4. Character Strengths and Health – Positive Psychology

CHAPTER 4

Character Strengths and Health

Amrita Yadava
Professor, Department of Psychology, Maharishi Dayanand University, Rohtak

Abstract:    The concept of virtues, which are the core characteristics of an individual, and character strengths are positive traits reflected in thoughts, feelings and behaviour and has been proposed by positive psychologists to provide a description and classification of traits, emotions and beliefs that enable humans to thrive. Common sense connotes the role of strength of character in coping with adverse circumstances. This strength of character is generally considered to be ‘moral’ rather than ‘physical’ as physical strength is a natural endowment and moral strength is acquired through initiative and effort. This moral strength is connoted as a virtue only when it is exercised to overcome obstacles. A number of studies show that character strengths are associated with better quality of life, faster recovery and adherence to medical regime and negatively to depression and mortality. Elevations of some specific character strengths have been reported to help in coping with stressful situations and leading to positive consequences, thereby providing support to the modulator role of character strengths in health and well-being. Positive mood, optimistic outlook, social support and happiness have been found to be associated with better health and longevity, indicating that positive traits might act as buffers against illness and promote psychological well-being. Researchers have proposed a strength-based approach to improving job satisfaction which involved identification of strengths associated with a particular job, integration of these strengths into the worker’s self-image, such that he/she defined himself/herself according to the signature themes, and lastly attribution of success by worker to these signature strengths, thereby leading to satisfaction and productivity. Seligman, Steen, Park and Peterson (2005) proposed that a similar strength-based approach could be applied in the area of positive health, whereby identification of signature strengths associated with health and psychological well-being could lead to the development of intervention programmes as use of signature strengths leads to positive emotions and well-being both in the present as well as in future. The present article focuses on the linkage of character strengths with health and psychological well-being.

Character Strengths and Health

Generally, ill health is equated with disease and infirmity and is considered as the antithesis of health, while being healthy is a coveted state. In 1973, Rokeach, while developing his value survey, had originally planned to use health as one of the values. However, there was no variability with regard to health as everybody ranked health first. This indicated that nearly everyone valued health more than any other personal asset. Paradoxically, the behaviour of people does not reflect this, as they do not behave in ways that maximize health and minimize disease and disability. Common sense connotes the role of strength in coping with disease and other life stresses. This strength is generally considered to be ‘moral’ rather than ‘physical’ as physical strength is perceived as a natural endowment, and moral strength is acquired through initiative and effort. This moral strength is connoted as a value or virtue only when it is exercised to overcome obstacles.

Values are social agreements about what is right, good and to be cherished, which contain cognitive and affective elements, and therefore, act as implicit or explicit guides for action and framing what is sought after and what is to be avoided. People appeal to these social or moral beliefs as the ultimate rationale for their action and they provide a means of self-regulation of impulses as these are individually endorsed and highly accessible to the individual so that individuals can maintain harmony with the group within which they live. Values predict an individual’s behaviour, yet at times, even personally endorsed values do not influence action unless they are made salient to the individual at the time of action. Moreover, in any given situation, more than one personally endorsed value may apply, and the behavioural choice appropriate for one value may conflict with the behavioural choice appropriate to another value (Oyserman, 2002). Seligman and Peterson (2000) advocated development of the strengths which would be instrumental in dealing with the present stressors and equip the individual with the ability to mature, function well, become successful, find personal fulfilment and optimum potential. They developed the concept of values in action; to identify the internally held beliefs (and their levels of behaviours) which shape a person’s destiny. These values were operationally defined as positive traits of an individual which were classified as character strengths and virtues (CSV) to provide a description and classification of traits that enable human thriving along the same lines as the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychological Association (APA) does for psychological disorders that disable human beings (Peterson and Seligman, 2004). The present chapter focuses on the relationship between character strengths and health.

Health–Behaviour Linkage

Health is a tangible yet elusive concept. It is an implicit characteristic of an individual which is described as a feeling of equilibrium or well-being, although it is perceived only when there is an imbalance or reduction. On the other hand, illness is acquired and is perceived by its presence. The advent of positive psychology at the beginning of the present millennium culminated in the conceptualization of the concept of positive health, where health was considered as a positive state, much beyond the mere absence of disease, which was operationalized by a combination of excellent status on biological, subjective and functional measures and suggested that a focus on health rather than illness would be cost saving and lifesaving (Seligman, 2008). The positive view of health implicates the linkage of physical, psychological and social variables to longevity, where being healthy is conceived as a state that can be achieved only by continuous effort. A person who does not consciously exert effort to maintain his/her health cannot be healthy, even if there is nothing functionally or biologically wrong with the person.

Various health-behaviour models (Health Belief Model; Theory of Reasoned-Action; Self-Regulation Theory; Precaution Adoption Process Model) have been proposed which implicate a role of knowledge, attitudes and beliefs in health related behaviour, as the individual’s perception about the disease and his own ability to cope with the disease strongly affect the ability to manage diseases and have an impact on every domain of health. The relationship of attitude, belief and values with health has been demonstrated by a number of researchers. Brownlee–Deffeck, Peterson, Simons, Goldstein, Kilo and Hoette (1987), examined health beliefs in diabetic patients and reported a facilitative effect of these beliefs on adherence to treatment regimen. Domingo (1989) empirically demonstrated that the Theory of Reasoned Action predicted beliefs about the behaviour, as well as beliefs about the consequences of performing the behaviour.

Illness intrusiveness also has a direct influence on health behaviours when the condition interferes with valued activities and interest, and indirectly through reduced perception of personal control, self-efficacy and self-esteem. Penninx, Tilburg, Boeke, Deeg, Kriegsman and Eijk (1998) have shown that having strong social support and good personal coping resources, along with high self-esteem, a sense of mastery and feelings of self-efficacy in the face of adversity are associated with fewer depressive symptoms in people with diabetes. For adults, the belief that compliance would benefit health predicted adherence while among adolescents adherence was influenced by perceived severity of illness and the belief that they were susceptible to diabetic complications if the treatment regimen was not followed.

Subjective norms, which are internalized beliefs, are learnt through modelling and observational learning and, are generally, in cognizance with the cultural norms. These, in turn, assume control of the individual’s behaviour and can be equated with values of the individual. Nyazema (1984) found that diabetic and hypertensive patients in Zimbabwe who believed in traditional healers did not adhere to modern medical procedures. Ruiz and Ruiz (1983) reported that Latino patients readily complied with the recommendation of physicians who demonstrated understanding of Hispanics cultural norms and practices. Finlay, Trafimow and Moroi (1999) reported that people whose behaviours are generally under normative control have the intention to perform more healthy behaviours than the people whose behaviours are generally under attitudinal control. Taken together, these researches provide support for the fact that attitude, beliefs and values influence health behaviour and recovery from illness.

Virtues and Character Strength

Values can be conceptualized as codes or general criteria which represent what is expected and hoped for and what is avoided or forbidden, which play a decisive role in the occurrence of behaviour. Proponents of positive psychology have proposed that good character is a function of virtues which are the core characteristics of the individual and character strengths are positive traits reflected in thought, feeling and behaviour, which exist in degrees rather than all or none categories and can be measured as individual differences. These virtues and character strengths are ubiquitous and probably universal as they are endorsed by almost every culture across the world (Dahlsgard, Peterson and Seligman, 2005). Peterson and Seligman (2004) speculate that these virtues are grounded in biology through an evolutionary process that led to their selection as a means of managing the important tasks necessary for the survival of the species.

Peterson and Seligman (2004) developed the Values in Action (VIA) classification of strengths as an initial step towards specifying the important positive traits. The strengths were identified via an esoteric route by analyzing the religious teachings of major Eastern (Taoism, Confucianism, Hinduism and Buddhism) and Western (Judaism, Christianity, Athenian virtue and Islam) religion and going into authoritative texts of these religions. They identified twenty-four character strengths which were further grouped under six virtues (wisdom and knowledge, courage, humanity, justice, temperance and transcendence). Signature strengths (top five character strengths) have been found to vary with demographic variables, such as age, gender and culture (Linley et al., 2007; Priti, 2010; Singh and Choubisa, 2010). However, the strength of fairness was universally endorsed.

The classification of character strengths into virtues was purely theological as empirical research has not revealed six dimensions of character strengths. Some researchers have identified four or five dimensions (Park and Peterson, 2005, 2006; Peterson, Park, Pole, D’Andrea, and Seligman, 2008; Priti, Yadava and Sharma, 2011a). A factor analysis of VIA by Brdar, Todd and Kashdan (2010) revealed a four-factor solution (interpersonal strengths, fortitude, vitality and cautiousness) where vitality (with zest, hope, curiosity and humour as indicators) emerged as most relevant to well-being. When examining individual strengths, zest, curiosity, gratitude and optimism/hope emerged with the strongest associations with elevated life satisfaction, subjective vitality, satisfaction of autonomy, relatedness and competence needs, and a pleasurable, engaging and meaningful existence. Park, Peterson and Seligman (2004) had also reported that strengths ‘of the heart’—zest, gratitude, hope and love—were more robustly associated with life satisfaction than cerebral strengths, such as curiosity and love of learning.

On the other hand, Van Eeden, Wissing, Dreyer, Park and Peterson (2008) and Singh and Choubisa (2010) found that all the twenty-four strengths formed a single cluster. The emergence of a single factor solution has been interpreted in terms of a master value which might be responsible for covertly controlling the expression of other character strengths deliberatively when called into action. A study by Peterson and Seligman (2003) provides support for the above view. Comparison of VIA scores of 4817 American respondents, two months after 9/11 with scores of those individuals who had completed the survey before September 11, revealed that seven character strengths, i.e., gratitude, hope, kindness, leadership, love, spirituality and teamwork were higher in the later assessed sample. These strengths were still elevated when assessed two months later although their degree was somewhat lesser than immediately following the attacks. Thus, it appears that elevations of some specific character strengths help in coping with stressful situations and lead to positive consequences.

Character Strengths and Health

Positive psychology postulates two general approaches to happiness and good life: (1) the eudaemonist approach, which focuses on doing and thinking rather than emotions (virtue, character and morality); and (2) the hedonic approach, where emphasis is on achieving a balance between positive and negative affect (finding pleasure or happiness and avoiding pain). Positive health which emerged from positive psychology suggests that positive affective states and purposeful life experiences influence the immune system and lead to psychological well-being. Further, it advocates that a focus on health rather than illness would be more economical both in terms of saving cost as well as life. It can be operationalized by a combination of excellent status on biological, subjective and functional measures. Positive health predicts increased longevity, decreased health costs, better mental health in aging and better prognosis when illness strikes (Seligman, 2008).

Empirical evidence implicates a role of character strengths in maintenance of health. Qualitative differences in character strengths have been reported in healthy and unhealthy groups. Comparison of character strengths between healthy and unhealthy (non-disease, but reporting lower score on perceived health measures) respondents revealed significant differences in only one character strength, i.e., self-regulation (Priti, 2010). Further, spirituality surfaced as the topmost signature strength of the unhealthy group while it did not even figure in the top five strengths of the healthy sample, i.e., open mindedness, love, teamwork, self-regulation and humour (Priti, Yadava and Sharma, 2011b). Proyer, Gander, Wellenzohn and Ruch (2013) reported greater endorsement of character strengths with a number of health behaviours and physical fitness. All character strengths (except humility and spirituality) were associated with multiple health behaviours. While self-regulation had the highest overall association, curiosity, appreciation of beauty/excellence, gratitude, hope and humour also displayed strong connections with health behaviours. However, Eracleous (2008) failed to observe any significant differences in the character strengths of healthy and unhealthy respondents.

Perusal of the studies relating to non-diseased sample reveals a positive relationship between emotional and social intelligence and positive psychological health (Hooda, Sharma and Yadava, 2008; Hooda, Sharma and Yadava, 2009). Govindji and Linley (2007) and Proctor, Maltby and Linley (2009) in studies on university students (214 and 135 students, respectively), showed that people who used their strengths more, reported higher levels of subjective well-being (i.e., happiness) and psychological well-being (i.e., fulfilment). Park, Peterson and Seligman (2004) reported that life satisfaction had a robust correlation with hope, zest, gratitude, love and curiosity. In contrast, modesty and the intellectual strengths were weakly associated with life satisfaction. A monotonic relationship was observed between character strengths and life satisfaction indicating that excess of any strength does not diminish life satisfaction. Results of an internet based intervention study (Seligman, Park and Peterson, 2005) indicate that participants tended to be happier and less depressed immediately post test (one week after intervention) and at every testing (up to six months). These results indicate that identification of character strengths led to positive effect on the immediate post test, while using signature strengths in new ways lead to steady improvement up to one month, which lasted ever after six months. Harker and Keltner (2001) reported that women who flashed a genuine smile in their yearbook photos as freshmen have more marital satisfaction twenty-five years later. Optimism in early adulthood has been found to be a good predictor of health in later adulthood over periods up to thirty-five years (Peterson, Seligman and Valliant, 1998). Peterson (2000) reported that optimistic people actually avoid stress in lives by forming better social support networks, having healthier life styles and a better immune system which shields them from the development of illness. In looking at more severe physiological events, positive affect and positive explanatory styles have been found to be protective against stroke (Ostir, Markides, Peek and Goodwin, 2001), rapid progression of HIV (Taylor, Kemeny, Reed, Bower, and Gruenewald, 2000), and general mortality rates in the elderly (Cohen and Pressman, 2006; Maruta, Colligan, Malinchoc and Offord, 2000). Study of a sample of 334 Swiss adults and 634 peer (informant) ratings, suggested that hope, zest and curiosity (and gratitude and love) have key roles in the connection between character strengths and life satisfaction. Informant reports also related positively to the endorsement of pleasure, engagement, and meaning (Buschor, Proyer and Ruch, 2013).

Positive emotions (hope, optimism, etc.) and humour reduce the risk of infection, such as common cold (Cohen, Alper, Doyle, Treanor and Turner, 2006). Fredrickson (2003) found that positive emotions undo the cardiovascular effects of negative emotions when people experience stress. If individuals do not regulate the physiological changes once the stress is past, they can lead to illness, such as coronary heart disease (CHD) and heightened mortality. Study of children within the age range of three–nine years showed that love, zest and hope enhanced happiness in younger children while gratitude led to happiness in older children (Park and Peterson, 2006). Forgiveness has also been found to produce beneficial effects directly by reducing the physiological load associated with psychological stress (betrayal and conflict) and indirectly through reduction in perceived stress (Lawyer et al., 2004).

Empirical evidence also provides support to the modulatory role of character strengths in health maintenance and coping with diseases. Spirituality has been found to be related to quality of life and is an effective coping mechanism (Leung, Chiu and Chen, 2006; Riley, Perna, Tate, Forchheimer, Anderson and Luera, 1998; Tuck, McCain and Elswick, 2001). It lowers fear of death and discomfort and improves emotional adjustment by reducing health compromising behaviours (Hafen, Karren, Frandsen and Smith, 1996), thereby helping in adaptation to chronic illness (Livneh, Lott and Antonak, 2004).

Priti, Yadava and Sharma (2011a) reported a qualitative difference in factor structure of VIA in diseased (arthritis and diabetic patients) and non-diseased respondents, which implicated a role of fostering gratitude and spirituality in arthritis patients and curiosity and creativity in diabetics in coping with the disease and improving prognosis. Comparison of the signature strengths of the non-diseased and chronic disease groups showed that the strength of fairness was common across the signature strengths of all the three samples (non-diseased and two chronic diseases). In both the disease groups, spirituality was found to have the maximum score while it did not even figure in the signature strengths of the non-diseased sample (Priti, 2010), thereby providing support for the fact that elevations of some specific character strengths help in coping with a stressful situation and leads to positive consequences.

Since optimism reduces the risk of depression, it leads to better overall health and strong emotional coping skills, acts as a protective factor (Giltay, Geleijnse, Zitman, Hoekstra, and Schouten, 2004; Kubazansky, Sparrow, Vokonas and Kawachi, 2001; Livneh, Lott and Antonak, 2004) and facilitates recovery (Scheier et al., 1989) by improving positive aspects of recovery (Chamberlain, Petrie and Azariah, 1992), such as greater adherence to medical regime (Leednam, Meyerowitz, Muirhead and Frist, 1995), thereby reducing mortality (Buchanan, 1995; Giltay et al., 2004; Ostir, Ottenbacher and Markides, 2004).

Humour helps in successful adaptation to live with chronic illness (Peterson, Park and Seligman, 2006b). Forgiveness also leads to better recovery as it helps to reduce the psychological load by reducing the perceived stress (Lawyer et al., 2004). Carver, Scheier and Pogo (1992) reported that optimists adapted better after surgery and appeared to get along with their normal lives at a more rapid pace. Further, optimism was found to be predictive of physical and mental health, which in turn, was found to be mediated by positive mood, immunological robustness, effective coping and health promoting behaviour.

People who believe that they are personally responsible for their personal health are more likely to adhere to medical advice (Heiby, Gafaria and McCann, 1989). The importance of sense of control extends to the beliefs about health outcomes determined by powerful people in the environment, such as health care providers. For patients, who had severe rheumatoid arthritis, beliefs in internal control have been found to be associated with greater mood disturbance. It might be argued that it is bothersome to have exacerbations of a serious illness when one thinks that these events are under their control (Affleck, Tennen, Pfeiffer and Fifeld, 1987). Sherbourne, Hays, Ordway, Dimatteo and Kravitz (1992) reported that patients who use avoidance coping strategies like denying personal vulnerability or avoiding personal responsibility for taking actions are less likely to comply with the doctor’s advice.

With regard to specific diseases, character strengths have been mainly studied in chronically ill patients (cancer, CHD, HIV). People who express positive emotions come down with fewer colds and flues after being exposed to the viruses than those who express negative emotions like anger, sadness or stress (Cohen and Pressman, 2006). In patients with CHD and heart ailment, optimism and spirituality were found to reduce mortality (Giltay et al., 2004) as it protected against cardiovascular events (Kubazansky et al., 2001), improved adherence to medical advice (Leednam et al. ,1995) and increased the speed of recovery from depression in the chronically ill patients (Durham, 1998). Patients who show a fighting spirit seem to do better than those who do not. Patients with higher ratings of hopelessness and negative beliefs about the future had poorer health outcomes (Goodkin, Antoni and Balaney, 1986). Pettingale, Morris, Greer and Haybittle (1985) have also reported that patients with a fighting spirit are more likely to survive breast cancer.

In cancer patients, spirituality and humour were found to be an effective coping mechanism (Ferrell, Smith, Juarez and Melancon, 2003). Religious activities and spirituality reduced the rates of cancer (Hafen et al., 1996) and distress (Laubmeier, Zakoswski and Bair, 2004) leading to better quality of life and increased life satisfaction (Riley, Perna, Tate, Forchheimer, Anderson and Luera, 1998). Appreciation of beauty, bravery, curiosity, fairness, forgiveness, humour, gratitude, love of learning and spirituality was higher in the diseased respondents (Peterson, Park and Seligman, 2006a). However, comparison of character strengths of adolescents who have survived cancer to healthy adolescents by Guse and Eracleous (2011) revealed that the experience of serious illness, such as cancer neither hindered nor enhanced the development of character strengths in the group of adolescent survivors. Comparison of VIA scores of cancer patients with healthy respondents indicated higher scores on humour, fairness, zest, honesty and perspective (Peterson, Park and Seligman, 2006a) although another study (Eracleous, 2008) reported no differences.

In HIV patients, spirituality was found to be positively associated with well-being (Debra, and Elaine, 1998) as it was related with quality of life, social support, and negatively with perceived stress, uncertainty and psychological distress (Tuck, McCain and Elswick, 2001). Life satisfaction in HIV patients was found to be associated with the character strengths of hope, zest, gratitude, love of learning and curiosity (Park, et al., 2004).

In orthopedic patients (amputation, spinal injury), non-spiritual patients were found to have lower quality of life and life satisfaction (Riley, et al., 1998). An in-depth interview of osteoarthritis patients revealed five major themes, i.e., strengths, prudence, gratitude, self worth and insight into flourishing (Swift, Ashcroft, Todd, Campbell and Dieppe, 2002).

Although intervention studies related to enhancement of character strength are sparse, they indicate that use of signature strengths lead to positive emotions, well-being, coping as well as recovery from disease. Proyer, Ruch and Buschor (2013) compared the impact of character strengths-based positive interventions in adults. Pre-post comparison of life satisfaction of a group trained on strengths of curiosity, gratitude, hope, humour and zest with a group trained on strengths that usually demonstrate low correlations with life satisfaction, i.e., appreciation of beauty and excellence, creativity, kindness, love of learning, and perspective and a wait-list control group indicated that strengths that correlate highly with life satisfaction should be addressed in strengths-based interventions. Subjective ratings of well-being after the interventions concluded, indicated gains in both the intervention groups above that of a wait-listed control group, thereby implicating the potential of strength-based interventions for improving well-being. However, analyses underscore the special role of self regulation in facilitating success in the interventions.

Random assignment to a group instructed to use two signature strengths or use one signature strength and one bottom strength revealed significant gains in satisfaction with life compared with a control group but no differences between the two treatment groups (Rust, Diessner and Reade, 2009). The identification of signature strengths followed by discussion with a friend about strengths and use of three signature strengths in daily life was reported to boost cognitive (but not affective) well-being at three months’ follow-up (Mitchell, Stanimirovic, Klein and Vella-Brodrick, 2009).

Peterson, Park and Seligman (2006a) conducted a retrospective web-based study of 2087 adults and reported small but reliable associations between a history of physical illness and the character strengths of appreciation of beauty, bravery, curiosity, fairness, forgiveness, gratitude, humour, kindness, love of learning and spirituality. A history of psychological disorder and the character strengths of appreciation of beauty, creativity, curiosity, gratitude and love of learning were also associated. A history of problems was linked to decreased life satisfaction, but only among those who had not recovered. In the case of physical illness, less of a toll on life satisfaction was found among those with the character strengths of bravery, kindness and humour, and in the case of psychological disorder, less of a toll on life satisfaction was found among those with the character strengths of appreciation of beauty and love of learning. They suggested that recovery from illness and disorder may benefit character.

Thus, it appears that understanding the relationship between stress, health and illness, identifying risk factors for sickness and protective factors for health, developing programmes for illness prevention and for ensuring compliance with medical treatment regimens (Blumenthal, Matthews and Weiss, 1994) can be furthered by understanding the links between character strengths and health. Although major differences in character strengths have not been observed in healthy and unhealthy groups, self-regulation has been found to be associated to health in healthy respondents. Surprisingly, it appears to lose its relevance once disease sets in. The reason could be that other strengths gain more importance as they are required to deal with the stresses associated with the disease or may be these strengths may increase as the perspective of the individual changes as a consequence of the disease, where things which were taken for granted earlier, now assume greater significance.

The above reviewed studies clearly reflect that positive affect and traits have an impact on health enhancing behaviours, act as buffers against illness, enhance physiological functioning as well as compliance with medical treatment regimes. Specific character strengths (mainly the strengths of the heart) have been found to be associated with health maintenance and prognosis from chronic diseases. Thus, interventions which increase positive affect (happiness, optimism, hope, flow) could be helpful in reducing the stress associated with the disease, boost the immune system and facilitate adherence to medical regime. Further, strengths of the heart (spirituality, forgiveness, gratitude) may go a long way in helping the patient to focus on intrinsic goals (emotional intimacy, community service, personal growth) and accept the disease as inevitable. This could set the stage for positive change as acceptance and giving meaning to the present reality is necessary to let go of the negative emotions and stresses associated with one’s limitations along with existential anxiety, make the most of one’s brief life by living authentically and passionately, find recourse in faith, meaning and relationships, thereby accepting what cannot be changed. Wong (2012) developed a resource-congruence model of effective coping (Meaning Management Theory), where acceptance is implicated as a strategy for coping with problems and stresses that are appraised as uncontrollable where meaning management refers to how one manages meaning-seeking, meaning-making and meaning reconstruction in order to survive and flourish. People are considered as meaning-seeking and meaning-making a creature that live in a world of meaning, attribute meaning to events that affect them more than the events themselves, and offers them the best protection against threats and losses and the best means to achieve well-being. Thus, acceptance can be an effective and versatile way of adaptation, capable of repairing the worst and bringing out the best in a person. Wong has suggested five pathways of acceptance which cover five major life domains—personhood; relationships; existential issues regarding the human condition; stress, loss and suffering; and mindfulness. This is presently an important, but under-researched area in the positive psychology of well-being which appears to have a lot of potential in health maintenance and prognosis in chronic diseases.

Thus, it can be concluded that a conflux of some character strengths might help in dealing with chronic disorders because onset of these disorders demands a major change in the lifestyle or perspective of the individual. Since maintaining health and dealing with disease, specially chronic disorders which have a prolonged span or are not treatable, require a diligent health/treatment regime focusing on health promoting behaviours, reducing the disease symptoms and/or slowing down the progression of diseases, character strengths, such as patience, perseverance, self-regulation, hope, spirituality, forgiveness, gratitude, creativity, etc., could go a long way in dealing with stress-associated health and disease. A strength-based approach, as proposed by Seligman, Steen, Park and Peterson (2005) could be applied in the area of positive health, whereby identification of signature strengths associated with health and prevention/ prognosis of diseases could lead to the development of intervention programmes for managing chronic disorders as use of signature strengths leads to positive emotions and well-being both in the present as well as future.

References

Affleck, G., Tennen, H., Pfeiffer, C., and Fifeld, J. (1987). Appraisals or Control and Predictability in Adapting to a Chronic Disease. Journal of Personality and Social Psychology, 53(2), 273–79.

Blumenthal, S. J., Matthews, K., and Weiss, S. M. (1994). New Research Frontiers and Behavioral Medicine: Proceedings of the National Conference. (NIH Publication No. 94–3772). Washington DC: U.S. Printing Office.

Brdar, I., Todd B., and Kashdan, T. B. (2010). Character Strengths and Well-being in Croatia: An Empirical Investigation of Structure and Correlates. Journal of Research in Personality, 44(1), 151–54.

Brownlee-Deffeck, M., Peterson, L., Simond, J. F., Goldstein, D., Kilo, C., and Hoette, S. (1987). The Rate of Health Beliefs in the Regimen Adherence and Metabolic Control of Adolescents and Metabolic Control of Adolescents and Adults with Diabetes Mellitus. Journal of Consulting and Clinical Psychology, 55(2), 139–44.

Buchanan, G. M. (1995). Explanatory Style and Coronary Heart Disease. In G. M. Buchanan and M. E. P. Seligman (Eds.), Explanatory Style (pp. 225–32). Hillsdale, NJ: Erlbaum.

Buschor, C., Proyer, R. T., and Ruch, W. (2013). Self-and Peer-rated Character Strengths: How Do they Relate to Satisfaction with Life and Orientations to Happiness? Journal of Positive Psychology, 8(2), 116–27.

Carver, C. S., Scheier, M. F., and Pogo, C. (1992). Conceptualizing the Process of Coping with Health Problems. In H. S. Friedman (Ed.), Hostility, Coping, and Health (pp. 167–87). Washington DC: American Psychological Association.

Chamberlain, K., Petrie, K., and Azariah, R. (1992). The Role of Optimism and Sense of Coherence in Predicting Recovery Following Surgery. American Journal of Psychology and Health, 7(4), 301–10.

Cohen, S., and Pressman, S. D. (2006). Positive Affect and Health. Current Directions in Psychological Science, 15(3), 122–25.

Cohen, S., Alper, C. M., Doyle, W. J., Treanor, J. J. and Turner, R. B. (2006). Positive Emotional Style Predicts Resistance to Illness After Experimental Exposure to Rhinovirus or Influenza a Virus. Psychosomatic Medicine, 68(6), 809–15.

Dahlsgaard, K., Peterson, C., and Seligman, M. (2005). Shared Virtue: The Convergence of Valued Human Strengths across Culture and History. Review of General Psychology, 9(3), 203–13.

Debra, P. O. N., and Elaine K. K. (1998). Spirituality and Chronic Illness. Journal of Nursing Scholarship, 30(3), 275–80.

Domingo, M. A. B. (1989). Attitude-Behavior Relationship: A Comparative Analysis Using the Health Belief Model and the Theory of Reasoned Action, Unpublished M. A. Thesis, University of Delaware, USA.

Durham, N. C. (1998). Scientists Find Direct Link between Religious Faith and Recovery from Depression. American Journal of Psychiatry, 155(4), 536–42.

Eracleous, G. (2008). Character Strengths of Adolescents Who Have Survived Cancer: A Comparative Study. Ph. D. Thesis, University of Johannesburg.

Ferrell, B. R., Smith, S. L., Juarez, G., and Melancon, C. (2003). Meaning of Illness and Spirituality in Ovarian Cancer Survivors. Journal of Oncology Nursing Forum, 30(2), 249–57.

Finlay, K. A., Trafimow, D. and Moroi, E. (1999). The Importance of Subjective Norms on Intentions to Perform Health Behaviours. Journal of Applied Social Psychology, 29(11), 2381–93.

Fredrickson, B. L. (2003). The Value of Positive Emotions. American Scientist, 91(4), 330–35.

Giltay, E. J., Geleijnse, J., Zitman, M., Hoekstra, F. G., and Schouten, E. G. (2004). Dispositional Optimism and All-cause and Cardiovascular Mortality in a Prospective Cohort of Elderly Dutch Men and Women. Archives of General Psychiatry, 61(11), 1126–35.

Goodkin, K., Antoni, M. and Balaney, P. H. (1986). Stress and Hopelessness in the Promotion of Cervical Intraepithelial Neoplasia to Invasive Squamous Cell Carcinoma of the Cervix. Journal of Psychosomatic Research, 30(1), 67–76.

Govindji, R., and Linley, P. A. (2007). Strengths Use, Self-concordance and Well-being: Implications for Strengths Coaching and Coaching Psychologists. International Coaching Psychology Review, 2(2), 143–53.

Guse, T., and Eracleous, G. (2011). Character Strengths of Adolescent Survivors of Childhood Cancer. Health SA Gesondheid, 16(1), 1–6.

Hafen, B. Q., Karren, K. J., Frandsen, K. J., and Smith, N. L. (1996). Mind Body Health. Boston: Allyn and Bacon.

Harker, L., and Keltner, D. (2001). Expressions of Positive Emotion in Women’s College Yearbook Pictures and Their Relationship to Personality and Life Outcomes across Adulthood. Journal of Personality and Social Psychology, 80(1), 112–24.

Heiby, E. M., Gafaria, C. T., and McCann, S. C. (1989). Situational and Behavioural Correlates of Compliance to a Diabetic Regimen. Journal of Compliance in Health Care, 4(2), 101–16.

Hooda, D., Sharma, N. R., and Yadava, A. (2008). Emotional Intelligence as a Predictor of Positive Health in Working Adults. Journal of Indian Health Psychology, 2(2), 196–207.

Hooda, D., Sharma, N. R., and Yadava, A. (2009). Social Intelligence as a Predictor of Positive Psychological Health. Journal of the Indian Academy of Applied Psychology, 35(1), 143–50.

Kubazansky, L. D., Sparrow, D., Vokonas, P., and Kawachi, I. (2001). Is the Glass Half Empty or Half Full? A Prospective Study of Optimism and Coronary Heart Disease in the Normative Aging Study. Psychosomatic Medicine, 63(6), 910–16.

Laubmeier, K. K., Zakoswski, S. G., and Bair, J. P. (2004). The Role of Spirituality in the Psychological Adjustment to Cancer: A Test of the Transactional Model of Stress and Coping. International Journal of Behavioral Medicine, 11(1), 48–55.

Lawyer, K. A., Younger, J. W., Piferi, R. L., Billington, E., Jobe, R. E., Edmondson K., and Warren, J. H. (2004). A Change of Heart: Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict. Journal of Behavioral Medicine, 26(5), 373–93.

Leednam, B., Meyerowitz, B. E., Muirhead, J., and Frist, W. H. (1995). Positive Expectations Predict Health after Heart Transplantation. Health Psychology, 14(1), 74–79.

Leung, K., Chiu, T., and Chen, C. (2006). The Influence of Awareness of Terminal Condition on Spiritual Well-being in Terminal Cancer Patients. Journal of Pain and Symptom Management, 31(5), 449–56.

Linley, P. A., Maltby, J., Wood, A. M., Joseph, S., Harrington, S., Peterson, C., Park, N., and Seligman, M. (2007). Character Strengths in the United Kingdom: The VIA Inventory of Strengths. Personality and Individual Differences, 43(2), 341–51.

Liveneh, H., Lott, S., and Antonak, R. (2004). Patterns of Psychosocial Adaptation to Chronic Illness and Disability: A Cluster Analytic Approach. American Journal of Psychology, Health and Medicine, 9(4), 411–30.

Maruta.T., Colligan, R. C., Malinchoc, M., and Offord, K. P. (2000). Optimists vs. Pessimists: Survival Rate Among Medical Patients over a 30-Year Period. Mayo Clinic Proceedings, 75(2), 140–43.

Mitchell, J., Stanimirovic, R., Klein, B., and Vella-Brodrick, D. (2009). A Randomised Controlled Trial of a Self-guided Internet Intervention Promoting Well-being. Computers in Human Behavior, 25(3), 749–60.

Nyazema, N. Z. (1984). Toward Better Patient Drug Compliance and Comprehension: A Challenge to Medical and Pharmaceutical Service in Zimbabwe. Social Science and Medicine, 18(7), 551–54.

Ostir, G. V., Markides, K. S., Peek, M. K., and Goodwin, J. S. (2001). The Association Between Emotional Well-being and The Incidence of Stroke in Older Adults. Psychosomatic Medicine, 63(2), 210–15.

Ostir, G. V., Ottenbacher, K. J., and Markides, K. S. (2004). Onset of Frailty in Older Adults and the Protective Role of Positive Affect. Psychology and Aging, 19(3), 402–08.

Oyserman, D. (2002). Values: Psychological perspectives. In N. Smelser and P. Baltes (Eds.), International Encyclopedia of the Social and Behavioral Sciences (Vol. 22, pp. 16150–53). New York, NY: Elsevier Science.

Park, N., and Peterson, C. (2005). The Values in Action Inventory of Character Strengths for Youth. In K. A. Moore, and L. H. Lippman (Eds.), What do Children Need to Flourish: Conceptualizing and Measuring Indicators of Positive Development (pp. 13–23). New York, NY: Springer.

Park, N., and Peterson, C. (2006). Moral Competence and Character Strengths among Adolescents: The Development and Validation of the Values in Action Inventory of Strengths for Youth. Journal of Adolescent, 29(6), 891–909.

Park, N., and Peterson, C. (2008). Positive Psychology and Character Strengths: Application to Strengths-Based School Counseling. Professional School Counseling, 12(2), 85–92.

Park, N., Peterson, C., and Seligman, M. (2004). Strengths of Character and Well-being. Journal of Social and Clinical Psychology, 23(5), 603–19.

Penninx, B. W., Van Tilburg, T., Boeke, A. J., Deeg, D. J., Kriegsman, D. M., and Van Eijk, J. T. (1998). Effects of Social Support and Personal Coping Resources on Depressive Symptoms: Different for Various Chronic Diseases. Health Psychology, 17(6), 551–58.

Peterson, C. (2000). The Future of Optimism. American Psychologist, 55(1), 44–55.

Peterson, C, and Seligman, M. (2003). Character Strengths Before and after September 11. Psychology Science, 14(4), 381–84.

Peterson, C., and Seligman, M. (2004). Character Strengths and Virtues. A Handbook and Classification. New York: Oxford University Press.

Peterson, C., Park, N., and Seligman, M. (2006a). Strengths of Character and Well-being Among Youth. Journal of Youth, 4(1), 35–40.

Peterson, C., Park, N., Pole, N., D’Andrea, W. and Seligman, M. (2008). Greater Strengths of Character and Post-traumatic Growth. Journal of Traumatic Stress, 21(2), 214–17.

Peterson, C., Seligman, M., and Vaillant, G. E. (1998). Pessimistic Explanatory Style is a Risk Factor for Physical Illness: A Thirty-five Year Longitudinal Study. Journal of Personality and Social Psychology, 55(1), 23–27.

Peterson, C., Park, N., and Seligman, M. E. P. (2006b). Greater Strengths of Character and Recovery from Illness. The Journal of Positive Psychology, 1(1), 17–26.

Pettingale, K. W., Morris, T., Greer, S., Haybittle, J. L. (1985). Mental Attitudes to Cancer: An Additional Prognostic Factor. The Lancet, 325(8431), 750.

Priti (2010). Role of Values-in-Action in Health Maintenance and Prognosis from Chronic Disease. Unpublished Ph. D. Thesis. Department of Psychology, M. D. University, Rohtak.

Priti, Yadava, A., and Sharma, N. R. (2011a). Factor Structure of Values-in-Action in Diseased and Non-diseased Adults. Journal of Indian Health Psychology, 5(2), 81–90.

Priti, Yadava, A. and Sharma, N. R. (2011b). Perceived Health in Diseased and Non-diseased Respondents. Indian Journal of Psychology and Education, 1(2), 75–86.

Proctor, C., Maltby, J., and Linley, P. A. (2009) Strengths use as a Predictor of Well-being and Health-related Quality of Life. Journal of Happiness Studies, 10(5), 583–30.

Proyer, R. T., Gander, F., Wellenzohn, S., and Ruch, W. (2013). What Good are Character Strengths Beyond Subjective Well-being? The Contribution of the Good Character on Self-reported Health-oriented Behaviour, Physical Fitness, and the Subjective Health Status. Journal of Positive Psychology, 8(3), 222–32.

Proyer, R. T., Ruch, W., and Buschor, C. (2013).Testing Strengths-Based Interventions: A Preliminary Study on the Effectiveness of a Program Targeting Curiosity, Gratitude, Hope, Humor, and Zest for Enhancing Life Satisfaction. Journal of Happiness Studies, 14(1), 275–92.

Riley, B., Perna, R., Tate, D., Forchheimer, M., Anderson, C., and Luera, G. (1998). Types of Spiritual Well-being Among Persons with Chronic Illness: Their Relation to Various Forms of Quality of Life. Archives of Physical Medicine and Rehabilitation, 79(3), 258–64.

Rokeach, M. (1973). The Nature of Human Values. Free Press, New York.

Ruiz, P., and Ruiz, P. P. (1983). Treatment Compliance among Hispanics. Journal of Operational Psychiatry, 14(4), 112–14.

Rust, T., Diessner, R., and Reade, L. (2009). Strengths Only or Strengths and Relative Weaknesses? A Preliminary Study. Journal of Psychology, 143(5), 465–76.

Scheier, M. F., Mathews, K. A., Owens, J. F., Magovern, G. J., Lefebvre, R. C., Abbott, R. A., and Carver, C. S. (1989). Dispositional Optimism and Recovery from Coronary Artery Bypass Surgery: The Beneficial Effects on Positive Physical and Psychological Well-being. Journal of Personality and Social Psychology, 57(6), 1024–40.

Seligman, M. and Peterson, C. (2000). Values in Action (VIA) Classification of Strengths. Retrieved from http://www.positivepsychology.org/toxonomy/htm.

Seligman, M. (2008). Positive Health. Applied Psychology: An International Review, 57, 3–18.

Seligman, M., Park, N., Peterson, C. (2005). VIA Institute on Character: Research Abstracts. Review of General Psychology, 9(3), 203–13.

Seligman, M., Steen, T. A., Park, N., and Peterson, C. (2005). Positive Psychology Progress. Empirical Validation of Interventions. American Psychologist, 60(5), 410–21.

Sherbourne, C. D., Hays, R. D., Ordway, L., Dimatteo M. R., and Kravitz, R. L. (1992). Antecedents of a Adherence to Medical Recommendations: Results from the Medical Outcomes Study. Journal of Behavioural Medicine, 15(5), 447–68.

Singh, K., and Choubisa, R. (2010). Empirical Validations of Values in Action-inventory of Strength (VIS-IS) in Indian Context. Psychological Studies, 55(2), 151–58.

Swift, T. L., Ashcraft, R. E., Todd, W., Campbell, A. V., and Dieppe, P. A. (2002). Living Well Through Chronic Illness; the Relevance of Virtue Theory to Patients with Chronic Osteoarthritis. Arthritis and Rheumatology: Arthritis Care and Research, 47(5), 474–78.

Taylor, S. E., Kemeny, M. E., Reed, G. M., Bower, J. E., and Gruenewald, T. L. (2000). Psychological Resources, Positive Illusions, and Health. American Psychologist, 55(1), 99–109.

Tuck, I., McCain, N. L., and Elswick, R. K., Jr. (2001). Spirituality and Psychosocial Factors in Persons Living with HIV. Journal of Advance Neuroscience, 33(6), 776–83.

Van Eeden, C., Wissing, M. P., Dreyer, J., Park, N., and Peterson, C. (2008). Validation of the Values in Action Inventory of Strengths for Youth Among South African Learners. Journal of Psychology in Africa, 18(1), 145–56.

Wong, P. T. P. (2012). The Human Quest for Meaning: Theories, Research, and Applications (2nd Ed.). New York, NY: Routledge.