The following article was kindly written and contributed by Brad Bowins, M.D. - bowins.com
Identifying what mental health is characterised by is crucial if we are to fully understand the concept and advance psychotherapy effectiveness. Key states and processes for mental health consist of: activity, psychological defense mechanisms, social connectedness, regulation, human specific cognition, self-acceptance, and adaptability.
ACTIVITY: Being active in general and specifically in regards to physical, social, nature, cognitive, art/hobby, and music activity advances mental health, and is effective in treating mental illness. Activity entails high behavioral activation and low behavior inhibition bolstering positive emotions and diminishing negative emotions, and absorbs a person in positivity countering negativity.
PSYCHOLOGICAL DEFENSE MECHANISMS: The nature of life is such that negative circumstances tend to outweigh positive scenarios, contributing to negative emotions such as sadness and fear over positive ones like happiness and interest. Psychological defense mechanisms counter negativity and favor positivity. Mature defenses such as humor, sublimation, positive anticipation, altruism, and suppression are powerful in this regard. Positive spins on events representing positive cognitive distortions and dissociating from negativity are two major ways we defend against negativity.
SOCIAL CONNECTEDNESS: Humans evolved in hunting-gathering groups, and consequently we require good quality social contact for mental health, with loneliness contributing to mental illness. Such is our need for positive social contact that any form including social media helps, and isolated individuals respond well to compensatory strategies such as pets.
REGULATION: Mental illnesses including depression, anxiety, mania, and psychosis entail compromised regulation over emotions and thought processes. Emotion regulation is potent for ensuring that positive emotions exceed negative emotions. Equally important is regulation of thought processes to ensure that they are compatible with reality.
HUMAN SPECIFIC COGNITION: Basic cognition, social cognition, and motivation comprise the fundamental aspects of human cognition. Basic cognition largely consists of executive functions such as attention, set shifting, and multitasking. Social cognition includes the capacity to interpret emotions in facial expression, understand the intent of others, and one’s own role in relationships. Motivation takes various forms that enhance the acquisition of important resources. Discussions of mental health and illness frequently omit human specific cognition, but deficits contribute to autism spectrum disorders, intellectual disability, attention deficit hyperactivity disorder, schizophrenia, bipolar disorder, and even depression.
SELF-ACCEPTANCE: Accepting oneself is an important component of mental health, and not liking who you are favors mental illness. Self-acceptance involves both evaluative and perspective components. Self-esteem is the evaluative aspect referring to a person’s global appraisal of their positive or negative value. Self-concept can be viewed as the sum of an individual’s self-efficacy beliefs regarding personal attributes and qualities. Self-acceptance transpires when both self-esteem and self-concept are robust.
ADAPTABILITY: Circumstances are ever changing and the capacity to flexibly adjust behavior to align with these changes is crucial for success and mental health. In contrast, lack of flexibility results in unfavorable outcomes contributing to mental illness. Indeed, repetitive maladaptive behavior is a key contributor to recurrent and persistent mental health problems.
When these states and processes are intact, mental health including positive emotions is facilitated, and when compromised mental health suffers with negative emotions and mental illness ensuing. Given this occurrence a focus on activity, psychological defense mechanisms, social connectedness, regulation, human specific cognition, self-acceptance, and adaptability, provides an innovative trans-therapy and trans-diagnostic approach to treating mental illness and advancing mental wellbeing. Trans-therapy refers to strategies that apply across all forms of psychotherapy, and trans-diagnostic across various types of mental illness. Such an approach to psychotherapy is greatly needed due to major problems inherent in the current format characterized by numerous discrete forms of psychotherapy.
SHEER NUMBERS: Numerous specific forms of psychotherapy exist with the number growing rapidly. The sheer number is overwhelming for consumers, providers, students, and funders.
RESEARCH BIAS: Competition for funding amongst the various forms of psychotherapy results in unintentionally biased research, with studies typically conducted by the originator or students of the particular type, and almost no negative result studies.
FADES AND FADES: Related to promotion of various forms of psychotherapy, those that succeed in marketing achieve fade status. However, history reveals that after the originator and a generation or two of students fades, so does the specific type of therapy.
FORMS OF PSYCHOTHERAPY FOR A GIVEN MENTAL ILLNESS: Virtually every version of psychotherapy treats conditions such as depression and anxiety, which is impossible if it is the special sauce of a form of therapy that is instrumental: the probability that so many diverse approaches could treat a specific problem is very unlikely.
EXTENSION TO MANY MENTAL HEALTH PROBLEMS: Most forms of psychotherapy are initially directed towards one mental illness but rapidly expand to treat many types of psychopathology. If most forms of psychotherapy work for many conditions, the real mechanism of action is almost certainly trans-therapy in nature.
NON-SPECIFIC PSYCHOTHERAPY FACTORS: Various non-specific factors such as hope and the therapeutic alliance are robust in psychotherapy outcomes, but do not align with specific forms of psychotherapy accounting for mental health gains. The impact of non-specific factors strongly suggests that trans-therapy influences account for the effectiveness of psychotherapy.
In STATES AND PROCESSES FOR MENTAL HEALTH: ADVANCING PSYCHOTHERAPY EFFECTIVENESS (ACADEMIC PRESS, 2021), I examine 15 major forms of psychotherapy—Acceptance & Commitment Therapy, Behavioral Therapy, Cognitive Therapy, Compassion-Focused Therapy, Emotion-Focused Therapy, Existential Psychotherapy, Gestalt Therapy, Interpersonal Psychotherapy, Mindfulness-Based Therapy, Narrative Therapy, Person-Centered Therapy, Positive Psychotherapy, Problem-Solving Therapy, Psychoanalytic Therapy, Rational-Emotive Therapy—and Non-Specific Psychotherapy Factors, demonstrating how they actually work by enhancing activity, psychological defense mechanisms, social connectedness, regulation, human specific cognition, self-acceptance, and adaptability.
Given this occurrence, a unified trans-therapy approach to advance these key states and processes for mental health is developed, drawing on both general strategies and robust techniques from existing forms of psychotherapy. To demonstrate how this works, the example of adaptability is provided:
ADAPTABILITY:
Flexibly adapting to ever changing circumstances is key to mental health. Generally, this can be advanced in psychotherapy by examining how a client perceives behavior in relation to circumstances. I have noted that many clients think in terms of good-bad, right-wrong, and the like, applying absolutes. Shifting their perspective to what is adaptive for the given circumstances can be quite enlightening, paving the way for more adaptive behavior. Encouraging the person to think of behavior relative to circumstances ongoing instills this approach as a pattern. The general way that non-specific factors appear to foster neural plasticity (see the Non-Specific Factors chapter) enables them to enhance adaptability.
Adaptability is advanced by strategies drawn from different major forms of psychotherapy. Acceptance & Commitment Therapy does so by having the client flexibly adjust behavior in the service of valued goals. Behavioral flexibility, labelled psychological flexibility, is encouraged to achieve these goals despite adversity. Cognitive flexibility itself is enhanced by producing broad and balanced perspectives to minimize avoidance responses. Cognitive Therapy also advances psychological flexibility and so adaptability, largely by the reframing of negative perspectives including specific thoughts and underlying beliefs. Adhering to unreasonably negative thoughts typically results in maladaptive outcomes, whereas flexibly shifting perspectives to see the positive side fosters behavior that aligns with circumstances.
When relationships are a focus, Interpersonal Psychotherapy produces more adaptive behavior by resolving role disputes, fostering smoother role transitions, and improving social skills. Role issues often involve inflexible thoughts and actions, such as a man expecting his wife to do all the housework like his mother, and by adjusting expectations for this role transition, adaptive alterations in behavior ensues. If interpersonal skill deficits are a concern, improving these skills will provide for a more extensive range of social behaviors increasing the probability of adaptive outcomes.
Mindfulness-Based Therapy improves adaptability by instilling greater cognitive flexibility, likely due to improved control over attention, inhibiting negative thought streams, and shifting to a focus on the peaceful present. By altering negative and limiting self-stories to positive ones that are coherent and balanced, Narrative Therapy advances adaptability: limited and negative self-narratives often occur with repetitive maladaptive behavior, such as “I can never win,” whereas positive and more comprehensive narratives favor actions adaptive to circumstances, with an example being, “I can win when the task matches my skill set.” Psychotherapists can readily assist a client in producing narratives that favor adaptive behavior. “Innovative moments” in story generation appear to shift rigid self-narratives into more flexible and adaptive stories.
Even the title, Problem-Solving Therapy suggests that it can promote adaptive behavior. Problems that bring people into psychotherapy commonly involve inflexible repetitive approaches that do not fit with circumstances. Solutions derived from the problem-solving steps—problem identification, clarification, generating realistic solutions, selecting the best option, developing an action plan, implementing it, and monitoring the outcome—will fit behavior to circumstances enhancing adaptability. Rationale-Emotive Therapy is ideally suited to improving adaptability given its focus on irrational negative beliefs that are not consistent with the demands of reality. Assertively addressing these irrational beliefs in therapy, and having the client develop rational beliefs fitting with reality greatly advances flexibility and adaptability.
Psychotherapy generally can advance adaptability if the therapist looks at how the client perceives behavior in relation to circumstances. The common emphasis on absolutes such as good-bad and right-wrong favors inflexible and maladaptive actions. Encouraging, guiding, and supporting the client in processing behavior in relation to circumstances will produce much more adaptive behavior. Neural plasticity appears to increase as a non-specific psychotherapy influence, thereby fostering adaptive thoughts and actions. Several major forms of psychotherapy provide strategies to advance psychological flexibility, producing a shift from inflexible maladaptive perspectives and actions to flexible and adaptive behavior aligning with circumstances.
Applying general psychotherapy strategies and those derived from specific forms of psychotherapy to enhance the key states and processes for mental health, provides a unified approach to psychotherapy that resolves the practical and conceptual problems associated with the current discrete psychotherapy format. Change is a challenge, but in line with one of the states and processes for mental health—adaptability—the current discrete system of psychotherapy does need to shift to a trans-therapy orientation. The approach advocated based on key states and processes for mental health represents a comprehensive trans-therapy format, drawing on the strengths of existing forms of psychotherapy, to advance psychotherapy effectiveness.