Interventions, Decisions, and Actions

We have compiled here a few evidence-based interventions or actions that are most closely related to our research on pathways to human flourishing including religious community, family, work, and education and on aspects of human flourishing such as happiness, health, virtue, meaning, and close social relationships. The interventions and actions here are focused on those that individuals can implement themselves. There is of course a much broader literature on interventions requiring special resources, trained therapists or health care providers, or which may require significant expense. The interventions described here constitute individual actions or easy to access books or resources that evidence suggests contribute to various aspects of human flourishing.

Religious Service Attendance

Our own research, and that of many others, has suggested that religious service attendance powerfully affects health and other aspects of flourishing such as meaning in life, character, and close social relationships. Specifically, our research has indicated that those who attend religious services at least weekly are about 30% less likely to die over a 15 year follow-up, are about 30% less likely to become depressed and are over five times less likely to commit suicide (Li et al., 2016ab; VanderWeele et al., 2016a). While religious service attendance cannot be randomized and the evidence comes from observational data, our own research has used multiple measurements of religious service attendance and health over time to try to rule out the possibility that such associations are only due to reverse causation – that only those who are healthy can attend. Even using very rigorous methodology, taking into account whether changes in attendance precede health or vice versa, the associations between religious service attendance and better mental and physical health appear to hold up. Other evidence suggests that religious service attendance is associated with subsequent greater meaning in life, greater social connection and support, and lower likelihood of divorce. Our summary of the existing research on the topic is available here. One interesting aspect of the associations is that it seems to be service attendance, rather than religious or spiritual identity, or private practices that most strongly predicts health (VanderWeele et al., 2016b). Something about the communal religious experience seems very powerful. People of course do not become religious principally for health reasons. However, for those who are already religious, attending services could be encouraged as a powerful, meaningful form of social participation, one that is central to the understanding of most religious groups and one that also powerfully affects numerous aspects of human flourishing.

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Job Crafting

The idea of job crafting is that one reflects upon one’s work environment and takes actions at work to try (i) to structure one’s tasks so that they can be done more effectively, or so that tedious tasks are no longer necessary, or so that more challenging tasks are available; (ii) to have better, more meaningful, or more effective social interactions at work; and (iii) to find meaning and purpose in the work being done. Our own research has synthesized the available longitudinal studies on job crafting and has suggested that the use of job crafting increases work engagement and performance and may also have effects on meaning in work and various measures of psychological well-being (Frederick and VanderWeele, 2016). Such job crafting can of course be done by simply setting time aside to reflect upon one’s work environment and how one might act, or structure tasks, or think about work differently. The researchers who provided the original theoretical framework for job crafting (Wrzesniewski and Dutton, 2001) have also developed a workbook to assist in the process of job-crafting. The workbook is available for a modest fee at the website: http://positiveorgs.bus.umich.edu/cpo-tools/job-crafting-exercise/. However, the effectiveness of the use of the workbook has not itself yet been tested in a randomized trial.

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Forgiveness

Research has indicated that forgiving others for wrongs they have done to you is generally associated with better mental health, greater hope, and possibly better physical health. Often forgiveness of another for a substantial wrong is difficult and takes considerable time. Interventions have been developed to promote forgiveness and have been found to be effective in randomized trials. Such interventions have been shown to be effective not only in increasing forgiveness but also in decreasing depression, decreasing anxiety, and increasing hope (Wade et al., 2014). Most of the interventions require many sessions with a trained therapist or counselor. However, very recently a workbook intervention to promote forgiveness has been developed and has been shown to be effective in a small randomized trial (Harper et al., 2014). The “Paths to Forgiveness” workbook is freely available for download at: http://www.evworthington-forgiveness.com/diy-workbooks. Further research on the effectiveness of such workbook interventions is needed, but the initial results seem promising.

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Gratitude

Simple easy-to-use interventions have been developed to increase gratitude in life.  Numerous variations on these simple interventions and actions exist but the original intervention (Emmons and McCullough et al., 2003) consisted of taking time once per week to reflect upon five things in life that one was grateful or thankful for and writing these down, and then repeating this for ten consecutive weeks. In a randomized trial, those who were assigned to participate in this gratitude intervention as compared to writing about life events or hassles or having no instructions, were found to have higher levels of gratitude as well as better feelings about life as a whole, and about the upcoming week, fewer physical symptom complaints, and more and better sleep (Emmons and McCullough et al., 2003). Another variation of this gratitude exercise used a more compressed time scale and had participants write down three things that went well each day, and also write about their causes, and to do so every night, for one week. Those who were assigned to do this, versus to simply write about memories, had higher levels of happiness and lower levels of depressive symptoms, even six months later (Seligman et al., 2005). There are of course numerous other variations on this exercise of expressing gratitude. A recent meta-analysis synthesizing the evidence from the various interventions that have been developed suggests that, although there is some variation across interventions, these types of gratitude exercises do tend to increase overall measures of gratitude and also feelings of psychological well-being more generally (Davis et al., 2016).

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Virtue

Aristotle argued that happiness is attained by action in accord with virtue. While the empirical study of virtues is relatively new, there is now reasonably good evidence that the exercise of virtue does indeed, perhaps unsurprisingly, contribute, on average, to greater happiness. Results from a randomized trial suggest that the implementation of an intervention designed to promote the use of one’s central character strengths in new ways increases happiness and decreases depressive symptoms with results lasting at least six months (Seligman et al., 2005). The intervention consisted of taking a survey to identify one’s five central character strengths and then using one of these top five strengths in a new and different way, every day, for one week. Those who were assigned to do this, versus to simply write about memories, had higher levels of happiness and lower levels of depressive symptoms, even six months later. The survey on character strengths is available at www.authentichappiness.sas.upenn.edu/questionnaires/survey-character-str... or a brief version available at

www.authentichappiness.sas.upenn.edu/questionnaires/brief-strengths-test;

The surveys are free but do require registration.

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Depression Recovery

Depression is one of the most common mental health issues world-wide. Numerous treatment options have been developed including various pharmacological treatments and different types of therapy. Cognitive behavioral therapy is focused on changing the thought processes and behaviors that may contribute to depression and numerous forms of cognitive behavioral therapy have been shown to have effects on alleviating depression in randomized trials (Cuijpers et al., 2013). The principles of cognitive behavioral therapy have also been implemented in various self-help books. One particularly popular self-help book, “Feeling Good” by David Burns, has itself been tested in various randomized trials and shown to have an effect on alleviating depression (Anderson et al., 2005). The book is available for purchase in numerous bookstores or online.

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Marriage

Online Marriage and Relationship Resources

Over the last decade, research on relationship education and marriage counseling has become increasingly based on evidence as to what actually improves relationship quality. Some of this evidence has been incorporated into marriage counseling practices. However, many couples may feel that they lack the money, time, resources, motivation, or need, to seek out a marriage counselor or therapist. Recently, easy to use and accessible online relationship education programs have been developed to enhance marriage and relationship quality and to work through marriage difficulties. Some of these have begun to be tested in randomized trials. A recent randomized trial found one such online program, OurRelationship, which consists of about eight hours of exercises for a couple, to have fairly substantial effects on relationship satisfaction and relationship confidence, as well as lower rates of individual depression and anxiety, and better quality of life (Doss et al., 2016). The program is available at the website: www.ourrelationship.com and could potentially be used quite broadly. Marriage and marriage quality is an important determinant of happiness in life and many other aspects of human flourishing and easy-to-use resources to strengthen relationship and marriage quality have tremendous potential to contribute to human well-being.

Decisions to Marry and Stay Married

The decision to marry, and attempting to find the right partner, can be very difficult. Research does, however, strongly indicate that the commitment made in marriage affects numerous aspects of human flourishing. Marriage itself of course cannot be studied in a randomized trial, but evidence from longitudinal studies suggest that marriage, compared to being single or cohabiting, leads to better physical health, greater levels of happiness and life satisfaction, less depression, more meaning in life, greater financial stability and closer relationships (Waite and Gallagher, 2000; Wilcox et al., 2011). Marriage may not be the right decision for everyone, but the research suggests that the commitment in marriage is something quite different from cohabiting. One of the difficulties in studying the effects of marriage versus cohabiting is that couples that choose to marry versus cohabit may well be quite different from one another. Attempts are made to control for these differences statistically and it is likely that some of the differences in health, happiness, meaning, relationship quality, and financial stability between married and cohabiting couples are due to differences in the couples themselves, but the evidence suggests that some of it is due to the actual effects of the commitment of marriage. The commitment of marriage for life does have concrete implications for a couple, often including the merging of financial resources, a greater sense of security in the relationship, an increased capacity to plan, greater commitment to sexual fidelity, and stronger relationships with extended family (Waite and Gallagher, 2000). These things likely go on to affect various human flourishing outcomes such as health, happiness, meaning and purpose, character, financial stability and close social relationships. Moreover, research indicates that the children of married couples are likewise more likely to have better mental and physical health, to be happier in childhood and later in life, are less likely to engage in delinquent and criminal behaviors, are more likely to have better relationships with their parents, and are themselves less likely to later divorce (Waite and Gallagher, 2000; Wilcox et al., 2011). Single parents of course often do heroic work in caring for children, and should not be neglected in policy or the provision of resources, but the research suggests that there are, on average, benefits to children of having both parents present and married. Thus, although the actual effects of the marriage commitment itself are not easy to study, there are plausible mechanisms for these effects, and some progress in understanding these is possible. We are currently working on a report synthesizing the most rigorous research on the topic. The decision to marry is an important one. The research suggests the effects of marriage on human flourishing are profound.

While marriage itself seems to contribute to health, happiness, meaning, purpose, character, financial stability and close social relationships, divorce, on average, does the opposite. Research indicates that divorce is associated longitudinally with poorer mental and physical health outcomes, lower levels of happiness and self-acceptance, lower levels of purpose in life, poorer relationship quality, poorer outcomes for children, and greater levels of poverty for both children and mothers (Marks and Lambert, 1998; Waite and Gallagher, 2000; Wilcox et al., 2011). The decision to divorce or stay married will often be difficult, and is compounded further in cases of persistent infidelity or abuse. As is the case with studying the effects of the marriage commitment, it is likewise challenging to study the effect of divorce itself, rather than just the poor relationship quality that might precede it, but again the research seems to indicate that, at least on average, the effects of divorce are substantial and detrimental for spouses and children. Efforts that can be made to enhance relationship and communication quality before marriage deteriorates could have profound effects on the flourishing of both spouses and children. The passage of time can sometimes of course also help. One study indicated that of those who were stably married and rated their marriage as “very unhappy”, 77% said that five years later the same marriage was either “very happy” or “quite happy” (Waite and Gallagher, 2000). Given the negative effects of divorce, and the profound positive effects of marriage, the commitment to marriage, and resources that promote marriage and relationship quality, have tremendous potential to contribute to well-being.

Religious Participation of Married Couples

Religious communities often provide numerous resources to support families and marriage including programs for couples and children, social support from other families with shared values, reinforcement of the importance and sanctity of marriage vows, profound understandings of the meaning of marriage, and encouragement and teachings on fidelity, love, sacrifice, and commitment. Empirical research indicates that joint religious service attendance is longitudinally associated with greater marital satisfaction and lower likelihood of divorce (Wilcox and Wolfinger, 2016; Call and Heaton, 1997). Shared family religious activities and praying together are likewise associated with greater relationship satisfaction (Wilcox and Wolfinger, 2016; Ellison et al., 2010). A randomized trial that assigned religious couples to either pray together or to discuss positive news stories likewise found effects of praying together on couple unity and trust (Lambert et al., 2012). For religious couples, praying together may help to deal with stress, and allow them to focus on shared belief and hopes for the future, and deal constructively with problems in their relationship. For those who already consider themselves religious, thus both service attendance and joint prayer may be important resources to strengthen marriage and trust.

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Summary of Actions and Interventions to Promote Flourishing

The evidence summarized above thus suggests that each of the above interventions or actions can be helpful in promoting various aspects of human flourishing including mental and physical health, happiness and life satisfaction, meaning and purpose, character and virtue, and close social relationships. A summary of these actions and interventions is given below. Again, although many other interventions and resources are available, most of the various actions and interventions summarized here are ones that are relatively easy to implement or access or can be done without substantial expense.

The empirical studies only give evidence for effects on average, and individual experience will, of course, be variable, but for many of these actions and interventions, the evidence does suggest that the average effects on various human flourishing outcomes are relatively substantial.

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References

Anderson, L., Lewis, G., Araya, R., Elgie, R., Harrison, G., Proudfoot, J., Schmidt, U., Sharp, D., Weightman, A., Williams, C. (2005). Self-help books for depression: how can practitioners and patients make the right choice? British Journal of General Practice 55:387-392. 

Call, V., and Heaton, T. (1997). Religious Influence on Marital Stability. Journal for the Scientific Study of Religion, 36:382.

Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., and Dobson, K.S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry,58:376-385.

Davis, D.E., Choe, E., Meyers, J., Wade, N., Varjas, K., Gifford, A., Quinn, A., Hook, J.N., Van Tongeren, D.R., Griffin, B.J., and Worthington, E.L. (2016). Thankful for the little things: a meta-analysis of gratitude interventions. Journal of Counseling Psychology, 63:20-31. 

Doss, B.D., Cicila, L.N., Georgia, E.J., Roddy, M.K., Nowlan, K.M., Benson, L.A., and Christensen, A. (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology. 84:285-296.

Ellison, C.G., Burdette, A.M., and Wilcox, W.B. (2010). The couple that prays together: race and ethnicity, religion, and relationship quality among working-age adults. Journal of Marriage and Family, 72:963-975.

Emmons, R.A., and McCullough, M.E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84, 377-389. 

Frederick, D. and VanderWeele, T.J. (2016) A meta-analysis of the association of job-crafting and work engagement. Technical Report.

Harper, Q., Worthington, E.L., Griffin, B.J., Lavelock, C.R., Hook, J.N., Vrana, S.R., and Greer, C.L. (2014). Efficacy of a workbook to promote forgiveness: a randomized controlled trial with university students. Journal of Clinical Psychology 70:1158–1169.

Lambert, N.M., Fincham, F.D., Lavallee, D.C., and Brantley, C.W. (2012). Praying together and staying together: couple prayer and trust. Psychology of Religion and Spirituality. 2012;4:1-9. 

Li, S., Okereke, O.I., Chang, S.-C., Kawachi, I., and VanderWeele, T.J. (2016a) Religious service attendance and lower depression among women - a prospective cohort study. Annals of Behavioral Medicine, Published online July 8, 2016. doi: 10.1007/s12160-016-9813-9. 

Li, S., Stamfer, M., Williams, D.R. and VanderWeele, T.J. (2016b). Association between religious service attendance and mortality among women. JAMA Internal Medicine, 2016;176(6):777-785. doi: 10.1001/jamainternmed.2016.1615

Marks, N.F. and Lambert, J.D. (1998). Marital status continuity and change among young and midlife adults longitudinal effects on psychological well-being. Journal of Family Issues, 19:652-686

Seligman, M.E.P., Steen, T.A., Park, N., and Peterson, C. (2005). Positive psychology progress: empirical validation of interventions. American Psychologist, 60:410–421.

VanderWeele, T.J., Li, S., Tsai, A., and Kawachi, I. (2016a). Association between religious service attendance and lower suicide rates among US women. JAMA Psychiatry, Published online June 29, 2016. doi:10.1001/jamapsychiatry.2016.1243.

VanderWeele, T.J., Yu, J., Cozier, Y.C., Wise, L., Argentieri, M.A., Rosenberg, L., Palmer, J.R., and Shields, A.E. (2016b). Religious service attendance, prayer, religious coping, and religious-spiritual identity as predictors of all-cause mortality in the Black Women’s Health Study. American Journal of Epidemiology, in press.

VanderWeele, T.J. (2016). Religion and health: a synthesis. In: Peteet, J.R. and Balboni, M.J. (eds.). Spirituality and Religion within the Culture of Medicine: From Evidence to Practice. New York, NY: Oxford University Press. 

Wade, N.G., Hoyt, W.T., Kidwell, J.E., and Worthington E.L. (2014). Efficacy of psychotherapeutic interventions to promote forgiveness: a meta-analysis. Journal of Consulting and Clinical Psychology, 82:154-170. 

Waite, L.J. and Gallagher, M. (2000). The Case for Marriage. New York: Doubleday. 

Wilcox, W.B. (2011). Why Marriage Matters: 30 Conclusions from the Social Sciences. 3rd Edition. New York: Institute for American Values/National Marriage Project.

Wilcox, W.B., and Wolfinger, N.H. (2016). Soul Mates: Religion, Sex, Love, and Marriage among African Americans and Latinos. New York: Oxford University Press. 

Wrzesniewski, A. and Dutton, J.E. (2001). Crafting a job: revisioning employees as active crafters of their work. Academy of Management Review, 26:179-201.

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