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VCRHYP Thriving on the Front Lines

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1 VCRHYP Thriving on the Front Lines
Strengths-Based Youth Care Work Bob Bertolino, Ph.D. Associate Professor, Maryville University-St. Louis Sr. Clinical Advisor, Youth In Need, Inc. Introduction – My jobs at Maryville; YIN; Private Practice; Training; Writing

2 Tidbits For copyright reasons and confidentiality some of PowerPoint slides may be absent from your handouts. To download a PDF of this presentation, please go to: Please share the ideas from this presentation. You have permission to reproduce the handouts. I only ask that you maintain the integrity of the content. Contact: My site with updates & resources; YIN; Maryville; ICCE Active Note-taking & 3) We will practice reflection bobbertolino.com

3 2010 2012 2014 2015

4 Better Than Zero From Pathology to Strengths
EBP is the language of the land. And

5 Comprehensive Soldier Fitness – Efforts to shift the curve to the right.

6 Comprehensive Soldier Fitness – Efforts to shift the curve to the right.

7 Posttraumatic Stress Disorder
Comprehensive Soldier Fitness – Efforts to shift the curve to the right.

8 The Pathology Bias Freud thought the best we could hope for was “ordinary misery” and questioned the quest for happiness. As a field, we have focused on pathology and problems. Until recently, psychological publications and studies dealing with negative states outnumber those examining positive states by a ratio of 15 to 1. The bias of both psychology and psychotherapy has been to get people back to zero. A result has been the “empty person.” The 65% barrier. Help individuals, couples, families, and groups to develop skills to flourish by reducing negative symptoms and building well-being. By leveraging assets we create opportunities for present and future change.

9 Posttraumatic Stress Disorder
Comprehensive Soldier Fitness – Efforts to shift the curve to the right.

10 Posttraumatic Growth Comprehensive Soldier Fitness – Efforts to shift the curve to the right.

11 From Pathology to Strengths
“What we have learned over 50 years is that the disease model does not move us closer to the prevention of these serious problems. Indeed the major strides in prevention have largely come from a perspective focused on systematically building competency, not correcting weakness. Prevention researchers have discovered that there are human strengths that act as buffers against mental illness: courage, future- mindedness, optimism, interpersonal skill, faith, work ethic, hope, honesty, perseverance, the capacity for flow and insight, to name several. Much of the task of prevention in this new century will be to create a science of human strength whose mission will be to understand and learn how to foster these virtues in young people. Working exclusively on personal weakness and on the damaged brains, however, has rendered science poorly equipped to do effective prevention. We need now to call for massive research on human strength and virtue. We need to ask practitioners to recognize that much of the best work they already do in the consulting room is to amplify strengths rather than repair the weaknesses of their clients.” (p. 6-7) 1) African Violet Queen; 2) Gillian Lynne Seligman, M. E. P., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55(1), 5–14.

12 Defining Strengths-Based
A strengths-based perspective emphasizes the abilities and resources people have within themselves and their support systems to more effectively cope with life challenges. When combined with new experiences, understandings and skills, those abilities and resources contribute to improved well-being, which is comprised of three areas of functioning: individual, interpersonal relationships, and social role. Strengths-based practitioners value relationships convey this through respectful, culturally-sensitive, collaborative, practices that support, encourage and empower. Routine and ongoing real-time feedback is used to maintain a responsive, consumer-driven climate to ensure the greatest benefit of services. Bertolino, B. (2014). Thriving on the front lines: Strengths-based youth care work. New York: Routledge.

13 Youth are the Most Significant Contributors to Service Success
1 Key Competency Maximize youth contributions to change The youth and factors in the youth’s life account for more variance (80-87%) in the outcome than any other factor. Focus on youths’ ratings of distress and change. Recognize youth as competent and capable of change. Identify and utilize youth contributions including internal strengths (i.e., abilities, coping skills, resiliencies) and external resources (i.e., relationships, social support systems).

14 The Variance in Treatment Outcome
Client/Extratherapeutic Factors = 80-87% Treatment Effects = 13-20% Therapist Effects = 4-9% The Alliance = 5-8% Expectancy, Placebo, and Allegiance = 4% Model/Technique = 1% Bertolino, B., Bargmann, S., & Miller, S. D. (2013). Manual 1: What works in therapy: A primer. The ICCE manuals of feedback informed treatment. Chicago, IL: International Center for .Clinical Excellence. Wampold, B. E., & Brown, G. S. (2005). Estimating variability in outcomes attributable to therapists: A naturalistic study of outcomes in managed care. Journal of Consulting and Clinical Psychology, 73(5),

15 The Variance in Treatment Outcome

16 Engage youth through the working alliance
The Therapeutic Relationship Makes Substantial and Consistent Contributions to Outcome 2 Key Competency Engage youth through the working alliance The quality of the youth’s participation (engagement) in services the most important process determinant in outcome. Youth who are more engaged and involved in services are likely to receive greater benefit. The youth’s rating of the alliance is more highly correlated with outcome than provider ratings. Alliances that strengthen and improve from intake to termination tend to yield better outcomes than alliances which start and stay good or deteriorate over time.

17 What is the Therapeutic Alliance?
The therapeutic alliance refers to the quality and strength of the collaborative relationship between the client and therapist and is comprised of four empirically established components: agreement on the goals, meaning or purpose of the treatment; agreement on the means and methods used; the client’s view of the relationship (including the therapist being perceived as warm, empathic, and genuine); and, accommodating the client’s preferences. Means or Methods Goals, Meaning or Purpose Client’s View of the Therapeutic Relationship Consumer Preferences

18 Session Rating Scale (SRS)
A 40 point measure with 4 subscales Two versions that can be scored: SRS & CSRS Complete near the end of session (last 5-10 minutes) Overall scores below 36 or any subscale below 8 should be discussed with clients Lower scores at the beginning of services can mean very different things Lower scores as services progress are 4x likely to contribute to dropout Takes less than 1 minute to administer Paper/pencil and electronic scoring systems Can plot personal data on Excel spreadsheet

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20 Culture Influences and Shapes All Aspects of Youth’s Lives
3 Key Competency Convey respect for youth and their culture Create and sustain culturally safe environments. Services are provided with respect to youth culture and preferences. Maintain self-awareness of one’s heritage, background, and experiences and their influence on attitude, values, and biases. Emphasize a multi-level understanding, encompassing the client, family, community, helping systems, etc. Recognize limits of multicultural competency and expertise; consult others who share cultural similarities and expertise with youth being served. Acknowledge youth as teachers and experts on their own lives.

21 Effective Services Promote Growth, Development, and Well-Being
4 Key Competency Utilize strategies that empower youth and improve their lives Early response to services is strong indicator of eventual outcome. The longer youth engage in services without experiencing a positive change the greater the likelihood they will experience a negative or null outcome and/or drop out. View change as attainable and problems as challenges to progress, not fixed pathology. Focus on maximizing the impact of each interaction. Monitor change from the outset through feedback. Maintain a future focus. Use language as a vehicle for change. Explore exceptions—how change is already happening. Focus on small changes. Allow reentry or easy access to future services as needed.

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23 Goal Setting Separates being/experience from actions
Clarify “empty words” Accommodate services to youth’s ideas about concerns and goals Gain clear action descriptions of problems/ concerns and goals (what youth want instead of what they do not want) Determine indicators of progress toward goals Monitor for changing goals

24 Using Action-Talk Non-Action Talk Cab driver talk Politician talk
Opinions, evaluations, assessments, judgments Politician talk Vague, general, not specific as to person, place, time, thing, or action “Someday” talk Vague as to time or frequency

25 Using Action-Talk (cont.)
Action-Talk/Videotalk Move from vague, non-sensory-based descriptions to clear, observable, behaviors Using Action-Talk to Clarify Meanings Action complaints – specifics about what one doesn’t like or one wants to have change Action requests – specifics about what one would like to have happen Action appreciation – specifics about what has liked about something and would like more of Specific to person, place, time, thing, action, or result Who is to do what by when? Who did what, when?

26 3-Point Strategy Problem Description: What needs to change?
Scaling questions Vision of the Future: How will we know that change has been achieved? Miracle question, crystal ball, time machine, etc. General future-oriented questions Scaling questions (revisited) Movement: How will we know that progress is being made?

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28 Expectancy and Hope are Catalysts of Change
5 Key Competency Demonstrate faith in the restorative effects of services Evidence shows that the pretreatment expectations of youth effect engagement, retention, and outcome. Have faith in youth and the restorative effects of services. Believe and demonstrate faith in the procedures/practices. Show interest in the results of the procedure or orientation. Ensure that the procedure or orientation is credible from the youth’s frame of reference and is connected with or elicits previously successful experiences. View youth as people, not as their problems or difficulties or in ways that depersonalize them. 1) Pat Summitt Story; 2) The Shawshank Redemption; and 3) Minnesota CPS Worker

29 Asset-Building Increasing Well-Being

30 Positive Psychology Defined
Positive Psychology focuses on: “What kinds of families result in children who flourish, what work settings support the greatest satisfaction among workers, what policies result in the strongest civic engagement, and how people’s lives can be most worth living.” (p. 5) Seligman, M. E. P., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55(1), 5–14.

31 The Benefits of Increased Well-Being (Happiness)
Happy People: Are half as likely to die over the same time period as others Live longer than average Have better health habits Have lower blood pressure Have more robust immune systems Are more productive on the job Are able to tolerate more pain

32 What Does Not Make Us Happier?
Age Gender Beauty IQ Fame Mental/physical energy levels Education (only to a degree, most likely because of its relationship to income level) Income/Wealth (to a degree)

33 What Positively Influences Happiness?
Good family relationships Community and friends Financial situation (up to a certain level) Work (being employed and having meaningful work) Subjective health Personal freedom Personal values (belief in God or bigger purpose or meaning)

34 What Influences Happiness?
What we think will make us happy is mostly mistaken People are generally poor at predicting what will make them happy Bad things don’t cause the permanent decrease in happiness we fear they will; good things don’t cause the permanent increase in happiness we think they will Interests/preferences change Happiness is relatively stable (is genetically-influenced but not fixed) Happiness over the life cycle is U-shaped; well-being typically reaches the lowest point in one’s late 40s and is higher earlier and later in life The hedonic treadmill

35 The Hedonic Treadmill “When we have an experience…hearing a particular sonata, making love with a particular person, watching the sunset from a particular window, of a particular room on successive occasions, we quickly begin to adopt it, and the experience yields less pleasure each time. Psychologists call this habituation, economists call it declining marginal utility, and the rest of us call it marriage.” Gilbert, D. (2006). Stumbling on happiness. New York: Vintage.

36 Happiness and Life Satisfaction Levels Can Change
Some things seem to have a lingering effect on happiness or life satisfaction levels Negative things: e.g., being a caregiver for a family member with Alzheimer's; death of a spouse; death of a child (remember that these are average findings and people fall on a range within these averages) Positive things: e.g., Having a wider ranger of social connections; having a basic amount of income; having a sense of freedom; having life purpose and so on

37 Well-Being Contributors
Lyubomirsky, S. (2007). The how of happiness: A scientific approach to getting the life you want. New York: Penguin.

38 Life Circumstances Country Level of national income Comparative income
Job security Meaningful work/life Age

39 Set Point/Temperament Factors
Range in which a person’s set point varies Explanatory style Depression tendencies

40 Five Pillars of Well-Being
Positive Emotion Engagement Meaning Relationships Accomplishments Seligman, M. E. P. (2011). Flourish: A visionary new understanding of happiness and well-being. New York: The Free Press.

41 Measuring Well-Being PERMA VCRHYP-RA Positive Emotion Engagement
Meaning Relationships Accomplishments Safety Well-Being Permanent Connections Self-Sufficiency

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43 Measuring Well-Being PERMA ORS VCRHYP R-A Positive Emotion Engagement
Meaning Relationships Accomplishments Individual Interpersonal Social Role Safety Well-Being Permanent Connections Self-Sufficiency

44 ORS – Individual + Self-esteem + Self-perception + Sense of Self + Internal Strengths + Healthy activities and behaviors + Coping Skills + Safety - Anxiety - Depression - Substance Abuse - Somatic problems (i.e., sleep, headaches, etc.)

45 ORS – Interpersonal + Close Relationships + Romantic Relationships + Family + Close Friends + Stable Living Environment + Conflict Resolution + Safety - Violence - Mystification - Disconnection

46 ORS – Social Role + Other Friends and Supports + Community Connections (to individuals, groups, and the community at-large) + Education (School, GED, Job Skills Programs) + Employment + Volunteering + Feeling Valued and Empowered as a Member of a Community (there can be more than one) + Safety - Feeling Isolated (disconnection) - Lack of Acceptance - Lack of Opportunity

47 The Outcome Rating Scale (ORS)
A 40 point measure with 4 subscales Two versions that can be scored: ORS & CORS Higher score indicate lower levels of distress; lower scores indicate higher levels of distress Clinical Cutoffs: 25 (> Age 19); 28 (Ages 13-19); 32 (≤ Age 12) Reliable Change Index (RCI): 5 Complete at the beginning of session Takes less than 1 minute to administer Paper/pencil and electronic scoring systems Can plot personal data on Excel spreadsheet

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50 Positive Youth Development (PYD) Defined
An ongoing process of engaging youth in safe, secure environments through activities, interventions, and programs that promote growth, development, and overall well-being. Bertolino, B. (2014). Thriving on the front lines: Strengths-based youth care work. New York: Routledge.

51 Positive Youth Development (PYD)
Rewarding bonding Fostering resilience Promoting social, emotional, cognitive, behavioral, and moral competence Fostering self-determination Fostering spirituality Fostering clear and positive identity Building belief in the future Providing recognition for positive behavior Providing opportunities for prosocial development Fostering prosocial norms

52 Considerations for Leveraging Assets Gawande – The Bell Curve & CF

53 Considerations for Leveraging Assets
Focus on fundamental skills such as listening, attending, and eliciting client feedback and respond to that feedback immediately as a means of strengthening the therapeutic relationship. Researchers have identified several aspects of the alliance (i.e., empathy, positive regard, congruence) that are known contribute to contribute to better overall alliances.

54 Considerations for Leveraging Assets (cont.)
Collaborate with clients on determining which exercises provide the best fit. Numerous studies in psychotherapy have demonstrated the client’s rating of the therapeutic alliance (i.e., the combination of client-therapist bond, collaboration with the client on goals, and collaboration with the client on tasks to accomplish those goals) as a reliable and consistent predictor of eventual treatment outcome.

55 Considerations for Leveraging Assets (cont.)
Consider cultural and contextual factors with positive interventions. Any fixed moral vision that sees happiness as a yardstick of a good life should be avoided. For example, a youth raised in a European-American culture may think of happiness as a process of autonomy and self-determination, whereas a client from another culture may see happiness as relating to others and fulfilling obligations. Rashid, T. (2009). Positive interventions in clinical practice. Journal of Clinical Psychology: In Session, 65(5),

56 Considerations for Leveraging Assets (cont.)
Encourage clients to use agreed-upon exercises in a routine and ongoing manner, continue those exercises that have proven beneficial, and experiment with new ones as needed. In studies researchers have found that people with the highest levels of happiness are the ones who maintain adherence to the exercises they were asked to try. “Circumstances happen to people, and activities are ways that people act on their circumstance.” (Lyubomirsky et al., 2005, p. 118) Lyubomirsky, S., Sheldon, K. M., Schkade, D. (2005). Pursuing happiness: The architecture of sustainable change. Review of General Psychology, 9,

57 Considerations for Leveraging Assets (cont.)
Package exercises to increase the likelihood of benefit. It may not be practical for clients to do several exercises in given day; however, it is suggested that therapists encourage clients to try more than one exercise and do so on multiple occasions over an agreed-upon time frame. In doing so it can be helpful to work with clients on a combination of exercises that can both contribute to an immediate boost of happiness and those that can be incorporated into everyday routines and provide longer-term satisfaction.

58 Positive Emotion Gawande – The Bell Curve & CF

59 Positive Emotion The subjective well-beings: Happiness (and lastingly happier); Joy; Life Satisfaction VCRHYP-RA: Safety; Well-Being; Self-Sufficiency Past, Present, and Future Positivity: 3:1 Ratio (Fredrickson) Day Reconstruction Signature Strengths The Language of Change Gratitude Savoring Mindfulness Focus on What Went Well (or 3 Things) Exercise Forgiveness

60 Positivity Ratios Give the youth a notebook, journal, calendar, or piece of paper. Divide the paper into sections with each section representing a day of the week. There should be enough room for up to 20 entries per day. Have the youth write down events that affect how they feel during the course of the day. The youth should write the event down in as close proximity as possible to the actual time of the event. Next to each event, have the youth select one of the following words to describe how they felt about that event: Type 1: Amused, grateful, inspired, interested, joyful, love, proud, serene Type 2: Angry, ashamed, disgust, guilt, hate, sad, scared, stressed Add up number of Type 1 responses, then Type 2 responses. Divide the Type 1 total by the Type 2 total to create a Positivity Ratio. Examples: 5 events listed, 2 Type 1 and 3 Type 2 their ratio would be 0.67:1 Example 2: 11 events listed, 8 Type 1 and 3 Type 2 their ratio would be 2.67:1

61 Day Reconstruction Have the youth create a log for the day that includes as many as 30 and as few as 10 time frames. Example: 8:00-8:30am; 8:30-9:00am Example: 8:00-8:20am; 8:20-8:40am For each time frame listed have the youth write down the task(s) that occurred. Example: 8:00-8:20am – Get up and dressed Example: 2:30-3:00pm – Attended English class At the end of the day, the youth should think back over each event. Then choose a word from the list of Type 1 and Type 2 descriptors that best fits his or her experience with the event. The youth then calculates his or her Positivity Ratio.

62 VIA Signature Strengths
Values in Action (VIA) Six Categories: Strengths of Wisdom and Knowledge Strengths of Courage Strengths of Humanity Strengths of Justice Strengths of Temperance Strengths of Transcendence

63 VIA Signature Strengths (cont.)
Wisdom and Knowledge: Cognitive strengths that entail the acquisition and use of knowledge Courage: Emotional strengths that involve the exercise of will to accomplish goals in the face of opposition, external or internal Humanity: Interpersonal strengths that involve “tending and befriending” others Justice: Civic strengths that underlie healthy community life Temperance: Strengths that protect against excess Transcendence: Strengths that forge connections to the larger universe and thereby provide meaning

64 VIA Signature Strengths
Strengths of Wisdom and Knowledge Creativity Curiosity Love of learning Open-mindedness Perspective Strengths of Courage Authenticity Bravery Persistence Zest

65 VIA Signature Strengths
Strengths of Humanity Kindness Love Social intelligence Strengths of Justice Fairness Leadership Teamwork

66 VIA Signature Strengths
Strengths of Temperance Forgiveness/mercy Modesty/humility Prudence Self-regulation Strengths of Transcendence Appreciation of beauty and excellence Gratitude Hope Humor Religiousness/spirituality

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68 Character Strengths and Posttraumatic Growth
Character Strengths that have been found to predict Posttraumatic Growth: Bravery Gratitude Hope Kindness Religiousness Character Strengths found to be important mediators of success in situations characterized by significant cognitive, emotional, and physical challenges: Courage Honesty Leadership Optimism Self-regulation Teamwork Mathews, M. D. (2008). Positive psychology: Adaptation, leadership, and performance in exceptional circumstances. In P. A. Hancock & J. L. Szalma (Eds.), Performance under stress (pp ). Aldershot, England: Ashgate.

69 Character Strengths and Common Concerns
Presenting Problem Potential Character Strength Utilized Effective prevention of depression relapse Perspective, Curiosity, Judgment, Spirituality Residual depressive symptoms Curiosity, Perseverance Anxiety Self-Regulation, Bravery, Fairness, Curiosity Body-image issues Gratitude, Kindness Drug Use Self-Regulation, Bravery Trauma Perseverance, Bravery, Hope Improved attention and working memory Self-Regulation, Love of Learning Reduced anxiety; adaptive learning dealing with threat Self-Regulation, Curiosity, Perspective Improved romantic relationships Love, Kindness, Social Intelligence Decreased negative self-focused attention Zest, Humor Decreased negative affect Zest, Hope Rashid, T. (2009). Positive interventions in clinical practice. Journal of Clinical Psychology: In Session, 65(5),

70 Signature Strengths Exercise
Take one signature strength and for the following week use that strength in a new way, every day. Peterson, C. (2006). A primer in positive psychology. New York: Oxford University Press. Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60(5),

71 The Influence of Words Sad. Helpless. Inconvenienced. Defeated. Tired. Oppressed. Doubtful. Uninterested. Life is so hard. Nothing seems to go my way. There is no one to turn to. It feels like I’ve been forgotten. Times are hard. Nothing helps. Things will not get better. In fact, they will probably get worse. There is no hope.

72 The Influence of Words Exciting. Fun. Laughter. Joy. Anticipation. Possibility. Aliveness. Love. Peace. When I think about the future I become energized. There is so much I can accomplish. There are many possibilities in the world. Life is wonderful.

73 The Costs of Negativity
A recent study shows that extensive discussions of problems and encouragement of ‘‘problem talk,’’ rehashing the details of problems, speculating about problems, and dwelling on negative affect in particular, leads to a significant increase in the stress hormone cortisol, which predicts increased depression and anxiety over time. People who are in a more positive mood are better liked by others and more open to new ideas and experiences. Byrd-Craven, J., Geary, D. C., Rose, A. J., & Ponzi, D. (2008). Co-ruminating increase stress hormone levels in women. Hormones and Behavior, 53, 489–492. Fredrickson, B. (1998). What good are positive emotions? Review of General Psychology, 2,

74 Bertolino, B. (2015). The residential youth care worker in action: A collaborative, strengths-based approach. New York: Routledge.

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76 Say it in Another Way “He doesn’t want to change”
“She is manipulative” “He’s got an antisocial personality” “She’s overly sensitive” “He’s got an anger management problem.” “She’s too dependent and needy” “He’s always in appropriate around females” “She’s borderline”

77 Risk

78 Protective

79 Possibility Language From: “It’s always that way.”
Reflect client statements in the past tense. From: “It’s always that way.” To: “It’s been that way.” Move from global (“everybody,” nobody,” “always,” “never”) to partial (“recently,” “somewhat more,” “a lot”). From: “I’m always in trouble.” To: “You’ve been in trouble a lot.” Move from truth/reality to perception (“It seems to you,” “You’ve gotten the idea”). From: “Things will never get better.” To: “It really seems to you that it will never get better.”

80 Possibility Language Assume the possibility of future change and/or solutions by using words such as “yet” and “so far.” From: “It’s always going to be this way.” To: “So far you haven’t found any evidence that things will be different than the way they are now.” Recast the problem statement into a statement about a preferred future or goal. From: “I’ll never be able to have the life I really want.” To: “So you’d like to be able to move toward the life you really want.” Presuppose that changes and progress toward goals will occur by using words such as “when” and “will.” From: “No one wants to be around me.” To: “So when you begin to notice that there are people who enjoy your company and want to be around you what will be different for you?”

81 Possibility Language Give permission “to,” “not to have to,” and both
From: “I shouldn’t be angry.” To: “It’s okay to be angry.” From: “People keep saying that it really should make me angry.” To: “It’s okay to not be angry about it.” From: “Sometimes I’m angry and sometimes I’m not. I must be crazy!” To: “It’s okay to be angry and you don’t have to be angry and you’re not crazy.”

82 Gratitude A prized propensity in the Hindu, Buddhist, Muslim, Christian, and Jewish traditions. Being thankful for and appreciating the actions of another. Emerges upon recognizing that one has received a positive outcome from another person who behaved in a manner that was costly to him or her, valuable to the recipient, and intentionally rendered. Can also result from a nonhuman action or event.

83 Gratitude Visit Think of someone who has done something important and wonderful for you, yet who has not been properly thanked. Reflect on the benefits you received from this person, and write a letter expressing your gratitude for all he or she did for you. The letter should be approximately 300 words. Rehearse the letter over and over until you know it by heart. Arrange to deliver the letter personally, and spend some time with this person talking about what you wrote.

84 Gratitude Searches Journals; Diaries; Post-its Poster Boards
Bulletin Boards Private and Public “Expressions”

85 Strategies for Savoring
Share with Others: Seek out other to share an experience. Memory Building: Take a mental photograph or a physical souvenir of an event and reminisce about it later with others. Sharpening Perceptions: Focus on specific aspects of an experience. Absorption: Become totally immersed in the pleasure and try not to think about other matters. By Comparison: Once a day, take the time to enjoy something that is usually hurried; note the difference.

86 Mindfulness Mindfulness is an overarching human strength closely linked with human well-being and the ability to adaptively self-regulate feelings and actions; In flexing the self-regulation muscle, a mindful disposition offers new insights by enhancing cognitive flexibility, which decreases the need to control or alter environment and experiences; the individual then moves toward acceptance and genuine appreciation Rashid, T. (2009). Positive interventions in clinical practice. Journal of Clinical Psychology: In Session, 65(5),

87 Mindfulness Exercises
Identify key words that are validate, support, inspire, and increase optimism. Then, say those key words, repeating them in different ways while noticing the feelings, thoughts, and images that arise. When you are done, write about your experience for 5-10 minutes. Capture a positive state (i.e., feeling joy, spontaneous, inspired, or the like) and focus on the words for minutes, becoming fully immersed in the positive state. Breathing space exercise is when a 3-minute exercise in which the person tunes into the present moment, focusing on the breath, and then expanding the awareness to sense the whole body. Mindful walking and other forms of behavioral activation have been linked with increased energy and well-being.

88 What Went Well? For one week, identify and write down three good things that went well each day; Write down what influenced or caused those things; At the end of the week reflect on the collection of good things.

89 The Benefit of Activity
“We know that sedentary behavior contributes to a host of chronic diseases, and regular physical activity is an important component of an overall healthy lifestyle. There is strong evidence that physically active people have better health-related physical fitness and are at lower risk of developing many disabling medical conditions than inactive people.” – Michael O. Leavitt, U.S. Secretary of Health and Human Services ( )

90 The Benefit of Activity
We have seen how norms change in society; for example, how we as a culture now look at tobacco usage, underage drinking, highway safety, seat belts, child car seats, air bags, fluoride, and vaccines. The idea of smoking changed from cool and sophisticated to stupid and dangerous. Physical Activity as a preventative intervention can have a profoundly positive effect in our changing world. We are facing an epidemic of inactivity in our homes, communities and around the world. Places in the world that are successful in encouraging physical activity include Copenhagen, China and Brazil, and U.S. programs in Arkansas, Oregon, and Wisconsin.

91 Exercise and Happiness
Exercise has been show to lessen depression and anxiety, which usually decrease happiness levels. Exercise is known to increase brain growth (by increasing levels of neuronal growth factor and connections between neurons), thereby making one more available to change (since the brain tends to get patterned and grooved). Exercise has been shown to reduce the use of antidepressants. Work with youth to develop a plan to do a minimum of 50 minutes of physical activity each week. Have the youth write about the activity or activities including feelings and thoughts.

92 Forgiveness A freeing from negative attachment to the source that transgressed against that person. Forgiveness is a process involving: Cognitive-affective transformation following a transgression in which the victim makes a realistic assessment of the harm done and acknowledges the perpetrator’s responsibility, but freely chooses to “cancel the debt,” giving up the need for revenge or deserved punishments and any quest for restitution. The “cancelling of debt” also involves a cancellation of negative emotions directly related to the transgression In forgiving the victim overcomes his or her feelings of resentment and anger for the act

93 Worthington’s Five-Step Process for Forgiveness (REACH)
R is for Recall. Recall the events and the hurt as accurately and objectively as you can. E is for Empathize. Try to understand what happened from the point of view of the person who wronged you. A is for the Altruistic gift of forgiveness. Recall a time that you hurt someone else and were forgiven. And offer this gift to the person who wronged you. C is for Committing yourself to forgive publicly. Write a letter of forgiveness (whether you send it or not), write in a journal, tell a trusted friend, or, if you can, tell the person who wronged you. H is for Holding onto forgiveness. Forgiving is not forgetting. Memories of the wrong and feelings will come up. Remind yourself that you have made a choice to forgive.

94 Lyubormirsky’s Exercises
Appreciate being forgiven; reflect on a time when you were forgiven; or seek forgiveness for a wrong you have done. Imagine forgiveness; imagine what you might say to the person and how you would feel. Write a letter of forgiveness; not necessarily to send, but to write out what happened and how it affected you, what you wish the person had done, and end with a statement of understanding and forgiveness. Write the other person’s apology letter; imagine the explanation the person would give for her behavior and how she feels about the harm she has done. Lyubomirsky, S. (2008). The how of happiness: A scientific approach to getting the life you want. New York: Penguin.

95 Creating Positive Emotion: Further Exercises
“Your Way” – (1) Ask the youth to give his or her definition of “happiness”; (2) Have the youth rate his or her current level of happiness on a scale of 1-10; (3) Work with the youth to identify two ways to boost his or her level of happiness up to one point over the next week “Broaden-and-build” – positive emotions expand what an individual feels like doing at any given time. (1) Have the youth listen to a song, watch a movie, or read a passage from a book; (2) Have the youth identify one of five emotions he or she feels (i.e., joy contentment, fear, anger, or neutral); (3) Have the youth list everything he or she would like to do at that moment.

96 Creating Positive Emotion: Further Exercises (cont.)
Help youth to more easily adapt to changing circumstances by trying something new “on the fly,” then writing or talking with someone about how it felt to exercise creativity Encourage youth to experiment with “practicing happiness” (start small – example: smiling at others) Use music, stories, movies and other similar mediums to help youth experience positive emotion

97 Engagement Gawande – The Bell Curve & CF

98 Engagement Considered the opposite of Positive Emotion
Involves loss of self-consciousness Goal-directed VCRHYP-RA: Well-Being; Self-Sufficiency Conversation Art Sports Flow: “Being at one” with some absorbing activity

99 Flow in Action Choose an activity that the youth can focus on without interruption (e.g., a creative endeavor, conversation, etc.) Have the youth engage in the activity for a minimum of 20 minutes Immediately following the activity, have the youth write down what he or she remembers about the experience

100 Positive Relationships
Gawande – The Bell Curve & CF

101 Positive Relationships
Building positive relationships and social connections People who are socially connected are more resilient to the challenges of life Two kinds of social connections One to one: friendships; pets Group/community connections: neighborhoods, interest groups, church communities, professional or work groups, groups of friends, sports teams, military units, support groups and so on.

102 Positive Relationships
Countless studies document the link between society and psyche: people who have close friends and confidants, friendly neighbors, and supportive co-workers are less likely to experience sadness, loneliness, low self-esteem, and problems with eating and sleeping. The single most common finding from a half century's research on the correlates of life satisfaction, not only in the United States but around the world, is that happiness is best predicted by the breadth and depth of one's social connections. Putnam, R. D. (2000). Bowling alone: The collapse and revival of American community. New York: Simon & Schuster.

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104 Exercises for Building Positive Relationships
Active Constructive Responding (ACR) Use activities, games, puzzles, or problems situations that foster cooperation and “working together,” the end purpose of which is for all involved to benefit and possibly benefit others not involved. Track and monitor, in real-time, your relationship with youth

105 Active Constructive Responding
Active-constructive responding (an enthusiastic response): “That’s great! I wonder what other positive changes might be on the horizon for you.” Active-destructive responding (a response that points out the potential downside): “So is that going to be their expectation going forward?” Passive-constructive responding (a muted response): “That’s nice, Mike.” Passive-destructive responding (a response that conveys disinterest): “I didn’t get outside all day.”

106 Meaning Gawande – The Bell Curve & CF

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108 Meaning Subjective sense of meaning is strongly correlated with happiness VCYHYP-RA: Well-Being; Self-Sufficiency Using what is best inside you to belong to and serve something bigger than you are (the “larger” world and society) Positive Institutions (i.e., religion, politics, family, community, etc.) Practice Positive Deviance Altruism Future Focus – “Future-Mindedness” can help a person to become more creative, optimistic, and hopeful Finding Life Purpose (and/or developing the spiritual self) Pascale, R., Sternin, J., & Sternin, M. (2010). The power of positive deviance: How unlikely innovators solve the world’s toughest problems. Boston, MA: Harvard Business Press.

109 Future Focus Creating a sense of a problem-free future or a future with hope and possibilities Assume change will happen Let your language reflect that sense of hope Presuppose change Tell stories of possibility without being invalidating or “too positive” Help the person imagine a time after the problem The miracle question

110 Future Pull Find a vision for the future
Identify and dissolve perceived barriers to the preferred future Make an action plan to reach the perceived future

111 What About You? What passion or area of interest do you often think about but have not yet pursued? What dreams or images continue to come to mind? What theme emerges from those dreams or images? What would it take for you to begin to develop that theme further and act on it?

112 Meaning and Purpose: Further Exercises
Encourage youth to join a movement or social cause or engage in philanthropic interests. Encourage youth to develop a new cause or effort to invest self in (sometimes it is necessary to challenge youth and others to use their dissatisfaction, anger, and/or hurt and take action)

113 Finding Life Purpose or Direction
Four signals or life energies: Blissed Blessed Pissed Dissed

114 Blissed: Steve Jobs “You’ve got to find what you love. And that is true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know it when you find it.” Your time is limited, so don’t waste it living someone’s life. Don’t be trapped by dogma–which is living with the results of other people’s thinking. Don’t let the noise of others’ opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.”

115 Blessed People who believed in you, encouraged you or told you you were good at something or could do something. Talents, developed or natural, that you have. Incidents of good luck (being in the right place at the right time-and taking advantage of that luck).

116 Pissed or Dissed The Key:
Transform the “negative” energy of anger and hurts into positive energy

117 Pissed (Righteous Indignation)
What would you talk about if given an hour of prime time television to influence the nation or the world? What pisses you off that you would like to correct in the world or other people? What can’t you sit still for?

118 Dissed (Wounded): Ann Rice
Daughter who died of leukemia at 5. Rice wrote a novel that featured a 5-year-old who could never die. (Interview with a Vampire)

119 Accomplishment Gawande – The Bell Curve & CF

120 Accomplishment Often pursued for its own sake
Self-discipline (Grit and Determination) is twice as important as IQ Achievement Competence Mastery Development of New Skills Accomplishments over life span VCRHYP-RA: Self-Sufficiency “Donors” and “Accumulators”

121 Accomplishment: Exercises
Donors – Collect to give Accumulators – Collect to accomplish “Spread the Word” Diaries, journals, scrapbooks Artwork, music Public speaking

122 Comprehensive Soldier Fitness – Efforts to shift the curve to the right.


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