Well-Being Therapy. G.A. Fava

a psychological work aimed at improving psychological well-being appeared to be quite difficult and I did not know how it could be achieved. In 1954, Parloff et al. [16] suggested that the goals of psychotherapy were not necessarily the reduction of symptoms, but instead increased personal comfort and effectiveness. However, there had been a very limited response to these needs in subsequent years. Notable exceptions were Ellis and Becker's A Guide to Personal Happiness [17], a modification of rationale-emotive therapy for removing the main blocks to personal happiness (shyness, feeling of inadequacy, feeling of guilt, etc.), Fordyce's program to increase happiness [18], Padesky's work on schema change processes [19], Frisch's quality of life therapy [20], and Horowitz and Kaltreider's work on positive states of mind [21]. Unfortunately, these approaches had not undergone sufficient clinical validation and did not seem to target what I had in mind in terms of psychological well-being.

      References

1 Fava GA, Sonino N: Psychosomatic medicine. Int J Clin Practice 2010;64:999-1001.

2 Engel GL: A unified concept of health and disease. Perspect Biol Med 1960;3:459-485.

3 Engel GL: The need for a new medical model. Science 1977;196:129-136.

4 Lipowski ZJ: Physical illness and psychopathology. Int J Psychiatry Med 1974;5:483-497.

5 Fava GA, Sonino N, Wise TN (ed): The Psychosomatic Assessment. Basel, Karger, 2012.

6 Engel GL: ‘Psychogenic’ pain and the pain-prone patient. Am J Med 1959;26:899-918.

7 Fava GA, Tomba E, Grandi S: The road to recovery from depression. Psychother Psychosom 2007;76:260-265.

8 Fava GA: Do antidepressant and antianxiety drugs increase chronicity in affective disorders? Psychother Psychosom 1994;61:125-131.

9 Levy SB: The Antibiotic Paradox: How Miracle Drugs Are Destroying the Miracle. New York, Plenum, 1992.

10 Andrews PW, Kornstein SG, Halberstadt LJ, Gardner CO, Neale MC: Blue again: perturbational effects of antidepressants suggest monoaminergic homeostasis in major depression. Front Psychol 2011;2:159.

11 Fava GA, Kellner R: Prodromal symptoms in affective disorders. Am J Psychiatry 1991; 148:823-830.

12 Fava GA: The concept of recovery in affective disorders. Psychother Psychosom 1996;65:2-13.

13 Bech P: Clinical Psychometrics. Chichester, Wiley, 2012.

14 Ryff CD: Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989;6:1069-1081.

15 Jahoda M: Current Concepts of Positive Mental Health. New York, Basic Books, 1958. https://archive.org/details/currentconceptso-00jaho

16 Parloff MB, Kelman HC, Frank JD: Comfort, effectiveness, and self-awareness as criteria of improvement in psychotherapy. Am J Psychiatry 1954;11:343-351.

17 Ellis A, Becker I: A Guide to Personal Happiness. Hollywood, Melvin Powers Wilshire Book Company, 1982.

18 Fordyce MW: A program to increase happiness. J Couns Psychol 1983; 30:483-498.

19 Padesky CA: Schema change processes in cognitive therapy. Clin Psychol Psychother 1994;1:267-278.

20 Frisch MB: Quality of life therapy and assessment in health care. Clin Psychol Sci Pract 1998;5:19-40.

21 Horowitz MJ, Kaltreider NB: Brief therapy of stress response syndrome. Psychiatr Clin N Am 1979;2:365-377.

       Part I: THE DEVELOPMENT

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Chapter 2

       The Philosophy Student and the Pursuit of a Well-Being-Enhancing Strategy

      I was wondering about developing a form of psychotherapy based on psychological well-being, but the idea did not seem to materialize. One day, I evaluated Tom, a 23-year-old philosophy student suffering from a severe form of obsessive-compulsive disorder. The disorder was mainly characterized by obsessions related to his girlfriend Laura and had started about a year before. Since then, Tom was unable to study, did not take any examinations, and stopped going to the university. His social life had also been affected. Aside from Laura, whom he kept on pestering with questions about her past, he stopped seeing friends. Tom went to see a psychiatrist, who prescribed fluvoxamine, a selective serotonin reuptake inhibitor. However, the medication did not yield any relief and the psychiatrist switched him to clomipramine, a tricyclic antidepressant drug. Yet, again, no response was observed. These medications were reasonable and appropriate prescriptions on the basis of the available literature. He then underwent cognitive behavior therapy (CBT), but he dropped out of treatment after 6 sessions because he felt he was getting worse. The latter event attracted my attention.

Generally, in the clinical literature no response and deterioration are considered to be the same thing. Yet they are different. In the 1990s, a group of Yale investigators headed by Ralph Horwitz [1] reanalyzed the data of a larger randomized controlled trial that involved the use of a β-blocker after myocardial infarction. Randomized controlled trials are not intended to answer questions about the treatment of individual patients, but to compare the efficacy of a treatment for the average patient who is randomly assigned to one of the groups. Horwitz et al. [1] analyzed the trial in a