Using Positive Psychology to Enhance Well-being

By Arthur Graber, Pharm.D., PGY1 Pharmacy Practice Resident, Medstar Georgetown University Hospital

Do we really want our students to merely learn how to be successful in their work environments … or do we want them to thrive and have a high sense of well-being?  Recently, the study of “positive” psychology (PP) has taken flight. This is a new type of psychology that focuses on the achievement of well-being. In traditional psychology, there is a focus on solving a problem and correcting weaknesses.  However, the positive psychology perspective states that if you focus on your strengths and talents, you will indirectly address your weaknesses and achieve success.¹ PP is an exciting area of focus that can help people discover meaning in their lives and build resilience in tough times.

Residency training and medical education are some of the psychologically hardest times for young professionals.  Not exactly the best time to learn how to flourish into well rounded, patient-centered practitioner.  Indeed, the rate of emotional exhaustion and depersonalization among medical residents and students has been estimated to be between 40% and 70%.² Burnout adversely affects judgment and clinical decision-making as well as undermines satisfaction.¹ In order to prevent burnout, it is important for educators, preceptors, and (most importantly) students to understand how they can improve their experience, develop a sense of

well-being, and make the most of the educational experience.

Well-being encompasses a wide range of factors including the following components: Positive emotion, engagement, meaning, positive relationships, and accomplishment.³ Put into play, these elements create an environment that allows students to flourish.

Positive emotion or as Dr. Seligman, one of the founders of PP, likes to describe it, living the pleasant life, is the component that encompasses happiness and life satisfaction.  Engagement is also pleasurable but we realize it only in retrospect. “Wow, I got lost in what I was doing!”  Engagement occurs when a person uses their personal strengths and virtues in a manner that causing them to experience “flow.”³  For a teacher, the use of “strength-based education” is a shift in paradigm from focusing on the clinical expertise of the instructor to one of cooperative management and exploration of the skills, knowledge, and resources of each student.¹ Students can be coached to determine what their strengths are and evaluate if potential projects, work settings, and other life pursuits provide opportunities for the student to use their strengths.⁴  Meaning, belonging to and serving something greater than yourself, is another measure of well-being.  Positive relationships add significantly to a person’s well-being. Relationships allow us to perform acts of kindness for others.  It is through acts of kindness that we can produce the most reliable increase in our sense of well-being.³  And finally, Accomplishment can be objectively measured and describes what people pursue in order to increase their well-being.³

Activities that allow us to build our positive emotions, engagement, meaning, positive relationships, and accomplishment substantially increase our sense of well-being.   Those who have a sense of well-being are in a better position to learn and to perform well in their responsibilities.  The following exercises can be applied by teachers to increase student well-being:⁵

Reflective Learning Exercises

Three Good Things

• Activity: Write down three positive events that happened during the work day every night for one week and answer the question of why the positive outcome occurred.
• Benefit: Provides changes in perspective, a cognitive-behavioral strategy, to improve stress management and self-care. It can also be used as a reflection strategy to understand how to approach future endeavors in order to get more positive results. These lessons can be shared with group members.

Not Always, Not Everything

• Activity: Reflect on negative outcomes and attribute them to factors that are not innate to the student and are temporary and specific.
• Benefit: This allows students to see that failure may be situational instead of innate and allow them to perform better in subsequent attempts.

Satisfice more

• Activity: Choose to purposely do what is good enough as opposed to maximize, a.k.a. obtain the best possible outcome by default. Determine what features are desired and pick the first option that meets those criteria.
• Benefit: Teaching this skill to students builds efficiency. It can teach students the importance of prioritizing effort for for major projects, while doing less for minor ones and still obtaining positive outcomes while lowering stress levels.

Team-Building Exercises

Capitalization

• Activity: Spend time sharing positive news and events that occurred such as the events stated in the above activity.
• Benefit: For residency programs, the development of a structured support group that meet regularly in order to share positive events and accomplishments instead of just problems may improve and enhance the quality of the work/education setting.

Personal Development Exercises

Signature Strengths

• Activity: Identify your top strengths by visiting www.authentichappiness.org. Aim to use these strengths intentionally every day or choose one to develop.
• Benefit: This is one of the best methods of developing skills and overcoming weaknesses while increasing active learning. Using these strengths purposely for one week has been associated with increased happiness and less depression up to 3 months into the future.

Since fit between academic interest and career reduce the risk of burnout, using activities aimed at cultivating positive behaviors and the development of personal strengths will benefit students and teachers. These benefits are related to achieving greater student engagement as well as promoting mindful empathy, critical thinking, professionalism, and stress management.¹

References

1.  Pedrals NG, et al. Applying positive psychology to medical education. Rev Med 2011; 139: 941-9.

2.  Thomas NK. Resident burnout. JAMA 2004; 292: 2880-9.

3.  Seligman MEP. Flourish.  New York: Free Press, 2011.

4.  Skerrett K. Extending family nursing: concepts from positive psychology.  Journal of Family Nursing 2010; 16: 487-502.

5.  Hershberger PJ. Prescribing happiness: positive psychology and family medicine.  Family Medicine 2005; 37: 630-4.

What Do Elvis Presley and Aristotle Have in Common? Metaphor!

by Peggy Kraus, Pharm.D., Clinical Pharmacy Specialist, the Johns Hopkins Hospital

Aristotle once observed that “Those words are most pleasant which give us new knowledge.  Strange words have no meaning for us; common terms we know already. It is metaphor which gives us most of this pleasure.”

The word metaphor comes from the Greek words meta or “over, across” and pherein or “to carry.”¹  They are often used in education to help “bridge the distance” (a metaphor) between what students already know and what they need to know.¹  Every metaphor highlights one aspect of the concept, just as it hides another.¹  George Lakoff, Professor of Linguistics at University of California, Berkeley and Mark Johnson, Knight Professor of Liberal Arts and Sciences at University of Oregon, called this “metaphorical systematicity.”¹ Are we not “bridging the distance” through distance learning (yep a metaphor) thanks to the power of technology in our own class?

Metaphors can be used to create a pattern and expectations, shape the way we think, and influence the decisions or thoughts of others. ^1,2,3  In education, are we not trying to do these very things?  We need to relay complex, often abstract concepts.  Metaphors can help students understand the concepts.⁴

Using “the web” as a metaphor for the Internet highlights some of its essential characteristics while making other, non-web-like qualities less apparent.¹   Information is education (another metaphor).¹ Some assume information transmission is the main purpose of education, or that the content of education is synonymous with information.¹  But if this were the case, the internet would do away with the need for schools and colleges.¹ What is lost or hidden in this metaphor is that attending too closely to information overlooks the social context that helps people understand what the information means and why it matters.¹ This information needs to assimilated, understood and made sense of, and that understanding is different depending on the learner.¹

We use metaphors as a bridge to understand educational contexts.  Researchers and participants often draw on pre-existing knowledge to explain current experiences.³ Metaphors accomplish this by enabling the connection of information about a familiar concept to another familiar concept.³ That can lead to a new understanding in which the comparison between the two concepts acts as generators for new meaning(another metaphor).³  They can be used to take knowledge that is already held and build the scaffold (another one) to teach or learn a newer concept.⁴

In order to examine the use of metaphor, Devon Jensen classified metaphors into four categories: active, inactive, dead, and foundational.³  Active metaphors carry saliency between the topic and vehicle terms.  For example, “This school is a real melting pot.”³  Inactive metaphors, the optic term must be interpreted through the vehicle term just as “The car race ended in a massacre.”³  Dead metaphors , the saliency between the topic and the vehicle terms are not apparent to due a lack of knowledge or experience with the characteristics of the vehicle term.  For example, “working downtown is a real rat race” is only understandable to modern man when the concept of a “rat race” is explained; few of us today have had experience or witnessed rats in a frenzy. ³  The last category, foundational, the metaphor defines the centrally important features of the concept.  Example: “ organization as machine.”³

Jensen then used these classifications and searched for studies that used metaphors and metaphor analysis as their central method.³  He found 1,128 studies, which surprised me.  He then classified the studies into five major themes. Studies in theme one attempted to raise awareness of modern metaphors that legitimized social process with regard to power and politics.³ In the second theme, these studies examined the metaphoric usage within an educational setting and led to change in education practice, policy and/or roles.³ The third theme was a group of studies that examined techniques and procedures for measuring, understanding, and interpreting metaphors in educational and literary writing.³ Theme four examined the usages, implementation, and/or analysis of metaphor in student, school, and institutional writing.³ And the last theme was on qualitative education research characterized by studies that look at how participants use metaphor to describe existing educational states.³  Metaphors can be myths that limit growth or new ideas that expand possibilities.³

One must be careful about the use of metaphors because it can lead to confusion or misunderstanding.⁴ This is particularly true when there are culture differences between students and instructors or when the metaphor is too old for a younger audience to understand.  Metaphors mean different things to people of different cultures and ages.

James Geary, a writer and the former European Editor of Time, during his TED talk entitled "Metaphorically Speaking" claims that we use six metaphors a minute.²  I really did not spend much time thinking about metaphors until I started working on this blog, but I now recognize that I use them a lot without even realizing it.  Geary starts his presentation by analyzing the many metaphors found in Elvis Presley’s song, “I’m All Shook Up.”  It might sound a little weird but its an interesting analysis.  Later in his presentation, he draws parallels between  René Descartes famous philosophical declaration and Elvis’ song.  “I think therefore I am” was translated into English from the Latin “cogito ergo sum.”   But according to Geary, the literal translation should be “I shake things up, therefore I am.”  So perhaps Elvis was trying to tell us something really deep through the use of metaphor!

References:

1.  Meyer, K.A. Common Metaphors and Their Impact on Distance Education: What They Tell Us and What They Hide. Teachers College Record. 2005; 107 (8):1601-1625.

2.  Geary J.  Metaphorically speaking. TED.com.   Accessed February 20, 2013.

3.  Jensen, D.F.N. Metaphors as a bridge to understanding educational and social contexts. International Journal of Qualitative Methods 2006, 5(1), Article 4. Accessed March 30, 2013.

4.  Ritcher, R. The use of metaphors in teaching and learning. The teaching tomtom. Accessed March 30, 2013.