Well-Being Therapy in the Netherlands
Authors: Peter Meulenbeek, Lieke Christenhusz, Ernst Bohlmeijer
Journal: Psychotherapy and Psychosomatics (2015)

One of the truly innovative psychotherapies in the past decades has been well-being therapy (WBT) [1]. Psychotherapy and Psychosomatics published several papers about the efficacy of WBT [2,3]. In this letter to the editor, we present an adaptation of WBT in the Netherlands and 2 case reports based on a pilot project.The Dutch WBT contains 5-8 weekly and biweekly individual sessions of 45 min each. The first 2 sessions aim at psycho-education about WBT, identifying episodes of well-being in a patient's life and restructuring thoughts that interrupted periods of well-being. Furthermore, between the first and second sessions, the patient is asked to complete Ryff's Scales of Psychological Well-Being (PWS) [4], discusses with the therapist which dimensions of psychological well-being deserve more attention (e.g. impaired levels) and chooses 1 or 2 dimensions for further treatment. In modules of 3 sessions, the patient will work on each selected dimension, using exercises to develop skills that promote psychological well-being.In the first case study, WBT is applied to a patient with recurrent depression. WBT has been found to be effective for people with recurrent depression [5]. Jim is a 42-year-old married male with one child. He was referred by his general practitioner to a community mental health centre and received the diagnosis of recurrent depression and obsessive-compulsive disorder from the psychiatrist according to DSM-IV-TR criteria. Jim became obsessed with the thought that his wife would leave him. After pharmacological treatment (selective serotonin reuptake inhibitor antidepressant) and cognitive behavioural therapy, his complaints decreased but he did not fully recover and still felt unable to resume work full time, visit friends and practice sports. His psychiatrist recommended WBT and continued medication. After psycho-education about WBT during the first session, Jim began to monitor episodes of well-being. Furthermore, he registered the thoughts that interrupted these positive feelings. By means of this registration he concluded that a positive experience stopped because of his fear it would lead to a disappointment (e.g. rejection by others). A social talk with a colleague or time spent with his wife ended prematurely because of negative cognitions (e.g. 'The colleague doesn't like me', 'My wife is going to leave me'). He developed alternative interpretations (e.g. 'I have no reason to expect being rejected by others', 'There are no signs my wife wants to leave me, because she is nice to me') and had positive experiences when he stayed in contact with others instead of avoiding contact. The PWS showed that he had impaired levels on the domains 'purpose in life' and 'self-acceptance'. After the first 2 sessions, he decided to work 3 sessions on the domain 'self-acceptance' by writing about his talents (e.g. intelligent, reliable) and discussed his past (positive) life experiences with the therapist to become more self-compassionate. The last 3 sessions he worked on the domain 'purpose in life'. He described important changes he wanted to reach in his life to make it more meaningful (e.g. socialize more in daily work, be active in positive relations) and made plans for the near future (e.g. visit friends weekly, spend more time with his wife during the weekends). At the end of the treatment he felt more self-confident and fully recovered. Furthermore, he became more active, resumed playing football and working full time. He still remained well after 6 months of follow-up.In the second case study, WBT has been, to our knowledge for the first time, applied to a patient with a dysthymic disorder. Lucy is a 28-year-old unmarried female referred to a community mental health centre by her general practitioner because of enduring depressive symptoms. From the psychiatrist at the centre she received the diagnosis of dysthymic disorder according to DSM-IV-TR criteria. After cognitive behavioural therapy, she recovered partially. Although the symptoms became less severe, she still had periods suffering from depressive symptoms. Lucy preferred a treatment without medication. Therefore, her therapist referred her to WBT. During the first session she received information about the therapy and a homework assignment to monitor episodes of well-being. She noted in the second session that in most self-observations she appeared to stop positive feelings by having negative thoughts. For example, her boss gave her a compliment for her hard work, but the positive feeling she got from this compliment stopped when she thought that she would never get an employment contract. Accepting compliments and positive feelings became one of her goals in treatment. Furthermore, she learned to restructure irrational thoughts (e.g. 'I will never get an employment contract') in more realistic thoughts (e.g. 'I have to ask my boss about my chances to get an employment contract'). On the PWS she had impaired scores on the domains 'self-acceptance' and 'positive relations with others'. She started with the domain 'self-acceptance' after the first 2 sessions. Writing about her personal qualities (e.g. sociable, committed) was difficult for her because she was used to criticize herself. She also had a negative image of herself ('I am fat and ugly'). To stimulate a more positive and realistic self-image she practiced positive thoughts (e.g. 'I have beautiful eyes and legs'). By sharing her past (positive) life experiences with the therapist she became more self-compassionate. The second domain she worked on was 'positive relations with others'. Although she had friends, she never had close friends because she feared rejection. She restructured her negative thoughts ('friends did not reject me in the past, and there are no signs they will reject me if I get more personal') and became more active in positive social relations by visiting friends more frequently and talking about personal issues. She evaluated the WBT positively, there were no more depressive periods, she became happier with her body and dressed fashionably. Also, some of her friends became close friends. At 6 months of follow-up she remained well, had received an employment contract and started a relationship.The above case reports on WBT provide preliminary evidence for the effectiveness and acceptability of the therapy, comprising 5-8 sessions, in the Netherlands. Further studies on the efficacy of WBT and large-scale implementation are warranted.No external financial support. No conflict of interest.