Positive Psychology Interventions in Oncology Care

Positive psychology is the study of human well-being and flourishing, with a focus on increasing well-being through evidence-based practices. Positive psychology interventions can have a positive impact on depression, quality of life, anxiety, and stress reduction.¹ Martin Seligman’s PERMA Theory of Well-Being brings together 5 factors: positive emotions, engagement, relationships, meaning, and accomplishments; each contribute to human flourishing and well-being.² Specific, actionable practices and tools in these areas may be utilized to potentially increase one’s level of happiness. The PERMA model has been studied in people with cancer and has been shown to improve well-being and quality of life.^3,4 

Positive Emotions

Barbara Frederickson, PhD, director of the Positive Emotions and Psychophysiology Laboratory (PEP Lab) at UNC-Chapel Hill, identified “the big ten” positive emotions that contribute to psychological well-being: joy, gratitude, serenity, interest, hope, pride, amusement, inspiration, awe, and love. Dr Frederickson proposed that people can intentionally seek out opportunities to experience and savor these emotions to positively impact mental health.⁵

Gratitude interventions have been shown to improve quality of life, reduce psychological distress, and even improve sleep quality.^6,7 Gratitude journaling is one simple intervention.⁶ Patients can write down 3 things each day that they are grateful for. This practice may help patients cultivate the skill of attention and focusing on what is going right in each day. Patients could also consider keeping a journal to record “glimmers,” a term coined by Deb Dana, a licensed clinical social worker, that refers to the small, ordinary things in everyday life that activate a sense of safety and connection, such as encounters with nature, beauty, music, scent, or positive social interactions. This practice may reduce stress and anxiety by activating the parasympathetic nervous system.⁸

Engagement

Being fully engaged in the present moment is described as a state of “flow.”⁹ Some activities that can induce flow include playing a musical instrument, painting, writing, cooking, and baking. Patients with cancer may want to re-engage with activities that they used to enjoy to help create these positive immersive experiences. Patients with cancer who have limitations due to their diagnosis or treatment may be able to engage in immersive activities such as listening to music or reading.⁹ Spending time in nature may be another way to promote full engagement with the present moment.

Relationships

The Harvard Study of Adult Development identified positive relationships as the most significant factor influencing quality of life and overall happiness.¹⁰ Patients may find a sense of community by joining a support group or signing up to give or receive peer mentoring. Patients may also find satisfying relationships by volunteering or joining noncancer related groups such as a walking group, book club, or adult education class. Connecting or reconnecting with friends and family may help to reduce feelings of isolation and depressive symptoms and increase feelings of well-being.

Meaning

Meaning-making interventions can increase self-esteem, optimism, and self-efficacy.¹¹ Acknowledging the present, reflecting on the past, and committing to the present and future are ways to promote meaning-making following a cancer diagnosis.¹¹ One example of a meaning-making exercise is reflecting on one’s life goals and values. Oncology nurses can provide a list of general core values to aid patients in identifying and exploring their personal set of core values. Legacy letter writing, in which patients distill their accumulated wisdom and life lessons to share with loved ones, may help patients concretize their values and sense of meaning in their lives.

Victor Frankl, the Austrian neurologist and psychologist who authored Man’s Search for Meaning, wrote “When we are no longer able to change a situation, we are challenged to change ourselves.”¹² Reflecting on how the cancer experience may have changed one’s worldview, relationships, or spiritual life can help patients find meaning in painful and unwanted circumstances.

Accomplishments

A sense of accomplishment or mastery increases well-being.² Listing past accomplishments and identifying future goals may help to promote a sense of hope and self-efficacy. Identifying achievable goals, such as learning a new skill or contributing to a meaningful cause, may provide patients with cancer something positive on which to focus during or after cancer treatment. 

Positive psychology practices, such as gratitude journaling, spending time in nature, and reconnecting with loved ones, may contribute to increased quality of life in people with cancer. These practices present simple, actionable steps patients can take to increase positive feelings and reduce anxiety and depressive symptoms during and after treatment.

Sarah Tennenhaus is a licensed clinical social worker with CancerCare.