The Great Debate: Scrutinizing the Value of Positive Psychology for Health Research

Suzanne M. Miller, PhD
Allen C. Sherman, PhD, Cancer SIG Member

In recent years, "positive psychology" has commanded appreciable attention. In particular, growing interest has focused on whether variables included within this broad rubric might influence health processes. Research regarding links between positive constructs and health has expanded markedly, and SBM has been an active forum for some of this work.

Efforts in this area have been greeted with both warm receptivity and deep skepticism. In response to this controversy, the SBM Cancer SIG sponsored a debate at the 2008 Annual Meeting in San Diego, CA. The panelists were invited to present a critical appraisal of the implications of positive psychology for health research. The ensuing exchange was lively, incisive, and thought-provoking. These papers were subsequently further developed into a special series for publication in Annals of Behavioral Medicine.

Raising the standard for the "pro" position were Drs. Lisa G. Aspinwall and Richard G. Tedeschi. The "con" position was championed by Drs. James C. Coyne and Howard Tennen; Dr. Richard P. Sloan also participated on the "con" team in the conference debate. Dr. Sherri Sheinfeld Gorin provided commentary. Of course, we cannot capture the richness or complexity of the exchange in a brief synopsis, but we can trace some interesting themes. (Interested readers will find a more nuanced treatment in the forthcoming series in Annals.)

It is unlikely that the diverse constructs often enfolded within "positive psychology" have identical health correlates. Drs. Aspinwall and Tedeschi begin by considering some of the better established lines of research, such as optimism, sense of coherence, and posttraumatic growth. They briefly review evidence regarding some of the pathways through which these variables might affect health outcomes, including effects on neuroendocrine and immune function, as well as less direct mechanisms involving health behaviors, attention to health risks, treatment adherence, and coping. They note that prospective relationships between health outcomes and positive constructs (e.g., positive affect) often remain statistically significant after adjusting for the effects of negative states- suggesting that more is at play than simply the absence of distress. Moreover, the magnitude of the effects for positive states seems generally comparable to that of negative ones.

Finally, Drs. Aspinwall and Tedeschi take aim at a number of assumptions that they perceive as common but empirically unfounded. They argue that positive thoughts and feelings do not constrain medical decision-making (i.e., feeling good does not blind one to relevant threats). Furthermore, they note that positive and negative responses are often experienced concurrently; (positive reactions do not necessarily betoken denial or poor coping). Moreover, positive and negative states do not necessarily have symmetrical and opposite effects (e.g., low distress is not synonymous with enhanced well-being). In sum, they argue that both positive and negative phenomena should be studied concurrently if investigators seek to capture the fullness and complexity of human adaptation.

Drs. Coyne and Tennen provide a more critical or disenchanted perspective regarding the contributions of positive psychology to health research. Focusing more explicitly on oncology research, they examine the impact of fighting spirit and other positive factors on disease incidence and progression. They review prospective data that fail to support the hypothesized benefits of these constructs for disease outcomes. They also cast a skeptical eye toward research on benefit-finding. They note the conceptual ambiguity re: how best to understand this construct (e.g., positive illusion, temporal comparison process, coping response), and its inconsistent associations with indicators of adjustment. They also observe that psychosocial intervention research has failed to provide compelling evidence of effects on immune parameters, or more critically, on disease outcomes. Finally, Drs. Coyne and Tennen challenge findings regarding posttraumatic growth. In particular, they examine the thorny complexities of evaluating growth with instruments that involve retrospective assessments of change over time. Overall, they argue that the quality of the database concerning relationships between positive constructs and health outcomes is unconvincing.

These themes are further elaborated and debated in rebuttals crafted by each side. On the other hand, a number of points of agreement emerge as well. These include encouragement for (1) more sophisticated methodological approaches (which is a common evolutionary development in a more recent field of inquiry), (2) more specific elucidation and testing of mechanisms potentially linking positive constructs with health outcomes, and (3) vigilance regarding the exaggerated claims that sometimes characterize accounts in the popular press.

We are grateful to our participants for taking on such a challenging mission and offering such incisive contributions. Investigators may find much in these reflections to stimulate, nettle, and inspire them, and we believe, to help refine developments in a highly intriguing area of research.

Suzanne M. Miller, PhD, Fox Chase Cancer Center; Allen C. Sherman, PhD, Winthrop P. Rockefeller Cancer Institute; James C. Coyne, PhD, University of Pennsylvania School of Medicine and Graduate School for Health Research University Medical Center Groningen, University of Groningen, the Netherlands; Howard Tennen, PhD, University of Connecticut School of Medicine; Lisa G. Aspinwall, PhD, University of Utah; Richard G. Tedeschi, PhD, University of North Carolina at Charlotte; and Sherri Sheinfeld Gorin, PhD, Columbia University