Integrating Positive Psychology and Recovery | Frameworks #5 (the last!)

Frameworks for Change

Jul 19, 2024

This is post #5, the last in a series about “frameworks for understanding recovery.”

Post one discussed theories of human flourishing and considered the wisdom of definitive prescriptions for “how to live.”
Post two looked at recovery definitions and discussed various components to consider for working toward change, or helping others to do so.
Post three addressed definitions of happiness and wellness, critiqued contemporary perspectives on happiness, and emphasized pursuing meaningful, value-based goals.
Post four was about recovery capital—all the internal and external resources that can help overcome a substance problem—and discussed how the individual-, micro-, and meso-levels can help us think in systems.

I want to wrap up this series by discussing how the insights of positive psychology and flourishing can help us craft a meaningfully integrative conception of recovery. In turn, I’d like to suggest that insights from recovery can better inform positive psychology practices, which, after all, are just one perspective on what it means to thrive.

From self-help books to research reports, from various clinical schools of change to numerous rapidly proliferating gurus, we don’t lack information. There’s an endless list of things you can work on if you feel the need to change your thoughts and feelings. Grit (Angela Duckworth). Flow (Mihaly Csikszentmihalyi). Mindfulness (take your pick!). (Learned) Optimism (Marty Seligman). Self-compassion (Krisin Neff). Awe (Dacher Keltner). Altruism (Matthieu Richard). Vulnerability (Brené Brown).

Listen, I like most of these books and writers. Many have been directly helpful to my clinical practice and my life. But, after reading all this and taking their suggestions, you either spend half your waking hours practicing positive psychology interventions (in a sort of protocol-mania that is especially fashionable today), or, perhaps more realistically, you pick up a few pointers here and there but otherwise continue with the status quo.

There is something to be said for the latter, a relaxed process of experimenting, and trying out different ways of working with the unruly mind. But there also comes a time when crisis strikes. Those of us in addiction recovery know this well, but we also don’t have a monopoly on crisis. If one day you find yourself screaming at your kid for, say, weeding the garden the wrong way, you might need to get serious about change.

The challenge is translational: how do we translate all this theoretical knowledge into practical use? With limited time and attention, how do we chart a meaningful, integrated approach without being scattershot or overly rigid?

Frameworks from addiction recovery and positive psychology offer structured ways to address this translational challenge. In the last of these “frameworks” posts, I discussed how people in addiction recovery have tried to bring order to the complex, messy world of recovery components under the banner of “recovery capital.” This post is about comparable frameworks from positive psychology.

It’s odd that there has been so much focus and energy in each field with so little cross-talk, and I think it’s worthwhile to consider how these two perspectives could be better integrated and synthesized.

No one framework has the final word on defining, measuring, or promoting flourishing. However, by thinking comprehensively and synthetically across these frameworks, we can better focus our efforts on meaningful, lasting change for ourselves and others.

The building blocks of flourishing - PERMA

The usual origin story of positive psychology starts with Marty Seligman, a U Penn psychology professor who earlier in his career published a raft of influential studies, perhaps most famously on “learned helplessness,” which involved giving painful electrical shocks to dogs. It’s a fascinating and important series of experiments that, like many classics, could never pass an ethics board today. For example, when dogs were zapped unexpectedly and then prevented from getting to a “safe” area of a cage, they seemed to lose hope and gave up trying to escape the painful stimulus entirely.

Seligman garnered professional accolades and made influential contributions to traditional psychopathology, but even after decades of success, he felt dissatisfied and unfulfilled.

One day in the 1990s, while working in his garden with his 5-year-old daughter, Seligman, a “very serious gardner,” became frustrated when his daughter got messy, throwing dirt and weeds into the air. He lost his temper and yelled at her. Here’s the rest of the story as he tells it:

“Nicki got a stern look on her face, and she walked right over to me. ‘Daddy,’ she said, ‘I want to talk with you.’ And this is just what she said. ‘From the time I was three until I was five, I whined a lot. But I decided the day I turned five, to stop whining. And I haven’t whined once since the day I turned five.'”

“Then Nicki looked me right in the eye, and said ‘Daddy, if I could stop whining, you can stop being such a grouch.'”

Seligman shifted his focus to positive psychology and began working to bring more rigorous science and empirical research to it. A major part of that work was developing a construct called PERMA, a framework that categorizes the five major “building blocks” that contribute to well-being:

Positive emotions - e.g., joy and gratitude.
Engagement - fully using one’s skills and being absorbed in activities.
Relationships - feeling valued and supported by others.
Meaning - having a sense of purpose and placing one’s role in the larger context of life.
Accomplishment - achieving goals and having a sense of success.

This work was subsequently refined, and others added four more building blocks of well-being, making it “PERMA+4:“

Physical health,
Economic security,
Mindset, and
Environment.

What’s the point of a framework like this? PERMA was criticized for being indistinguishable from the good old standby of subjective well-being. Seligman’s response was that PERMA is not a new type of well-being; it seeks to provide a framework for understanding how to direct our efforts to improve well-being. In other words, PERMA describes “building blocks;” it’s not a definition of well-being but a description of specific, modifiable antecedents of well-being.

Awareness and Insight - ACIP

I love mindfulness-based work, and there’s a lot of evidence supporting their benefits. Mindfulness-derived clinical therapies like MBSR, MBCT, MBRP, and other mindfulness-based treatments also offer unique benefits beyond traditional therapies. But where does mindfulness fit into PERMA or PERMA+4? Those building blocks don’t seem to capture the idea. So we may need to supplement things a little.

The point is not to find the one perfect framework, because that would be a fool’s errand, but comparing reputable frameworks to round out your specific situation can be useful. Another framework worth considering here comes from Richie Davidson, who is widely recognized for his research on meditation and as a major figure in the general neuroscience of emotion. His idea is particularly skills-based and labeled as “A training-based framework for the cultivation of human flourishing:”

Awareness - attentiveness to both environmental and internal states.
Connection - the subjective sense of care and connection to other people.
Insight - self-knowledge about one’s own psychological processes.
Purpose - clarity about aims and values.

The value of “awareness” in particular is bolstered by the research on mindfulness and meditation. Awareness has positive effects on flourishing in at least two senses, first, that simply being aware is a positive experience, and second, that awareness supports other kinds of self-regulation and action. I also like the way he and his coauthors articulate “connection:” it’s skills-based in the sense that it focuses on the feeling and perspective of care and connection with other people. The focus is on perceptions of care, perspectives of shared humanity, and not solely the presence or absence of a relationship itself.

Depending on how you look at it, both ”awareness“ and “insight” might be considered part of a secular spirituality, if only in the sense of the ineffable, noetic, ego-transcending experiences we might get from contemplative practice.

Character and Virtue

Now, imagine an academic psychologist hollering at his daughter in the garden. Imagine that he’s been grouchy and disillusioned for a while, despite stunning successes. After hitting this emotional bottom, he shifts his research focus to the more positive side of psychology and begins to feel better. Perhaps he has more of a sense of meaning and purpose in his new work—the “M” of PERMA. Perhaps he’s just paying more attention to cultivating positive emotions and caring for his relationships. But perhaps there was also something nagging him about his old work. Perhaps, for example, his conscience was bugging him about shocking dogs to the point of helplessness. Sure, the work was in line with the ethics of the time, and sure, we need some amount of animal research to advance important human knowledge, but maybe for him, it just felt wrong, enough to leave a residue on his conscience that no amount of gardening could clear.

I don’t know if this is true. But suppose it is. The turn toward meaningful work can be encapsulated in PERMA’s meaning, or the purpose Davidson’s ACIP, but neither quite capture the ethical dimension of turning away from harm, in that sense of attending to virtue and justice.

Practical ethics is missing from the frameworks above, but it is present in the framework from Tyler VanderWeele, a measurement-focused epidemiologist. He is the director of Harvard’s Human Flourishing Program and Co-Director of the Initiative on Health, Spirituality, and Religion. In keeping with that interdisciplinary perspective, his framework includes a domain about “character and virtue.” The full list as part of their flourishing measure is here, and most of the other items will be familiar:

happiness and life satisfaction,
physical and mental health,
meaning and purpose,
character and virtue, and
close social relationships.

Acknowledging “character and virtue” inherently acknowledges the normativity of ideas about flourishing. We discussed this at length in frameworks post #3 about defining happiness. Definitions of well-being, thriving, or flourishing are necessarily value-laden; they are inherently bound up in norms—moral, political, or otherwise. The definition and promotion of happiness is not a philosophically neutral exercise. A person is happy or flourishing only relative to some standard or definition. Likewise, in recovery definitions discussed in frameworks post #2, several definitions have incorporated particular moral, ethical, and “citizenship”-based conceptions of recovery.1

Notice also that VanderWeele’s framework is more of a list of outcomes, whereas Seligman’s and Davidson’s are more about antecedents or modifiable skills. This makes sense. The PERMA positive psychology approach seems better known in educational curricula, psychotherapy, corporate wellness, and popular science writing. VanderWeele’s framework is more in line with policy and measurement goals.

Bringing Positive Psychology into Recovery

The words “integrative and holistic” have sadly been reduced to buzzwords and branding labels, but the true meanings of these words still represent useful approaches to care. Integrative approaches are comprehensive, coordinated, and systematic across multiple levels. Holistic approaches consider the whole person, rather than attaching to specific symptoms or change processes.

In that spirit, there’s much to be gained from reviewing these frameworks and considering what’s missing from your current conceptions—from your clinical work, your personal recovery, or any of your efforts toward change. This is the real promise of integration and holism.

It’s also good to ask if there are experiences in addiction recovery that have not been adequately captured by these broader frameworks.

There’s precious little work to find synthesis and connection between positive psychology and recovery, but one excellent recent example is a thesis from Hannah Carlon of the University of New Mexico, who explored the relationship between the PERMA model and measures of recovery from Alcohol Use Disorder. Two hundred fifty people in recovery were assessed with the standard PERMA questionnaire, and they were also asked questions like “what has helped you experience positive emotions, specifically during alcohol recovery?”

The big surprise from this work was that the PERMA model didn’t fully align with the data from people in recovery. The qualitative work identified certain themes that were missing from the PERMA questionnaire when measuring flourishing in recovery from Alcohol Use Disorder. Carlon wasn’t able to reproduce the same five distinct factors found in PERMA. Instead, she found three cross-cutting themes that might in part explain why it wasn’t a perfect fit: “mutual help,” “helping others,” and “mindfulness.” Considering the other frameworks above, this suggests to me that the practical ethics component of service in mutual help was missed by PERMA, and that there is indeed something to the factors Davidson identifies as “awareness” and “insight.”

My Own Framework

Here’s how I might think about a framework for flourishing that balances simplicity with some descriptive heft. This is not a detailed research or theoretical proposal but rather my own back-of-the-envelope attempt to organize domains of change for my own work and with special attention to flourishing in recovery.

It’s motivated in the first place by the fact that insights from recovery research—both the Carlon thesis above and the ideas I’ve discussed in the prior posts in these series—makes a case for including both practical ethics and spirituality. I’m not convinced those dimensions are necessary for every person, and as a therapist I always take pains not to push my own values on patients, but I think they still belong on the list.

Also, considering the different definitions and frameworks here and elsewhere, we easily mix up some of the things we put on a list that are meaningfully different, such as causes, versus outcomes, versus aspirations. That’s an insight that some of the philosophers discussed in previous posts have helped me to clarify. My focus is more on listing out domains of life that are relevant to processes of change. In other words, like Davidson’s framework, consider this a skills-based framework:

Physical - e.g., physical health, sleep, nutrition.
Intrapersonal - i.e., awareness, self-knowledge, insight, etc.—i.e., psychological flexibility (If you want to get fancier with this dimension, there are plenty of more specific psychological models, such as Hayes’ and Hofmann’s Extended Evolutionary Meta-Model, or really any theory of psychotherapy you choose.)
Interpersonal - the sense of care and connection toward immediate relationships, family of choice, and social supports.
Meaning and purpose - defining chosen values and taking action toward them.
Practical ethics - including memberships in a broader community, service, interconnectedness—but only according to a person’s own values.
Spirituality - at least in the secular sense of numinous, ineffable, noetic, ego-dissolving experiences—again, only according to a person’s chosen values.

From the What to the How

These frameworks are useful heuristics, and thinking across multiple levels can be a practical check on our biases. It’s good to take an inventory.

In the end, these frameworks are the “what.” What to focus on? What to work on when we are working on flourishing?

Another crucial question—perhaps a harder one—is the “how.” How do we change? How do we work within a given domain of recovery or flourishing? How do we maintain motivation and energy?

One nice perspective on these “how” questions comes from one of my favorite therapies, ACT.

Steven Hayes (previous podcast guest) says that as a corrective against standardized treatment protocols, we need a “functional, idionomic approach.” “Idionomic” means to take into account individual variability, and to dynamically assess it over time. “Functional” in this context means looking at the practical utility of psychological processes, including the variability and interactions between different processes.

For example, in a standard, diagnosis-based protocol, everyone with the same diagnostic label receives similar treatments. Social anxiety? Here comes a manualized therapy or a medication guideline built for that label. An idionomic approach instead focuses on the unique patterns of each individual, using frequent, dynamic, ongoing assessments to assess what patterns of thought and behavior are trying to do for someone and develop a personalized plan. The point is to focus on processes of suffering and change, rather than just loading up protocols for DSM syndromes.

I suppose I’m introducing this perspective as a corrective against the possibility of over-systematizing our approaches to recovery. All of these frameworks are just maps of possibilities for change; in the end, one has to choose a path that makes sense, and the only way to do that is to be diligently and rigorously attentive to the human element of this work. So by all means, use frameworks. I’ve enjoyed thinking about them for a little bit. But I would recommend you also hold them loosely.

I started this series with what I called a modest argument:

“Thinking rigorously about recovery is worthwhile for clinicians, people in recovery, and everyone with addictions, which I also argue is all of us. Recovery is more than stopping addictive behaviors; it’s a holistic and multilevel process toward thriving and well-being—toward what we all want, a life full of enjoyment and meaning. This means the concept of recovery should intersect with and incorporate various insights from psychology, psychotherapy, and more.”

I suppose I’ve stuck close enough to this commitment. I hope that thinking rigorously about recovery has been worthwhile for you!

What’s Next for Rat Park

I joined Substack back in January because I was interested in the idea of posting a serialized set of reflections on “frameworks,” so here we are. It’s been fun to write as part of that series, but there’s also a way that hitching myself to that linear structure was limiting. (I felt like I was cheating when I wrote a post on harm reduction vs abstinence, and that wound up being a popular post!) So from here on out I’m going to write with a looser agenda and in response to different issues.

If you’ve read this far, you must care about this stuff. Let me know what you’re interested in seeing here going forward. I’d love to hear what you're looking for and what you’d like me to explore.

Rat Park with Carl Erik Fisher

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