Statement of the Problem
For decades, the focus of clinical diagnosis has been on classifying mental health problems into separate disease categories, as can be observed in the various versions of the International Classification of Diseases (ICD) and Diagnostic and Statistical Manual (DSM). However, the prevalence of comorbidity, or co-occurrence, among ICD or DSM disorders has cast doubt on the idea that these classifications reflect topographic variations (1–4). Further, the distinct diagnostic categories defined in frameworks such as the DSM are inconsistent with the findings from clinical neuroscience, which indicates redundancies among classifications and suggests that they are not capturing the common underlying syndromes (5). Based on these findings, a new transdiagnostic trend is developing, which aims to identify shared underlying mechanisms across different classes of mental health problems, to provide more parsimonious classification systems, and identify treatment techniques targeting common underlying mechanisms (3, 6, 7). Research into transdiagnostic processes underlying multiple mental health problems is, therefore, promising for making clinical practice and interventions more effective and resource-efficient. In this protocol, we describe a systematic review and meta-analysis that will explore time perspective as a possible transdiagnostic factor that may contribute to issues across wide-ranging domains of mental health.
Conceptualization of Time perspective
Time perspective, sometimes referred as “temporal focus”, is defined as an individual’s relative investment of attention on the past, present and future and is assumed to filter temporal information and influences behaviour (8–10). Zimbardo and Boyd (11) described time perspective as a nonconscious personal attitude, which helps to give order, coherence, and meaning to the continual flow of existence. Importantly, it assigns life experiences into temporal categories. In other words, time perspective is like lens through which one’s life events are processed (12). A particularly influential theory on time perspective has been Zimbardo’s theory, which proposes that time perspective is situationally determined, relatively stable, and subject to individual differences. Based on this definition, Zimbardo and colleagues have operationalised time perspective and developed a widely used and well-validated assessment tool, Zimbardo Time perspective Inventory (ZTPI) (11, 13). ZTPI consists of 56 items which are scored on a 5-point Likert scale ranging from 1-very uncharacteristic to 5-very characteristic. Based on a mix of cognitive, affective and behavioural items, the ZTPI yields 5 dimensions of time perspective: past-negative (aversive view of the past), past-positive (warm, sentimental attitude toward the past), present-hedonistic (enjoyment, pleasure risk-taking attitude towards life), present-fatalistic (helpless and hopeless attitude towards the future and life), and future (planning for and achievement of future goals) (11). Zimbardo’s theory also emphasizes a balanced time perspective, which is defined as the mental ability to switch flexibly among the different time perspectives based on the situation and personal resource (11, 12). Other assessment tools have also been constructed to evaluate a comprehensive time perspective view, such as the Temporal Orientation Scale (TOS) (14), the Balanced Time perspective Scale (BTPS) including past and future (15, 16), and the Temporal Focus Scale (TFS) with past, present and future included (10). These instruments have, however, been less widely used than the ZTPI (e.g., according to google scholar citations until 6th March 2021, ZTPI: TOS: BTPS: TFS = 3986:485:118:507).
Growing evidence illustrates that people organise their life experience using the frame of time as a reference which shapes their judgements, decisions and behaviours (8), as well as mentally constructs the continuity and stability of self, others and objects (17). However, the relations between time perspective and psychological problems are not straightforward. Overemphasizing any one frame (past, present or future) could cause bias and bring dysfunctions (11). For example, low future and high present temporal orientation is a key underlying process in impulsive decision-making regardless of future consequences (18), or choosing “the more immediate smaller rewards over the later bigger rewards” in delay discounting (19), which contributes to impulsivity related mental problems (20, 21). Also, despite future orientation is a predictor of well-being and achievement (22–24), being biased towards the future does not correlate with subjective happiness due to less enjoyment of the present pleasure and goal-related stress (23, 25). It is for this reason that the ability to flexibly switching between time frames is proposed as an indicator of mental health (12, 26, 27), and a balanced time perspective is deemed to consist of high past-positive, moderate future, moderate present-hedonistic, low past-negative and low present-fatalistic time orientation (28). A balanced time perspective has been linked to general satisfaction with life (29, 30), while biasing to a particular time orientation is potentially a predictor of different problematic human behaviours (31).
Time perspective as An Important Underlying Element in Intervention Techniques
Previous research suggests that time perspective is related to a range of psychological traits and processes that have been implicated in the risk for different types of mental health issues. For example, time perspective has been linked to impulsivity (important in issues such as attention deficit hyperactivity disorder, ADHD) and addiction (32, 33), emotional dysfunction (important in issues such as mood disorders) (34), and identity discontinuity (important in issues such as personality disorders) (35). As such, a time perspective may be promising for illuminating, profiling, and addressing a broad range of mental health issues (17, 26, 36, 37). For example, the ZTPI could be a potential diagnostic tool, such as the present hedonism scale for impulsivity related mental problems (32). Further, an assessment of how patients organize and feel about their past, present and future experiences can be a starting point for planning intervention; and high past-positive and moderate future time perspectives can be the index for subject well-being (28).
Indeed, there is already some evidence for the clinical utility of time perspective as an intervention target. A recent systematic review by Rung and Madden (37), analysing the effectiveness of intervention techniques in reducing impulsive choice (bias to choose the more immediate rewards despite it is smaller than the long-term one) on delay discounting, showed that time perspective, as encoded in concepts such as “temporal priming” (experimentally manipulating participants’ perception of time), “framing of time” (description of intertemporal choices with equivalent outcomes across different time frames), and “episodic future thinking” ( imagining or episodic simulation of one’s future) was the key effective element in numerous intervention studies. Time perspective is, in fact, an existing element in many psychological therapies (38). One well-evidenced transdiagnostically effective therapy, acceptance and commitment therapy (ACT), includes time perspective elements. For example, the Value intervention element of ACT encourages people to look into their long-term values with future positive outcomes while the “contact with the present moment” and “self as context” components, which are adopted from the mindfulness skill sets, train people to focus on the ongoing flows of the present moment (7, 39, 40).
Further, based on Zimbardo’s theory, Time perspective Therapy, aimed at restoring a balanced time perspective to shift from the past to present and to future, was developed at the beginning in treating mental problems that “stuck in the painful past”, such as post-traumatic stress disorder (PTSD), anxiety and depression symptoms (41–43). Despite limited evidence so far, Time perspective Therapy is regarded as promising in treating difficulties associated with ADHD and impulsivity (32), particularly in conjunction with established therapies (44–46). Finally, one study suggested that targeting self-discontinuity, a sense that the present self is fundamentally different from the past self, was effective in changing addiction behaviours among problem gamblers and problem drinkers by serving as a catalyst in moving people from addiction to positive action (47).
Rationale for A Systematic Review
Despite previous studies identifying links between time perspective and mental health issues and preliminary evidence that it is a potentially useful intervention target, no comprehensive overview of the links between specific time perspectives and different mental health issues is available to guide the development and targeting of therapeutic components to optimize their effectiveness. Robust evidence on this is critical for mapping time perspective interventions to specific problems, including considering time perspective as a potential transdiagnostic intervention target that can be used in prevention and intervention efforts for a wide range of mental health issues simultaneously. A systematic review and meta-analytic study on the link between time perspective and related psychological problems is thus valuable for offering a robust foundation for clinical techniques targeting time perspective.
Despite the value of considering a more encompassing multidimensional construct of time perspective, previous studies have disproportionately exclusively focused on future time perspective and there have been a number of systematic reviews on this topic. For instance, Henry and colleagues (22) reviewed the future time perspective in occupational contexts, examining its antecedents and consequences in 33 primary studies, and found that both occupational future time perspective (OFTP) and future time perspective (FTP) were related to occupational well-being, motivation, attitude and behaviour. Rudolph and colleagues (48) conducted a meta-analysis of 40 primary studies on the antecedents and outcomes of OFTP, and the results showed that OFTP was related to important work outcomes (job satisfaction, organizational commitment, work engagement, retirement intention), work continuance intentions and task and contextual performance (49). Andre and colleagues (50) reviewed the predictive power of FTP in education, work and health domains of 77 studies, and found that the strength varied for attitudes, perceived behaviour control, behaviour intention and behaviours. Kooij and colleagues (23) analysed 212 studies regarding FTP across 65 years (1950–2015), and demonstrated that FTP was positively correlated with grade point average, life satisfaction, subjective health, physical exercise, and retirement-related financial knowledge, while negatively related with anxiety, depression, risk behaviour and substance abuse. They also reported that FTP was associated with outcomes over and above the effects of personality traits, showing its incremental contribution over and above major dispositional factors. All these findings indicated that time perspective may play an important role in a wide range of domains of people’s life; however, they exclusively focused on the future time perspective or analysed its relations with various life domains but not including mental health issues. Recent research found that people scoring high on future dimension do not necessarily score low on the present or past dimensions, demonstrating the need to consider a multidimensional view of time perspective (9, 23) and suggesting that reviews focusing only on future perspective may be missing a key part of the picture.
Taken together, there remains a need for a systematic synthesis of the evidence for time perspective-mental health associations based on a time perspective conceptualisation that includes a focus on the past, present and future. A recent systematic review study helped shift attention to the relation between Balanced Time perspective/Deviation from the Balanced Time perspective and psychological variables (well-being, mental health, personality, cognitive functioning, self-control, interpersonal relations, biological features, and demographic variables), and concluded from 49 studies that BTP in general were an important mechanism of adaptation, with particularly pronounced effect on well-being (12). However, this study, together with the previously mentioned reviews, did not discuss different dimensions of time perspective and their relationship with various mental health issues from a transdiagnostic angle to provide a ‘bigger picture’ view of whether and how time perspective may contribute to a range of mental health issues. This is not due to a lack of primary studies: when a scoping search (using the terms showed in the “search strategy” section of the present study) in titles and abstracts have been conducted in PubMed to gain an overview of the range and depth of the present topic, a total number of 1076 articles were located. Therefore, the current protocol describes a systematic review and meta-analysis of the association between the different dimension (past, present, future) of time perspective and various mental health issues of the existing literature.
Review Questions
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What mental problems correlate/are predicted by each specific dimension of time perspective (past, present, future), respectively?