Justine Megan Gatt
Neuroscience Research Australia, Sydney, NSW, Australia
School of Psychology, University of New South Wales, Sydney, NSW, Australia
There is a growing recognition in mental health research for the need to understand the mechanisms of mental well‐being over and above mental illness. The need for this research is driven by evidence suggesting that the absence of mental illness is not necessarily equivalent to optimal mental health or well‐being. In fact, mental illness and mental well‐being share only 25% in common variance (Keyes, 2005). This variance implies that the factors that contribute to mental illness are not necessarily the same factors that also contribute to mental well‐being. Another need for the research is that optimal well‐being transverses superior physical functioning and predicts increased longevity and healthy aging (Diener & Chan, 2011), resistance to infection (Steptoe, Dockray, & Wardle, 2009), and reduced risk for illness and mortality (Chida & Steptoe, 2008). Therefore, developing an understanding of the factors that mediate and promote mental well‐being is vital for the future development of health promotion interventions. In particular, it would be important to understand the neurobiological mechanisms that mediate well‐being and determine whether or not an individual is more or less likely to flourish. The purpose of this chapter is to provide a review of the conceptual definitions of well‐being and the ways that it is currently being measured. A potential neural framework to help understand well‐being is then presented, drawing from previous and current research. Suggestions for future research and clinical developments in this field are then discussed.
Mental well‐being is conceptualized and defined by one of three paradigms: (a) the hedonic perspective (subjective well‐being), (b) the eudaimonic perspective (psychological well‐being), and (c) the composite perspective (combination of both subjective and psychological well‐being).
The construct of hedonia or “subjective well‐being” (SWB) is defined by measures of happiness and life satisfaction. Bradburn (Bradburn & Caplovitz, 1965) was the first to differentiate positive and negative affect in the context of social change, a factor structure later confirmed by Diener and colleagues (Diener, Smith, & Fujita, 1995). Andrews and Withey (Andrews & Withey, 1976) enhanced this model and added life satisfaction as a separate dimension to the two major types of affect. These three factors were shown to correlate substantially yet were clearly separable using multitrait‐multimethod techniques (Lucas, Diener, & Suh, 1996). Wilson (Wilson, 1967) was the first to review the SWB literature of happiness, followed by a 30‐year review by Diener (Diener, Suh, Lucas, & Smith, 1999). Diener summarized this work and defined SWB as three correlated yet separable components: pleasant affect such as joy, contentment, pride, affection, happiness, and elation; unpleasant affect including sadness, anxiety, stress, depression, guilt, and envy; and life satisfaction such as satisfaction with current, past, and future life and a desire to change. Other theorists have since expanded on specific elements of this model, specifically in terms of understanding pleasant affect and positivity. For example, Peterson and Seligman (Peterson & Seligman, 2004) attempted to identify and classify positive psychological traits in terms of what they refer to as the “six virtues”: wisdom and knowledge, courage, humanity, justice, temperance, and transcendence. Each virtue taps into 24 specific character strengths, which are thought to be measurable traits that transcend culture and history.
Commonly used self‐report questionnaires of SWB include the 5‐item Satisfaction with Life Scale (SWLS) (Diener, Emmons, Larsen, & Griffin, 1985) as a measure of overall life satisfaction and the 26‐item WHO Quality of Life Scale (WHOQOL) (Murphy, Herrman, Hawthorne, Pinzone, & Evert, 2000) as a measure of quality of life for the domains of physical and psychological health, social relationships, and environment. Other more specific measures of SWB include measures of happiness using the 4‐item Subjective Happiness Scale (SHS) (Lyubomirsky & Lepper, 1999), flourishing using the 8‐item Flourishing Scale (Diener et al., 2010), and positive/negative feelings using the 12‐item Scale of Positive and Negative Experience (SPANE) (Diener et al., 2010).
Eudaimonia or “psychological well‐being” (PWB) in contrast defines well‐being in terms of the development of the human potential. This perspective was originally derived from Aristotle's philosophy of happiness and what it means to live a good life as articulated in his Nicomachean Ethics (Broadie & Rowe, 2002). Ryff (Ryff, 1989) was a strong proponent for this perspective as she believed the previous literature on well‐being was not strongly theoretically guided and that it neglected important aspects of positive psychological functioning. Some missing perspectives included Jung's (Jung, 1933) formulation of individuation, Roger's (Rogers, 1961) view of the fully functioning person, Allport's (Allport, 1961) conception of maturity, and Maslow's (Maslow, 1968) view of self‐actualization. Ryff (Ryff, 1989) also suggested that we need to consider how PWB may change and evolve over the lifespan to deal with ongoing life challenges as purported by Buhler's (Buhler, 1935) work on life fulfillment, Erikson's (Erikson, 1959) psychosocial stage model, and Jahoda's (Jahoda, 1958) definition of positive mental health over and above the absence of illness. To this end, Ryff (Ryff, 1989) proposed six essential dimensions of PWB: self‐acceptance, the acceptance of self and one's past life; positive relations with others, the ability to feel empathy and affection for others and to be able to develop warm and intimate relationships; autonomy, the ability to be self‐determined and independent and to possess an internal locus of control; environmental mastery, the ability to choose or create environments suitable to one's needs, to control complex environments, and to capitalize on environmental opportunities; purpose in life, to possess goals, intentions, and a sense of direction that provide a meaning to life; and personal growth, the ability to actualize and realize one's potential and to grow and expand as a person. Empirical evidence supports the six‐factor structure of these dimensions with a higher‐order common factor of PWB (Ryff, 1989).
Scientists have since studied specific elements of eudaimonic well‐being to better understand its role in mental health. Goal theorists such as Scheier and Carver (Carver, Scheier, & Segerstrom, 2010) discuss how behavioral self‐regulation and well‐being can be maintained and emphasize the role of goal orientation, confidence, and optimism. In this sense, working toward particular goals is considered to make an impact on outcomes in future health and one's ability to deal with health scares. Confidence to achieve set goals is thought to lead to a more optimistic assessment of the expected outcome and therefore engages the necessary behaviors to see the goal through to fruition. This concept is akin to Ryff's (Ryff, 1989) dimension of purpose in life and how goals are central to achieve a meaningful life. Other theorists focus on a self‐deterministic view of well‐being whereby eudaimonia is characterized in terms of motivation, like pursuing intrinsic goals such as personal growth, intimacy, being mindful, and acting with a state of awareness (Ryan, Huta, & Deci, 2008). Mindfulness is an awareness of the present moment and facilitates meaningful decision making and enactment of intrinsic values. Intrinsic aspirations and mindfulness are contrasted to extrinsic aspirations such as wealth, fame, and image, which do not increase well‐being because they do not satiate the basic psychological needs of autonomy, competence, and relatedness (Ryan et al., 2008).
The Ryff Scales of Psychological Well‐Being (Ryff, 1989) are commonly used to measure specific components of PWB including autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self‐acceptance. Other more specific measures of PWB include measures of gratitude using the 6‐item Gratitude Questionnaire (GC‐6) (McCullough, Emmons, & Tsang, 2002) and mindfulness using the 15‐item Mindful Attention Awareness Scale (MAAS) (Brown & Ryan, 2003).
SWB and PWB are conceptually related but empirically distinct streams of positive psychological functioning. A number of studies have demonstrated this distinctiveness with factor analysis across measures of both SWB and PWB (Compton, Smith, Cornish, & Qualls, 1996). Findings from Keyes and Huta suggest that both SWB and PWB are important aspects of well‐being and that they may have features that overlap such as mastery, self‐acceptance or life satisfaction, and vitality (Huta & Ryan, 2010). Indeed, Keyes went on to develop one of the first composite indices of well‐being called the Mental Health Continuum (long and short forms,MHC‐LF and MHC‐SF, respectively) (Keyes, 2002, 2007). The MHC index measures aspects of emotional, psychological, and social well‐being with strong internal consistency (Keyes, 2005) and test–retest reliability over 4 weeks (Robitschek & Keyes, 2009) and 9 months (Lamers, Glas, Westerhof, & Bohlmeijer, 2012). Ryan further suggested that SWB and PWB are not distinct types of well‐being but different endpoints for the same outcome. PWB specifies the conditions of optimal living and the effects of these conditions, which include not only hedonic aspects of pleasure seeking but also other elements of good health such as vitality, intimacy, and a sense of meaning. In contrast, SWB focuses on the experience of pleasure as a state that can be obtained through intrinsic goal‐driven eudaimonic living or through extrinsic (albeit, less altruistic) means such as living a life of greed, materialism, or exploitation (Ryan et al., 2008).
More recently, Seligman integrated aspects of PWB and SWB into the PERMA theory of well‐being, which includes the constructs of engagement (the loss of self‐consciousness during an absorbing activity, also referred to as flow [Csikszentmihalyi, 1992]), relationships (the presence of positive and supportive relationships), accomplishment (the intrinsic goal of achievement and goal orientation), positive emotion (happiness and life satisfaction), and meaning (purpose in life) (Seligman, 2011). Consistent with this theory, Gatt and colleagues have developed a short 26‐item composite scale of well‐being called COMPAS‐W (Gatt, Burton, Schofield, Bryant, & Williams, 2014), which includes some of the constructs proposed by Seligman. The COMPAS‐W scale provides both an overall measure of total well‐being and specific measures of subjective and PWB, including sub‐measures of composure (competency and adaptability in stressful situations), own‐worth (autonomy and independent self‐worth), mastery (self‐confidence and perceived control over one's environment), positivity (optimism and positive outlook), achievement (goal orientation and striving), and satisfaction (satisfaction with life, health, work, personal relationships, and emotions). This scale was tested in 1,669 healthy twins and showed strong internal reliability, test–retest reliability over 12 months, and construct validity with other physical and psychological health indicators. Individuals are scored along a continuous dimension of well‐being or classified into three groups: flourishing, moderate, or languishing well‐being. Univariate twin modeling of monozygotic and dizygotic twin pairs demonstrated a moderate impact of genetics toward overall well‐being (heritability of 48%), plus an important role of unique environment at 52% (Gatt et al., 2014). Evidence from other twin studies has similarly suggested that common genetic factors contribute to overall well‐being and its subjective and psychological subcomponents (Keyes, Myers, & Kendler, 2010). Moreover, in a later study, the COMPAS‐W well‐being scale was shown to share approximately 30% of variance in common with depression and anxiety symptoms in a large sample of healthy adult twins, of which 56% was due to genetic effects (Routledge et al., 2016). This finding is consistent with previous reports in healthy and clinical samples whereby mental health and mental illness have been shown to share about 25% in common variance (Keyes, 2005).
Together, this evidence suggests that both SWB and PWB contribute to overall mental well‐being, thereby supporting the use of composite models and composite scales. Twin studies also suggest that both genetics and environment contribute to variance in well‐being. The specific role of genetic factors may pertain to a protective effect toward positive well‐being attributes, and/or they may modulate sensitivity to environmental influences, heightening responses, or biases toward positive life events and lifestyle factors (e.g., exercise, healthy diet) and against negative life events and factors (e.g., poor diet, alcohol and drug use). The moderate impact of environment also suggests that well‐being is malleable to some degree and could be promoted further with enriched positive environments and/or intervention. If we can understand the neural mechanisms that mediate well‐being, we can pinpoint which specific characteristics or patterns of behavior to target in interventions.
In the next chapter (Part 2), the core neural networks that are typically implicated in mental illness are summarized and discussed in relation to mental well‐being. Current evidence will be reviewed and suggested future research developments will be discussed.
Dr. Justine Gatt is currently supported by an NHMRC CDF Fellowship APP1062495.
Dr. Justine Megan Gatt is group leader and senior research scientist at Neuroscience Research Australia and at the School of Psychology at the University of New South Wales, Australia. Dr. Gatt leads a research program focusing on the neuroscience and gene–environment mechanisms of resilience and mental well‐being across adult and youth groups. This work incorporates various genetic, neuroimaging and neurocognitive techniques, and various methodological designs (twin/singleton studies, longitudinal and intervention work), with the ultimate aim being to understand and promote optimal mental health in the general population.