Happiness means different things to different people. However Mazuchelli and colleagues have a simple and effective definition of happiness. In a 2009 paper they write that happiness
‘is usually defined as a combination of frequent positive affect, infrequent negative affect and a high level of satisfaction with life‘
In other words happiness is a combination of having more positive feelings, less negative feelings and being satisfied with life. This leads onto the next question – can we train ourselves to be happier? The quote from the above paper leads neatly onto an answer because the same authors in the same paper show us some evidence that we can indeed train to be happier. The above paper is a meta-analysis of an approach called ‘Behavioural Activation’.
What is Behavioural Activation?
We need to take a slight detour here to understand a bit more about Behavioural Activation. Behavioural activation is a therapeutic approach which increases behaviours that help people to engage with life. Avoidance behaviours are challenged. Whether a person engages or avoids with these behaviours depends on the context. Behavioural Activation was first developed for use in the treatment of depression (Lewinsohn and Graf, 1973). Here are a few useful resources for learning more about Behavioural Activation.
#1 The World Health Organisation has a webpage about Behavioural Activation and includes evidence of efficacy in the treatment of depression
#2 An article on Behavioural Activation for the treatment of Depression by Dr Veale in Advances in Psychiatric Treatment here
#3 Trevor Mazzucchelli’s PhD thesis on Behavioural Activation Interventions for Depression and Well-Being here.
#4 Health Skills post by Bronwyn Thompson.Behavioural activation has an overlap with approaches used in Occupational Therapy. Bronwyn Thompson is an Occupational Therapist who has also trained in Psychology and writes about the similarities in this post
#6 Dr Martell’s has an overview of Behavioural Activation on his website.
In the 2009 paper by Mazzucchelli and colleagues they use a meta-analysis of studies on Behavioural Activation in well-being to answer the question of whether it is beneficial in achieving happiness.
How Did They Do The Study?
Mazzucchelli and colleagues searched academic databases (PsycInfo and Medline) for papers published between 1970 and 2008. They used special terms to identify the papers of interest e.g ‘behavioural activation’. They also contacted the authors of papers by e-mails to get further information. They located more than 520 papers, book chapters and other sources. They used strict criteria for measuring the quality of studies including the use of treatment manuals to ensure a standardised approach. The researchers go on to describe the statistical methods they use to determine the size of the effect of treatment. The studies also needed to use tools which were effective at measuring relevant aspects of well-being.
What Did They Find?
The researchers identified 20 studies which met their criteria. There were a total of 1353 people in these studies.
Although many of the studies differed in the activities used for Behavioural Activation, a number of the studies focused on the use of pleasant activities. Other studies used more complex criteria for activities. Some of the studies compared Behavioural Activation with treatment-as-usual and others with a placebo group. Although there was a lot of variation, readers can see from Figure 1 above that most of the studies showed a treatment effect that favoured Behavioural Activation. Looking carefully at Figure 1, the diagram shows 5 vertical lines. The middle line is 0. The treatment effects are represented by squares. The relation of the squares to the lines shows how effective the treatments are.
The top square falls to the left of 0. This means that the Behavioural Activation treatment shows an effect whose average is less than that the approach used for the control group. However most of the squares are to the right of the middle line showing that the average effect of the Behavioural Activation group is greater than that of the average effect of the intervention in the control group. The lines on each side of the squares indicates the 95% Confidence Interval and can be used to see if the average effect size really does lie to the right or left of the 0 line. For instance the sample group might not be characteristic of the general population and might be very small giving us less confidence in the results. The average effect size of all the studies is shown as a black diamond shape at the bottom of the diagram and is positive (greater than 0) indicating that Behavioural Activation is effective. The effect size was 0.52 in favour of Behavioural Activation. The researchers used another approach to see if there was asymmetry in the results and concluded that there was no evidence of publication bias which can sometimes affect the results.
Now the question you might ask is what was being measured? The answer is that the researchers in the different studies were assessing well-being. Although there were different measures of well-being it didn’t matter for the purposes of the meta-analysis because the researchers looked at the effect size. In other words they wanted to compare the mean effect size and standard deviation for the different measures being used. This is a clever way of comparing ‘apples and oranges’. Just so long as you accept that there are different measures of well-being and they all measure the same kind of thing, its OK to combine the results in this way.
What Does This Meta-Analysis Tell Us?
This Meta-Analysis tells us that Behavioural Activation is useful not just for Depression but also for people who aren’t depressed but just trying to experience more well-being. The Meta-Analysis could have focused on very specific forms of Behavioural Activation to draw more focused results but at the time of publication there weren’t enough studies to be able to draw those more narrow conclusions. A few of the studies looked at the use of pleasant activities but not enough to generalise from the results because they include other types of activity. The researchers have an interesting discussion in the paper which is well worth a look. Perhaps the simplest conclusion that can be drawn is that this behavioural approach can contribute to well-being.
What’s Your Definition of Happiness?
Lewinsohn, P. M., & Graf, M. (1973). Pleasant activities and depression. Journal of Consulting and Clinical Psychology, 41, 261–268.
An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail email@example.com. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.