Research Project

Efficacy of a positive psychological intervention in improving mental health status among methadone maintenance treatment users in Guangzhou, China; a randomized controlled trial

In recent years, positive psychology has drawn much attention. Compared to other methods dealing with mental health problems, positive psychology focuses less on deficits, and more on recognizing and building on positives, as positive states, such as positive affects and positive behaviors (e.g., expressing emotions), are associated with better physical, social and psychological wellbeing. It is suggested that 40% of the variance of happiness is attributable to one’s positive cognitive, behavioral, and goal-based activities. Evidence- based PPI (e.g., the “Three Good Things”) has been developed and is widespread in the U. S. and European countries. Such interventions are backed up by the “Broaden and Build” theory, which suggests that positive emotions enable people to develop and broader psychological and social resources.

The “Three Good Things” method is one of the commonly used PPI. Unlike most of the psychological interventions dealing with mental health problems (e.g., cognitive behavior therapy, narrative therapy etc.) which require trained psychologists, the “Three Good Things” method is a simple approach which needs no psychological professionals to implement and requires low-cost for maintenance. It requires the participants to write down three things that go well each day and continue for a period of time (e.g., one week). The “Three Good Things” has been applied in the general population and people with neuromuscular diseases in the U.S., and the results are very encouraging that a one-week intervention has the beneficial effects on decreasing depression and increasing happiness at one month after intervention, and the effects remain for at least six months. The application of the “Three Good Things” in a clinical MMT setting is also a new attempt.

 

Research Significance

China has about two millions registered drug users, and heroin is the most popular drug choice (over 80%). HIV prevalence among drug users in China ranges from 18% to 72%. The association between drug use and mental health problems is well established. The prevalence of depression (41%-84%) and suicidal ideation (25%-53%) is high among drug users in both China and other countries. In our previous study of drug users attending MMT, 46%-73% had depressive symptoms and 15% reported suicidal ideation in the last six months. Poor mental health status is significantly associated with HIV- related risk behaviors, HIV infection, and poor compliance to drug treatment.

Given the great shortage of psychiatrists (only about 4,000 fully qualified psychiatrists in the whole country) and under-development in clinical psychology in China, the availability of mental health care for drug users is very limited. MMT is the flagship harm reduction program for controlling drug use in China, covering about 30% of all drug users. However, the current MMT services in China mainly involve prescription of methadone and are usually not well supported by allied services (e.g., mental health care), as the service providers are clinicians and nurses who are not well trained in psychology and counseling services, and are usually occupied by routine clinical duties.

Developing sustainable and scalable mental health interventions for MMT users is greatly warranted. Most of the current intervention studies targeting MMT users in China focused on reduction of drop-out and HIV-related risk behaviors, while few of them targeted on mental health promotion. In this study, we will use the novel “Three Good Things” approach of the PPI, which can be provided by general health care workers without special psychological training. It is hence highly scalable in current MMT settings in China. The findings will have important public health implications. This study will apply PPI to drug users for the first time and expand our knowledge to the applicability of PPI in different populations.

 

Mentors

• Joseph Tucker, MD, MPH
• Jane Simoni, PhD, MA
• Yuantao Hao, PhD

 

 

 

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