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Behavior Research and Therapy, 25, 124.

Positive Psychotherapy
Martin E. P. Seligman, Tayyab Rashid,
and Acacia C. Parks
Positive Psychology Center, University of Pennsylvania

Positive psychotherapy (PPT) contrasts with standard

interventions for depression by increasing positive emotion,
engagement, and meaning rather than directly targeting
depressive symptoms. The authors have tested the effects of
these interventions in a variety of settings. In informal
student and clinical settings, people not uncommonly
reported them to be life-changing. Delivered on the
Web, positive psychology exercises relieved depressive
symptoms for at least 6 months compared with placebo
interventions, the effects of which lasted less than a week.
In severe depression, the effects of these Web exercises
were particularly striking. This address reports two
preliminary studies: In the first, PPT delivered to groups
significantly decreased levels of mild-to-moderate
depression through 1-year follow-up. In the second, PPT
delivered to individuals produced higher remission rates
than did treatment as usual and treatment as usual plus
medication among outpatients with major depressive
disorder. Together, these studies suggest that treatments
for depression may usefully be supplemented by exercises
that explicitly increase positive emotion, engagement, and
meaning.
Keywords: positive psychology, depression, psychotherapy,
strengths

For over 100 years, psychotherapy has been where clients

go to talk about their troubles. In addition to trying many
brands of psychotherapy, every year hundreds of thousands

Editors Note
Martin E. P. Seligman received the Award for Distinguished Scientific Contributions. Award winners are invited
to deliver an award address at the APAs annual convention. A version of this award address was delivered at the
114th annual meeting, held August 10 13, 2006, in New
Orleans, Louisiana. Articles based on award addresses are
reviewed, but they differ from unsolicited articles in that
they are expressions of the winners reflections on their
work and their views of the field.
November 2006 American Psychologist

of people attend retreats, workshops, camps, and courses

where the focus is nearly always on repairing negatives
symptoms, traumas, wounds, deficits, and disorders. These
activities are based on a bold (but largely untested) axiom
that talking about troubles is curative. Be that as it may,
positives are rarely the focus of therapy, and never are they
systematically so.
In its emphasis on troubles, psychology has done well
in ameliorating a number of disorders but has seriously
lagged behind in enhancing human positives. Mental health
in the hands of talk therapy is all too often seen as the
mere absence of symptoms. Although notions such as individuation, self-realization, and peak experiences (Maslow,
1971), full functioning (Rogers, 1961), maturity (Allport,
1961), and positive mental health (Jahoda, 1958) dot the
literature, these are mostly viewed as by-products of symptom relief or as clinical luxuries that, in this rushed age of
managed care, clinicians cannot afford to address head on.
Indeed, therapies that attend explicitly to the positives
of clients are few and far between. The first we know of
was created by Fordyce (1977), who developed and tested
a happiness intervention consisting of 14 tactics, such as
being more active, socializing more, engaging in meaningful work, forming closer and deeper relationships with
loved ones, lowering expectations, and prioritizing being
happy. He found that students who received detailed instructions on how to do these were happier and showed
fewer depressive symptoms than a control group (Fordyce,
1977, 1983). More recently, Fava and colleagues (Fava,
1999; Fava & Ruini, 2003) developed well-being therapy
(WBT), which is based on the multidimensional model of
psychological well being proposed by Ryff and Singer
(1998). It consists of building environmental mastery, personal growth, purpose in life, autonomy, self acceptance,
and positive relations with others, and is provided after
patients with affective disorder have successfully completed a regime of drugs or psychotherapy. Similarly,
Frisch (2006) proposed quality of life therapy, which integrates a life satisfaction approach with cognitive therapy.
Both Favas and Frischs approaches explicitly target faulty
cognitions, troubling emotions, or maladjusted relationships, offering a well-being component as a supplement.
This article narrates the story of our using positive psychology to relieve depression. We call this approach positive psychotherapy (PPT). PPT rests on the hypothesis that
depression can be treated effectively not only by reducing
its negative symptoms but also by directly and primarily
building positive emotions, character strengths, and meaning. It is possible that directly building these positive resources may successfully counteract negative symptoms
and may also buffer against their future reoccurrence. In
the last six years, the field of positive psychology, from
which PPT emerged, has made significant scientific gains
in analyzing the nature and benefits of these targets (e.g.,
November 2006 American Psychologist

Fredrickson & Losada, 2005; Haidt, 2006; Joseph & Linley, 2005; Seligman, 2002; Seligman, Steen, Park, & Peterson, 2005). In doing so, positive psychology has drawn on
traditional scientific methods to understand and treat
psychopathology.
Although we believe that PPT may be an effective treatment for many disorders, depression is our primary empirical target now. The symptoms of depression often involve
lack of positive emotion, lack of engagement, and lack of
felt meaning, but these are typically viewed as consequences or mere correlates of depression. We suggest that
these may be causal of depression and therefore that building positive emotion, engagement, and meaning will alleviate depression. Thus PPT may offer a new way to treat and
prevent depression.
Anecdotal Evidence and Exploratory Research
We began by developing pilot interventions over the past
six years with hundreds of people, ranging from undergraduates to unipolar depressed patients. Martin E. P. Seligman
taught five courses involving a total of more than 200 undergraduates, with weekly assignments to carry out and
write up many of the exercises described below. These
seemed remarkably successful. Seligman cannot resist mentioning that he has taught psychology, particularly abnormal psychology, for 40 years and has never before seen so
much positive life change in students: Life-changing was a
word not uncommonly heard when students described their
experience with the exercises. The popularity of the Positive Psychology course at Harvard (855 undergraduates
enrolled in spring 2006; Goldberg, 2006) is likely related
to the impact of this material on the lives of students.
In the next phase of piloting interventions, Seligman
taught more than 500 mental health professionals (clinical
psychologists, life coaches, psychiatrists, educators); each
week for 24 weeks, trainees heard a one-hour lecture and
then were assigned one exercise to carry out in their own
lives and with their patients or clients. Once again, at the
anecdotal level, we were astonished by the feedback from
mental health professionals about how well these interventions took, particularly with their clinically depressed
patients. This feedback was not entirely surprising, and,
indeed, the application of a positively focused therapy for
depression is a natural extension of the work that successfully builds optimism to treat and prevent depression
among children and young adults (Buchanan, Rubenstein,
& Seligman, 1999; Gillham & Reivich, 1999; Gillham,
Reivich, Jaycox, & Seligman, 1995; Seligman, Schulman,
DeRubeis, & Hollon, 1999). These pilot endeavors yielded
so many powerful case histories and testimonials that we
decided to try out positive psychology interventions in
more scientifically rigorous designs.
We developed detailed instructions for how to teach
these exercises. We then administered several of them sin775

gly on the Web in a random-assignment placebo-controlled

study. Almost 600 Web users volunteered to be randomly
assigned to one of six interventionsfive from our battery
of exercises and one placebo exercise. They did that one
assigned exercise over one week. Three of these exercises
(the gratitude visit, the three blessings exercise, and the
use your strengths exercise; see Table 1) significantly
lowered depressive symptoms and increased happiness
compared with the placebo, which required participants to
record their earliest memories each night. These effects
lasted for six months for the blessings and strengths exercises. Two of the exercisestaking a strengths questionnaire alone, and writing an essay about oneself at ones
best had, like the intended placebo, only transient effects.
In January of 2005, an exercise Web site, www
.reflectivehappiness.com, was opened. This site has a book
club, a newsletter, and forum discussion of positive psychology each month, but most important, one new positive
psychology exercise is posted each month. The first
months exercise is the three blessings (Write down three
things that went well today and why they went well), and
the first months subscription to the Web site is free (thereafter it costs $10 per month). In the first month of operation, 50 subscribers had scores in the range of severe depression, scoring 25 or higher on their Center for
Epidemiological StudiesDepression Scale (CESD; Radloff, 1977) pretests. Their mean was 33.90, close to what
might be termed extremely depressed. Each of them then
did the three blessings exercise and returned to the Web an
average of 14.8 days later. At that time, 94% of them were
less depressed, with a mean score of 16.90, which is down
into the border of the mild-to-moderate range of depression. We replicated these findings several months later with
essentially the same substantial results. Although this was

an uncontrolled study, such a dramatic decrease in depression over a short period of time compares favorably to
medication and to psychotherapy. These interventions,
moreover, cost only a small fraction of therapy; they are
self-administered; they can be done without the stigma of
pathology; and they are accessible anywhere the Web
reaches to the many people who cannot find face-to-face
treatment nearby.
Remember that all of the preceding tests consisted only
of single exercises. We then packaged exercises together in
order to create PPT for treating depression. We identified a
core of the 12 best-documented exercises and then wrote
detailed instructions for how to administer PPT in groups
and a detailed manual for individual PPT (Rashid & Seligman, in press). Following is the theoretical rationale for the
construction of the packages.
Theoretical Background
Seligman (2002) proposed that the unwieldy notion of
happiness could be decomposed into three more scientifically manageable components: positive emotion (the pleasant life), engagement (the engaged life), and meaning (the
meaningful life). Each exercise in PPT is designed to further one or more of these.
The Pleasant Life
The pleasant life is what hedonic theories of happiness endorse. It consists in having a lot of positive emotion about
the present, past, and future and learning the skills to amplify the intensity and duration of these emotions. The positive emotions about the past include satisfaction, contentment, fulfillment, pride, and serenity, and we developed
gratitude and forgiveness exercises that enhance how positive memories can be (e.g., Lyubomirsky, Sheldon, &

Table 1
Week-by-Week Summary Description of Group Positive Psychotherapy Exercises
Session

Description

Using Your Strengths: Take the VIA-IS strengths questionnaire to assess your top 5 strengths, and think of ways to use
those strengths more in your daily life.
Three Good Things/Blessings: Each evening, write down three good things that happened and why you think they
happened.
Obituary/Biography: Imagine that you have passed away after living a fruitful and satisfying life. What would you want
your obituary to say? Write a 12 page essay summarizing what you would like to be remembered for the most.
Gratitude Visit: Think of someone to whom you are very grateful, but who you have never properly thanked. Compose a
letter to them describing your gratitude, and read the letter to that person by phone or in person.
Active/Constructive Responding: An active-constructive response is one where you react in a visibly positive and
enthusiastic way to good news from someone else. At least once a day, respond actively and constructively to
someone you know.
Savoring: Once a day, take the time to enjoy something that you usually hurry through (examples: eating a meal, taking
a shower, walking to class). When its over, write down what you did, how you did it differently, and how it felt
compared to when you rush through it.

2
3
4
5
6

Note.

776

VIA-IS Values in Action Inventory of Strengths.

November 2006 American Psychologist

Schkade, 2005; McCullough, 2000; Seligman et al., 2005).

Positive emotions about the future include hope and optimism, faith, trust, and confidence, and these emotions, especially hope and optimism, are documented to buffer
against depression (Seligman, 1991, 2002). To address
these in our interventions, we used modified versions of
optimism and hope interventions that have been found to
counteract pessimism in previous studies (Seligman, 1991,
2002; Snyder, 2000). Positive emotions about the present
include satisfaction derived from immediate pleasures, and
PPT contains exercises for learning to savor experiences
that one often rushes through (e.g., eating).
More positive emotion is often associated with lower
depression and anxiety. Is this merely a correlation, or
could it be causal? Barbara Fredrickson and colleagues
have provided evidence that positive emotions counteract
the detrimental effects of negative emotion on physiology,
attention, and creativity (Fredrickson & Branigan, 2005;
Fredrickson & Levenson, 1996; see Fredrickson, 2000, for
a review). They also contribute to resilience in crises
(Fredrickson, Tugade, Waugh, & Larkin, 2003; Tugade &
Fredrickson, 2004). The cognitive literature on depression
documents a downward spiral in which depressed mood
and narrowing thinking perpetuate each other. In contrast,
Fredrickson and Joiner (2002) reported that positive emotions and a broad thoughtaction repertoire amplify each
other, leading to an upward spiral of well-being. These
data support the hypothesis that low positive emotion may
be causal in depression and that building positive emotions
will buffer against depression.
The Engaged Life
The second happy life in Seligmans theory is the engaged life, a life that pursues engagement, involvement and
absorption in work, intimate relations, and leisure (Csikszentmihalyi, 1990). Flow is Csikszentmihalyis term for
the psychological state that accompanies highly engaging
activities. Time passes quickly. Attention is completely
focused on the activity. The sense of self is lost (Moneta &
Csikszentmihalyi, 1996). Seligman (2002) proposed that
one way to enhance engagement and flow is to identify
peoples highest talents and strengths and then help them
to find opportunities to use these strengths more. We call
the highest strengths signature strengths (Peterson & Seligman, 2004). This view is as old as Aristotle and consonant
with more modern psychological notions such as Rogerss
(1951) ideal of the fully functioning person, Maslows
(1971) concept of self-actualization, and Ryan and Decis
(2000) self-determination theory. We believe not only that
depression correlates with lack of engagement in the main
areas of life but that lack of engagement may cause
depression.
The Milan Group built a program of therapeutic interventions aimed at transforming the structure of daily life
November 2006 American Psychologist

toward more engagement. Among the reported benefits are

reduced levels of depression and anxiety (Nakamura &
Csikszentmihalyi, 2002). For example, a client with the
signature strength of creativity is encouraged to take a pottery, photography, sculpture, or painting class, or someone
with the signature strength of curiosity is encouraged to
make a list of things he or she would like to know, to
identify ways to find them out, and to meet someone else
who has successfully marshaled curiosity to create engagement. We hypothesize that identifying the signature
strengths of clients and teaching practical ways to use these
strengths more will significantly relieve the negative symptoms of depression, and we have developed such exercises.
The Meaningful Life
The third happy life in Seligmans theory involves the
pursuit of meaning. This consists in using ones signature
strengths and talents to belong to and serve something that
one believes is bigger than the self. There are a large number of such positive institutions: religion, politics, family,
community, and nation, for example. Regardless of the particular institution one serves in order to establish a meaningful life, doing so produces a sense of satisfaction and
the belief that one has lived well (Myers, 1992; Nakamura
& Csikszentmihalyi, 2002). Such activities produce a subjective sense of meaning and are strongly correlated with
happiness (Lyubomirsky, King, & Diener, 2005). A consistent theme throughout meaning-making research is that the
people who achieve the greatest benefits are those who use
meaning to transform the perceptions of their circumstances from unfortunate to fortunate (McAdam, Diamond,
de St. Aubin, & Mansfield, 1997; Pennebaker, 1993). We
suggest that lack of meaning is not just a symptom but a
cause of depression, and it follows that interventions that
build meaning will relieve depression.
Data on the Three Lives
We tested the robustness of the correlation of the lack of
positive emotion, lack of engagement, and lack of meaning
with depression. We studied the pleasant, engaged, and
meaningful lives of 327 young adults at the University of
Pennsylvania (mean age 23.51 years, SD 6.63; 53%
women, 69% Caucasian); the sample included clinically
depressed (n 97), nondepressed psychiatric (n 46),
and nondepressed nonpsychiatric (n 184) students. Clinically depressed students experienced significantly fewer
positive emotions, less engagement, and less meaning in
their lives than did nondepressed psychiatric (d 0.37)
and nondepressed nonpsychiatric samples (d 1.17). In 15
replications, Huta, Peterson, Park, and Seligman (2006)
measured life satisfaction as a function of pursuing each of
these three lives. They found that the pursuit of meaning
and engagement were robustly (p .0001) correlated with
higher life satisfaction (rs .39 and .39, respectively) and
777

lower depression (rs .32 and .32, respectively), whereas

the pursuit of pleasure, surprisingly, was only marginally
correlated with higher life satisfaction (r .18) and lower
depression (r .15).
At this point, we were sufficiently intrigued by the robustness of the correlations with depression to intervene,
hypothesizing that moving the empty life (lack of pleasure, lack of engagement, and lack of meaning) in the direction of the full life (presence of positive emotion, engagement, and meaning) would relieve depression. This has
been the focus of our work for the last three years.
Testing PPT
We conducted two face-to-face studies of PPT, one with
mildly to moderately depressed young adults and the other
with severely depressed young adults, to examine the
causal effect of enhancing positive emotion, engagement,
and meaning. We now present a summary of these two
therapy studies.
Study 1: Group PPT With Mild-to-Moderate Depressive
Symptoms
Our first therapy study involved mildly to moderately depressed students treated in group therapy and followed for
one year. Group PPT included the following exercises: using signature strengths, thinking of three blessings, writing
a positive obituary, going on a gratitude visit, active constructive responding, and savoring (see Table 1). PPT was
a six-week, two-hours-per-week intervention administered
in two groups of 8 11 clients. One group was led by Acacia C. Parks, and the other was led by a clinical psychology postdoctoral fellow. Each session was evenly split between a group discussion of the previous weeks exercise
and a lecture-style introduction to the current weeks exercise that included explicit instructions for how to do the
exercise. At each of the six weekly sessions, participants
were asked to complete homework exercises and then to
return to the group with a completed worksheet outlining
what they did. Unlike individual PPT (see below), the bulk
of group PPT was not custom-tailored to each participant,
and all participants received the same homework exercises
in a fixed sequence. The final session focused on maintenance and individual customizing of the exercises in order
to promote maintenance after termination.
Participants were 40 students at the University of Pennsylvania. The only inclusion criterion was a score in the
mild-to-moderate symptom range (10 24) on the Beck Depression InventoryII (BDI; Beck & Steer, 1992). Eligible
students were given a thorough description of the study
and then were asked to give written consent. They then
completed a baseline assessment and were randomly assigned to either group PPT (n 19) or a no-treatment control group (n 21). The PPT group was 42% female and
778

26% Caucasian, and the control group was 43% female

and 52% Caucasian.
We used two outcome measures: the BDI to assess depressive symptoms and the Satisfaction With Life Scale
(SWLS; Diener, Emmons, Larsen, & Griffin, 1985) to assess changes in well-being. Both measures were administered in a Web-based format prior to and immediately following the six-week period during which PPT was
administered and again three months, six months, and one
year following the postintervention assessment.
Overall, group PPT worked well compared with no
treatment. Substantial symptom relief lasted through one
year of follow-up. One year after the end of treatment, PPT
participants scored, on average, in the nondepressed range
on depressive symptoms, whereas controls remained in the
mild-to-moderate range (see Table 2 and Figure 1).
We used a hierarchical linear model (HLM; Hedeker &
Gibbons, 1997) to estimate the effect of PPT on the rate of
change in depression and well-being experienced by participants. A piecewise linear model with two legs (see Table
3) allowed us to look at change in treatment versus control
between pre- and posttreatment (Leg 1) as compared with
the rate of change between posttreatment and subsequent
follow-ups (Leg 2). In Leg 1, we expected to see a large
positive change in the PPT group and no change in the
control group, resulting in a significant difference between
groups in rate of change. In Leg 2 we expected to see no
change in either group as the PPT group maintained its
gains over follow-up and the control group remained symptomatic as it was in Leg 1.
During Leg 1, clients who received PPT experienced
significant decreases in depressive symptoms and increases
in life satisfaction over the course of the intervention,
whereas control participants did not. PPT clients experienced a significant BDI score reduction of 0.96 points per
week (p .003), a rate of change that was significantly
greater than that of the control clients (p .05), whose
change estimate did not differ significantly from zero.
SWLS scores also changed as expected, increasing by 0.77
points per week in the PPT group (p .001) but not
changing in the control group. Over the course of Leg 2
(three-month, six-month, and one-year follow-ups), neither
group experienced changes in depression, suggesting that
the PPT participants maintained their gains through oneyear follow-up whereas control participants moderate-tomild depression remained at their baseline levels. Life satisfaction increased in both groups over time, but the PPT
group maintained its advantage over the control group
throughout.
In our experience, the maintenance of gains for a year
after psychotherapy for depression is unusual in the absence of booster sessions. This leads us to believe that important self-maintaining factors are imbedded in our
exercises.
November 2006 American Psychologist

Table 2
Means, Standard Deviations, Significance Levels, and Effect Sizes for Group Positive Psychotherapy (PPT) and
Control Participants at All Time Points
PPT
Time point

Control
SD

SD

df

Beck Depression Inventory

Baseline
Posttest
3-month
6-month
1-year

16
14
13
13
14

14.94
9.57
8.69
8.21
7.57

6.26
6.32
6.73
4.66
5.08

21
20
19
18
19

13.81
13.10
13.95
13.33
11.32

5.25
8.29
8.79
8.15
7.38

1,
1,
1,
1,
1,

35
31
29
29
30

0.36
2.15
3.89
4.87
4.40

.56
.15
.06
.04
.04

0.48
0.67
0.77
0.59

1,
1,
1,
1,
1,

35
31
29
28
30

1.83
1.35
5.26
3.23
4.17

.19
.25
.03
.08
.05

0.30
0.27
0.08
0.29

Satisfaction With Life Scaleb,c

Baseline
Posttest
3-month
6-month
1-year

16
14
13
13
14

12.25
14.29
21.15
20.92
23.80

6.22
7.40
7.73
6.96
7.58

21
20
19
18
19

15.05
14.40
19.26
20.44
22.05

6.24
6.36
6.29
5.98
6.15

a
Higher scores mean more depression. b Higher scores mean more life satisfaction. c Although the difference between the control and PPT groups at baseline was not
significant, it may have contributed to the small effect sizes for absolute mean differences. Marginal means controlling for baseline provided a more convincing group
comparison, with effect sizes more comparable with those found for depression.

Study 2: Individual Positive Psychotherapy With Unipolar

Depression
Participants in our individual PPT pilot study were 46 clients seeking treatment at Counseling and Psychological
Services (CAPS) at the University of Pennsylvania. Inclusion criteria were as follows: (a) being between 18 and 55
years old, (b) fulfilling DSMIV (fourth edition of the Diagnostic and Statistical Manual of Mental Disorders;
American Psychiatric Association, 2000) criteria for major

depressive disorder (MDD), (c) having a score of at least

50 on the Zung Self-Rating Scale (ZSRS; Zung, 1965), and
(d) having a score of at least 50 on the Outcome Questionnaire (OQ; Lambert et al., 1996). Exclusion criteria included (a) current treatment for depression (b) substance
abuse disorder for the last 12 months, panic disorder,
manic or hypomanic episodes (past or present), or psychotic disorder (past or present); and (c) refusal to participate in a 10 12-week individual psychotherapy treatment.

Figure 1
Mean Beck Depression Inventory (BDI) Scores for Group Positive Psychotherapy (PPT) and Control Participants at All
Time Points
20

BDI Scores

16
12

PPT
Control

8
4
0
Baseline

Posttest

November 2006 American Psychologist

Three-month
follow-up

Six-month
follow-up

One-year
follow-up

779

Table 3
Hierarchical Linear Model Estimates of Change on
Outcome Measures During and After 6-Week
Intervention Period and Effects of Group in Mildly to
Moderately Depressed Patients Receiving Group
Positive Psychotherapy or No Treatment
Positive
psychotherapy
Variable

BDIb
Treatment period
Follow-up period
SWLSc
Treatment period
Follow-up period

No-treatment
control

Change
estimate

ta

Change
estimate

.957
.039

3.05**
0.98

.053
.036

.774
.162

3.69**
5.43**

.229
.126

Beck Depression
Inventory
Variable

Change rate during Leg 1

(pre- to posttreatment)
Effect of condition
Change rate during Leg 2
(posttreatment to
follow-ups)
Effect of condition

0.20
1.09
1.30
4.98**

Satisfaction With
Life Scale

Estimate

SE

Estimate

SE

.905*

.411

.544*

.274

.002

.052

.036

.039

Test statistic evaluates whether change estimate is significantly greater than

zero. b BDI Beck Depression InventoryII; change over time was estimated in
a two-piece hierarchical linear model with df 76 for change during treatment
and df 120 for change after treatment in both conditions. c SWLS Satisfaction With Life Scale; change over time was estimated in a two-piece hierarchical linear model with df 100 for change during treatment and df 54 for
change after treatment in both conditions.
*
p .05. ** p .001.

The study was approved by the University of Pennsylvanias Internal Review Board, and it followed guidelines
regarding consent and confidentiality.
After the initial intake assessment, if a student met inclusion criteria he or she was contacted by the project
manager and was provided with the details regarding study
participation. This included a description of the measures,
an introduction to the various treatment conditions, and the
taping of the treatment. If the client showed interest and
signed the consent form, he or she was randomly assigned
to either individual PPT (n 13) or treatment as usual
(TAU; n 15). PPT clients were also compared with a
nonrandomized matched group receiving TAU and antidepressant medications during the same time period
(TAUMED; n 17). Clients in the TAUMED group were
matched with PPT participants on diagnosis, time of start
of treatment, and both ZSRS and OQ scores. We did not
randomize patients to the TAUMED group, because we
have doubts about the ethics and the scientific logic of as780

signing patients to medication regardless of their preferences for drugs or psychotherapy.

Thirteen participants (2 in PPT [13%], 6 in TAU [40%],
and 5 [29%] in TAUMED) dropped out before the end of
treatment, but this was not statistically significant, nor were
there significant differences between dropouts and completers in terms of demographic variables and baseline assessments in the treatment groups. A total of 11 participants in
the PPT condition, 9 in the TAU condition, and 12 in the
TAUMED condition were therefore included in the final
analyses.
Process of PPT for unipolar depression. In our treatment of mild-to-moderate depression (see Table 1), the
sessions concentrate heavily on the positive rather than the
negative symptoms of depression. With unipolar depression, however, we introduce a balance between focusing on
positive symptoms and focusing on negative symptoms,
and we regard PPT as a supplement to more traditional
treatment approaches. We have two considerations in mind:
On the one hand, patients have long been socialized into
believing that therapy entails talking about troubles. Any
perceived failure to take their troubles seriously violates
these expectations and can undermine good rapport. On the
other hand, there is a noticeable dropout rate in traditional
cognitive behavioral therapy (CBT) for depression: At the
very onset of CBT, the therapist asks clients to record their
pessimistic, self-critical, and globally negative thoughts and
then helps them to identify how such thinking causes and
maintains depression. For some depressed clients, pointing
out deficits in their thinking, as an exclusive focus, may be
counterproductive and may rupture the therapeutic alliance
(Burn & Nolen-Hoeksema, 1992; Castonguay et al., 2004).
This may be one reason for some adults to prematurely
terminate CBT treatment (Oei & Kazmierczak, 1997; Persons, Burns & Perloff, 1988; Robins & Hayes, 1993).
From the onset, PPT, in contrast, builds a congenial and
positive relationship by asking clients to introduce themselves through telling a real-life story that shows them at
their best. This is followed by clients identifying signature
strengths and the therapist coaching them to find practical
ways of using these strengths more often in work, love,
play, friendship, and parenting. Clients set goals of using
and enhancing their signature strengths through real-life
exercises. Substantial time is spent coaching clients to reeducate their attention and memory to what is good in their
lives, with the goal of providing them a more balanced
context in which to place their problems. Although some
problem-solving and discussion of troubles does take place
in PPT, the goal is to keep the positive aspects of the clients lives in the forefront of their minds, to teach behaviors that bring positive feedback from others, and to
strengthen already existing positive aspects, rather than
teaching the reinterpretation of negative aspects. When clients report negative emotions or troubles, however, they
November 2006 American Psychologist

are empathically attended. This balanced process enables

the therapist to become a witness to the clients deepest
positive characteristics rather than just an authority figure
who highlights faulty thinking, negative emotions, and
maladjusted relationships. Usually there are already plenty
of such critical individuals in clients lives, and this can be
the very reason clients seek therapy.
PPT took place over up to 14 sessions over at most 12
weeks and was conducted by Tayyab Rashid, who has a
doctorate in clinical psychology. He followed a manualized
protocol (Rashid & Seligman, in press; see Table 4 for the
session-by-session structure). Supervisionprovided by
Ilene Rosenstein, a licensed clinical psychologist and the
director of CAPS consisted of randomly sampled reviewing of therapy tapes as well as ongoing individual supervision throughout treatment. PPT was custom tailored to
meet clients immediate clinical needs (e.g., romantic
break-up, conflict with significant others, or career-related
issues), and the order of the exercises varied with each clients circumstances and the feasibility of completing the
exercise. Homework assignments were selected from the
pool of potential exercises in Table 4, and the exercises
were tailored to the individual.
Treatment as usual (TAU) at CAPS consisted of an integrative and eclectic approach administered by five doctorallevel licensed psychologists, two licensed social workers,
and two graduate-level interns supervised by licensed psychologists. The therapists performing TAU were instructed
to provide whatever treatment they deemed appropriate for
their clients without following a particular theoretical orientation or a treatment protocol. Clients in the TAUMED
group were offered antidepressant medication, in addition
to the TAU provided at CAPS, as an adjunct to their psychotherapy. We matched TAUMED clients to PPT clients
on the diagnosis and the severity of depression. Psychopharmacotherapy followed a standardized protocol including review of symptoms, adverse events, illnesses, and
concomitant medication (Fawcett, Epstein, Fiester, Elkin,
& Autry, 1987).
We assessed four kinds of outcomes: The first one was
symptomatic, including depressive symptoms as measured
by the ZSRS, a 20-item self-report scale, and the Hamilton
Rating Scale for Depression (HRSD; Hamilton, 1960), a
17-item version administered by an independent clinician
at the end of the treatment (see Figure 2). The second domain assessed more global improvement as measured by
the OQ (Lambert et al., 1996), a self-report measure
widely used with college-age students, and by DSMIVs
Global Assessment of Functioning (GAF) rated by an independent clinician who was blind to treatment condition.
The third domain was happiness and well-being, assessed
by the Positive Psychotherapy Inventory (PPTI), a 21-item
PPT outcome measure we created and validated (Rashid,
2005), and by the SWLS.
November 2006 American Psychologist

Fourth, and perhaps most important, we examined remission, defined as a composite of the following strong,
joint criteria: (a) a ZSRS score 50 (Oei & Yeoh, 1999);
(b) an HRSD score 7 (Santor & Kusumakar, 2001; Zimmerman, Posternak, & Chelminski, 2005); (c) at least a
15-point pre- to posttreatment decline in OQ scores, and
posttest scores of 63 (Kadera, Lambert, & Andrews,
1996); and (d) a GAF score 70 (Erikson, Feldman, &
Steiner, 1997). If a client met all four of these criteria at
the end of treatment, we termed them in remission. Client
characteristics are presented in Table 5. The three groups
did not differ at baseline on any outcome measure.
Pre- and posttreatment means, standard deviations, significance levels, and effect sizes are presented in Table 6.
Overall, the three treatments differed significantly in all
four domains: On self-report measures (the ZSRS and the
OQ), PPT significantly exceeded TAUMED, with large
effect sizes (d 1.22 and 1.13, respectively). On clinicianrated measures (the HRSD and the GAF), PPT did significantly better than TAU, with large effect sizes (d 1.41
and 1.16, respectively) as well. On well-being measures,
the three groups did not differ significantly on the SWLS,
but PPT differed significantly from both TAU and
TAUMED on the PPTI, our measure of happiness, with
large effect sizes (d 1.26 and 1.03). On the basis of the
fourfold remission criteria described above, 7 of 11 (64%)
clients in PPT, 1 of 9 (11%) in TAU, and 1 of 12 (8%) in
TAUMED remitted by the end of treatment, 2(2, N
32) 10.48, p .005.
Overall, these results indicate that PPT did better than
two active treatments with large effect sizes. Thus, systematically enhancing positive emotions, engagement, and
meaning was quite efficacious in treating unipolar
depression.
To summarize these two therapy studies: Individual PPT
with severely depressed clients led to more symptomatic
improvement and to more remission from depressive disorder than did treatment as usual and treatment as usual plus
antidepressant medication. It also enhanced happiness.
Group PPT given to mildly to moderately depressed students led to significantly greater symptom reduction and
more increases in life satisfaction than in the no-treatment
control group. This improvement, moreover, lasted for at
least one year after treatment. The effect sizes in both studies were moderate to large, and in the outpatient study, all
indices of clinical significance showed a substantial advantage for PPT.
How Does PPT Work?
The negative quite easily attracts human attention and
memory, and the large literature on bad is stronger than
good (Baumeister, Bratslavsky, Finkenauer, & Vohs,
2001) testifies to this. It makes evolutionary sense that negative emotions, tied as they are to threat, loss and trespass,
781

Table 4
Idealized Session-by-Session Description of Positive Psychotherapy
Session and theme

Description

1: Orientation

Lack of Positive Resources Maintains Depression

The role of absence or lack of positive emotions, character strengths and meaning in maintaining
depression and empty life is discussed. The framework of PPT, therapists role and clients
responsibilities are discussed.
Homework: Clients write a one-page (roughly 300-word) positive introduction, in which they tell
a concrete story illustrating their character strengths.

2: Engagement

Identifying Signature Strengths

Clients identify their signature strengths from the positive introduction and discuss situations in
which these signature strengths have helped previously. Three pathways to happiness
(pleasure, engagement, and meaning) are discussed in light of PPTI results.
Homework: Clients complete VIA-IS questionnaire online, which identifies clients signature
strengths.

3: Engagement/pleasure

Cultivation of Signature Strength and Positive Emotions

Deployment of signature strengths is discussed. Clients are coached to formulate specific,
concrete and achievable behaviors regarding cultivation of signature strengths.
Role of positive emotion in well-being is discussed.
Homework (ongoing): Clients start a Blessings Journal in which three good things (big or small)
that happened during the day are written.

4: Pleasure

Good Versus Bad Memories

Role of good and bad memories is discussed in terms of maintenance of symptoms of
depression. Clients are encouraged to express feelings of anger and bitterness. Effects of
holding onto anger and bitterness on depression and well-being are discussed.
Homework: Clients write about three bad memories, anger associated with them, and their
impact in maintaining depression.

5: Pleasure/engagement

Forgiveness
Forgiveness is introduced as a powerful tool that can transform anger and bitterness into feelings
of neutrality or even, for some, into positive emotions.
Homework: Clients write a forgiveness letter describing transgression, related emotions, and
pledge to forgive transgressor (if appropriate) but may not deliver the letter.

6: Pleasure/engagement

Gratitude
Gratitude is discussed as enduring thankfulness, and the role of good and bad memories is
highlighted again with emphasis on gratitude.
Homework: Clients write and present a letter of gratitude to someone they have never properly
thanked.

7: Pleasure/engagement

Mid-therapy Check
Both Forgiveness and Gratitude homework are followed up. This typically takes more than one
session. Importance of cultivation of positive emotions is discussed. Clients are encouraged to
bring and discuss the effects of the Blessing Journal. Goals regarding using signature strengths
are reviewed. The process and progress are discussed in detail. Clients feedback toward
therapeutic gains is elicited and discussed.

8: Meaning/engagement

Satisficing Instead of Maximizing

Satisficing (good enough) instead of maximizing in the context of the hedonic treadmill is
discussed. Satisficing through engagement is encouraged instead of maximizing.
Homework: Clients write ways to increase satisficing and devise a personal satisficing plan.

9: Pleasure

782

Optimism and Hope

Clients are guided to think of times when they lost out at something important, when a big plan
collapsed, and when they were rejected by someone. Then clients are asked to consider that
when one door closes, another one almost always opens.
Homework: Clients identify three doors that closed and three doors that then opened.

November 2006 American Psychologist

Table 4 (continued)
Session and theme

10: Engagement/meaning

11: Meaning

Description

Love and Attachment

Active-constructive responding is discussed. Clients are invited to recognize signature strengths of a
significant other.
Homework 1 (on-going): Active-constructive feedbackclients are coached on how to respond
actively and constructively to positive events reported by others.
Homework 2: Clients arrange a date that celebrates their signature strengths and those of their
significant other.
Family Tree of Strengths
Significance of recognizing the signature strengths of family members is discussed.
Homework: Clients ask family members to take VIA-IS online and then draw a tree that includes
signature strengths of all members of their family including children. A family gathering is to
be arranged to discuss everyones signature strengths.

12: Pleasure

Savoring
Savoring is introduced as awareness of pleasure and a deliberate attempt to make it last. The
hedonic treadmill is reiterated as a possible threat to savoring and how to safeguard against
it.
Homework: Clients plan pleasurable activities and carry them out as planned. Specific savoring
techniques are provided.

13: Meaning

Gift of Time
Regardless of their financial circumstances, clients have the power to give one of the greatest
gifts of all, the gift of time. Ways of using signature strengths to offer the gift of time in serving
something much larger than the self are discussed.
Homework: Clients are to give the gift of time by doing something that requires a fair amount of
time and whose creation calls on signature strengthssuch as mentoring a child or doing
community service.

14: Integration

The Full Life

The concept of a full life that integrates pleasure, engagement, and meaning is discussed. Clients
complete PPTI and other depression measures before the final session. Progress is reviewed,
and gains and maintenance are discussed.

Note:

PPT Positive psychotherapy; PPTI Positive Psychotherapy Inventory; VIA-IS Values in Action Inventory of Strengths.

should trump happiness. Emergencies have first call in survival selection. What kind of brain survived the ice ages?
The one that assumed the good weather would last, or the
one that was strongly biased toward anticipating disaster
any moment now?
Human beings are naturally biased toward remembering
the negative, attending to the negative, and expecting the
worst. Negative emotion is most proximally driven by negative memories, attention, and expectations, and depressed
individuals exaggerate this natural tendency. They strongly
gravitate toward attending to and remembering the most
negative aspects of their lives, and several of our exercises
aim to re-educate attention, memory, and expectations
away from the negative and the catastrophic toward the
positive and the hopeful. For example, when a client does
the three good things exercise (Before you go to sleep,
write down three things that went well today and why they
went well), the depressive bias toward ruminating only
about what has gone wrong is counteracted. The client is
November 2006 American Psychologist

more likely to end her day remembering positive events

and completions rather than her troubles and her unfinished
business. The gratitude visit, similarly, may shift memory
away from the embittering aspects of the clients past relationships to savoring the good things that her friends and
family have done for her.
The mechanism of other PPT exercises is likely more
external and behavioral. For example, increasing clients
awareness of their signature strengths likely encourages
them to more effectively apply themselves at work by approaching tasks in a way that better uses their abilities.
Having more flow at work and doing better work can lead
to an upward spiral of engagement and positive emotion.
Similarly, teaching clients to respond in an active and constructive manner to good news from co-workers, friends,
and family teaches a social skill that likely improves most
relationships (Gable, Reis, Impett, & Asher, 2004).
Another possible mechanism is PPTs sustained emphasis on strengths as a way to have more engagement and
783

Figure 2
Mean Hamilton Rating Scale for Depression (Hamilton) Scores and Standard Errors at the End of Treatment for
Individual Positive Psychotherapy (PPT), Treatment as Usual (TAU), and TAU Plus Antidepressant Medication
(TAUMED) Groups

16
14
Hamilton Scores

12
10
8
6
4
2
0
PPT

TAU

TAUMED

Treatment Groups

meaning in life. Throughout therapy, PPT clients are encouraged and assisted in identifying their signature
strengths: Near the onset of the therapy, clients are asked
to introduce themselves through a real-life story about their
highest character strength. Then the client takes the Values
in Action Inventory of Strengths (VIA-IS; Peterson & Seligman, 2004; see www.authentichappiness.org), a wellvalidated test that identifies clients signature strengths.
Therapist and client collaboratively devise new ways of
using clients signature strengths in work, love, friendship,
parenting, and leisure. Further, we ask clients to tell us
detailed and rich narratives about what they are good at.
Table 5
Characteristics of Clients With Major Depressive
Disorder Receiving Individual Positive Psychotherapy
(PPT), Treatment as Usual (TAU), or TAU Plus
Antidepressant Medication (TAUMED)
PPT
(n 11)

Women
Caucasians
Undergraduates
Previous episodes of
depression
Comorbid diagnosis
Previous treatment

784

TAU
(n 9)

TAUMED
(n 12)

8
6
5

73
55
46

7
6
6

78
67
73

7
5
9

58
42
75

7
9
6

64
82
55

2
3
2

18
27
18

5
8
7

42
67
58

Although we do not ignore clients concerns about their

deficiencies, lest as therapists we may seem unfeeling
and unsympathetic toward troubles, we emphasize identifying, attending to, remembering, and using more often the
core positive traits that clients already possess. This may produce end-runs around their perceived faults, faults they
know all too well. One newspaper article headlined this approach as You already have a life, now use it. In addition,
we emphasize using signature strengths to solve problems.
In addition to increasing clients general awareness of
strengths, we coach them on how to explicitly employ their
signature strengths to counter depression. For example, one
client devised several new, specific ways of using her signature strength of appreciation of beauty to manage negative moods. She rearranged her room in the way that she
found to be most aesthetically pleasing and decorated her
wall with a print by her favorite artist, so that she woke up
to beauty. She had always wanted to do poetry but never had
time for it, and she was able to find a poetry club. For one
week, she wrote three experiences of beauty every day in her
journal; some of her entries were watching the sunset at the
Schuylkill River near Fairmont Park, noticing beauty on the
face of a child, and seeing how happy and beautiful her dog
looked while they were playing. She also loved hiking, and so
she took a hiking trip and climbed Mount Washington.
Another client used his signature strength of love to
undo his depression: His girlfriend was away in Europe for
the spring semester, and he was quite depressed on Valentines Day. He decided to arrange a long-distance ValenNovember 2006 American Psychologist

Table 6
Means, Standard Deviations, Significance Levels, and Effect Sizes on Outcome Measures for Individual Positive
Psychotherapy (PPT), Treatment as Usual (TAU), or TAU Plus Antidepressant Medication (TAUMED)
TAU
(n 9)

PPT
(n 11)
Outcome measure

SD

TAUMED
(n 12)
SD

Effect size (Cohens d)

SD

F(2, 32)

Between
PPT and TAU

Between
PPT and TAUMED

Symptomatic
ZSRS (Higher is more depressed)
Pre
Post
HRSD (Higher is more depressed)
Post

63.91
43.27a

7.71
11.21

64.33
54.67b

9.10
9.85

63.83
55.50b

11.07
9.86

ns
5.02*

1.12

1.22

5.13a

3.89

13.00b

6.80

10.08a

5.90

5.28*

1.41

ns

Overall functioning
OQ (Lower is better functioning)
Pre
Post
GAF (Higher is better functioning)
Pre
Post

76.27
45.82a

12.86
25.15

72.44
63.67a

29.92
25.15

63.83
55.50b

21.07
9.86

ns
3.81*

ns

1.13

61.18
75.73a

6.60
9.05

63.00
67.67b

6.60
7.78

60.58
69.00a

5.43
7.05

ns
3.79*

1.16

ns

1.26

1.03

Well-being
SWLS (Higher is more satisfaction)
Pre
Post
PPTI (Higher is more happiness)
Pre
Post

19.22
21.91

5.02
4.76

20.00
19.00

5.00
7.71

17.50
18.50

4.32
4.25

ns
2.21

28.27
35.00a

6.45
8.11

29.33
28.33b

9.14
7.14

27.67
28.75b

6.11
5.43

ns
4.46*

Note. Posttreatment significant differences and effect sizes were adjusted for pretreatment scores. Significant differences between pretreatment OQ scores were explored
by mixed-model analysis of variance, because data did not meet the assumption of homogeneity of variance, Levene F(2, 29) 4.51, p .05. The HRSD was administered
only at the end of treatment. Pretreatment scores on the ZSRS for Depression were entered as a proxy covariate. Posttreatment HRSD and ZSRS, controlling for pretreatment
ZSRS, correlated .54 (p .01, two-tailed). Within each row, means with different subscripts differ at the .05 level of significance. Because of the exploratory nature of
the study and the small sample size, pairwise correction was not applied. ZSRS Zung Self-Rating Scale for Depression; OQ Outcome Questionnaire; GAF Global
Assessment of Functioning (DSMIV Axis V) clinician rating; SWLS Satisfaction With Life Scale; PPTI Positive Psychotherapy Inventory, PPT outcome measure (details
regarding its psychometric properties are available by e-mail from Martin E. P. Seligman).
*
p .05.

tines dinner. They each independently acquired their favorite foods and talked via internet phone as they ate together,
listened to their favorite songs together, and each talked about
their appreciation for the others character strengths. Then
during spring break, he traveled to Europe, took her to a surprise dinner at her favorite restaurant, and read out his gratitude letter. At the end of the therapy, their relationship, which
had been on the brink of break-up, was flourishing.
Although the exercises presented on the Web with no human hands are efficacious, we suspect that individual PPT for
severe depression is much more effectively delivered with the
basic therapeutic essentials: warmth, empathy, and genuineness. Hence, when these nonspecifics are integrated with
PPT exercises and are supplemented with documented techniques such as CBT, interpersonal therapy, and antidepressant
medication, we expect that efficacy will be better.
Conclusions and Limitations
Although PPT led to clinically and statistically significant
decreases in depression, we view these results as highly
November 2006 American Psychologist

preliminary, and we urge caution on several grounds. First,

both therapy trials had small samples, but we note that our
sample size is on a par with those of most psychotherapy
outcome studies. For example, in a meta-analysis conducted by Kazdin and Bass (1989), the median sample size
was 12. Similarly, Shapiro and Shapiro (1982) included
only 28% studies that contained 13 or more clients. Second, the clients in both of our studies were university or
professional students. This may well limit the generalizability of PPT to other populations varying in age, ethnicity, socioeconomic status, and IQ. Currently, Lisa Lewis
and her colleagues at the Menninger Clinic are comparing
PPT with a traditional psychotherapy with a larger inpatient sample (N 100). We hope that such endeavors will
help us to unearth important questions regarding PPTs
generalizability, specificity, and response rate. Third, we
doubt that the effects of PPT are specific to depression,
and we expect that increasing positive emotion, engagement, and meaning promote highly general ways of buffer785

ing against a variety of disorders and troubles. Fourth, we

did not counterbalance therapists, and so we dont know if
we have talented therapist effects. Finally, the mechanisms by which PPT operates, including the moderating
role of therapists and the commonalities of PPT and other
therapeutic approaches, are matters for further research.
Nevertheless, we are encouraged by the potency of positive psychology exercises delivered on the Web with no
human hands, by the congeniality of the approach to young
depressed students, by how long the benefits lasted after
treatment ended, and by the sheer effect size of PPT when
delivered by a skilled therapist. Should these results be
replicated, we speculate that future therapy for depression
may combine talking about troubles with understanding
and building positive emotion, engagement, and meaning.
Authors Note
This research was supported by Grants MH63430 and
MH52270 from the National Institute of Mental Health,
Grant R215S020045 from the U.S. Department of Education, and Grant 11286 from the John Marks Templeton
Foundation.
Conflict of interest notice: As an author, Martin E. P.
Seligman receives royalties based on subscriptions to
www.reflectivehappiness.com, which is one source of the
exercises described in this address.
We gratefully acknowledge Ilene Rosenstein, William
Alexander, Dianne Chambless, Robert DeRubeis, Sara
Jaffee, Afroze Anjum, Charles May, Yan Leykin, Michael
Maniaci, Christopher Brown, David Meyerson, Erin
OBrien, Tracy Steen, George Vaillant, and Hayden Victor.
Correspondence concerning this article should be addressed to Martin E. P. Seligman, Positive Psychology
Center, 3701 Market Street, University of Pennsylvania,
Philadelphia, PA 19104. E-mail:
[email protected]

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