When the Label Does Not Match the Content of a Trial: “Well‐Being Therapy” in Posttraumatic Stress Disorder: Commentary on Radstaak et al. (2020)

Abstract

Radstaak, Hüning, and Bohlmeijer (2020) reported on a randomized controlled trial (RCT) of well‐being therapy (WBT) compared to treatment as usual (TAU) in the treatment of residual posttraumatic stress disorder (PTSD) symptoms. No significant differences emerged between treatment conditions. However, our view is that what the authors labeled as WBT did not match the manualized psychotherapeutic strategy, and what was defined as TAU was actually an active control group. Further methodological limitations hinder the interpretation of results and make it difficult to draw conclusions from the study. Radstaak et al. (2020) deserve credit for addressing the vexing and neglected problem of residual symptoms in PTSD. However, the role of WBT in PTSD treatment still needs to be explored via an effectively designed RCT. Given that WBT does not require exposure to a patient's index traumatic event as a means of alleviating PTSD symptoms, WBT may represent a promising alternative to current treatments of PTSD.

Integration of Well‐Being Therapy and Positive Psychotherapy: A Response to Fava and Guidi's (2021) Commentary on Radstaak et al. (2020)

“…The authors argued that what was called TAU could be better defined as an active, psychoeducational treatment. We agree with Fava and Guidi (2021) that defining our control condition as an active, psychoeducational treatment fits the control condition well. An active psychoeducational control condition implies a control condition that maintains.…”

“…In 2020, the results of our study on the effects of well‐being therapy (WBT) compared with treatment as usual (TAU) among individuals with residual symptoms of posttraumatic stress disorder (PTSD) were published in this journal (Radstaak et al., 2020). In a subsequent commentary, Fava and Guidi (2021) asserted that the WBT intervention offered to participants with residual PTSD symptoms in our study cannot be defined as such. We termed the intervention WBT given that some of the main components of WBT as developed by Fava (1999) were applied.…”

“…However, we made one important adaptation in our study. One of the aims of WBT is to elicit psychological well‐being and optimal experiences (Fava, 1999; Fava & Guidi, 2021); thus, we integrated positive psychotherapy interventions into the six sessions of WBT to enhance those feelings and experiences. In the first session, the importance of positive emotions and exercises to promote positive emotions were introduced, as positive emotions have been shown to be related to “human flourishing” (Fredrickson, 2004; Fredrickson & Losada, 2005).…”

“…In their Commentary, Fava and Guidi (2021) pointed out two concerns about the control condition, the first of which was regarding the operationalization of the control condition. The authors argued that what was called TAU could be better defined as an active, psychoeducational treatment.…”

“…Fava and Guidi (2021) raise a second concern that due to its focus on the pursuit of goals, the TAU condition had more similarities to WBT than to the experimental condition. Successful goal attainment can indeed increase psychological well‐being, but holding goals does not necessarily lead to goal attainment and can even undermine well‐being (Boudreaux & Ozer, 2013).…”