Personalizing Positive Psychological Change Interventions

{Ciarrochi, Hayes, Oades, & Hofman, 2022. Toward a Unified Framework for Positive Psychology Interventions: Evidence-Based Processes of Change in Coaching, Prevention, and Retaining. Frontiers in Psychology 12:809362.}

How do we make positive psychology interventions (PPIs) stronger and more effective for more people? Despite decades of effort designed to promote wellbeing, there is no clear evidence that wellbeing is increasing globally.

Understanding why PPIs work in a more granular way helps us refine, target, and tailor interventions for particular people in particular contexts.

PPIs are effective, and most people need these interventions. But unfortunately, many people who are languishing fail to receive help.

A process-based approach to positive psychology can help. The key is to focus training on specific intervention kernels linked to specific processes that could be adequately taught to a specific helper in a specific context. Helpers must be taught a core set of skills that will reduce the risk of alliance raptures and minimize helper behavior such as rigidity, overcontrol, and delving into areas like past abuse and trauma without adequate knowledge. All of these behaviors disempower and devalue the client.

From Evidence-Based Packages to Processes

The package approach does not allow us to identify what elements in the package are active. A complex package may produce benefits while also having many unnecessary elements. Mostly, there is little evidence that all package elements are equally valuable or necessary. Assessing the effect of entire packages does not let us assess the importance of components within it, nor the change process they engage.

Theory-Based: Processes are based on clear, testable scientific theories of positive influence. For example, Self-determination theory provides clear, testable theories that increasing autonomous motivation in the workplace will lead to increased productivity.

Dynamic: Processes can be bidirectional, interactive, and nonlinear.

Progressive: Therapeutic change processes may need to be ordered in particular ways to produce optimal effects. For example, increasing self-esteem may be a useful precursor to increasing self-compassion if a person who feels worthy of compassion is more willing to treat themselves kindly.

Contextually Bound and Modifiable: Contextual knowledge is useful. Processes must start with contextual factors that practitioners can actually change. We also must deploy processes sensitive to context features of the client’s life. Similarly, the precise nature of the contextualized skill must be known.

For example, (it is evidenced that) skillful practitioners can increase (i.e., actually change) the extent people “think in broader and more useful ways in a difficult situation,” making “reappraisal” a potentially strong change focus more useful than something difficult to modify, like personality or temperament. However, considered in context, reappraisal may not be useful for all people in all situations. For example, youth may be less able to use reappraisal strategies than adults. Similarly, reappraisal is most helpful when it fosters cognitive flexibility.

Multilevel: Processes are nested within others.

Consider the construct of hope or one’s sense of agency and efficacy in identifying pathways for achieving one’s goals. A hope intervention may focus on biological, psychological, and social functioning. For example, at the psychological level, self-reported hope is associated with individual wellbeing and achievement. At the physiological level, it may be associated with higher heart rate variability, and at the group level, increased hope may increase individuals’ hope within the group.

From Generic to Personalized Interventions

ergodic: [adjective] of or relating to a process in which every sequence or sizable sample is equally representative of the whole (regarding a statistical parameter).

Ergodic theory (Greek: ergon “work,” hodos “way”) is a branch of mathematics that studies the statistical properties of deterministic dynamical systems; it is the study of ergodicity. In this context, statistical properties mean properties expressed through the behavior of time averages of various functions along trajectories of dynamical systems.

Ergodicity is a system property; it states that the system cannot be reduced or factored into smaller components.

idiographic: [adjective] 1. Relating to or concerned with discrete or unique facts or events. 2. Of or pertaining to an idiograph. 3. Of or pertaining to individuals.

[adjective] relating to or dealing with something concrete, individual, or unique.

What intervention do we use for a particular individual in a particular context?

Currently, positive psychology intervention research designs are mostly classical group comparison-based and consequently analyzed statistically. Our current knowledge base assumes that the average group-level effect applies to individual development over time of persons in the group, at least probabilistically. But, such an assumption is legitimate only if the modeled events are “ergodic.” Ergodicity requires the studied phenomenon to be stationary and that the same dynamic model applies to all persons. Still, that assumption is violated in psychological areas where we cannot use between-person variation to predict or model within-person variation. Group effects cannot be used to model individual change even probabilistically.

Idiographic findings use experience sampling and similar high temporal density approaches to analyze relationships within individuals over time. When aggregated nomothetically, might nomothetic generalizations increase the precision of idiographic findings? Such a research approach is termed “idionomic” (Hayes & Hofmann, 2021). It is particularly well-suited to examining change processes that are not stationary and thus cannot be properly modeled using classical statistical approaches without violating their underlying assumptions. In addition, idionomic research allows more personalized modeling of intervention impact.

The package approach has given us the processes that are likely to be generally effective in groups of people: promoting hope, meaning, positive activities, kindness, self-compassion, and strengths identification. These processes form the core of effective interventions. Our next step as a practitioner is to create a personalized intervention: What processes are most important to a particular client at this time, given this goal in this context? We need to create a case conceptualization based on idiographic and idionomic data and then target these bio-psychosocial change processes with specific elements or components.

There is no reason to give individuals the same packaged intervention within a process-based approach. For example, we don’t think of someone struggling to engage in an activity as having a deficiency or disorder. Instead, we identify what drives activity for that individual, leaving behind the false assumption that the same processes drive activity in all individuals. For example, imagine two people who want more physical activity. The first person experiences substantial positive affect but struggles to stay organized and committed to long-term goals. Perhaps this person would respond better to behavioral activation and goal-setting. The second person is extraordinarily organized but experiences little motivation or positive affect. This person may need more focus on value clarification and motivation.

A Unified Framework: The Extended-Evolutionary Meta-Model, EEMM

Evolution is the foundation of all life sciences. We can apply modern evolutionary science principles to genes, epigenetics, behavioral learning, and symbolic thought. Moreover, evolutionary principles can be linked to context and purpose and promote equality, reconciliation, peace, prosocial behavior, and meaningful living.

The core driving force behind evolutionary change is the principles of variation, selection, and retention, in a specific context.

Without variation, behavior change is impossible. Indeed, some PPIs focus specifically on inducing healthy variation. For example, inducing people to experience positive affect makes them more likely to be exploratory, socialize, and build skills and resources. Similarly, mindfulness is expected to broaden awareness and increase variability. On the other hand, psychopathology is often characterized by rigidity over flexibility and approaches like ACT deliberately seek to increase value-based behavioral activation and exploration, even in distress.

We can think of selection as the goal of the intervention or desired behavior. It is what works for the client in a particular context and how an intervention serves the client’s needs and values short and long term. The client may want to achieve a goal, develop meaning, connection, joy, and curiosity, or live in a valued way. For example, the needs addressed by self-determination theory are selection criteria for change processes. A self-determination practitioner might ask, does this process support the client’s need for autonomy, competence, or connection?

Retention relates to how we maintain adaptive behavior. Many PPIs promote retention through maintenance, follow-up, homework, practice, broadening psychological patterns, or habit formation.

Action and context are intertwined. Context includes the client’s current situation, history, environment, repertoire, and goals. Change processes must consider the context. For example, sharing emotions may be adaptive at home but harmful in some work environments. In addition, people are not passive responders to the environment but actively select, change, and create the niches in which life unfolds. For example, job crafting interventions encourage people to redesign the workplace to be more need satisfying. Mate selection assistance or relationship-enhancing skills help people create more supportive social niches to develop their lives.

We can cast every intervention and change process in terms of variation, selection, and retention, in context. Everyone’s context and demands are likely to vary importantly. The skillful practitioner will thus seek to identify what the problem is and what the client needs. Even common problems are unlikely to have a common solution. Even in complex problems, each personalized intervention might introduce something new into the client’s life. It would be selected and retained if it altered targeted change processes and improved goal attainment.

Organizing Evidence-Based Processes 

The processes of variation, selection, retention, and context can be applied on multiple levels (sociocultural, psychological, and bio-physiological) and dimensions, each of which can be targeted for a particular change process. For example, useful psychological dimensions include affect, cognition, attention, self, motivation, and overt behavior. Besides the psychological, change processes can occur at the sociocultural or the bio-physiological level. In addition, processes can be adaptive or maladaptive. Taken together, these form a conceptual space for examining change processes.

Building and Extending on Past Approaches

The EEMM builds on approaches focused on enhancing treatment effectiveness by tailoring treatment to the unique individual and their situation, also labeled as adaptation, responsiveness, individualizing, personalizing, and tailoring.

Second, we must measure important change-promoting processes to guide action. Processes and outcome measures feed into an interactive network of multidirectional, nonlinear influences.

Third, a consilient approach suggests interventions have detailed target behavior specifications and alignment between intervention components and outcomes. For example, we can specify behavior in terms of Action, Actor, Contex, Target, and Time. In addition, we might use actions to promote variation, selection, or retention across six dimensions and multiple levels.

Fourth, using the EEMM, we can compare specific process-based interventions or models for their completeness with a common language and well-accepted framework of evolutionary science to communicate what is essential about different approaches.

Imagine an educational context: a specific student is procrastinating and consistently does not feel smart enough to achieve academic goals (low and rigid self-concept) and does not have a clear sense of why they are attending the university (low or unclear motivation), and feels incompetent, with no sense of academic self-efficacy. As a result, the student does not complete work on time and is in danger of dropping out. Something must change to prevent dropout (the targeted outcome). Still, the hypothesized change processes, in this case, might be rigid and low self-concept, unclear academic motivation, and a lack of a sense of behavioral competence and self-efficacy.

The practitioner might induce healthy variation in low self-concept by encouraging the client to engage in something new, such as a mindfulness intervention designed to help notice and let go of negative self-talk and thus counteract the low self-concept. Say, after two weeks of implementing the intervention, the student has made no noticeable improvements in self-concept or procrastinating. Since this variation-focused intervention did not lead to healthy variations in self-concept, it is not surprising that procrastination did not change.

Suppose the practitioner shifts toward low or unclear motivation and a low sense of competence and self-efficacy. She now encourages the student to engage in mental contrasting, asking them to consider and elaborate on the most positive outcome they associate with achieving their goal and also to elaborate on important obstacles. A week later, we discovered that mental contrasting had increased academic motivation and self-efficacy and reduced procrastination. The success of this intervention suggests that motivation and self-efficacy are key change processes for this person, and mental contrasting is a key intervention.

The practitioner might work with the student to make “mental contrasting” a habit (retention) and monitor motivation and self-efficacy going forward.

This simple example illustrates how variation, selection, and retention can be used to personalize an intervention. For example, perhaps mindfulness would have worked with another client or in another context, but not mental contrasting.

Future Directions

Positive psychology has shifted the focus from fixing problems to promoting thriving. To progress, the field must shift from focusing on complex packages toward evidence-based processes to identifying and effectively combining the most powerful ingredients in different interventions. In addition, individual assessment is needed to tailor intervention kernels within an approach for maximizing individual gains. Future “packages” will be coherent, flexible models linked to sets of modifiable elements instead of one-size-fits-all collections.

Second, negative and positive processes interact to influence individual outcomes in a dynamic network. For example, positive emotion helps people to manage and recover from stress. Likewise, treating oneself with kindness and compassion protects people from the harmful effects of low self-esteem.

Third, a personalized positive psychology approach would start with case conceptualization by identifying the core processes likely to apply to a particular client to promote positive change. For example, while promoting positive thinking seems like a universally “good” process, we must recognize the contexts when it is potentially unhelpful. Perhaps one client needs more focus on building hope, whereas another needs to develop social skills. Based on the tentative conceptualization, the practitioner implements a process-based intervention, receives client feedback about what is and is not working, and adapts the case conceptualization and intervention accordingly. Thus, the practitioner implements different, evidence-based processes (variation), selects those benefiting the client, and then helps the client retain the skills through practice and habit formation.

Evidence-Based Processes Classified by Dimension

All change processes need additional evidence to determine whether they are useful in predicting individual change. The EEMM’s contextual nature emphasizes that all “positive” or “negative” change processes must be placed in square quotes concerning their impact on a particular individual, which is more based on the idiographic relations network than overall nomothetic expectations (e.g., cross-sectional correlations).  

Some interventions, e.g., mindfulness or self-compassion, may alter change processes in various dimensions, producing substantially different outcomes. For example, mindfulness can be linked to positive and negative cognition, affect, attention, and sense of self. Strength spotting, too, consists of multiple components, such as building one’s sense of self (courage is your strength) and developing motivation (your love of learning is a strength), and the same caution applies. The EEMM is more a reminder of dimensions and domains we can address than an ontological periodic table.

Clinical psychology has largely focused on undermining maladaptive processes that lead to mental health problems. Positive psychology has largely focused on promotive adaptive processes that lead to flourishing. Naturally, both fields target both kinds of processes, so the difference is primarily emphasis. “Positive” and “negative” are not on a single dimension; studying mental health problems will not lead you to understand flourishing and vice versa. Adaptive and maladaptive processes are separable while being related as part of a complex dynamic network that changes over time.

Processes classified by Dimension, Undermining negative processes, and Promoting positive processes:

Social level (or non-specified dimension)

Reducing loneliness, conflict, and social skill deficit

& Promoting social connection; Civic engagement; Promoting prosocial behavior; Relationship with animals; Help-seeking; Couple resilience

Overt behavior dimension

Undermining unhelpful behavior and habits

& Promoting positive behavior and habits

Promoting perseverance (persistence in behavior in the presence of negative affect or pain)

& Promoting patience (persistence in the absence of immediate reward)

Increasing pleasurable or fun activities; Goal setting and planning skills; Courageous behavior;

Job crafting: Altering work environment and behavior

Promoting leisure or physical activity

Attention dimension

Mindfulness: Awareness of negative feelings, acting with awareness of negative behavior consequences. Reducing the focus on task-irrelevant thoughts. Reducing attentional bias to negative information.

& Mindfulness: awareness of positive behavior consequences

Savoring: Embracing the present moment

Focusing on things I’m grateful for; Focusing on the positive

Flow: full attentional task-absorption

Noticing nature

Affect dimension

Reducing negative affect

& Increasing positive affect, happiness, feelings of curiosity or awe

Mindfulness: Non-reactivity to negative emotion, acceptance of negative feelings

& Non-attachment: Letting go of pride and the need to hold on to positive feelings when doing so is beneficial

Emotional intelligence: emotion identification and management

Promoting contentment, tranquility

Resilience and coping (focused on the emotional rebound from the challenge)

Love

Cognition dimension

Mindfulness: Non-reactivity to thoughts; disengage or defuse from unhelpful thoughts

& Seeking accurate information, effective problem solving; Developing positive or helpful self-talk, reappraisal, optimism, hope, attitudes

Reappraise or reframe negative thinking; Challenge dysfunctional thinking

& Solution-focused interventions

Disrupt excessive worry or rumination

& Positive imagery; Recalling positive memories; imagining positive futures

Mental contrasting: identify achievement barriers

& Mental contrasting: identify goal achievement benefits

Job crafting: job redesign; problem-solving

Wellbeing literacy; Wisdom; Creativity (divergent thinking), open-mindedness

Motivation dimension

Undermining a-motivation, and unhelpful aversive motivation (e.g., escape from guilt, pressure)

& Identifying strengths: focusing on what one loves and values

Promoting positive motivation, e.g., supporting autonomy, connectedness, and competence needs

Values clarification and recognizing passions and preferences; Identifying motivation for personal strivings

Promoting people to value humility, patience, courage, gratitude, responsibility, and other character aspects

Job crafting: improving needs and job fit

Self dimension

Undermining negative self-concepts, low self-esteem, low self-efficacy; Undermining fixed mindset

& Best possible self interventions; Growth mindset; Positive self-esteem and self-efficacy; Identifying strengths: focused on skills and capabilities

Self-compassion: seeing oneself as suffering and deserving compassion

& Self-compassion: seeing self through the eyes of a friend

Promoting a transcendent sense of self; Spirituality; Post-traumatic growth, authenticity

Case Conceptualization

A conceptual and idiographic analysis helps personalize interventions. A network shows positively and negatively linked processes of various dimensions and domains. Each element is tentatively revealed and subsequently revised as the client and practitioner work together. Such a network shows causes, consequences, and unfolding life events and actions, within the context and goals of the client’s environment.

Successfully implementing positive psychology processes and constructs requires considering variation, selection, and retention, in context. In addition, it requires considering process orders.

For example, assume a client wants to improve workplace performance (context) but feels stuck and is, at present, unwilling to do anything new. We might start with strength building to get them doing and thinking in new ways (variation). Once the person believes they have the strength to improve, we might move on to goal setting, encouraging them to try new things at work (variation) and see what improves performance (selection). Perhaps they might try bringing kindness to the workplace, use slow breathing to manage stress and be more present to colleagues, improve organizational skills, or practice empathy. Finally, we would have them monitor what worked and didn’t work (selection) and seek to reinforce and make into a habit (retention) what was improving performance.

The best way forward is to identify what a particular individual needs, in a specific context, and then provide them with the essential components of the interventions that target those needs. Again, start with the person, not the protocol.

Program packages frequently combine wellbeing interventions focused on promoting positive affect or include components focused on behavior and character; some focus on the individual process level, whereas others focus more on the social level.

Positive psychology processes and constructs are multi-dimensional. Future intervention research is expected to reveal further how interventions link to process variables and might have unexpected longer-term benefits not immediately observable.