The Smile-Sun Method (SSM): Procedures for Enhancing Interpersonal Skills and Producing Affective Change

 

Kazue Takayanagi1, MD, Hiroshi Matsuoka1, and Kana Ishii2, MD
Bunkyo Gakuin University1
Nippon Medical School2

 

Abstract

Participants (N=212) were exposed to the Smile-Sun Method (SSM) geared to promote positive affect and laughter, in a workshop format that included formal lectures, and application in dyadic and group interactions. The training involved initially establishing conditions presumed to be precursors to improved emotionality and mirthfulness: (a) safety and security; (b) Relaxation skills; (c) involvement in rhythmic-type activities; and (d) interpersonal skills development. Included was the teaching of a communication using Smile-Sun messages (e.g., starting social interchanges with “thank you”). Profile Mood Scores (POMS) were collected before and after the workshop. Three years later a sample of workshop attendees re-assembled and discussed their workshop-related experiences. Their free verbal interactions were analyzed via text mining. In addition, community involvement was evaluated in relation to frequency of invited lectures among another subset of workshop participants. These data suggested reduced negative affect, increased vigor, and improved self- efficacy together with extension of self to others and to community and society at large.

Introduction

 

In Japan, there are approximately 30,000 suicides per year. Suicidal inclinations among Japanese seem related to Physical health issues, economic problems, and depression. The suicide rate in the Aomori prefecture, the site of our study, is the second highest in Japan (.037% in 2002). In Japan the quality of human interactions and relationships are being weakened by a breakdown in the nuclear family, environmental problems and economic instability. In addition to stress factors common across cultures, the Japanese people may have other culture-specific traits such as shyness, other-directedness and low self- esteem, and low self- efficacy that reduce the potential for rewarding and mood-elevating experiences that can emanate from social interactions. For example, low self-esteem and shyness may preclude acceptance and internalization of genuine compliments (see Benedict, 1946; Seligman, et al., 2006).

We opine that the capacity to engage in mirthfulness (laughter; elevated affect) may be an essential element in one’s adaptation to the stressors in life that lead to depression and suicidal ideation. Norman Cousins (1976) documented laughter as paramount in overcoming a serious illness, for example. The senior author (KT) developed procedures for persons in Japan that focused on developing personal skills that enable more satisfying social interchanges. One key principle was the importance of spontaneous, appropriate laughter; the core premise was that the ability to accept (love) oneself allows the individual to extend her or himself to others in an empathic manner. The components of training that may remove barriers to self-acceptance, laughter, and extension to others are: (a) a sense of safety and security; (b) relaxation skills that aid in regulation of stress reactions; (c) increased activities that include rhythmic motions (e.g., walking, chewing, breathing) that activate the dopaminergic reward systems; (d) development of interpersonal skills that bring more satisfying interactions and may lead to greater participation and involvement in society at large in improving life for other citizens and generations to come.

Method

Three day workshops were held in five different cities in Japan: Hirosaki, Aomori, Hachinohe, Mutsu, and Towada. Each workshop was attended by 30-50 individuals. A total of 212 adults participated. They were recruited by the welfare department of the Aomori Prefecture. It was explained that the workshops were for the purpose of improving personal and interpersonal skills that if generalized to society at large would help to reduce adverse events such as suicide and cruelty. Each workshop had the same content and was conducted by the same leader.

Components of the Workshop Experience
Lectures and demonstrations were initially presented, designed for general education about laughter, physiological and psychological aspect of stress, dopamine and the reward circuitry of the brain, self –acceptance, interpersonal skills, and extending self to others and to society at large.

The leader attempted to establish a workshop atmosphere conducive to experiencing a sense of safety and security. Participants were assured that anything they discussed in the workshop setting, for example, would be confidential; each person pledged to maintain the confidentiality of what others related in the group. It was explained that speaking in the group and expressing one’s thoughts and feelings would likely be helpful but was totally voluntary. In order to prevent or reduce possible social anxiety, relaxation skills were taught and practiced. Rhythmic activities designed to stimulate the dopaminergic brain systems were also part of the curricula.
Communication skills were implemented didactically and through practice. Non-verbal components of smiling, eye contact and active listening were emphasized. The importance of expressing feelings and avoiding the unimportant and irrelevant by quickly getting to the point was also stressed. Participants were taught never to discount what another person said to them. Special “Smile-Sun” messages were practiced in dyadic and group interactions: Focusing on praising a communication partner appropriately; accepting negative expressions and rephrasing or re-interpretation in positive manner; use of “I” messages; starting messages with a “thank you.”
Role-playing simulation was also a part of the workshop experience. Participant might be asked to take a position in discussion that they did not agree with, in order to develop empathic understanding of communication partner’s point of view.
Participants were also exposed to stress-inducing negative feedback and practiced adaptive ways of responding in role-playing experiences. When expressing an honest but adverse message to a communication partner, the message itself was preceded by a positive phrase to promote relaxation and then followed by another positive comment related to the potential for a constructive change (called the Positive-Negative-Positive or PNP approach). In a complementary “I” as opposed to a more harsh “you” message, the individual expresses personal views with compassion and good eye contact (termed the “I-Love-Eye” message).

Measure
The Profile of Mood States Questionnaire (POMS) includes 65 items and a Likert-type response format. It contains six subscales: Anxiety-tension; Anger-hostility; Fatigue-inertia; Depression-dejection; Vigor-activity; Confusion-bewilderment. The technical aspects (reliability; validity) and interpretation of the Japanese translation of POMS are reported by Yokoyama, Araki, Kawakami, and Takakeshita (1990). Elevated scores on the Vigor-activity scale reflect overall mood elevation, vigor and enthusiasm. Negative affect is calculated by subtracting the Vigor-activity scores from the total score across the other subscales.

Procedure
The POMS was administered prior to the formal workshop, immediately after the workshop experience. Scores on the subscales were computed. Difference scores were then analyzed. Three years later, 41 of the participants re-assembled and interacted together. Their free comments were categorized, clustered and analyzed using text mining. In addition, the number of speeches made by workshop participants to organizations in the Aomori prefecture (e.g., schools, hospitals, rehabilitation centers, in industrial and agriculture facilities, and chambers of commerce) were gathered as an unobtrusive index of community and societal involvement.

Results

Data from the POMS indicated significant (t =<.05) improvements in Tension, Depression and Anger, and importantly, Vigor. Declines in Depression and Anger, and increased Vigor were also corroborated by the Wilcoxon signed-rank test (all probabilities beyond .001)(see figure 1). Text mining of 79 comments indicated that 38 of the 41 individuals maintained positive emotional and attitudinal changes, including improved self-efficacy. Approximately 33% noticed such changes in other workshop participants. The number of lectures evinced a geometric increase in the three year period from approximately 1000 to almost 30,000.

Discussion

The goals of this study were generally achieved. Participants showed declines in negative affect, increases in positive affect, and improved self-acceptance. And, they were able to extend themselves to others in the community. It is reasonable to assume that these changes are attributable to the information received in the workshop format and the interpersonal skills that were engendered, practiced and ostensibly maintained. The techniques used were also apparently successful albeit they were included in a “packaged” approach. It is unknown whether all components in the “package” are important (safety, relaxation, understanding of the physiology of stress and the dopaminergic reward system, etc.) or if some or several might be eliminated in future studies of this type, while maintaining the same level of efficacy. Future studies might use a “dismantling” strategy for finding possible central versus peripheral or non-essential components of the Smile-Sun techniques.
The theoretical underpinnings of the approaches used were based assumptions about interventions that would counter the traditional forces in the Japanese society that may render certain citizens prone to negative affect, degrees of social isolation or interpersonal and self-estrangement, a sense of helplessness and suicidal-types of thinking. Our study suggests that greater happiness, self- acceptance, efficacy and community involvement are realistic goals that can be achieved using an intensive short-term workshop intervention called the Smile-Sun Method.
Finally, it should be noted since completion of the current study the Smile-Sun Method has been extended to 40,000 persons in the Aomori prefecture. Subsequently, suicide rates in the prefecture have been reduced in relation national data in Japan.

Appreciation

The study was sponsored by the Welfare Department of the Aomori Prefecture from 2007-2010 for preventing bullying, cruelty and suicide. Authors would like to express our appreciation for the Governor and staff of the Welfare Department of the Aomori Prefecture, all participants for the project. We would like to send special appreciation for Dr. Steven Thurber for re –writing the paper for the English speaking reader. We thank Ms. Sanae Ishii for her secretarial work for translation.
We appreciated Dr. Yasuhiro Kishi, MD, Department of Neuropsychiatry at Nippon Medical School, for peer review of this paper to determine the originality of research and the viability of publication.

 

Reference

1. Benedict, R. (1946) The Chrysanthemum and the Sword: Patterns of Japanese Culture. Houghton Mifflin.
2. Cousins, N. (1976) Anatomy of an illness: as perceived by the patient. New Engl J Med. Vol.295. 1458-63.
3. Seligman, M E, Rashid, T, Parks, A C. (2006) Positive psychotherapy. Am Psychol. Vol. 61(8). 774-88.
4. Takayanagi, K. (2007) Laughter Education and the Psycho-physical Effects: Introduction of SSM. JAPAN HOSPITALS. Vol. 26 31-35.
5.Yokoyama K, Araki S, Kawakami N, Takakeshita T. Production of the Japanese edition of profile of mood states (POMS): assessment of reliability and validity. Nippon Koshu Eisei Zasshi. 1990;37:913-918.

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