Edited by: Cristina Torrelles-Nadal, University of Lleida, Spain
Reviewed by: Tânia Correia, University of Porto, Portugal
Sarah Markham, King’s College London, United Kingdom
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In serving college students with mental disorders, on-campus mental health professionals have been lacking integrative theoretical frameworks to guide their missions of prevention, remedy, and development facilitation. In the current paper, we propose the positive clinical psychology as a theoretically and practically valuable framework for these missions by narratively reviewing the preventive, remedial, and developmental mechanisms derived from the theory and summarizing the most recent empirical evidence that supports each mechanism. We further discuss why and how these mechanisms and findings can be applied to on-campus mental health services to facilitate the resilience and optimal development of college students with mental disorders. Particularly, the use of resilience-focused and strength-based intervention strategies are promoted for services.
College students are commonly experiencing the beginning of their early adulthoods, being challenged by such developmental tasks as the completion of identity development, autonomy development, and the pursuit of post-secondary education. It was estimated that over three-quarters of college students in the U.S. struggled with mental distresses with anxieties and depressive emotions being the most common symptoms (
Traditionally, the goals of mental health services on post-secondary campuses are centered on prevention, remedy, and development facilitation (
Positive clinical psychology (PCP) is conceived of to shift the focuses of existing clinical psychology into a balanced fashion, where both maladaptive and adaptive functioning are valued and learned in research and practices. In response to concerns over a separatist trend between an illness-oriented clinical psychology and a virtue-oriented positive psychology, PCP views the natures, pathologies, and remedies of mental disorders from an integrative standpoint.
Positive clinical psychology inherits some basic philosophies from its two major sources. First, in line with its positive psychology root, it views human conditions from an optimistic perspective, assuming individuals’ inherent capabilities for growth, potential fulfilment, and the development of positive adaptation. Second, PCP concentrates on the adaptiveness of a functioning, hinting its evolutionary view on human natures. That is, it simply sees humans as organisms to adapt the environment and is neutral on the nature of a functioning. Correspondingly, it opposes the illness ideology and the social construction process underlying the conception and nomenclature of mental disorders. In this lens, although harmful in general, even a maladaptive behavior can be helpful in a particular context. Lastly, PCP takes a constructivist approach to the way everyone interprets their experiences by valuing ones’ creativity in finding their own meaning and purposes out of objective conditions.
Positive clinical psychology views mental disorders as being dimensional. That is, the diagnostic criteria are simply the dimensions used to locate one’s positions on the continua of a set of characteristics with one end indicating adaptiveness and the other maladaptiveness. As such, any features that are clinically meaningful exist on continua ranging from low to high. Thus, to completely profile a mental disorder (e.g., the major depressive disorder), one’s conditions related to both “negative” features (e.g., a high sense of self-worthlessness) and “positive” ones (e.g., a low level of self-efficacy) need to be considered.
Relatedly, PCP reconceptualizes the pathologies of mental disorders by including the absence of adaptive functioning as a complement to the tradition of heavily attending to clients’ deficits in psychopathology. The idea is that not only what is going wrong (e.g., depressive or anxious emotions) but what is impeding the right (e.g., a low sense of optimism or self-efficacy) serves the causes of mental disorders, and each part works on ones’ adaptation via its distinctive route (
The PCP approach to psychotherapy includes a strength-building process, through which not only can one reduce symptoms, but pursue a cure. PCP assumes a mutually inhibitory dynamic between symptom occurrence and strength building with a raise of one process leading to a fall of the other. Per PCP, building strengths and positive resources deliberately is therapeutic in that it helps lift one’s overall level of functioning despite of the maladaptation in particular domains. One’s functioning improvement enables them to meet challenges in life, activates their agency, and keeps them motivated in therapy. Also, strengthened rational and positive thoughts and (emotional and social) experiences per se are the therapeutic keys for the reduction of a variety of psychological symptoms.
The focus of prevention is on how to minimize the risk of developing a mental illness. PCP meets the preventive goal via increasing one’s resilience, defined as one’s capability to exert personal virtues and assets to stay adaptive under the negative effects of adversities and stresses. These virtues profile one’s characteristics of thoughts, beliefs, perception, and attribution styles, and conceptually are continua indicating two opposite directions toward adaptation and maladaptation. Thus, one’s resilience can also be seen as a continuum, contributing to the adaptative outcome, or interfering with the risk-illness chain. In facing adversities, the resilient tend to exert personal assets to actively cope with stresses, which lowers the risk; while the non-resilient take stresses passively, which exacerbates the risk (
Resilience alters the risk-illness chain via two mechanisms: the compensatory process and the buffering process. The former is built upon the negative association between resilience and a mental illness, which, serving as a protective factor, offsets the effect of risk factors on the illness (
Both processes have been evidenced. For instance, in a non-randomized clinical trial,
Also, various resiliency factors (e.g., gratitude, flexibility, and optimism) have been shown to alter the risk-illness link in longitudinal studies. For example,
In PCP, the process of remedy means to pursue a cure, rather than symptom reduction per se. Particularly, PCP therapists believe that one’s mental health problems could be fixed by developing and using their strengths and by building their positive resources. Strengths has been defined as one’s built-in capacities for ways of thinking, feeling, and behaving, which allow them to achieve optimal functioning while pursuing valued outcomes (
At the microlevel, it has been proved that interventions focusing on facilitating strength identification and strength use are effective in enhancing clients’ agency for changes, self-efficacy, and the acquisition of personal resources (
The broaden hypothesis originates from the broaden-and-build theory (
Positive clinical psychology assumes that development is a strength-driven process, and that the optimal development can be achieved via maximizing the benefits from one’s potentials and strengths. To maximally fulfil potentials, one needs to endeavor to spot and exert what they excel at, which has been described as a strength identification and use process (
Research has documented that strength-based interventions that focus on strength identification and use can lead to a wide scope of positive changes in one’s psychological, social, and occupational functioning, such as meaning pursuit, well-being, work performance, and education outcomes (
The idea behind strength development is that strength utilization is conditional on both individual and situational factors. Thus, developing the competence of strength use is essentially a process of learning how to adjust one’s characteristics, values, and interests to situational needs.
College students with mental disorders (CSMD) face adversities caused by dealing with the symptoms of their psychological dysfunctions, stresses from post-secondary education, and challenges in completing developmental tasks as emerging adults. From a PCP standpoint, the presence of mental illnesses complicates the challenges CSMD face in pursuing educational, developmental, and career goals, and meanwhile, provides them with opportunities to learn about and cope with their dysfunctions and to develop resilience and strengths for optimal development.
According to
Given these adaptive characteristics of resilient CSMD, building up such a virtue profile is a learning process. That is, to adapt to adversities, CSMD need to gain new insights into their mental health situations, lives, and themselves, to adjust their mindsets and lifestyles, and to learn new coping skills. Such a process may include formal or informal psychoeducation, effective clinical interventions, specific promotion programs for coping skills, and the advocacy of a supportive and flexible environment for learning and living. Under the PCP framework, various positive psychology intervention strategies (e.g., strength-based interventions and positive-emotion-focused interventions) are valuable additions to traditional therapeutic approaches. These strategies can be either employed separately or integrated into the therapeutic procedures of traditional approaches, such as cognitive behavioral and solution-focused approaches.
For CSMD, post-secondary education is an opportunity to earn academic qualifications, learn professional skills, and develop readiness for future career. However, with impaired academic and social functioning, CSMD face challenges on and off campus in their journeys to both mental health and a successful education. Given the potential benefits one can have from their post-secondary education, researchers (e.g.,
Per PCP, the goal of facilitating CSMD’s optimal development is to maximize the benefits of their recognized and potential strengths during post-secondary education. Identifying and using one’s strengths in the context of mental illness need additional conceptual and practical considerations. On one hand, one’s strengths and capabilities to use strength can be utilized as strategies in coping with their mental health problems. On the other hand, efforts to facilitate the maximum development of one’s strengths could help CSMD find meaning and purposes of their lives, and further lift their psychological well-being. The ideal of optimal development is that CSMD can grow and even thrive along with their symptoms.
To facilitate CSMD’s mental health and success in post-secondary education, mental health professionals on college campuses need to systematically provide psychoeducation and clinical interventions and advocate a CSMD-friendly campus environment. Specifically, PCP-based interventions may be designed to focus on building CSMD’s future-oriented and gratitude mindset, on acquiring knowledge for their mental health conditions, and on learning coping skills to facilitate resilience, positive lifestyle, and strength use and development.
The goal of future-oriented interventions is to help CSMD build optimistic mindsets via psychoeducation, cognitive restructuring, and the improvement of overall well-being. Optimism is essentially a cognitive-emotional construct, describing one’s tendency to think and feel positively about future. Optimistic individuals see future positively despite the adversities, and therefore are more likely engage in coping activities, such as proactively learning about their illnesses, seeking for professional helps, setting realistic therapeutic goals, and exploring pathways toward their attainment (
Per PCP, one’s positive experiences, agency, self-efficacy, psychological well-being, and overall level of coping can be improved through maximumly developing and using their strengths. For CSMD, the development and use of strengths can also facilitate their success in post-secondary education. The context of post-secondary education is particularly valuable for strength-based intervention strategies because the strength identification, use, and development are generally valued and encouraged in educational settings. Effective strength-based interventions may need to focus on improving CSMD’s awareness, knowledge, and skills in developing and using strengths (
As a coping skill, intentionally increasing CSMD’s positive affect can effectively reduce mental illness symptoms and boost positive experiences and resources (e.g.,
Positive clinical psychology (PCP) provides a conceptual framework and pathways for CSMD to build resilience, reduce symptoms, and fulfil optimal development. Its resilience-focused and strength-based intervention strategies are suited for the needs of CSMD as the post-secondary education and PCP interventions share common focuses on CSMD’s growth and development. For the same reason, in an ideal educational environment, the post-secondary education itself can be seen as a great opportunity for CSMD to learn coping skills and develop adaptive functioning. In practice, mental health professionals on campuses are suggested making further efforts in recognizing and utilizing their clients’ strengths and intellectual advantages, as well as the potential resources and supports from an educational environment. Future studies are needed to identify the obstacles to practicing the PCP approach in on-campus mental health services. Efforts are also needed to integrate PCP-based strategies into traditional intervention approaches, and further to evaluate the efficacy of each endeavor.
BH: Writing−original draft. YH: Writing−review and editing, Project administration. XY: Writing−review and editing, Project administration. CC: Writing−review and editing, Conceptualization.
The author(s) declare financial support was received for the research, authorship, and/or publication of the article. BH was supported by the Grant 24NDJC07Z from Zhejiang Federation of Humanities and Social Sciences.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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