BUILDING INNOVATIVE MODELS OF POSITIVE PSYCHOTHERAPY FOR PEOPLE LIVING WITH ACQUIRED

BRAIN INJURY

ASSOCIATE PROFESSOR ANDREW KEMP, PHD, FBPSS

ASSOCIATE PROFESSOR ZOE FISHER, PHD, DCLIN PSYCH

HEALTH AND WELLBEING

• OXFORD DICTIONARY: DEFINES “HEALTH” AS “THE STATE OF BEING FREE FROM ILLNESS OR

INJURY”

• WORLD HEALTH ORGANISATION (WHO) DEFINITION: COMPLETE PHYSICAL, MENTAL, AND

SOCIAL WELLBEING, NOT MERELY THE ABSENCE OF DISEASE AND INFIRMITY

• BUT…

GLOBAL CONTEXT: HEALTH IN THE 21ST CENTURY

• SHIFT IN THE ‘EPIDEMIOLOGICAL TRANSITION’: INCREASING BURDEN ATTRIBUTABLE TO

CHRONIC DISEASE BURDEN RELATIVE TO ACUTE DISEASE

• CAN WE OFFER THOSE WITH ABI AN OPPORTUNITY TO EXPERIENCE WELLBEING DESPITE

LIVING WITH A CHRONIC CONDITION?

LONELINESS DISTRESS MORTALITY

• ‘KODOKUSHI’

• IN U.K., MORE THAN 25% LIVE ALONE

• 60% TEENAGERS REPORT FEELING LONELY

• LONELINESS INCREASES DISTRESS RISK FOR

MORBIDITY, MORTALITY

Kemp et al., 2017. In book titled: Neuroscience and Social Science: The Missing Link

OVER 8YRS, MENTAL DISTRESS WAS LINKED TO:

RUSS ET AL., 2012, BMJ

MODELS OF HEALTHCARE

• ACUTE MEDICAL MODEL IS THE DOMINANT MODEL OF CARE

• ASSUMPTIONS INCLUDE:

• FOCUS ON PEOPLE WITH ACUTE CONDITIONS

• FIX & RETURN TO ‘PRE –INJURY STATE’

• THE PATIENT IS A PASSIVE RECIPIENT OF CARE

• HEALTH AND WELLBEING IS SYNONYMOUS WITH THE ABSENCE OF ILLNESS

MODELS OF HEALTH CARE HAVE NOT CHANGED TO REFLECT THE EPIDEMIOLOGICAL TRANSITION

NEURO-REHABILITATION

• NEUROREHABILITATION IS DEFINED AS ‘A COMPLEX MEDICAL PROCESS, WHICH AIMS TO AID

RECOVERY FROM NERVOUS SYSTEM INJURY, AND TO MINIMIZE AND/OR COMPENSATE FOR

EVERYDAY DIFFICULTIES RESULTING FROM IT’

• FOCUS ON REDUCING IMPAIRMENT AND PSYCHOLOGICAL DISTRESS

• TREMENDOUS SCOPE TO BROADEN THE EFFICACY OF NEUROREHABILITATION BY INCREASING

FOCUS ON BUILDING WELLBEING IN ADDITION TO REDUCING IMPAIRMENT AND DISTRESS

A BRIEF BACKGROUND TO PP

Hedonic

Wellbeing

Eudaimonic

Wellbeing

Hedonic Well-Being = happiness you get from

feeling pleasure in the moment, typically short lived,

we have to keep topping up our reserves to maintain

its effects.

Eudaimonic Well-Being = happiness gained from

having meaning and purpose in our life, fulfilling our

potential and feeling that we are part of something

bigger than ourselves.

A BRIEF BACKGROUND TO PP

Hedonic Theory of

Wellbeing

Integrated Theory

of Wellbeing Eudaimonia Theory

of Wellbeing

Subjective Wellbeing Theory

& Broaden & Build Model

PERMA Theory Six Factor Model of Psychological

Wellbeing (PWB)

Life

Satisfaction

Positive

Emotion

Negative

Emotion

Positive

Relationships

Engagement

Achievement

Meaning &

Purpose

Autonomy

Personal

Growth

Self-

Acceptance

Environmental

Mastery

PP & VAGAL FUNCTION

Kok et al (2013). Psych Sci

• INCREASES IN VAGAL FUNCTION

INCREASES IN POSITIVE EMOTIONS

INCREASES IN SOCIAL CONNECTEDNESS IN

AN UPWARD SPIRAL RELATIONSHIP

• THESE FINDINGS HAVE IMPORTANT

IMPLICATIONS FOR POSITIVE PSYCHOLOGY

VAGAL NERVE FUNCTION

• VAGAL FUNCTION IS AN INDEX OF:

• AUTONOMIC FLEXIBILITY

• EMOTIONAL FLEXIBILITY

• PHYSICAL HEALTH

• RESILIENCE

• VAGAL FUNCTION IS INDEXED BY HEART RATE

VARIABILITY (HRV)

• HRV IS DETERMINED FROM BEAT TO BEAT

VARIATION IN CONSECUTIVE HEART BEATS

WHY SHOULD HEART RATE BE VARIABLE?

Kashdan & Rottenberg, 2010; Kemp et al., 2017a,b

• RESPIRATORY SINUS ARRHYTHMIA

• VARIABILITY ALLOWS ONE TO BE

FLEXIBLE TO ENVIRONMENTAL STRESS

• FLEXIBILITY IS A FUNDAMENTAL

ASPECT OF HEALTH

• VAGAL FUNCTION RESILIENCE

HOW IS VAGAL FUNCTION ALTERED?

• VAGAL FUNCTION IS ADVERSELY AFFECTED BY:

• SMOKING

• PHYSICAL INACTIVITY

• DISTRESS

• WE CAN IMPROVE VAGAL FUNCTION THROUGH:

• POSITIVE PSYCHOLOGY

• POSITIVE HEALTH BEHAVIOURS

• POSITIVE SOCIAL TIES

• POSITIVE ENVIRONMENTS

Image from forthcoming review on neuroscience of sadness, Kemp et al., submitted

THEORETICAL UNDERPINNINGS – GENIAL 1.0

BUILDING WELLEBING MUST TARGET: -

- POSITIVE HEALTH BEHAVIOURS

- POSITIVE PSYCHOLOGICAL EXPERIENCES

- SOCIAL RELATIONSHIPS AND INTEGRATION

Kemp, Arias & Fisher., 2017. In book titled: Neuroscience and Social Science: The Missing Link

Individual Community

Environment

Mead, Fisher & Kemp & colleagues, 2019

BUILDING SERVICES THAT IMPROVE WELLBEING: THEORETICAL

UNDERPINNINGS – GENIAL 2.0

GENIAL 2.0:

Individual Community

Environment

Social

cohesion

Reconnecting

to nature

Health

behaviours

Health

behaviours

Social

cohesion

Reconnecting

to nature

Psychological

experience

Health behaviours

impact on wellbeing

Psychological experience

has implications for

individual, community &

the environment

Social cohesion has

important impacts on

individual wellbeing

Nature-based experience

has implications for

individual & community

wellbeing

Positive

Emotion

Engagement

Relationships Meaning

Achievement

Wellbeing = connection (underpinned by healthy vagal function)

Mead, Fisher & Kemp & colleagues, 2019

Prosociality

Sustainable

happiness

Meaning

Hope

Empathy

Love

Genetics

Social

harmony

Sumbiophilia

Volunteering

Resilience Engagement

Endemophilia

Social justice

Social

capital

Social

cohesion

Time in

nature

Self-

esteem

Diet

Sleep

Physical

activity

Family

Emotions

Life

satisfaction

Happiness

Positive

relationships

Comfort

Sustainable

behaviour Salutogenesis

Mental

health

Sense of

purpose

Mindfulness Acceptance

National

wellbeing

Opposite of

illbeing

Social

networks

Achievement Wellbeing = connection

(underpinned by healthy vagal function)

Relationships

Positive mind

Self-

acceptance

Self-

regulation

Autonomy

Soliphilia

Eutierria

Friends

Biophilia

Flourishing

GENIAL Science: A

transdisciplinary and life-

course research effort focused

on health & wellbeing

Gratitude

Community

Personal

growth

Psychological

flexibility

Active hope Psychological

wellbeing

Maturity

Joy

Spirituality

Optimism

Socio-

economic

status

Individual

Quality of

life

Equality Environment

Character

strengths

Environmental

mastery

Self-

actualisation

THE GENIAL DEFINITION OF WELLBEING

“POSITIVE PSYCHOLOGICAL EXPERIENCE, WHICH CAN BE IMPACTED ON BY POSITIVE HEALTH

BEHAVIOURS, AND IS PROMOTED THROUGH A SENSE OF CONNECTEDNESS TO OURSELVES AS

INDIVIDUALS, AS WELL AS TO THE COMMUNITIES AND ENVIRONMENT WITHIN WHICH WE

LIVE.”

BRAIN INJURY CAN AFFECT ALL ASPECTS OF WELLBEING

Health

Behaviour

Psychological

Experiences

Social

Connections

1. CHARACTER STRENGTHS

THEORY

• Y-SHAPED MODEL TO RECOVERY (GRACEY, 2009)

• NIEMIEC, R. (2017). CHARACTER STRENGTHS INTERVENTIONS:

A FIELD GUIDE FOR CLINICIANS

• ACTIVITIES:

• VIA 24 CHARACTER STRENGTHS QUESTIONNAIRE

• POSITIVE INTRODUCTIONS

• STRENGTHS MAPPING

https://www.viacharacter.org

2. MIND AND BODY CONNECTION

POLYVAGAL THEORY (STEPHEN PORGES, DEB DANA)

• NEUROCEPTION

• HIERACHY (CALM AND CONNECT; FLIGHT OR FIGHT; FREEZE)

• REGULATION AND CO-REGAULATION

ACTIVITIES:

• MAPPING ANS: THE AUTONOMIC LADDER

• TRIGGERS AND GLIMERS MAP

• THE REGULATION RESOURCE MAP (E.G. BREATHING,

MEDIATION, MUSIC, ART, MOVEMENT)

Psychophysiological flexibility is a fundamental

aspect of health

3. POSITIVE EMOTIONS & FLOW

• FLOW IS FUNDAMENTAL TO HAPPINESS:

CSIKSZENTMIHALYI

• POSITIVE EMOTION: BROADEN AND BUILD (FREDRICKSON,

1998, 2001, 2013)

• ACTIVITIES:

• BUILDING POSITIVE EMOTIONS – 3 GOOD THINGS,

• MEDIATION: LOVING KINDNESS

• SAVOURING EXERCISES

• OPTIMISM TRAINING – CBT

4. POSITIVE HEALTH BEHAVIOURS

• SLEEP, EXERCISE, DIET

• UPWARD SPIRAL THEORY OF LIFESTYLE CHANGE

• INFORMATION IS NOT TRANSFORMATION –

COMMON KNOWELDGE IS NOT COMMON ACTION

• ACTIVITIES:

• GOAL SETTING & BEHAVIOURAL CHANGE

• FACILITATING SOCIAL CONNECTION - GROUPS

• POSITIVE EMOTIONS SUSTAIN BEHAVIOURAL CHANGE

(CAPPELLEN, 2018)

Cappellen et al., 2018, Psychol Health

SWANS

5. SOCIAL RELATIONSHIPS & COMMUNITY

• SOCIAL IDENTITY THEORY – HASLAM

• PERMA – SELIGMAN

• POSITIVITY RESONANCE – FREDICKSON

• ACTIVITIES:

• GRATITUDE JOURNAL

• RANDOM ACTS OF KINDNESS

• LAUGHTER YOGA

• FACILITATE COMMUNITY INTERGRATION BASED ON

STRENGTHS, TALENTS AND VALUES

• GROUP ACTIVITIES

Laughter yoga session for Headway charity

@ Margam Abbey

BUILDING COMMUNITY

Positive Psychological Experiences

Positive Health Behaviours

Positive SocialConnections

Healthy Vagal

Function

Co-creating Health and Wellbeing

Community Connectors SWWBIG

ABMU, Rehabilitation

Engineering

6. RECONNECTING WITH NATURE

• GLEN ALBRECHT’S EARTH EMOTIONS (E.G.

BIOPHILA, TOPOPHILIA)

• ACTIVITIES:

• TIME SPENT IN NATURE (MINDFUL

PHOTOGRAPHY; SURFABILITY; FOREST BATHING)

• POS HEALTH BEH

• SUSTAINABLE BEHAVIOUR - MENOTR AND

VOLUNTEER ROLES

Taylor et al., 2015. Landscape and Urban Planning

7. MEANING AND PURPOSE

• KEY THEORISTS - VIKTOR FRANKL AND PAUL

WONG

• POST TRAUMATIC GROWTH

• LOSS OF SELF IDENTITY

• SYSTEM DISRUPTION – ‘LOSING ONES WAY’

(JUMISKO ET AL., 2006); ‘ EMPTINESS AND

DISCONNECTION’ (SOEKER, 2011)

ACTIVITIES:

• VALUES IDENTIFICATION AND GOAL SETTING

• INTEGRATION OF CHARACTER STRENGTHS – Y

SHAPED MODEL (GRACEY, 2009)

• OPPORTUNITIES FOR CONNECTION TO

SOMETHING BIGGER THAN ONES SELF

8. ACHIEVEMENT

• GRIT AND MINDSET (GROWTH VS FIXED) THEORIES

• ACTIVITIES:

• GTD – GOAL SETTING AND IDENTIFYING VALUES

(GET STUFF OUT HEAD AND ORGANISE)

• CO-PRODUCTION/CO-CREATION –

QUALIFICATIONS, AWARDS, MENTOR ROLES

• GOAL SETTING WITH CHARACTER STRENGTHS

Tulip, Fisher, Bankhead, Wilkie, Pridmore, Gracey, Tree and Kemp (2019). Building wellbeing in people with chronic conditions: A qualitative

evaluation of an 8-week positive psychotherapy intervention for people living with an acquired brain injury. Submitted to Frontiers in

Psychology

ACKNOWLEDGEMENTS

Add clinical team here