“Wisdom is a complex multicomponent human personality trait that confers benefits at the individual and societal levels,” explains Dilip V. Jeste, MD. “Empirical research in wisdom has escalated in the last few decades. Wisdom may be an important antidote to the world’s current behavioral epidemics: suicide, opiate dependence, and loneliness.” With few interventions focused on enhancing wisdom itself, Dr. Jeste, Ellen E. Lee, MD, and colleagues conducted a systematic review and meta-analysis—published in JAMA Psychiatry—in order to evaluate the effectiveness of interventions to enhance the individual components of wisdom. “We embarked on this line of research due to the consistent and strong associations of wisdom with better mental and physical health outcomes that has been observed in cross-sectional samples,” notes Dr. Lee. “We wanted to know if enhancing wisdom was one way to improve health outcomes.”
Prosocial Behaviors, Emotional Regulation, and Spirituality
The meta-analysis included randomized controlled trials of interventions that enhanced a component of wisdom, used published measures for the wisdom component, had minimal sample sizes of 40 participants, were published in English, provided effect size data, and were published through December 31, 2018. Review criteria were met by 57 studies with a total of 7,096 participants, including 29 focused on prosocial behaviors, 13 on emotional regulation, and 15 on spirituality (Table); no published randomized controlled trials were found that focused on self-reflection, social decision making or social advising, acceptance of uncertainty, and decisiveness.
“Notably, the spirituality interventions were conducted only in adults, and emotional regulation interventions were not conducted in people with physical illnesses,” says Dr. Lee. “Aside from those points, the three groups of interventions were not significantly different in their format or participants. We extracted data from these studies and ran meta-analysis and meta-regression to see if the wisdom components were improved by these psychosocial interventions and to see what other intervention characteristics (sample size, percent of women, etc.) were associated with effect size.”
Improvement in Wisdom Components
With nearly half (47%) of the included studies reporting significant improvement with medium to large effect sizes, Dr. Lee notes that they meta-analysis “found that psychosocial interventions can improve different components of wisdom across diverse populations, including individuals with mental and physical illnesses.” Indeed, significant pooled standardized mean differences (SMDs) were revealed for prosocial behaviors (23 studies; pooled SMD, 0.43), emotional regulation (12 studies; pooled SMD, 0.67), and spirituality (12 studies; pooled SMD, 1.00). Although publication bias was present for prosocial behavior and emotional regulation studies, after adjusting for it, the pooled SMD remained significant for prosocial behavior (SMD, 0.4). “A number of the studies also reported that improving spirituality, emotional regulation, and prosocial behaviors were associated with better mental and physical health outcomes,” adds Dr. Lee.
Meta-regression analysis found that effect sizes did not generally vary by wisdom component, participant type, or intervention format or length. However, “interventions to improve prosocial behaviors had larger effect sizes in older adults, whereas interventions to improve spirituality had larger effect sizes in younger adults,” says Dr. Lee. Also, higher quality spirituality interventions had larger effect sizes than lower quality spirituality interventions. Among prosocial behavior interventions, lower quality studies reported larger effect sizes than did higher quality studies.
Consider Psychosocial Interventions
Although a few studies included in the meta-analysis used objective wisdom assessments, expansion of wisdom measures to capture behaviors as well as self-assessments will be invaluable, according to Dr. Lee. “We would also like to see future work in interventions that improve multiple components of wisdom in diverse populations,” she adds. “In addition, the impact of wisdom interventions on neurobiological correlates is another key area in need of research.”
In the meantime, with their findings showing promise of novel multi-component psychosocial interventions that can improve mental and physical health outcomes by enhancing wisdom in a number of populations (children and adults as well as people with and without mental and physical illnesses), Dr. Lee, Dr. Jeste, and colleagues hope physicians will be encouraged to consider psychosocial interventions as part of their clinical interventions.