Optimism, Hope & Control: Attitudes & Health

By Bruce Campbell

Can your attitude affect your health? If so, can a change in attitude help you to feel better?

Over the last two decades, many studies have suggested that a connection between health and a positive attitude, as indicated by an optimistic and hopeful outlook. One famous research project found that optimism among college students predicted their health 35 years later. A group of Harvard undergraduates were studied first during World War II and then followed through their adult lives. One of the questionnaires they completed  while young measured their optimism. Researchers investigating the relation between their earlier attitudes and their health several decades later found that the optimistic students had better health in middle age than those who had been pessimistic as students.

Explanatory Style

The researchers in this and some other studies of attitude and health measured optimism using a concept called explanatory style, which means the way a person interprets negative events. We all experience disappointments, but two people may interpret the same negative event in very different ways and their different interpretations can affect their outlook and behavior.

To understand explanatory style, imagine that two CFS or fibromyalgia patients go for a walk and both return with higher symptoms. One says: “Another setback! I’ll never get any better.” This person has a pessimistic way of interpreting her experience. She sees specific events as examples of permanent, far-reaching negative forces. The thought “I’ll never get any better” tends to lead to frustration, depression and despair. The mood of despair is associated with a feeling of helplessness, the sense of not having control and a belief that effort will not be effective.

The second patient responds to her increase in symptoms by saying: “I walked too far today. Next time, I’ll try walking less.” She has a more optimistic way of seeing her experience. She sees an event as something specific, limited and temporary. She has a more hopeful explanatory style. It suggests she can learn from experience, that tomorrow need not be the same as today. Note that optimism does not mean denial; the second person does not ignore the fact that she felt worse after exercising. But she frames her experience in a way that motivates her to try something different rather than to give up.

Other studies have also shown a link between explanatory style and physical health. Research at the University of Pennsylvania found that optimistic subjects had higher measures of immune system activity. This suggested that their bodies were better able to ward off disease. Another study from the same university found that optimism was one of the factors predicting longer survival time in women with recurrent breast cancer. A study of men who had experienced heart attacks documented a longer survival time for those having an optimistic explanatory style. Other studies have found a relationship between a positive outlook and health among college students. One study, for example, found that those with a high optimism score made only one-third as many visits to the student health center as those with low scores.

Can Optimism Be Learned?

Several decades ago, psychologists showed that pessimism can be learned. In a series of experiments, the scientists first gave dogs mild shocks that they were not able to avoid. When later the dogs were placed in a pen with a low wall and shocked again, the animals passively endured the shock rather than jumping to safety. The psychologists concluded that the dogs had learned from the first situation that there was nothing they could do to avoid pain and this belief carried over into a situation in which control was possible. They coined the term learned helplessness to refer to lasting effects of experiencing a situation in which control is not possible.

Having a chronic illness can induce feelings of helplessness similar to those experienced by the dogs. It can be difficult to feel in control when struck unexpectedly by a serious and debilitating illness. But further work in psychology offers hope. Just as feelings of pessimism and helplessness can be learned in response to experience, so can optimism. In fact, Martin Seligman, a psychologist involved in developing the idea of learned helplessness, has written a book called Learned Optimism to explain how to change your thinking in a more positive direction.

Seligman’s ideas are part of a popular and widely-proven method for changing explanatory style called cognitive therapy. This approach is based on the idea that many people hold unrealistically pessimistic thoughts about themselves and that their ideas about themselves can be changed to be more accurate and hopeful. Cognitive therapy is often taught through therapy lasting several months. It is also possible to learn its principles through reading and applying the ideas in books such as Seligman’s Learned Optimism, Feeling Good by David Burns or Mind Over Mood by Dennis Greenberger and Christine Padesky.

The process is often divided into three steps. In the first step, you learn to recognize the things you tell yourself when you experience negative or upsetting events. For example, if you experience a relapse, you might say something like “I’ll never get any better. This is hopeless.” This self-talk is called automatic thinking because it is a habitual way of responding to experience. Often we are more harsh and judgmental with ourselves in our inner dialogue than we would be with others.

Once you have identified negative thoughts, you examine them to see how realistic they are. In evaluating your thoughts, you ask yourself to what extent the thoughts are valid. The idea is to suspend temporarily your belief that the thoughts are true, and instead look for both evidence that supports and evidence that refutes the thoughts. Writing down the evidence you find helps you gain distance from your thoughts and makes them less self-evident

Third, you train yourself to have more realistic thoughts about your experience. Often the new thought you formulate will be more positive than the automatic thought you started with, but it is not merely the substitution of a positive for a negative thought. Rather, the new thought integrates all evidence both positive and negative in a realistic, balanced way. It should reduce your stress by helping you feel better, less anxious and sad. And, at the same time, it should help you to deal more effectively with your illness. (For more on cognitive therapy and step-by-step examples, see the discussion of "Changing Your Thinking" in Chapter 13 in our course text or the article Taming Stressful Thoughts.)

Explaining the Link

So, there is a well-established connection between attitude and health. And there is evidence that attitude can be changed through approaches such as cognitive therapy. What explains the link between a positive outlook and health? What mechanisms could produce a positive health effect given an optimistic attitude?

Stress and the Immune System

Several factors have been identified. One was mentioned earlier: immune system activity. Studies with both animals and humans suggest that pessimism and a sense of helplessness may affect the functioning of the immune system. A possible linkage is stress, the hypothesis being that stress lowers the body’s defenses and thus may lead to illness. Many studies have indicated that animals and people under stress have their “fight or flight” reaction stuck in the “on” position and that this may gradually wear down the immune system.

Stress management offers one way to break the negative link between stress and immune function. You might think of a combination of stress reduction and stress avoidance. It’s common for people in our classes to report that they use several forms of stress reduction, such as deep breathing, meditation, relaxation tapes and massage, in combination with stress avoidance strategies such as having a regular routine and avoiding stressful situations. (For more, see the chapter on Stress Management in our course text or the article “Key 7: Manage Stress” in the series “Ten Keys to Successful Coping.”)

Control

Another factor that may contribute to the link between attitude and health is a sense of control. Many studies have shown a connection between a person’s sense of control and health. Among the most famous are studies of control among nursing home patients. Researchers gave half of residents some control over their lives by giving them plants to take care of and some choice over things like what movie to watch. The other residents were not offered these options. The residents offered greater control were found to be happier and, surprisingly, lived longer. After a year and a half, only 15 percent had died in comparison to 30 percent of the control group.

Researchers at Stanford found similar, though less dramatic, results in a study of arthritis patients who took a six-week self-help course. Patients taking the class significantly reduced their pain and depression, and increased their activity level. Those who benefited the most were those who believed in their ability to exercise some control over their illness. These people did not deny they were sick or hold unrealistic hopes for recovery, but they had confidence that they could find things to make their lives better. 

How can you increase your sense of control? Using self-help strategies such as pacing, problem solving and target setting can help. Pacing,  knowing and honoring the limits imposed by illness, offers a way to replace the roller coaster of push and crash with predictability. Problem solving and setting realistic short-term goals replaces anxiety with a sense of accomplishment.

Healthy Activities

Probably the best documented link between attitude and improved health is through behavior. People who are upbeat and hopeful are more likely to engage in effective actions that will help. This is sometimes referred to as the “grandmother factor”: doing more of the things that your grandmother would advise, like eating well, getting adequate rest and staying connected with family and friends.

Support

The last potential link between attitude and health is support. People with long-term illness are often isolated and there have been many studies linking social isolation to poor health and early death. The relationship between isolation and death are as strong as the relationships between smoking and death, and cholesterol and death.

Quality as well as quantity of relationships is important. The limits created by illness often force patients to choose which relationships to pursue; some may be dropped and others kept because they are necessary. Many students have told us that they particularly value relationships in which they feel understood, respected and inspired.

Concluding Thoughts

While I have tried to show that there is a connection between attitude and health, I don’t mean to suggest that CFIDS and fibromyalgia patients should feel responsible for making themselves sick. Usually, we either don’t know what causes people to become sick with these illnesses or they result from a trauma over which a person may have little control. Rather, I intended to suggest that you can make the link between attitude and health work in your favor from here forward if you are mindful of your explanatory style and if you utilize strategies such as pacing, stress management and problem solving that promote better health.