Skip to main content

Conceptual and Clinical Innovations of Well-being Therapy

Abstract

The evidence supporting the use of well-being therapy (WBT), a specific psychotherapeutic strategy for modulating psychological well-being, and its specific contribution when it is combined with other psychotherapeutic techniques is still limited. However, the insights gained by the use of WBT may unravel innovative approaches to assessment and treatment of mood and anxiety disorders. An important characteristic of WBT is self-observation of psychological well-being associated with specific homework. Another important feature of WBT is the assumption that imbalances in well-being and distress may vary from one illness to another, and from patient to patient. A final characteristic is its reference to the concept of euthymia, where lack of mood disturbances is associated with positive affect and psychological well-being (flexibility, consistency, and resilience). Progress can be achieved by modifying our clinical approach to mental disorders, and by promoting self-observation of psychological well-being and the pursuit of a state of euthymia.

This is a preview of subscription content, access via your institution.

References

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed. (DSM-5)). Washington: APA.

    Google Scholar 

  • Baldessarini, R. J., & Tondo, L. (2019). Effects of treatment discontinuation in clinical psychopharmacology. Psychotherapy and Psychosomatics, 88(2), 65–70.

    PubMed  Google Scholar 

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.

    Google Scholar 

  • Belaise, C., Gatti, A., Chouinard, V. A., & Chouinard, G. (2014). Persistent postwithdrawal disorders induced by paroxetine, a selective serotonin reuptake inhibitor, and treated with specific cognitive behavioral therapy. Psychotherapy and Psychosomatics, 83, 247–248.

    PubMed  Google Scholar 

  • Bockting, C. L. H., Klein, N. S., Elgersma, H. J., van Rijsbergen, G. D., Slofstra, C., Ormel, J., et al. (2018). The effectiveness of preventive cognitive therapy while tapering antidepressants compared with maintenance antidepressant treatment and their combination in the prevention of depressive relapse or recurrence (DRD study). Lancet Psychiatry, 5, 401–410.

    PubMed  Google Scholar 

  • Brailovskaia, J., Forkmann, T., Glaesmer, H., Paashaus, L., Rath, D., Schönfelder, A., et al. (2019). Positive mental health moderates the association between suicide ideation and suicide attempts. Journal of Affective Disorders, 245, 246–249.

    PubMed  Google Scholar 

  • Carrozzino, D., Svicher, A., Patierno, C., Berrocal, C., & Cosci, F. (2019). The Euthymia Scale: a clinimetric analysis. Psychotherapy and Psychosomatics, 30, 1–3.

    Google Scholar 

  • Chaves, C., Lopez-Gomez, I., Hervas, G., & Vazquez, C. (2017). A comparative study of the efficacy of positive psychology intervention and a cognitive behavioral therapy for clinical depression. Cognitive Therapy and Research, 41, 417–433.

    Google Scholar 

  • Chouinard, G., & Chouinard, V. A. (2015). New classification of selective serotonin reuptake inhibitor (SSRI) withdrawal. Psychotherapy and Psychosomatics, 84, 63–71.

    PubMed  Google Scholar 

  • Coote, H. M. J., & MacLeod, A. K. (2017). A self-help positive goal focused intervention to increase well-being in people with depression. Clinical Psychology and Psychotherapy, 19, 305–315.

    Google Scholar 

  • Cosci, F. (2015). Well-Being Therapy in a patient with panic disorder who failed to respond to paroxetine and cognitive behavior therapy. Psychotherapy and Psychosomatics, 84, 318–319.

    PubMed  Google Scholar 

  • Cosci, F., & Chouinard, G. (2020). Acute and persistent withdrawal syndromes following discontinuation of psychotropic medications. Psychotherapy and Psychosomatics, 89, 283–306.

    PubMed  Google Scholar 

  • Cosci, F., & Fava, G. A. (2013). Staging of mental disorders: systematic review. Psychotherapy and Psychosomatics, 82, 20–34.

    PubMed  Google Scholar 

  • Craske, M. G., Meuret, A. E., Ritz, T., Treanor, M., Dour, H., & Rosenfield, D. (2019). Positive affect treatment for depression and anxiety. Journal of Consulting and Clinical Psychology, 87, 457–471.

    PubMed  Google Scholar 

  • Csikszentmihalyi, M., & Csikszentmihalyi, I. S. (1988). Optimal experience: Psychological studies of flow in consciousness. Cambridge: Cambridge University Press.

    Google Scholar 

  • de Jonge, M., Bockting, C. L. H., Kikkert, M. J., van Dijk, M. K., van Schaik, D. J. F., Peen, J., et al. (2019). Preventive cognitive therapy versus care as usual in cognitive behavioral therapy responders: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 87(6), 521–529.

    PubMed  Google Scholar 

  • de Leon, J., Baca-Garcia, E., & Blasco-Fontecilla, H. (2015). From the serotonin model of suicide to a mental pain model of suicide. Psychotherapy and Psychosomatics, 84, 323–329.

    PubMed  Google Scholar 

  • Ducasse, D., Jaussent, I., Arpon-Brand, V., Vienot, M., Laglaoui, C., Béziat, S., et al. (2018). Acceptance and commitment therapy for the management of suicidal patients: a randomized controlled trial. Psychotherapy and Psychosomatics, 87, 211–222.

    PubMed  Google Scholar 

  • Dunn, B. D., Widnall, E., Reed, N., Owens, C., Campbell, J., & Kuyken, W. (2019). Bringing light into darkness: a multiple baseline mixed methods case series evaluation of Augmented Depression Therapy (ADepT). Behaviour Research and Therapy, 120, 103418.

    PubMed  Google Scholar 

  • Emmelkamp, P. M. G., Bouman, T. K., & Scholing, A. (1993). Anxiety disorders. Chichester: Wiley.

    Google Scholar 

  • Farb, N., Anderson, A., Ravindran, A., Hawley, L., Irving, J., Mancuso, E., et al. (2018). Prevention of relapse/recurrence in major depressive disorder with either mindfulness-based cognitive therapy or cognitive therapy. Journal of Consulting and Clinical Psychology, 88, 200–204.

    Google Scholar 

  • Fava, G. A. (1996). The concept of recovery in affective disorders. Psychotherapy and Psychosomatics, 65, 2–13.

    PubMed  Google Scholar 

  • Fava, G. A. (2016). Well-Being Therapy. Treatment manual and clinical applications. Basel: Karger.

    Google Scholar 

  • Fava, G. A., & Bech, P. (2016). The concept of euthymia. Psychotherapy and Psychosomatics, 85, 1–5.

    PubMed  Google Scholar 

  • Fava, G. A., & Belaise, C. (2018). Discontinuing antidepressant drugs. Psychotherapy and Psychosomatics, 87, 257–267.

    PubMed  Google Scholar 

  • Fava, G. A., & Guidi, J. (2020). The pursuit of euthymia. World Psychiatry, 19(1), 40–50.

    PubMed  PubMed Central  Google Scholar 

  • Fava, G. A., & Kellner, R. (1993). Staging: a neglected dimension in psychiatric classification. Acta Psychiatrica Scandinavica, 87, 225–230.

    PubMed  Google Scholar 

  • Fava, G. A., & Rafanelli, C. (2019). Iatrogenic factors in psychopathology. Psychotherapy and Psychosomatics, 88, 129–140.

    PubMed  Google Scholar 

  • Fava, G. A., Grandi, S., Zielezny, M., Canestrari, R., & Morphy, M. A. (1994). Cognitive behavioral treatment of residual symptoms in primary major depressive disorder. American Journal of Psychiatry, 151, 1295–1299.

    Google Scholar 

  • Fava, G. A., Rafanelli, C., Cazzaro, M., Conti, S., & Grandi, S. (1998a). Well-Being Therapy: a novel psychotherapeutic approach for residual symptoms of affective disorders. Psychological Medicine, 28, 475–480.

    PubMed  Google Scholar 

  • Fava, G. A., Rafanelli, C., Grandi, S., Conti, S., & Belluardo, P. (1998b). Prevention of recurrent depression with cognitive behavioral therapy: preliminary findings. Archives of General Psychiatry, 55, 816–820.

    PubMed  Google Scholar 

  • Fava, G. A., Ruini, C., Rafanelli, C., Finos, L., Conti, S., & Grandi, S. (2004). Six-year outcome of cognitive behavior therapy for prevention of recurrent depression. American Journal of Psychiatry, 161, 1872–1876.

    Google Scholar 

  • Fava, G. A., Ruini, C., Rafanelli, C., Finos, L., Salmaso, L., Mangelli, L., et al. (2005). Well-Being Therapy of generalized anxiety disorder. Psychotherapy and Psychosomatics, 74, 26–30.

    PubMed  Google Scholar 

  • Fava, G. A., Ruini, C., & Belaise, C. (2007). The concept of recovery in major depression. Psychological Medicine, 37, 307–317.

    PubMed  Google Scholar 

  • Fava, G. A., Rafanelli, C., Tomba, E., Guidi, J., & Grandi, S. (2011). The sequential combination of cognitive behavioral treatment and Well-Being Therapy in cyclothymic disorder. Psychotherapy and Psychosomatics, 80, 136–143.

    PubMed  Google Scholar 

  • Fava, G. A., Rafanelli, C., & Tomba, E. (2012a). The clinical process in psychiatry. Journal of Clinical Psychiatry, 73, 177–184.

    Google Scholar 

  • Fava, G. A., Sonino, N., & Wise, T. N. (2012b). The psychosomatic assessment. Basel: Karger.

    Google Scholar 

  • Fava, G. A., Tomba, E., & Sonino, N. (2012c). Clinimetrics: the science of clinical measurements. International Journal of Clinical Practice, 66, 11–15.

    PubMed  Google Scholar 

  • Fava, G. A., Gatti, A., Belaise, C., Guidi, J., & Offidani, E. (2015). Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: a systematic review. Psychotherapy and Psychosomatics, 84, 72–81.

    PubMed  Google Scholar 

  • Fava, G. A., Cosci, F., Guidi, J., & Tomba, E. (2017a). Well-Being Therapy in depression: new insights into the role of psychological well-being in the clinical process. Depression and Anxiety, 34, 801–808.

    PubMed  Google Scholar 

  • Fava, G. A., Cosci, F., & Sonino, N. (2017b). Current psychosomatic practice. Psychotherapy and Psychosomatics, 86, 13–30.

    PubMed  Google Scholar 

  • Fava, G. A., Guidi, J., Rafanelli, C., & Rickels, K. (2017c). The clinical inadequacy of the placebo model and the development of an alternative conceptual framework. Psychotherapy and Psychosomatics, 86(6), 332–340.

    PubMed  Google Scholar 

  • Fava, G. A., Benasi, G., Lucente, M., Offidani, E., Cosci, F., & Guidi, J. (2018a). Withdrawal symptoms after serotonin-noradrenaline reuptake inhibitor discontinuation: systematic review. Psychotherapy and Psychosomatics, 87, 195–203.

    PubMed  Google Scholar 

  • Fava, G. A., Carrozzino, D., Lindberg, L., & Tomba, E. (2018b). The clinimetric approach to psychological assessment. Psychotherapy and Psychosomatics, 87, 321–326.

    PubMed  Google Scholar 

  • Fava, G. A., Tomba, E., Brakemeier, E.-L., Carrozzino, D., Cosci, F., Eöry, A., et al. (2019). Mental pain as a transdiagnostic patient-reported outcome measure. Psychotherapy and Psychosomatics, 88(6), 341–349.

    PubMed  Google Scholar 

  • Fava, G. A., Cosci, F., Guidi, J., & Rafanelli, C. (2020). The deceptive manifestations of resistance in depression. Psychotherapy and Psychosomatics, 89, 265–273.

    PubMed  Google Scholar 

  • Favrod, J., Nguga, A., Chaix, J., Pellet, J., Frobert, L., Fankhauser, C., et al. (2019). Improving pleasure and motivation in schizophrenia. Psychotherapy and Psychosomatics, 88(2), 84–95.

    PubMed  PubMed Central  Google Scholar 

  • Feinstein, A. R. (1987). Clinimetrics. New Haven: Yale University Press.

    Google Scholar 

  • Garamoni, G. L., Reynolds III, C. F., & Thase, M. E. (1991). The balance of positive and negative affects in major depression: a further test of the states of the mind model. Psychiatry Research, 39, 99–108.

    PubMed  Google Scholar 

  • Geschwind, N., Arntz, A., Bannink, F., & Peeters, F. (2019). Positive cognitive behavior therapy in the treatment of depression: A randomized order within-subject comparison with traditional cognitive behavior therapy. Behavior Research and Therapy, 116, 119–130.

    Google Scholar 

  • Gilleen, J., Shergill, S. S., & Kapur, S. (2015). Impaired subjective well-being in schizophrenia is associated with reduced anterior cingulated activity during reward processing. Psychological Medicine, 45, 589–600.

    PubMed  Google Scholar 

  • Guidi, J., & Fava, G. A. (2020). Sequential combination of pharmacotherapy and psychotherapy in major depressive disorder. A systematic review and meta-analysis. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2020.3650.

  • Guidi, J., Tomba, E., & Fava, G. A. (2016). The sequential integration of pharmacotherapy and psychotherapy in the treatment of major depressive disorder: a meta-analysis of the sequential model and a critical review of the literature. American Journal of Psychiatry, 173, 128–137.

    Google Scholar 

  • Guidi, J., Tomba, E., Cosci, F., Park, S. K., & Fava, G. A. (2017). The role of staging in planning psychotherapeutic interventions in depression. Journal of Clinical Psychiatry, 78, 456–463.

    Google Scholar 

  • Guidi, J., Brakemeier, E.-L., Bockting, C. L. H., Cosci, F., Cuijpers, P., Jarrett, R. B., et al. (2018a). Methodological recommendations for trials of psychological interventions. Psychotherapy and Psychosomatics, 87, 285–295.

    Google Scholar 

  • Guidi, J., Rafanelli, C., & Fava, G. A. (2018b). The clinical role of Well-Being Therapy. Nordic Journal of Psychiatry, 72, 447–453.

    PubMed  Google Scholar 

  • Guidi, J., Piolanti, A., Gostoli, S., Schamong, I., & Brakemeier, E.-L. (2019). Mental pain and euthymia as transdiagnostic clinimetric indices in primary care. Psychotherapy and Psychosomatics, 88(4), 252–253.

    PubMed  Google Scholar 

  • Hayes, S. C., Strosahal, K., & Wilson, K. G. (1999). Acceptance and commitment therapy. New York: Guilford Press.

    Google Scholar 

  • Holt, R. I. G. (2019). The Management of Obesity in People with Severe Mental Illness: An Unresolved Conundrum. Psychotherapy and Psychosomatics, 88(6), 327–332.

    PubMed  Google Scholar 

  • Jahoda, M. (1958). Current concepts of positive mental health. New York: Basic Books.

    Google Scholar 

  • Kennard, B. D., Emslie, G. J., Mayes, T. L., Nakonezny, P. A., Jones, J. M., Foxwell, A. A., et al. (2014). Sequential treatment with fluoxetine and relapse-prevention CBT to improve outcomes in pediatric depression. American Journal of Psychiatry, 171, 1083–1090.

    Google Scholar 

  • MacLeod, A. (2017). Prospection, well-being and mental health. Oxford: Oxford University Press.

    Google Scholar 

  • MacLeod, A. (2020). Euthymia: why it really does matter. World Psychiatry, 19(1), 1–2.

    PubMed  PubMed Central  Google Scholar 

  • Mansueto, G. (2019). The effects of Well-Being Therapy in chronic migraine. Psychotherapy and Psychosomatics, 88(suppl 1), 80–81.

    Google Scholar 

  • Meulenbeek, P., Christenhusz, L., & Bohlmeijer, E. (2015). Well-Being Therapy in the Netherlands. Psychotherapy and Psychosomatics, 84, 316–317.

    PubMed  Google Scholar 

  • Nierenberg, A. A. (2008). An analysis of the efficacy of treatments for bipolar depression. Journal of Clinical Psychiatry, 69(suppl 5), 4–8.

    Google Scholar 

  • Nierenberg, B., Mayersohn, G., Serpa, S., Holovatyk, A., Smith, E., & Cooper, S. (2016). Application of Well-Being Therapy to people with disability and chronic illness. Rehabilitation Psychology, 61, 32–43.

    PubMed  Google Scholar 

  • Penn, D. L., Mueser, K. T., Tarrier, N., Gloege, A., Cather, C., Serrano, D., et al. (2004). Supportive therapy for schizophrenia. Possible mechanisms and implications for adjunctive psychosocial treatments. Schizophrenia Bulletin, 30, 101–112.

    PubMed  Google Scholar 

  • Quoidbach, J., Mikolajczak, M., & Gross, J. J. (2015). Positive interventions: an emotion regulation perspective. Psychological Bulletin, 141, 655–693.

    PubMed  Google Scholar 

  • Rafanelli, C., Park, S. K., Ruini, C., Ottolini, F., Cazzaro, M., & Fava, G. A. (2000). Rating well-being and distress. Stress Medicine, 16, 55–61.

    Google Scholar 

  • Rafanelli, C., Gostoli, S., Buzzichelli, S., Guidi, J., Sirri, L., Gallo, P., et al. (2020). Sequential Combination of Cognitive-Behavioral Treatment and Well-Being Therapy in Depressed Patients with Acute Coronary Syndromes: A Randomized Controlled Trial (TREATED-ACS Study). Psychotherapy and Psychosomatics, 89, 345–356.

    PubMed  Google Scholar 

  • Rotterman, E., & Wright, J. H. (2019). Well-Being Therapy for recurrent depression and chronic pain. Psychotherapy and Psychosomatics, 88, 378–379.

    PubMed  Google Scholar 

  • Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 6, 1069–1081.

    Google Scholar 

  • Ryff, C. D. (2014). Psychological well-being revisited. Psychotherapy and Psychosomatics, 83, 10–28.

    Google Scholar 

  • Sartorius, N., Holt, R. I. G., & Maj, M. (2015). Comorbidity of mental and physical disorders. Basel: Karger.

    Google Scholar 

  • Schamong, I. (2019). From CBASP to WBT. Clinical case presentation of WBT as second line treatment in a patient with depression. Psychotherapy and Psychosomatics, 88(Suppl 1), 114.

    Google Scholar 

  • Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression. New York: Guilford.

    Google Scholar 

  • Segal, Z. V., Anderson, A. K., Gulamani, T., Williams, L. D., Desormeau, P., Ferguson, A., et al. (2019). Practice of therapy acquired regulatory skills and depressive relapse/recurrence prophylaxis following cognitive therapy or mindfulness based cognitive therapy. Journal of Consulting and Clinical Psychology, 87(2), 161–170.

    PubMed  Google Scholar 

  • Sensky, T. (2020). Mental pain and suffering. Psychotherapy and Psychosomatics, 89, 337–344.

    PubMed  Google Scholar 

  • Slade, M., Blacke, L., & Longden, E. (2019). Personal growth in psychosis. World Psychiatry, 18, 29–30.

    PubMed  PubMed Central  Google Scholar 

  • Sonino, N., & Fava, G. A. (2003). Tolerance to antidepressant treatment may be overcome by ketoconazole. Journal of Psychiatric Research, 37, 171–173.

    PubMed  Google Scholar 

  • Stangier, U., Hilling, C., Heidenreich, T., Risch, A. K., Barocka, A., Schlosser, R., et al. (2013). Maintenance cognitive-behavioral therapy and manualized psychoeducation in the treatment of recurrent depression: a multicenter prospective randomized controlled study. American Journal of Psychiatry, 170, 624–632.

    Google Scholar 

  • Tinetti, M. E., & Fried, T. (2004). The end of the disease era. American Journal of Medicine, 116, 179–185.

    Google Scholar 

  • Tomba, E., & Tecuta, L. (2016). Well-Being Therapy in a patient with anorexia nervosa. Psychotherapy and Psychosomatics, 85, 369–370.

    PubMed  Google Scholar 

  • Vazquez, C. (2017). What does positivity add to psychopathology? Cognitive Therapy and Research, 41, 325–334.

    Google Scholar 

  • Wood, A. M., & Tarrier, N. (2010). Positive clinical psychology. Clinical Psychology Review, 30, 819–829.

    PubMed  Google Scholar 

  • Wright, J. H., Brown, G. K., Thase, M. E., & Ramirez-Basco, M. (2017). Learning cognitive-behavior therapy (2nd ed.). Arlington, VA: American Psychiatric Association Publishing.

    Google Scholar 

Download references

Acknowledgments

This paper is based on two presentations delivered at the 9th World Congress of Behavioural and Cognitive Therapies that was held in Berlin, July 17–19, 2019: The assessment of psychological well-being (Guidi J) and Well-Being Therapy (Fava GA)

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giovanni A. Fava.

Ethics declarations

Conflict of Interest

The Authors have no conflicts of interest to disclose. Professor Fava has written a book on Well-Being Therapy, for which he receives no royalties.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Guidi, J., Fava, G.A. Conceptual and Clinical Innovations of Well-being Therapy. J Cogn Ther 14, 196–208 (2021). https://doi.org/10.1007/s41811-021-00101-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41811-021-00101-1

Keywords

  • Euthymia
  • Psychological well-being
  • Clinimetrics
  • Well-being therapy