Motivation and emotion/Book/2020/Hope therapy

Hope therapy:
What is hope therapy and how can it be applied?

Multimedia presentation (3 min)

Overview

Have you ever felt so optimistic that you feel you can achieve anything you set your mind too? This may have happened when you start exercising to lose weight, or when you start a new job and you feel can make a real impact. This feeling is a sense of hope; and hope can be a state of mind that allows us to strive or achieve want we want (Snyder et al., 2003)

A recent emergence in psychology is the idea of positive psychology; and a key part of this is Hope Therapy. Hope Therapy has been recognised as a potential therapeutic application to aid behaviour change for many different individuals (Duncan et al., 2020). Hope theory was developed by Charles Snyder and explored individuals' strengths and abilities to achieve their goals (Snyder et al., 2003). By understanding and applying the principles of Hope Therapy, individuals can learn to create and accomplish goals which in turn improve their overall well-being.

Focus questions: What is the Hope Therapy? How to measure hope? How can Hope Therapy be used and applied to help people? What is the biological basis of hope? How does Hope Therapy differ from other positive psychology theories?

What is Hope Therapy?

"Hopeful thought reflects the belief that one can find pathways to desired goals and become motivated to use those pathways" (Snyder et al., 2018).

Figure 1. An image of Pandora's box. An Ancient Greek story about hope.

Hope Therapy: The origins

It is important to understand the positive psychology theoretical framework which provides the basis for hope therapy. Positive psychology can be viewed as a collection of therapeutic techniques that seek to enhance an individual's positive virtues and experiences (Christopher et al., 2008). Many different theories and therapies have stemmed from positive psychology, with Hope Therapy being one of those theories. The importance of Hope Therapy is paramount in aiding goal-directed behaviour to create positive behaviour change (Snyder, 2003). By encompassing both the cognition and emotions involved in goal-directed behaviour, individuals are able to feel more optimistic and maintain their changed behaviour (Duncan et al., 2020).

Hope Therapy stems from the idea that hope is a concept that can be manipulated to help an individual achieve their goals (Snyder et al., 2018). Snyder and his colleagues believed this idea about hope was too simplistic. Thus, through further research, they developed an initial theory that explored how hope can affect individual change. This was expanded by Snyder who suggested that the initial hope theory should be viewed as a cognitive motivational model that reflects the strength of hope an individual displays in order to set out and achieve their goals (Lopez et al., 2007). According to this model, hope could be viewed in three components:

1. Hope is shown by an individual in their own perceptions of their capacities to develop a set of goals;
2. An individual's abilities to create strategies to complete their goals; and
3. The individual's ability to continue using their strategies to achieve their goals.

As Hope Theory was developed into a cognitive model, therapeutic application were derived to help individual's increase their hope in order to achieve their goals (Duncan et al., 2020). This therapeutic approach is called Hope Therapy.

How Hope Therapy affects change?

As mentioned above, two key components of hope theory are the strategies an individual uses to reach their goals and the ability to sustain those strategies. This means goal-directed behaviour requires two pathways of thinking (Lopez et al., 2007). The two pathways required are pathway thinking and agency thinking (Duncan et al., 2020).

Pathway thinking is how an individual assesses their resources (e.g. the strategies they can use) and environment to determine if a goal is possible or not (Duncan et al., 2020). Whereas, agency thinking is the motivation one has to complete their goals. Therefore, it can be easier to view pathway thinking as the external influence and agency thinking as our internal influence. Both pathways are essential for achieving goals; as one pathway alone doesn't have the strength to complete the set upon goal (Lopez et al., 2007).

Hope Therapy is based on the idea that humans are goal-driven beings (Duncan et al., 2020). Not all individuals share the same amount of hope. Therefore, Hope Therapy can be used to increase an individual's level of hope in order to increase the likelihood of achieving their goals. This is done by exploring a person's deeper self-perception (Lopez et al., 2007). As an individual strives towards a goal there will be circumstances that hinder their progress. Therefore, Hope Therapy combines other forms of therapies such cognitive-behavioural therapy, solution focused therapy, and narrative therapy which allows change to occur at a cognitive, emotional and solution focused level of thinking (Samavi et al., 2018). Combining aspects of these different therapeutic approaches to Hope Therapy enhances the goal-directed behaviour of the individual (Lopez et al., 2007). Recent research has shown Hope Therapy to be an effective treatment for creating positive behaviour change (Duncan et al., 2020). Further, there has been research to support the use of Hope Therapy as an effective treatment for many mental health and psychological disorders (Samavi et al., 2018).

How to measure hope?

The goal of measuring hope is to determine both a person's level of trait hope and state hope (Snyder et al., 2003). The trait hope test measures an individual’s pathway thinking and agency thinking in terms of how they imagine themselves in different situations. State hope measures how hopeful an individual feels at the moment of taking the test (Snyder et al., 2018). Both are important for understanding an individual's level of hope and ability to reach their desired goals.

Hope measurement tests

Children's Hope Scale: The children's hope scale was developed to measure the trait hope levels of children aged between 7 and 14 (Snyder et al., 2003). It consists of three agency thinking and three pathway thinking questions. This scale has been tested on psychologically healthy children; children with mental disorders; and children suffering from a range health issues making this a valid form of testing.

Hope Scale: This scale was developed to measure trait hope in teenagers from 15 years and older (Snyder et al., 2003). This scale consists of four question regarding agency and pathway thinking. It also contains an extra four questions to validate previous answers.

Herth Hope Scale: This scale was designed to measure different aspects of hope in adults (Morote et al., 2017). This scale measures levels of optimism compared to hopelessness and an individuals social support and agency thinking. This scale is mainly used in Spanish speaking countries but has been adopted to English.

Adult Hope Scale: The Adult Hope Scale (AHS) is designed to measure state hope (Snyder et al., 2018). This questionnaire contains three agency and three pathway related questions.

The different scales for hope all have one very important aspect in common. They have all reported satisfactory levels of validity, test-retest reliability and discriminate validity (Snyder et al., 2018). There have been studies to show these scales produce similar results across time and situations (Snyder et al., 2018). However, there have been some reports of inconsistent results. Due to a lack of therapeutic alliance between client and therapist, or when a researcher is inexperienced with the specific type of scale (Snyder et al., 2003). However, hope measurement scales are generally good predictors of an individual's level of hope.

Applications of Hope Therapy

Angus is an intelligent, 22 year old university student. He is doing very well at university and is a very sociable with a large group of friends. When he was younger he was very active and played many team sports. However, in recent times due to his current academic responsibilities, Angus has become less active and is exercising less. As a result he has put on weight and is facing minor health issues. Angus is aware of how a lack of exercise can be detrimental to his health; but lacks any hope of improving the situation. A friend recommend a hope therapist to Angus to explore ways to set goals that will change his thoughts and behaviour towards exercise.

Lifestyle

A key feature of Hope Therapy and positive psychology is how they can be applied to aid behaviour change in individuals' lifestyles (Duncan et al., 2020). There has been evidence to show that increasing an individual's level of hope can achieve a greater sense of social and academic competence (Lopez et al., 2007). Further, important health benefits can be achieved through Hope Therapy, such as increased exercise. The influence Hope Therapy has on an individual's lifestyle can't be underestimated. A recent study has shown that a majority of deaths in the United States of America are caused by lifestyle associated chronic diseases (Duncan et al., 2020). To combat this issue, Hope Therapy has been applied and seen to be successful in creating positive cognitive change to how individuals approach and achieve their goals. Taking exercise as an example, individuals can feel that losing weight or regularly exercising is an impossible mission. Hope Therapy targets pathway and agency thinking to find ways to incorporate exercise into daily life and improve the chances of maintaining that behaviour (Duncan et al., 2020). Increasing levels of hope about a situation tends to push people to achieve their goals (Gustafsson et al., 2013). Further, more hopeful individual will seek out the positives from situations and tend to thrive when faced with tough circumstances. By incorporating emotional and cognitive change to a situation, individuals can feel more positive about being able to accomplish their goals. Therefore, as health related issues cause a vast amount of deaths across the world having an effective treatment option such as Hope Therapy is of the utmost importance.

Figure 2: An artists interpretation of what depression feels like. It shows a man sitting alone who appears to be falling apart.

Mental health

Alongside Hope Therapy's numerous applications to an individual's health, there has been research to show this approach is an effective treatment for mental health disorders. There are examples of Hope Therapy being used to treat depression, anxiety, suicidal individuals and childhood trauma (Cheavens et al., 2006; Munoz et al., 2019).

The fundamentals behind the effectiveness of Hope Therapy in treating mental disorders is that increased levels of hope are linked with improved stress management, self-esteem, self-efficacy and emotional regulation (Snyder C., 2002). Increasing these aspects for an individual can add more meaning to a person's life; which in turn reduces symptoms of depression and anxiety (Cheavens et al., 2006). Through the process of goal-setting; a client will explore ways to seek out the positives in their lives. (Samavi et al., 2018). Hope Therapy focuses on incorporating positive expectations, a realistic future and allowing the individual's goals to fit into their lifestyle.

A natural progression for Hope Therapy is its application as a treatment for major depressive disorders (Chan et al., 2019). Major depressive disorders can revolve around a sense of hopelessness. Lacoviello and his colleagues (2013) found that a sense of hopelessness can trigger an onset of depression. Further, a sense of hopelessness will lead an individual to limit their goal pursuits and hinder their ability to carry out actions that have successful outcomes. Therefore, a review on Hope Therapy's effectiveness as treatment towards depression was conducted. The results found hope acted as a guard against depression symptoms (Chan et al., 2019). Further, the results show that targeting an individual's agency thinking increased optimism. However, like other therapeutic approaches, Hope Therapy does have limitations. One key limitation Hope Therapy faces is that achieving high levels of optimism can be detrimental if a major setback is experienced. This can negatively impact a person's agency thinking as it may not be able to cope with strenuous external forces (Tong et al., 2010).

Overall, Hope Therapy has emerged as an effective therapy in treating mental disorders. Evolving from a positive psychology approach allows Hope Therapy to focus on adopting a positive outlook on working towards goals. This positive approach has shown significant reductions in anxiety, depression and stress scores for individuals who took part in Hope Therapy (Rahimipour et al., 2015). With further research and application, Hope Therapy could emerge as a staple for many effective treatment methods in treating mental disorders.

The biology of hope

As mentioned earlier hope is a stable trait. This has allowed for the concept of hope to be measured and compared to different areas of the brain. Understanding the biological basis of hope is important for the application of Hope Therapy. It is important because by identifying regions of the brain associated with hope has led to the development of neural training methods that can target these brain regions (Lui et al., 2016). This provides Hope Therapy with the potential to combine both behavioural and neural therapy methods to enhance the effectiveness of creating higher levels of hope.

Figure 3. An image of the prefrontal cortex. A region of the brain that plays an important role in trait hope.

Brain structure	Role	Relevance to Hope Therapy
Prefrontal cortex	Intelligence, initatining motivation, goal-oriented behaviour	Goal-directed behaviour through agency and pathway thinking
Hippocampus	Goal-directed behaviour, episodic memory, and integrating agency and pathway thinking	Allows cohension between agency and pathway thinking. Further, motivates individual to achieve goals
Medial Orbitogrontal cortex (mOFC)	Goal-directed behaviour, decision making and reward values	Maintains goal-directed behaviour through rewards and reinforcements

Prefrontal Cortex

A meta-analysis reviewed f-MRI scans on trait hope and found that there is a strong link between hope and the prefrontal cortex (Wang et al., 2017). This finding can be crucial to the application of Hope Therapy as an individual's level of hope can be a strong guard against disorders such as anxiety (Snyder et al., 2000). The prefrontal cortex is also associated with anxiety and therefore the relationship between hope and the prefrontal cortex could have useful impacts on the application of Hope Therapy.

Two key functions of the prefrontal cortex are problem solving and motivation (Wang et al., 2017). The Hope Therapy models works off the idea that pathway and agency thinking are crucial to reaching our goals. Thus, when the functions of the prefrontal cortex where analysed it was found that that problem solving is associated with pathway thinking and motivation is associated with agency thinking (Wang et al., 2017). Therefore, it was concluded that the prefrontal cortex is crucial to the understanding of hope.

Hippocampus

The hippocampus impacts our goal-directed behaviour; and plays a key role in integrating pathway and agency thinking (Lisman et al., 2017). Further, the hippocampus develops an individual's episodic memory which is crucial to relying the importance of hope and motivation towards pursing goals (McCormick et al., 2018). Damage to the hippocampus affects cognition. This damage would hinder an individual's goal-directed behaviour as they would be unable to develop clear strategies to reach their goals. Further, their goals would become unclear making them harder to achieve (McCormick et al,. 2018). The hippocampus provides an indirect link to hope, but affects the motivation and memories one has of achieving their goals (Lisman et al., 2017).

Medial Orbitofrontal Cortex (mOFC)

As a core component of Hope Therapy is goal-directed behaviour, assessing the medial orbitofrontal cortex is crucial. The main function of the mOFC is related to goal-directed behaviour and decision making (Gourley et al., 2016). As an individual strives towards a goal, the mOFC regulates the value of the rewards they will receive for accomplishing that goal. In other words it decides if that goal is worth the effort (Wang et al., 2017). Research has shown that the mOFC is essential for maintaining proactive goal-directed behaviour through reinforcement (Gourley et al., 2016). This applies to Hope Therapy as the more goals a person achieves the more hopeful they feel and the more their mOFC aids and maintains this goal-directed behaviour. Further, a link has been established between the mOFC and levels of hope as a protection against anxiety disorder symptoms (Wang et al., 2017). This evidence suggests that the neurobiological advantage of Hope Therapy is that it can be used to treat anxiety on a biological level.

This form of research can allow for the implementation of behavioural and neural training methods to further influence Hope Therapy to help treat patients with mental health disorders and improve the well-being of individuals in the general population (Lui et al., 2016).

Quiz

Quiz Time! 1 According to Snyder which form of thinking can be described as our external form of thinking? The agency pathway The linear pathway The central pathway The medial pathway The pathway thinking 2 The prefrontal cortex functions associated with agency and pathway thinking are? Problem Solving and Intelligence Motivation and Problem Solving Motivation and Episodic Memory Spatial Awareness and Intelligence Goal-Directed Behaviour and Spatial Awareness

How Hope Therapy differs from other positive psychology theories?

Figure 4. An image of a man with positive thoughts in his head

For Hope Therapy to be established as a valid psychological theory there was a need for it to be compared to other positive psychology theories. There needs to be enough of a similarity for it to belong to the positive psychology family, but there also needs to be a distinct difference from other theories to justify it's inclusion as a separate framework. Thus, this section compares and contrasts Hope Therapy to other positive psychology theories and frameworks.

Bandura's Self-Efficacy

A major similarity between Hope Therapy and Self-Efficacy is that they are both goal-related theories (Snyder et al., 2003). Self-Efficacy states that an individual must develop a cognitive belief that they can attain a situation specific goal. This is similar to Hope Therapy as Bandura's idea of cognitive thought is well aligned with the idea of pathway thinking. However, a major difference is the inclusion of agency thinking in goal pursuit for Hope Therapy (Duncan et al., 2020). Hope Therapy believes that one form of thinking alone isn't sufficient to allow an individual to reach their goals. Further, Hope Therapy emphasises the variety of situations that an individual may want to achieve goals. Whereas, Self-Efficacy is one dimensional (Snyder et al., 2003).

Another difference lies in how Self-Efficacy ignores the emotional drive for goal-directed behaviour (Snyder et al., 2003). Whereas, Hope Therapy has incorporated emotions as fundamental to achieving your goals. It has also been reported that by incorporating an emotional aspect can influence a person's well-being.

Self-Esteem

The theory of Self-Esteem does influence well-being and is a reliable predictor of improving a person overall well-being (Pepping et al., 2013). Self-Esteem is also a goal-directed theory which emphasises that if a goal is achieved it will enhance a persons self-esteem. Where these two theories differ is in how hope doesn't appear influence esteem and how esteem doesn't influence hope (Snyder et al., 2003). Further, there is evidence to suggest that Hope Therapy affects other positive outcomes and can protect an individual from mental health disorders; whereas, Self-Esteem generally impacts self-esteem alone.

Optimism

Optimism is the idea that an individual will tend to seek out positive outcomes and that the future will be fortunate for them (Duque et al., 2019). The optimism model is a goal-directed approach that similarly to Hope Therapy incorporates a form of cognitive based thoughts (i.e agency and pathway thinking) that can influence behaviour across a variety of situations (Synder et al., 2003). However, the optimism model assumes that individuals are striving towards positive goals in order to avoid negative outcomes. This differs to Hope Therapy as the positive emotional value of the goal is the driving force for the behaviour.

Positive Psychology Theory	Similarities	Differences
Bandura's Self-Efficay	Both goal-directed and contains similar concept as pathway thinking	Hope Therapy Includes an emotional drive, and can influence overall wellbeing
Self-Esteem	Both influence well-being and are both goal-directed theories	Hope doesn't influence esteem and esteem doesn't influence hope
Optimism	Both look to seek out positive goals via goal-directed behaviour and they both incorporate a form of pathway and agency thinking	Optimism assumes individuals are moving away from negative outcomes and it ignores a emotional drive

Conclusion

Synder's original idea of Hope Theory has quickly developed into a well researched and applied therapy style. Working off the idea that humans are constantly striving to achieve goals has provided Hope Therapy with the framework to target an individual's cognitive and emotional way of thinking (Samavi et al., 2018). Improving both the lifestyle and mental health of individuals is a key component that sets Hope Therapy apart from other therapeutic approaches.

With research now focusing on the biological aspects of hope, behavioural and neural methods are being developed to increase the effectiveness of Hope Therapy (Lui et al., 2016). This research has enhanced Hope Therapy's effectiveness in treating mental health disorders ; particularly depression and anxiety. Further researching and a greater understanding of the biological basis of hope can only improve the application of Hope Therapy.

Overall, Hope Therapy allows individuals to gain a sense of control over their goal-directed behaviour. As a form of therapy, hope can act as guard against mental health disorders, improve aspects of your lifestyle and create more meaning in a person's life.

See also

• Hope theory (Book chapter, 2019)
• Hope and emotion (Book chapter, 2018)
• Hope and motivation (Book chapter, 2018)
• Positive Psychology (Wikipedia)

References

Chan, K., Wong, F., & Lee, P. (2019). A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: Feasibility Test. SAGE Open Nursing, 5, 237796081984438. https://doi.org/10.1177/2377960819844381

Cheavens, J., Feldman, D., Gum, A., Michael, S., & Snyder, C. (2006). Hope therapy in a community sample: A pilot investigation. Social Indicators Research, 77(1), 61-78. https://doi.org/10.1007/s11205-005-5553-0

Christopher, J., Richardson, F., & Slife, B. (2008). Thinking through positive psychology. Theory & Psychology, 18(5), 555-561. https://doi.org/10.1177/0959354308093395

Duncan, A., Jaini, P., & Hellman, C. (2020). Positive psychology and hope as lifestyle medicine modalities in the therapeutic encounter: A narrative review. American Journal Of Lifestyle Medicine, 155982762090825. https://doi.org/10.1177/1559827620908255

Duque, L., Brown, L., Celano, C., Healy, B., & Huffman, J. (2019). Is it better to cultivate positive affect or optimism? Predicting improvements in medical adherence following a positive psychology intervention in patients with acute coronary syndrome. General Hospital Psychiatry, 61, 125-129. https://doi.org/10.1016/j.genhosppsych.2019.06.001

Gustafsson, H., Skoog, T., Podlog, L., Lundqvist, C., & Wagnsson, S. (2013). Hope and athlete burnout: stress and affect as mediators. Psychology Of Sport And Exercise, 14(5), 640-649. https://doi.org/10.1016/j.psychsport.2013.03.008

Lacoviello, B., Alloy, L., Abramson, L., Choi, J., & Morgan, J. (2013). Patterns of symptoms onset and remission in episodes of hopelessness depression. Depression And Anxiety, 30(6), 564-573. https://doi.org/10.1002/da.22085

Lisman, J., Buzsáki, G., Eichenbaum, H., Nadel, L., Ranganath, C., & Redish, A. (2017). Viewpoints: How the hippocampus contributes to memory, navigation and cognition. Nature Neuroscience, 20(11), 1434-1447. https://doi.org/10.1038/nn.4661

Lui, S., Zhou, X., Sweeney, J., & Gong, Q. (2016). Psychoradiology: The frontier of neuroimaging in psychiatry. Radiology, 281(2), 357-372. https://doi.org/10.1148/radiol.2016152149

McCormick, C., Ciaramelli, E., De Luca, F., & Maguire, E. (2018). Comparing and contrasting the cognitive effects of hippocampal and ventromedial prefrontal cortex damage: A review of human lesion studies. Neuroscience, 374, 295-318. https://doi.org/10.1016/j.neuroscience.2017.07.066

Munoz, R., Hanks, H., & Hellman, C. (2020). Hope and resilience as distinct contributors to psychological flourishing among childhood trauma survivors. Traumatology, 26(2), 177-184. https://doi.org/10.1037/trm0000224

Pepping, C., O’Donovan, A., & Davis, P. (2013). The positive effects of mindfulness on self-esteem. The Journal Of Positive Psychology, 8(5), 376-386. https://doi.org/10.1080/17439760.2013.807353

Samavi, S., Najarpourian, S., & Javdan, M. (2018). The effectiveness of group hope therapy in labor pain and mental health of pregnant women. Psychological Reports, 122(6), 2063-2073. https://doi.org/10.1177/0033294118798625

Shahgholian, N., Rahimipour, M., & Yazdani, M. (2015). Effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis. Iranian Journal Of Nursing And Midwifery Research, 20(6), 694. https://doi.org/10.4103/1735-9066.170007

Snyder, C. (2002).: Hope theory: Rainbows in the mind. Psychological Inquiry, 13(4), 249-275. https://doi.org/10.1207/s15327965pli1304_01

Snyder, C., Lopez, S., Shorey, H., Rand, K., & Feldman, D. (2003). Hope theory, measurements, and applications to school psychology. School Psychology Quarterly, 18(2), 122-139. https://doi.org/10.1521/scpq.18.2.122.21854

Snyder, C., Feldman, D., Taylor, J., Schroeder, L., & Adams, V. (2000). The roles of hopeful thinking in preventing problems and enhancing strengths. Applied And Preventive Psychology, 9(4), 249-269. https://doi.org/10.1016/s0962-1849(00)80003-7

Tong, E., Fredrickson, B., Chang, W., & Lim, Z. (2010). Re-examining hope: The roles of agency thinking and pathways thinking. Cognition & Emotion, 24(7), 1207-1215. https://doi.org/10.1080/02699930903138865

Wang, S., Xu, X., Zhou, M., Chen, T., Yang, X., Chen, G., & Gong, Q. (2017). Hope and the brain: Trait hope mediates the protective role of medial orbitofrontal cortex spontaneous activity against anxiety. Neuroimage, 157, 439-447. https://doi.org/10.1016/j.neuroimage.2017.05.056

External links

• Ted Talk: Hope through the treatment of depression(YouTube)
• Ted Talk: Prescribing hope(YouTube)
• Hope Theory: Rainbows in the mind (APA Psychnet)
• Ted Talk: Depression, suicide and the power of hope (YouTube)