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DOI 10.1007/s10879-014-9269-9
ORIGINAL PAPER
Introduction
The aim of this paper is to describe the Say Yes to Life
(SYTL) program, a group-based intervention for major
depressive disorder (MDD). The program is informed by
research on cognitive behavior therapy (CBT), positive
psychology, and group-based psychological interventions
(Carr 2011; Feng et al. 2012; Kleinberg 2012).
The lifetime prevalence rate for MDD is 625 %
(Kessler and Wang 2009). It is one of the most prevalent
psychological problems for which outpatients seek treatment and entails a highly significant disease burden internationally (World Health Organization 2008). Best practice
A. Carr (&)
School of Psychology, UCD, Belfield, Dublin 4, Ireland
e-mail: alan.carr@ucd.ie
L. Finnegan
St James Hospital, Dublin, Ireland
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J Contemp Psychother
Positive Psychotherapy
While CBT aims to treat MDD by reducing negative
affectivity, positive psychology interventions treat depression by increasing positive affectivity and building personal strengths. These strategies derive from broaden and
build theory (Fredrickson 2013) which argues, with considerable empirical support, that positive psychology
interventions increase positive mood states. Positive
affectivity broadens thought-action repertoires. This facilitates the development of personal resources. These
enhanced personal resources may be used to induce further
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Group Therapy
In a meta-analysis of 23 studies of the efficacy of group
therapy for major depressive disorder Huntley, Araya and
Salisbury (Huntley et al. 2012) found that at post-treatment
and follow-up group CBT was more effective than usual
care. Individual CBT was more effective than group CBT
at post-treatment, but at 3 months follow-up, both group
and individual CBT were equally effective in decreasing
depressive symptoms. The meta-analysis included two
studies of dialectical behavior therapy, one study of interpersonal therapy and one trial which evaluated self-control
therapy. In all of these trials, group therapy led to greater
reductions in depressive symptoms than usual care.
Research on contemporary group therapy for a range of
adult mental health problems provides evidence for the
importance of a number of common factors which contribute to effective group interventions (Burlingame et al.
2013; Kleinberg 2012). These include induction of group
members into the group program prior to treatment and
during early sessions, fostering group cohesion, flexible use
of treatment manuals, managing conflict within sessions,
facilitating appropriate emotional expression, and dealing
with potential adverse outcomes or tensions in a timely and
thoughtful way. All of these elements were incorporated
into the SYTL program.
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Table 1 Say Yes to Life (SYTL) program
Session title
Theory
Skills
CBT & PP
PP
Pathway 1
3. Reach beyond
PP & CBT
Pathways 2 & 13
Pathway 3
CBT
Cognitive restructuring
CBT
Cognitive restructuring
Pathway 3
CBT
Self-talk
Pathway 4
7. Let laughter in
PP
Pathway 5
PP
CBT
Pathway 6
Pathway 7
CBT
Anger management
Pathway 10
CBT
Pathway 11
PP
Pathway 12
PP
Pathway 17
CBT
Assertiveness training
Pathway 14
PP
Forgiveness facilitation
Pathway 15
PP
Forgiveness facilitation
Pathway 15
17. Be thankful
PP
Thankfulness facilitation
Pathway 16
PP
Pathway 18
PP
Pathway 20
PP & CBT
CBT cognitive behavior therapy, PP positive psychology, SYTL say yes to life self-help book by Finnegan and Kennally (2013)
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involves identifying and challenging anxiety-related negative automatic thoughts and cognitive distortions, such as
catastrophizing (discussed in session 4); confining worrying to set periods of the day; and practicing breathing
exercises and progressive muscle relaxation.
Session 10: Face Your Anger
Anger management is addressed in the tenth sessions. Key
points about this theme are presented. Anger may be
constructively used to address injustice and improve society, or destructively used to hurt others. Cognitive distortions can lead to inappropriate anger. For example, we can
become angry because we misinterpret the actions of other
people as being directed against us. Anger may be used as a
defense. That is, when we have been hurt, rather than
allowing ourselves to feel sad and vulnerable, we feel
angry. Unfortunately expressing this anger can alienate
people who could support us by empathizing with our pain.
Processing these vulnerable feelings is essential for
moving on from defensive anger. We are all prone to
irritation when we are tired, stressed, hungry or when we
have previously suppressed anger. We can avoid inappropriate angry outbursts by paying attention to these
processes.
Participants are guided through a process to help them
explore the impact of anger on their relationships and
changes they would like to make in the way they deal with
anger. This is followed by coaching in anger management
where participants learn to recognize early warning signals
for anger, breathing and relaxation exercises for reducing
physiological arousal, cognitive techniques for reappraising situations in less threatening ways, constructive
responses to anger provoking situations, and positive ways
that anger can be channeled.
Participants are invited to practice anger management as
homework. They are also invited to write (but not send) a
letter to the person who hurt them, to help them process
unresolved anger. In this letter participants describe vividly
how the other persons actions affected them, state what
they needed from the other person at the time, and ask
questions about issues that remain unclear.
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