5MinuteConsult Journal Club
Brief Playfulness Exercise Improves Patient Outcomes
Proyer RT, Gander F, Brauer K, et al. Can Playfulness be Stimulated? A Randomised Placebo-Controlled Online Playfulness Intervention Study on Effects on Trait Playfulness, Well-Being, and Depression [published online ahead of print, 2020 Aug 25]. Appl Psychol Health Well Being. 2021 Feb;13(1):129-151. doi: 10.1111/aphw.12220. PMID: 32844597
Randomized, controlled trial of 533 adults (81% female) to determine if recognizing “playfulness” in their day for one week improved outcomes of well-being and depression over the subsequent 12 weeks. They defined playfulness as: “treatment methods or intentional activities aimed at cultivating positive feelings, positive behaviors, or positive cognitions” and made the distinction between “play” (the activity or behavior) and playfulness (personality trait or way of interaction).
Subjects were divided into one of 4 groups: the 3 experimental groups completed daily “playfulness” exercises for 7 days. These groups were:
- Group I (Write it Down) was asked to set aside 15 minutes at the end of the day and write down 3 playful things that happened that day.
- Group 2 (Different Way) was asked to set aside 15 minutes before bed to write down how they used “playfulness in a different way” (writing signature differently, acting playfully at work, etc.)
- Group 3 (Self and Others) was asked to set aside 15 minutes at the end of the day to write down playful experiences they observed, of themselves or others from the day, then count them up for a total score.
- Group 4 (Placebo) was asked to set aside 15 minutes at the end of the day to write down an early childhood memory.
Outcomes were based upon pre- and post-tests on well-being and depression scores over the subsequent 2, 4 and 12 weeks. The OLIW‐S test evaluates three items using a Likert‐type scale (1 = “does not apply at all” to 7 = “applies completely”) in each of the following categories: Other‐directed, Lighthearted, Intellectual, and Whimsical playfulness.
In this study, all 3 intervention groups benefited from interventions with outcomes of improved well-being and diminished depression scores, compared to the placebo group (except for no effect on “whimsical playfulness” scores from the “Self and Others” group).
The greatest effect came from documenting how others were playful and from trying to use playfulness in a new way.
At 12 weeks, playfulness continued to have a positive effect in the intervention groups although there was some decrease over time, yet findings remained significant.
Spending 15 minutes at the end of the day documenting playfulness in the day can improve a patient’s sense of well-being and lower feelings of depression.
Nominal vs. Ordinal scales
In this study, an ordinal “Likert‐type” scale was used. Ordinal scales evaluate the order of values (“on a scale from 1 to 10, with 10 being…”). They help understand a range of preferences, but do not quantify the difference between two numbers. Ordinal scales measure concepts, like happiness, playfulness, discomfort/pain, etc.
Nominal scales measure different categories and variables using “labels.” They do not have quantitative value and are often binary, meaning 2 outcomes like dead or alive, pregnant or not, etc. Nominal scales allow direct comparison between incidence of outcomes, so when they are statistically different from each other, conclusions can be made about which group may have benefited.
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Contributed by Frank J. Domino, MD, March 10, 2021