via referral from a health care professional or hospital. Quality rating also moderated the effect on depression: the higher the quality, the smaller the effect. Interestingly, these characteristics did not significantly moderate subjective well-being and psychological well-being. However, there was a trend in the moderation of psychological well-being that was the same as that observed in the studies which included depression as an outcome. In general, effectiveness was increased when interventions were offered over a longer period, face-to-face on an individual basis in people experiencing psychosocial problems and when participants were recruited via the health care system.

Although it is clear that more intensive and face-to-face interventions generate larger effects, the effects of short-term self-help interventions are small but significant. From a public health perspective, self-help interventions can serve as cost-effective mental health promotion tools to reach large target groups which may not otherwise be reached [ 86 – 88 ]. Even interventions presenting small effect sizes can in theory have a major impact on populations’ well-being when many people are reached [ 89 ]. The majority of positive psychology interventions (in our study 26 out of 39 studies) are already delivered in a self-help format, sometimes in conjunction with face-to-face instruction and support. Apparently, self-help suits the goals of positive psychology very well and it would be very interesting to learn more about how to improve the effectiveness of PPI self-help interventions. However, a separate subgroup analysis on the self-help subgroup revealed no significant differences in the present meta-analysis. There was very little variation in the subgroups as regards population, duration of the intervention and recruitment method. As a result, this analysis does not give firm indications on how to improve the effectiveness of self-help interventions. It is possible that self-help could be enhanced by offering interventions to people with specific psychosocial problems, increasing the intensity of the intervention and embedding the interventions in the health care system. However, more studies in diverse populations, settings and with varying intensity are needed before we can begin to derive recommendations from this type of meta-analysis. Other research gives several additional indications on how to boost the efficacy of self-help interventions. Adherence tends to be quite low in self-help interventions [ 90 , 91 ] and therefore, enhancing adherence could be a major factor in improving effectiveness. Self-help often takes a ‘one size fits all’ approach, which may not be appropriate for a large group of people who will, as a consequence, not fully adhere to the intervention. Personalization and tailoring self-help interventions to individual needs [ 92 ] as well interactive support [ 93 ] might contribute to increased adherence and likewise improved effectiveness of (internet) self-help interventions.

Study limitations

This study has several limitations. First, the quality of the studies was not high, and no study met all of our quality criteria. For example, the randomization procedure was unclear in many studies. Also, most studies conducted completers-only analysis, as opposed to intention-to-treat analysis. This could have seriously biased the results [ 35 ]. However, the low quality of the studies could have been overstated as the criteria were scored conservatively: we gave a negative score when a criterion was not reported. Even so, more high-quality randomized-controlled trials are needed to enable more robust conclusions about the effects of PPIs. Second, different types of interventions are lumped together as positive psychology interventions, despite the strict inclusion criteria we applied. As expected, we found a rather high level of heterogeneity. In the future, it might be wise and meaningful to conduct meta-analyses that are restricted to specific types of interventions, for example gratitude interventions, strengths-based interventions and well-being therapy, just as has already been carried out with, for example, mindfulness and life review. In the present meta-analysis, studies on these specific interventions were too small and too diverse to allow for a subgroup-analysis. Third, the exclusion of non peer-reviewed articles and grey literature could have led to bias, and possibly also to the publication bias we found in our study. Fourth, although we included a relatively large number of studies in the meta-analysis, the number of studies in some subgroups was still small. Again, more randomized-controlled trials are needed to draw firmer conclusions. Sixth, the study of positive education is an emerging field in positive psychology [ 94 – 98 ] but school-based interventions were excluded from our meta-analysis due to the strict application of the inclusion criteria (only studies with randomization at individual level were included).

This meta-analysis demonstrates that positive psychology interventions can be effective in the enhancement of subjective and psychological well-being and may help to reduce depressive symptom levels. Results indicate that the effects are partly sustained at short-term follow-up. Although effect sizes are smaller in our meta-analysis, these results can be seen as a confirmation of the earlier meta-analysis by Sin and Lyubomirsky (2009). Interpretation of our findings should take account of the limitations discussed above and the indications for publication bias.

Implications for practice

In mental health care PPIs can be used in conjunction with problem-based preventive interventions and treatment. This combination of interventions might be appropriate when clients are in remission; positive psychology interventions may then be used to strengthen psychological and social recourses, build up resilience and prepare for normal life again. On the basis of the moderator analysis, we would recommend the delivery of interventions over a longer period (at least four weeks and preferably eight weeks or longer) and on an individual basis. Practitioners can tailor their treatment strategy to the needs and preferences of a client and can use positive psychology exercises in combination with other evidence-based interventions that have a positive approach and aim to enhance well-being, such as mindfulness interventions [ 40 ], Acceptance and Commitment Therapy [ 7 , 99 ], forgiveness interventions [ 42 ], behavioral-activation [ 100 ] and reminiscence [ 41 , 101 ].

In the context of public health, positive psychology interventions can be used as preventive, easily accessible and non-stigmatizing tools. They can potentially be used in two ways: 1) in mental health promotion (e.g. leaflets distributed for free at community centers, (mental) health internet portals containing psycho-education), and 2) as a first step in a stepped care approach. In the stepped care model, clients start with a low-intensity intervention if possible, preferably a self-directed intervention. These interventions can be either guided by a professional or unguided, and are increasingly delivered over the internet. Clinical outcomes can be monitored and people can be provided with more intensive forms of treatment, or referred to specialized care, if the first-step intervention does not result in the desired outcome [ 102 ].

Recommendations for research

Regarding the research agenda, there is a need for more high-quality studies, and more studies in diverse (clinical) populations and diverse intervention formats to know what works for whom. Standards for reporting studies should also be given more attention, for example by reporting randomized controlled trials according to the CONSORT statement [ 103 ]. In addition, we encourage researchers to publish in peer-reviewed journals, even when the sample sizes are small or when there is a null finding of no effect, as this is likely to reduce the publication bias in positive psychology. Furthermore, most studies are conducted in North America. Therefore, replications are needed in other countries and cultures because some positive psychology concepts may require adaptation to other cultures and outlooks (e.g. see Martinez et al., 2010) [ 68 ]. Last but not least, we strongly recommend conducting cost-effectiveness studies aiming to establish the societal and public health impact of positive psychology interventions. This type of information is likely to help policy makers decide whether positive psychology interventions offer good value for money and should therefore be placed on the mental health agenda for the 21 st century.

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We are grateful to Toine Ketelaars and Angita Peterse for the literature search and Jan Walburg for his comments on the manuscript. We would also like to thank Deirdre Brophy for the English language edit.

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Bolier, L., Haverman, M., Westerhof, G.J. et al. Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health 13 , 119 (2013). https://doi.org/10.1186/1471-2458-13-119

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Seligman’s PERMA+ Model Explained: A Theory of Wellbeing

Yet the concept of “happiness” is often hard to accurately define.

Living the good life, flourishing, self-actualization, joy, and purpose are words that come to mind with happiness. Is it possible to experience any of these in the middle of a chaotic world and negative circumstances? Can we learn to grow or find skills that lead to this “good life?”

Positive psychology takes you through the countryside of pleasure and gratification, up into the high country of strength and virtue, and finally to the peaks of lasting fulfillment, meaning and purpose.

Seligman, 2002

This article will outline the PERMA+ model and the theory of wellbeing, and provide practical ways to apply its components in your private practice or personal life.

Before you continue, we thought you might like to download our three Happiness & Subjective Wellbeing Exercises for free . These detailed, science-based exercises will help you or your clients identify sources of authentic happiness and strategies to boost wellbeing.

This Article Contains:

What is seligman’s perma+ model, p – positive emotion, e – engagement, r – positive relationships, m – meaning, a – accomplishments/achievements, the plus (+) in perma, training in perma+: 3 options, 3 perma+ activities & interventions, 4 helpful questionnaires and questions to ask, positivepsychology.com’s relevant resources, a take-home message.

Abraham Maslow (1962) was one of the first in the field of psychology to describe “wellbeing,” with his characteristics of a self-actualized person. The description of self-actualization is a foreshadowing of the PERMA model, which outlines the characteristics of a flourishing individual and Wellbeing Theory (WBT).

In 1998, Dr. Martin Seligman used his inaugural address as the incoming president of the American Psychological Association to shift the focus from mental illness and pathology to studying what is good and positive in life. From this point in time, theories and research examined positive psychology interventions that help make life worth living and how to define, quantify, and create wellbeing (Rusk & Waters, 2015).

In developing a theory to address this, Seligman (2012) selected five components that people pursue because they are intrinsically motivating and they contribute to wellbeing. These elements are pursued for their own sake and are defined and measured independently of each other (Seligman, 2012).

Additionally, the five components include both eudaimonic  and hedonic components, setting WBT apart from other theories of wellbeing.

These five elements or components (PERMA; Seligman, 2012) are

• Positive emotion
• Relationships
• Accomplishments

The PERMA model makes up WBT, where each dimension works in concert to give rise to a higher order construct that predicts the flourishing of groups, communities, organizations, and nations (Forgeard, Jayawickreme, Kern, & Seligman, 2011).

Research has shown significant positive associations between each of the PERMA components and physical health, vitality, job satisfaction , life satisfaction, and commitment within organizations (Kern, Waters, Alder, & White, 2014).

PERMA is also a better predictor of psychological distress than previous reports of distress (Forgeard et al., 2011). This means that proactively working on the components of PERMA not only increases aspects of wellbeing, but also decreases psychological distress.

Watch this video where Seligman discusses the PERMA model.

Positive emotions include hope, interest, joy, love, compassion, pride, amusement, and gratitude.

Positive emotions are a prime indicator of flourishing, and they can be cultivated or learned to improve wellbeing (Fredrickson, 2001).

When individuals can explore, savor, and integrate positive emotions into daily life (and visualizations of future life), it improves habitual thinking and acting. Positive emotions can undo the harmful effects of negative emotions and promote resilience (Tugade & Fredrickson, 2004).

Increasing positive emotions helps individuals build physical, intellectual, psychological, and social resources that lead to this resilience and overall wellbeing.

Ways to build positive emotion may include:

• Spend time with people you care about (Kok et al., 2013).
• Do hobbies and creative activities that you enjoy (Conner et al., 2018).
• Listen to uplifting or inspirational music (Juslin & Sakka, 2019).
• Reflect on things you are grateful for and what is going well in your life (Emmons & McCullough, 2003).

Download 3 Free Happiness Exercises (PDF)

These detailed, science-based exercises will equip you or your clients with tools to discover authentic happiness and cultivate subjective well-being.

Download 3 Free Happiness Tools Pack (PDF)

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According to Seligman (2012), engagement is “being one with the music.” It is in line with Csikszentmihalyi’s (1989) concept of “flow.” Flow includes the loss of self-consciousness and complete absorption in an activity. In other words, it is living in the present moment and focusing entirely on the task at hand.

Flow, or this concept of engagement, occurs when the perfect combination of challenge and skill/strength is found (Csikszentmihalyi & LeFevre, 1989).

People are more likely to experience flow when they use their top character strengths . Research on engagement has found that individuals who try to use their strengths in new ways each day for a week were happier and less depressed after six months (Seligman, Steen, Park, & Peterson, 2005).

The concept of engagement is something much more powerful than simply “being happy,” but happiness is one of the many byproducts of engagement.

Ways to increase engagement:

• Participate in activities that you really love, where you lose track of time when you do them (Bonaiuto et al., 2016).
• Practice living in the moment, even during daily activities or mundane tasks (Belitz & Lundstrom, 1998).
• Spend time in nature , watching, listening, and observing what happens around you (Petersen et al., 2021).
• Identify and learn about your character strengths, and do things that you excel at (Lai et al., 2018).

Relationships in the PERMA model refer to feeling supported, loved, and valued by others. Relationships are included in the model based on the idea that humans are inherently social creatures (Seligman, 2012). There is evidence of this everywhere, but social connections become particularly important as we age.

The social environment has been found to play a critical role in preventing cognitive decline , and strong social networks contribute to better physical health among older adults (Siedlecki et al., 2014).

Many people have a goal of improving relationships with those they are closest to. Research has demonstrated that sharing good news or celebrating success fosters strong bonds and better relationships (Siedlecki et al., 2014). Additionally, responding enthusiastically to others, particularly in close or intimate relationships, increases intimacy, wellbeing, and satisfaction.

How to build relationships:

• Join a class or group that interests you.
• Ask questions of the people you don’t know well to find out more about them.
• Create friendships with people you are acquainted with.
• Get in touch with people you have not spoken to or connected with in a while.

Another intrinsic human quality is the search for meaning and the need to have a sense of value and worth. Seligman (2012) discussed meaning as belonging and/or serving something greater than ourselves. Having a purpose in life helps individuals focus on what is really important in the face of significant challenge or adversity.

Having meaning or purpose in life is different for everyone. Meaning may be pursued through a profession, a social or political cause, a creative endeavor, or a religious/spiritual belief. It may be found in a career or through extracurricular, volunteer, or community activities.

A sense of meaning is guided by personal values, and people who report having purpose in life live longer and have greater life satisfaction and fewer health problems (Kashdan et al., 2009).

Ways to build meaning:

• Get involved in a cause or organization that matters to you (Tang et al., 2022).
• Try new, creative activities to find things you connect with.
• Think about how you can use your passions to help others.
• Spend quality time with people you care about.

A sense of accomplishment is a result of working toward and reaching goals, mastering an endeavor, and having self-motivation to finish what you set out to do. This contributes to wellbeing because individuals can look at their lives with a sense of pride (Seligman, 2012).

Accomplishment includes the concepts of perseverance and having a passion to attain goals. But flourishing and wellbeing come when accomplishment is tied to striving toward things with an internal motivation or working toward something just for the sake of the pursuit and improvement (Quinn, 2018).

Achieving intrinsic goals  (such as growth and connection) leads to larger gains in wellbeing than external goals such as money or fame (Seligman, 2013).

Ways to build accomplishment:

• Set goals that are SMART – specific, measurable, achievable, realistic, and time bound (Falecki et al., 2018).
• Reflect on past successes.
• Look for creative ways to celebrate your achievements.

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Yet happiness goes beyond just these five elements, and the + can include other important areas we well, such as optimism, nutrition, physical activity and sleep. These are areas equally important to mental wellbeing.

Optimism is a positive emotion critical to building resilience and wellbeing. Optimism is the belief that life will have more good outcomes than bad. People who are optimistic are more likely to be resilient to stressful life events (Carver, Scheier, & Segerstrom, 2010).

Optimistic people tend to live longer, have better postoperative outcomes and lower levels of depression, and adjust better to college life (Carver et al., 2010).

Encouraging youth to become more resilient would build help in establishing a more optimistic outlook on life. Our article, How to Build Resilience in Children , as well as Teaching Resilience in Schools, are great starting points to have youth who are optimistic, resilient, and can handle life’s stressful events better.

Physical activity

Physical activity has been linked to wellbeing in numerous ways. Negative emotions are associated with an increased risk of physical disease and poor health habits, and people with mental illness are more likely to be physically inactive (Hyde, Maher, & Elavsky, 2013).

There are obvious physical benefits to being active, but increasing movement or activity also decreases symptoms of depression, anxiety, and loneliness and improves mental focus and clarity (Hyde et al., 2013).

Read our article on Cognitive Health , to understand the connection between exercise and mental wellbeing.

Poor nutrition leads to physical health problems such as obesity, diabetes, heart disease, and even cancer, but there is significant research demonstrating a relationship between diet and mental health (Stranges, Samaraweera, Taggart, Kandala, & Stewart-Brown, 2014).

Eating a balanced diet rich in vegetables and nutrients (and limiting processed or sugary foods) has been associated with wellbeing. High levels of wellbeing were reported by individuals who ate more fruits and vegetables (Stranges et al., 2014). A review of research on children and adolescents found that a poor diet (high levels of saturated fat, refined carbohydrates, and processed foods) was linked to poorer mental health (O’Neil et al., 2014).

So what should we eat? There are many “super foods” found in nature, such as berries, cruciferous vegetables, avocados, nuts, and seeds. A Mediterranean diet that is high in vegetables, fruits, legumes, nuts, beans, cereals, grains, fish, and unsaturated fats has been shown to reduce depression symptoms and provides an array of physical health benefits (Parletta et al., 2017).

Neuroimaging and neurochemistry research suggests that good sleep hygiene fosters mental and emotional resilience, and sleep deprivation leads to negative thinking and emotional vulnerability (Harvard Medical School, 2019). Further, sleep problems are more likely to affect people with psychiatric disorders and may increase the risk of developing mental illness.

Particularly, insomnia increases the risk of developing depression.

Getting seven to nine hours of quality sleep during the same hours every night is recommended (Harvard Medical School, 2019). Lifestyle changes such as avoiding caffeine, nicotine, and alcohol; getting physical activity; decreasing screen time; and using the bedroom only for sleep and sex can improve sleep quality.

Relaxation techniques and cognitive behavioral techniques to reduce stress and anxiety can also be effective ways to improve sleep and overall wellbeing.

Training in PERMA can be helpful for improving performance, building resilience, and increasing success and life satisfaction. Here are three options for obtaining training in PERMA.

The Penn Resilience Program and PERMA workshops

The Penn Resilience Program and PERMA workshops are evidence-based training options that strive to build resilience, wellbeing, and optimism. The workshops are designed to offer practical skills for individuals, teams, and organizations that reduce mental health issues and improve quality of life.

The SAHMRI Wellbeing and Resilience Centre

The Wellbeing and Resilience Centre aims to decrease mental illness by improving mental health and wellbeing. With the understanding that wellbeing is multi-dimensional, PERMA+ is the foundation used to train leaders how to deliver skills and interventions to the community.

The Science of Happiness Course

Offered through UC Berkeley, the Science of Happiness Course , with an optional certificate, focuses on all aspects of PERMA without actually focusing on the acronym.

The course discusses research on happiness (positive emotions, engagement, relationships, meaning, and achievements) and provides practical activities to improve and measure individual happiness and wellbeing.

Martin Seligman designed the PERMA model to conceptualize the main factors contributing to wellbeing (Seligman, 2012). Research has found positive associations between the PERMA components and improved health and life satisfaction (Kern et al., 2014).

The PERMA model includes five elements:

P – Positive Emotions

Positive Emotion is much more than happiness. Positive emotions include hope, joy, love, compassion, amusement, and gratitude. Positive emotions are a prime indicator of flourishing (Fredrickson, 2001) and can be cultivated. However, this does not mean we need to repress negative emotions. Instead, we can accept all emotional experiences but expose ourselves to situations where positive emotions arise naturally.

E – Engagement

According to Seligman, engagement is being one with the music (2012). Engagement is similar to the concept of flow. It refers to a loss of self-consciousness and complete absorption in an activity. It is mindfully focusing on the task at hand.

R – Relationships

Relationships encompass all the interactions individuals have with partners, friends, family members, and their community at large. This part of the model refers to feeling supported, loved, and valued by others.

M – Meaning

Meaning is defined as belonging and serving something greater than ourselves. Having a purpose helps individuals focus on what is important in the face of significant challenges or adversity (Seligman, 2012).

A – Accomplishments

A sense of accomplishment results from mastering an endeavor and working towards goals. Achievements contribute to wellbeing because individuals can look at their lives with a sense of pride.

PERMA activities and interventions are applicable to individuals suffering from mental health disorders as well as those who simply want to improve levels of flourishing. The following interventions can be implemented during any point in a treatment program or as standalone activities to increase wellbeing.

1. Your character strengths

Find your character strengths using the VIA Survey . Much of the research on PERMA uses the assessment of these 24 character strengths.

Learning your unique character strengths can help guide you into meaningful activities (engagement) and work (accomplishment).

2. Track and measure success

This worksheet helps clients set goals and track progress. Often, we take the first step in setting goals but do not take the time to reflect on the emotions elicited when we have achieved them.

3. Gratitude journal

One of the most common activities mentioned throughout research on flourishing and wellbeing is the impact of gratitude. This article about creating a Gratitude Journal  provides comprehensive background information and specific details and activities to implement a gratitude journal or routine into daily life.

Not only do they provide a way to measure wellbeing, but they are another way to track the effectiveness of interventions and therapeutic techniques.

The following assessments can also offer ideas for specific or individual questions that help clients gain insight and self-awareness.

1. PERMA Profiler

The PERMA Profiler is an extensive questionnaire from the University of Pennsylvania that assesses each of Seligman’s (2012) components of wellbeing or flourishing.

This can be an excellent resource to assess clients as they progress through therapy, coaching, or interventions in positive psychology or counseling.

2. The Workplace PERMA Profile

The Workplace PERMA Profile is created by the same authors as the individual PERMA Profiler, but it is designed to assess groups and organizations.

Leaders can use this to assess workers or teams and improve wellbeing in the environment, which will lead to better performance.

3. PURPOSE+ PERMA Profiler

This PURPOSE+ PERMA Profiler is a quick online assessment that asks relevant questions related to each component of PERMA.

It is a fast and efficient way to assess and compare levels of wellbeing. It will email the results directly to you and compares your PERMA scores with other people in the same demographic. The questions asked in the short survey also provide a great starting point for therapy, coaching, or consulting.

4. The Flourishing Scale

The Flourishing Scale asks participants to rate themselves on specific areas of wellbeing. Flourishing is one of the most important components of resilience and wellbeing.

This scale can be used as a tool for motivational interviewing to inspire ideas for self-improvement, or it can be used as an assessment to track progress. The full description of the scale, with scoring, can be accessed in the Positive Psychology Toolkit© .

17 Exercises To Increase Happiness and Wellbeing

Add these 17 Happiness & Subjective Well-Being Exercises [PDF] to your toolkit and help others experience greater purpose, meaning, and positive emotions.

Created by Experts. 100% Science-based.

Our Positive Psychology Toolkit©  provides a wealth of resources that cover the full range of components from Wellbeing Theory and PERMA. The assessments, exercises, and activities can be implemented and integrated into any stage of therapy or as standalone activities.

1. Strengths for Altruism

The Strengths for Altruism worksheet, available in the Toolkit, is helpful once an individual has identified their strengths. We all have strengths and have a choice of what we do with them. Using strengths in an altruistic way can promote engagement, relationship, and meaning.

2. Gratitude Letter

Creating a Gratitude Letter is one of the most effective exercises used in the PERMA model. Just like the gratitude journal mentioned earlier, fostering gratitude can significantly improve all aspects of PERMA (positive emotions, engagement, relationships, meaning, and accomplishment). To make the letter specific to Wellbeing Theory, gratitude can be targeted to each of the five areas.

3. Build an Emotions Portfolio

This free Emotions Portfolio tool is a great resource to help clients build a database or toolbox of positive emotions. Hope , gratitude, awe, joy, and inspiration are positive emotions that have been linked to wellbeing and are explored here.

4. 17 Happiness Exercises

If you’re looking for more science-based ways to help others develop strategies to boost their wellbeing, this collection contains 17 validated happiness and wellbeing exercises . Use them to help others pursue authentic happiness and work toward a  life filled with purpose and meaning.

We all want to experience a higher level of wellbeing and “flourish” in life. The PERMA+ model is an evidence-based approach to improve “happiness” and decrease anxiety, depression, and stress.

Many activities can be used to systematically increase positive emotions, engagement, relationships, meaning, and achievement (PERMA). The good thing is that the areas of PERMA can be mutually exclusive, but in most ways, they are not. For example, by using mindfulness exercises to increase engagement, one will probably also experience more positive emotion and meaning in life.

We hope you enjoyed reading this article. Don’t forget to download our three Happiness Exercises for free .

[Reviewer’s update:

Citations of new research have been added where appropriate.]

• Belitz, C., & Lundstrom, M. (1998).  The power of flow: Practical ways to transform your life with meaningful coincidence . Harmony.
• Bonaiuto, M., Mao, Y., Roberts, S., Psalti, A., Ariccio, S., Ganucci Cancellieri, U., & Csikszentmihalyi, M. (2016). Optimal experience and personal growth: Flow and the consolidation of place identity.  Frontiers in Psychology ,  7 .
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• Harvard Medical School. (2019). Sleep and mental health. Harvard Mental Health Letter. Retrieved from https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health
• Hyde, A. L., Maher, J. P., & Elavsky, S. (2013). Enhancing our understanding of physical activity and wellbeing with a lifespan perspective. International Journal of Wellbeing , 3 (1), 98–115.
• Juslin, P. N., & Sakka, L. S. (2019). Neural correlates of music and emotion. In M. H. Thaut & D. A. Hodges (Eds.),  The Oxford handbook of music and the brain  (pp. 285–332). Oxford University Press.
• Kashdan, T. B., Mishra, A., Breen, W. E., & Froh, J. J. (2009). Gender differences in gratitude: Examining appraisals, narratives, the willingness to express emotions and changes in psychological needs. Journal of Personality , 77 (3), 691–730.
• Kern, M., Waters, L., Alder, A., & White, M. (2014). Assessing employee wellbeing in schools using a multifaceted approach: Associations with physical health, life satisfaction and professional thriving. Psychology , 5 (6), 500–513.
• Kok, B. E., Coffey, K. A., Cohn, M. A., Catalino, L. I., Vacharkulksemsuk, T., Algoe, S. B., Brantley, M., & Fredrickson, B. L. (2013). How positive emotions build physical health: Perceived social connections account for the upward spiral between positive emotions and vagal tone.  Psychological Science , 24(7), 1123–1132.
• Lai, M. K., Leung, C., Kwok, S. Y. C., Nui, A. N. N., Lo, H. H. M., Leung, J. T. Y., & Tam, C. H. L. (2018). A multidimensional PERMA-H positive education model, general satisfaction of school life, and character strengths use in Hong Kong senior primary school students: Confirmatory factor analysis and path analysis using the APASO-II.  Frontiers in Psychology ,  9 .
• Maslow, A. (1962). Toward a psychology of being . D. van Nostrand.
• O’Neil, A., Quirk, S. E., Housden, S., Brennan, S. L., Williams, L. J., Pasco, J. A., & Jacka, F. N. (2014). Relationship between diet and mental health in children and adolescents: A systematic review. American Journal of Public Health , 104 (10), 31–42.
• Parletta, N., Zarnowiecki, D., Cho, J., Wilson, A., Bogomolova, S., Villani, A., … O’Dea, K. (2017). A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial. Nutritional Neuroscience , 22 (1), 1–14.
• Petersen, E., Bischoff, A., Liedtke, G., & Martin, A. J. (2021). How does being solo in nature affect well-being? Evidence from Norway, Germany and New Zealand.  International Journal of Environmental Research and Public Health ,  18 (15), 7897.
• Quinn, A. (2018, February 3). Theory of well-being: Elements and interventions. GoodTherapy Blog . Retrieved from https://www.goodtherapy.org/blog/theory-of-well-being-elements-interventions-0203184
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Top positive psychology research of 2021 (so far)

07/07/2021 by Marie

Top positive psychology research of 2021

There is so much research happening around the world into what is arguably the most important question you can ask: how can I be happy? As global mental health stats continue to decline, particularly during COVID, this is good news. There’s now a raft of actionable science-backed research you can apply in your life to take you from simply languishing in life, to thriving.

While the rest of this article is a catalogue of the top positive psychology research in 2021 so far, I would like to acknowledge one other piece of sad news from this year: Edward Diener, Psychologist Known as Dr. Happiness, Dies at 74 . Since the 1980s, Ed Diener was recognised as a leader in measuring what he called “subjective well-being” and his passing is a loss for not only his family and friends, but the entire positive psychology community.

In this article, we take a look at the top positive psychology research of 2021, so far. Let me know in the comments about how you are using the latest research to achieve a happier, healthier life!

Frequent travel could make you 7% happier  (Science Daily). People dreaming of travel post-COVID-19 now have some scientific data to support their wanderlust. A new study shows frequent travellers are happier with their lives than people who don’t travel at all.

Research suggests positive forward-thinking safeguards mental health during lockdowns  (Mental Health Today). We all might feel nostalgic for a time when we weren’t confined to our homes or had rules imposed upon us in public spaces; however new research from the University of Surrey suggests that if we forget about 2020 or even our current lockdown state in 2021 and look forward to the future, our mental wellbeing will presently be more resilient.

Learning Boosts Happiness, New Study Suggests  (Sci News). New research from University College London suggests that how we learn about the world around us can be more important for how we feel than rewards we receive directly.

Study suggests link between word choices and extraverts  (Science Daily). A study by a team of Nanyang Technological University, Singapore (NTU Singapore) psychologists has found a link between extraverts and their word choices.

Why living in the future, rather than the past, is key to coping with lockdowns – new research  (The Conversation).  Researcher in the UK recruited 261 people during the first lockdown in the UK (March-May 2020) to explore the impact of the three different time orientations on wellbeing.

Being around birds linked to higher happiness levels  (World Economic Forum). Greater bird biodiversity can make people more joyful, according to a study published in Ecological Economics. The happiest Europeans are those who see the most bird species in their day-to-day life. 

Research shows positive effect of street trees on mental health  (De Montfort University). Daily contact with trees in the street may significantly reduce the risk of depression and the need for antidepressants, according to new research by a De Montfort University Leicester (DMU) academic.

Heading outdoors keeps lockdown blues at bay  (Science Daily). A new study has found that spending time outdoors and switching off devices, such as smartphones, is associated with higher levels of happiness during a period of COVID-19 restrictions.

Money matters to happiness—perhaps more than previously thought   (Penn Today). Research shows that contrary to previous influential work, there’s no dollar-value plateau at which money’s importance lessens. One potential reason: Higher earners feel an increased sense of control over life.

Happiness and life expectancy by main occupational position among older workers: Who will live longer and happy?   (ScienceDirect) We show that women in routine jobs were systematically the ones who were expected to live shorter and unhappier. Men and women in managerial positions lived longer, but only men record more years with happiness.

Why being resilient won’t necessarily make you happy new research  (The Conversation). Resilience featured at the core of the World Health Organization’s policy framework for health and well-being in 2020. This states that “building resilience is a key factor in protecting and promoting health and wellbeing”. Similar statements have also been made by wellbeing researchers. Despite this, most resilience research focuses on how to help individuals avoid negative outcomes, rather than achieve positive outcomes. Very few who investigate resilience actually assess wellbeing.

Happiness really does come for free  (Science Daily). Economic growth is often prescribed as a sure way of increasing the well-being of people in low-income countries, but a study led by McGill and the Institute of Environmental Sciences and Technologies at the Universitat Autònoma de Barcelona (ICTA-UAB) suggests that there may be good reason to question this assumption.

20 surprising, science-backed health benefits of music  (USA Today). Research suggests that music not only helps us cope with pain — it can also benefit our physical and mental health in numerous other ways. Read on to learn how listening to tunes can ramp up your health.

Mental Health Plays a Role in Treating and Preventing Heart Disease  (VeryWell) Researchers are stressing the important links between your mental health and heart health. And they’re calling on clinicians to screen and address mental health when seeking to treat heart conditions.

COVID-19’s Impact on Mental Health Hasn’t Been All Bad   (Psychology Today). The COVID-19 pandemic has caused mental distress, but it has also strengthened people’s mental health in many ways. New research shows how the crisis has increased mental health through three main processes.

Study uncovers a psychological factor that predict one’s motivation to boost happiness  (PsyPost). A group of researchers from Seoul National University and Korea University have found evidence that “essentializing” happiness—i.e., attributing one’s happiness to immutable factors like genetics—renders individuals less likely to adopt behaviors intended to (and in many cases, proven to) increase happiness.

To Get Through Tough Times Turn Down Your Pessimism   (Psychology Today). New research shows the value of remaining positive when things look negative. There is a personality trait that can explain this tendency to overlook the negative and find reason to celebrate each day as it comes. Optimism, from this perspective, reflects not some delusional form of denial, but a stable quality that allows people to feel genuinely hopeful no matter what’s going on around them.

Emotional Well-Being Under Conditions of Lockdown  (Springer) The coronavirus pandemic and related lockdown measures present serious threats to emotional well-being worldwide. Researchers examined the extent to which being outdoors (vs. indoors), the experience of loneliness, and screen-time are associated with emotional well-being during the COVID-19 pandemic.

How Trip Planning and Happiness Are Directly Correlated  (Psychology Today). Research reveals that planning future travel may boost mood and mindset.

A Tale of Three Countries: What is the Relationship Between COVID‐19, Lockdown and Happiness ?  (Wiley Online Library). Though lockdowns do minimise the physical damage caused by the virus, there may also be substantial damage to population well‐being. 

Does Volunteering Make Us Happier, or Are Happier People More Likely to Volunteer? Addressing the Problem of Reverse Causality When Estimating the Wellbeing Impacts of Volunteering   (Springer Link). New research shows that volunteering does indeed make people measurably happier.

Is Awareness of Strengths Intervention Sufficient to Cultivate Wellbeing and Other Positive Outcomes?   (Springer Link). A new study shows that students who reflected on strengths for a 5-week period prior to exams prevented the surfacing of negative emotions and distress, as well as a decline in wellbeing due to the impending examination period. The intervention also enhanced feelings of optimism about the future.

Mental Health Declining During COVID, But Not For Regular Church Attenders  (Theravive). A recent Gallup study reveals a positive connection between regular church attendance and a positive self-evaluation of one’s mental health. I invited experts to give their opinions on these findings and what it is about church attendance that contributes to positive mental health.

Happiness of centenarians a severely neglected area of research  (Mirage). A systematic review by researchers at the Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney has highlighted the need for clearer definitions of ‘happiness’, ‘life satisfaction’ and ‘positive affect’ in centenarians. This is the first systematic review to summarise the literature on the subjective wellbeing of this unique age group.

Forget what you think happiness is  (Wall Street Journal). Think you know what it means to be happy? Think again. Scientists are learning how to better measure and improve happiness, as the pandemic forces many to question what brings them joy. In the future, some experts believe, people will embrace a more complex definition of happiness that focuses less on uninterrupted bliss and involves everything from a person’s environment to exercises that train the brain in ways to be happy.

How watching TV in lockdown can be good for you — according to science  (Salon). Many mental health organizations have proposed strategies to protect mental health, such as exercising, sleeping well and enjoying nature. This may make us assume that watching TV is ultimately bad for our mental wellbeing. But there is evidence to suggest that watching TV can also be good for us – if we go about it the right way.

One team is redefining how the world measures happiness, for the better  (Inverse).  First released in 2012, the World Happiness Report aims to both quantify and analyze well-being around the world. Each year, it generates press coverage because of its ranking of the world’s happiest countries — typically Nordic countries like Finland and Denmark top the charts.

Women reported decreased happiness during COVID-19 pandemic: Study   (ZEE5).  A recent study found that during the COVID-19 pandemic women, especially mothers, spent more time on tasks such as childcare and household chores than men. In turn, time spent completing household chores was linked to lower well-being and decreased happiness during the pandemic.

Why Older People Managed to Stay Happier Through the Pandemic  (New York Times) . New surveys over the last year show that the ability to cope improves with age.

Australia ‘most expensive country in the world to be happy,’ study finds  (DMarge)  Researchers at Purdue University in the United States have come up with a metric called ‘income satiation’ – basically, the point at which you have enough money to be happy.

Degrees of happiness? Formal education does not lead to greater job satisfaction  (Science Daily).  Education is considered one of the most critical personal capital investments. But formal educational attainment doesn’t necessarily pay off in job satisfaction, according to new research from the University of Notre Dame.

Happiness can be learned through meditation, philosophy and training  (Medical Xpress). Is it possible to learn to be happier? Well, it seems it is—at least according to a scientific study coordinated by the University of Trento and carried out in collaboration with Sapienza University of Rome, now published in Frontiers in Psychology.

Make mine a micro-job! Why working one day a week is the secret of happiness  (The Guardian). Working only one day a week is the secret of happiness, according to researchers at the University of Cambridge.

Do you ever struggle to overcome a bad mood? Scientists have finally figured out why this happens  (News24). In a new study on brain activity led by University of Miami psychologists, researchers explain why some of these emotional experiences persist. According to their research, how a person’s brain evaluates fleeting negative stimuli may influence their long-term psychological well-being.

The unsung secret to stability and happiness during the pandemic  (ZDNet). It’s been a hard year, but at least many people have found a reliable way to reduce stress and increase happiness. Netflix is great and exercise is important, but music, it turns out, has made a positive difference in the lives of many during an often-bleak and perpetually uncertain pandemic year.

How Life Could Get Better (or Worse) After COVID  (Greater Good Magazine). Fifty-seven scientists make predictions about potential positive and negative consequences of the pandemic.

Want a Happier Workplace? Studies Say the Best Companies Do These 5 Things Every Single Day  (Inc.). It will not only make employees happy, it will also increase their productivity.

UK workforce finds happiness in ability to work from anywhere  (Computer Weekly). Study finds 44% of UK workers consider the ability to work remotely as a driver of happiness and 61% would support government policies aimed at the widespread adoption of ‘hybrid’ working practices.

Scientists explore the source of well-being and happiness  (ZJU University). Serotonin, or 5-hydroxytryptamine (5-HT), is a messenger molecule that produces a sense of well-being and happiness and is therefore also known as the “happy hormone”. However, the biological mechanism as to how 5-HT generates a sense of well-being has yet to be deciphered.

How has WFH impacted employee happiness? results by sector, revealed  (HRD). If there’s one thing we can all agree on about 2020/21, it’s that most of us have never spent so much time at home. But how has working from home (WFH) affected us? Expert Insolvency Practitioners, Hudson Weir, polled 3,500 employees across the country to find out how well we have taken to it…

Social comparisons with similar people determine income’s effect on happiness  (Phys.org). Researchers have found that in states where incomes were relatively equal, individuals’ happiness was affected less by their incomes because their economic positions were less clearly defined, making social comparisons less meaningful.

Can Online Psychology Classes Increase Well-Being?  (Psychology Today). A study found that participants in online psychology courses saw increases in well-being from their baseline measures. If these classes have long-term benefits, they could become reliable public health interventions.

8 Mix-and-Match Ingredients for a Tailored Be-Well Plan  (Psychology Today). A new systematic review and meta-analysis of well-being studies identified 8 core psychological interventions that delivered positive results. The researchers found, though, that no one approach was best, and encouraged clinicians and individuals to “mix and match” strategies. 

Curiosity and happiness go hand in hand  (The Philadelphia Inquirer). As Einstein said: The important thing is to never stop questioning. Recent research suggests that consistent curiosity goes hand in hand with happiness. 

Lockdown has had a positive effect on some people’s mental health, study reveals  (GentSide). Researchers from the University of Manchester have found that lockdown brought forth a sense of relief for those who struggled with pre-existing depression. 

If You Want to Be Happy, Try to Make Someone Else Happy  (Greater Good Berkeley). What if happiness comes from aiming to make others happy, instead of doing nice things for yourself? That is exactly what a recent study found. 

How to Draw On Your Psychological Resources  (Psychology Today). An international team of psychologists has explored various ways individuals can help alleviate the pandemic’s massive psychological toll – with an arsenal of researched-backed skills, states, and competencies that can help us buffer against stress, bolster mental health, and build new capacities. 

3 Reasons Real-Life Social Support Is Best for Mental Health  (Psychology Today). Many people rely on social media platforms for social support. New research suggests that social media social support (SMSS) doesn’t have a negative impact on mental health. However, real-life social support (RLSS) can reduce anxiety, depression, and loneliness; RLSS has a positive effect on mental health.

The impact of staff happiness on customer service   (Convenience and Impulse Retailing). Three-quarters or 79 per cent of Australian casual workers say their happiness at work directly impacts on the customer experience they can deliver.

Happiness statistics 2021  (Finder.com). Data reveals children, financial security and a good Internet connection make Aussies happy.

So Happy Fur You: Elmhurst Research Links Pet Spending to Joy  (Elmhurst University). In findings published in The Journal of Positive Psychology, Elmhurst University faculty and students showed that a person’s happiness can be affected by purchasing a gift for their pet. Study participants reported being happier when buying for a pet than spending money on themselves or another person.

Happiness Comes from Making Others Feel Good   (Psychology Today). New research published by a team of psychologists at the University of Missouri-Columbia suggests that King’s words are as true today as they were a half-century ago — that our own happiness is, in part, influenced by the kindness and generosity we show others.

Happiness & Sustainability Go Hand In Hand’: New Survey Shows Vegans Are Happier Than Meat Eaters  (Green Queen). A new study was looking to do a deeper dive into the many misconceptions about vegans and vegetarians has taken meat eaters by surprise, with the results showing that vegans reported higher happiness levels (+7%) than those who consume meat.

Zest, Hope, And Humor Are The Most Important Character Strengths, Suggests New Psychological Research  (Forbes). A new study published in the Journal of Positive Psychology suggests that while all character strengths serve an important function, some may be more central to psychological well-being than others — and that zest, hope, and humor are the three strengths most commonly found in well-rounded and psychologically healthy individuals.

Employee happiness drops 75% in two years  (Employee Benefits).The happiness of workers has decreased by 75% since 2019, according to new findings from employee engagement consultancy Inpulse.

If You Want to Be Happy, Try to Make Someone Else Happy  (Epoch Times). In a recent study, college students reported on their happiness and on their sense of autonomy, competence, and connection to others—all what researchers consider to be “basic psychological needs” for well-being.

Green space around primary schools may improve students’ academic performance  (The Conversation). Greenery around primary schools may improve students’ academic performance, while traffic pollution may be detrimental, our study shows. 

This is where older Americans find the most happiness  (Market Watch). A new study “The Four Pillars of the New Retirement: What a Difference a Year Makes” conducted by Edward Jones, the large investment and financial services advisory firm, in partnership with Age Wave, a think tank and consulting firm, and The Harris Poll reports that 70% of Americans say the pandemic has caused them to be more reflective and pay more attention to their long-term finances.

‘Urban green space affects citizens’ happiness’  (Science Daily). A recent study revealed that as a city becomes more economically developed, its citizens’ happiness becomes more directly related to the area of urban green space.

Considering happiness and stress as leading indicators  (OHS Canada). As our understanding of neuroscience evolves, how we manage workplace safety and health must also evolve.

How You Decorate Your Home Can Impact Your Happiness   (Women’s Health). Google partnered with the Arts & Mind Lab at Johns Hopkins University to explore the impact of sensory input on our minds and bodies. They designed three different rooms, and participants wore bands to track their physiological responses as they moved through each room.

One Walking Strategy That Will Secretly Make You a Happier Person  (Eat This. Not That). If you’re looking to really boost your mood—and to view the world in a much more positive light—walking can help you out there, too. You just need to employ one specific mental technique devised by researchers at Iowa State University and published in the Journal of Happiness Studies.

Find this useful? Sign up to my weekly newsletter to get the internet’s best happiness news and tips and deliver it straight to you every Monday for free!

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Please note you do not have access to teaching notes, positive psychology in individual wellness: a thematic illustration of drama as a therapeutic framework in identity transformation.

International Journal of Organizational Analysis

ISSN : 1934-8835

Article publication date: 8 July 2024

The language of participative theatre can be considered immersive in the treatment of its dialectics where participants engage fully with their dichotomies and value systems through physical and psychological exploratory processes as they commit themselves to transformation.

Design/methodology/approach

The use of drama as an intervention for challenging recurring mental models of oppressive narratives is used extensively in experiential psychotherapy and as a socio-psychological integrative tool. This experiential methodology allows for an organic development and expression of themes and motifs by encouraging a participant to develop a deeper awareness of how he/she interprets their identity and that of the community in which they function.

This paper aims to review the implications of applying drama-based interventions as positive psychotherapeutic devices to facilitate self-reflection and active-constructive responding in enabling a rendering of positive patterns of thought and purposeful movement towards emotional and physical well-being.

Practical implications

Research on the principles of positive psychology suggests that positive emotions lead to therapeutic change. Nurturing positive emotions which are immanent in spirituality, creativity and optimistic perseverance through autonomy and self-regulation enable individual potential to come to meaningful fruition.

Originality/value

The paper conceptualizes psychodrama as a framing technique in enabling reflexive action in identity transformation and well-being.

• Positive psychology
• Theatre and drama
• Theatre of the Oppressed
• Psychodrama

Acknowledgements

Funding : The authors declare that no funds, grants or other support were received during the preparation of this manuscript.

Conflict of interests : The authors declare that there is no conflict of interest during the preparation of this manuscript.

D’Souza, A. and Rani, J. (2024), "Positive psychology in individual wellness: a thematic illustration of drama as a therapeutic framework in identity transformation", International Journal of Organizational Analysis , Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/IJOA-01-2024-4236

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• Open access
• Published: 15 July 2024

Enhancing psychological well-being in college students: the mediating role of perceived social support and resilience in coping styles

• Shihong Dong 1 ,
• Huaiju Ge 1 ,
• Wenyu Su 1 ,
• Weimin Guan 1 ,
• Xinquan Li 1 ,
• Yan Liu 2 ,
• Qing Yu 1 ,
• Yuantao Qi 2 ,
• Huiqing Zhang 3 &
• Guifeng Ma 1  

BMC Psychology volume  12 , Article number:  393 ( 2024 ) Cite this article

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Metrics details

The prevalence of depression among college students is higher than that of the general population. Although a growing body of research suggests that depression in college students and their potential risk factors, few studies have focused on the correlation between depression and risk factors. This study aims to explore the mediating role of perceived social support and resilience in the relationship between trait coping styles and depression among college students.

A total of 1262 college students completed questionnaires including the Trait Coping Styles Questionnaire (TCSQ), the Patient Health Questionnaire-9 (PHQ-9), the Perceived Social Support Scale (PSSS), and the Resilience Scale-14 (RS-14). Common method bias tests and spearman were conducted, then regressions and bootstrap tests were used to examine the mediating effects.

In college students, there was a negative correlation between perceived control PC and depression, with a significant direct predictive effect on depression ( β = -0.067, P  < 0.01); in contrast, negative control NC showed the opposite relationship ( β  = 0.057, P  < 0.01). PC significantly positively predicted perceived social support ( β  = 0.575, P  < 0.01) and psychological resilience ( β  = 1.363, P  < 0.01); conversely, NC exerted a significant negative impact. Perceived social support could positively predict psychological resilience ( β  = 0.303, P  < 0.01), and both factors had a significant negative predictive effect on depression. Additionally, Perceived social support and resilience played a significant mediating role in the relationship between trait coping styles and depression among college students, with three mediating paths: PC/NC → perceived social support → depression among college students (-0.049/0.033), PC/NC→ resilience → depression among college students (-0.122/-0.021), and PC/NC → perceived social support → resilience → depression among college students (-0.016/0.026).

The results indicate that trait coping styles among college students not only directly predict lower depression but also indirectly influence them through perceived social support and resilience. This suggests that guiding students to confront and solve problems can alleviate their depression.

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Introduction

Depression is a complex mental disorder, characterized by cognitive, affective and psychosocial symptoms [ 1 , 2 ]. It is projected that by 2030, depression will rank first globally in terms of years lived with disability [ 3 , 4 ]. Depression is also one of the most common mental health issues among contemporary college students [ 5 , 6 ]. Studies have shown that the detection rate of depression among Chinese college students ranges from 23–34% [ 7 , 8 ]. Compared to non-student populations, college students have a higher prevalence of depression, and this rate seems to be increasing [ 9 ]. This vulnerable group of college students is in a unique developmental stage, facing pressures not only from life but also from the demands of academic coursework and complex interpersonal relationships, making the factors influencing depression among college students, particularly complex [ 9 , 10 ].

Exploring the mechanisms by which influencing factors affect the occurrence of depression in college students is of significant importance for early prevention [ 11 ]. Research has demonstrated that trait coping style is one of the risk factors for depression among college students. Trait coping refers to the strategies individuals employ in challenging situations, categorized into positive coping and negative coping [ 12 , 13 ]. Positive coping focuses on taking effective action and changing stressful situations, typically associated with problem-solving behaviors and regulation of positive emotions, which can help reduce the incidence of depression [ 14 ]. Conversely, negative coping is a passive approach centered around negative evaluations and emotional expression, often involving avoiding problems and social isolation, which is more likely to lead to the development of depression [ 14 ]. Research indicates that positive coping strategies are inversely correlated with depression, serving as protective factors against depression. Conversely, negative coping strategies are positively associated with depression, acting as risk factors for its onset [ 15 ].

Perceived social support refers to an individual’s subjective emotional state of feeling supported and understood by family, friends, and other sources [ 16 , 17 ]. Prior studies have shown that perceived social support can directly impact an individual’s level of depression and also have indirect effects [ 18 ]. The data indicate that social support can significantly influence coping mechanisms, with groups having higher levels of social support tended to respond more actively and positively to stress from various sources [ 19 ]. Social support is considered an important mediating factor in determining the relationship between psychological stress and health, representing an emotional experience where individuals feel supported, respected, and understood [ 16 ]. The relationship between individuals’ coping strategies and depression may be influenced by the mediating role of perceived social support [ 20 , 21 ]. In addition to this, resilience plays a role in all three.Resilience refers to the ability to adapt to stress and adversity, enhancing an individual’s psychological well-being [ 22 ]. Both coping styles and perceived social support significantly predict resilience positively [ 23 ]. For individuals with strong resilience, possessing a high level of adaptive capacity can mitigate the negative effects of stress on individuals, thereby enhancing their mental health.

In recent years, there has been a growing body of research on the prevalence of depression among college students. However, the rates of depression vary in different environments, and there is limited research on the mechanisms through which trait coping styles, perceived social support, and resilience impact depression. Therefore, this study aims to investigate the mechanisms through which positive coping styles(PC), negative coping styles(NC), perceived social support, and resilience influence depression among college students. Additionally, it seeks to analyze the mediating roles of perceived social support and resilience in this context. The goal is to provide insights into the reasons behind depression among college students under different coping strategies, aiding in timely psychological adjustment to promote the comprehensive development of the mental and physical well-being of college students.

The following assumptions were made:

Hypothesis 1

PC has a significant negative predictive effect on depression among college students. NC has a significant positive predictive effect on depression among college students.

Hypothesis 2

Perceived social support serves as a mediator between PC/NC and depression among college students.

Hypothesis 3

Resilience mediates the relationship between PC/NC and depression among college students.

Hypothesis 4

Perceived social support and psychological resilience mediate the relationship between PC/NC and depression among college students in a serial manner.

Data and methods

This is a cross-sectional study that was conducted from January through February 2024. Using the Questionnaire Star network platform, we presented the questionnaire online, which was openly accessible to college students at a university in Shandong. The average time to complete the survey was 15 min. Participation was voluntary and students were informed about the purpose of the study. Confidentiality was assured and questionnaires were submitted anonymously. A total of 1267 enrolled college students participated in the questionnaire survey. After excluding invalid questionnaires, 1262 valid questionnaires were included, resulting in an effective rate of 99.57%.

Trait coping style questionnaire

The Trait Coping Style Questionnaire (TCSQ) [ 24 ], developed by Qianjin Jiang, was utilized to assess the trait coping styles of college students. This questionnaire reflects the participants’ approaches to coping with situations, comprising a total of 20 items. It consists of two dimensions: negative coping style and positive coping style, each with 10 items. Using a 5-point Likert scale ranging from “definitely not” to “definitely yes,” scores were assigned from 1.00 to 5.00. The Cronbach’s α coefficient for negative coping style was 0.906 and for positive coping style was 0.786 in this study.

Depression scale

The Patient Health Questionnaire-9 (PHQ-9) [ 25 ] was used to assess depressive symptoms in the past two weeks. This scale consists of 9 items rated on a 4-point Likert scale ranging from “not at all” to “nearly every day,” with scores from 0 to 3. The total score ranges from 0 to 27, with higher scores indicating more severe depressive symptoms. The Cronbach’s α coefficient for this scale in the current study was 0.884.

Perceived Social Support Scale

The Perception Social Support Scale (PSSS) was compiled by James A.Blumenthal in 1987 and later translated and modified by Qianjin Jiang to form the Chinese version of the Zimetm Perception Social Support Scale (PSSS) [ 26 , 27 ]. PSSS comprises 12 self-assessment items rated on a 7-point Likert scale. The scale includes three dimensions: family support (items 3, 4, 8, 11), friend support (items 6, 7, 9, 12), and other support (items 1, 2, 5, 10), with a total score ranging from 12 to 84. Scores of 12–36 indicate low support, 37–60 indicate moderate support, and 61–84 indicate high support. The Cronbach’s α for this scale in the current survey was 0.968.

Resilience scale

The Resilience Scale (RS-14) [ 28 ] Chinese version consists of 14 items, each rated on a 7-point Likert scale from “not at all” to “completely,” with scores ranging from 1 to 7. The total score ranges from 14 to 98, with higher scores indicating better resilience. The Cronbach’s α for this scale in the current study was 0.925.

Statistical analysis

Data were organized and analyzed using SPSS 26.0 software. Confirmatory factor analysis was first conducted on the questionnaires. Descriptive analysis was then performed on the scores of each scale. Spearman was used to examine the relationships between trait coping styles, perceived social support, resilience, and depression. Mediation analysis was carried out using the SPSS PROCESS macro 3.4.1 software model 6 developed by Hayes, specifically designed for testing complex models. Model 6 was applied for two mediating variables, followed by the bias-corrected percentile Bootstrap method with 5000 resamples to estimate the 95% confidence interval of the mediation effect. A significant mediation effect was indicated if the 95% confidence interval (CI) did not include zero. A significance level of P  < 0.05 was considered statistically significant.

Examination of common method bias

Systematic errors in indicator data results caused by the same data collection method or measurement environment can typically be assessed through the Harman single-factor test on 55 items in the dataset to examine common method bias. The results indicated that there were 7 factors with eigenvalues greater than 1, and the variance explained by the first factor was 34.84%, which was below the critical threshold of 40%. Therefore, this study may not have a significant common method bias.

Descriptive statistics and correlation analysis

The mean scores, standard deviations, and correlations of each variable are presented in Table  1 . PC ( r = -0.326, P  < 0.01), resilience ( r =-0.445, P  < 0.01), and perceived social support ( r =-0.405, P  < 0.01) were negatively correlated with depression. PC ( r  = 0.336, P  < 0.01) and resilience ( r  = 0.469, P  < 0.01) were significantly positively correlated with perceived social support. PC was significantly positively correlated with resilience( r  = 0.635, P  < 0.01). NC was significantly positively correlated with depression( r  = 0.322, P  < 0.01) and PC( r  = 0.146, P  < 0.01). NC was significantly negatively correlated with perceived social support ( r =-0.325, P  < 0.01).

Analysis of chain mediation effects

The chain mediation model was validated using SPSS PROCESS Model 6. Trait coping styles were considered as the independent variable, while depression among college students was treated as the dependent variable. Perceived social support and resilience were included as the mediating variables, culminating in the path model depicted in Figs.  1 and 2 .

The results of the regression analysis, as shown in Table  2 , indicated that PC could significantly predict perceived social support in a positive direction ( β  = 0.575, P  < 0.01). Both PC ( β  = 1.363, P  < 0.01) and perceived social support ( β  = 0.303, P  < 0.01) had significant positive predictive effects on psychological resilience. When simultaneously predicting depression using PC, perceived social support, and psychological resilience, all three exhibited significant negative predictive effects ( β = -0.067, β = -0.085, β = -0.090, P  < 0.01). NC could significantly predict perceived social support in a negative direction ( β = -0.457, P  < 0.01). When NC ( β  = 0.191, P  < 0.01) and perceived social support ( β  = 0.508, P  < 0.01) jointly predict psychological resilience, they both had significant positive predictive effects. When simultaneously predicting depression using NC, perceived social support, and psychological resilience, NC ( β  = 0.057, P  < 0.01) showed a significant positive predictive effect, while perceived social support ( β = -0.072, P  < 0.01) and psychological resilience ( β = -0.112, P  < 0.01) demonstrated significant negative predictive effects.

Further employing the Bootstrap sampling method, with 5000 repetitions, the significance of the mediating effects and chain mediation effects between trait coping styles and depression among college students was examined. The results indicated that the direct effects of PC/NC on depression were significant, with direct impact values of -0.067/0.057 (26.38%/60.00%). Perceived social support and psychological resilience mediated the relationship between PC/NC and depression, with this mediation encompassing three pathways: the separate mediating effect of perceived social support, with effect values of -0.049 and 0.033 respectively; the separate mediating effect of resilience, with effect values of -0.122 and − 0.021 respectively; and the serial mediating effect from perceived social support to resilience, with effect values of -0.016, -0.021, and 0.026. The 95% confidence intervals for all pathways did not include 0, indicating significant indirect effects. Therefore, the total indirect effects were − 0.187 (73.62%) and 0.038 (40.00%), showing that PC had a weaker direct effect on depression compared to NC, but a stronger indirect effect. This was illustrated in Table  3 .

Chain mediation model of perceived social support and resilience between PC and depression. ** p  < 0.01

Chain mediation model of perceived social support and resilience between NC and depression. ** p  < 0.01

Previous research on the associations and specific pathways among depressive symptoms, trait coping styles, perceived social support, and resilience in college students has been limited. Therefore, this study utilized a chain mediation model to examine how trait coping styles, perceived social support, and resilience influence depressive symptoms in college students. The results indicate that perceived social support and resilience not only act as separate mediators between PC/NC and depression but also exhibit a chain mediation effect.

Mechanisms of the impact of PC/NC on depression in college students

This study found that trait coping styles can significantly and negatively predict depressive symptoms in college students directly, consistent with previous research [ 29 ]. In recent years, amidst the backdrop of the pandemic, numerous studies have emerged domestically and internationally focusing on college students’ mental health from the perspective of crisis event coping [ 30 ]. These studies have predominantly concentrated on trait coping styles as a mediating variable in predicting the occurrence of depressive symptoms, with fewer studies examining the direct impact of trait coping styles on depressive symptoms. College students, being in a unique developmental stage, face challenges from various aspects and bear the pressures of academic coursework, interpersonal relationships, and future employment. Research indicates that trait coping styles are a key factor influencing mental health [ 31 ]. Implementing healthy coping techniques and interventions can help individuals overcome negative emotions caused by stress, which is an adaptive coping mechanism that assists college students in facing stress and enhancing problem-solving abilities, thus preventing or reducing the occurrence of depression. Conversely, adopting passive or avoidant coping strategies, leading to inadequate resolution of stress events, can increase psychological stress [ 14 ], thereby exerting a negative impact on the mental health of college students [ 32 ]. Therefore, trait coping styles play a negative predictive role in depressive symptoms among college students. PC was a positive predictor of depression and NC was a negative predictor of depression. This is consistent with previous studies [ 24 , 29 ].

Separate mediating effects of perceived social support and resilience

After introducing perceived social support and resilience as two mediating variables, the predictive effect of PC/NC on depressive symptoms in college students remained significant. The results show that PC can positively predict perceived social support, and NC is the opposite, consistent with previous research [ 33 ]. Trait coping styles are an important predictive factor in altering college students’ perceptions of social support and the occurrence of depression. Individuals who adopt negative coping styles tend to perceive relatively less external support. Some argue that social support plays a reverse predictive role in trait coping styles; the more social support college students receive and feel, the more likely they are to actively adopt positive coping strategies to alleviate stress, potentially due to variations in study subjects and time [ 34 ]. In this pathway, perceived social support can significantly and negatively predict depressive symptoms, aligning with previous research findings [ 35 ]. Perceived social support is considered a crucial mediating factor influencing mental health, referring to an individual’s ability to perceive support and understanding from family, friends, and others. College students with lower levels of perceived social support often feel neglected and undervalued, leading to negative evaluations and self-doubt, making them more susceptible to depression. PC/NC and perceived social support can interact and influence the occurrence of depressive symptoms in college students [ 16 ].

Research indicates that PC can significantly and positively predict resilience, with an indirect effect value of 48.03%.In this pathway, the mediating effect of resilience is more pronounced, consistent with previous studies [ 36 ]. There is a close connection between resilience and coping styles; college students who adopt positive coping strategies often exhibit stronger psychological resilience, being more willing to confront issues and seek help from others to solve problems. When facing pressures such as academic challenges, they approach them with a positive mindset, overcoming adversity [ 37 ]. It is believed that adopting positive coping strategies to address problems can enhance college students’ levels of psychological resilience [ 10 , 38 ]. Resilience can significantly and negatively predict depressive symptoms. depressive symptoms, College students with higher levels of resilience tend to define the severity of events less severely when stress events occur, resulting in lower psychological burdens and reduced likelihood of experiencing depressive symptoms [ 10 ]. Additionally, when facing setbacks or stress, individuals who adopt positive coping strategies actively utilize internal and external protective factors to combat current difficulties and pressures, and employ effective emotional control to mitigate the impact, thereby enhancing their levels of psychological resilience and reducing the occurrence of depression.

Chain mediation effect of perceived social support and psychological resilience

This study elucidates that PC/NC perceived social support, and psychological resilience are independent factors influencing depressive symptoms in college students, with perceived social support and psychological resilience playing a mediating role between coping styles and depressive symptoms. The share of total indirect effect values is 73.62% and 40.00%, respectively, with the third chain path accounting for 6.30% and 27.37% of the total effect ratio, respectively. This confirms the existence of this chain mediation effect, although the chain mediation effect is not as pronounced as the individual mediation effects. Positive coping styles not only directly negatively predict depressive symptoms in college students but also exert an indirect influence on depressive symptoms through perceived social support and psychological resilience. Likewise, negative coping styles not only directly positively predict depressive symptoms in college students but also have an indirect impact on depressive symptoms through perceived social support and psychological resilience, thus demonstrating the value and significance of these two mediating variables in reducing the occurrence of depressive symptoms in college students.

Initially, adopting positive coping styles and being able to perceive social support are crucial factors influencing psychological resilience in college students. There exists a relatively stable systemic relationship between students’ social support and psychological resilience, confirming that social support can enhance individuals’ levels of psychological resilience [ 16 ]. Furthermore, coping styles can affect the occurrence of depressive symptoms from both internal and external perspectives. This is because the social support perceived by college students includes not only tangible social support resources but also their subjective perception of social support, with these two factors constituting external and internal protective factors of psychological resilience [ 39 ]. Positive coping and effective adaptation can enhance college students’ perception of social support, enabling them to mobilize personal, familial, and societal protective factors better when facing various life challenges, thereby mitigating or eliminating difficulties and suppressing the onset of depressive symptoms, whereas negative coping styles yield the opposite effect. The chain mediation proposed in this study integrates the research on perceived social support, psychological resilience, and depressive symptoms in college students, facilitating a more comprehensive understanding of the internal mechanisms through which coping styles influence depressive symptoms in college students. This holds significance in advocating for a proactive attitude in college students to confront and resolve difficulties and in increasing attention to the mental health of college students.

Limitations, strengths and future research

The findings of this study hold theoretical value and practical implications, offering a reference basis for improving the mental health of college students. However, there are certain limitations to consider. Firstly, the survey in this study was conducted through self-reporting, which may introduce certain biases. Future research could explore data collection through various methods. Secondly, this study employed a cross-sectional design to investigate the impact of trait coping styles, on depression among college students and its potential mechanisms. However, this research approach does not allow for causal inferences between variables, and further validation of the study’s conclusions could be achieved through longitudinal or experimental research.

In summary, this study aims to improve the mental health of college students by examining how their coping styles, along with their perceived social support and psychological resilience, affect depressive symptoms. The research analyzes the connections between these factors and suggests that positive coping styles may help prevent depression. However, the study has its limitations and future research should use long-term experiments to better understand these relationships. Since depression in college students can be influenced by many factors, future studies should also consider additional variables and use a mix of experimental and longitudinal approaches to more clearly understand how to reduce depression in this group.

Data availability

The datasets used and analysed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

Patient Health Questionnaire-9

Trait Coping Style Questionnaire

Positive coping styles

Negative coping styles

Resilience Scale

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Acknowledgements

We would like to provide our extreme thanks and appreciation to all students who participated in our study.

This work was financially supported by the National Food Safety Risk Center Joint Research Program [grant number (LH2022GG06)] and the Weifang Medical College Teaching Reform Program (2023YBC008).

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SD and GM conceived and designed the study. HG, WS, WG, and YL undertook the data collection and analysis. SD, QY, YQ, XLand HZ drafted the manuscript. SD and GM reviewed the manuscript. The authors read and approved the final manuscript.

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Dong, S., Ge, H., Su, W. et al. Enhancing psychological well-being in college students: the mediating role of perceived social support and resilience in coping styles. BMC Psychol 12 , 393 (2024). https://doi.org/10.1186/s40359-024-01902-7

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Why We Should Focus on Positive Childhood Experiences

Benevolent childhood experiences are linked to flourishing and personality..

Posted July 19, 2024 | Reviewed by Tyler Woods

• Understanding Child Development
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• Psychology has historically focused its research on adverse childhood experiences.
• There is growing research on benevolent childhood experiences (BCEs).
• BCEs are correlated with flourishing and the light triad.
• A positive childhood environment influences the development of human flourishing and personality.

We’ve all heard of “adverse childhood experiences” (ACEs). Psychology has focused a large chunk of research on these negative experiences of childhood and found that children with a high number of ACEs tend to develop higher levels of neuroticism and lower levels of conscientiousness . ACEs are also correlated with the development of dark triad traits, including psychopathy , borderline personality disorder , and narcissism , as well as lower levels of happiness .

While the study of ACEs is certainly important, what about benevolent childhood experiences (BCEs)?

Childhood experiences can be either benevolent (positive) or adverse (negative). People differ substantially in the amount of stress they experienced as a child . Curiously, however, BCEs haven’t received as much attention in psychology. This is a pet peeve of mine: Psychology has disproportionately been focused on the darker aspects of human development and personality and has neglected research on benevolent developmental experiences and personality traits. Sometimes I think the field of psychology is like Netflix documentaries: Much more fascinated with understanding serial killers than serial saints.

This was a major impetus behind my team and I initiating an entire research program on the light triad , or as we alternatively refer to them, “everyday saints.” We found that the three light triad characteristics of Kantianism (the belief that people are ends unto themselves), Humanism (the belief that people are inherently worthy and have dignity), and Faith in Humanity (a belief in the fundamental goodness of humans) strongly predict a wide range of well-being variables, including higher meaning in life, spirituality , and prosocial behaviors.

Thus, I was happy to discover that there exists a small but growing research literature on benevolent childhood experiences . BCEs consist of the social and family support a person receives before the age of 18, and include comforting beliefs, opportunities for joy, stable home routines, self-acceptance, and school enjoyment (Narayan et al., 2018). Here is the full list of BCEs:

• At least one caregiver with whom you felt safe
• At least one good friend
• Beliefs that comforted you
• Liked going to school
• At least one teacher who cared for you
• Good neighbors
• Had an adult who supported or advised you
• Opportunities to have a good time
• Liked yourself or felt comfortable with yourself
• Predictable home routine

Recent research suggests that children with a higher number of BCEs tend to display reduced symptoms of depression , stress , and loneliness during adulthood. What’s more, BCEs appear to substantially predict mental health independently of ACEs . So it would seem that BCEs are pretty darn important to study!

Enter a brand new study that directly tackles the link among BCEs, the light triad, and human flourishing. I must admit, I was so excited and giddy when I saw this paper. I know, I’m a nerd. But I do think this line of research is so important. Let’s see what they found.

The Impact of Benevolent Childhood Experiences on Adult Flourishing: The Mediating Role of Light Triad Traits

In a new study , Miguel Landa-Blanco and his colleagues studied 410 participants in Honduras, considered one of the most violent countries in the world. This context is important. As the researchers note, “Research conducted in diverse cultural contexts helps us move beyond a narrow focus on Western perspectives and provides a more comprehensive understanding of the universal and cultural specific factors contributing to positive childhood development.”

While a number of studies have found a link between certain aspects of Honduran life and ACEs, researchers have overlooked key dimensions of well-being and positive life experiences. Their findings are interesting and important.

On average, respondents reported 7.34 benevolent childhood experiences. On average, men were more likely to have at least one teacher who cared about them, had more opportunities to have a good time, and were more likely to like/feel comfortable with themselves compared to women.

Critically, the more BCEs the person had, the more likely they were to report flourishing, which was measured by eight items assessing a sense of competence as well as purpose and meaning in life. The largest effect size was found for those who reported they liked going to school. Medium effect sizes were found for having at least one good friend, good neighbors, having comfortable beliefs, liking/feeling comfortable with oneself, and having a predictable home routine.

The researchers also found a positive link between BCEs and the light triad. In particular, those scoring higher in faith in humanity were more likely to report the presence of having at least one good friend, comforting beliefs, liking school, good neighbors, having an adult supporter/adviser, opportunities for a good time, liking/feeling comfortable with oneself, and having a predictable home routine. Humanism and Kantianism were higher for those who liked attending school and had an adult advisor/supporter. What’s more, all the light triad traits were significantly associated with flourishing scores.

Reflections

The results of this study have a number of important implications. For one, the findings suggest that benevolent childhood experiences are associated with the development of positive personality traits as well as a sense of flourishing in life. As the researchers note, their findings underscore “the importance of a positive childhood environment in fostering healthy personality traits." This seems pretty obvious to anyone who has lived life, but it’s nice to see researchers actually care about documenting this systematically.

The link to the light triad is especially interesting considering that the three members of the light triad are basically benevolent beliefs about others and how one should interact with others. The study found that Faith in Humanity and Humanism were particularly important pathways for nurturing flourishing through positive childhood experiences .

This suggests that our childhood experiences (positive or negative) can have an important influence on the beliefs we develop about how we should engage in our social world: Should I be exploitative, manipulative, and try to extract scarce resources from as many people as possible or should I be benevolent, caring, and treat all people with humanity and dignity? Along with our genetic endowment, our childhood experiences play a critical role in the development of these beliefs.

The key mechanism explaining this relationship may be that BCEs involve nurturing relationships and support from caregivers that foster trust and security. You can view our early childhood experiences like a weather forecasting system—if it’s harsh and unpredictable, our brains (which are essentially prediction machines) will come to expect a harsh and unpredictable world as an adult. On the other hand, experiencing a reliable and compassionate childhood can cause our brains to expect such a social world moving forward with our lives.

While families can offer such a nurturing relationship, this study also points to the importance of a nurturing school environment for positive development. Liking school was a big factor in explaining these relationships and no doubt lay an important foundation for adult growth. The researchers suggest incorporating socioemotional education and universal positive mental health screenings into school, as well as promoting teacher mental health and well-being.

The field of psychology has been obsessed with adverse childhood experiences and the development of dark triad traits. I look forward to seeing more research (and conducting more research with my team) on benevolent childhood experiences so we can shine a spotlight on the existence of these important childhood experiences.

Scott Barry Kaufman is a humanistic psychologist exploring the depths of human potential.

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ORIGINAL RESEARCH article

The positive impact of identity-affirming mental health treatment for neurodivergent individuals.

• 1 Charlie Health, Inc., Bozeman, MT, United States
• 2 The Center for Applied Research and Educational Improvement, University of Minnesota, Saint Paul, MN, United States

Introduction: The medical and social definitions of neurodivergence have become a common topic of discussion in recent years, and the ways that we define, measure and report on conditions within the neurodivergent umbrella are changing. The objective of this study was to analyze differences in mental health symptom presentation at intake and compare treatment outcomes among three groups: clients with an affirming neurodivergent diagnosis, clients without an affirming diagnosis, and neurotypical clients.

Methods: Data were collected at intake and discharge. Clients self-reported neurodivergent identity, neurodivergent diagnoses, as well as the severity of depression symptoms, anxiety symptoms and self-harm frequency. One-way multivariate analysis of variance tests were run to assess differences in mental health symptoms at intake and discharge based on neurodivergent identity and corresponding diagnosis. When MANOVAs indicated significant differences, follow-up univariate one-way ANOVAs were conducted for each dependent variable.

Results: Neurodivergent clients reported significantly worse mental health symptoms at intake than neurotypical clients, regardless of diagnosis status. Additionally, clients who identified as neurodivergent but did not report an affirming medical diagnosis reported significantly worse mental health symptoms than those who did report an affirming medical diagnosis. By discharge from IOP treatment, no significant differences were found in symptom change scores between neurodivergent and neurotypical individuals, or neurodivergent individuals with an affirming diagnosis and those without.

Discussion: These findings highlight the importance of acknowledging client identity as a key component of mental health treatment. The act of validating symptoms and experiences, allowing accommodations when requested, and exploring identity formation regardless of diagnosis, allowed all clients who identified as neurodivergent to benefit from treatment.

1 Introduction

1.1 what is neurodivergence.

As a relatively new concept, neurodivergence seems to have multiple definitions and no consensus on which definition to use. It’s both a collection of medical conditions ( American Psychiatric Association, 2013 ), and an identity (Lewis et al., 2016; Lewis et al., 2017). It can be a set of symptoms that impact daily functioning ( Pellicano and den Houting, 2022 ), but also a different way of processing information ( Singer, 1999 ; Jaarsma and Welin, 2012 ). To simplify this concept, neurodivergence is often viewed through two lenses: the medical model, and the social model. While other models of neurodivergence do exist ( Dwyer, 2022 ), in this paper, we focus on exploring and comparing symptoms and outcomes between clients whose neurodiversity is affirmed or denied by the social and medical models specifically, so as not to overcomplicate the analysis.

Medically, neurodivergence is equated to neurodevelopmental disabilities. These are defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as “a group of conditions with onset in the developmental period. The disorders typically manifest early in development, often before the child enters grade school, and are characterized by developmental deficits that produce impairments of the personal, social, academic, or occupational functioning.” ( American Psychiatric Association, 2013 , p 31). These disorders include intellectual disorders, communication disorders, Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), Specific Learning disorders, motor disorders, and Tic disorders. Neurodevelopmental disorders are often summarized as any condition in which someone develops atypical cognitive processes early in life. Critics of the medical model argue that it pathologizes normally occurring variations in processing and can therefore lead to stigmatization and marginalization of neurodivergent individuals. Often, the goal of treatment in the medical model is seen as “normalization” or “curing” of neurodivergent individuals.

From a social perspective, the concept of neurodivergence embodies a broader and more inclusive definition than the medical model. For some, it has come to mean anything that resembles processing, learning, or behaving differently from what is considered normal or typical, including common neurodevelopmental disorders such as attention deficit hyperactive disorder (ADHD), and non-developmental disorders such as anxiety or OCD. Neurodiversity, established as a concept within online autistic communities in the mid 1990s (Botha et al., 2024), and further expounded upon in the late 1990s by journalist Blume (1998) and sociologist Singer (1999) , is equated to biodiversity: if biodiversity makes an ecosystem stronger, then neurodiversity may do the same for culture and society. It has become a popular social topic over the past few years, with Google Trends-a (2023a) and Google Trends-b (2023b) showing spikes in searches for the words “neurodivergent” and “neurodivergence” starting in April of 2020. The neurodiversity paradigm follows the disability movement, claiming that the struggles that neurodivergent individuals face are not a result of the symptoms that they present, but rather the rigidity of the environment.

Historically, the medical model excluded neurodivergent viewpoints ( Milton, 2014 ), as neurodivergent individuals were seen as less intelligent and less reliable than their neurotypical counterparts ( Chellappa, 2023 ). However, epistemology suggests that neurodivergent individuals have a deeper knowledge and understanding of the neurodivergent experience than non-neurodivergent individuals, including professionals. Simply put, the neurodivergent experience is best understood by neurodivergent individuals themselves. A 2017 study surveyed 636 adults and found that autistic individuals tended to have a less biased and more scientific understanding of autism than non-autistic respondents ( Gillespie-Lynch et al., 2017 ), thus supporting the argument that neurodivergent individuals should be included in the foundational research around what it means to be neurodivergent.

In an attempt to reframe neurodivergence within the research community and society at large, advocates emphasize the importance of participatory research with the neurodivergent community ( Pellicano and den Houting, 2022 ; Sonuga-Barke et al., 2023 ). As neurodivergent voices are included in the growing research and treatment of conditions falling under the neurodevelopmental umbrella, beliefs around what constitutes neurodivergence and what it means to be neurodivergent are beginning to change and the language that we use to describe neurodivergence is changing as well. Throughout the remainder of this paper, identity-first language will be used when describing neurodivergent individuals, as a large portion of neurodivergent individuals prefer this model compared to person-first language ( Chapman and Bovell, 2022 ; Wooldridge, 2023 ). Furthermore, we acknowledge that the neurodivergent community prefers the social model over the medical model when describing neurodivergence and emphasize that medical language is only used throughout the paper when necessary to illustrate the differences between the two theories.

1.2 Medical diagnosis vs. self-identification

It is estimated that approximately 20% of the population falls within the medical definition of “neurodivergence” ( Doyle, 2020 ). Of the neurodevelopmental diagnoses listed previously, ASD and ADHD are the most well known and most commonly diagnosed, with 2.7% of children between the ages of 3–17 receiving an ASD diagnosis, and 9.8% receiving an ADHD diagnosis ( Centers for Disease Control and Prevention, 2023a , b ). Furthermore, both ASD and ADHD have seen a recent increase in diagnoses, with a 400% increase in ASD diagnoses between 2000 and 2020 ( Maenner et al., 2023 ), and up to a 200% increase in ADHD diagnoses between 2005 and 2014 ( Davidovitch et al., 2017 ). However, it is still debated to what degree these increases are due to an increase in occurrence, a greater understanding of the disorder, or an overdiagnosis.

Due to the growing social movement around neurodiversity and rising calls for neurodivergent self-advocacy, self-identifying as neurodivergent is becoming more common ( Lewis, 2016 ; Lewis, 2017 ), regardless of whether a person has a medical diagnosis or not. Self-identification is seen by some as an important step in identity formation for neurodivergent individuals ( Wylie, 2014 ). Additionally, research has shown that diagnosed autistic individuals and self-identified autistic individuals have similar autism identity scores, as well as rates of internal stigma, quality of life, and self-esteem, all of which are significantly worse than the general population ( McDonald, 2020 ). The results from this study indicate a strong inherent similarity between medically diagnosed individuals and self-identifying individuals and calls for additional investigation into the validity of self-identification.

There are a multitude of reasons why neurodivergent individuals may be self-identifying and not medically diagnosed. Receiving a diagnosis for many of the medically defined neurodivergent conditions can be difficult. Common barriers include access, cost, and fear of not being believed ( Lewis, 2017 ). As an additional barrier, neurodivergent individuals who did not receive a diagnosis as a child have a difficult time finding providers who have experience evaluating and treating adults, leading to further delays in receiving proper diagnoses ( Jones et al., 2014 ). All of these barriers delay and ultimately discourage neurodivergent individuals from seeking a diagnosis at all and, as a result, they remain only self-identified as neurodivergent instead of formally diagnosed. Furthermore, some neurodivergent individuals do not feel the need for a medical diagnosis, claiming that they receive the support and resources they need without a diagnosis.

However, lack of diagnosis has been correlated with increased mental health issues such as loneliness, isolation, underachievement at school, general unhappiness, and anxiety ( Mason et al., 2023 ). Conversely, receiving a medical diagnosis for a neurodivergent disorder may have benefits. Earlier diagnosis has been shown to improve family support and has been noted as an important gateway for parent understanding and adaptation with neurodivergent children ( Vanaken et al., 2023 ), and diagnosis at any age is associated with increased self-acceptance ( Moore, 2016 ; Hickey et al., 2018 ; Lilley et al., 2022 ).

1.3 Co-occuring conditions

Medically diagnosed neurodivergent individuals report a high rate of co-occurring psychiatric disorders, such as depression, anxiety, conduct disorder, and substance dependence ( Biederman et al., 1999 , 2006 ; Gupte-Singh et al., 2017 ; Riglin et al., 2021 ). ADHD and depression co-occur anywhere between 35 and 50% of the time ( Gnanavel et al., 2019 ) and this co-occurence is associated with a higher rate of suicidality, and a higher likelihood of needing psychiatric hospitalization ( Biederman et al., 2008 ). ADHD youth are 4–6 times more likely to develop depression than non-ADHD youth, and ADHD girls with depression have a significantly higher risk of suicidal ideation than ADHD boys diagnosed with depression ( Kessler et al., 2006 ; Chronis-Tuscano et al., 2010 ). Similarly, ADHD and anxiety have a co-occurrence rate nearing 50% ( Kessler et al., 2006 ), and ADHD patients who presented with anxiety were more likely to struggle with emotion regulation ( Reimherr et al., 2017 ).

Autism also has a high rate of co-occurrence with psychiatric disorders ( Kirsch et al., 2020 ), with almost half of ASD individuals being diagnosed with at least two other conditions ( Simonoff et al., 2008 ). Rates of co-occurrence with depression range anywhere from 20 to 70% ( Simonoff et al., 2008 ). Importantly, ASD individuals who score higher on cognitive ability tests tend to have higher rates of depression and a lower sense of self-worth ( Magnuson and Constantino, 2011 ). Social anxiety is another common co-occurring condition for ASD individuals, and is often correlated with decreased social skills, poor social competence, and low social motivation ( Spain et al., 2018 ). Additionally, Rieske et al. (2013) found that severity of autism symptoms can account for approximately 50% of the variance in generalized anxiety symptoms.

Unfortunately, due to the lack of substantial research on non-diagnosed neurodivergent individuals, it is unclear how accurate these rates of co-occurrence are for the neurodivergent community as a whole. By excluding self-identified neurodivergent individuals from analyses on co-occuring conditions, the literature is lacking a clear understanding of how all neurodivergent individuals experience psychiatric conditions and how the experiences may differ depending on access to treatment or the affirming nature of a diagnosis.

1.4 Service utilization

Due to the high rate of co-occurring mental health issues and increased symptom severity, neurodivergent individuals have a high rate of mental health service utilization. Medically diagnosed ADHD and autistic individuals are more likely to utilize mental health care and psychiatric services compared to the general population, and spend almost three times as much on mental health care in a year ( Zerbo et al., 2019 ). Additionally, diganosed ADHD or autistic adults are more likely to be taking antidepressant medication, or antipsychotic medication than the general public ( Zerbo et al., 2019 ). This trend is similar in diagnosed neurodivergent children. Gupte-Singh et al. (2017) found that the average direct expenditure cost for ADHD children was almost twice as high as for non-ADHD children.

Despite the high rate of service utilization, neurodivergent individuals, regardless of diagnosis, still have lower quality of life, and academic and social outcomes ( Bagwell et al., 2001 ; Barry et al., 2002 ; Van der Oord et al., 2005 ; Loe and Feldman, 2007 ; Fleming et al., 2017 ). These consistently poor outcomes indicate that existing services are not meeting the needs of neurodivergent individuals, either in quality or accessibility. A systematic review of the literature on care access for autistic families found major discrepancies in access to care, referral frequency, number of service hours, and proportion of unmet service needs based on socioeconomic status as well as racial and ethnic minority background ( Smith et al., 2020 ). Moreover, once ASD individuals gain access to mental health care, they report a lack of therapist knowledge in treating autistic individuals ( Adams and Young, 2021 ). National treatment data also suggests under-treatment of ADHD ( Cuffe et al., 2009 ) and ADHD individuals often struggle with maintaining support as they transition out of childhood ( Swift et al., 2014 ; Reale et al., 2018 ).

1.5 Neurodivergent affirming care

Improvements to neurodivergent affirming mental health care are cited as one of the most pressing needs for the neurodivergent community at present ( Mason et al., 2023 ; Pantazakos and Vanaken, 2023 ). Importantly, neurodivergent affirming care is not based around the goal of “normalization” and does not require a medical diagnosis. While most historical treatment options for these conditions, such as ABA, focus on reducing neurodivergent symptoms and increasing “normal” behavior ( Wilkenfield and McCarthy, 2020 ; Chapman and Bovell, 2022 ), affirming care aims to adapt common treatment methods so they are more effective with neurodivergent individuals in addressing underlying mental health concerns such as depression or anxiety. Studies have found that the wellbeing of neurodivergent individuals, and more specifically of autistic individuals, is dependent on perceived levels of support and acceptance from peers and family members ( Renty and Roeyers, 2006 ; Milton and Sims, 2016 ; Cage et al., 2018 ; Di Renzo et al., 2020 ), and not in the reduction of neurodivergent symptoms directly.

While the neurodivergent community is still evolving, experts in the field have started to address the characteristics necessary for providing efficacious and ethical neurodivergent-affirming care. Simple adaptations have been suggested, such as discussing with clients how the treatment setting might be altered to reduce the activation of threat systems (lowering the lights, reducing aroma therapy, etc.), and asking clients what aspects of their neurodivergence they would like support in addressing (e.g., time-management, emotion regulation, etc.) as opposed to assuming all neurodivergent conditions need to be addressed ( Jones et al., 2024 ). Compassion-focused therapy has been suggested as a way to balance dysregulated emotion regulation systems in neurodivergent individuals, and reduce feelings of shame and low-self compassion brought on by social stigma ( Mason et al., 2023 ).

1.6 The present study

This study represents a quality improvement analysis within an intensive outpatient program that serves a high proportion of neurodivergent clients. This study has two main goals. The first goal is to examine the differences in symptoms at the time of intake between neurotypical clients, non-affirmed neurodivergent clients, and affirmed neurodivergent clients. The second goal is to assess the benefits of an affirming care model for all neurodivergent clients by analyzing symptom improvement at discharge. The hope is that these analyses will shed light on disparities in mental health symptoms between clients who have received affirming care and those who have not, and guide future treatment decisions when working with this population.

2 Materials and methods

2.1 setting.

Charlie Health is a virtual intensive outpatient program that treats clients between the ages of 10 and 34 who present with complex and highly acute mental health disorders. Programming at Charlie Health consists of 9 h of virtual group sessions per week, as well as 1 h of individual therapy and a 1 h family therapy session. Each group session is 3 h long, broken into 50 min sessions with 10 min breaks in between hours. These group sessions include 1 h of evidence-based, relationally-informed, guided process work; 1 h of experiential therapy (e.g., art, music, mindfulness) and; 1 h of evidence-based skill building curriculum. Group and individual sessions are offered throughout the day, 6 days a week, to increase accessibility. The average length of stay in the program is 10–12 weeks.

A key component of treatment at Charlie Health is a compassion-focused, identity-affirming, relationally-informed approach to care delivery. Each hour of an IOP session is adapted to create a neuro-inclusive, supportive environment for connecting around lived experiences. Curricular interventions address sensory needs, multiple dimensions of communication and expression, emotional and physical self care, and an exploration of needs for social and civic engagement. Varying support needs across contexts are explored and modification of environment, where possible, is encouraged to better accommodate individual needs. Across all offerings, affirming care is a central tenet when designing programming and support opportunities.

2.2 Ethics considerations

This study was reviewed and approved by the NorthStar Institutional Review Board (IRB) who deemed this investigation exempt as secondary research usage (NB400170).

2.3 Positionality statement

Drawing from their own experiences of navigating undiagnosed neurodivergent conditions for many years, the lead researcher of this study recognizes the critical importance of validation and tailored support for neurodivergent conditions in fostering resilience and recovery and aims to advocate from within the mental health care system. Additionally, their background is informed by previous quality improvement work with neurodivergent individuals. While they acknowledge their biases in favor of neurodivergent individuals, they are committed to assessing the data with humility and developing approaches to care that honor all unique identities and strengths. Furthermore, questions regarding neurodivergence were reviewed by Charlie Health’s director of clinical curriculum who identifies as neurodivergent. Finally, the analyses and report presented here were reviewed by multiple individuals who identify as neurodivergent, as well as individuals who do not identify as neurodivergent, but have a history of working with neurodivergent individuals.

2.4 Data collection

Between May 2023 and October 2023, intake data were collected from 6,753 participants. All data were self-reported. Clients were given an intake survey in the first hour of their orientation session. A Charlie Health staff member joined the group and distributed personalized links to each client, and then stayed to answer questions until all clients were finished. Clients were instructed that the survey was optional and would not affect their admission status. Of those 6,753 participants, 1,140 submitted discharge surveys at the time of the analysis. Discharge surveys were distributed on the client’s last day in group sessions. Clients were pulled into a breakout room on Zoom with a Charlie Health staff member who then gave the client a personalized link to their discharge survey. Clients were informed that the survey was optional and would not affect their discharge status. If the client opted out of the survey, they were sent back to their group; otherwise, once the survey was complete, they were sent back to their group. If a client missed their final group session, they were emailed and texted a personalized link to the discharge survey and prompted to fill it out with a $25 incentive.

2.5 Measures

2.5.1 demographics.

Demographics were collected at intake. Clients were asked to disclose their age, gender ( male, female, non-binary, genderqueer, nonconforming, gender fluid, gender neutral ), sexual orientation ( straight, asexual or gray-sexual, bisexual, pansexual, gay, lesbian, queer, questioning ), race ( Black or African American, Indigenous peoples around the world, Asian, Middle Eastern or North African, White, other ), neurodivergent identity ( autism, attention deficit hyperactive disorder, dyslexia/dyscalculia, speech or language disorder, sensory processing disorder, tourettes, down syndrome, none, other ), and neurodivergent diagnosis ( autism, attention deficit hyperactive disorder, dyslexia/dyscalculia, speech or language disorder, sensory processing disorder, tourettes, down syndrome, none, I do not know, other ).

For this study a neurodivergent identity of “other” could be anything the client deemed neurodivergent due to the lack of a social definition for neurodivergence. The researchers aimed to emphasize that a client’s identity labels are their decision, and it is this act of identifying as neurodivergent that they aimed to analyze. All questions were multi-select to allow clients to select all answers that they felt represented them.

2.5.2 Depression

The Patient Health Questionnaire Modified for Adolescents (PHQ-A) is a 9 item scale that was used to measure depressive symptoms. Questions are rated on a scale from 0 (“not at all”) to 3 (“nearly every day”). A sum score, ranging from 0 to 27 was calculated and scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively ( Johnson et al., 2002 ).

2.5.3 Anxiety

The Generalized Anxiety Disorder-7 (GAD-7) is a 7 item scale that was used to measure anxiety symptoms. Questions are rated on a scale from 0 (“not at all”) to 3 (“nearly every day”). A sum score, ranging from 0 to 21 was calculated and score cut offs of 5, 10, and 15 represent mild, moderate, and severe anxiety, respectively ( Spitzer et al., 2006 ).

2.5.4 Self-harm

Self-harm was measured by asking clients how many days in the 30 days prior to the survey they had engaged in self-harm. Answers could range from 0 to 30.

2.6 Data preparation

To determine if a client had a fully affirming neurodivergent diagnosis, we reviewed our neurodivergent demographic questions and calculated a binary variable indicating whether a client’s reported neurodivergent identities matched their reported neurodivergent diagnoses. Additionally, we calculated binary variables to determine if clients had an ASD affirming diagnosis or an ADHD affirming diagnosis to further understand symptom differences within the more concise medical model. Only clients who completed treatment and were discharged on clinical recommendation from their individual therapist were included in the outcomes analyses.

2.7 Data analysis strategy

2.7.1 descriptive statistics.

Descriptive statistics were run to gain a better understanding of the demographic distribution of the sample that was surveyed. This included age, gender, sexual orientation, race, neurodivergent identities, and neurodivergent diagnoses.

2.7.2 Missing data

Missing data was analyzed using R Statistical Software (v4.4.1, R Core Team, 2021 ). Chi-square tests were run to compare missingness rates between demographic groups.

2.7.3 Outcomes analyses

A series of one-way multivariate analysis of variance (MANOVA) tests were run to compare three groups–individuals who are neurotypical, who identify as neurodivergent and have an affirming diagnosis, and who identify as neurodivergent and do not have an affirming diagnosis– by the three outcome variables of depression, anxiety, and self-harm. Six sets of tests were run, including (1) neurodivergent groups predicting symptoms at intake, (2) neurodivergent groups predicting symptom change at discharge, (3) ADHD group predicting symptoms at intake, (4) ADHD group predicting symptom change at discharge, (5) Autism group predicting symptoms at intake, (6) Autism group predicting symptom change at discharge. All tests were run in SPSS version 29 ( IBM Corp, 2020 ). When MANOVAs indicated significant differences, follow-up univariate one-way ANOVAs were conducted for each dependent variable. The assumptions of linearity, multicollinearity, outliers, multivariate normality, and adequate sample size were tested and met. The assumption of homogeneity was violated for the neurodivergent group’s symptoms at intake, and so the Games-Howell method was used for the post-hoc tests at intake. The assumption of homogeneity was met for the ADHD and Autism-specific groups, so a Tukey post-hoc test was used for intake symptoms within these two groups. In the ADHD and Autism-specific analyses, there were unequal sample sizes across groups, so Pillai’s Trace was used rather than Wilkes’ Lambda in the MANOVA tests.

3.1 Demographics

Data were collected from 6,753 clients within Charlie Health’s IOP program who were in treatment between April 2023 and October 2023. Ages of this sample ranged from 10-years-old to 34 years-old, with a mean age of 18.66 years-old. 54.6% of clients fell within the adolescent (ADOL) age group (10–17), and 44.4% fell into the young adult (YA) population (18+). 51.9% of clients identified as female, 27.0% identified as male, and 11.7% identified as a gender minority group. 36.5% of clients identified as heterosexual or straight, and 51.9% of clients identified as a sexual minority. Table 1 details demographics further.

Table 1 . Demographics collected at intake for all clients included in the analysis.

Table 2 demonstrates the breakdown of neurodivergent identities and diagnoses. Over half of the sample (61%) held at least 1 neurodivergent identity, and neurodivergent clients held an average of 1.4 neurodivergent identities, with ASD (17.0%) and ADHD (42.9%) being the most common. Slightly fewer clients endorsed having a neurodivergent medical diagnosis (56.6%). In total, 53.4% of neurodivergent identifying clients reported a diagnosis that fully affirmed their neurodivergent identity and approximately 8% of clients who reported a neurodivergent diagnosis did not identify as neurodivergent at all. When focusing on ASD and ADHD respectively, only 45.3% of clients who identified as being autistic had an autism diagnosis, and 75.5% of clients who identified as ADHD had an ADHD diagnosis.

Table 2 . Neurodivergent identities and demographics collected at intake for all clients included in the analysis.

3.2 Missing data

3.2.1 intake data.

To better understand the patterns of missing data within our analyses, chi-square tests were run to assess missingness patterns on outcomes variables between clients who had a neurodivergent identity and those who did not. While there was a significant difference in the amount of missing PHQ data at intake between clients who identified as neurodivergent (5.43%) and those who did not (4.22%) ( p  = 0.0294), based on a chi-square test, the amount of overall missing data was only 4.96% and therefore we do not believe this difference will impact our outcomes. There was not a significant difference in the amount of missing GAD data or days of self-harm data at intake between neurodivergent identifying individuals and non-neurodivergent identifying individuals.

A similar missingness pattern emerged when reviewing the data for diagnosed neurodivergent clients compared to non-diagnosed clients. Based on a chi-squared test, diagnosed neurodivergent clients had significantly more missing PHQ9 data (5.65%) than those who did not report a neurodivergent diagnosis (4.06%) ( p  = 0.003), however since the total amount of missing PHQ9 data at intake is less than 5% we do not believe this will impact our findings. Furthermore, no significant differences in amounts of missing GAD data or days of self-harm data were found between diagnosed neurodivergent clients and non-diagnosed clients.

3.2.2 Discharge data

Approximately 17% of clients who had intake surveys also submitted discharge surveys by the time of the analysis. A chi-square test showed no statistically significant difference in the rate of discharge survey submission between neurodivergent identifying individuals (16.24%) and neurotypical identifying individuals (17.90%) ( p  = 0.082). Furthermore, there was no difference in the patterns of missing PHQ9 data ( p  = 0.367), GAD7 data ( p  = 0.366) or days of self-harm data ( p  = 0.365).

Based on a chi-square test, individuals who did reported a neurodivergent diagnosis at intake were less likely to submit a discharge survey (15.89%) compared to individuals who did not report a neurodivergent identity (18.17%) ( p  = 0.015). This difference is small enough that we do not anticipate that it will affect our analyses. Diagnosed neurodivergent individuals were also more likely to have more missing PHQ9 data (74.77%) compared to non-diagnosed participants (72.43%) ( p  = 0.033). There were no significant differences in missingness of GAD7 or days of self-harm.

3.3 Broad neurodivergence

A MANOVA was run to determine the effect of neurodivergent identity and diagnosis on a client’s mental health symptoms at intake. Three measures of mental health symptoms were assessed: depression, generalized anxiety, and days of self-harm. Three groups of neurodivergent identity were included in the sample: neurotypical, neurodivergent without a fully affirming neurodivergent diagnosis (non-affirmed neurodivergent clients), and neurodivergent with a fully affirming neurodivergent diagnosis (affirmed neurodivergent clients). Average depression scores ranged from moderate to moderately severe, anxiety scores were in the moderate range, and days of self-harm were on the low end of clinically significant for all groups ( Table 3 ). The differences between neurodivergent groups on combined dependent variables was statistically significant F (6, 12,134) = 27.204, p  = <0.001, Wilks 𝝠 = 0.974; partial η 2  = 0.013.

A follow-up univariate ANOVA showed that depression scores [ F (2, 6,069) = 62.431, p  < 0.001, partial η 2  = 0.020], generalized anxiety scores [ F (2, 6,069) = 73.649, p  < 0.001, partial η 2  = 0.024] and days of self-harm [ F (2, 6,069) = 12.368, p  < 0.001, partial η 2  = 0.004] were all statistically significantly different depending on neurodivergent identity and diagnosis label. Games-Howell post-hoc tests were run for all dependent variables. Non-affirmed neurodivergent clients had significantly worse depression than neurotypical clients ( p  < 0.001) and affirmed neurodivergent clients ( p  < 0.001). Affirmed neurodivergent clients had significantly worse depression symptoms than neurotypical clients ( p  < 0.001). For anxiety, the post-hoc test showed that non-affirmed neurodivergent clients had significantly worse scores compared to neurotypical clients ( p  < 0.001), and affirmed neurodivergent clients ( p  < 0.001). Additionally, affirmed neurodivergent clients had significantly worse anxiety scores compared to neurotypical clients ( p  < 0.001). Finally, a third Game-Howell post-hoc test for self-harm days showed that non-affirmed neurodivergent clients reported significantly higher days of self-harm compared to neurotypical clients ( p  < 0.001), and affirmed neurodivergent clients ( p  = 0.003). However, there was no significant difference in the number of self-harm days at intake between neurotypical clients and affirmed neurodivergent clients ( p  = 0.297) ( Table 3 ).

Table 3 . Symptoms at intake by neurodivergent grouping.

Another one-way MANOVA was run to identify any differences in change scores for mental health symptoms at discharge based on their neurodivergent identity and diagnosis group. Change scores, or deltas, from intake to discharge were calculated for depression scores, generalized anxiety scores, and days of self harm and were used as the dependent variables to measure change in mental health symptoms at discharge. The same three groups were assessed: neurotypical, neurodivergent without a fully affirming diagnosis, and neurodivergent with a fully affirming diagnosis ( Table 4 ). The differences between groups of neurodivergent clients on combined dependent variables at discharge was not found to be statistically significant F (6, 1866) = 1.294, p  = 0.256, Wilks 𝝠 = 0.992; partial η 2  = 0.004.

Table 4 . Symptoms at discharge by neurodivergent groupings.

3.4 ADHD and autism

To assess the effect of an affirming diagnosis and affirming care on a more tightly defined concept of neurodivergence, one-way MANOVAs were performed specifically looking at ADHD and Autism clients. Additional tests were conducted on clients with ADHD and autism identities due to sample size, and the frequency with which ADHD and autism are diagnosed in the larger population. Additional neurodivergent diagnoses captured in the data collection, such as dyslexia or Tourette’s, were not analyzed further because of the small sample sizes.

The MANOVA test for ADHD clients was run using depression scores, anxiety scores, and days of self-harm at intake as the dependent variables. The three groups of ADHD that were included were: Neurotypical clients, clients with an ADHD identity without an ADHD diagnosis (non-affirmed ADHD clients), and clients with an ADHD identity and an ADHD diagnosis (affirmed ADHD clients). Depression scores at intake once again ranged from moderate to moderately severe across all groups, anxiety scores fell within the moderate range, and days of self harm were on the low end of clinically significant ( Table 5 ). The differences between groups of ADHD clients on combined variables was found to be statistically significant F (6, 10,180) = 18.207, p  = <0.001, Pillai’s Trace = 0.021; partial η 2  = 0.011.

Table 5 . Symptoms at intake by ADHD groupings.

To follow up, univariate ANOVAs showed that depression scores [ F (2, 5,091) = 46.873, p  < 0.001, partial η 2  = 0.018], and anxiety scores [ F (2, 5,091) = 48.899, p < 0.001, partial η 2  = 0.019], were significantly different between the different groups of ADHD clients, while days of self-harm were not [ F (2, 5,091) = 1.945, p  = 0.143, partial η 2  = 0.001]. A Tukey post-hoc test showed that non-affirmed ADHD clients had statistically significantly worse depression scores than neurotypical clients ( p  < 0.001), and affirmed ADHD clients ( p  = 0.045). Additionally, affirmed ADHD clients had significantly worse depression scores than Neurotypical clients ( p  < 0.001). For anxiety scores at intake, another Tukey post-hoc test was run and revealed that ADHD clients, regardless of an affirming diagnosis, had worse anxiety symptoms at intake than neurotypical clients ( p  < 0.001, p  < 0.001). However, non-affirmed ADHD clients did not have significantly different anxiety scores than affirmed ADHD clients ( p  = 0.081). Finally, a Tukey post-hoc test revealed that there was no significant difference in the number of self-harm days between neurotypical clients and ADHD clients without an ADHD diagnosis ( p  = 0.431), or ADHD clients with an ADHD diagnosis ( p  = 0.153).

At discharge, change scores for depression, generalized, and days of self-harm were used to determine outcomes differences between the three groups of ADHD clients ( Table 6 ). The differences between groups of ADHD clients at discharge on combined variables was not found to be statistically significant. F (6, 1,576) = 0.298, p  = 0.938, Pillai’s Trace = 0.002; partial η 2  = 0.001.

Table 6 . Symptoms at discharge by ADHD groupings.

The same MANOVA tests were run to compare clients who identified as having ASD. Depression scores, anxiety scores, and self-harm days at intake were looked at as our dependent variables. The three groups of Autistic clients were: Neurotypical, Autistic identity without an Autism diagnosis (non-affirmed ASD), and Autistic identity with an Autism diagnosis (affirmed ASD). Average depression scores ranged from moderate to moderately severe, average anxiety scores were in the moderate range, and days of self-harm was at the low end of clinically significant ( Table 7 ). The differences between groups of ASD clients on combined variables was found to be statistically significant F (6, 7,000) = 24.008, p  = <0.001, Pillai’s Trace = 0.040; partial η 2  = 0.020.

Table 7 . Symptoms at intake by ASD groupings.

A univariate ANOVA was run as a follow up test and showed that depression scores [ F (2, 3,501) = 58.995, p  < 0.001, partial η 2  = 0.033], anxiety scores [ F (2, 3,501) = 59.292, p  < 0.001, partial η 2  = 0.033], and days of self-harm [ F (2, 3,501) = 14.508, p  < 0.001, partial η 2  = 0.008] were statistically significantly different between the different ASD groups. A Tukey post-hoc test showed that non-affirmed ASD clients had significantly worse depressive scores than neurotypical clients ( p  < 0.001), and affirmed ASD clients ( p  = 0.006). Additionally, affirmed ASD clients also had significantly worse depressive scores than neurotypical clients ( p  < 0.001). Non-affirmed ASD clients had significantly worse anxiety scores than neurotypical clients ( p  < 0.001) and affirmed ASD clients ( p  = 0.005), while affirmed ASD clients had significantly worse anxiety scores than neurotypical clients ( p  < 0.001). Finally, non-affirmed ASD clients reported significantly more self-harm days at intake than neurotypical clients ( p  < 0.001), but not compared to affirmed ASD clients ( p  = 0.870). Affirmed ASD clients also reported significantly more days of self-harm than neurotypical clients ( p  < 0.001).

At discharge, depression score deltas, generalized anxiety score deltas, and days of self-harm deltas were used as our dependent variables to determine outcomes differences between the ASD groupings ( Table 8 ). The differences between groups of ASD clients on combined variables was not found to be statistically significant at discharge F (6, 1,088) = 0.779, p  = 0.586, Pillai’s Trace = 0.009; partial η 2  = 0.004.

Table 8 . Symptoms at discharge by ASD groupings.

4 Discussion

4.1 importance of identity.

This study provides clinical data that supports the need for neurodivergent-affirming care in mental health treatment for all clients who identify as neurodivergent, regardless of diagnosis. Within Charlie Health’s virtual intensive outpatient program, clients who identified as neurodivergent consistently reported higher levels of mental health symptoms at intake compared to their neurotypical counterparts. Additionally, non-affirmed neurodivergent clients reported worse mental health symptoms across the board compared to neurodivergent individuals who had received a fully affirming diagnosis. Non-affirmed clients scored worse in depression symptoms, anxiety symptoms, and days of self-harm compared to fully affirmed clients.

While the social definition of neurodivergence is still evolving, the medical definitions of neurodivergent conditions are much more rigid and therefore provide a more consistent response from clients. By narrowing the scope to only ADHD and autistic clients, we demonstrated that these patterns of mental health symptom presentation in affirmed and non-affirmed clients fit within the more tightly defined medical definition, as well as the broader social definition of neurodivergence. Clients who identified as being ADHD without the affirming ADHD diagnosis had significantly worse depression scores at intake compared to ADHD affirmed clients and neurotypical clients, and all ADHD clients regardless of affirming diagnosis had significantly worse anxiety scores than neurotypical clients. Additionally, non-affirmed autistic clients had significantly worse depression and anxiety scores compared to both neurotypical clients and fully-affirmed autistic clients, and all autistic clients regardless of diagnosis reported more days of self harm than neurotypical clients.

We found the differences in symptoms between our neurotypical and neurodivergent participants to be large enough to be clinically significant, confirming prior literature that showed lower quality of life for neurodivergent individuals ( Barry et al., 2002 ; Van der Oord et al., 2005 ; Loe and Feldman, 2007 ; Fleming et al., 2017 ). The effect sizes for our affirmed and non-affirmed neurodivergent sample were smaller, however, they boarder on clinically significant. Because all participants are being treated for high acuity mental health conditions, we expected to see high rates of anxiety and depression across the board, making small variations in scores more practically significant. Variations in effect size between the general neurodivergent population, and our smaller sample of ASD and ADHD clients should also be noted. Effect sizes were larger when there was more flexibility in the social definition of neurodivergence. Further research examining depression and anxiety symptoms within affirmed and non-affirmed neurodivergent individuals who are not already high acuity will help us understand what these symptomology differences might look like outside of a high acuity population and how to address them in a therapy setting.

This study also demonstrates the effectiveness of affirming care for clients who identify as neurodivergent, regardless of diagnosis. Identity-affirming care does not need to come in the form of a diagnosis. The diagnosis of neurodevelopmental disorders is not a part of Charlie Health’s care model, yet clients who identified as neurodivergent without an affirming diagnosis had similar rates of improvement as those with an affirming diagnosis simply by participating in a program that worked to affirm and validate their lived experience while treating their mental health symptoms. The act of validating symptoms and experiences, allowing accommodations when requested, and exploring identity formation regardless of diagnosis, allowed all clients who identified as neurodivergent to benefit from treatment. As mentioned previously in this paper, these adaptations to treatment are just the start of what experts propose for neurodivergent affirming care ( Jones et al., 2024 ).

These findings highlight the importance of acknowledging client identity and validating lived experience as a key component of mental health. When identity is not reflected in mental health care, neurodivergent clients suffer from more severe mental health symptoms, and ultimately access unhelpful services at an extremely high rate. By supporting a neurodivergent client’s identity, regardless of medical assessment or diagnosis, clients report strong outcomes post-treatment.

4.2 Constraints on generality

This study assessed anxiety and depression symptomology differences between neurotypical individuals, affirmed neurodivergent individuals, and non-affirmed neurodivergent individuals who were all receiving treatment for high acuity mental health concerns. As such, the generalizability of the results is limited to the population of youth and young adults who are experiencing high acuity mental health conditions and have the resources to receive care. Prior to further studies with a general sample, these results should not be used to predict mental health symptoms in the broader population. Additionally, as noted previously, the social definition of neurodivergence is in flux. As such, the findings in this paper may be constrained by the current social climate and understanding of what neurodivergence means and may be subject to change as the definition of neurodivergence changes.

4.3 Limitations and further research

The key limitation to the current study is the method of data collection. All data used for analysis was self-reported, which specifically posed challenges with verifying claims of neurodivergent diagnoses. Future research should aim to gather paperwork detailing any formal neurodevelopmental diagnoses from participants. This additional data collection method would provide a confirmation of diagnoses and allow for more verifiable data and therefore, more reliable analyses. Additionally, anxiety in this study was measured using a single standardized scale for generalized anxiety disorder. Patterns of anxiety presentation between diagnosed and undiagnosed neurodivergent individuals could be further improved by using multiple anxiety scales to determine differences between generalized anxiety, social anxiety, phobias, and more. Taking a closer look at how anxiety is presenting, and the common coping mechanisms used between each population may help us understand why rates of anxiety differ.

Further research is needed into what the agents of change are when receiving an affirming diagnosis. Theories include diagnoses affording additional resources, and feeling as though an official diagnosis lends support to identities that a client may still be unsure of. Additional research should also be conducted with the general population to assess how neurodivergent identities and affirming care affect mental health outside of a high acuity setting, therefore increasing the generalizability of these findings. Finally, as the social definition of neurodivergence changes, continued research is needed to track how these trends may change over time. Mixed methods studies may provide further insight into how and why these trends are changing.

Data availability statement

The datasets presented in this article are not readily available because of the sensitive nature of the data. Requests to access the datasets should be directed to EK, [email protected] .

Ethics statement

The studies involving humans were approved by Northstar Research Ethics Review Board. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required from the participants or the participants’ legal guardians/next of kin because data was not identifiable and the project was deemed exempt under Common Rule 45 CFR 46.104(d)(4)(ii): Secondary research for which consent is not required.

Author contributions

EK: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing. ML: Supervision, Writing – review & editing. JK: Conceptualization, Writing – review & editing. KK: Writing – review & editing. JB: Writing – review & editing. IZ: Writing – review & editing. CF: Supervision, Writing – review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Conflict of interest

EK, ML, JK, IZ, KK, and CF were employed by Charlie Health at the time of this study. JB was contracted with Charlie Health at the time of this study. No employment status or compensation was based on the outcomes of the study.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: neurodivergence, identity, mental health, IOP, treatment, affirming care, Intensive Outpatient Program

Citation: Kroll E, Lederman M, Kohlmeier J, Kumar K, Ballard J, Zant I and Fenkel C (2024) The positive impact of identity-affirming mental health treatment for neurodivergent individuals. Front. Psychol . 15:1403129. doi: 10.3389/fpsyg.2024.1403129

Received: 18 March 2024; Accepted: 27 June 2024; Published: 15 July 2024.

Reviewed by:

Copyright © 2024 Kroll, Lederman, Kohlmeier, Kumar, Ballard, Zant and Fenkel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Elizabeth Kroll, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Arts, Humanities, & Social Sciences

Studying the benefits of virtual art engagement

James pawelski and katherine cotter talk to penn today about their research into digital art galleries..

The everyday visitor to an art museum may not know how many seconds or minutes they spent looking at a given painting or whether they spent more time with purple art or green art. But by placing participants in a virtual art gallery and using an open-source tool, researchers from the Humanities and Human Flourishing Project at the Positive Psychology Center have been able to track this kind of data and match behavior with questionnaire responses.

Studying virtual art galleries and their wellbeing benefits is a relatively new line of inquiry for the Project, a National Endowment for the Arts Research Lab. Some digital art experiences take the form of an online picture catalog of artwork while others “are almost like Google Maps Street View, where you can click through,” says Katherine Cotter , associate director of research.

Cotter and James Pawelski , principal investigator and founding director of the Humanities and Human Flourishing Project, talked with Penn Today about their research into digital art engagement.

How did you begin studying virtual art galleries?

Pawelski: This is a case of necessity being the mother of invention. When we brought Katherine on as a part of the Humanities and Human Flourishing Project, we had great plans and support to conduct research in the Philadelphia Museum of Art to see how visits there affected the visitor’s wellbeing. Unfortunately, the pandemic had other ideas. 

A lot of art museums pivoted very quickly to making their exhibitions available online. Katherine had a colleague who had a very creative and dedicated partner who offered to create a virtual platform for study during the pandemic. He followed through and OGAR—the Open Gallery for Arts Research—was born. We then helped to co-develop it to add more functions. 

Because of these various projects that museums had undergone—putting their art online, making it accessible virtually—these opportunities were not going to go away when the pandemic was over. Instead, they realized this is a very powerful way of engaging audiences who can’t come, or can’t come today, to the art museum. We’ve been in conversations with a variety of art museums, including the Metropolitan Museum of Art and their digital folks there, and thinking, “How can we continue to use this platform to study the wellbeing effects of engaging with art?”

For people interested in exploring art from the comfort of their homes, what are some of your favorite virtual art experiences?

Cotter: One that I think is also really cool is Google Arts & Culture because they have such high-resolution images. You can scroll in so close to see the brushstrokes. James and I also taught a course for the Barnes Foundation in Philadelphia around this topic of visual art and flourishing on their online platform, which also has some of these really nice zoom-in features. They’re doing a lot of robust online teaching and programming on a variety of topics.

How does this work fit into the larger Humanities and Human Flourishing Project, and what does human flourishing mean in the context of engaging with art?

Pawelski: The Humanities and Human Flourishing Project is interested in looking at connections between arts and culture and various positive outcomes. These can range from physiological outcomes—Does it have an effect on your cortisol levels? Does it have an effect on your heart rate?—to neuroscientific effects. What happens in our brains as we walk into an art museum or as we go onto OGAR? 

We have a very broad notion of what we mean by these flourishing outcomes, and we have five different key pathways that we’ve identified. The first one is immersion; it’s hard to be changed by an experience in the arts and humanities if you’re not paying attention to it. The others include being able to express your feelings and your thoughts, acquiring long-term skills that you can put to use elsewhere, connecting with others, and reflecting on what the experience means to you.

You recently published a study on the wellbeing benefits of virtual art galleries. Can you talk about the design of the study and the digital art gallery that you used?

Cotter: This was a gallery put together with OGAR where we partnered with the Philadelphia Museum of Art to utilize their collection and create a set of galleries featuring 30 artworks. Part of what we were interested in was what happens in the virtual gallery but also what happens when people have repeated engagement. We had people complete a series of four gallery visits, and each gallery was different, so they were seeing new art each time. 

We see that people—across time—are having changes in their positive emotions, their negative emotions, and what we call aesthetic emotions, so feeling moved or in awe, or getting goosebumps or chills. But what seems to be particularly important is their immersion levels. People who are more immersed in these experiences overall have greater positive emotion, lower negative emotion, and more of these aesthetic feelings. 

All five personality traits—openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism—were uniquely linked to immersion, so people who are higher in these traits are reporting greater immersion. An interesting lack of effect was that none of these things was associated with people’s interest in art coming in, so it didn’t mean you had to be highly engaged with art or highly interested in art to see these benefits. 

Pawelski: Another aspect of our work that I think is really valuable is that if you go to an art museum and you ask these questions, that’s great, but you have to keep in mind that you have a biased sample. These are people who have decided, for whatever reason, that this is the way they’re going to spend their day. What is it about those people versus the other people driving by who have not decided to do that? Can you really generalize from that self-selected population to everyone? But with the work that we’re doing with OGAR, these are people who are representatively selected.

Are there particular benefits to a virtual art engagement compared to an in-person experience?

Cotter: There are unique affordances to the digital. I can go to three different international museums in the same day if I want to and not have to spend all that money on airfare to get to them. 

I got a not-infrequent number of responses from people doing this study saying they haven’t been to a museum in a long time because of physical or geographic accessibility, and they’re like, “It was so nice to view art again because I couldn’t.” I think there’s also some of these broader accessibility factors that come into play. If you want to go to a museum, they’re open at certain times; the internet’s always open. There’s mobility considerations as well; there’s not always a lot of spots to sit in the galleries, or they’re often taken.

Pawelski: I think in some ways, our attitudes about art need to catch up with our attitudes about music. I don’t think anybody would say, “You’re listening to Spotify? Why would you do that? That’s kind of nuts. You’re not actually with the musician? You’re not actually at the concert?” 

We have incredible richness available to us in music. Why not take advantage of a similar kind of richness that we have available to us in art?

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Study on positive psychology from 1999 to 2021: A bibliometric analysis

Feifei wang.

1 Department of Developmental Psychology of Armyman, School of Psychology, Army Medical University, Chongqing, China

2 Department of Financial Management, Chongqing Business Vocational College, Chongqing, China

Associated Data

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Positive psychology is a revolution in the science of psychology as well as a new milestone in the development of human society. The purpose of the study was to use bibliometrics and visual analysis to assess the current state and trends in positive psychology research.

The Web of Science Core Collection was searched for 4,378 papers on positive psychology between 1999 and 2021. The features of positive psychology research were analyzed using Microsoft Excel 2013, VOSviewer (1.6.17), and CiteSpace (5.8.R1).

The findings demonstrate a steady growth in positive psychology publications from 1999 to 2021. The United States (1,780) and Harvard University (104), respectively, were the most productive nations and organizations in this subject. Frontiers in Psychology was the most productive journal (288), while the Journal of Personality and Social Psychology had the most co-citations (8,469). Seligman was the most influential author, with 3,350 citations and 5,020 co-citations. The top ten co-cited references, in terms of citation explosion, suggesting that these papers provide the foundation for the growth of this discipline. The systematic review, character strengths, positive psychology intervention, language pleasure, and the COVID-19 pandemic are the focal points of research and development developments in this discipline.

These findings have helped researchers in positive psychology find new ways to collaborate with partners, hot topics, and research frontiers.

1. Introduction

Positive psychology is a vibrant field of research, and concepts about the components of well-being predate the positive psychology movement. Diener (1984) evaluated the literature on subjective well-being (SWB) in 1984, then created and validated the Life Satisfaction Scale (SWLS) ( Diener et al., 1985 ). Ryff (1989 , 2014 , 2022) has studied psychological well-being for over 30 years in an effort to determine its fundamental components, find what conditions encourage or hinder it, and investigate how it impacts health. In 1998, Seligman was elected president of the American Psychological Society. He advocated that psychologists and practitioners concentrate on enjoyment rather than illness reduction. Many psychologists advocate a greater emphasis on positive psychological development. It discusses how to develop attributes such as imagination, optimism, foresight, interpersonal talents, moral judgment, patience, humor, and fearlessness, as well as how to promote pleasure and life satisfaction ( Gillham and Seligman, 1999 ). The Millennium issue of American Psychologist focuses on the emerging science of positive psychology. Psychologists are beginning to consider what advantages humans have at the end of the twentieth century. Positive Psychology , published in 2000 by Seligman and Csikszentmihalyi (2000) , marked the formal beginning of positive psychology. So this manuscript will focus on the development of positive psychology after its formal beginning. Therefore, Seligman (2019) is often called the “Father of Positive Psychology.”

The application of psychological ideas, research, and intervention strategies to comprehend the good, adaptable, imaginative, and emotionally satisfying elements of human behavior is known as positive psychology ( Seligman and Csikszentmihalyi, 2000 ). It shifts the research’s focus to “ordinary people” ( Sheldon and King, 2001 ). Positive psychologists, like other natural or social scientists, seek to understand psychological structure, phenomena, and functions. There has been significant progress in the theory of positive psychology, as evidenced by PERMA (the five elements of well-being; Seligman, 2011 ), the dual-factor model of mental health ( Suldo and Shaffer, 2008 ), the complete state model of health ( Keyes, 2005 ), and the broaden-and-build theory of positive emotions ( Fredrickson, 2001 ). Subsequently, positive psychology was widely used, including national psychological accounts of well-being ( Diener and Seligman, 2018 ), positive psychotherapy ( Seligman et al., 2006 ), a classification of strength and virtue ( Snow, 2018 ), comprehensive soldier fitness ( Lester et al., 2022 ), positive education ( Seligman et al., 2009 ), and so on. With the advancement of positive psychology studies, positive psychology intervention has attracted researchers’ attention. Positive psychological intervention (PPI) is defined as “building its intervention on positive psychology theory and employing its coherent theoretical model to achieve the objective of promoting happiness” ( Carr et al., 2020 ). Many positive psychology interventions have been shown to significantly boost well-being and minimize depressive symptoms ( Sin and Lyubomirsky, 2009 ; Bolier et al., 2013 ; Carr et al., 2020 ). As the COVID-19 global health crisis unfolds, positive psychology is critical for sustaining mental wellness ( Waters et al., 2021 ).

After more than two decades of development, many research papers have been published in the field of positive psychology research. Researchers systematically reviewed 1,336 articles published between 1999 and 2013 and found that positive psychology is a growing and dynamic subfield within the broader discipline of psychology ( Donaldson et al., 2014 ). However, the field has grown rapidly in recent years, adding a large body of literature that requires us to use scientometric methods for analysis. Therefore, we must pay more attention to the research hotspots and trends in positive psychology. Scientometrics is a powerful tool for identifying emerging trends and hotspots in the subject ( Chen, 2017 ; Hou et al., 2018 ). Bibliometric analysis is more objective and efficient than standard qualitative analysis approaches. In recent years, the advancement of scientific mapping techniques has increased ( Cobo et al., 2011 ). Scientific mapping technologies generally capture a bibliographic record of a group of study fields and create an overview of the underlying knowledge domains. Typical tools are CiteSpace ( Chen, 2006 ) and VOSviewer ( van Eck and Waltman, 2010 ; Ding and Yang, 2020 ). Computationally aided literature reviews are not intended to replace expert-written reviews; rather, they are intended to provide an additional point of reference with some advantages ( Chen et al., 2014b ). Bibliometric analysis is currently used extensively in a variety of research areas, including depression ( You et al., 2021 ; Zhou Y. et al., 2021 ); mindfulness research ( Baminiwatta and Solangaarachchi, 2021 ); COVID-19 ( Chen, 2020 ; Yu et al., 2020 ); and so on. The use of bibliometric analysis in clinical practice has become increasingly popular. Unlike typical expert-compiled evaluations, scientometrics covers a broader and more diverse range of critical issues. A collection of scholarly literature reflecting positive psychology research was used as input for this research. As a result, the purpose of this research is to conduct a bibliometric analysis of positive psychology research from 1999 to 2021 using the software packages CiteSpace and VOSviewer in order to better understand the field’s current condition, hotspots, and developmental trends.

2. Data and methods

2.1. data acquisition.

The study’s data source was the Web of Science database, which is the world’s most reliable citation database and has numerous high-quality papers ( Huertas González-Serrano et al., 2019 ; Luo et al., 2021 ). The data is gathered mostly from the Web of Science Core Collection (WoSCC), which includes SCI-Expanded, SSCI, ESCI, and A&HCI. Due to the WoSCC literature retrieval database’s ongoing updating, we only conducted a single search on April 18, 2022.

The elements of the field of positive psychology were initially outlined by Seligman (2019) in 1998. Additionally, the APA Thesaurus included the index phrase “positive psychology” ( Gallagher Tuleya, 2007 ) in June 2003. Positive psychology topics are also reflected by a variety of additional thesaurus phrases (for example, “well-being,” “life satisfaction,” “positive emotions,” “happiness,” and so on). It was challenging to establish the eligibility of the literature due to the abundance of terminology connected to the issue of positive psychology. This study focuses on the exact term “positive psychology” ( Schui and Krampen, 2010 ), as well as the time period 1999–2021.

2.2. Inclusion criteria

The search yielded approximately 5,374 publications. The language utilized is English, and the type of literature is limited to “article” or “review.” This advanced search process excludes 996 articles. Finally, 4,378 publications were obtained and analyzed.

2.3. Analysis methods

Analytics used in the study include Microsoft Excel 2013; VOSviewer (1.6.17); and CiteSpace (5.8.R1). We use Microsoft Excel 2013 to analyze the changes and trends in the number of documents ( Zhou T. et al., 2021 ). VOSviewer is a document analysis software package that has been developed by Van Eck and Waltman ( van Eck and Waltman, 2010 ). It has been proven to have excellent visualization and analysis results and is widely used for document analysis ( van Eck and Waltman, 2010 ; Liao et al., 2018 ). In this study, the software is used to analyze the features of positive psychology studies, such as Countries/Regions, institutions, journals, and authors. Using the method of full counting to construct a bibliometric network ( Perianes-Rodriguez et al., 2016 ). The size of the nodes represents the number of publications, while the overall connection strength value illustrates the degree of collaboration between a subject and others ( Zou and Sun, 2019 ).

CiteSpace is bibliometric analysis software ( Chen, 2006 ), which can be used for the analysis of co-citations, burst detection, and emerging research trends in the literature ( Chen et al., 2012 ; Hou et al., 2018 ). By developing a collection of visual knowledge maps, CiteSpace explores the states, hotspots, frontiers, and evolution processes in a scientific field.

The parameters of CiteSpace are as follows: time split between January 1999 and December 2021 (each slice is 1 year), the analysis items are selected as references, one node type is selected at a time, the selection criteria [g-index ( k  = 35)], and pruning (Pathfinder). A visual knowledge map is created using nodes and connections. In the map, each node represents one reference. The size of the nodes reveals the frequency of reference, while different colors of nodes stand for different years. In the center, the burst node as a red circle represents the number of co-occurrences or references that grow with time. Purple nodes represent the centrality and important knowledge exhibited by the data ( Chen, 2012 ). The line of connection between nodes is taken to be a co-occurrence or co-cited relation; the thickness of the line signifies the strength of the relationship, and the color corresponds to the time of the first node ( Liu and Chen, 2012 ). Cold to warm colors represent the early to recent. Betweenness centrality is another name for centrality. Nodes with high mental quality (>0.1) are frequently considered paradigmatic or pivotal moments in a discipline. An explosion of references to citations explores the trend and shows if the relevant writers have gotten significant attention on this subject ( Chen et al., 2014a ). Researchers may use this map to better understand new trends and identify hotspots by using burst detection and analysis ( Chen et al., 2014a ; Shi et al., 2022 ).

3.1. Time trend analysis of publication outputs

The search yielded a total of 4,378 publications, of which 4,021 were articles and 357 were reviews. This annual publication may demonstrate the trend in this field of research, which we portray as a broken line chart ( Figure 1 ). Figure 1 shows that the number of papers published between 1999 and 2021 continues to increase, indicating that related research areas are increasingly attracting academic interest. In particular, the literature on positive psychology has grown substantially in the last 3 years. The number of publications is expected to continue to grow.

Trends in annual publications in positive psychology research.

3.2. Analysis of countries/regions

Between 1999 and 2021, 96 countries/regions published research on positive psychology. We use the parameters of the number of publications (≥10) and the strength of the lines (≥1), generating 46 nodes and 428 links in the network of partner countries/regions ( Figure 2 ). In Figure 2 , we can see that the United States had the most publications (1,780), accounting for 40.66% (1,780/4,378), much outnumbering the rest, followed by England (420), Australia (388), the People’s Republic of China (361), and Canada (298). The table compares the top 10 countries/regions in terms of the number of publications, WoS citations, citations per study, and overall link strength ( Table 1 ). The United States was the leading country, ranking first in terms of publications, WoS citations, citations per article, and total link strength, indicating that the United States is absolutely dominant in the field of positive psychology.

Map of countries/regions in positive psychology research.

Top 10 prolific countries/regions researching positive psychology.

3.3. Analysis of institutions

We use the parameters of the number of publications (≥20) and the strength of the line (≥1), generating 61 nodes and 268 links in the network of partner universities ( Figure 3 ). The research institution knowledge map assists us in understanding the key research institutions in this subject as well as their collaborative links. Harvard University, the University of Michigan, the University of Pennsylvania, and the University of Melbourne are all prominently displayed in Figure 3 . In terms of the number of publications, 11 universities rank in the top 10. Table 2 shows that each organization participated in at least 43 studies related to positive psychology. Seven of them are from the United States, with the others coming from Australia, Switzerland, South Africa, and Canada. Harvard University was placed first among these universities, with 104 studies completed, followed by the University of Michigan ( n  = 87) and the University of Pennsylvania ( n  = 84). The top 10 institutions, as shown in Table 2 , produced 15.50% of all publications. Among these institutions, the University of Michigan had the most WoS citations (13,234) and citations per article (152.11). The top 10 producing institutions are listed in Table 2 .

Map of institutions in positive psychology research.

Top 10 prolific institutions researching positive psychology.

3.4. Analysis of journals and co-cited journals

In Figure 4 , we use the parameters of the number of publications (≥20) and the strength of the line (≥1), generating 21 nodes and 156 links in the journal citation map. The top 10 academic journals that publish articles on positive psychology research are shown in Table 3 . These publications varied in IF from 0.917 to 4.614 (average IF: 3.228), and they are specialized journals in this field. Of these, the International Journal of Environmental Research and Public Health has the highest factor of influence (4.614). The 10 journals published a total of 986 papers connected to positive psychology research, accounting for 22.52% of the 4,378 studies collected. At least 138 papers were published in the top three journals. In terms of link strength, the Journal of Positive Psychology ranked first ( n  = 1,431), followed by the Journal of Happiness Studies ( n  = 1,130) and Frontiers in Psychology ( n  = 1,096). On this subject, they are quite important.

Map of journals in positive psychology research.

Top 10 scholarly journals and co-cited journals in positive psychology research.

Table 3 displays the top 10 co-cited journals. The journals with the highest academic power and important positions in the field are those with a high co-citation count. In terms of IF, these journals ranged from 2.935 to 23.027 (average IF: 8.214), and they are professional journals in this field. The most influential of these is Psychological Bulletin (23.227), followed by American Psychologist (16.358) and Journal of Applied Psychology (11.802). The Journal of Personality and Social Psychology had the highest number of co-citations (8,469), followed by American Psychologist (7,341), and then the Journal of Positive Psychology (4,057). As a result of the examination of the co-citation count, the Journal of Personality and Social Psychology has been recognized as the core journal in the positive psychology research area.

3.5. Analysis of authors and co-cited authors

For authors who posted more than 10 publications, generating a co-author map using VOSviewer resulted in 72 nodes and 107 links ( Figure 5 ). The largest network of partnerships we found included Huffman JC, Proyer RT, Fredrickson BL, Ruch W, and other lead authors ( Figure 6 ). In terms of publications, Ruch W published most of the research (51), followed by Huffman JC (40), Celano CM (30), and Proyer RT (30). In terms of citations, the top three authors are Seligman MEP (3,350), Wood AM (3,284), and Maltby J (2,432). Author Maltby J published most of the citations per paper (221.09) in terms of the number of citations per paper, followed by Wood AM (218.93) and Seligman MEP (159.52). Table 4 displays the top 10 authors in terms of publications, citations, and citations per paper in positive psychology research. They are well-known and active authors in this discipline. The top 10 co-cited authors are also shown in Table 4 . The most co-cited author is Seligman MEP (5,020), followed by Diener E (2,809) and Fredrickson BL (2,434). These authors have made remarkable contributions to the field of positive psychology.

The authors’ map of positive psychology research.

The largest author collaboration network in positive psychology research.

Top 10 active authors and co-authors in positive psychology research.

3.6. Analysis of co-cited references

Essentially, science is a dynamic accumulation process. This means that when scholars write scientific papers, they need to cite others’ academic works ( Shafique, 2013 ). The basis of this field of study is represented by the co-citations, which relate to the references that are also listed in the reference lists of other works. CiteSpace allows for automatic labeling of clustering, greatly reducing the subjectivity of the study of search bounds ( Hou et al., 2018 ).

Figure 7 depicts a cluster visualization of the CiteSpace software-generated coreference network, which was split into 28 clusters, only the 11 largest of which were retrieved from the references based on indexing terms and determined by a log-likelihood ratio algorithm. They are depicted in the image with various convex hulls, including systematic review (cluster #0), character strength (cluster #1), positive psychology intervention (cluster #2), level matrix model (cluster #3), positive psychology perspective (cluster #4), foreign language enjoyment (cluster #5), adolescent athlete well-being (cluster #6), coronary heart disease (cluster #7), employee well-being (cluster #8), the second wave (cluster #9), and subjective wellbeing questionnaire (cluster #10). The authors of each node in the map are identified in red, and each node indicates a referenced reference. The reference co-citation map’s cluster representation is shown in Figure 7 . Table 5 displays the characteristics of the top 11 reference clusters in the co-citation network. The configuration’s overall clarity is stronger the closer each cluster’s silhouette score is to one ( Chen, 2020 ). Each cluster had an average silhouette greater than 0.9348 and an overall Q -value of 0.8649, indicating that the quality of the cluster was extremely reliable.

Reference co-citation network analysis of publications in positive psychology research. Cluster visualization of the reference co-citation map.

The largest 11 clusters of references in the co-citation network.

We can map the same group of words to the same horizontal axis in the timeline view, with the document located below the horizontal axis; the closer to the left, the newer the document ( Figure 8 ). The figure allows us to see the temporal characteristics of each cluster and the extent of clustering. A total of seven clusters lasting until 2020 are shown in the figure, including systematic review (cluster #0), character strength (cluster #1), foreign language enjoyment (cluster #5), health behavior (cluster #11), COVID-19 pandemic (cluster #14), theoretical model (cluster #18), and momentary blip (cluster #27). Indicating that these fields of research are still receiving scholarly attention.

Timeline view in positive psychology research.

The top five references in positive psychology research were listed according to their characteristics (see Supplementary material for details). They are regarded as the cornerstone research for the field of positive psychology. The top-ranked paper was published by Seligman MEP, with 1,619 co-citations. The articles with the most co-citations are usually key foundational works in this discipline. Positive Psychology: an Introduction received the most co-citations, making it the most important reference. The research concludes by defining the positive psychology scientific framework, pointing out knowledge gaps, and predicting the future of science careers in the twenty-first century. Furthermore, the authors noted that it enables individuals, communities, and society to thrive ( Seligman and Csikszentmihalyi, 2000 ).

While the strongest reference citation burst is considered the primary knowledge of the trend. As can be seen, Seligman MEP led the reference burst in 2000, and the burst was 52.03. The top 30 most potent citation bursts from 1999 through 2021 are shown in Figure 9 . Additionally, the number of red squares corresponds to the time of the epidemic in the literature, and each red square indicates a year. Figure 9 lists a few important works of literature. It demonstrates that the red arrow’s target reference is a crucial one with a powerful explosion. Seligman and Csikszentmihalyi (2000) , Peterson (2004) , Seligman et al. (2005) , Sin and Lyubomirsky (2009) , Seligman (2011) , and Lyubomirsky and Layous (2013) are a few examples of references. Hayes (2017) and Rashid (2014) are still bursting and need our high attention.

Top 30 references with strong citation bursts in positive psychology research.

Important references are also included in Table 6 . Bolier et al. (2013) is the highest-ranked object per burst in Cluster #2, with bursts of 57.41. The second is Seligman et al. (2005) in Cluster #4, with bursts of 56.59. The third is Seligman and Csikszentmihalyi (2000) in Cluster #248, with bursts of 52.03. The 4th is Sin and Lyubomirsky (2009) in Cluster #2, with bursts of 49.35. Peterson (2004) is the 5th in Cluster #3, with a burst number of 37.29. More detailed information is shown in Table 6 .

Top 10 co-cited references in positive psychology research in terms of citation bursts.

4. Discussion

4.1. general information in positive psychology research.

In this study, a bibliometric analysis of positive psychology research was conducted from 1999 to 2021. Based on the overall analysis of publications, productive countries/regions, institutions, journals, and authors, we can provide further research suggestions for researchers. The summary is as follows:

• Publications in the field of positive psychology have continued to grow since 1999. The annual output of positive psychology publications from 1999 to 2021 was divided into three phases. Less than 100 publications were generated annually during the first phase, which lasted from 1999 to 2007. The second phase lasted from 2008 until 2018. The number of publications has been steadily increasing. For the first time, more than 100 papers were published in 2008, and that number climbed to 378 articles in 2018. The third phase lasted from 2019 to 2021. In the past 3 years, there has been a considerable growth in the number of articles published; all of them have exceeded 500 articles. In general, positive psychology is still a popular area of study.
• With global communication, the physical distance between collaborators in research becomes increasingly irrelevant ( Ruhl and Priede, 2011 ), and researchers in the field of positive psychology are also engaged in extended cooperation ( Figures 2 , ​ ,3). 3 ). Based on the number of publications, positive psychology publications from the United States are more influential than those from other countries. Seven of the top 10 institutions are from the United States, which demonstrates that American institutions have significant influence in this field. In addition, in a model for developing countries, China ranked fourth with 361 studies published, and South Africa ranked eighth with 158.
• Analysis of co-cited journals and journals has shown that scholars may focus on all three of these journals when publishing papers, namely, Frontiers in Psychology (288), Journal of Positive Psychology (253), and Journal of Happiness Studies (138). And when referring to articles, scholars can focus on these journals, for example, the Journal of Personality and Social Psychology (8,469), American Psychologist (7,341), Journal of Positive Psychology (4,057), Journal of Happiness Studies (3,589), and Psychological Bulletin (3,085).
• In the co-author map, Ruch has the most publications, Seligman has the most citations, and Maltby J has the most citations per paper. These three authors are thus important influences in positive psychology research. The most co-cited author is Seligman (5,020), followed by Diener (2,809) and Fredrickson (2,434). Seligman is a well-known and extensively quoted author on positive psychology. In 1999, he released an essay describing the significance of positive psychology research ( Gillham and Seligman, 1999 ), which also served as the inception of the discipline.

4.2. Emerging trends and hotpots in positive psychology research

The co-cited references are what make up the knowledge base. A key component of CiteSpace is co-citation analysis. The time slice used in this study was 1 year; the selection criteria used a modified g index ( k  = 35); and the period is from 1999 to 2021 years. CiteSpace describes the trends and patterns of change in the co-citation reference map, which can be used to capture the research focus of the prospective scientific community. The node in Figure 7 represents a single reference, and the line indicates that the two references are connected in some way.

The most representative articles of the cluster list in Supplementary material . For example, in cluster #0, the papers cited that are most related to the cluster are Hendriks et al. (2020) , which cited 19% of the contributions of the cluster; Neumeier et al. (2017) , Moskowitz et al. (2020) , Hausler et al. (2017) , which cited 17%; and Job and Williams (2020) , which cited 14% of the literature.

4.2.1. Clustering visualization of the reference co-citation map

CiteSpace divides the co-citation network into clusters of many co-citation references so that connections across clusters are weak but strong inside each cluster. The 11 major clusters are listed in Table 5 according to their size, or the total number of persons in each cluster. Large-membership clusters are displayed. If the silhouette score is close to 1, it indicates that the cluster has better homogeneity or coherence. Table 5 shows that all clusters had a high silhouette score, indicating better homogeneity or coherence. Based on the labels selected for the clusters by the log-likelihood ratio test method (LLR) ( Chen et al., 2010 ). The three largest clusters were analyzed, and the results are as follows:

With 150 members and a silhouette value of 0.872, cluster #0 is the biggest cluster. All references were across 14 years, from 2007 to 2020, and the median year was 2014. It is labeled “systematic review” by LLR. Hendriks et al. (2020) published an article that cited the most references in cluster #0. Through a detailed review and meta-analysis, this paper aims to determine if MPPIs are effective. These findings show that MPPI is successful in enhancing mental health. Further good research in different populations is needed to strengthen the claim for the effectiveness of MPPI. While the label for this cluster is “systematic review,” which states that the article type is “review,” the focus of the article is primarily on positive psychology interventions. Neumeier et al. recently developed an online intervention program aimed at improving employees’ well-being ( Neumeier et al., 2017 ). Moskowitz et al. reviewed emotion measurement in positive psychology interventions ( Moskowitz et al., 2020 ), and Job and Williams reviewed the role of online positive psychology interventions in sexual and gender minorities (SGM) ( Job and Williams, 2020 ). From many reviews, it is also found that there has been a lot of research on positive psychology intervention, which is a hot spot in the field of positive psychology.

With 117 members and a silhouette value of 0.898, cluster #1 is the second-largest cluster. For all references across 10 years (from 2011 to 2020), the median year was 2014. It is labeled as a character strength by LLR. Waters et al. (2021) published an article that cited the most references in cluster #1. The authors underline that strengthening mental health during COVID-2019 and developing positive processes and capacities will benefit the future development of mental health. This study covers the research and applied positive psychology themes of meaning, coping, self-compassion, courage, gratitude, personality advantage, positive emotion, a positive interpersonal process, and high-quality connection to help individuals cope with the epidemic. Apart from this paper, other papers also satisfy the clustering theme of “character strength.” Miglianico et al. (2019) review the literature on the use and development of strengths in the workplace. Strecker et al. (2020) will discover the circumstances for the use of individual character strengths in the workplace, resulting in enhanced job engagement and well-being. Mayerson (2020) proposed a model for the role of character strengths in the success of individuals, groups, and species. Hausler et al. (2017) examined the individual relationships between 24 different aspects of personality strengths, subjective well-being (SWB), and psychological well-being (PWB). Overall, the correlation between “good personality” and PWB was significantly stronger than that of SWB. As can be seen in Cluster #1, not only is “character strength” research emphasized, but more researchers are paying attention to “character strength” in the workplace.

With 104 members and a silhouette value of 0.886, cluster #2 is the third-largest cluster. All references were across 14 years, from 2005 to 2018, and the median year was 2011. It is labeled as a positive psychology intervention by LLR. Bolier et al. (2013) published an article that cited the most references in cluster #2. The goal of this meta-analysis is to look into the effectiveness of a positive psychology intervention on the general population as well as on those who have specific psychosocial issues. Overall, the paper shows that positive psychology interventions can successfully improve subjective and psychological well-being while also assisting in the reduction of depressive symptoms. Figure 7 shows that clusters #2 and #0 partially overlap, there are some similarities between the two clusters, and there are many papers cited to investigate positive psychology intervention. Schueller and Parks (2014) summarized the current state of positive psychology interventions as they relate to self-help and that the next stage in research necessitates the application of these tactics in ways that allow them to be used in real-world circumstances. Gander et al. (2012) conclude that some “strengths-based” therapies can improve happiness. Likewise, Proyer et al. (2014) conducted a positive psychology intervention on older people over 50 years of age, and the results showed that the intervention was effective. The results of the Hone et al. (2014) meta-analysis show that positive psychology interventions have a clear effect on promoting well-being. To maximize the potential of PPI to promote population health, there is a need to extend the efficacy trial report in the future. Positive psychology intervention is a hotspot for positive psychology research. A great deal of research has been conducted by researchers from the perspectives of meta-analysis, literature reviews, and intervention experiments.

4.2.2. Co-citation clusters timeline map

Figure 8 depicts the age span of the literature in each cluster. The clusters are placed vertically in decreasing size order, and each cluster is presented from left to right ( Chen, 2017 ). Based on the timeline map, we should focus on larger and more recent clusters. The three largest clusters are #0, #1, and #2, which were analyzed earlier in this paper. Clusters #5, #14, #18, and #27 are relatively recent in terms of time and require further attention. Since clusters #18 and #27 contain few articles and are not representative, we retain only clusters #5 and #14 for the analysis. The results are as follows:

Cluster #5 consists of 79 members with a silhouette value of 0.981. All references covered over 9 years, from 2012 to 2020, and the median year was 2017. It is labeled “foreign language enjoyment” by LLR. Elahi Shirvan et al. (2021) published an article that cited the most references in cluster #5. In response to the dynamic change in the SLA domain and the necessity for the creation of appropriate methodologies to evaluate the dynamics of developing notions in the field such as grit and pleasure, the current study sought to investigate the rise of foreign language enjoyment (FLE) and L2 grit over time. Wang X. et al. (2021) investigate Chinese university students’ enjoyment of a web-based language learning environment. In L2 education, Li and Xu (2019) found that an intervention focused on emotional intelligence has a good effect on promoting positive emotions. At the same time, as a result of the positive impact of second language acquisition (SLA) on the promotion of academic achievement and language learners’ well-being ( Guo, 2021 ). Recently, Wang Y. L. et al., (2021) reviewed the role of positive psychology in promoting second language learning. Accordingly, until recently, with the emergence and rapid development of positive psychology in general education ( Dewaele, 2014 ), there has been a clear positive revival in the area of L2 education ( Lake, 2015 ; Kruk, 2019 ), which has also emerged as a hotspot for study and a trend in the discipline of positive psychology.

Cluster #14 consists of 31 members and has a silhouette value of 1. This cluster has the highest homogeneity or coherence, indicating that the degree of coherence in the literature in this cluster is the highest. All references were over 9 years from, 2012 to 2020, and the median year was 2018. It is labeled as a COVID-19 pandemic by LLR. Waters et al. (2021) published an article that cited the most references in cluster #14. Although almost all of the papers cited within the cluster were published recently, the topics covered were COVID-19 and positive psychology, demonstrating that positive psychology plays a crucial role in the epidemic ( Quiroga-Garza et al., 2021 ). The COVID-19 epidemic had a significant impact on people’s lives and mental health ( Luo et al., 2020 ). Researchers should concentrate more on applying positive psychology to COVID-19.

5. Conclusion

In conclusion, our bibliometric analysis of positive psychology found that positive psychology is a rapidly growing discipline with some achievements that warrant further research. In this study, Microsoft Excel 2013, VOS viewer (1.6.17), and CiteSpace (5.8.R1) software were used to analyze the annual number of documents, cooperation networks (countries/regions, institutions, journals and cited journals, authors and cited authors), and total cited documents. By analyzing data from the large-scale literature, we can gain a comprehensive understanding of the development of the field of positive psychology research and the research trends in the field.

We can understand the general information in this field. Firstly, the number of papers published on this topic continues to grow, indicating that it is a research hotspot in the field of psychology. Secondly, in the analysis of the cooperation network, we can find that the United States and the institutions of the United States occupy a dominant position in this field; in journals, we should pay attention to several major journals, such as Frontiers in Psychology , Journal of Positive Psychology , Journal of Happiness Studies , and so on; In terms of an author analysis, authors such as Ruch W, Huffman JC, Celano CM, Proyer RT, Fredrickson BL have more output, while authors such as Seligman MEP, Diener, ED, Fredrickson BL, Peterson C, Snyder CR have been cited more and have a greater impact.

Analysis of the cited literature allows us to understand the research base and research frontier in this field. First, jointly cited literature forms the research base for a research field. Documents such as Bolier et al. (2013) , Seligman et al. (2005) , Seligman and Csikszentmihalyi (2000) , Sin and Lyubomirsky (2009) , and Peterson (2004) can be found to be highly explosive in nature, indicating that these papers are the foundation for the development of this field, to which we must pay close attention. Second, through cluster analysis of co-citations, we can find research hotspots and development trends in this field. The systematic review, character strengths, positive psychology intervention, language enjoyment, and the COVID-19 pandemic are the foci of research and developmental trends in this field that need our high attention.

6. Strengths and limitations

This is the first large-scale data analysis of positive psychology papers utilizing CiteSpace and VOSviewer software. Furthermore, our findings offer a clear visual analysis, and so forth, of positive psychology publications. In addition, the co-citation analysis can also capture the research base and hot trends in this field, providing a reference for researchers to fully understand this field.

This study used the scientometric method for literature analysis, which has objectivity but also some limitations. First, the results of the software analysis are somewhat mechanical and require us to select meaningful results. At the same time, there is a possibility of ignoring some meaningful literature. For example, in considering the role of positive psychology in global issues, some researchers suggest that positive psychology may benefit from the integration of spirituality to better support people’s well-being ( Bellehumeur et al., 2022 ); others have found that positive psychology has a considerable impact on employees’ green behavior ( Meyers and Rutjens, 2022 ). Second, we did not conduct an in-depth assessment of the literature, only those in WoSCC; other databases, such as Scopus, MEDLINE, and PubMed, are available. We analyzed the type of literature and selected only papers and reviews, ignoring other types of literature. We also analyzed only English literature and ignored literature in other languages, which may have led to a lack of attention to other cultures. Related to this is the need to recognize the parochial nature of positive psychology, which seems to be US-centric, especially in terms of leadership ( Ryff, 2022 ). All of these may have biased the data. For example, in studies across cultures, Appiah et al. (2020) found that positive psychology interventions promote mental health among rural Ghanaian adults; a study in Hong Kong, China, found that a multifaceted positive psychology program was effective in reducing adolescent anxiety and increasing subjective well-being ( Kwok et al., 2022 ). Finally, potential bias in the data may be caused by duplicate author names of authors, or the use of different names by the same author; or by irregularities in literature citation, where different authors cite the same literature in different formats in the analysis of co-cited literature. This is where the practice of some researchers is worthy of consideration; for example, Donaldson et al. (2014) coded all articles in their review by raters using a systematic coding scheme.

Data availability statement

Author contributions.

FW and JG contributed to the study design, acquisition of research data, and drafted the manuscript. FW conducted the data analysis. GY contributed to critical revising of the manuscript. All authors contributed to the article and approved the submitted version.

This study was supported by the National Social Science Fund Project of China (No. 19XSH018).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2023.1101157/full#supplementary-material

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