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Examining Hope as a Transdiagnostic Mechanism of Change Across Anxiety Disorders and CBT Treatment Protocols
Abstract
Hope is a trait that represents the capacity to identify strategies or pathways to achieve goals and the motivation or agency to effectively pursue those pathways. Hope has been demonstrated to be a robust source of resilience to anxiety and stress and there is limited evidence that, as has been suggested for decades, hope may function as a core process or transdiagnostic mechanism of change in psychotherapy. The current study examined the role of hope in predicting recovery in a clinical trial in which 223 individuals with 1 of 4 anxiety disorders were randomized to transdiagnostic cognitive behavior therapy (CBT), disorder-specific CBT, or a waitlist controlled condition. Effect size results indicated moderate to large intraindividual increases in hope, that changes in hope were consistent across the five CBT treatment protocols, that changes in hope were significantly greater in CBT relative to waitlist, and that changes in hope began early in treatment. Results of growth curve analyses indicated that CBT was a robust predictor of trajectories of change in hope compared to waitlist, and that changes in hope predicted changes in both self-reported and clinician-rated anxiety. Finally, a statistically significant indirect effect was found indicating that the effects of treatment on changes in anxiety were mediated by treatment effects on hope. Together, these results suggest that hope may be a promising transdiagnostic mechanism of change that is relevant across anxiety disorders and treatment protocols.
... Hope has been framed as a common therapeutic process, with Frank and Frank (1991) suggesting that clients' development of hope is a crucial process across therapies. Scholars have examined the importance of hope in psychotherapy as a factor that contributes to clients' distress reduction (e.g., Bartholomew et al., 2015Bartholomew et al., , 2021Gallagher et al., 2020;Larsen & Stege, 2010). Elsewhere, researchers have also correlated outcome expectations with general hope (Swift et al., 2012), but no researchers are yet to study therapist hope specifically as an independent predictor of clients' distress when client hope is also controlled. ...
... Within the domain of psychotherapy, scholars have found correlational associations between hope and therapeutic processes like the working alliance (Bartholomew et al., 2015(Bartholomew et al., , 2021 and alliance ruptures (Bartholomew et al., 2017) as well as clients' outcomes (Bartholomew et al., 2021;Gallagher et al., 2020), and others have long argued for the role of hope in psychotherapy (e.g., Frank & Frank, 1991). If clients come to therapy demoralized and without hope (Frank & Frank, 1991), it follows that the development of hope coincides with the reduction of distress and remoralization in psychotherapy. ...
... If clients come to therapy demoralized and without hope (Frank & Frank, 1991), it follows that the development of hope coincides with the reduction of distress and remoralization in psychotherapy. These findings demonstrate that clients who experience increasing levels of hope for psychotherapy, or general hope (see Gallagher et al., 2020), over the course of treatment also appear to have concordant decreases in their psychological distress. Though not causal findings, these studies support the belief that the growth of clients' hope during treatment aids in distress reduction (Frank & Frank, 1991). ...
Therapist and client hope have both been conceptualized and empirically examined as factors that contribute to the reduction of clients' distress in treatment. That is, clients may come to therapy demoralized and without hope per Frank and Frank's contextual model of psychotherapy. Therapy can serve to increase their hope and thereby contribute to the reduction of distress; however, therapists also bring their own individual hope to the therapeutic process. Despite both parties contributing their hope as treatment factors, no research has yet simultaneously examined therapist and client hope. The purpose of this preliminary study was to test the relationships between therapist and client hope with the clients' distress to assess if these relationships hold when both perspectives are modeled. Naturalistic psychotherapy data from 99 clients receiving treatment in a community-serving, doctoral-training clinic were included. Multilevel modeling results indicated that therapist and client hope both significantly and negatively predict clients' distress over the course of treatment. Cross-lagged panel modeling demonstrated that therapists' hope predicted reductions in future sessions' psychological distress. Implications of these significant findings are discussed in connection with therapist and client factor literature, and future directions for the co-occurring examination of therapist and client hope are described. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... Knowledge about how participants hope practices influence how they interact with intervention activities is important information in public health interventions at all levels, not only to avoid unintended adverse effects. In mental health research hope has been found to be central in the recovery of the mentally ill and results suggest that targeting and improving hope may be promising in reducing mental health disorders such as anxiety (Redlich et al., 2010;Gallagher et al., 2020;Karababa, 2020;Pouyanfard et al., 2020). While several studies demonstrate the moderating effects of hope in relation to mental health (Gallagher et al., 2020;Karababa, 2020), some studies additionally show that hope is a relevant intervention target related to better physical health and functioning in somatic disease, such as coping with chronic disease and better pain tolerance and has the potential to support patients with chronic diseases to engage in goal pursuits across life domains (Berg et al., 2008(Berg et al., , 2020McLouth et al., 2021). ...
... In mental health research hope has been found to be central in the recovery of the mentally ill and results suggest that targeting and improving hope may be promising in reducing mental health disorders such as anxiety (Redlich et al., 2010;Gallagher et al., 2020;Karababa, 2020;Pouyanfard et al., 2020). While several studies demonstrate the moderating effects of hope in relation to mental health (Gallagher et al., 2020;Karababa, 2020), some studies additionally show that hope is a relevant intervention target related to better physical health and functioning in somatic disease, such as coping with chronic disease and better pain tolerance and has the potential to support patients with chronic diseases to engage in goal pursuits across life domains (Berg et al., 2008(Berg et al., , 2020McLouth et al., 2021). The question remains whether targeting hope in public health intervention targeting individual-level behavior changes can facilitate processes to achieve and sustain goal-directed actions in relation to health behavior changes? ...
... Discussing ethics in implementation research, Gopichandran et al. (2016) suggest that researchers establish an awareness and identification of problems that fall outside the scope of the research. Identifying this process as 'ancillary care', the authors state that ethical considerations and responsibility are conditioned by and emerge from the particular situation and depend on the people and the social situation under investigation and on the researcher's ability to identify and react in that situation. ...
This study examines hope practices in the context of participation in a public health intervention. Theoretically, the study builds upon Cheryl Mattingly’s notion of hope as a practice, which renders the possibility of examining participants actions, interactions and challenges with participating. This analytical lens contributes knowledge about how interventions are incorporated into participants’ hopes for a future life and the consequences of intervening in peoples’ everyday lives. The study builds on empirical material from a pilot study of the primary preventive intervention known as TOF (Tidlig Opsporing og Forebyggelse—a Danish acronym for ‘Early Detection and Prevention’) which aimed to identify high risk individuals and provide targeted preventive services. A by-product of a larger qualitative study, itself based on the TOF pilot study in 2019, this single-case study illustrates how participants’ life situation influence how they interpret and manage activities in a public health intervention. The study shows how the practice of hope in public health interventions is closely linked to participants’ own interpretations of how participation can lead to a life worth living. The findings, which show that participants’ needs, and life situation influence the ways in which they respond to an intervention, adds to the complexity in intervention research. Further, the study illustrates some of the ethical challenges that arise when researchers intervene in people’s everyday life. It reinforces the need for ongoing critical reflection and attention to be directed at how those being studied articulate and practice hope.
... The UP targets underlying mechanisms of emotional disorders that are transdiagnostic in nature, concentrating on modifying aversive reactivity and responses to emotions through emotion regulation and awareness-focused psychoeducation and skill-building strategies (Barlow et al., 2017). While research on the UP has largely focused on its capacity to reduce symptoms of psychopathology, recent literature highlights its potential to modify psychological factors associated with both decreased symptom severity and positive functioning (Barlow & Long, 2023;Gallagher et al., 2020;Spencer-Laitt et al., 2023, in press). ...
... Additionally, this study contributes to prior research exploring the effect of the UP on "common factors" across psychotherapy modalities that may contribute to positive change (Frank, 1961). For instance, Gallagher et al. (2020) found that the proposed common factor, hope, was a salient treatment mechanism for both transdiagnostic (i.e., the UP) and single-disorder CBT protocols, underscoring the scope and interconnected nature of underlying psychotherapeutic processes involved in treatment. In summary, the present findings support strengths use as a potential treatment target for clients with emotional disorders. ...
Strengths use, the engagement of positive character traits in everyday contexts, is associated with both positive functioning and symptom reduction. The present study examined longitudinal relationships between strengths use and emotional disorder symptoms (anxiety, stress, and depression) during a randomized clinical trial of the Digital Unified Protocol, a transdiagnostic cognitive behavioral therapy. Participants (N = 120) completed assessments at four major time points during treatment and at 3-month follow-up. We specified three random-intercept cross-lagged panel model to capture within-person, bidirectional, time-lagged relationships between strengths use and anxiety, stress, and depression, respectively. Prospective increases in strengths use were associated with significant decreases in anxiety at all time points (β = −0.26 to −0.49), while prospective decreases in anxiety were associated with significant increases in strengths use at most time points (β = −0.25 to −0.36). Prospective increases in strengths use were associated with significant decreases in stress at most time points (β = −0.23 to −0.54), while prospective decreases in stress were associated with significant increases in strengths use at Week 4 (β = −0.21) and at follow-up (β = −0.41). Prospective increases in strengths use were associated with significant decreases in depression at Week 8 (β = −0.63) and at posttreatment (β = −0.67), while prospective decreases in depression were associated with significant increases in strengths use at most time points (β = −0.34 to −0.47). Clinical implications of findings are discussed, including the potential role of strengths use as a treatment target.
... Such coping mechanisms can potentially increase feelings of hope, which is a positive motivational state goal that helps individuals to identify strategies for achieving goals and effectively pursuing their objectives (Gallagher et al., 2020;Snyder et al., 2002). Hope is especially important in stressful situations that demand resilience (Coppola et al., 2021). ...
... Therefore, this feeling may be helpful in a challenging and unpredictable context. Previous literature already stated that it is related to the resilience someone demonstrates in stressful situations (Gallagher et al., 2020), because it enhances the meaning of life, coping with stress and improving life satisfaction (Karatas and Tagay, 2021). ...
Purpose
The changes in the service context due to COVID-19 have challenged service marketers to understand and react to consumers’ feelings that impact their shopping behavior in services. Moreover, consumers had to face a challenging situation with an impact on mental health. This study aims to assess the impact of spirituality and compassionate love as coping mechanisms that might increase hope, which, in turn, decreases anxiety. Hope also mitigates the impact of fear on anxiety. The authors also investigate the mediate effect of hope in its relationship to spirituality and well-being during the pandemic in Brazil and its potential impact on services marketing.
Design/methodology/approach
To investigate the relationship between fear, anxiety, hope, compassionate love, spirituality and well-being, the authors conducted an online survey with 469 Brazilians who had been in quarantine for more than 45 days. To conduct the investigation, the authors used a purposive sampling to reach respondents due to the exceptional situation of the COVID-19 pandemic.
Findings
Using a structural equation model, the authors found that hope is a mediator with a buffer effect on the relationships between anxiety and fear and between spirituality and anxiety. Moreover, the authors found that hope mediates the relationship between spirituality and well-being, leading to greater levels of well-being. Service companies in general can benefit from using these findings to better manage their relationships with consumers during and after COVID-19 pandemic.
Research limitations/implications
The sample included only Brazilian respondents, and pre-pandemic well-being was not measured.
Originality/value
There is evidence that traumatic events (e.g. war) influence feelings and consumer behavior. The findings suggest that the adoption of practices related to spirituality during an extreme, stressful situation has an influence on people’s hope and potentially mitigates anxiety. Increasing spirituality and hope can also benefit perceptions of well-being. Besides, in this context, the authors recommend that service providers communicate unobservable elements in a transaction (e.g. care, safety) by providing observable signals of spirituality and hope to reduce negative emotions.
... 30 Previous research has shown that hope can be strengthened through positive relationships and can function as a mediator in the relationship between social support and mental-healthrelated outcomes. 29 Hopefulness is associated with improved mental health, including reduced depression 29 and anxiety, 31 whereas hopelessness is positively associated with significant outcomes such as suicidal ideation and suicide attempts. 32 Hopefulness is also considered to promote perceived emotional control and well-being during adverse life events, such as the COVID-19 pandemic. ...
... Although this broadly aligns with the evidence that in-person social supportand not online social supportis associated with reduced anxiety, 52 it contests the evidence that hopefulness is consistently associated with lower anxiety. 31 As hope is relationally driven, it is possible that social groups can negatively affect levels of hope. However, more research is clearly needed to understand how and why group processes and the potential psychological resources they reinforce may be more or less strongly associated with different mental disorders or symptom profiles. ...
Background:
There is growing evidence of a beneficial effect of social group processes on well-being and mental health.
Aims:
To investigate the role of group membership continuity in reducing mental ill-health among young people who were already vulnerable pre-pandemic, and to understand the social and psychological mechanisms of the benefits of group memberships for vulnerable young people.
Method:
This study takes a cross-sectional design, using survey data from a sample of 105 young people aged 16-35 years, collected approximately 1 year after the global COVID-19 outbreak (January to July 2021). Correlational and path analyses were used to test the associations between group membership continuity and mental health problems (depression, anxiety, psychotic-like experiences) and the mediation of these associations by hope and social connectedness (in-person and online). To correct for multiple testing, the Benjamini-Hochberg procedure was implemented for all analyses. Indirect effects were assessed with coverage of 99% confidence intervals.
Results:
Multiple prior group memberships were associated with preservation of group memberships during the COVID-19 pandemic. In-person social connectedness, online social connectedness and hope mediated the relationship between group membership continuity and mental health problem symptoms.
Conclusions:
The results suggest that clinical and public health practice should support vulnerable young people to foster and maintain their social group memberships, hopefulness and perceived sense of social connectedness as means of helping to prevent exacerbation of symptoms and promote recovery of mental health problems, particularly during significant life events.
... Irving et al., 2004;Ritschel et al., 2012Gallagher et al., 2020Snyder, 2000Irving et al., 2004Gallagher et al., 2020Barrett & Barrett, 2001Merolla et al., 2021Snyder 2000 Dispositional Hope Scale Snyder et al., 1991 State Hope Scale Snyder et al., 1996Snyder 20052003 State Hope Scale Snyder et al., 1996Snyder et al. 1996 30 1 1 Erikson, 1950Erikson, 1977Erikson, 1980Levinson, 19781980Khodarahimi, 2013Snyder et al., 1996Arnau et al., 2007Li et Table 3 Step 1Step 2 Step 3Step 2Step 3Step 3 Table 3 β R 2 R 2Step 1 .07.15.08**Step 2 .27 .20*** ...
... Irving et al., 2004;Ritschel et al., 2012Gallagher et al., 2020Snyder, 2000Irving et al., 2004Gallagher et al., 2020Barrett & Barrett, 2001Merolla et al., 2021Snyder 2000 Dispositional Hope Scale Snyder et al., 1991 State Hope Scale Snyder et al., 1996Snyder 20052003 State Hope Scale Snyder et al., 1996Snyder et al. 1996 30 1 1 Erikson, 1950Erikson, 1977Erikson, 1980Levinson, 19781980Khodarahimi, 2013Snyder et al., 1996Arnau et al., 2007Li et Table 3 Step 1Step 2 Step 3Step 2Step 3Step 3 Table 3 β R 2 R 2Step 1 .07.15.08**Step 2 .27 .20*** ...
In this study, we created a Japanese version of the State Hope Scale which assesses the level of hope at the current time, and examined its reliability and validity. Confirmatory factor analysis revealed that the Japanese version of the State Hope Scale had a two-factor structure similar to the original version and good internal consistency. State hope was directly associated with trait hope, state self-esteem, and positive affect; it was inversely correlated with negative affect. These findings support the construct validity of the scale. Furthermore, state hope had unique explanatory power in state anxiety beyond the influence of trait hope, indicating the incremental validity of the scale. In addition, construct validity was demonstrated with a 30-day daily report, which was prepared with college students (N = 154), and showed that state hope was associated with everyday events. Cross-delayed effects modeling also showed associations between state hope, trait hope, and mental health. The results of this study indicate that the State Hope Scale has adequate reliability and validity.
... There is substantial evidence for hope as a common factor across therapeutic approaches (Alarcón & Frank, 2012;Wampold & Imel, 2015) as well as a transdiagnostic mechanism of change (Gallagher, Long, Richardson, et al., 2020;Gilman et al., 2012). Yet, where does hope come from, and how might therapists foster it? ...
Background
Despite the recognition of meaning and hope as salient for many individuals in mental health treatment, little empirical attention has been given to patient perspectives. Research has primarily looked at the presence—or absence—of meaning and hope, and associations with symptom distress and suicidality.
Aims
These constructs are multi‐faceted and influenced by social, cultural and spiritual/religious contexts. Understanding where clients draw meaning and hope from can provide valuable information to inform case formulation, treatment planning and intervention.
Materials and Methods
This mixed method practice‐based study ( N = 233) in an outpatient community clinic (a) elucidated key areas that fuel clients' sense of meaning and hope and (b) explored associations with well‐being.
Results
Qualitatively, we identified six domains through thematic analysis: interpersonal, action‐based, transcendent, intrapersonal, environmental/contextual and lacking/searching. A sub‐set of clients also emerged who were lacking in and/or searching for meaning or hope. Quantitatively, one‐way ANOVA results indicated that source diversity was associated with greater well‐being.
Discussion
Findings illustrate that patients draw from culturally and spiritually embedded sources to construct meaning and hope in their lives, with distinctions between areas most salient for meaning, hope and both. Furthermore, having fewer sources of meaning and/or hope may represent a well‐being liability.
Conclusion
Therapists should pro‐actively explore and consider ways to bolster patients' sources of meaning and hope, considering evidence of implications for well‐being outcomes.
... Further, hope can be a protective factor against anxiety (Gallagher et al., 2021;Gallagher, Long, et al., 2020). Several studies have demonstrated that hope is a negative predictor of anxiety (Ai & Carretta, 2020;Germann et al., 2018;Yeung et al., 2015). ...
Background and objectives:
During large-scale stressful events such as pandemics, situational uncertainty and daily routine disruptions increase anxiety prevalence, underscoring the need for research on approaches to promote effective coping. This study focused on the psychological function of benefit finding in the context of the COVID-19 pandemic.
Design and methods:
Both Study 1a (a cross-sectional survey of 567 Chinese adults) and Study 1b (a two-wave longitudinal survey of 406 Chinese adults) examined the relationship between benefit finding and anxiety, with hope as the mediator. Study 2 used an interventional design to examine the efficacy of daily benefit-finding writing among 129 Chinese college students.
Results:
In Studies 1a and 1b, benefit finding was positively associated with anxiety, which was mediated by hope. Study 2 showed that daily writing tasks significantly promoted benefit finding. Hope mediated the relationship between benefit finding and anxiety at both the within- and between-person levels.
Conclusions:
Benefit finding can foster hope and relieve anxiety. Daily benefit-finding activities, which can be conducted online, can help improve mental health during pandemics.
... Significantly, hope has been identified as a protective factor, capable of reducing suicidal tendencies in cancer patients due to despair and depression, and preventing the psychological burden posed by illnesses [46][47][48]. However, researches on hope's impact on anxiety are limited, with only a few studies clearly demonstrating that changes in hope levels are closely associated with shifts in anxiety symptoms [49,50], though the specific mechanism remains unclear [40]. Thus, investigating the mediating role of hope levels in anxiety and depression symptoms is of substantial importance. ...
Background
Adolescents diagnosed with depression are particularly susceptible to anxiety and depressive symptoms, this vulnerability often diminishes their future expectations and overall outlook on life. The objective of this research was to scrutinize the associated risk factors of adolescent depression and delineated the interplay between anxiety and depressive symptoms. Concurrently, it sought to ascertain the latent mediating effects of hope levels and coping strategies within this framework.
Methods
A mixed-methods research approach was employed. For the qualitative component, 18 adolescents with depression were interviewed following a semi-structured interview guide, with sessions audio-recorded. The data were subsequently transcribed and subjected to thematic content analysis. In the quantitative phase, a cross-sectional online survey was administered to 210 adolescents diagnosed with depression using Questionnaire Star, with data analysis performed using SPSS25.0 and AMOS 24.0.
Results
The qualitative analysis identified three major themes and nine categories as key risk factors influencing the onset of adolescent depression. Three major themes were generated: school factors, family factors, and other factors. Nine categories were generated: heavy academic load, strained peer, and teacher-student relationships; unstable family structures, internal familial conflicts, and high parental expectations; a strong sense of social isolation, insufficient sexual education, and prevalent suicidal ideation or attempts. A nurturing and supportive school environment significantly bolsters adolescents' sense of hope and coping abilities, while a warm and encouraging family setting effectively mitigates psychological stress. Conversely, heightened loneliness and the onset of suicidal ideation are frequently linked to diminished hope and the adoption of maladaptive coping strategies. Hence, to comprehensively understand the intricate interplay of these factors, this study concentrated on the levels of hope and coping mechanisms, investigating their potential mediating role in adolescent anxiety and depression. Quantitative analysis revealed a positive correlation between anxiety and depression (r = 0.767, p＜0.01). Additionally, it was found that hope levels and coping strategies mediated the relationship between anxiety and depressive symptoms (β = −0.24–0.84 = 0.20, p < 0.001; β = 0.19–0.51 = −0.10, p < 0.01), with the mediating influence of hope levels being more significant than that of coping strategies.
Conclusion
Enhancing hope levels and fostering positive coping strategies are instrumental in aiding adolescents with depression to alleviate their anxiety and depressive symptoms. Moreover, this study underscored the importance of focusing on adolescents' mental health and providing them with emotional support, thereby increasing their hope levels and encouraging the adoption of positive coping mechanisms to effectively address their challenges.
... Furthermore, increased positive emotion confers several benefits that offer prophylaxis against future emotional disorder symptoms, including bolstering resilience, motivating approach and, therefore, personal growth, decreasing overall stress, and promoting the overall expansion of psychological resources (Fredrickson, 2001). Most evidence-based treatments for emotional disorders tend to focus on reducing negative affect, though we note effects on positive emotion without an explicit focus on this construct (e.g., Gallagher et al., 2020). To maximize effects on positive emotion, several recent efforts have been made to target it directly in treatment (e.g., Craske et al., 2019), showing greater effects on positive emotion than when negative emotion is targeted exclusively. ...
... With this in mind, the intervention blueprint provides guidance for a range of 4-12 sessions, approximately hourly in length and held weekly, but emphasises collaborative flexibility in determining session number, duration, and pacing. • Hope as a robust predictor of positive youth outcomes [71][72][73], buffer against the impact of negative events [74], and transdiagnostic mechanism of psychotherapeutic change [75] • Particular dearth of theory-driven intervention for the NEET population [17] • • The most severe and socially-disabling mental health problems begin before age 25 years [79,80], and sociooccupational withdrawal is a key robust risk factor of transition from subthreshold difficulties to enduring diagnosable disorders [7,8] • Hopes seems most closely linked to positive social outcomes for adolescents compared to adults [81] • Young people emphasise the importance of supporting the hope of marginalised groups [42] • All three stakeholder groups agreed on late adolescence to early adulthood as the right period within which a hope-focused intervention should be offered • Engagement of NEET young people is increased by offering flexible support with a high degree of personalisation [43] • Allowing for periods of disengagement and missed appointments is often necessary when working with young people with complex problems, including social and occupational withdrawal [82] • Emerging adults find it helpful to receive encouraging and supportive messages and advice, especially when these messages relate to specific strengths and are aligned to specific goals [102] • All three participant groups emphasised that hope is unique, and that the intervention should be person-centred, focusing on young women's individual goals and preferences • More successful interventions for NEET young people have higher contact hours [17] • Hope-based interventions can have positive effects when supported by nonexperts/nonpractitioners as well as when expert professional-delivered [42] • Emerging adults, and their levels of hope, are best served by seeking advice and help from people with whom they have a pre-existing relationship characterised by highquality support [102] • Broad and significant benefits on health and functioning achieved using a youth-initiated mentor model [103] • All stakeholder groups supported use of mentoring type approach, practitioners emphasised utility of NEET young women being able to pick a mentor that they already had a relationship with, either professional or personal ...
Young women who are not in education, employment, or training (NEET) experience poorer health and social outcomes compared to non-NEET young women and to NEET young men, especially in deprived areas with intersecting inequalities. The evidence on effective public health approaches is scarce. Interventions that target hope, which NEET young women notably lack, offer a promising theory-driven and intuitive means to prevent mental health problems and improve social outcomes. Hope can be defined as a goal-focused mindset comprising self-agency (motivation and self-belief) and pathways (identifying routes to achieving goals). Hope is implicated in a variety of evidence-based psychosocial interventions for young people, but is not directly targeted by existing prevention programmes for NEET populations. The current study used a phased qualitative research design and participatory methods to model a hope-focused intervention for NEET young women. Phase 1 investigated population needs and intervention parameters through semi-structured interviews with 28 key informants living or working in disadvantaged coastal communities in South-East England. The sample comprised eight NEET young women, four family members, and 16 practitioners from relevant support organisations. Phase 2 refined intervention parameters and outcomes through co-design sessions with four NEET young women, followed by a theory of change workshop with 10 practitioners. The resulting intervention model is articulated as a mentor-supported, in-person psychosocial intervention that builds hope by enhancing positive sense of self and time spent in meaningful activities, before explicitly teaching the skills needed to identify, set, and pursue personally meaningful goals.
... That is, insight, practiced behaviors, and support may be most effective when they are coordinated (e.g., Flückiger et al., 2022). Another practical implication of this finding might be that individuals are more likely to assess their engagement in the intervention from a holistic perspective and that this assessment corresponds to a more optimistic expectation of the intervention (Gallagher et al., 2020;Wampold & Imel, 2015). Overall, the realization of change factors may increase the likelihood of subsequent change in personality states, especially for individuals who wish to cultivate affective traits, that is, Emotional Stability and Extraversion. ...
The mechanisms of change underlying the effectiveness of personality change interventions are largely unclear. In this study, we used data from a three-month digital intervention with an intensive longitudinal design to test whether a greater realization of general change factors is partly responsible for personality change. Participants (N = 679, 53.0% female; age: M = 25.3 years, SD = 7.1) seeking to increase either Emotional Stability, Conscientiousness, or Extraversion provided self-ratings on their weekly personality states and the three generic change factors of strengths, insights, and behavioral practice. We found a single-factor structure of change factors within and between individuals. Results showed within-person increases in Emotional Stability, Extraversion, and Conscientiousness states as well as increases in change factors across the intervention. Changes in personality states were coupled with changes in generic change factors. Finally, the results provide initial support for the hypothesis that the realization of general change factors is partly responsible for the effects of the intervention. Within-person increases in the change factors were associated with subsequent increases in Extraversion and Emotional Stability states during the following week. The present findings highlight the need to better understand how and why people change in personality as a result of interventions. Plain language summary: Recent studies have shown that it is possible to change personality traits through psychological interventions. However, the mechanisms of change are largely unclear. The present study therefore examined whether targeting supportive (strengths), learning (insight) and action (behavioral practice) factors through intervention contributes to personality change. Our results provide initial evidence that these general change mechanisms are partly responsible for personality changes.
... Several scholars stressed that positive mental health can be promoted through psychological factors including hope (10,11). Specifically, hope was associated with a positive affect and higher flourishing, greater life satisfaction, enhanced perceptions that life is meaningful, and a higher sense of purpose in life (11-13). ...
Background
This study examined the interplay between engagement in social unrest, mental indicators, state-hope and demographic variables. In addition, mental indicators and state-hope were compared in line with levels of engagement in social unrest.
Methods
In a cross-sectional study, conducted from March 23 to April 10, 2023, 2031 Israelis were recruited via a survey company. Participants completed self-report questionnaires to assess engagement in social unrest, anxiety, social unrest related distress, state-hope and demographic variables.
Results
Participants with higher engagement in social unrest, who opposed the law reform, were prone to higher levels of social unrest related distress, anxiety, and lower levels of state-hope compared to those not engaged in social unrest activities or those who supported the law reform.
Conclusions
Concerns regarding unmet mental health needs, during and following social unrest, regardless of the engagement level, should be actively addressed by mental health professionals and health policy makers.
... In addition to these views, the similar biological and cognitive processes in the development and maintenance of disorders and the high rate of comorbidity, especially in mood disorders, have led some researchers to adopt a transdiagnostic approach (Barlow 2002, Kessler et al. 2005, Clark and Taylor 2009, Aldao and Nolen-Hoeksema 2010. For example, hope has been viewed as a transdiagnostic mechanism that leads to positive changes in the treatment of anxiety disorders (Gallagher et al. 2020). ...
The number of studies conducted with a holistic perspective as an alternative to the traditional clinical psychology approach has increased. It is noteworthy that studies examine the effects of positive concepts on human health in addition to discomfort. In this study, it was aimed to examine four concepts that are frequently researched in positive psychology, namely well-being, psychological resilience, hope and coping in an integrative context. Also, it was aimed to give information about the positive clinical psychology approach and the studies which investigate these four positive concepts. Studies were searched through PsycARTICLE, EBSCO and Pubmed electronic databases. Totally 208 studies were reached and 26 articles were included in this review article. As a result, the effective results in treatment of psychological disorders and increase of well-being of an individual with positive psychology interventions suggest that it is important to expand the positive perspective in clinical psychology. It is thought that it may be clinically important that the presence/increase of positive concepts as well as the absence/decrease of psychopathologies should be one of the treatment targets of mental health specialists. It is hoped that adopting an integrative perspective in future studies will enrich empirical research in the field of psychotherapy.
... Evidence suggests that peer support can provide the support and connection necessary to increase people's sense of hope for recovery, as a key mechanism of change [29,48,86,101,110]. ...
Background
There is significant value in co-produced health research, however power-imbalances within research teams can pose a barrier to people with lived experience of an illness determining the direction of research in that area. This is especially true in eating disorder research, where the inclusion of co-production approaches lags other research areas. Appealing to principles or values can serve to ground collaborative working. Despite this, there has not been any prior attempt to co-produce principles to guide the work of a research group and serve as a basis for developing future projects.
Methods
The aim of this piece of work was to co-produce a set of principles to guide the conduct of research within our lived experience led research clinic, and to offer an illustrative case for the value of this as a novel co-production methodology. A lived experience panel were recruited to our eating disorder research group. Through an iterative series of workshops with the members of our research clinic (composed of a lived experience panel, clinicians, and researchers) we developed a set of principles which we agreed were important in ensuring both the direction of our research, and the way in which we wanted to work together.
Results
Six key principles were developed using this process. They were that research should aim to be: 1) real world—offering a clear and concrete benefit to people with eating disorders, 2) tailored—suitable for marginalised groups and people with atypical diagnoses, 3) hopeful—ensuring that hope for recovery was centred in treatment, 4) experiential—privileging the ‘voice’ of people with eating disorders, 5) broad—encompassing non-standard therapeutic treatments and 6) democratic—co-produced by people with lived experience of eating disorders.
Conclusions
We reflect on some of the positives as well as limitations of the process, highlighting the importance of adequate funding for longer-term co-production approaches to be taken, and issues around ensuring representation of minority groups. We hope that other health research groups will see the value in co-producing principles to guide research in their own fields, and will adapt, develop, and refine this novel methodology.
... Several scholars stressed that positive mental health can be promoted through psychological factors including hope (e.g., 7,8). Speci cally, hope was associated with a positive affect and higher ourishing, greater life satisfaction, enhanced perceptions that life is meaningful, and a higher sense of purpose in life (e.g., 8-10). ...
Background
This study examined the interplay between engagement in social unrest, mental indicators, state-hope and demographic variables. In addition, mental indicators and state-hope were compared in line with levels of engagement in social unrest.
Methods
In a cross-sectional study, conducted from March 23 to April 10, 2023, 2015 Israelis were recruited via a survey company. Participants completed self-report questionnaires to assess engagement in social unrest, anxiety, social unrest related distress, state-hope and demographic variables.
Results
Participants with higher engagement in social unrest, who opposed the law reform, were prone to higher levels of social unrest related distress, anxiety, and lower levels of state-hope compared to those not engaged in social unrest activities or those who supported the law reform.
Conclusions
Concerns regarding unmet mental health needs, during and following social unrest, regardless of the engagement level, should be actively addressed by mental health professionals and health policy makers.
... In 2019, we published an article reporting that increases in hope served as a transdiagnostic mechanism of change in the UP (Gallagher et al., 2020). Soon after that, we were pleasantly surprised to receive the following response from Aaron T. (Tim) Beck, who was 98 and blind at the time: ...
... Snyder et al., 2018). Psychotherapy can be an important mechanism for enhancing hope, as seen with cognitive behavioral therapy (Gallagher et al., 2020) and the working alliance (Bartholomew et al., 2021). In sum, the importance of hope has been well-documented in the psychological literature. ...
The negative impact of racism on Black, Indigenous, and People of Color's (BIPOC's) mental and physical health is well-documented. Research supports the critical role of personal hope as a buffer against despair and adverse health outcomes among BIPOC. However, there is a dearth of empirical research exploring the experiences of BIPOC's sense of collective hope. This study aimed to help fill this gap in the literature by extending Mosley et al.'s (2020) multidimensional psychological framework of radical hope via a qualitative study. Radical hope includes a collective motivation of hope for BIPOC communities to work toward a more egalitarian future. In this study, focus groups and interviews were conducted with 29 BIPOC adults, with and without mental health training, to explore participants' perceptions of radical hope. Seven interrelated themes were identified. Two core components and four themes aligned with and extended Mosley et al.'s (2020) framework: Collective Orientation, Faith and Agency, Resisting Racism, Embracing Racial Pride, Envisioning Possibilities, and Meaning Making and Purpose. We also identified a new theme, Valuing Self. Implications for clinical practice and research are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... The current narrative review also found that interpretation bias was not a significant mediator of the relationship between increased trait mindfulness and reductions in anxiety symptoms following MBSR (Hoge et al., 2020). Moreover, changes in negative cognitions appear to be particularly relevant mechanisms of anxiety reduction following CBT (e.g., Gallagher et al., 2020;Gómez Penedo et al., 2021;Kladnistki et al., 2022). The current findings may support the possibility that, in GAD, mindfulness exerts its effects through practice of adopting a mindful, non-judgemental, and distanced relationship with one's thoughts and feelings, rather than challenging maladaptive thinking, as in other Cognitive Therapy approaches (Baer, 2003;Kabat-Zinn, 2003;Wells, 2002). ...
Unlabelled:
This systematic review aimed to identify 1) the effect of mindfulness training on pre-post measures of anxiety and attention among adults experiencing high levels of generalised anxiety; and 2) the impact of predictors, mediators and moderators on post-intervention changes in anxiety or attention. Trait mindfulness and distress measures were included as secondary outcomes. A systematic search was conducted in November 2021 in electronic databases using relevant search terms. Eight articles comprising four independent studies were included (N = 334). All studies included participants diagnosed with generalised anxiety disorder (GAD) who participated in an 8-week manualised program. The meta-analysis indicated that mindfulness training had a large effect on anxiety symptoms (g = -1.92, 95%CI[-3.44, -0.40]) when compared to inactive (i.e., care as usual, waitlist) or non-specified (i.e., condition not defined) controls. However, a significant effect was not found when compared to active controls. Effects for depression, worry and trait mindfulness did not reach statistical significance, despite small-large effect sizes favouring mindfulness compared to inactive/non-specified controls. Our narrative review found evidence that changes in aspects of trait mindfulness mediate anxiety reduction following mindfulness training. However, a small number of studies were available for inclusion in the review, with high risk of bias and low certainty of evidence present. Overall, the findings support the use of mindfulness training programs for GAD and indicate mechanisms that may differ from those involved in other cognitive therapy approaches. Further RCTs with evidence-based controls are needed to clarify techniques most beneficial for generalised anxiety to support individually tailored treatment.
Supplementary information:
The online version contains supplementary material available at 10.1007/s12144-023-04695-x.
... CBT was developed in an ethnocentric environment however, recent research has enabled adaptations to be made to CBT in various aspects [2]. Changes to treatment goals, assigned homework, and types of coping mechanisms taught are some of the adjustments that have been made to this intervention to make it more applicable to different psychological conditions [3,4]. Currently, adaptations to CBT to ensure relevancy and accessibility to ethnic minority groups are also being implemented such as introducing family involvement, use of appropriate language terms, and developed understanding of psychopathology from a culture viewpoint [5,6]. ...
BACKGROUND
Recommendations for psychotherapy have evolved over the years, with cognitive behavioral therapy (CBT) taking precedence since its inception within clinical guidelines in the United Kingdom and United States. The use of CBT for severe mental illness is now more common globally.
AIM
To investigate the feasibility and acceptability of a culturally adapted, CBT-based, third-wave therapy manual using the Comprehend, Cope, and Connect approach with individuals from a diverse population presenting to primary and secondary healthcare services.
METHODS
A pilot study was used to assess the feasibility and acceptability of the manualised intervention. Outcome measures were evaluated at baseline, post-intervention and 12 wk-follow up. 32 participants with mental health conditions aged 20-53 years were recruited. Assessments were completed at three time points, using Clinical Outcomes in Routine Evaluation (CORE), Hospital Anxiety and Depression Scale (HADS), Bradford Somatic Inventory and World Health Organization Disability Assessment Schedule 2.0 (WHODAS). The Patient Experience Ques-tionnaire was completed post-treatment.
RESULTS
Repeated measures of analysis of variance associated with HADS depression, F (2, 36) = 12.81, P < 0.001, partial η2 = 0.42 and HADS anxiety scores, F (2, 26) = 9.93, P < 0.001, partial η2 = 0.36; CORE total score and WHODAS both showed significant effect F (1.25, 18.72) = 14.98, P < 0.001, partial η2 = 0.5. and F (1.29, 14.18) = 6.73, P < 0.001, partial η2 = 0.38 respectively.
CONCLUSION
These results indicate the effectiveness and acceptability of the culturally adapted, CBT-based, third-wave therapy manual intervention among minoritized groups with moderate effect sizes. Satisfaction levels and acceptability were highly rated. The viability and cost-effectiveness of this approach should be explored further to support universal implementation across healthcare systems.
... Digital treatments could further house testimonial videos, quotes, or other messages from past patients to influence beliefs. In other treatments, expectations have been shown to change over time during treatment (Gallagher et al., 2020;Meyerhoff & Rohan, 2016). Indeed, participants expressed such change during the open pilot study of the Perspectives app, providing high satisfaction scores at treatment end and noting for example "I thought there was no help for me. ...
... As a matter of fact, Yılmaz (2019) has determined in his study in our country that the most obvious reason for the formation of career anxiety is the fear of not being appointed and not being able to have a job. The anxiety experienced by the individual during the career development process has a negative effect on his / her career (Çetin Gündüz & Nalbantoğlu Yılmaz, 2016;Gallagher et al., 2020). According to Vignoli (2015), as career anxiety increases, so does the likelihood of career failure. ...
Bu araştırmanın amacı ortaöğretim öğrencilerinin mükemmeliyetçilik algılarının ve meslek seçimine ilişkin akıl dışı düşüncelerinin kariyer kaygısını yordama durumunu belirlemektir. Araştırmaya 2021-2022 eğitim-öğretim döneminde Erzincan ilinde öğrenim gören 279 (%54) kadın, 240 (%46) erkek toplam 519 öğrenci dahil edilmiştir. Araştırma korelasyonel modele göre tasarlanmıştır. Katılımcılara Kişisel Bilgi Formu, Kariyer Kaygısı Ölçeği, Frost Çok Boyutlu Mükemmeliyetçilik Ölçeği, Lise Öğrencileri İçin Meslek Seçimine İlişkin Akılcı Olmayan İnançlar Ölçeği uygulanmıştır. Araştırmada ortaöğretim öğrencilerinin mükemmeliyetçilik algılarının ve meslek seçimine ilişkin akıl dışı düşüncelerinin kariyer kaygısını yordamasını belirlemek amacıyla doğrusal çoklu regresyon analizi yapılmıştır. Araştırmadan elde edilen sonuçlara göre mükemmeliyetçilik algıları, meslek seçimine ilişkin akıl dışı düşünceler ve kariyer kaygısı arasında ilişki bulunmaktadır. Araştırmadan elde edilen sonuçlara göre mükemmeliyetçilik algıları ve meslek seçimine ilişkin akıl dışı düşünceler kariyer kaygısının %19’unu açıklamaktadır.
... Identification of mechanisms of change in treatment may be particularly important for transdiagnostic interventions, such as the UP, given the emphasis on underlying core processes. Thus far, working alliance (Sauer-Zavala et al., 2018), hope (Gallagher et al., 2020), experiential avoidance , negative affect (Talkovsky & Norton, 2018), or emotion regulation (Khakpoor et al., 2019), among others, have been identified as potential mediators in CBTs among heterogeneous samples. As far as we know, no studies to date have examined mediators of change in CBT or transdiagnostic treatments for homeless populations. ...
Background
The general aim of the study was to examine potential mediators and moderators in an adaptation of the Unified Protocol for Homeless Women (UPHW).Methods
We conducted a secondary analysis in a sample of 80 homeless women participated in the study: 37 in the UPHW and 43 in the waitlist control condition. The assessment before and after the program included primary outcomes (anxiety and depression) and secondary outcomes, including different mediators (positive and negative affect, well-being, and social support) and moderators (demographics, homelessness, physical function, drug and alcohol abuse).ResultsThe UPHW showed significant improvements on anxiety and depression outcomes at post-intervention compared to waitlist control condition. Negative affect was the only significant mediator of the relationship between the UPHW and reductions in anxiety and depression symptoms. Physical functioning was the only significant moderator of the relationship between the UPHW and depression symptoms.Conclusion
To our knowledge this is the first study examining potential mediators and moderators of change in an evidence-based psychological treatment in a population experiencing homelessness. Findings suggest that transdiagnostic protocols may be a promising approach to improving psychological outcomes in this population.
... The answers are probably no, so the key is catching, checking, and changing these automatic negative thoughts to more positive ones to feel emotionally better. This technique comes from cognitive behavioral therapy and has been demonstrated to increase feelings of hope (Gallagher et al., 2020). ...
... When despair is experienced people may lean on churches to provide spiritual support that provides hope (Spencer-Thomas, 2018). Perhaps practising hopeful thinking may have positively decreased feelings of sadness and despair and by intentionally meditating on the hope of God found in the scriptures, people sustained wellbeing and a sense of purpose in the immense challenges to faith and practice they encountered during the pandemic (Gallagher et al., 2020;Ritschel and Sheppard, 2018). ...
The pandemic and resulting stay-at-home orders since March 2020 have come at a high cost to lives and livelihoods around the globe including ways in which faith communities meet. This paper forms part of a wider study Exploring hope, grace, and resilience in parish communities in COVID-19 times. It investigates how members of Christian faith communities in Melbourne (Australia) made meaning of their understanding of hope during the pandemic. The authors draw on survey data gathered between November 2021 and mid-March 2022 and using thematic analysis they discuss two overarching themes (Light despite the darkness and Connection to God). While generalisations to other faith communities cannot be made, the findings indicate churches fostered hope and offered a sense of belonging. The paper discusses implications for ways in which churches can continue to build faith with church members and the wider community in the changing landscape of the pandemic.
... " 32 While a full discussion of the mechanisms of hope therapy is beyond the scope of this article, hope therapy has been shown to reduce symptoms of anxiety in community 33 and oncological samples, 34 while hope was a transdiagnostic mechanism of change for cognitive-behavioral therapy for anxiety disorders. 35 Further research should be conducted for specific mechanisms of hope therapy in modulating trait resilience in the service of improving anxiety symptoms, as well as specifically investigating hope as a mechanism of change in this context. Relatedly, hope and resilience are 2 of 4 domains of the construct of psychological capital, which also includes self-efficacy and optimism. ...
Background:
Despite negative associations of trait resilience with depression and anxiety symptoms, the mechanisms by which resilience may buffer against these symptoms remain underexplored. This study investigated emotion regulation difficulties as a potential link in the relationship between trait resilience and depression and anxiety severity in psychiatric outpatients (N = 353).
Methods:
Participants diagnosed with primary depression or anxiety disorders were evaluated prior to treatment initiation with the Connor-Davidson Resilience Scale, Difficulties in Emotion Regulation Scale (DERS), Clinically Useful Depression Outcome Scale (CUDOS), and Clinically Useful Anxiety Outcome Scale (CUXOS).
Results:
In the depression sample, the effect of resilience on CUDOS scores was fully mediated by total DERS scores. In the anxiety sample, the effect of resilience on CUXOS scores was partially mediated by total DERS scores. Exploratory parallel mediation analyses showed only the DERS subscale strategies had a significant effect on CUDOS scores, while only goals had a significant effect on CUXOS scores.
Conclusions:
Emotion regulation difficulties are a mediator of trait resilience in psychiatric outpatients. For patients seeking treatment for depression, difficulties with accessing emotion regulation strategies may be particularly relevant, while difficulties meeting one's goals may be most relevant for patients seeking treatment for anxiety.
... Hope is associated with improved outcomes of CBT [39], increased quality of life [40] and reported as an outcome of gardening for both healthy and clinical populations [23]. Members expressed hope for the future through personal ambitions, including employment and education. ...
The UK government has invested £5.77 million in green social prescribing to prevent and tackle mental ill-health. Therapeutic community gardening, one type of green social prescription, provides a range of health outcomes. However, for increased accessibility, a greater understanding of how it impacts mental health and the facilitators and barriers to referral, uptake, and attendance by individuals with mental health problems is required. We conducted and thematically analysed interviews with thirteen stakeholders including social prescribing link workers and garden staff; and focus groups with twenty garden members. The mechanisms by which therapeutic community gardening were suggested to impact mental health were by engaging members with nature and the outdoors, providing hope for the future and facilitating social support and relationships. Factors facilitating referral, uptake, and attendance included a holistic and person-centred approach, which is flexible around health needs. Barriers included awareness of the full offering of therapeutic community gardens and accessibility, in terms of physical location and waiting lists. Given that nature-based interventions have the potential to protect and enhance population health and offer cost savings through reduced reliance on other health services; overcoming these barriers is key to ensuring that therapeutic community gardening is more widely available as an additional mental health treatment.
... Hope as a mechanism of change for PTSD treatment Given the link between hope and less PTSD symptoms, it follows that bolstering hope would promote recovery during trauma-focused treatment. Hope is considered a "common factor," or transdiagnostic change mechanism that drives improvement across treatment modalities [7, 54,55]. In addition to helping patients achieve treatment goals and cope effectively, hopeful thinking allows them to develop positive relationships with therapists, remain engaged in treatment, and prevents dropout [7,14,56,57]. ...
This paper reviews the present literature examining how hope relates to PTSD and broader functioning after a trauma, including potential underlying mechanisms and significant factors impacting these relationships and the role of hope as a mechanism of change within interventions for PTSD. First, the ways in which trauma impacts hope are discussed. Afterwards, an overview is provided of cross-sectional and prospective research indicating that greater hope reduces the risk of PTSD and promotes positive outcomes of adversity. Next, potential underlying mechanisms and determinants of the relationship between hope and adjustment are explored, including adaptive appraisals, productive coping, and social support. Finally, evidence supporting the role of hope as a mechanism of change in treatments for PTSD is reviewed.
... Several authors contend that therapists who build a positive working alliance, make strategic use of interventions, and manage group dynamics will achieve better therapy outcomes than therapists who are less skilled (Leszcz, 2018;Norcross & Wampold, 2011). Other authors argue that the application of a treatment protocol with specific techniques will improve treatment effectiveness by providing a coherent approach that generates consistency, confidence and hope (Bieling et al., 2009;Gallagher et al., 2020). Probably a combination of manual-based interventions and strong therapist skills create a positive working alliance, which enables change (Burlingame et al., 2013;McAleavey & Castonguay, 2015;Wampold et al., 2017). ...
This qualitative study investigated which types of interventions are made by group therapists during group cognitive–behavioral therapy (GCBT) with individuals who have perpetrated intimate partner violence (IPV) in the “Not ‘Losing It’ Anymore”(NLIA) outpatient programs across the Netherlands. Audio recordings of group sessions (N = 60) facilitated by 13 co-therapist teams across 25 different groups were analyzed using the general inductive approach. Fifteen distinct therapist interventions were identified, categorized, and described using examples from the data. Two categories of interventions could be distinguished: CBT interventions and process-oriented interventions. In future research the coding manual can be tested for interrater reliability and might be used in research on the effectiveness of GCBT therapist interventions.
... Despite cognitive-behavior therapy being commonly presented as the gold standard for treating anxiety, there is no sufficient evidence to support its superiority (Wampold, 2019). The presentation of a rationale focused on the client's symptoms, which promotes a sense of hope for therapy outcomes, is suggested as an important mechanism of change and a predictor of anxiety symptom reduction (Gallagher et al., 2020;Yulish et al., 2017). Kazdin and Krouse (1983) analogue study with participants suffering from anxiety proposed that a persuasive communication of the rationale promotes positive expectations and evaluations of the treatment as potent. ...
Persuasión del psicoterapeuta en la ansiedad: desarrollo de la escala y relación con la alianza de trabajo
Comunicar un razonamiento pesuasivo que explique los problemas del cliente y cómo psicoterapia puede aliviarlos se ha propuesto como un determinante crucial de los resultados que combate el estado de angustia del cliente, promueve expectativas positivas y facilita la alianza de trabajo. Sin embargo, sigue siendo una de las habilidades interpersonales facilitadoras de psicoterapeutas menos investigados y sin una medida validada. El presente estudio observacional correlacional tuvo como objetivo desarrollar una escala de calificación que mide la capacidad de persuasión del psicoterapeuta, y para examinar su relación con la alianza de trabajo. Basado en una revisión de la literatura de la capacidad de persuasión del psicoterapeuta, la Escala de Calificación de Persuasión del Terapeuta (TPRS) fue construido. Se utilizaron 17 grabaciones de sesiones de pscioterapia para validar la escala mediante análisis factorial exploratorio y confirmatorio, y evaluación de validez, confiabilidad y sensibilidad. Catorce grabaciones de sesiones de psicoterapia con clientes que sufren de ansiedad fueron calificados usando el TPRS y el Inventario de la Alianza de Trabajo-Versión del Observador-Forma Corta (WAI-O-S) para examinar la relación entre las dos variables. El proceso de validación resultó en una escala de 10 ítems de 4 factores. Excepto por la validez discriminante, que fue revelada inadecuada, la TPRS demostró ser una medida válida, confiable y sensible de la capacidad de persuasión del psicoterapeuta. A pesar de una correlación no significativa encontrada en el modelo de correlación Spearman, un modelo de regresión lineal sugirió que la capacidad de persuasión del psicoterapeuta explica el 65,1% de la alianza de trabajo al inicio de la sesión. El TPRS reveló una medida prometedora con buenas cualidades psicométricas para avanzar en la investigación sobre la capacidad de persuasión del psicoterapeuta. Hay alguna sugerencia del efecto de persuasión del psicoterapeuta en la alianza de trabajo, pero el resultado no tuvo significación estadística.
... Second, hope has been discovered to predict positive outcomes across various domains, i.e., hope envisages improved understanding and implementation of preventive approaches when facing high-risk situations (Irving et al., 1998). Hope's attribute of improved coping links it with mental well-being (Gallagher et al., 2020). Numerous studies establish the relevance of mental health with hope (Snyder, 2002, Gallagher & Lopez, 2018Ritschel & Sheppard, 2018). ...
Drawing on COR (conservation of resources) theory, the current study investigates the impact of personal resources on mental health and hope on work engagement. The study assesses the mediation of hope on mental health and works on engagement relationship. Data was gathered in two waves with a gap of one month between T1 and T2 from 200 frontline healthcare workers employed in Pakistan's public and private sector hospitals. The findings reveal that hope establishes an essential role in explicating mental health and work engagement relationship, particularly during the challenging times of the COVID-19. Implications of the findings have also been discussed.
... Thus, realistic expectations for clinicians and patients regarding the length of treatment should be set early and reviewed as needed. Treatment expectancy (a patient's belief that s/he will benefit from treatment) is a positive predictor of outcomes in BDD , and observations of CBT for related disorders indicates that patients' treatment expectations can shift over time, influencing clinical outcomes dynamically (Gallagher et al., 2020;Meyerhoff and Rohan, 2016). Moreover, clinician expectations can also impact outcomes (Constantino et al., 2011). ...
Individuals with body dysmorphic disorder (BDD) suffer from distressing or impairing preoccupations with perceived imperfections in their appearance. This often-chronic condition is associated with significant functional impairment and elevated rates of psychiatric comorbidity and morbidity, including depression, substance use disorders, and suicidality. Cognitive behavioral therapy (CBT) for BDD has been shown to be efficacious. However, this intervention is long (up to 24 weeks) relative to many manualized approaches for other related conditions, there is a significant shortage of clinicians trained in CBT for BDD, and some patients drop out of treatment and/or do not respond. Thus, there is great interest in understanding and predicting who is most likely to respond, to better allocate clinical resources. This secondary data analysis of participants enrolled in prior uncontrolled and controlled studies of CBT for BDD explored whether early response to CBT, operationalized as percentage change in symptom severity within the first four weeks and the first 12 weeks of this 24-week treatment, predicts clinical outcomes for patients with BDD (n = 90). The findings indicated that minimal early symptom change was not indicative of eventual non-response. This suggests that patients and clinicians should not be discouraged by limited early improvement but should instead continue with a full course of treatment before reevaluating progress and alternative interventions. Overall, the results support the view that treatment success is more likely if a longer CBT protocol is followed. More work is needed to understand mechanisms of change and thus match optimal interventions to patient characteristics.
... These two factors contribute significantly to the prediction of the level of general distress as well as anxiety in a negative relationship. The relationship between hope and anxiety has been well established in the previous literature (Gallagher et al., 2020) as well as between anxiety and self-efficacy (Ng & Lovibond, 2019). A low level of hope contributed to the prediction of This study has some limitations. ...
Background
Drastic changes in the lifestyle of individuals have been caused by coronarivus SARS‐CoV‐2 with lethal effects associated with COVID‐19, which acts as a stressor for the population with adverse effects on mental health status. The aim was to identify which sociodemographic variables and psychological factors predict psychological disorders in the general Spanish population.
Methods
The sample consisted of 699 people exposed to a confinement situation, where 402 (57.51%) were women and 297 (42.49%) were men, between 18 and 73 years old (M = 27.79; SD = 12.68). Different sociodemographic and psychological variables were assessed to see if they predicted levels of anxiety and depression.
Results
The results identify the predictive capacity of some sociodemographic risk variables such as sex (β = .144; IC95% = 1.341–3.376) and living with people who are ill with COVID‐19 (β = .088; IC95% = 1.157–6.785), as well as protective factors such as self‐efficacy (β = −.126; IC95% = −0.282–0.066) and hope (β = −.429; IC95% = −0.591–0.408) in mental health. In predicting anxiety levels, self‐efficacy and hope are protective factors, especially when living with people in essential services. In levels of depression, only hope is considered a protective factor in people living with patients infected by COVID‐19.
Conclusions
This study is the first to advance in the understanding of sociodemographic and psychological variables in a Spanish sample subjected to the stressful and traumatic effects of the SARS‐CoV‐2 viral agent.
Hope is a cognitive trait defined as the perceived capacity to identify strategies (pathways) and maintain motivation (agency) in the pursuit of goals. Hope is most commonly measured using the Adult Hope Scale (AHS). Past work has provided support for the factor structure and reliability of the AHS, but there is limited evidence of measurement invariance of the AHS. The present study examined measurement invariance across race/ethnicity and gender in a large and diverse (n = 3495; 76.9% Women, 32.9% Hispanic, 32.3% Asian/Pacific Islander, 22.1% White, and 12.7% Black/African American) sample of young adults in the United States. Results supported scalar measurement invariance across all race/ethnicity and gender groups and minimal differences in associations between the agency and pathways components of hope or mean levels of hope across groups with the exception of Asian adults reporting lower levels of hope than other groups. These results provide clear empirical support for the consistency of the factor structure and assessment of hope across race/ethnicity and gender and provide an important foundation for examining the potential benefits of hope across diverse populations.
Introduction
The COVID‐19 pandemic posed a threat to public health and psychological functioning, with early studies documenting higher rates of psychopathology within the United States and globally. Hope and optimism promote adjustment and are associated with positive physical and mental health outcomes. Thus, individual differences in hope and optimism may also foster resilience during a global health crisis.
Aims
The current study examined how hope and optimism influenced longitudinal health‐focused distress and wellbeing during the pandemic.
Methods
Data were collected from 788 American adults across three periods during Spring‐Summer 2020 using MTurk. Latent growth curve modeling examined whether hope and optimism predicted COVID stress, health anxiety, and wellbeing trajectories.
Results
COVID stress and health anxiety decreased after the onset of the pandemic, whereas wellbeing was stable. Individually, hope and optimism predicted lower initial COVID stress and health anxiety, along with greater initial wellbeing. When examining the combined influence of hope and optimism, optimism was more strongly related to health‐focused distress, though both were strong predictors of wellbeing.
Conclusions
These findings indicate that Americans were resilient and positive expectancies, particularly optimism, predicted better initial adjustment to the early phases of the pandemic. Thus, positive expectancies appear to be protective during a global health crisis.
Existing research supports the therapeutic value of hope in different therapies and for diverse patient groups. Patients who are socially inhibited tend to have a particularly difficult time in group therapy, and the experience of hope in that context may be especially poignant for them. The present study investigated the impact of hope on the outcome of a group-based treatment and whether this impact differed for patients depending on their level of social inhibition. The sample consisted of 49 consecutively admitted patients who completed treatment in an intensive, integrative group therapy program. Patients completed four self-report measures to assess hope, social inhibition, quality of life, and depression. Regression with moderation analysis was employed. The analyses revealed that social inhibition significantly moderated the impact of hope on treatment outcome, indicating that hope had a more pronounced effect among those patients with relatively higher levels of social inhibition.
Self-efficacy is a key construct in behavioral science affecting mental health and psychopathology. Here, we expand on previously demonstrated between-persons self-efficacy effects. We prompted 66 patients five times daily for 14 days before starting cognitive behavioral therapy (CBT) to provide avoidance, hope, and perceived psychophysiological-arousal ratings. Multilevel logistic regression analyses confirmed self-efficacy’s significant effects on avoidance in daily life (odds ratio [ OR] = 0.53, 95% confidence interval [CI] = [0.34, 0.84], p = .008) and interaction effects with anxiety in predicting perceived psychophysiological arousal ( OR = 0.79, 95% CI = [0.62, 1.00], p = .046) and hope ( OR = 1.21, 95% CI = [1.03, 1.42], p = .02). More self-efficacious patients also reported greater anxiety-symptom reduction early in treatment. Our findings assign a key role to self-efficacy for daily anxiety-symptom experiences and for early CBT success. Self-efficacy interventions delivered in patients’ daily lives could help improve treatment outcome.
Anxiety-related disorders continue to be one of the most prevalent and burdensome psychiatric disorders. Research has examined resilience factors, such as hope, that can build resilience toward or mitigate the impact of anxiety disorders. The following review provides a summary of hope as a factor of resilience as well as a mechanism of change in reducing levels of anxiety. First, hope and anxiety are conceptualized as future-oriented traits. Then, hope as a source of resilience against trait anxiety is discussed. The article then discusses the moderate, indirect relationship between hope and general as well as specific forms of anxiety before providing empirical support for hope as a mechanism of change in the reduction of anxiety. Finally, considerations for future study of hope and anxiety are discussed.
Objective:
Firefighters represent an understudied population with high rates of chronic exposure to stress and potentially traumatic events. Thus, there is a need to identify modifiable resilience factors to address posttraumatic stress disorder (PTSD) symptoms (PTSD) and chronic pain in firefighters to inform prevention and intervention efforts.
Methods:
The current sample included 155 firefighters (93.5% male; Mage = 42.2, SD = 9.8) recruited online from career, volunteer, and combination (i.e., volunteer and career) departments in a large metropolitan area in the southern United States.
Results:
Structural equation modeling (SEM) was used to investigate the associations between/among resilience and hope on PTSD symptoms, chronic pain, well-being, and posttraumatic growth (PTG). Resilience had a stronger, negative relationship with PTSD and chronic pain compared to hope, while hope had a stronger, positive relationship with PTG and well-being compared to resilience. Hope and resilience combined predicted 10%-33% of the variance in the outcomes.
Conclusion:
The current findings may provide evidence to promote interventions that increase resilience and hope in firefighters.
A number of psychological factors contribute to students’ capacity to access and benefit from instruction. These include motivation, self-efficacy, agency, social skills, student engagement, and hope. This chapter aims to explore the relationship between student engagement, hope, and student outcomes. Both student engagement and hope serve as psychological facilitators of achievement. That is, students who are actively engaged in learning and who have high levels of hope are likely to benefit from instruction and experience positive academic, social, emotional, and behavioral outcomes at school. In this chapter, we first describe and define our conceptualization of student engagement. Then, we define hope, explore Hope Theory, and describe how hope is measured in children and adolescents. Following this foundational discussion, we provide an integrative review of the extant literature regarding student outcomes associated with hope and student engagement, and we explore how student engagement and hope may interact to impact student outcomes. We also briefly describe interventions which show promise for promoting hope among students. The chapter ends with a discussion of future directions for research from which findings may assist educators in fostering student engagement and hope in order to promote positive outcomes for all students. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
Suicide is the second leading cause of death for adolescents in the United States, and suicide rates are increasing for ethnically diverse youth. Reasons for living (RFL) have been found to be a protective factor against suicidality, but few studies have assessed this amongst ethnically minoritized youth. The current study sought to examine the relationships between RFL and suicidal ideation (SI), suicide attempt (SA), and non-suicidal self-injury (NSSI) in a clinical sample of low-income, ethnically minoritized youth (n = 191, Mage = 15.12 years). Results indicate that survival and coping beliefs may be important protective factors for SI and NSSI. Fear of social disapproval may be particularly salient but was not protective within this population. Clinical implications and future directions are discussed.
Research over the past three decades has established that hope is related to positive outcomes. Hope therapy was originally developed to optimize successful goals pursuits by increasing hopeful thought. Here, we briefly review the current state of hope therapy research and offer directions for future investigations. We note that hope therapy has been adapted to be delivered in different formats, by providers from various professional backgrounds, and to participants presenting with a variety of chronic health conditions. We suggest there is a need to reach a consensus about what characterizes hope therapy. Further, we note the need for well-designed trials to test potential mechanisms of change. We believe that these future directions will result in a more efficacious hope therapy that can be widely disseminated.
The purpose of this study is to explain model of coronavirus anxiety based on parental distress, Hope for the future and obsessive behaviors mediated by fear of death. This study is applied in terms of purpose and the method of data collection was descriptive correlation. Statistical population of this study included parents of children and adolescents living in central and southern regions of Tehran. Sample of the study was 231 people who participated in the research by two stages of cluster and available sampling and through the internet. Data collection instruments included Alipour et al. coronavirus Anxiety Questionnaire (2020), Abidin Parenting Distress Questionnaire (1995), Snyder Hope Questionnaire (1991), Researcher-Made Obsessive Behaviors Questionnaire, and Templer Fear of Death Questionnaire (1970). Data were analyzed using Pearson correlation and path analysis using SPSS and AMOS software. Results showed that modified research model is a good fit after removing the variable of future hope (GFI=0.99). Obsessive behaviors have a significant direct and indirect effect on coronavirus anxiety (p<0.01). Parental distress also has a significant indirect effect on corona anxiety (p<0.05). Considering the relationship between coronavirus anxiety with obsessive behaviors and parental distress, interventions for parents during and post-corona outbreaks with the aim of reducing psychological harm is essential.
The purpose of this study was to explain model of corona anxiety based on parental distress, future hope and obsessive behaviors mediated by fear of death. This study is applied in terms of purpose and the method of data collection was descriptive correlation. Statistical population of this study included parents of children and adolescents living in central and southern regions of Tehran. Sample of the study was 231 people who participated in the research by two stages of cluster and available sampling and through the internet. Data collection instruments included Alipour et al. Corona Anxiety Questionnaire (2020), Abidin Parenting Distress Questionnaire (1995), Snyder Hope Questionnaire (1991), Researcher-Made Obsessive Behaviors Questionnaire, and Templer Fear of Death Questionnaire (1970). Data were analyzed using Pearson correlation and path analysis using SPSS and AMOS software. Results showed that modified research model has good fit after removing the variable of future hope (GFI=0.99). Obsessive behaviors have significant direct and indirect effect on corona anxiety (p<0.01). Parental distress also has significant indirect effect on corona anxiety (p<0.05). Considering the relationship between corona anxiety with obsessive behaviors and parental distress, addressing interventions for parents during and post-corona outbreaks with the aim of reducing psychological injuries is essential.
This study evaluated the sensitivity of maximum likelihood (ML)- generalized least squares (GLS) - and asymptotic distribution-free (ADF)-based fit indices to model misspecification under conditions that varied sample size and distribution. The effect of violating assumptions of asymptotic robustness theory also was examined. Standardized root-mean-square residual (SRMR) was the most sensitive index to models with misspecified factor covariance(s) and Tucker–Lewis Index (1973; TLI)Bollen's fit index (1989; BL89) relative noncentrality index (RNI) comparative fit index (CFI) and the ML- and GLS-based gamma hat McDonald's centrality index (1989; Mc) and root-mean-square error of approximation (RMSEA) were the most sensitive indices to models with misspecified factor loadings. With ML and GLS methods we recommend the use of SRMR supplemented by TLI BL89 RNI CFI gamma hat Mc or RMSEA (TLI Mc and RMSEA are less preferable at small sample sizes). With the ADF method we recommend the use of SRMR supplemented by TLI BL89 RNI or CFI. Finally most of the ML-based fit indices outperformed those obtained from GLS and ADF and are preferable for evaluating model fit.
This article describes a scale measuring dispositional optimism, defined in terms of generalized outcome expectancies. Two preliminary studies assessed the scale’s psychometric properties and its relationships with several other instruments. The scale was then used in a longitudinal study of symptom reporting among a group of undergraduates. Specifically, respondents were asked to complete three questionnaires 4 weeks before the end of a semester. Included in the questionnaire battery was the measure of optimism, a measure of private self-consciousness, and a 39-item physical symptom checklist. Subjects completed the same set of questionnaires again on the last day of class. Consistent with predictions, subjects who initially reported being highly optimistic were subsequently less likely to report being bothered by symptoms (even after correcting for initial symptom-report levels) than were subjects who initially reported being less optimistic. This effect tended to be stronger among persons high in private self-consciousness than among those lower in private self-consciousness. Discussion centers on other health related applications of the optimism scale, and the relationships between our theoretical orientation and several related theories.
Patients' outcome expectation (OE) represents their belief about the mental health consequences of participating in psychotherapy. A previous meta-analysis of 46 independent samples receiving the treatment of at least 3 sessions revealed a significant association between more optimistic baseline, or early treatment, OE and more adaptive posttreatment outcomes (weighted r-.12 or d-.24; Constantino, Glass, Arnkoff, Ametrano, and Smith, 2011). The present study represents an update to that meta-analysis. To be included, articles published through June 2017 had to (a) include a clinical sample, (b) include a therapist-delivered treatment of at least 3 sessions, (c) include a measure of patients' own OE, (d) include at least 1 posttreatment mental health outcome not explicitly referenced as a follow-up occasion, and (e) report a statistical test of the OEoutcome association. The updated meta-analysis was conducted on 81 independent samples (extracted from 72 references) with 12,722 patients. The overall weighted effect size was r-.18, p .001, or d-.36, with high heterogeneity (I2-76%) and no evidence of publication bias. Several variables (patient age, measure type, and treatment manual used) moderated the OEoutcome association. These robust, replicated meta-analytic findings are discussed in light of methodological limitations and with regard to their practice implications.
The two-volume third edition of this book identifies effective elements of therapy relationships (what works in general) as well as effective methods of tailoring or adapting therapy to the individual patient (what works in particular). Each chapter features a specific therapist behavior (e.g., alliance, empathy, support, collecting feedback) that demonstrably improves treatment outcomes or a nondiagnostic patient characteristic (e.g., reactance, preferences, culture, attachment style) by which to effectively tailor psychotherapy. Each chapter presents operational definitions, clinical examples, comprehensive meta-analyses, moderator analyses, and research-supported therapeutic practices. New chapters in this book deal with the alliance with children and adolescents, the alliance in couples and family therapy, and collecting real-time feedback from clients; more ways to tailor treatment; and adapting treatments to patient preferences, culture, attachment style, and religion/spirituality.
Trauma-focused cognitive behaviour therapy is effective in treating posttraumatic stress disorder but non-response rates range between 25% and 50%. Results of previous research on patient characteristics predicting outcome are inconsistent and mainly focused on demographic and diagnostic variables. This study examined whether behavioural predictors of poor treatment response can be observed in early sessions. It was predicted that greater patient perseveration, lower expression of thoughts and feelings and weaker therapeutic alliance would be associated with poorer outcomes. We also explored the relationships of patient behaviours with therapeutic alliance and the efficiency and competence of treatment delivery. Audio or video recordings of the initial treatment sessions of 58 patients who had shown either good (n = 34) or poor response (n = 24) to cognitive therapy for PTSD (CT-PTSD, Ehlers & Clark, 2000) were blindly coded for patient perseveration, expression of thoughts and feelings, therapeutic alliance, efficiency and competency of treatment delivery and therapist competence. Poor responders showed more perseveration and less expression of thoughts and feelings in the initial session. Patient perseveration and low expression of thoughts and feelings were associated with poorer therapeutic alliance and compromised treatment delivery. Patients with these behavioural characteristics may benefit from additional treatment strategies. Limitations of the study and implications for clinical practice are discussed.
Objectives:
The constructs optimism, pessimism, hope, treatment credibility and treatment expectancy are associated with outcomes of medical treatment. While these constructs are grounded in different theoretical models, they nonetheless show some conceptual overlap. The purpose of this study was to examine whether currently available measurement instruments for these constructs capture the conceptual differences between these constructs within a treatment setting.
Methods:
Patients undergoing Total Hip and Total Knee Arthroplasty (THA and TKA) (Total N = 361; 182 THA; 179 TKA), completed the Life Orientation Test-Revised for optimism and pessimism, the Hope Scale, the Credibility Expectancy Questionnaire for treatment credibility and treatment expectancy. Confirmatory factor analysis was used to examine whether the instruments measure distinct constructs. Four theory-driven models with one, two, four and five latent factors were evaluated using multiple fit indices and Δχ2 tests, followed by some posthoc models.
Results:
The results of the theory driven confirmatory factor analysis showed that a five factor model in which all constructs loaded on separate factors yielded the most optimal and satisfactory fit. Posthoc, a bifactor model in which (besides the 5 separate factors) a general factor is hypothesized accounting for the commonality of the items showed a significantly better fit than the five factor model. All specific factors, except for the hope factor, showed to explain a substantial amount of variance beyond the general factor.
Conclusion:
Based on our primary analyses we conclude that optimism, pessimism, hope, treatment credibility and treatment expectancy are distinguishable in THA and TKA patients. Postdoc, we determined that all constructs, except hope, showed substantial specific variance, while also sharing some general variance.
Contemporary theories of psychopathology suggest a lack of perceived control as central to the experience of negative emotion and to be particularly relevant to the development of anxiety disorders. The present study meta-analytically reviewed the relationship between perceived control and both trait and disorder-specific measures of anxiety in order to determine whether current evidence is consistent with perceived control functioning as a transdiagnostic vulnerability factor. A comprehensive literature review identified 51 studies with a total of 11,218 participants that were determined to meet eligibility criteria. The mean effect sizes between perceived control and trait measures of anxiety (k = 29) and disorder specific measures of anxiety (k = 37) were calculated using random-effects methods. Results indicated a large, negative association between perceived control and both trait measures of anxiety and disorder-specific measures of anxiety, with the largest associations being between perceived control and generalized anxiety disorder. Moderator analyses indicated that the associations between perceived control and trait anxiety were greater in adults than children, and varied across different measures of perceived control. These results underscore the importance of perceived control as a transdiagnostic vulnerability factor across the anxiety disorders.
Contemporary theories of psychopathology suggest a lack of perceived control as central to the experience
of negative emotion and to be particularly relevant to the development of anxiety disorders. The present study
meta-analytically reviewed the relationship between perceived control and both trait and disorder-specific measures of anxiety in order to determine whether current evidence is consistent with perceived control functioning as a transdiagnostic vulnerability factor. A comprehensive literature review identified 51 studies with a total of 11,218 participants that were determined to meet eligibility criteria. The mean effect sizes between perceived control and trait measures of anxiety (k = 29) and disorder specific measures of anxiety (k = 37) were calculated using random-effects methods. Results indicated a large, negative association between perceived control and both trait measures of anxiety and disorder-specific measures of anxiety,
with the largest associations being between perceived control and generalized anxiety disorder. Moderator analyses indicated that the associations between perceived control and trait anxiety were greater in adults than children, and varied across different measures of perceived control. These results underscore the importance of perceived control as a transdiagnostic vulnerability factor across the anxiety disorders.
Perceived control has been proposed to be a general psychological vulnerability factor that confers an elevated risk for developing anxiety disorders, but there is limited research examining perceived control during cognitive–behavioral therapies (CBT). The present study examined whether treatment resulted in improvements in perceived control, and the indirect effects of CBT on changes in symptoms of obsessive-compulsive disorder, social phobia, generalized anxiety disorder, and panic disorder via changes in perceived control. Participants (n = 606) were a large clinical sample presenting for treatment at an outpatient anxiety disorders clinic. Participants completed a series of self-report questionnaires and a structured clinical interview at an intake evaluation and at two follow-up assessments 12 and 24 months later, with the majority of participants initiating CBT between the first two assessments. Results of latent growth curve models indicated that individuals initiating CBT subsequently reported large increases in perceived control and significant indirect effects of treatment on intraindividual changes in each of the four anxiety disorders examined via intraindividual changes in perceived control. These results suggest that the promotion of more adaptive perceptions of control is associated with recovery from anxiety disorders. Furthermore, the consistent finding of indirect effects across the four anxiety disorders examined underscores the transdiagnostic importance of perceived control in predicting CBT outcomes.
Despite extensive research demonstrating relationships between hope and well being, little work addresses whether hope is malleable. We test a single-session, 90-min intervention to increase college students’ hopeful goal-directed thinking (as defined by Snyder et al. in, Pers Soc Psychol 60:570–585, 1991). To date, this study represents the only test of hope’s malleability in fewer than five sessions and contributes to the small but growing literature regarding positive-psychology interventions. This intervention is especially relevant to college students, given the increasing psychological distress and lack of perceived control noted among this population (Lewinsohn et al. in, J Abnorm Psychol 102:110–120, 1993; Twenge et al. in, Pers Soc Psychol Rev 8:308–319, 2004). Ninety-six participants were assigned to the hope intervention or one of two comparison/control conditions—progressive muscle relaxation or no intervention. Assessment occurred prior to intervention (pre-test), following intervention (post-test), and at one-month follow-up. Participants in the hope intervention showed increases in measures of hope, life purpose, and vocational calling from pre- to post-test relative to control participants. They also reported greater progress on a self-nominated goal at one-month follow-up. Counterintuitively, although hope predicted goal progress, hope did not mediate the relationship between intervention condition and goal progress. Implications of these findings and future directions are discussed.
The present study examined two potential mechanisms of change, hopelessness cognitions and habituation, in a randomized controlled trial of cognitive processing therapy (CPT) and prolonged exposure therapy (PE) for posttraumatic stress disorder (PTSD). Participants were 171 adult women with a current primary diagnosis of sexual assault related PTSD. The potential mechanisms were examined by evaluating the intraindividual change in hopelessness within the course of both treatments and subjective units distress (SUDS) ratings (a proxy for habituation) within the course of PE. The effects of intraindividual change in the proposed mechanisms were then examined on within-treatment changes in PTSD symptoms. Findings indicated that the participants assigned to the CPT treatment had significantly greater pre-post reductions in hopelessness than those assigned to PE and that the changes in hopelessness predicted changes in PTSD symptoms (R
2
= .24). Intraindividual changes in SUDS ratings for participants in the PE treatment condition also predicted changes in PTSD symptoms and did so independently of the effect of changes in hopelessness. Future research should examine these mechanisms using more intensive methods of data collection that would permit the demonstration of temporality of change.
Contemporary theories of hope and optimism provide two explanations for how positive expectancies can shape human behavior and promote well-being. Scheier and Carver's theory of optimism focuses on generalized expectations of positive outcomes, whereas Snyder's hope theory focuses on how evaluations of personal agency can facilitate goal attainment. Although the theoretical distinctions between these constructs have previously been articulated, few studies have jointly examined the two constructs in order to determine unique effects, and some have questioned whether the constructs are truly distinct. This study therefore examines whether hope and optimism (1) are distinct latent constructs, (2) have unique effects on components of flourishing mental health, and (3) differentially relate to the components of flourishing mental health. Confirmatory factor analysis results and a bootstrapped structural equation model indicate that hope and optimism are distinct latent constructs that each uniquely predict a moderate proportion of variance of the components of well-being.
Research exploring nonspecific mechanisms of change is necessary to understand processes that contribute to psychotherapy outcomes. Many veterans diagnosed with posttraumatic stress disorder (PTSD) report a profound sense of hopelessness prior to receiving treatment, and thus one possible nontargeted change mechanism is the enhancement of hope. In this study, 164 veterans diagnosed with PTSD and admitted to a Veteran's Administration residential treatment program received 6 weeks of cognitive processing therapy. Measures of PTSD symptoms, depression and hope were gathered across the course of treatment. Results revealed that higher levels of hope midway through treatment affected reductions in PTSD and depression from mid- to posttreatment (and not the other way around), thus supporting that hope is one nonspecific change mechanism toward symptom reduction. Implications of these findings as they extend to cognitive-behavior therapies as a whole, and to the understanding of how psychological strengths serve as nonspecific change mechanisms in the treatment of PTSD, conclude the article. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Individual differences in self-reported hope assessed before and during treatment were related to outcome markers of therapeutic improvement. Clients were assigned to either a motivational orientation group or a waiting list group. All clients thereafter received 12 weeks of individual therapy. As hypothesized, higher baseline hope was associated with greater client wellbeing, functioning and coping, and regulation of emotional distress and fewer symptoms. High- relative to low-hope clients also reported that the orientation group was significantly more helpful. As hypothesized, agency scores (tapping motivation) from baseline were associated with positive changes in outcome variables early in therapy, and pathways scores (tapping planfulness) from baseline were associated with positive changes in later therapy sessions. The implications of these findings are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Hamilton Anxiety Rating Scale, a widely used clinical interview assessment tool, lacks instructions for administration and clear anchor points for the assignment of severity ratings. We developed a Structured Interview Guide for the Hamilton Anxiety Scale (SIGH-A) and report on a study comparing this version to the traditional form of this scale. Experienced interviewers from three Anxiety Disorders research sites conducted videotaped interviews using both traditional and structured instruments in 89 participants. A subset of the tapes was co-rated by all raters. Participants completed self-report symptom questionnaires. We observed high inter-rater and test-retest reliability using both formats. The structured format produced similar but consistently higher (+ 4.2) scores. Correlation with a self-report measure of overall anxiety was also high and virtually identical for the two versions. We conclude that in settings where extensive training is not practical, the structured scale is an acceptable alternative to the traditional Hamilton Anxiety instrument. Depression and Anxiety 13:166–178, 2001. © 2001 Wiley-Liss, Inc.
A cognitive, two-component model of hope proposed by Snyder and colleagues is reviewed. Hope is defined as the perceived capability to (1) derive pathways to desired goals and (2) motivate oneself via agentic thinking to initiate and sustain movement along those pathways. The roles of these pathways and agency components of hope theory are described along with similarities and differences relative to other motivational and emotional theories, including optimism, self-efficacy, self-esteem, and problem solving. The goal focus, agentic thought, and pathways thought of hope theory are used as a framework for understanding the adaptive processes in the various phases of cognitive-behavior therapies, including relapse prevention. It is concluded that hope theory offers a valuable overarching framework for understanding common factors in behavior therapies.
The present research evaluated the psychometric properties of the credibility/expectancy questionnaire, a quick and easy-to-administer scale for measuring treatment expectancy and rationale credibility for use in clinical outcome studies. The results suggested that this questionnaire derives the two predicted factors (cognitively based credibility and relatively more affectively based expectancy) and that these factors are stable across different populations. Furthermore, the questionnaire demonstrated high internal consistency within each factor and good test–retest reliability. The expectancy factor predicted outcome on some measures, whereas the credibility factor was unrelated to outcome. The questionnaire is appended to the paper, yet the authors stress care when utilizing the scale. During the administration of the questionnaire, the participant sees two sections — one related to thinking and one related to feeling. However, the researcher needs to be aware that the 2 factors derived are not grouped into those questions. Instead credibility was found to be derived from the first three think questions and expectancy was derived from the fourth think question and the two feel questions.
Normed and nonnormed fit indexes are frequently used as adjuncts to chi-square statistics for evaluating the fit of a structural model. A drawback of existing indexes is that they estimate no known population parameters. A new coefficient is proposed to summarize the relative reduction in the noncentrality parameters of two nested models. Two estimators of the coefficient yield new normed (CFI) and nonnormed (FI) fit indexes. CFI avoids the underestimation of fit often noted in small samples for Bentler and Bonett's (1980) normed fit index (NFI). FI is a linear function of Bentler and Bonett's non-normed fit index (NNFI) that avoids the extreme underestimation and overestimation often found in NNFI. Asymptotically, CFI, FI, NFI, and a new index developed by Bollen are equivalent measures of comparative fit, whereas NNFI measures relative fit by comparing noncentrality per degree of freedom. All of the indexes are generalized to permit use of Wald and Lagrange multiplier statistics. An example illustrates the behavior of these indexes under conditions of correct specification and misspecification. The new fit indexes perform very well at all sample sizes.
This article describes a scale measuring dispositional optimism, defined in terms of generalized outcome expectancies. Two preliminary studies assessed the scale's psychometric properties and its relationships with several other instruments. The scale was then used in a longitudinal study of symptom reporting among a group of undergraduates. Specifically, respondents were asked to complete three questionnaires 4 weeks before the end of a semester. Included in the questionnaire battery was the measure of optimism, a measure of private self-consciousness, and a 39-item physical symptom checklist. Subjects completed the same set of questionnaires again on the last day of class. Consistent with predictions, subjects who initially reported being highly optimistic were subsequently less likely to report being bothered by symptoms (even after correcting for initial symptom-report levels) than were subjects who initially reported being less optimistic. This effect tended to be stronger among persons high in private self-consciousness than among those lower in private self-consciousness. Discussion centers on other health related applications of the optimism scale, and the relationships between our theoretical orientation and several related theories.
Defining hope as a cognitive set comprising agency (belief in one's capacity to initiate and sustain actions) and pathways (belief in one's capacity to generate routes) to reach goals, the Hope Scale was developed and validated previously as a dispositional self-report measure of hope (Snyder et al., 1991). The present 4 studies were designed to develop and validate a measure of state hope. The 6-item State Hope Scale is internally consistent and reflects the theorized agency and pathways components. The relationships of the State Hope Scale to other measures demonstrate concurrent and discriminant validity; moreover, the scale is responsive to events in the lives of people as evidenced by data gathered through both correlational and causal designs. The State Hope Scale offers a brief, internally consistent, and valid self-report measure of ongoing goal-directed thinking that may be useful to researchers and applied professionals.
The purpose of this study was to compare cognitive-processing therapy (CPT) with prolonged exposure and a minimal attention condition (MA) for the treatment of posttraumatic stress disorder (PTSD) and depression. One hundred seventy-one female rape victims were randomized into 1 of the 3 conditions, and 121 completed treatment. Participants were assessed with the Clinician-Administered PTSD Scale, the PTSD Symptom Scale, the Structured Clinical Interview for DSM-IV, the Beck Depression Inventory, and the Trauma-Related Guilt Inventory. Independent assessments were made at pretreatment, posttreatment, and 3 and 9 months posttreatment. Analyses indicated that both treatments were highly efficacious and superior to MA. The 2 therapies had similar results except that CPT produced better scores on 2 of 4 guilt subscales.
Significant shifts or discontinuities in symptom course can mark points of transition and reveal important change processes. The authors investigated 2 patterns of change in depression-the rapid early response and a transient period of apparent worsening that the authors call a depression spike. Participants were 29 patients diagnosed with major depressive disorder who enrolled in an open trial of an exposure-based cognitive therapy. Hierarchical linear modeling revealed an overall cubic shape of symptom change and that both the rapid response and spike patterns predicted lower posttreatment depression. Patients wrote weekly narratives about their depression. Early narratives of rapid responders were coded as having more hope than those of nonrapid responders. The narratives of patients with a depression spike had more cognitive-emotional processing during this period of arousal than those without a spike. Findings are discussed in the context of cognitive-emotional processing theories in depression and anxiety disorders.
Designed to be used in conjunction with its companion online patient workbook, this Therapist Guide includes supporting theoretical, historical and research background information, diagnostic descriptions, differential diagnoses, session by session treatment outlines, case examples, sample dialogues, practice assignments, and tailored application to the vast variety of presentations and nuances of the disorder. It contains the 'nuts and bolts' of how to provide the treatment and is a comprehensive resource for therapists. It is an invaluable guide for clinicians in overcoming the barriers and difficulties that are part and parcel of every treatment.
This edition of the Mastery of Your Anxiety and Panic Workbook has been updated to include strategies and techniques for dealing with both panic disorder and agoraphobia. The program outlined is based on the principles of cognitive behavioral therapy (CBT) and is organized by skill, with each chapter building on the one before it. It covers the importance of recordkeeping and monitoring progress, as well as breathing techniques and thinking skills. The main focus of the treatment involves learning how to face agoraphobia situations and the often frightening physical symptoms of panic from an entirely new perspective. Self-assessment quizzes, homework exercises, and interactive forms allow patients to become active participants in treatment and to learn to manage panic attacks, anxiety about panic, and avoidance of panic and agoraphobic situations.
Written for clients, this workbook teaches that social anxiety is a normal part of life, but it can sometimes have a negative impact. The important question is not whether someone experiences social anxiety but to what degree and how often. The term social anxiety disorder describes the distress and interference that comes along with severe social anxiety. Information is presented on the nature of social anxiety, empirically supported cognitive–behavioral techniques used to treat it, how to best implement these techniques, and how to deal with the problems that arise during treatment. The attempt is to offer a complete treatment that is informed by individual case conceptualization within an evidence-based practice framework. This third edition includes case examples that represent diverse clients across race/ethnicity, socioeconomic status, sexual orientation, and gender identity.
This study examines age differences in hope, from age 15 to 80 years, and the short-term stability of hope using longitudinal data collected from 1453 Portuguese participants. Hope levels were higher in the middle adult groups than in the adolescent, emerging adult and older adult groups, and reached a peak between early-middle adulthood (ages 30–45) and late-middle adulthood (ages 46–64). Marital status and educational levels were examined as potential moderators of both hope levels and stability of hope. Results indicated that the most hopeful person may be a married adult between the ages of 30–64. Hope rank-order stability over a 1-year interval was moderate in the middle adolescent and early adult groups, showed a peak stability occurring from 30 to 45 years of age, and was lower in old age than in the younger age groups. Together, these findings suggest that hope is relatively stable across time and the lifespan. Implications for our understanding of developmental trajectories of hope and how best to intervene to promote hope are discussed.
Importance
Transdiagnostic interventions have been developed to address barriers to the dissemination of evidence-based psychological treatments, but only a few preliminary studies have compared these approaches with existing evidence-based psychological treatments.
Objective
To determine whether the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is at least as efficacious as single-disorder protocols (SDPs) in the treatment of anxiety disorders.
Design, Setting, and Participants
From June 23, 2011, to March 5, 2015, a total of 223 patients at an outpatient treatment center with a principal diagnosis of panic disorder with or without agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, or social anxiety disorder were randomly assigned by principal diagnosis to the UP, an SDP, or a waitlist control condition. Patients received up to 16 sessions of the UP or an SDP for 16 to 21 weeks. Outcomes were assessed at baseline, after treatment, and at 6-month follow-up. Analysis in this equivalence trial was based on intention to treat.
Interventions
The UP or SDPs.
Main Outcomes and Measures
Blinded evaluations of principal diagnosis clinical severity rating were used to evaluate an a priori hypothesis of equivalence between the UP and SDPs.
Results
Among the 223 patients (124 women and 99 men; mean [SD] age, 31.1 [11.0] years), 88 were randomized to receive the UP, 91 to receive an SDP, and 44 to the waitlist control condition. Patients were more likely to complete treatment with the UP than with SDPs (odds ratio, 3.11; 95% CI, 1.44-6.74). Both the UP (Cohen d, −0.93; 95% CI, −1.29 to −0.57) and SDPs (Cohen d, −1.08; 95% CI, −1.43 to −0.73) were superior to the waitlist control condition at acute outcome. Reductions in clinical severity rating from baseline to the end of treatment (β, 0.25; 95% CI, −0.26 to 0.75) and from baseline to the 6-month follow-up (β, 0.16; 95% CI, −0.39 to 0.70) indicated statistical equivalence between the UP and SDPs.
Conclusions and Relevance
The UP produces symptom reduction equivalent to criterion standard evidence-based psychological treatments for anxiety disorders with less attrition. Thus, it may be possible to use 1 protocol instead of multiple SDPs to more efficiently treat the most commonly occurring anxiety and depressive disorders.
Trial Registration
clinicaltrials.gov Identifier: NCT01243606
This paper reviews the current status of transdiagnostic mechanisms of change targeted in cognitive-behavioral interventions, with a focus on mechanisms that are also relevant to emotional disorders that frequently co-occur with PTSD. First, an overview of the rationale for and key features of identifying mechanisms of change is presented, with a discussion of why it is crucial to examine mechanisms that are relevant across diagnostic boundaries. A review of the current evidence for five promising transdiagnostic mechanisms (hope, neuroticism, emotion regulation, cognitive reappraisal, and anxiety sensitivity) is then provided. Finally, the implications of the increasing evidence of transdiagnostic mechanisms of change are discussed in relation to recently developed transdiagnostic treatment protocols that provide an alternative treatment approach for PTSD.
Objectives The constructs optimism, pessimism, hope, treatment credibility and treatment expectancy are associated with outcomes of medical treatment. While these constructs are grounded in different theoretical models, they nonetheless show some conceptual overlap. The purpose of this study was to examine whether currently available measurement instruments for these constructs capture the conceptual differences between these constructs within a treatment setting. Methods Patients undergoing Total Hip and Total Knee Arthroplasty (THA and TKA) (Total N = 361; 182 THA; 179 TKA), completed the Life Orientation Test-Revised for optimism and pessimism , the Hope Scale, the Credibility Expectancy Questionnaire for treatment credibility and treatment expectancy. Confirmatory factor analysis was used to examine whether the instruments measure distinct constructs. Four theory-driven models with one, two, four and five latent factors were evaluated using multiple fit indices and Δχ 2 tests, followed by some posthoc models.
The present study examined temporal dependencies of change of panic symptoms and two promising mechanisms of change (self-efficacy and anxiety sensitivity) during an 11-session course of cognitive-behavior therapy (CBT) for Panic Disorder (PD). 361 individuals with a principal diagnosis of PD completed measures of self-efficacy, anxiety sensitivity, and PD symptoms at each session during treatment. Effect size analyses indicated that the greatest changes in anxiety sensitivity occurred early in treatment, whereas the greatest changes in self-efficacy occurred later in treatment. Results of parallel process latent growth curve models indicated that changes in self-efficacy and anxiety sensitivity across treatment uniquely predicted changes in PD symptoms. Bivariate and multivariate latent difference score models indicated, as expected, that changes in anxiety sensitivity and self-efficacy temporally preceded changes in panic symptoms, and that intraindividual changes in anxiety sensitivity and self-efficacy independently predicted subsequent intraindividual changes in panic symptoms. These results provide strong evidence that changes in self-efficacy and anxiety sensitivity during CBT influence subsequent changes in panic symptoms, and that self-efficacy and anxiety sensitivity may therefore be two distinct mechanisms of change of CBT for PD that have their greatest impact at different stages of treatment.
Optimism and hope—two psychological constructs reflecting positive expectations about one’s future—have garnered considerable research attention and each has been the subject of several narrative reviews. In the current meta-analysis, we examined the optimism–hope relationship and we examined several potential correlates and consequences of optimism and hope. Our results suggest that optimism and hope are distinguishable from each other. Furthermore, both are related to several indices of psychological and physical well-being and both are empirically distinguishable from other personality traits, such as the Five Factor Model characteristics and trait affectivity. We conclude by discussing directions for future research on optimism and hope.
Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.
Hope is defined as the perceived capability to derive pathways to desired goals, and motivate oneself via agency thinking to use those pathways. The adult and child hope scales that are derived from hope theory are described. Hope theory is compared to theories of learned optimism, optimism, self-efficacy, and self-esteem. Higher hope consistently is related to better outcomes in academics, athletics, physical health, psychological adjustment, and psychotherapy. Processes that lessen hope in children and adults are reviewed. Using the hope theory definition, no evidence is found for "false" hope. Future research is encouraged in regard to accurately enhancing hope in medical feedback and helping people to pursue those goals for which they are best suited.