Many adults suffer from mild to moderate depression and/or anxiety symptoms. This puts them at increased risk of developing a mental disorder. Proactive intervention by the mental health services is therefore crucial if we want to reduce this risk.

“The problem is, people suffering from this type of depression and/or anxiety symptoms often fall below the radar,” says Martine Fledderus at the University of Twente (the Netherlands). “A possible explanation for this is that the existing range of self-help and courses focuses solely on reducing psychological distress. They concentrate on what is wrong with a person, thereby putting even greater emphasis on the symptoms. Intervention is focused on the disease model.” This does not have to be the case, according to Fledderus, who defended her PhD thesis on the subject on February 10.

Martine Fledderus’ PhD thesis evaluated the course Living to the full for adults with mild to moderate depression symptoms. “This particular course focuses on promoting positive mental health, instead of eliminating suffering, or reducing symptoms. This is in line with new guidance on the recognition and treatment of mental health disorders — chiefly that mental health is more than just the absence of a mental illness. Positive mental health encompasses the social, psychological and emotional well-being of a person and various studies indicate that mental health may be a protective factor against mental disorders.”

The Living to the full course is based on Acceptance and Commitment Therapy (ACT), supplemented with mindfulness exercises. The most important process in this therapy is to increase psychological flexibility, i.e. the ability to accept negative feelings and thoughts, to be in touch with the present moment, and to act in every situation according to one’s own values. This helps develop the ability to lead a meaningful and valuable life and thus to become more psychologically flexible.

Fledderus’ study evaluated the course Living to the full as a group therapy course and a self-help course with e-mail counselling. Both the group therapy course and the self-help course were effective in reducing psychological symptoms (such as depression, anxiety and fatigue) and in increasing psychological flexibility, mindfulness and positive mental health. The findings of her thesis showed that by promoting psychological flexibility, psychological distress is reduced and positive mental health is increased.

Thirteen and many primary care psychologists are now offering the popular group therapy course Living to the full. The first self-help course received more than six hundred applicants within five days. This is confirmation that a course focusing on positive mental health is popular and accessible. Given the evident beneficial effects of such a course and its wide accessibility, Fledderus believes that the Living to the full course could have a significant impact on public .