Positive psychology has shown to impact the quality of life of individuals undergoing certain obstacles or hardships in their lives. Psychologists have used various methods to improve the well-being of individuals, including the PERMA model, which includes these five pillars: Positive emotions, Engagement, Relationships, Meaning, and Achievement (Park, 2014). Connecting the PERMA model to a real-life situation, it has been shown that positive distractions can impact individuals, especially those struggling with a certain illness. These positive distractions can include engaging in activities like games or using creative outlets like journaling to release built-up negative emotions and welcome these new positive feelings as a result. Additionally, placing the needs of an individual first can lead to the person feeling a sense of importance and acceptance, which is valuable when it comes to the relationship shared between a doctor and a patient. These ideas connect with the three themes that will be discussed throughout this paper: the importance of engagement during hard times, the positive emotional impact that creative arts have on individuals suffering from a disease, and the importance of the doctor-patient relationship. From these themes, I have created an intervention that uses journaling and reflective thinking as a way for individuals with amputations to recognize all that they are able to accomplish in their day-to-day lives.
Positive distractions have shown to help individuals escape the struggles of having a serious illness. This idea is discussed by Jane McGonigal (2012) in her TED talk, The Game that Can Give You 10 Extra Years of Life. Throughout her talk, Jane describes the impact that games have on a person’s life by giving her own personal example of how turning her life into a game allowed her to get through a dark time in her life. Jane found herself bed-ridden at one point in her life due to a concussion. During this time, she found herself having suicidal thoughts. Knowing just how much of an impact video games have had on her life, Jane decided to make her own life a game in which she battled her symptoms by using certain activities, which she referred to as “power-ups,” to defeat her symptoms and achieve her main goal: to heal her brain. This idea of making her life into a game impacted Jane by allowing her to mentally heal her mind from these suicidal thoughts while transitioning into an optimistic view of life in which she looked forward to seeing her progression throughout her recovery process.
Similarly, Josh Sundquist (2010) describes in his book, Just Don’t Fall, the impact that skiing had on him, especially when he reached a point in which he was not sure whether he would be able to live out a normal life. Throughout his book, Josh describes the shock he felt from his cancer diagnosis and just how much of a change he underwent after finding out the news. He then goes on to describe the impact that having his leg amputated had on his ability to complete his goals, specifically his goal to play soccer competitively. Knowing that having his leg amputated would mean that he might not be able to play soccer the same way, Josh tried to find ways around this obstacle, but eventually this feeling of hopelessness took over him. Similar to Jane and the game she created to heal her brain, Josh found this love for skiing and immersed himself in the sport (McGonigal, 2012). To Josh, skiing served as a distraction from his current reality, but after he saw just how quickly he was improving at the sport, he began to feel this sense of pride within himself. These positive distractions changed the mindsets of both Jane and Josh and allowed them to accept their current situations, but also welcome this new sense of optimism that they lacked before.
Creative Arts and Positive Emotion
Implementing creative arts into therapy has shown to positively impact the emotional state of individuals struggling with a disease. In particular, journaling has shown to have a positive impact on individuals facing certain health-related struggles. One study has shown the impact that journaling has had on Latina/o adolescents who are struggling with depression or other mental illnesses impacting their lives (Vela et al., 2019). In this study, the participants in the treatment group took part in seven peer-led creative journaling sessions geared to allow adolescents to feel comfortable expressing their emotions and hopes toward their own futures (Vela et al., 2019). The results from these sessions showed that in comparison to the control group, the Latina/o adolescents who were in the treatment group experienced an increase in resilience as well as a decrease in depressive symptoms once they took part in these seven creative journaling sessions. These results were possible because of the impact that journaling had on these adolescents and how this activity served as an emotional escape for them. For many Latina/o adolescents, there is not much time for them to release emotions seeing that in many cases, there are various expectations placed upon these individuals, and this can at times be emotionally draining. With journaling, these groups of adolescents were able to unpack these emotions without feeling this judgment that they would receive from their families, who might believe that these depressive symptoms will just disappear.
In addition to journaling, artmaking has shown to have similar effects on individuals suffering from a certain illness. Art therapy has shown to have quite a positive impact on the lives of individuals with Alzheimer’s disease. One study that showed this positive impact consisted of a participant with advanced Alzheimer’s disease who took part in 5 months of art therapy revolving around activities like mandala drawing, but the participant themself could also dictate what type of art activity they wanted to do for each session (Tucknott et al., 2016). At one point in the study, the participant began to create drawings that made no sense and at times were not considered to be pleasing to others. The art itself did not make sense, but the reason the participant created this type of art is that she used her time during these sessions to release her negative emotions associated with her illness onto a canvas, even if that meant that her final result was not understood or appreciated by others. The process of creating art allowed this individual to release her negative emotions and engage in an activity that provided her with a calming outlet for the emotions she was feeling while struggling with Alzheimer’s disease. In this specific example, the emotions are not being expressed through words, but taking out your own frustrations, as was seen with the participant of this study, results in an increase in happiness and accomplishment. Overall, art and journaling might revolve around different topics but just how journaling proved to be an emotional outlet for adolescents with depression, art allowed this individual who felt trapped due to her struggles with Alzheimer’s disease, to feel free from her own negative emotions that were weighing her down.
Establishing a positive doctor-patient relationship is quite impactful on the outcome of treatment. Josh Sundquist (2010) spent most of his life undergoing treatment, but also seeking help for the depression he felt during these dark times in his life. Rather than feeling comfortable and free to express himself during his time in therapy, Josh was not able to open up to his therapist on how he was feeling. In particular, the therapist would ask Josh questions like “Can you tell me why you decided to draw that picture? Or how it makes you feel?” (Sundquist, 2010). This line in particular seemed quite scripted when it was meant to be a conversation that Josh’s therapist was having with him. Asking about the drawing that Josh drew not only seemed quite odd, but it created this uncomfortable space that led to Josh not being able to truly express how he was feeling considering all the events occurring in his life. To add on to that awkward conversation, Josh’s therapist spent a good amount of time mocking Josh’s drawing. With people like Josh who have gone through much in life, having a safe space to let go of all those feelings is essential and Josh’s therapist was not giving him this opportunity.
On the other hand, in Matthew Quick’s (2012) Silver Linings Playbook, Pat did have a therapist who created a trusting relationship with him. Pat was struggling with the idea of whether he would be reunited with his wife, and with his former therapist he was told that his wife would never come back to him. The difference between Pat’s past therapist and his current therapist, Dr. Patel, is that although he did not promise Pat that his wife would come back, he also did not deny the possibility that she might come back, which made Pat feel this sense of hope and positivity that he was not feeling in past therapy sessions. Comparing Dr. Patel to Pat’s former therapists or even to Josh Sundquist’s (2010) therapist, you can clearly see that the one aspect that Dr. Patel has that is impactful towards patients is how understanding and caring he is. Dr. Patel did not have to listen to Pat’s story about his wife and could have easily told him that she was not going to come back to him, but instead, he listened to the story and took into consideration all possibilities.
In connection to the relationship created between a therapist and their patient, the relationship between a surgeon and a patient is different, but also similar in importance. It is common for surgeons to make mistakes during a procedure but disclosing these mistakes can result in lawsuits and other consequences that hospitals prefer to avoid at all costs. Surgeons like Atul Gawande (2002) have discussed the procedure that doctors take to have a conversation with patients or their families in the case that a mistake was made during surgery. In his book Complications, Gawande discusses how most of these conversations end up sounding along the lines of “I’m sorry that things didn’t go as well as we had hoped.” (Gawande, 2002) Similar to the conversation between Josh (2010) and his therapist, this line seems scripted, which would not be appropriate during a time where there is a loss or a mistake during surgery that caused serious complications. Instead, there should be an extensive conversation or at least an explanation on what has occurred rather than simply offering an apology. This connects back to this doctor-patient relationship because of how important this bond is for both the doctor and the patient. Rather than having these scripted lines, doctors should be trusting of their patients and feel comfortable sharing important information regarding the patient’s procedure which will then allow the patient to recognize that they can confide in their doctor and know that their health is being taken care of.
Patient Intervention: Journaling for Young Adults with Amputations
Seeing the importance of engagement, it is important to keep individuals who might be hospitalized or struggling with a disease motivated towards their own goals. One example of a population who would benefit from engagement would be patients with amputations. People who have had to undergo an amputation procedure have also had to adjust to various obstacles in their own lives. At times this adjustment can seem tiresome, and for many, there are instances in which giving up sounds like a better option than having to change one’s entire lifestyle due to this amputation. Individuals who have experienced an amputation at times may forget to reflect upon all that they are able to accomplish even if they do not have all limbs. Reminding these individuals of all that they can accomplish is of great importance. For these reasons, I propose a positive journaling intervention, Words of Affirmation, that revolves around reminding individuals with amputations of just how resilient they are.
Having read the story of Josh Sundquist (2010) and how he lived his life after having his leg amputated led me to want to learn more about individuals with amputations and the adjustment period they undergo after having a limb amputated. In particular, seeing the mental and emotional impact that having his leg amputated had on Josh led me to wonder whether all individuals with an amputation react the same way or if they experience different levels of emotional, mental, or physical distress. One aspect about Josh’s story that stood out to me was when he discussed how he felt as if his life was over because of his amputation. For example, he was unable to play soccer anymore. This part of the book led me to think about individuals who have also had to deal with the idea of not being able to continue their normal lives post-amputation. Keeping this information in mind, I propose an intervention that addresses the distress felt by young adults after having undergone an amputation. For many of these individuals, having to adjust to life after an amputation is one obstacle in itself. At times, people forget that this adjustment can cause emotional, mental, and physical distress that leads these individuals to feel hopeless. For these reasons, the intervention I propose takes into consideration the distress that these young adults endure after having undergone an amputation procedure and creating activities that keep them engaged, hopeful, and connected to a community of individuals that recognize their efforts to adjust to this new lifestyle.
Words of Affirmation is a program based on positive journaling that is geared towards individuals of ages 16 to 25 who have recently undergone an amputation or are still learning to live this new life. Each individual taking part in the program will be given art supplies in order to create a journal that is personal to them and represents any aspect of their own life. For the individuals who might not be able to write out their own thoughts, they will be given a device to record their ideas. Similar to the individuals personalizing their journals, those who will be recording their thoughts are also going to be given supplies to add pictures or drawings to their device that represent their personal interests. This modification will allow those patients who cannot write their thoughts down to still feel personally attached to the device in which they will be recording their goals. Once everyone has personalized their own journal or their recording device, they will be reflecting on certain aspects of their life after their amputation.
The individuals will start off by spending 10 to 15 minutes of their Sunday writing or speaking about the goals that they have set for themselves for the week. These goals can range anywhere from reading a new book to meeting a new person. The purpose of this journaling activity is to have something to look forward to during the week. This engagement aspect of the intervention allows the individuals to gain new interests and even feel this sense of accomplishment as they complete their weekly goals. As each individual works on their list of goals, we will introduce another journaling activity on Wednesday in which each person reflects on how completing their goals has been going.
Keeping this information in mind, I propose an intervention that addresses the distress felt by young adults after having undergone an amputation. For many of these individuals, having to adjust to life after an amputation is one obstacle in itself.
In particular, each individual will reflect on the obstacles they have faced as they complete these activities but follow these obstacles with a set of strategies that they have to overcome these challenges. These strategies can be ones that the individuals have come up with and done successfully or even ones they intend on trying before the end of the week. This activity will take 15 to 30 minutes in order to allow each person to deeply reflect on ways to overcome the obstacles of the week. By doing so, this journaling activity will serve to provide meaning to the lives of these individuals, who at times convince themselves that their amputation has taken away all chances of success.
Finally, on Friday, all the individuals taking part in this procedure will come together and share the journey they underwent to complete their list of goals for the week. This activity will include going around in a circle and reading your own goals out loud to the group and the process you went through to complete these goals. Once each individual shares their list of goals they completed for the week, each person will go on to give words of affirmation to the support group for completing their goals and stepping out of their comfort zone. The purpose of this last session is to reflect on the week and celebrate what the whole group has been able to accomplish. This last session will also serve as a reminder that even after having had an amputation, there are still ways to go about living a normal life even if it means adjusting certain aspects of your daily activities to fit your new lifestyle. This intervention will continue going on until the patients in the groups are either cleared to leave the hospital or have finished physical therapy. If the individuals taking part in the intervention are done with their in-hospital treatment and still would like to take part in the program, we will have separate groups for those individuals adjusting to life outside of the hospital, and they will also complete the same activities. In the end, the program is created for the patients, and limiting the time of the intervention might benefit some individuals while others might still have interest in having this support system present in their lives.
Although the intervention is meant to help individuals with an amputation live their lives after the procedure, there are certain limitations that might impact the intervention results. One main aspect is that although all these individuals have had an amputation, not all of them had to have the same limb amputated. For some individuals, it might have been their leg and for others their arms, but these circumstances can impact how the patient would take part in the journaling activities. For those individuals who might not be able to write down their own thoughts and create a journal to keep them in, it might feel different having to record your own thoughts. It might not seem as personal as it would writing all these thoughts on a journal personalized for you. To add to this, the severity of the amputation might be different for each individual. Some individuals might have multiple amputations and others might just have one. These differences would be a limitation because the severity of these amputations can affect each individual differently. Not every individual might feel motivated to take part in these journaling activities, especially if they have severe amputations that have completely altered their lifestyles. In the end, not every individual will react the same to these journaling activities, and at times there might not be any motivation to take part in these reflective activities. There could also be a limited number of people who are willing to take part in this intervention which can affect the group activities since there might not always be groups of the same size. The intervention is a start to addressing the distress felt by these individuals, but these limitations do impede the program and the impact that it will have on the patients taking part.
In the future of this intervention, I will consider expanding the availability of this program and the resources available throughout these sessions. Seeing that most of these sessions are taking part in a hospital setting, I will work towards creating an online platform that allows individuals who might be receiving treatment from home to take part in this program. Although an online version of this program might not be the same as an in-person version, the ideas behind what the program offers to these individuals will be present throughout these online sessions: the support from a strong community of individuals experiencing the same obstacles throughout their daily lives. Another aspect of this program that will develop with time is the inclusivity of the intervention. Although at the moment this intervention is provided to individuals who have undergone amputations, I intend on opening this program up to people who are struggling with other orthopedic injuries that have led to them losing hope and motivation for the future. In the end, this program is in its beginning stages, but as the intervention develops, I will proceed to make changes that will benefit the current individuals taking part in the program as well as the future people joining this community of support.
Overall, certain aspects of positive psychology like positive emotions, engagement, and the creation of trusting doctor-patient relationships impact how an individual goes about their life whether they are healthy or experiencing a medical disorder. With all these implementations of positive psychology, there are new tools and interventions being created to add to these existing methods. Various interventions have been created that use the arts as well as other activities promoting an individual’s well-being in order to treat the distress experienced by individuals with certain medical disorders. Although these interventions have shown to positively impact certain aspects of an individual’s health, they have all been used separately rather than together. Combining the arts with exercise and other forms of interventions that promote well-being can not only impact a patient emotionally, but also improve upon the mental and physical aspects of an individual at the same time. These therapy sessions should be offered for various types of diseases. Whether this disorder causes emotional or mental distress on a patient, or it mainly impacts an individual physically, these therapy sessions should be created to improve all aspects of a person’s health. Ultimately, by expanding on these new forms of treatment and therapy, patients are able to positively impact all aspects of their health and not need to rely on medication or surgical procedures alone to recover from a certain disease.
Gawande, A. (2002). Complications: A surgeon’s notes on an imperfect science. New York, NY: Henry Holt and Company.
McGonigal, J. (2012, June). The game that can give you 10 extra years of life. Retrieved November 13, 2020, from https://www.ted.com/talks/jane_mcgonigal_the_game_that_can_give_you_10_extra_years_of_life?language=e
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Quick, M. (2012). Silver linings playbook. New York, NY: Sarah Crichton Books.
Sundquist, J. (2010). Just don’t fall: A hilariously true story of childhood, cancer, amputation, romantic yearning, truth, and Olympic greatness. New York, NY: Penguin.
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Vela, J. C., Smith, W. D., Rodriguez, K., & Hinojosa, Y. (2019). Exploring the impact of a positive psychology and creative journal arts intervention with Latina/o adolescents. Journal of Creativity in Mental Health, 14(3), 280–291. https://doi.org/10.1080/15401383.2019.1610535