Effects of a Positive Psychotherapy Program on Positive Affect, Interpersonal Relations, Resilience, and Mental Health Recovery in Community-Dwelling People with Schizophrenia

Jinhee Kim; Hyunjoo Na

doi:10.4040/jkan.2017.47.5.638

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Kim and Na: Effects of a Positive Psychotherapy Program on Positive Affect, Interpersonal Relations, Resilience, and Mental Health Recovery in Community-Dwelling People with Schizophrenia

Original Article

J Korean Acad Nurs 2017;47(5):638-650.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.5.638

Effects of a Positive Psychotherapy Program on Positive Affect, Interpersonal Relations, Resilience, and Mental Health Recovery in Community-Dwelling People with Schizophrenia

Jinhee Kim, Hyunjoo Na

Department of Nursing, Dong-A University, Busan, Korea

Address reprint requests to : Na, Hyunjoo Department of Nursing, Dong-A University, 32 Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel: +82-51-240-2744 Fax: +82-51-240-2920 E-mail: hjna21@donga.ac.kr

Received 20 April 2017 Revised 22 September 2017 Accepted 24 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

Recently, the interest in positive psychotherapy is growing, which can help to encourage positive relationships and develop strengths of people. This study was conducted to investigate the effects of a positive psychotherapy program on positive affect, interpersonal relations, resilience, and mental health recovery in community-dwelling people with schizophrenia.

Methods

The research was conducted using a randomized control group pretest-posttest design. A total of 57 adults with schizophrenia participated in this study. The study participants in experimental group received a positive psychotherapy program (n=28) and the participants in control group received only the usual treatment in community centers (n=29). The positive psychotherapy program was provided for 5 weeks (of 10 sessions, held twice/week, for 60 minutes). The study outcomes included positive affect, interpersonal relations, resilience, and mental health recovery. The collected data were analyzed using repeated measures ANOVA for examining study hypothesis.

Results

Results showed that interpersonal relations (F=11.83, p=.001) and resilience (F=9.62, p=.003) significantly increased in the experimental group compared to the control group. Although experimental group showed a slight increase in positive affect, it was not significant.

Conclusion

The study findings confirm that the positive psychotherapy program is effective for improving interpersonal relations and resilience of community-dwelling people with schizophrenia. Based on the findings, we believe that the positive psychotherapy program would be acceptable and helpful to improve recovery of mental health in schizophrenia.

Keywords: Schizophrenia, Psychotherapy, Affect, Interpersonal relations, Psychological resilience

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Figure 1.

Model of the broaden-and-build theory of positive emotions Reprinted with permission of Guilford Press, Fredrickson and Cohn (2008, Figure 48.1) [17].

Figure 2.

Conceptual framework of the study.

Figure 3.

Flow diagram of the study participants.

Table 1.

Positive Psychotherapy Program for Community-Dwelling People with Schizophrenia

Session	Theme	Target Areas	Contents & Activities	Methods
1	Orientation	Positive relationships	Introduction positive psychotherapy program	PI
	(Opening mind)	Positive affect experiences	Signing of rules and pledge	Video
			Giving own positive nickname
2	Savoring	Positive affect experiences	Understanding about savoring	PI
			Guide of savoring methods	Savoring activity
			Savoring experience activity	Discussion
			Expression feelings after savoring - writing, drawing,
			singing, etc.
3	Positive communication	Positive affect experiences	Understanding about positive communication	PI
		Positive relationships	Practice positive communication skill – demonstration,	Video
			role play	Demonstration
				Role play
4	Good thing	Positive affect experiences	Introduction good thing mementos and story	PI
	collection box		Making good thing collection box	PP
			Publication good thing coupon	Making activity
5	Identifying personal	Identifying personal	Understanding about personal character strengths	PI
	character strengths	character strengths	Identifying personal character strengths - card test	Video
		Enhancing personal	Give and take positive feedback - decoration strengths &	Card test
		character strengths	positive tree	Decoration activity
		Positive affect experiences
6	Having positive view	Meaningful self-narrative	Understanding about positive view	PI
		Enhancing personal	Quiz four character idiom	Video
		character strengths	Introduction my adversity time’s personal character	Quiz
		Positive affect experiences	strengths - drawing my life curve	Drawing
				Discussion
7	Using personal	Enhancing personal	Introduction eyewitness account of secret angel’s personal	PP
	character strengths	character strengths	character strengths	Decoration activity
		Positive affect experiences	Introduction own personal character strengths application	Discussion
			Give and take positive feedback - decoration strengths &
			positive tree
8	Forgiveness	Meaningful self-narrative	Understanding about forgiveness	PI
		Positive affect experiences	Sharing forgiveness experience	Video
		Positive relationships	Tug-of-war game	Game
			Forgiveness activity – writing letter, post card or poem,	Forgiveness activity
			drawing, singing, etc.	Discussion
9	Gratitude	Positive affect experiences	Understanding about value of gratitude	PI
		Positive relationships	Making gratitude chronological table	Video
		Meaningful self-narrative	Gratitude activity - writing letter, post card or poem,	Gratitude activity
			drawing, singing, etc.	Singing
			Singing gratitude song	Discussion
10	Looking back &	Positive affect experiences	Looking back the past sessions	Discussion
	moving forward	Meaningful self-narrative	Recognition oneself at the present	Decoration activity
		Enhancing personal	Make personal character strengths application planning for
		character strengths	future positive figure
			Complete strengths & positive tree

PI=Presentation by instructor; PP=Presentation by participants.

Table 2.

Homogeneity Test for Subject’s General Characteristics and Study Variables (N=57)

Characteristics/Variables	Categories	Exp. (n=28)	Cont. (n=29)	χ² or t or U	p
		n (%) or M±SD or	n (%) or M±SD or
		Median (IQR)	Median (IQR)
Gender	Male	13 (46.4)	16 (55.2)	0.44	.509
	Female	15 (53.6)	13 (44.8)
Age (years)		43.64±9.43	45.72±8.73	−0.87	.391
Education	≤High school	19 (67.9)	16 (55.2)	0.97	.325
	≥Colleage	9 (32.1)	13 (44.8)
Religion*	No	8 (28.6)	4 (13.8)	1.87	.207
	Yes	20 (71.4)	25 (86.2)
Marital	No	23 (82.1)	23 (79.3)	0.07	.786
	Yes	5 (17.9)	6 (20.7)
Residential status^†	Living alone	7 (25.0)	7 (24.1)	0.17	>.999
	Living with family	19 (67.9)	20 (69.0)
	etc.	2 (7.1)	2 (6.9)
Occupation status*	Haven't	28 (100.0)	27 (93.1)	2.00	.491
	Have	0 (0)	2 (6.9)
Monthly income (10,000won)	<100	18 (64.3)	19 (65.5)	0.01	.922
	≥100	10 (35.7)	10 (34.5)
Duration of illness (years)^†		18.50 (15.50)	15.00 (11.50)	370.00	.565
Number of hospitalizations^†		3.00 (3.00)	4.00 (4.00)	320.00	.165
Last admission (years ago)^†		5.00 (8.00)	5.00 (10.00)	377.50	.993
Medication^†	Yes	28 (100.0)	28 (96.6)	0.98	>.999
	No	0 (0)	1 (3.4)
Positive affect		29.75±6.06	28.86±7.15	0.51	.616
Interpersonal relations		86.68±13.79	83.93±17.70	0.65	.517
Resilience		57.07±11.51	57.76±16.98	−0.18	.859
Mental health recovery		73.96±12.82	68.96±15.37	1.33	.189

Cont.=Control group; Exp.=Experimental group.

^*Fisher’s exact test. ^†Mann Whitney U-test.

Table 3.

Effects of Positive Psychotherapy Program on Positive Affect, Interpersonal Relations, Resilience, and Mental Health Recovery (N=57)

Variables	Group	Pretest	Posttest	Source	F	p
		M±SD	M±SD
Positive affect	Exp. (n=28)	29.75±6.06	32.75±6.51	Group	1.51	.224
				Time	5.21	.026
	Cont. (n=29)	28.86±7.15	29.31±8.81	Group*Time	2.86	.097
Interpersonal relations	Exp. (n=28)	86.68±13.79	90.11±16.15	Group	3.83	.055
				Time	1.21	.276
	Cont. (n=29)	83.93±17.70	77.28±16.08	Group*Time	11.83	.001
Resilience	Exp. (n=28)	57.07±11.51	60.79±16.82	Group	0.80	.376
				Time	0.16	.696
	Cont. (n=29)	57.76±16.98	52.96±17.64	Group*Time	9.62	.003
Mental health recovery	Exp. (n=28)	73.96±12.82	78.89±16.49	Group	3.70	.060
				Time	2.89	.095
	Cont.(n=29)	68.96±15.37	69.31±16.79	Group*Time	2.19	.145

Cont.=Control group; Exp.=Experimental group.

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