Research on whole systems of complementary and alternative medicine (WSCAM) [1–3] raises methodological questions concerning not only the use of individualized treatments with multiple components, but also the evaluation of patient-centered, whole person outcomes such as changes in a patient’s global status, and sense of wellness or well-being [4–7]. A key challenge is to design scientifically sound studies that have both internal and external validity from a WSCAM clinical perspective, including the assessment of positive outcomes, in addition to negative illness manifestations that are local and disease specific[8, 9].
WSCAM practices, such as traditional Chinese medicine, Ayurveda, homeopathy, and naturopathy (insert refs 10, 11), focus on the whole person indicators of health, including patients’ experienced global well-being [4, 10]. WSCAM clinicians assess the workings of multiple physiological subsystems concurrently and in relation to each other and rarely rely upon a single outcome (e.g., a single laboratory test biomarker) as evidence of “health” status. In contrast, most research designs emphasize evaluating static local outcomes for improvements in negatively-valenced symptoms and signs. Clinical studies that parse the person into separate local subsystems and investigate only disease- or lesion-specific outcomes and/or disease-related quality of life measures fail to capture evidence of actual clinical assessment practices of global outcomes and positive valences within a WSCAM framework.
Investigators have proposed using scientific concepts drawn from complex nonlinear dynamical systems theory towards improving the external validity of the clinical evidence base on WSCAM studies [8, 11, 12]. Several medical specialties are using methods of complex systems science to evaluate the functioning of body systems in an effort to increase diagnostic capability and assess patterns of disease [13–19]. Study designs such as these are well suited to non-reductive WSCAM studies that evaluate whole-person outcomes, because they attempt to quantify complex variables. In complexity theory the person is an indivisible complex adaptive system of interacting and interdependent parts, nested within and responsive/reactive to a complex environment. Synthesis of WSCAM with complexity theory suggests the need for characterizing WSCAM outcomes in terms of both (a) global and local outcomes and (b) positively and negatively valenced systemic behaviors (i.e., symptoms, signs) .
Psychologists have also utilized methods of complex systems science to investigate the concept of psychological flourishing. Flourishing is a “syndrome of positive feelings and positive functioning in life”, characterized by “goodness, generativity, growth, and resilience”, and is measured as self-reported well-being ratings. In a series of studies [21, 22], Losada, Heaphy, and Fredrickson have translated flourishing to a critical ratio of positive-to-negative affect (P:N), increasing accessibility of this concept as an objective marker of psychological health. Their body of work established the Losada line (P:N ≥ 2.9) as the key ratio where the nonlinear dynamics of human systems bifurcate into qualitatively opposite functional categories of optimal complexity (flourishing) versus less complexity (languishing).
How likely is it that an individual patient can change or increase their state of well-being? Patients commonly report “nonspecific effects” of treatment that are distinct from those relevant to their chief complaint, such as an increase in self-assessed positive affect and well-being following treatment by WSCAM [2, 10, 23–29]. Similarly, some patients report seeking WSCAM therapies in part to increase their sense of well-being . Keyes  has shown important public health benefits of flourishing, extending his research to findings in the medical realm. Flourishing individuals have lower rates of cardiovascular and chronic disease, and decreased health care utilization, among other benefits, thus it is a worthwhile construct to explore.
Studies on non-clinical populations may provide estimates of the rates of optimal well-being to which clinical populations might aspire. An implicit assumption of a high level of global well-being is that the individual can not only overcome adversity, but also flourish in his or her life course . Human beings commonly experience stress and environmental changes throughout their life cycle. Studies on the impact of adverse childhood experiences show that the number of such adverse experiences correlates with poorer mental, emotional, and physical health in adulthood [33–35]. Thus, an individual’s capacity to rebound from the impact of adverse events has major implications for long-term multidimensional well-being.
Resilience is the ability to bounce back or recover from stress [36, 37] and to show flexibility and adaptability to adverse life experiences [38, 39]. Previous research has demonstrated that resilient individuals use positive emotion to alleviate stress effects and show physiological differences in their ability to adapt to stress [32, 38]. Psychobiology research reveals that functional resilience differences among individuals stem from adaptive changes in neural circuitry in response to stress [39–41]. The more trait-like quality of resilience raises the question as to how much more of the variance in well-being it could explain. These studies suggest that there may be a global benefit to flourishing that merits evaluation as a marker of whole person health.
The purpose of this paper is to present a large sample study on a non-clinical young adult population that investigates the interrelationships between some previously-validated measures of whole person outcomes. First, we examine the relationships and relative contributions of global physical health, positive and negative mood separately and as the P:N, and resilience to integrative well-being ratings on a previously-validated scale, the Arizona Integrative Outcomes Scale (AIOS). This will determine whether the ratio of positive to negatively valenced mood has a unique relationship to overall well-being different from its individual components.
Secondly, we divide the sample into flourishers versus languishers using the P:N, to examine differences between flourisher and languisher groups on trait resilience. Fredrickson and Losada  have postulated that flourishers exhibit relatively higher levels of systemic resilience across biopsychosocial levels of organization in the face of stressors and other environmental changes. The paper concludes with a discussion of how these types of measures may benefit future WSCAM outcome studies.