Well-Being Therapy

Definition

Well-Being Therapy is a psychotherapeutic approach aimed at helping clients achieve sustained change.

Founder(s) and history

Giovanni Fava — an Italian psychiatrist at the University of Bologna — noticed a paradox: patients with depression who had completed a successful course of CBT or pharmacotherapy often remained with "residual symptoms" — they were not ill, but they were not well either. Remission ≠ well-being.

In 1998, Fava proposed Well-Being Therapy (WBT) — a short-term protocol focused not on removing symptoms, but on building up psychological well-being along Carol Ryff's model.

Core idea: the absence of depression is not yet the presence of well-being. Both poles must be worked on: reducing pathology AND cultivating health.

Publications:

Fava (1999): "Well-being therapy: Conceptual and technical issues" — the first description
Fava & Ruini (2003): protocol expansion
Fava (2016): "Well-Being Therapy: Treatment Manual and Clinical Applications" — full manual

Key concepts

Key ideas

Two-continuum model (Keyes, 2005): mental health is not a single scale (from illness to health), but TWO independent scales:

Axis 1: presence/absence of pathology (depression, anxiety)
Axis 2: presence/absence of well-being (flourishing)

A person can be without depression but also without well-being (languishing). WBT works on axis 2.

Ryff's model of psychological well-being (Carol Ryff, 1989) — six dimensions: 1. Self-acceptance: positive attitude toward oneself and one's past 2. Positive relations: deep, warm connections 3. Autonomy: internal locus of control, independence 4. Environmental mastery: ability to manage one's life 5. Personal growth: openness to development and new experience 6. Purpose in life: meaning and direction

Automatic thoughts that interrupt well-being — the central target of WBT. Analogous to negative automatic thoughts in CBT, but the focus is on thoughts that cut off the POSITIVE experience.

WBT as a second phase

WBT is most often used as a sequential combination: 1. First — CBT or pharmacotherapy (reducing acute symptoms) 2. Then — WBT (building well-being, preventing relapse)

This model is especially effective in:

Recurrent depression (preventing new episodes)
Residual symptoms after remission
GAD (switching from anxiety to functioning)
Cyclothymia

WBT can also be used as a standalone approach in subclinical conditions and for strengthening well-being in healthy people.

Therapy format

WBT is a short-term, structured protocol:

Phase 1 (sessions 1-2): Observation

Psychoeducation: the Ryff model, the two continua
Well-being diary: situation → well-being (0-100) → what interrupted
Task: learn to notice moments of well-being

Phase 2 (sessions 3-6): Cognitive work

Analysis of well-being "interrupters"
Link to the Ryff dimensions: which dimension has a deficit?
Cognitive restructuring: work with thoughts that cut off the good
Assigning activities for each dimension

Phase 3 (sessions 7-8): Integration and prevention

Review of progress across the six dimensions
Maintenance strategies
Relapse prevention

Format: individual, 8-12 weekly sessions of 50 minutes.

Evidence base

Fava et al. (1998): RCT, WBT + CBT vs CBT alone in recurrent depression — WBT group: 25% relapse over 6 years vs 80% in the control group
Fava et al. (2005): WBT in GAD — significant improvement in well-being and anxiety
Ruini et al. (2006): WBT in schools — improved adolescent well-being
Fava et al. (2011): WBT in cyclothymia — reduced mood swings
Guidi et al. (2018): meta-analysis — WBT is effective for raising well-being and preventing relapse
Fava & Guidi (2020): updated review — WBT as an adjunct to standard therapy

Limitations

Who it suits:

Recurrent depression (relapse prevention)
Residual symptoms after successful therapy
GAD, social anxiety
Subclinical conditions (languishing)
Healthy people who want to raise their well-being
Adolescents (school programs)

Limitations:

Not for acute states (symptoms must be reduced first)
Requires the capacity for self-observation
The client must be willing to focus on the GOOD (not everyone is)
Few specialists are trained in WBT
Small samples in research

Therapist's role: active, educational, CBT-style. Working with a structured diary, cognitive restructuring, assigning activities.

Opening phase: assessment and psychoeducation

WBT starts after acute symptoms have been partly reduced (WBT is often used as the second phase after CBT). The focus is on episodes of well-being, not on problems.

Over the past week, were there moments when you felt well — even briefly?

Key tasks:

Explain the Ryff model: six dimensions of well-being
Introduce the well-being diary: record moments when things felt good
Shift the focus: from "what is wrong?" to "what is good, and why does it not last?"

⚠️ WBT does not ignore problems. But its central question is: why is the GOOD not sustained?

Well-being diary

The core WBT tool is a structured diary where the client records moments of well-being and what interrupted them.

Column	Description
Situation	When and where I felt good
Well-being (0-100)	Intensity of the pleasant feeling
What interrupted	Thoughts, beliefs, actions that "cut off" the well-being

Write down every moment when you felt good this week — even 30 seconds over a cup of coffee. And note what happened next — why did the good not continue?

Examples of "interrupting" thoughts:

"This won't last"
"I don't deserve this"
"Things are good now — which means something bad is coming"
"This isn't real happiness"

The Ryff model: six dimensions

Carol Ryff (1989) defined six dimensions of psychological well-being. WBT assesses each one and works with the deficits.

Dimension	Description	Low score
Self-acceptance	Positive attitude toward oneself	Self-criticism, dissatisfaction with self
Positive relations	Warm, trusting connections	Isolation, conflict, loneliness
Autonomy	Independence, internal locus of control	Conformity, dependence on others' opinions
Environmental mastery	Competence in managing one's life	Helplessness, chaos, inability to organize
Personal growth	Development, openness to the new	Stagnation, boredom, hitting a "ceiling"
Purpose in life	Meaning and direction	Aimlessness, emptiness

Of these six areas — which would you rate as strong, and which as weak?

Working with well-being interruption

The central phase of WBT: working with the mechanisms that "cut off" well-being. This is close to cognitive therapy, but the focus is on thoughts that INTERRUPT the good, not thoughts that cause the bad.

You just felt good on the walk — and what happened? What thought came up?

Typical "interrupters" by dimension:

Self-acceptance: "I don't deserve this" → work with self-criticism
Relations: "If they see the real me, they'll leave" → work with closeness
Autonomy: "What will people think?" → work with dependence on approval
Environmental mastery: "I don't control anything anyway" → work with agency
Growth: "It's too late to change" → work with stagnation
Purpose: "What's the point?" → work with existential emptiness

⚠️ WBT does not force "positive thinking". It helps the client see how automatic thoughts CUT OFF the real experience of well-being.

Strategies for increasing well-being

In addition to working with interrupters, WBT proposes active cultivation of each dimension.

Dimension	Strategy
Self-acceptance	Diary of "what I like about myself", work with self-compassion
Positive relations	Planning social activities, skills for closeness
Autonomy	Practicing one's own decisions, holding a position
Environmental mastery	Small steps to organize daily life, planning
Personal growth	New activities, learning, gentle challenge to the comfort zone
Purpose in life	Identifying values, setting meaningful goals

Which one dimension would you like to strengthen first? What might be a small step?

Closing phase

Review of changes across the six dimensions
Comparison: diary from the first weeks vs the current one
Maintenance plan: which practices to continue?
Relapse prevention: what to do if well-being drops?

What have you learned about your well-being through our work? What supports it? What threatens it?

Well-Being DiaryWell-Being Diary

Daily recording of moments of well-being, rated for intensity (0-100), together with the thoughts or beliefs that interrupted the positive experience.

Explain the format: situation → well-being (0-100) → what interrupted
Ask the client to record EVERY moment when things felt good — even 30 seconds
Draw attention to what happens AFTER the good moment. What thought comes up?
In session: review 2-3 entries. What interrupted? Why?
Link the "interrupter" to a Ryff dimension
Discuss: how could the good moment have been held a little longer?

When to use:

From the first session and throughout therapy
The main tool of WBT

Key phrases:

Over the next week, I'd like you to write down every moment when you felt good — even briefly. For each one, note on a 0-100 scale how strong the feeling was, and what came afterwards that cut it off.

Follow-up questions:

What happened right after the good moment ended?

What thought or belief cut off the feeling?

Which of the six dimensions does that interrupter belong to?

If the interrupter hadn't shown up, how much longer could the good have lasted?

Warnings:

⚠️ The client may not notice moments of well-being at first. Start small: "Was there even a minute in the day when things were okay?"
⚠️ Do not turn the diary into an obligation. It should feel like noticing, not reporting.

Fava & Ruini, 2003; Fava, 2016

Details →

Well-Being Interruption AnalysisWell-Being Interruption Analysis

Cognitive work with the automatic thoughts that cut off positive experience: identification, classification by Ryff dimension, and restructuring.

From the well-being diary, pick an episode with a clear "interrupter"
Identify the thought: "What exactly did you think when the good feeling ended?"
Classify it: which dimension does it belong to? (self-acceptance, autonomy, and so on)
Explore the origin: "Where does this thought come from? Whose voice is it?"
Test its accuracy: "How true is this thought, really?"
Formulate an alternative: not a "positive" one, but a more flexible one
Assignment: next week, notice that thought and try the alternative

When to use:

Phase 2 (sessions 3-6)
When the diary has revealed stable patterns of interruption

Key phrases:

You just described a lovely moment, and then the thought "I don't deserve this" showed up and cut it off. Let's look at that thought together — is it a fact, or is it an old habit of the mind?

Follow-up questions:

Whose voice is that thought closest to?

When did you first start hearing it?

What would be a more flexible — not forced — way to hold this moment?

What would you keep from the good feeling if that thought lost some of its weight?

Warnings:

⚠️ Not all interrupters are irrational. Sometimes reality really is difficult.
⚠️ WBT works with AUTOMATIC interruption, not with realistic appraisal. Do not reframe genuine concerns away.

Fava, 1999; Fava, 2016

Details →

Ryff Six Dimensions AssessmentRyff Six Dimensions Assessment

Systematic assessment of the six dimensions of psychological well-being (self-acceptance, positive relations, autonomy, environmental mastery, personal growth, purpose in life) to define the targets of work.

Introduce the Ryff model: six dimensions of well-being
For each dimension: "How would you rate this in your life, 1-10?"
Explore each: examples, situations, concrete details
Identify 1-2 dimensions with the lowest scores — these are the targets
Identify 1-2 strong dimensions — these are the resources
Build a plan: which dimension to start with? What is the first step?

When to use:

Sessions 1-2, for orientation
Repeat every 4 weeks to track progress

Key phrases:

Ryff described six dimensions of psychological well-being: self-acceptance, positive relations, autonomy, environmental mastery, personal growth, and purpose in life. Let's go through them one by one and rate each from 1 to 10 in your life right now.

Follow-up questions:

Can you give me a concrete example of when this dimension was strong?

And when was it weakest in the past year?

Which dimension would make the biggest difference if it moved up by one point?

Which of these six is the easiest place to start?

Warnings:

⚠️ Do not turn this into a test. It is a tool for dialogue, not for psychometric diagnosis.
⚠️ Low scores are not verdicts. They are the pointers to where the work begins.

Ryff, 1989; Ryff & Keyes, 1995; Fava, 2016

Details →

Self-Acceptance EnhancementSelf-Acceptance Enhancement

Targeted work on the self-acceptance dimension: identifying self-criticism, revising one's attitude toward oneself, and developing self-compassion.

Map the client's relationship with themselves: what do they say to themselves in hard moments?
Identify the self-critical pattern: "What words do you use?"
Ask: "Would you say this to a friend? Why is it okay to say it to yourself?"
Propose an alternative inner voice: "How would a kind voice sound?"
Assignment: a "what I like about myself" diary — one quality per day
Track self-acceptance interrupters in the well-being diary

When to use:

When self-acceptance is one of the weak dimensions
Marked self-criticism or perfectionism

Key phrases:

You just described yourself the way you'd never describe a friend. Let's slow down. What would you say to someone you love if they spoke to you the way you just spoke to yourself?

Follow-up questions:

What words does your self-criticism use most often?

Whose voice does that inner voice most resemble?

If a kinder voice were speaking instead, what would it say right now?

One quality you don't hate about yourself — can we start there?

Warnings:

⚠️ Do not push "love yourself". Neutrality — "I am okay" — is already progress.
⚠️ Self-acceptance is not the same as self-satisfaction. It is the end of war, not the start of complacency.

Fava, 2016; Ryff, 1989

Details →

Purpose in Life ExplorationPurpose in Life Exploration

Work on the purpose-in-life dimension: searching for meaning, clarifying values and direction, and planning meaningful action.

Explore: "What gives your life meaning? What do you get up for in the morning?"
If "nothing": "And earlier? What mattered 5 or 10 years ago?"
Clarify values: what is truly important (not "should" but "matters")?
Translate values into goals: what actions line up with those values?
Plan one step: small, concrete, this week
Track: how does the sense of meaning change?

When to use:

When purpose in life is a weak dimension
Existential emptiness, or after a crisis when old meanings have been lost

Key phrases:

Meaning is not something we find lying around — it's something we build. Let's start small: tell me about one moment in the past year when your life felt like it meant something, even for an hour.

Follow-up questions:

What was present in that moment? Who, where, what mattered?

Which value was being expressed?

What is one small action this week that would honor that value?

If that action became a regular part of your week, what would change?

Warnings:

⚠️ Meaning is not found, it is created. Do not search for the "correct" meaning.
⚠️ Any direction that resonates is a good start.

Fava, 2016; Ryff, 1989

Details →

Positive Relations EnhancementPositive Relations Enhancement

Work on the positive-relations dimension: deepening connections, building intimacy skills, and developing the capacity to receive and offer support.

Map current relationships: where is warmth? Where is loneliness?
Identify interrupters: "If they see the real me", "I don't want to be a burden"
Plan one initiative: call a friend, propose a meeting
Practice vulnerability: share something real
Track moments of connection in the well-being diary
Discuss: what keeps relationships from deepening?

When to use:

When positive relations is a weak dimension
Isolation, or relationships that lack depth despite the presence of people

Key phrases:

You said there are people in your life, but the connections feel thin. Let's pick one relationship and ask a concrete question: what is one small thing that, if shared, would make that relationship a little more real this week?

Follow-up questions:

What stops you from sharing that thing?

What do you imagine would happen if you did?

Which relationship feels the safest to start with?

What would a small initiative look like — a message, a meeting, a question?

Warnings:

⚠️ Do not push for "more socializing". Sometimes one deep connection matters more than ten shallow ones.
⚠️ Vulnerability is practiced, not performed. Start with low-risk honesty.

Fava, 2016; Ryff, 1989

Details →

Relapse Prevention (WBT)Relapse Prevention (WBT)

Building a plan to sustain well-being after therapy ends: reviewing progress, spotting early warning signs, and coding self-help strategies.

Compare the six-dimension ratings: start vs now
Identify what helped most. Which tools are working?
List the "red flags": signals that well-being is dropping
For each flag — a plan: which dimension is slipping? What to do?
Schedule regular practice: diary, weekly dimensions map
Agree: when is it worth coming back to the therapist?

When to use:

Phase 3 (closing) — to consolidate gains and prevent relapse

Key phrases:

Well-being is not a final achievement. It's a practice you maintain. Let's build a one-page plan: which dimension first shows that you're slipping, what small action responds to it, and when it's time to come back.

Follow-up questions:

Which of the six dimensions drops first when you are under stress?

What early signal would you notice within a week?

Which practice from therapy is small enough to keep doing?

At what threshold would you pick up the phone?

Warnings:

⚠️ Well-being is not "once and for all". Normalize fluctuations.
⚠️ The plan is not for eternal happiness, it is for resilience.

Fava et al. 1998; Fava, 2016

Details →

Autonomy BuildingAutonomy Building

Strengthening the autonomy dimension: moving from dependence on others' opinions toward an internal locus of control through the practice of one's own decisions.

Identify areas of dependence: "Where do you orient on other people's opinions?"
Explore the fear: "What would happen if you decided on your own?"
Start small: choice of food, route, film — without asking anyone
Gradually expand: decisions at work, in relationships
Mark it: "You decided on your own. How does that feel?"
Work with interrupters: "What if I make a mistake?" → "A mistake is part of learning"

When to use:

When autonomy is a weak dimension
Conformism, dependence on approval, difficulty making decisions

Key phrases:

You noticed that you checked three people before choosing where to eat. Let's try a small experiment this week: one small decision per day made without consultation. No big stakes — just the practice of deciding.

Follow-up questions:

What thought shows up when you imagine deciding alone?

Whose opinion do you most anticipate?

What would change if you treated a mistake as part of learning, not as a verdict?

Which decision is small enough to feel safe, and real enough to feel yours?

Warnings:

⚠️ Autonomy ≠ isolation. Being autonomous means choosing for yourself, which can include the choice to take others into account.
⚠️ Don't confuse autonomy with defiance. The goal is internal locus, not opposition.

Fava, 2016; Ryff, 1989; Deci & Ryan, 2000

Details →

Environmental Mastery EnhancementEnvironmental Mastery Enhancement

Strengthening the sense of control over daily life through small steps of organizing the environment, planning, and achieving concrete results.

Map it: "Where do you feel you are not in control of your life?"
Pick one concrete area: home, finances, health, work
Define a small step: clear a desk, pay a bill, make a doctor's appointment
Do it — and mark it: "I did that"
Expand gradually: daily planning, budget, time organization
Link to well-being: "When I organize my space — I feel better"

When to use:

When environmental mastery is a weak dimension
A sense of chaos and helplessness, or after a long illness or crisis

Key phrases:

Let's not tackle "my whole life is chaos". Pick one surface — your desk, your inbox, one bill — and we'll define the smallest action that would count as "I handled it".

Follow-up questions:

What's the smallest piece of that area you could touch this week?

What does the finished version of that small piece look like?

How will you mark that you did it?

What does your body feel like after you've organized even a tiny thing?

Warnings:

⚠️ Do not turn this into a to-do list. The goal is the sense of competence, not productivity.
⚠️ Starting "big" (the whole apartment, the whole career) usually rebuilds helplessness, not mastery.

Fava, 2016; Ryff, 1989

Details →

Personal Growth ActivationPersonal Growth Activation

Work on the personal-growth dimension: stepping out of stagnation through new experience, learning, and gentle challenge to the comfort zone.

Explore: "When did you last try something new?"
Identify: what is interesting but "scary" or "not for me"?
Name the growth interrupters: "Too late", "I won't be good at it", "It's silly"
Plan an experiment: one new action this week
After: "How was that? What did you learn about yourself?"
Mark the growth: "A month ago you wouldn't have tried. Today — you did"

When to use:

When personal growth is a weak dimension
Stagnation, boredom, hitting a "ceiling", or midlife transitions

Key phrases:

Growth doesn't have to mean a new career. It can mean one new recipe, one new route home, one conversation with someone you usually avoid. Let's pick one small new thing for this week.

Follow-up questions:

What is something you've been curious about but haven't tried?

What is the voice that says "it's too late" or "not for me"?

What is the smallest version of that new thing that still counts?

What did you notice about yourself after trying it?

Warnings:

⚠️ Growth does not have to mean "big achievements". Trying a new recipe is growth too.
⚠️ Do not let "growth" become another perfectionism. Starting and quitting is still data.

Fava, 2016; Ryff, 1989

Details →

📋 Structured diary

Client diary — WBT

A diary helps notice changes between sessions and prepare topics to discuss with the therapist.

What did you notice?

What did you try?

How do I feel now?

12345678910

What do I want to discuss in session?

Materials are informational and educational and summarize publicly available scientific sources. They are not medical or psychological advice, are not intended for self-diagnosis or self-treatment, and do not replace consultation with a qualified professional.

Key ideas

WBT as a second phase

ALLIANCE

FOCUS

INTERVENTIONS

PRESENCE

CLOSING