among Selected Depressed Female Filipino Adolescentsâ to reduce depressionâ .... school students of grade 7-10, thirty students, between the ages of counselor ... Bibliotherapy Intervention Program: The eight-module intervention. Kutcher ...
Indian Journal of Positive Psychology 2015, 6(4), 331-339
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Development of taking in the good based-bibliotherapy intervention program in the female adolescent depression treatment John Jacob
Rosalito G. De Guzman
Graduate School, University of Santo Tomas Espana, Manila, Philippines
Department of Psychology, University of Santo Tomas Espana, Manila, Philippines
Adolescent depression is a severe mental health problem. Depressed female adolescents habitually seek and retain negative experiences. Despite the flourishing national economy and the rapid increase in human development, the Philippines has the highest incidence of depression in South East Asia. The aim of this study is to describe the processes of development and implementation of 'Taking in the Good Based-Bibliotherapy Intervention Program” for female adolescents to reduce depression. As an innovative type of psychotherapy treatment, which utilizes the elements of positive neuroplasticity and the principles of bibliotherapy, the program aimed to help them to build up their inner strengths by experiencing, enriching and absorbing daily events with a positive attitude and installing them in the brain. The process involves two phases: 1) determining the components of the taking in the good basedbibliotherapy intervention through research and survey; 2) the use of multi-disciplinary team of school directress, guidance counselor, teaching staff; team of clinical experts of psychotherapy and psychiatry and literary expert to review, to discuss and to give suggestion to formulate the program. Qualitative (interview), quantitative (survey) and mixed method research was used to obtain an extensive perspective of the intervention program. Empirical findings, theoretical models, and existing facts (testing the effectiveness of the program by implementation to the student participants) were combined to develop this pioneering intervention program. A structured intervention program to reduce the level of depression was developed, consisted of eight modules that are explained in detail. Implementation took place and the evaluation was being carried out. The “Taking in the Good based-Bibliotherapy Intervention” program proved to be effective in reducing depression in female adolescents.
Keywords: female adolescent, depression, positive-neuroplasticity, taking in the good, bibliotherapy, inner strengths Adolescent depression is a severe mental health crisis and about 15% of adolescents are subject to developing a major depressive disorder (Young, Miller & Khan, 2010; Auerbach & Ho, 2012). Depression is related to remarkable hindrances in a person's overall functioning. Moreover, it enhances an increased risk of future serious depressive episodes and other related mental health confusion. The adverse outcomes, associated with adolescent depression (Ferguson & Woodward, 2002), are startling because of a direct pathway linking depression in adolescence to increased risk of later depression and anxiety. Sex difference in depression is negligible prior to adolescence but there is a dramatic increase of depression in the prevalence, severity, and recurrence between the ages of 12 and 15 among girls (Hilt & Nolen-Hoeksema, 2009). It has been a question of interest among mental health professionals for many decades why girls are more affected than boys. Hyde and Mezulis (2008) proposed the Affect, Biology and Cognition (ABC) Model of Depression to identify depression in adolescent girls from a truly integrated developmental perspective in which affective, biological and cognitive vulnerabilities generate a form of cascade effect leading to adolescent depression and which should be a critical framework. Kerig, Ludlow, and Wenar (2012) observed that biology comes back into play when “early developing” girls experience interpersonal stressors such as peer teasing and sexual harassment, which are the gender-specific forms of life stress that provoke a most recent element in this model. For girls with a basic propensity to depression, these negative experiences can upset the balance and act on their emotional and cognitive vulnerabilities to produce an ideal Correspondence should be sent to Dr. John Jacob, Graduate School University of Santo Tomas, Espana, Manila, Philippines
breeding ground for depression. World Health Organization (WHO) showed that the Philippines has the highest incidence of depression in South East Asia with 93 suicides for every 100,000 Filipinos. Department of Health (DOH) found that 15 out of 900 teenagers tried to commit suicide (DOH, 2015). Among the students surveyed in the Global School-based Health Survey in 2003-2004 (GSHS), 42% had felt sad or hopeless for two weeks or more during the past year; 17.15% had seriously considered committing suicide and 16.7% had actually made a plan about how they would do it. Moreover, females were more than twice as likely as males to have suicidal thoughts. CalmaBalderrama (2004) found that adolescents are at risk of major difficulty in the Philippines where Young people (aged 10-24) will number 32 million by 2025. Hindin and Gultiano (2006) stated that in the Philippines domestic violence is a major stressor causing the onset of depression among adolescents. Chakkyath (2012) emphasized the fact that the modern Filipino family undergoes various changes and transitions including marital separation and that the number of single parent families is increasing rapidly. Weisz, McCarty, and Valeri (2006) consider depression in children and adolescents to be a significant, persistent, and recurrent public health problem that undermines social and school functioning, generates severe family stress, and calls for significant assistance from the mental health services. In the psychotherapy treatment for depression, relevant models are found to be effective for adolescents and adults. The Behavioral Activation Model (BAM) is recurrently a top priority in treatment because depression is seen as a loss of response support. Interpersonal Psychotherapy (IP) offers a skill-building approach to specific forms of primary interpersonal issues such as grief, role disputes, role transitions and
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interpersonal deficits. Self-Management Therapy (SMT) addresses the six deficits in self control behavior of depressed persons or persons prone to depression (Rehm, 2010). According to Power (2013) Cognitive Behavioral Therapy (CBT) is a helpful intervention for depression and is the treatment of choice for many groups. However, Thapar et al., found that “cognitve behavioral therapy is successful in the case of adolescents with milder forms of depression but it fails to consistently produce more beneficial effects than do control treatments in those with moderate to severe depression” (Thapar, Collishaw, Pine, & Thapar, 2012, p.1056). Nevertheless, research confirms that psychotherapy is a mainstay intervention for depression. Recent studies examined the effects of structured psychotherapy on neural function and found that they affect clinical recovery by modulating the functioning of specific sites in limbic and cortical regions (Singh & Gotlib, 2014). Among the exceptionally successful and recognized psychotherapy treatment interventions, bibliotherapy has been found to be comprehensively effective in alleviating the intensity of depression among adolescents (Betzalel & Shechtman, 2010; Pehrsson & McMillan, 2005; Shechtman, 2009). One of the unique features of bibliotherapy is that it is extremely flexible and therefore, it can embody different mediums and formats: from controlled clinical studies to poetry writing; from psychologists to students; and from self-help books to films (McCulliss & Chamberlain, 2013). Bibliotherapy is more effective when used in conjunction with other techniques (Pardeck, 1990) and with other treatments (Jones, 2006) such as group therapy which fosters greater involvement and insight into participants. Anderson and colleagues (2005) suggested that bibliotherapy would be the most appropriate treatment for those with mild to moderate levels of depression as well as for those interested in the self-management of chronic depression. When experiencing a complex situation, people often find comfort in knowing that they are not alone. By matching reading materials appropriately to students' situation and problem, the process of bibliotherapy gives an opportunity to students to realize that other people have encountered similar struggles. The basic assumption is that this identification with other people allows students to create an emotional connection to the story or text. By guided follow-up discussions and activities, students can experience a cathartic release of emotional tension or they may develop empathy toward others who experience a difficult situation. Students begin to develop insight and can learn to realize that there are ways to manage the problem. Then they become aware that they are not the only persons, who have such a problem. Finally, students consider what this could mean for the future. In short, the students are helped to create their own problem-solving mechanisms. Depressed adolescents may not be interested in looking at life and its manifold prospects. They have a relatively higher ratio of negative to positive thoughts and their thinking is characterized by numerous negative biases. If they are assisted for taking in the good, they will deliberately internalize the positive experiences in their implicit memory. Hanson (2013) promotes the taking in the good theory with HEAL, which offers a positive experience, enriches that experience, absorbs it and links positive and negative material, by replacing negative bias with healthy and positive responses. The practice of taking in the good would help to restore resilience in the individual, to heal distress and dysfunction, to advance relationships, to promote physical health and to nurture enduring happiness. Basically, by taking in the good the individual deliberately turns a passing mental
state into lasting neural structure. After moving through the successive stages of taking in the good, an individual's positive mental state will finally become positive neural traits; the individual will gradually rest in a natural state of contentment. With the increasing rate of depression among female adolescents and its devastating impact in respective major spheres such as individual, family, and society at large, the researcher formulated “Taking in the Good based Bibliotherapy Intervention Program among Selected Depressed Female Filipino Adolescents” to reduce depression. In this study, the researcher employed taking in the good theory and bibliotherapy principles jointly as a pioneering psychotherapy intervention for reducing depression in female adolescents because bibliotherapy is remarkably effective when it is administered in conjunction with other therapeutic interventions. The strategies of taking in the good based-bibliotherapy were designed specifically for female adolescents to practice simultaneously the HEAL steps and the bibliotherapy processes. As bibliotherapy aims at creating positive insights, the HEAL process focuses on taking in positive experiences and installing them in the brain. Eventually, female adolescents come to realize that the intensity of depression has been reduced and the level of cognitive appraisal augmented. They become aware that they are secure, satisfied, and connected in their life. The researcher used descriptive method for this study to obtain a better result. The goal is to develop and measure the effectiveness of the Taking in the Good Based-Bibliotherapy Intervention Program for the depressed female adolescents. The advantage of using descriptive research is that it would enable the researcher to explain the factual and essential information significant to the development of the intervention program. Program Development: The procedures used in the development of this researcher-designed intervention program are as the following: Studying the Actual Situation: Studying the current situation and understanding the need of developing an innovative intervention program was considered as the main step in this research. The researcher explored the cause and effect of female adolescent depression in the Philippines with the help of review of literature and media information like news and reports. The researcher tried to understand the interpersonal, intrapersonal, social, and environmental challenges of the adolescents in the Philippines as well as their struggles to cope up with the problems they encounter in the daily life. The researcher interviewed the Directress, Discipline officer, Guidance counselor and parents for a comprehensive understanding of psycho-social-ecological situation and to find out the most required intervention strategy to deal with the adolescent depression. Examining Relevant Academic Literature: After understanding the particular cause and effect of adolescent depression and depression symptoms in the Philippines, the researcher made an extensive research into the resources of literature and proper models of existing intervention programs to come up with a distinctive model with a view to helping depressed female adolescents in alleviating their depression and equipping them with new and positive insights. But the researcher could not find an appropriate intervention program particularly for the adolescents of this specific age and gender group. Therefore he decided to develop an innovative treatment model. Experience as a Counselor for Adolescents: The researcher as a counselor in clinical and non-clinical situation came across
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significant number of clients with depression and depressive symptoms due to psycho-socio-ecological reasons. Through the communications with the depressed adolescents in and out of the clinical arrangement, the researcher observed and learned the explicit nature of depression among the adolescents and the contributing factors for the onset and frequent episodes of depression. This recognition of the problem helped the researcher to develop an innovative approach with modules anchored on the principles of bibliotherapy and positive neuroplasticity to alleviate depression and to create positive insight into their life. Determination of the Research and Finalization of the Program Content: The researcher further clarified the problem of adolescent depression and its effective treatments with professional guidance counselor and adolescent psychiatrist. These deliberations had helped the researcher to focus more on the positive approaches that would much beneficial to the female adolescents. Survey among the Teachers: The researcher conducted a survey among the teachers to know how they help the students in times of acute crisis situation. This helped the researcher to find out how vital an intervention strategy which can be beneficial mainly to the depressed adolescent students. Determining the Components of the Taking in the Good BasedBibliotherapy Intervention: The recent research studies, interview, and related findings helped researcher to decide components for the intervention program to reduce intensity of depression, acquire positive insights and to become conscious of inner strength. Each component of intervention is designed with this aim. All through the intervention, researcher had maintained one principle: When bibliotherapy aimed at creating positive insights, taking in the good processes intended for taking in positive experiences and register it in the brain. Theoretical Basis and Design of Taking in the Good BasedBibliotherapy Intervention Program: The eight-module intervention program was developed to reduce the severity of depression and increase the positive cognitive appraisal. These modules and strategies were based on the taking in the good theory (Hanson, 2013) and the principles of bibliotherapy (McCullis & Chamberlain, 2013; Pehrsson & McMillen, 2005). The results from the research on positive neuroplasticity and process of bibliotherapy have been employed to bring out the concept of positive-cognitive-appraisal for the depressed adolescents. The researcher utilized the unique feature of bibliotherapy, explicitly flexibility, by selecting seven inspirational stories based on real life experiences from different cultures and their respective perspectives. Abiding by the fundamental standards for the selection of reading materials for bibliotherapy and its proper implementation for high school students, the researcher hoped that the seven inspirational stories selected would definitely assist depressed female adolescents in the process of identification, catharsis, insight, universalization and projection. Therapeutic reading together with relevant processes and follow-up activities helped them to acquire fresh insight, to overcome their discouraged state of worthlessness, helplessness and hopelessness and to face the challenges of the stressful and negative events in their daily lives. The modules are the following: Module I: Have a Positive Experience; Module II: Creating Positive Experience; Module III: Enrich the Experience; Module IV: Absorbing an Experience; Module V: Linking Positive and Negative Material: Holding Two Things in Mind; Module VI: Learning to Want the Things that Are Good for You; Module VII: Filling the Hole
in the Heart; Module VIII: Healing for the Female Adolescents; Honor your Sincere Effort, Celebrate the Results; Conclusion. Evaluation of Taking in the Good Based-Bibliotherapy Intervention Program by the expert team: The researcher-designed intervention program had been evaluated by a team of experts which consisted of two practicing clinical psychologists, a psychiatrist and a literary expert. Their comments and suggestions were then incorporated into improving the program.
Method Participants From the total of two hundred and sixty female adolescent high school students of grade 7-10, thirty students, between the ages of thirteen and sixteen, were randomly selected from the pool of sixty high scored population in depression. The randomly selected thirty students were randomly assigned to the experimental group (N-15) and the control group (N-15). The Taking in the Good BasedBibliotherapy Intervention was given to the experimental group upon their consent and that of their parents while the control group had pursued their regular activities. A summary of the program was given to the control group after conducting the post-test. After the treatment, thirty participants were given the test to measure the effectiveness of the intervention program in reducing their level of depression and increasing positive cognitive appraisal. Moreover, to ensure the homogeneity among the sample participants, the following criteria were used: 1) They were the female adolescent Filipino high school students who were from urban areas and who belonged to middle class families. 2) Their age level was from thirteen to sixteen and grade level was 7-10. 3) They were selected on the basis of the result of their high scores in depression in the pre-test: Beck Depression Inventory-II (BDIII>14), Asian Adolescent Depression Scale (AADS>61) and Kutcher Adolescent Depression Scale-11 (KADS-11>12). 4) They were not participating in any other intervention program for six months. Respondents who were excluded from this research were students who did not have the consent of their parents. From the results of the tests and by assessing the inclusion and exclusion criteria, 30 participants were selected for the intervention program of the study. Randomization technique was used to assign the participant randomly to the experimental and control groups.
Procedures The data gathering procedure was organized in three phases: preexperimental, experimental and post-experimental. Pre-Experimental Phase: The first step in this study was the preparation of the Taking in the Good Based-Bibliotherapy Intervention Program. It included an extensive searching into the literature and various treatment programs in the relevant field. Consequently, the researcher wanted to contribute in an exceptional manner to the field of clinical psychology, by bringing together certain elements of neuroscience and principles of bibliotherapy, chiefly for the relief of adolescent depression. It was followed by 1) Coordination with the Directress of the School in Question in Quezon City, Philippines: The researcher visited the school and discussed with the directress for an effective execution of the study. The researcher forwarded a letter explaining the study and the relevance of the intervention program to the directress of the privately managed school. A visit to the guidance counselor and the
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Discipline Officer was done to explain the scope of the program for the female adolescents and thereby obtained their assurance of cooperation for the successful implementation of the study; 2) Ensuring Supervisory Presence in the Research Site: The researcher made sure that the supervisory presence of the students' counselor was there at the research site for any type of urgent situation to helping participants; 3) The school medical clinic was made available for the participants to rest and to relax, if they experience any kind of discomfort during the intervention as a result of emotional variance; 4) The service of the resident nurse was made available to participants in any situation of emergency in the followup activities; 5) The researcher, through the Office of the Guidance and Counseling, made arrangements for the parents/guardians to respond immediately if there was any crisis situation; 6) Ensuring Support of School Staff Especially in Case of Emergency: The researcher got the assurance from the directress that administration was supportive and that the resources were available. After obtaining permission, the researcher coordinated with the directress of the school for an effective execution of the study. Experimental Phase: Considering the ethical principles of the research, researcher treated both the experimental group and control group equally; therefore arrangements were made to meet the respondents in two groups at different setting. One week after the completion of the pre-test, researcher started to administer the taking in the good based-bibliotherapy intervention program to the experimental group while the control group was not exposed to the program. Intervention was a six week program which included eight modules and the duration of each module was 90 minutes. Each module included a session, focused mainly on “taking in the good” theory of Rick Hanson (2013) as well as an explanation of the principles of bibliotherapy and the vicarious experience of the life stories of other people. Researcher gave a summary of the program to the control group after conducting the post-test'. Post-experimental Phase: One week after the conclusion of the intervention program, researcher conducted the post-test for the two groups, using similar protocols to measure the difference between the two groups as well as to examine the possible cause and effect relationship between taking in the good based-bibliotherapy and the level of depression. The results were evaluated by subjecting the preintervention and post-intervention scores to statistical analysis for significant differences. After the administration of the post-test, debriefing was done with the participants of the study, namely the members of experimental and control group. Ethical Considerations: The researcher respected the rights, preserved the dignity and maintained the well-being of the participants in this study. Besides, the researcher observed the human-ethics guidelines of USTGS-ERC (UST Graduate School Ethical Review Committee) and procured the required certificate from ERC (Ethics Review Committee). The researcher solicited the consent of the participant and the parent/guardian through the office of the school's discipline officer after administration of the pre-test. The researcher obtained the informed consent of each of the participants, and the written consent of the parent or guardian to make sure the rights of the participants were well protected, since they belong to the age group of 13-16. The researcher respected the right of the parents to refuse or withdraw his or her child from the program at any time without condition. The researcher observed strict confidentiality about the pertinent information participants provided. The researcher made sure that
involvement of the student participants in this study was truly voluntary. The researcher made the arrangements with Directress of the particular school that, when the participants wanted to create an emotional connection through 'identification', they might experience emotional variance or pain and that might lead to screaming or weeping, they would be assisted responsibly. Therefore, because of these potential harms, the researcher of this study was fully aware of an obligation to be vigilant throughout the study for any indication that the participant might be experiencing distress.
Controlling extraneous variables To ensure the validity and reliability of the researcher-designed intervention program, researcher considered significant external aspects that could influence the result of the research. a) To avoid selection threat researcher attentively selected only those students who meet criteria to balance the homogeneity and to manage subject's characteristics: depressed female adolescent high school students, pre-test scores were high in depression, from an urban area, from middle class families with similar socio-cultural-economic backgrounds and who were in the age group of 13-16. Moreover, researcher used randomization of groups. The participants were randomly assigned into the experimental group and the control group. b) To minimize history threat, the researcher had made arrangements with the director of the school that both the experimental and the control groups would not participate in any other similar program during the period of study. c) To control maturation threat, the researcher gave six weeks (between the pretest and post-test), as the maximum interval between measurements. The program implementation was carried out cautiously to avoid boredom in the subjects. Further, a well selected and homogenous comparison group (control group) served as control of the maturation threat in this study. d) To manage testing threat, the researcher, researcher arranged time span of six weeks between pretest and post-test. It is assumed that this length of time is the most appropriate in the design of this study. e) To minimize the instrumentation threat, researcher used the same test materials and following the same procedures in both the pre-test and post-test to balance the condition. f) To limit location threat, researcher administered all tests to experimental group and control group at same location and at same time with same measurement in both the pre-test and the post-test.
Results and discussion The Composition of the Taking in the Good Based-Bibliotherapy Intervention Program Taking in the Good Based-Bibliotherapy Intervention is a six week program aimed at reducing depression and increasing positivecognitive-appraisal. The intervention program is consisted of eight modules, and the duration of each module was 90 minutes. A module included a session, focused mainly on “taking in the good” theory of Rick Hanson (2013) as well as an explanation of the principles of bibliotherapy and the vicarious experience of the life stories of other people. The researcher designed the program with the aim of imparting the fundamental principles of “taking in the good” from one's daily experiences, creating insight and helping oneself to become aware of one's own inner strength. Besides the time required for the eight modules, the interventionist conducted personal interviews with those participants who needed further assistance. The researcher formulated interview questions for the same.
Indian Journal of Positive Psychology 2015, 6(4), 331-339
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Table 1: Taking in the Good Based-Bibliotherapy Intervention Program No
Module
Time
Objective
Activity
I
Have a Positive Experience
90 Min
To help participants to become aware of a positive experience; to assist them to overcome feelings and thoughts of worthlessness
II
Creating Positive Experience: Look around and find something that makes you happy Enrich the Experience
90 Min
IV
Absorbing an Experience
90 Min
V
Linking Positive and Negative Material: Holding Two Things in Mind
90 Min
To help participants to focus on facts that could truly prompt a good experience; to support participants to conquer their feelings and thoughts of helplessness; to help participants to turn facts into experience. To help the participants to strengthen their neural traces by repeated episodes of taking in the good; to enable participants to get rid of feelings and thoughts of hopelessness. To increase the installation of an enriched experience by internalizing & sensing that experience is deepening in; to overcome the intensity of negative energy with positive energy in their lives and to help them to become more positive, appreciative and stronger in their lives. To assist the participants to keep the negative material in the background of awareness & holding the positive material in the foreground; to listen to the positive inner voice; to reduce rumination and co-brooding.
1) HEAL Activity: Find something pleasurable in the foreground-positive in front of your mind. Find something positive in the background of your awareness. 2)Reading Activity: Homeless student goes to dream college-Harvard 1) From fact to personifying experience; 2) “Aim for what the heart will remember”!
VI
Learning to Want the Things That Are Good for You
90 min
VII
Filling the Hole in the Heart
90 min
VIII
Healing for the Female Adolescents; Honor Your Sincere Effort, Celebrate the Results; Conclusion
90 min
III
90 Min
To learn to want the things which are good for them; to train the participants in generating peace, joy and contentment despite personal losses & adversities of their lives. To realize that they cannot change the past but they can use key experiences today to fill that hole in the heart; to assist participants to be creative and to realize their own giftedness. 1) To build up inner strength in the participants as contented individuals; 2) To learn inner strengths as related to the three core needs: namely safety, satisfaction and connection and to help them practice them on a daily basis; 3) To conclude the intervention program
The Concept of the Taking in the Good Based-Bibliotherapy Intervention Program: The intervention is formulated for the depressed female adolescents to overcome the feeling and thinking of worthlessness, helplessness and hopelessness. The modules are tailored to assist them to find positive meaning in the stressful events of life and to realize with fresh insight the inner power of everyday experiences. The intervention is instrumental in enabling them to build up their inner strength to face the challenges of stressful and negative life events by experiencing and absorbing their daily events with a positive attitude. The more intense degree of depression is reduced and they would move forward as contented and confident people. By practicing the HEAL methods and by obtaining insight through the application of bibliotherapy, participants overcome their prevailing bias of negativity, they find a positive meaning in ordinary
1) Staying Aware of Positive Experience 2) “I did not allow our bad experience with Yolanda disturb me but rather used it to do better in our examinations” 1) Coloring water-metaphor for absorbing an experience-for fleeting experience and absorbing an experience. 2) “I started to count all the things I still had, and it was a revelation”
1) 'I am for the positive. I am ready to immerse myself in the positive 2)“Be the scribe of your journey”
1) Hardwiring Your Happiness chart for inner strength, contentment, joy, happiness, and peace. 2)"I want my girls to be empowered” 1) Design your heart and fill it with positive experiences. 2) “When your bucket is full, you feel happy; when your bucket is empty, you feel sad and lonely” 1) Format for continuing the HEAL practices for their daily life. 2)Dictum based on the new insight they have gained;3) Briefing and evaluation by the participants;4) Final remarks & concluding message
and stressful daily events and they will see themselves, others and the world in new ways. Besides the time required for the eight modules, the interventionist conducted personal interviews with those participants who needed further assistance. The researcher formulated interview questions for the same. In every session, Practice of One minute for Good, adapted from Hardwiring Happiness by Hanson (Hanson, 2013) was done at the beginning; there would be practice of the HEAL steps (HEAL: Have a beneficial experience, Enrich the experience, Absorb the experience, Link positive and negative material); and there would be the reading of selected texts and guided discussion among the participants based on bibliotherapy principles. For the guided discussion, relevant questions had been formulated by the researcher based on the selected reading text and these were given to
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them after the reading. Full texts of these selected reading materials and particular questions for guided discussion were given in the reading activity section of each module. The homework-activity sheets for particular modules were given to the participants after the module. The following are the main concepts of each module: Module I: Enjoying a Positive Experience: The participants are helped to become aware of a pleasant feeling. This is done by remembering a pleasant sensation, by focusing on it, and by staying with that pleasant sensation. The objective can then be reached by intensifying the sensation and by letting it sink deep into the whole self. A human person has many different experiences, which give color and texture to his or her life. According to Hanson (2013), becoming aware of the different aspects of one's experience gives a greater sense of integration and inner wholeness. The major elements in an experience are thoughts, sense perceptions, emotions, desires, and actions. As part of the “HEAL” activity, participants were asked to bring something pleasurable to the foreground of their minds; to find something positive in the background of their awareness and bring that feeling to their inner core: “Have a positive feeling, quiet yourself, enrich your feeling and stay with it. Find a feeling and let it be felt by your whole body. Absorb it.” Synopsis: Homeless Student Goes to Dream College-Harvard. Dawn's family was extremely dysfunctional. Her primary needs: safety, satisfaction and connection had not been met. However, she was able to overcome all of these adverse life situations by drawing on her positive inner strengths. Module II: Creating a Positive Experience: Look around and find something that makes you happy or think of something that makes you happy: People like to perform a specific action either simply to feel good or to meet a challenge (Hanson, 2013). By performing these actions, they are able to activate useful states of mind in themselves. The states of mind that would be most useful are often those that are hardest to generate by oneself. However, with practice, one can make progress. As one internalizes the experiences one creates, these experiences will remain as inner strengths and become a shield in critical times. This process is essential for a person's psychological well-being, effectiveness, personal growth and spiritual maturity. People may see a good “fact” but may not have any feeling about it. This ability to turn “fact” into experience may appear effortless, but it is a very important skill in order to create a positive experience. According to Hanson, neither the event nor the conditions of the event but a person's own experience of a “fact” is what is essentially important. In the process of creating a beneficial experience, the participants were taught and guided to create a positive experience by finding good “facts” in their immediate situation, in recent events, in stable conditions, their own qualities, their past treasures, or in the anticipation of good facts in the future, sharing the good with others, finding something good even in bad events, in caring about others, in seeing good in the lives of others, in imagining good facts, in producing good facts, in evoking a good fact directly and in seeing life as opportunity. For the HEAL activity the interventionist guided the participants “from fact to personalizing experience”, to help thoughts about a good fact to become good feelings, sensations, and desires. Synopsis: Aim for What the Heart will Remember! Neil lost his beloved father while he was still a college student and he had to shoulder all the responsibilities for the family immediately. The fact that he had had an excellent academic record all through his studies helped him to obtain a scholarship, which enabled him to continue his study and help his family, too.
This message was delivered by Mr. Neil Stephen Augusta Lopes on 02/04/2012 on the occasion of his graduation. Module III: Enrich the Experience: According to Hanson, there are five major factors that boost an individual's capacity for learning and are the ways of converting fleeting mental events into lasting neural structures (Hanson, 2013). When an individual repeatedly practices the episodes of taking in the good, there will be further neural firing in the neural pathways and this will strengthen the neural traces. The following are the five major ways or factors: 1) Duration - Helping a good experience to last for a few seconds longer; then activating and reactivating it, e.g. recalling the memory of having a delicious dinner. Recognize the pleasure. Stay there for three to five minutes. Give your mind over to it. Let it have you. Make room for it. Let there be a sanctuary for it in your mind. If a negative experience comes in, acknowledge it, but stay with your positive experience. Tell yourself 'stay with this'. Try to name the experience. Gently call the experience by name. Repeat it three to five times. 2) Intensity This is to encourage positive experiences to become more intense and to feel as good as possible; to become aware of things that are rewarding. Hanson observes that, as the intensity of experience increases, the levels of the neurotransmitter norepinephrine increases, and results in the formation of new synapses. Therefore, the more an experience nurtures new synapses, the more it gets merged into the brain. 3) Multimodality - This is to help the participants to become aware of as many aspects of the experience as possible: Good qualities of your friend; related with sensation, experience, desires and actions; get an image of the stream of good things. 4) Novelty -This is to help the participants to look for diverse aspects of an experience. According to Hanson, each time a person's attention moves to another aspect of an experience, it is a new thrust to the brain, because the human brain is a novelty dictator. Every experience is inimitable and it promotes a sense of freshness and novelty. Thompson stated “You are a living bodily subject of experience and an inter-subjective mental being” (Thompson, 2010). So it essentially supports neurogenesis. 5) Personal relevance - This is to assist the participants to use the natural process of relevance, seeking to build up the neural traces by positive experiences. Helping them to become aware of how an experience of “taking in the good” can help, and how this is valuable. It is like telling oneself that 'this is what I need, this really feels good and this is right for me' and doing so on a regular basis. For the HEAL activity, Staying Aware of Positive Experience; interventionist guided the participants to the experience and in sustaining it. For instance, as they are seated, let them become deeply aware of being placed in a comfortable chair. The more they become aware, the more they are in touch with the experience, as they become conscious of the present moment. Synopsis: “I did not allow our bad experience with Yolanda to disturb me, but rather, I used it to do better in my examinations”. By attaining first place in the examination for Certified Public Accountants (CPA), Edusma showed that the bad experiences, which he and his family had experienced during Yolanda (Super typhoon Haiyan, 2013), could in no way rob him of his determination and commitment. Module IV: Absorbing an Experience: Hanson (2013) theorized that enriching an experience will heighten its installation or registration in the brain as a person is intensifying and prolonging neural action which obviously tends to construct neural structure. It is also like recalling a mental picture of a sunrise or a sunset or a beautiful scene from the nature's wonders. Good experience makes its way into the
Indian Journal of Positive Psychology 2015, 6(4), 331-339
brain. As you are sinking into it, it is sinking into you. By the practice of absorbing an experience, an individual tries to have the willingness and the courage to change and to grow. By this practice he becomes more appreciative and positive in life and even stronger in facing the challenges of life. It is because the mind takes its shape from what it rests upon and an individual lets it mold itself around the positive experience that he is taking in. If you keep resting your mind on self-criticism, worries, grumbling about others, hurts, and stress, then your brain will be shaped into greater reactivity, vulnerability to anxiety and depressed mood, a narrow focus on threats and losses, and inclinations toward anger, sadness, and guilt. If you keep resting your mind on good events and conditions, pleasant feelings, the things you want to do get done, physical pleasures, and your good intentions and qualities, then over time your brain will take a different shape, one with strength and resilience hardwired into it, as well as a realistically optimistic outlook, a positive mood, and a sense of worth. For the HEAL activity, Coloring water a metaphor for absorbing an experience- a fleeting experience-and absorbing it, participants were asked to add oil and food coloring or sugar or salt in particular glass of water. They were asked to come up with insights in relation to their experiences in life. This was to help them to more knowledge about absorbing an experience from daily life. Synopsis: “I started to count all the things I still had, and it was a revelation!” A motor accident abruptly shattered in one moment his long-cherished dream and future plans for his career and for his family. Mustering all the positive aspects of his life, Leon started to write academic books on Computer Information and Programming, books which became best sellers in the field. He wrote and published more than 50 books. His is an amazing story. Module V: Linking Positive and Negative Material: Holding Two Things in Mind: As the participants were rooted in their positive experiences, they were guided to link these positive experiences with negative ones. They may hold both the negative and positive material in awareness as long as possible. This was to let go of the negative and allow them to persevere in the positive for a further few minutes. Negative material has negative consequences such as darkening the mood, increasing anxiety and irritability, making a person overreacts to others, wearing down mental and physical health and shortening the life span. To practice this fourth step, the participants were reminded of the three requirements: 1) they have to hold two things in mind at once; 2) they cannot allow themselves to be robbed by the negative material; and 3) they have to keep the positive material more in focus. By linking positive and negative, Hanson argued, (Hanson, 2013) one injects medicine for what troubles the mind directly into the neural networks where pain, distress and dysfunction are recorded. For HEAL activity, participants were asked to they were asked to design a poster with the caption “I am for the positive, I am ready to immerse myself in the positive”. Synopsis: “Be the scribe of your journey”. A 'wrong turn', as Luma drove back to home after office hours, changed her life perspective totally. Her wrong turn subsequently became a “right turn” in the lives of many. She co-founded Fugees, an organization for refugee children. Module VI: Learning to Want the Things That Are Good for You: As children grow up, there are stages in which they behave in an exceptionally reserved manner. A child knows that his parents want him or her to talk to others and to interact with strangers to help him/her to overcome timidity. Although children may try for a time, they do not continue. It is possible for a person to attempt continually
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to internalize rich experiences of great happiness; such experiences will steadily affect his brain (Hanson, 2013). These attempts will gradually make people realize a sense of worth in staying true to one's goal in life. For the HEAL activity, participants were guided to design a Hardwiring Your Happiness chart for a week with selected themes of inner strength, contentment, joy, happiness, and peace. Synopsis: “I want My Girls to be empowered”. As the result of accidental death of her son, Tina's perspectives on life became transformed. She sold her International Company and became a committed person to teenage mothers and their problems. Module VII: Filling the Hole in the Heart: From the moment of conception/birth, our needs are manifold. Some of them, such as the need to be loved, to be cared for, and to be appreciated have not been as fully met as we would wish. In a sense, we remain “malnourished.” Experiences of malnourishment can create a hole in one's heart: a hole which can deepen as we grow older. Gradually, the individual will fill that hole with negative experiences drawn from the environment. However, as he becomes more conscious of “taking in the good” experiences and retaining them, he will begin to build up an inner strength that will satisfy the unfilled needs of the past. For the HEAL activity, participants were asked to design a heart and fill it with positive experiences. Synopsis: “When your bucket is full, you feel happy; when your bucket is empty, you feel sad and lonely”. Inspired by some stories of charity, Eng decided at the early age of 11 to do something beautiful for children in the Philippines. Module VIII: Healing for the Female Adolescents; Honor Your Sincere Effort, Celebrate the Results; Conclusion: Repeatedly internalizing positive experiences builds up inner strength. These inner strengths become stable traits and an enduring source of wellbeing. They may include wise and effective action, contribution to the lives of others, a steady, positive mood; common sense; integrity, inner peace; determination; a warm heart; self- compassion; secure attachment; emotional intelligence; learned optimism, the relaxation response; self-esteem, self-regulation, tolerance of distress, resilience, and executive functions. Participants were asked to plan a definite program and to practice it regularly. Such a program might include building the capacity to keep oneself safe and the sense of feeling safe by regularly finding a refuge, feeling “all right” now and being at peace. She can build up both her capacity to be satisfied and her sense of feeling satisfied by regularly stimulating enthusiasm, feeling the fullness of this moment in contentment. She can build up her capacity to be connected by regularly taking in the feeling of being cared for, by feeling herself to be a good person and by feeling loved (Hanson, 2013). For the HEAL activity and as part of the conclusion of the program, interventionist guided the participants to express a format for continuing the HEAL practices for their daily life. Additionally, participants were challenged to formulate a dictum/motto, based on the new insight they have gained from the entire intervention program and to share it with the group. The implementation of the Taking in the Good Based-Bibliotherapy Intervention Program: Researcher implemented eight module treatments for the participants of the experimental group. The researcher analyzed the data by employing percentage and frequency distribution, mean scores, standard deviation, dependent t-test, independent t-test statistics and Cohen's d. The null hypothesis was tested at the 0.05 level of significance. The statistical analysis between the pre-test and post-test scores of the
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experimental group showed significant difference (p=.000) and the scores of the control and experimental group showed significant difference (p=.000) in all the dependent variables in the post-test. These results revealed that the “Taking in the Good basedBibliotherapy Intervention” was effective in reducing depression in female adolescents. The primary aim of this study was the development and testing the effectiveness of the “Taking in the Good Based-Bibliotherapy Intervention Program” for alleviating depression and thereby equipping female adolescents to face stressful life events and to overcome the negativity bias. In general, the results support the effectiveness of this intervention program. By using a 'pre-posttreatment-control' design, the present study discovered that the intervention had brought about a significant reduction in depression among female adolescents. The findings show that the treatment (i.e. the experimental) group had experienced significant changes, in that they had become secure, satisfied, and connected. They had gained inner strength in facing everyday stressful and negative life events and they had become confident and contented. They had not only attained an increased level of positive cognitive appraisal, but had also acquired an increased sense of peace, contentment, and love. This research study is unique because, for the first time, an intervention program has succeeded in combining the “taking in the good theory” with bibliotherapy for the alleviation of depression in female adolescents. The treatment used the hidden power of daily experience to build neural structures that created contentment, confidence and peace in female adolescents. The intervention confirmed the power of inspirational stories to create new insight into the crises and depressing conditions and to shed light on the three basic needs: for safety, for satisfaction and for connection. The study has taught the adolescent participants to find, to create and to nurture their positive experiences and the inner strength that will help them in both personal and collective ways not merely to endure and accomplish their goals, but to prosper fully as people with an increased sense of peace, contentment, and love.
Limitations There are limitations to the study that can affect the generalizeability of the results such as limited research settings and limited period of research. Recommendations: First, the present study represents the first experimental investigation of its kind combining taking in the good with bibliotherapy to reduce depression among the female adolescent high school students in the Philippines. The techniques used in this intervention will give the clients a comfortable intimacy with their experiences, a confident openness to life and a sense of competence and maturity in controlling their own thought processes. Therefore, outcome of this pioneering study provides valuable contribution to the field of psychology, psychiatry and education. Second, this prospective treatment design optimizes the effectiveness of bibliotherapy as it aims at creating positive insights, while the HEAL process focuses on taking in positive experiences and installing them in the brain. Third, Filipino adolescents found the “taking in the good based-bibliotherapy” and its approach so effective and enjoyable. Extensive application of a positive neuroplasticity program like this could make the clinical psychology and psychotherapy treatment more enjoyable and more appealing to clients. Therefore, the researcher recommends its strategies integrating into psychotherapy. Fourth, in the light of the
development of neuroscience, the effectiveness of positive neuroplasticity, and the outcomes of the present study, researcher strongly recommends practice of integrating positive neuroplasticity into the curriculum for undergraduate and graduate students of psychology and health sciences. Through seminars and workshops, the average adolescent could be introduced to the benefits of the practice of “taking in the good” on a daily basis, thus converting normal everyday experiences to personal benefit.
Conclusion In spite of certain limitations, the findings demonstrated that combining the taking in the good theory with the principles of bibliotherapy is highly effective in modulating the level of depression. Since there is a significant difference between the experimental group and control group in terms of the post-test scores, the researcher-designed intervention program is effective in reducing the depression level. Since there is a significant difference between the pre-test and post-test mean scores of the experimental group, the intervention program proves to be very effective in reducing the level of depression. Because of the effectiveness of this study, this newly developed Taking in the Good BasedBibliotherapy Intervention Program can be used as an effective tool for reducing the level of depression.
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Young, J.F, Miller, M.R., & Khan, N. (2010). Screening and managing depression in adolescents. Adolescent Health, Medicine and Therapeutics. 187-95. References for Seven Inspirational Stories of Reading Activity 'Homeless student goes to dream college-Harvard”! Retrieved from www.cnn.com/2012/06/07/us/fromjanitor-to-harvard/ “Aim for what the heart will remember”! Message by Mr. Neil Stephen Augusta Lopez of De La Salle University 02/04/2012. “I did not allow our bad experience with Yolanda to disturb me but rather used it to do better in our examinations”. Out of Tacloban, survivor tops CPA board examination by Joey A. Gabieta http://newsinfo.inquirer.net/625827/out-of-tacloban-survivortops-cpa-board-exams “I started to count all the things I still had, and it was a revelation. If I hadn't met with that road accident, I may never have written a book” Retrieved from http://www.alexisleon.com; Vidhi Nirashapedunna Idangal (Space where fate distresses) http://www.deepika.com/feature/SpecialNews.aspx?ID=2109&topicId =25 'Be the Scribe of Your Journey”. Ben-Shahar, Tal. (2012). Choose the Life You Want: The Mindful Way to Happiness. New York: The Experiment. (p.213). "I want my girls to be empowered” Retrieved from www.cnn.com/SPECIALS /cnn.heroes/2012.../catalina.escobar.html “When your bucket is full, you feel happy; when your bucket is empty, you feel sad and lonely” Fil-Am Girl fills Badjao Kid's Buckets with Happiness by Nina P. Calleja, August 2, 2014 Retrieved from http://globalnation.inquirer.net/108819/fil-am-girl-fillsbadjao-kids-buckets-with-happiness/
