Dear editor,
Positive psychology is a relatively new area in psychology. But, in my opinion it was saved under the physician patient relationship and communication skills during medical interview cover over many years. If we begin to talk about physicians’ essential therapeutic skills, primary care physicians will recognize the “support” term. The aim of positive psychology is to help people be happier, to make them to belive in the health related advantages of happiness, to emphasize the importance of using the scientific interventions to determine how things may go right and to support people to live a happier and healthier life. On the other hand, many academic organizations of family medicine retain patient-centeredness as a core concept and mean a family physician (also a family medicine student, resident…) who improves the health and wellbeing of the patients, care givers and people.¹

A variety of interventions have been developed in Wellbeing/Positive Psychology (PP) area. The aim of all these interventions is to facilitate positive emotions, wellbeing, growth, creativity, relationships, family or partner affairs, life satisfaction, and other desirable consequences. PP interventions facilitate the relationships, review the possibilities in the future, develop the applicants’ strengths, enhance their appreciation of life, and foster a spiritual awakening. One of the basics in family medicine is holistic approach and bio-psycho-social wellness. Negative feelings, stressor events and strains in life such as; marital adjustment, problems in family relationship, unanticipated, undesired, and acute events (such as death, rape, war, and natural disaster) or the effects of long term demands (such as chronic illnes, economic depression, unemployment, addiction, and migration or separation from the family or spirituality because of some obligations), all of them predict a decrease in physical, psychological, and social well-being, in health promotion and coping with illness. It is obvious that to present health promotion and to empower the patient to be able to cope with the illness are the objectives of a family medine.²

PP interventions are about the fundamentals of happiness and to make the person to be aware of his strengths. Across several studies, some of the participants were exposed to these programs. They learnt about the principles of wellbeing and self-efficacy, including the importance of a busy life, social interactions, close relationships, meaningful work, organized plans, plausible expectations, orientation to the present, maintaining integrity, and optimistic thinking. In some of the studies, other participants were assigned to various control groups to investigate the effect of the intervention. Seligman, Rashid, and Parks³ developed a procedure that was designed to enhance happiness and wellbeing for the people who ask for consultancy. Family physicians can learn that kind of structured procedures and use them. To ask for gratitude is another important character of PP interventions. Without gratitude, individuals would not reciprocate the support of one another. Therefore, gratitude encourages individuals to perceive cooperation, one another as affiliates who could help each other and, for example, increases the likelihood to mimic one another as a sign of trust and affiliation.⁴

Among these fundamentals, the most interesting ones for a family physician were: to identify the strengths today and be positive and helpful about the future. These two major interventions selected to inform the family physicians aim:

1- To explore and identify the key strengths of a person’s personality and attempt to apply these strengths to one’s own daily life (how to savor and enjoy daily experiences). This intervention provides the patient the possibility to understand the strong sides of themselves, to be aware about the self-efficacy, the best possible selves. Because that kind of interventions will be helpful for the patients who need support to increase their motivation for the adherence to the treatment.

2- To learn how to react positively, enthusiastically to favorable news from someone else and to be hopeful. (positivism and hope) This is important for the primary care physicians especially to motivate their patients who need behavioral change. For example, substance abuse and smoking as the most common problem that we deal with in primary care.

In a study by Lyubomirsky⁵ and Peters⁶, participants who completed the best possible selves exercise, experienced more elevated levels of positive affect regarding to the participants who merely wrote about the activities they completed over the last 24 hours. They also have experienced more flow. Indeed, many studies have confirmed this exercise enhances facets of wellbeing. The best possible selves, is an activity in which individuals write about the feelings and events they would experience if their life unfolded as favorably as possible in various domains, such as work, school, social life, or health. They are asked to think about the best possible life that could actually unfold in some setting, such as university, receiving excellent grades may be an example. Individuals are usually instructed to write for 10 minutes or so with any style they like. Next, they dedicate 5 minutes, writing about a specific goal or activity that could facilitate this best possible self. As a conclusion, it is observed that participants who reflected positive events, experienced more happiness and less depressive mood. It may be possible to tell that positivism will cause less depression in the near feature if there are some scientific research that should test the long-lasting effect of the intervention after months, too.

As Wood, Linley, Maltby, Kashdan, and Hurling⁷ showed, in a longitudinal study, the use or application of strengths seems to curb stress and increase self-esteem and vitality and this state will help the applicant to feel himself in a better state. In this study, participants completed a measure that gauges the extent to which they utilize their strengths. Typical questions include “I achieve what I want by using my strengths”, “I am able to use my strengths in lots of different ways”, and “My work gives me lots of opportunities to use my strengths”. In addition, participants completed measures of perceived stress over the last month, self-esteem, and vitality. The measure of vitality included questions like “I feel alive and vital”. These measures, apart from the questions on the degree to which they utilize their strengths, were administered on three occasions, over the six months. Application of strengths at one time was associated with reduced stress as well as increased self-esteem and vitality three and six months later. These findings confirm the benefits that apply when individuals are granted opportunities to apply their strengths.

Proctor, Tsukayama, Wood, Maltby, Eades, and Linley8 showed that strength based interventions can be applied to students in Years 7, 8, and 9 in high school-that is, when students are around 12 to 15 in age. Over six months, students were encouraged to identify their key strengths and become more sensitive to these strengths. For example, they were encouraged to write about or draw about occasions in which they, or someone they knew, exhibited and utilized a specific strength. In addition, throughout the day, they were encouraged to identify or utilize these strengths. This program significantly improved life satisfaction. According to the researchers, when individuals apply their strengths, they experience a sense of fulfillment, choice, and authenticity, improving their wellbeing. Even the recognition of personal strengths is positively associated with some outcomes. The strengths are associated with healthy behaviors in general. The emotional strengths in particular were also associated with physical fitness, motivation and life satisfaction.

As a conslusion PP interventions are usefull in general medicine, so can be learned and used as a tool by the family physicians to overcome all the stressors. The skills of the family physicians related to this subject must be improved through continuous professional development activities.

1. Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy—spiritual well-being scale (FACIT-Sp). Annals of Behavioral Medicine 2002;24(1):49–58.
2. Lavee Y, McCubbin HI, Olson DH. The Effect of Stressful Life Events and Transitions on Family Functioning and Well-Being. Journal of Marriage and Family 1987;49(4):857-73.
3. Seligman MEP, Rashid T, Parks AC. Positive psychology progress: Empirical validation of interventions. American Psychologist 2006;60:410-21.
4. Jia L, Lee LN, Tong EMW. Gratitude facilitates behavioral mimicry. Emotion 2015;15(2):134-8. doi: 0.1037/emo0000022
5. Lyubomirsky S, Dickerhoof R, Boehm JK, Sheldon KM. Becoming happier takes both a will and a proper way: An experimental longitudinal intervention to boost well-being. Emotion 2011; 11:391-402.
6. Peters ML, Flink IK, Boersma K, Linton SJ. Manipulating optimism: Can imagining a best possible self be used to increase positive future expectancies? The Journal of Positive Psychology 2010; 5:204-11.
7. Wood AM, Linley PA, Maltby J, Kashdan TB, Hurling R. Using personal and psychological strengths leads to increases in well-being over time: A longitudinal study and the development of the strengths use questionnaire. Personality and Individual Differences 2010; 50; 15-19.
8. Proctor C, Tsukayama E, Wood AM, Maltby J, Eades JF, Linley PA. Strengths Gym: The impact of a character strengths based intervention on the life satisfaction and wellbeing of adolescents. Journal of Positive Psychology 2011; 6:377-388. doi: 10.1080/17439760.2011.594079