Strength-Based Flourishing Intervention to Promote Resilience in Individuals With Physical Disabilities in Disadvantaged Communities: A Randomized Controlled Trial

Abstract

Purpose:

The current study developed a strength-based flourishing intervention (SFI) and examined its efficacy on fostering the resilience of people with physical disabilities in poor areas, using a randomized (1:1) parallel-group controlled, and single-blind trial.

Method:

A total of 51 participants (M _age = 42.16, standard deviation = 8.42; 43.14% males; 29 for the intervention group, whereas 22 for the control group) completed preintervention, postintervention, and 3-month follow-up tests.

Results:

The 2 × 3 mixed repeated measure analyses and post hoc analyses revealed a significant main group effect (F = 4.46, p = .04) and a short-term effect (i.e., 3 month; F = 6.35, p = .02) of the SFI. The results indicated that the SFI could significantly promote resilience in the intervention group. However, the effects of the intervention did not immediately appear.

Discussion:

The SFI could assist in providing research-based and cost-effective health services to promote flourishing and resilience in vulnerable populations.

Keywords

strength-based intervention physical disabilities economically disadvantaged areas flourishing resilience

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References

Abbe

Tkach

Lyubomirsky

(2003). The art of living by dispositionally happy people. Journal of Happiness Studies, 4(4), 385–404. https://doi.org/10.1023/B:JOHS.0000005769.54611.3c

Alschuler

K. N.

Kratz

A. L.

Ehde

D. M.

(2016). Resilience and vulnerability in individuals with chronic pain and physical disability. Rehabilitation Psychology, 61(1), 7–18. https://doi.org/10.1037/rep0000055

Auyeung

P. K. H.

(2019). The efficacy and mechanism of online positive psychological intervention (PPI) on improving well-being among Chinese university students: A pilot study of the best possible self (BPS) intervention. Journal of Happiness Studies, 20(8), 2525–2550. https://doi.org/10.1007/s10902-018-0054-4

Bausewein

Booth

Gysels

Kühnbach

Haberland

Higginson

I. J.

(2010). Individual breathlessness trajectories do not match summary trajectories in advanced cancer and chronic obstructive pulmonary disease: Results from a longitudinal study. Palliative Medicine, 24(8), 777–786. https://doi.org/10.1177/0269216310378785

Beaton

D. E.

Bombardier

Guillemin

Ferraz

M. B.

(2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186–3191. https://cadc.ucsf.edu/sites/g/files/tkssra881/f/wysiwyg/files/class7_beaton_2000.pdf

Bertisch

Rath

Long

Ashman

Rashid

(2014). Positive psychology in rehabilitation medicine: A brief report. NeuroRehabilitation, 34(3), 573–585. https://doi.org/10.3233/NRE-141059

Duan

(2019). A single-session positive cognitive intervention on first-year students’ mental health: Short-term effectiveness and the mediating role of strengths knowledge. Journal of American College Health, 67(6), 515–522. https://doi.org/10.1080/07448481.2018.1497639

Casellas-Grau

Font

Vives

(2014). Positive psychology interventions in breast cancer: A systematic review. Psycho-Oncology, 23(1), 9–19. https://doi.org/10.1002/pon.3353

China Disabled Persons’ Federation. (1995). Notification of China disabled persons’ federation of issuing certificates of persons with disabilities (CDPF[1995]-61). http://www.cdpf.org.cn/zcwj/zxwj/200804/t20080408_38100.shtml

10.

Chmitorz

Kunzler

Helmreich

Tüscher

Kalisch

Kubiak

Wessa

Lieb

(2018). Intervention studies to foster resilience: A systematic review and proposal for a resilience framework in future intervention studies. Clinical Psychology Review, 59, 78–100. https://doi.org/10.1016/j.cpr.2017.11.002

11.

Cohen

(1988). Statistical power analysis for the behavioural sciences (2nd ed.). Lawrence Erlbaum Associates.

12.

Cornum

Matthews

M. D.

Seligman

M. E. P.

(2011). Comprehensive soldier fitness: Building resilience in a challenging institutional context. American Psychologist, 66(1), 4–9. https://doi.org/10.1037/a0021420

13.

Cosci

Pennato

Bernini

Berrocal

(2011). Psychological well-being, negative affectivity, and functional impairment in fibromyalgia. Psychotherapy and Psychosomatics, 80(4), 256–258. https://doi.org/10.1159/000322031

14.

Diener

Wirtz

Tov

Kim-Prieto

Choi

D.-w.

Oishi

Biswas-Diener

(2010). New well-being measures: Short scales to assess flourishing and positive and negative feelings. Social Indicators Research, 97(2), 143–156. https://doi.org/10.1007/s11205-009-9493-y

15.

Duan

(2019). Randomized trial investigating of a single-session character-strength-based cognitive intervention on freshman’s adaptability. Research on Social Work Practice, 29(1), 82–92. https://doi.org/10.1177/1049731517699525

16.

Duan

Zhao

Guo

(2019). Examining the mediating roles of strengths knowledge and strengths use in a 1-year single-session character strength-based cognitive intervention. Journal of Happiness Studies, 20(6), 1673–1688. https://doi.org/10.1007/s10902-018-0014-z

17.

Duan

Fei

Tang

(2020). Latent profiles and grouping effects of resilience on mental health among poor children and adolescents. Child Indicators Research, 13(2), 635–655. https://doi.org/10.1007/s12187-019-09637-3

18.

Duan

(2017). Psychometric characteristics of strengths knowledge scale and strengths use scale among adolescents. Journal of Psychoeducational Assessment, 36(7), 756–760. https://doi.org/10.1177/0734282917705593

19.

Dunn

D. S.

Uswatte

Elliott

T. R.

(2009). Happiness, resilience, and positive growth following physical disability: Issues for understanding, research, and therapeutic intervention. In Lopez

S. J.

Snyder

C. R.

(Eds.), Oxford handbook of positive psychology (2nd ed., pp. 651–664). Oxford University Press. https://psycnet.apa.org/record/2009-05143-062

20.

Edwards

K. A.

Alschuler

K. A.

Ehde

D. M.

Battalio

S. L.

Jensen

M. P.

(2017). Changes in resilience predict function in adults with physical disabilities: A longitudinal study. Archives of Physical Medicine and Rehabilitation, 98(2), 329–336. https://doi.org/10.1016/j.apmr.2016.09.123

21.

Fava

G. A.

(2016). Well-being therapy: Treatment manual and clinical applications. Karger Medical and Scientific Publishers.

22.

Fava

G. A.

Cosci

Guidi

Tomba

(2017). Well-being therapy in depression: New insights into the role of psychological well-being in the clinical process. Depression and Anxiety, 34(9), 801–808. https://doi.org/10.1002/da.22629

23.

Fava

G. A.

Rafanelli

Tomba

Guidi

Grandi

(2011). The sequential combination of cognitive behavioral treatment and well-being therapy in cyclothymic disorder. Psychotherapy and Psychosomatics, 80(3), 136–143. https://doi.org/10.1159/000321575

24.

Fava

G. A.

Ruini

(2003). Development and characteristics of a well-being enhancing psychotherapeutic strategy: Well-being therapy. Journal of Behavior Therapy and Experimental Psychiatry, 34(1), 45–63. https://doi.org/10.1016/S0005-7916(03)00019-3

25.

Fava

G. A.

Ruini

Rafanelli

(2004). Psychometric theory is an obstacle to the progress of clinical research. Psychotherapy and Psychosomatics, 73(3), 145–148. https://doi.org/10.1159/000076451

26.

Fava

G. A.

Ruini

Rafanelli

Finos

Salmaso

Mangelli

Sirigatti

(2005). Well-being therapy of generalized anxiety disorder. Psychotherapy and Psychosomatics, 74(1), 26–30. https://doi.org/10.1159/000082023

27.

Fava

G. A.

Tomba

(2009). Increasing psychological well-being and resilience by psychotherapeutic methods. Journal of Personality, 77(6), 1903–1934. https://doi.org/10.1111/j.1467-6494.2009.00604.x

28.

Fraser

M. W.

Galinsky

M. J.

(2010). Steps in intervention research: Designing and developing social programs. Research on Social Work Practice, 20(5), 459–466. https://doi.org/10.1177/1049731509358424

29.

Ghosh

Deb

(2017). Positive psychology interventions for chronic physical illnesses: A systematic review. Psychological Studies, 62(3), 213–232. https://doi.org/10.1007/s12646-017-0421-y

30.

Goubert

Trompetter

(2017). Towards a science and practice of resilience in the face of pain. European Journal of Pain, 21(8), 1301–1315. https://doi.org/10.1002/ejp.1062

31.

Govindji

Linley

P. A.

(2007). Strengths use, self-concordance and well-being: Implications for strengths coaching and coaching psychologists. International Coaching Psychology Review, 2(2), 143–153. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.466.100&rep=rep1&type=pdf#page=31

32.

Gromisch

E. S.

Sloan

Zemon

Tyry

Schairer

L. C.

Snyder

Foley

F. W.

(2018). Development of the Multiple Sclerosis Resiliency Scale (MSRS). Rehabilitation Psychology, 63(3), 357–364. https://doi.org/10.1037/rep0000219

33.

Hendriks

Schotanus-Dijkstra

Hassankhan

Sardjo

Graafsma

Bohlmeijer

de Jong

(2020). Resilience and well-being in the Caribbean: Findings from a randomized controlled trial of a culturally adapted multi-component positive psychology intervention. The Journal of Positive Psychology, 15(2), 238–253. https://doi.org/10.1080/17439760.2019.1590624

34.

Khazem

L. R.

(2018). Physical disability and suicide: Recent advancements in understanding and future directions for consideration. Current Opinion in Psychology, 22, 18–22. https://doi.org/10.1016/j.copsyc.2017.07.018

35.

Kunming City Government. (2019). Statistical bulletin on Kunming’s economic and social development in 2018. http://www.km.gov.cn/c/2019-05-13/3007215.shtml

36.

Lena Morgon

Kuper

Polack

(2017). Poverty and disability in low- and middle-income countries: A systematic review. PLoS One, 12(12). https://doi.org/10.1371/journal.pone.0189996

37.

Mansueto

De Cesaris

Geppetti

Cosci

(2018). Protocol and methods for testing the efficacy of well-being therapy in chronic migraine patients: A randomized controlled trial. Trials, 19(1), 561–561. https://doi.org/10.1186/s13063-018-2944-5

38.

Martínez-Martí

M. L.

Ruch

(2017). Character strengths predict resilience over and above positive affect, self-efficacy, optimism, social support, self-esteem, and life satisfaction. The Journal of Positive Psychology, 12(2), 110–119. https://doi.org/10.1080/17439760.2016.1163403

39.

Moeenizadeh

Salagame

K. K. K.

(2010). The impact of well-being therapy on symptoms of depression. International Journal of Psychological Studies, 2(2), 223–230. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.667.3801&rep=rep1&type=pdf

40.

Moeenizadeh

Zarif

(2017). The efficacy of well-being therapy for depression in infertile women. International Journal of Fertility & Sterility, 10(4), 363–370. https://doi.org/10.22074/ijfs.2016.5087

41.

Moskowitz

J. T.

(2010). Positive affect at the onset of chronic illness: Planting the seeds of resilience. In Reich

J. W.

Zautra

A. J.

Hall

J. S.

(Eds.), Handbook of adult resilience (pp. 465–483). The Guilford Press.

42.

Niemiec

R. M.

Shogren

K. A.

Wehmeyer

M. L.

(2017). Character strengths and intellectual and developmental disability: A strengths-based approach from positive psychology. Education and Training in Autism and Developmental Disabilities, 52(1), 13–25. https://www.jstor.org/stable/26420372

43.

Nierenberg

Mayersohn

Serpa

Holovatyk

Smith

Cooper

(2016). Application of well-being therapy to people with disability and chronic illness. Rehabilitation Psychology, 61(1), 32–43. https://doi.org/10.1037/rep0000060

44.

Padesky

C. A.

Mooney

K. A.

(2012). Strengths-based cognitive–behavioural therapy: A four-step model to build resilience. Clinical Psychology & Psychotherapy, 19(4), 283–290. https://doi.org/10.1002/cpp.1795

45.

Perera

M. J.

Meade

M. A.

DiPonio

(2018). Use and psychometric properties of the Flourishing Scale among adults with spinal cord injury. Rehabilitation Psychology, 63(2), 250–257. https://doi.org/10.1037/rep0000184

46.

Peterson

Seligman

M. E. P.

(2004). Character strengths and virtues: A handbook and classification. Oxford University Press.

47.

Prizmić-Larsen

Kaliterna-Lipovčan

Larsen

Brkljačić

Brajša-Žganec

(2019). The role of flourishing in relationship between positive and negative life events and affective well-being. Applied Research in Quality of Life, 1–19. https://doi.org/10.1007/s11482-019-09743-y

48.

Quinlan

Swain

Vella-Brodrick

D. A.

(2012). Character strengths interventions: Building on what we know for improved outcomes. Journal of Happiness Studies, 13(6), 1145–1163. https://doi.org/10.1007/s10902-011-9311-5

49.

Rafanelli

Park

S. K.

Ruini

Ottolini

Cazzaro

Fava

G. A.

(2000). Rating well-being and distress. Stress Medicine, 16(1), 55–61. https://doi.org/10.1002/(SICI)1099-1700(200001)16:1<55::AID-SMI832>3.0.CO;2-M

50.

Rashid

(2015). Positive psychotherapy: A strength-based approach. The Journal of Positive Psychology, 10(1), 25–40. https://doi.org/10.1080/17439760.2014.920411

51.

Rashid

Louden

Wright

Chu

Maharaj

Hakim

Kidd

(2017). Flourish: A strengths-based approach to building student resilience. In Proctor

(Ed.), Positive psychology interventions in practice (pp. 29–45). Springer International Publishing. https://doi.org/10.1007/978-3-319-51787-2_3

52.

Ryff

C. D.

(1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069–1081. https://doi.org/10.1037/0022-3514.57.6.1069

53.

Ryff

C. D.

Keyes

C. L. M.

(1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69(4), 719–727. https://doi.org/10.1037/0022-3514.69.4.719

54.

Ryff

C. D.

Singer

(2000). Interpersonal flourishing: A positive health agenda for the new millennium. Personality and Social Psychology Review, 4(1), 30–44. https://doi.org/10.1207/s15327957pspr0401_4

55.

Seligman

M. E. P.

Steen

T. A.

Park

Peterson

(2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60(5), 410–421. https://doi.org/10.1037/0003-066X.60.5.410

56.

Shoshani

Slone

(2016). The resilience function of character strengths in the face of war and protracted conflict. Frontiers in Psychology, 6, Article 2006. https://doi.org/10.3389/fpsyg.2015.02006

57.

Silverman

A. M.

Molton

I. R.

Alschuler

K. N.

Ehde

D. M.

Jensen

M. P.

(2015). Resilience predicts functional outcomes in people aging with disability: A longitudinal investigation. Archives of Physical Medicine and Rehabilitation, 96(7), 1262–1268. https://doi.org/10.1016/j.apmr.2015.02.023

58.

Strober

L. B.

(2017). Personality in multiple sclerosis (MS): Impact on health, psychological well-being, coping, and overall quality of life. Psychology, Health & Medicine, 22(2), 152–161. https://doi.org/10.1080/13548506.2016.1164321

59.

Stuntzner

Hartley

M. T.

(2014, March 26–April 2). Resilience, coping, & disability: The development of a resilience intervention [Paper presentation]. American Counseling Association Conference, Honolulu, Hawaii, United States. https://www.counseling.org/docs/default-source/vistas/article_44.pdf?sfvrsn=3

60.

The State Council. (2008, March 28). The opinions of the CPC central committee and the state council on advancing the development of cause of the disabled. [中共中央、国务院关于促进残疾人事业发展的意见] http://www.cl.yn.gov.cn/show.aspx?cid=43&id=40008

61.

Tang

Duan

Wang

Liu

(2016). Psychometric evaluation of the simplified Chinese version of Flourishing Scale. Research on Social Work Practice, 26(5), 591–599. https://doi.org/10.1177/1049731514557832

62.

Tang

Duan

Cheng

(2019). Character strengths lead to satisfactory educational outcomes through strength use: A longitudinal analysis. Frontiers in Psychology, 10(1829). https://doi.org/10.3389/fpsyg.2019.01829

63.

Tomba

Tecuta

Guidi

Grandi

Rafanelli

(2016). Demoralization and response to psychotherapy: A pilot study comparing the sequential combination of cognitive-behavioral therapy and well-being therapy with clinical management in cyclothymic disorder. Psychotherapy and Psychosomatics, 85(1), 56–57. https://doi.org/10.1159/000438674

64.

Tough

Siegrist

Fekete

(2017). Social relationships, mental health and wellbeing in physical disability: A systematic review. BMC Public Health, 17, Article 414. https://doi.org/10.1186/s12889-017-4308-6

65.

Windle

(2011). What is resilience? A review and concept analysis. Reviews in Clinical Gerontology, 21(2), 152–169. https://doi.org/10.1017/S0959259810000420

66.

World Health Organization. (2011). World report on disability 2011 (9241564180). https://apps.who.int/iris/bitstream/handle/10665/44575/9789240685215_eng.pdf

67.

N. X.

Lam

T. H.

Liu

I. K. F.

Stewart

S. M.

(2015). Mediation of short and longer term effects of an intervention program to enhance resilience in immigrants from Mainland China to Hong Kong. Frontiers in Psychology, 6, Article 1769. https://doi.org/10.3389/fpsyg.2015.01769

68.

N. X.

Lau

J. T. F.

Mak

W. W. S.

Cheng

Zhang

(2014). A pilot theory–based intervention to improve resilience, psychosocial well-being, and quality of life among people living with HIV in rural China. Journal of Sex & Marital Therapy, 40(1), 1–16. https://doi.org/10.1080/0092623X.2012.668512