Optimism, Resilience, and Depression

A prospective, multidimensional study

By Peter Bongiorno, ND, LAc

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Reference

Kleiman EM, Chiara AM, Liu RT, Jager-Hyman SG, Choi JY, Alloy LB. Optimism and well-being: a prospective multi-method and multi-dimensional examination of optimism as a resilience factor following the occurrence of stressful life events. Cogn Emot. 2017;31(2):269-283.

Design

Prospective multimethod and multidimensional examination employing the principal components analysis (PCA) with subsequent evaluation via the confirmatory factor analysis (CFA) tool

Participants

The study volunteers (N=464) were undergraduate college students enrolled in introductory psychology classes. Seventy-six percent were female, with an average age of 19.5 years. The composition of the sample was as follows: 43% Caucasian, 34% African American, 12% Asian American, 3% Hispanic, and 7% other. A subset (n=96) of the original sample was invited for the prospective phase of the study. In this phase, participants were 82% female, composed as follows: 39% Caucasian, 36% African American, 10% Asian American, 4% Hispanic, and 10% other.

Study Parameters Assessed

The following study parameters were used:

  1. Beck Hopelessness Scale (BHS)—20-item self-reported measure of hopelessness, a main symptom of depressed emotion; total scores range from 0 to 20, with the lower scores revealing less pessimism.
  2. Revised Life Orientation Test (LOT-R)—10-item questionnaire designed to identify differences in a participant’s generalized optimism vs pessimism.
  3. Cognitive Style Questionnaire (CSQ)—suggests hypothetical scenarios to help evaluate the participant’s sense of self following a positive or negative life event.
  4. Event Questionnaire (EQ)—poses hypothetical events that each participant can rate as likely to happen to them in real life. Higher scores for positive events and lower scores for negative ones are taken to reflect biases each person employs to look at their own life.

Primary Outcome Measures

The primary outcome measures include the Beck Depression Inventory (BDI), which is a 21-item self-report measure of depression symptomatology over the past 2 weeks, and the Beck Anxiety Inventory (BAI), which is a 21-item self-report measure of symptoms of anxiety. In addition, the Expanded Schedule for Affective Disorders and Schizophrenia-Change interview (exp-SADS-C) was used to evaluate a psychopathological situation for appropriate DSM-IV diagnoses.

Key Findings

The study found optimism to be a multifaceted construct and identified 4 dimensions of optimism: positive expectations (PEs), inferential style (IS), sense of invulnerability (SI), and overconfidence (O). Different dimensions of optimism were found to have different effects on well-being. PE lessened the effects of stressful events on depressive symptoms and was associated with fewer depressive episodes. SI moderated the effects of stress on anxiety symptoms.

Practice Implications

Optimism is, in general, anathema to depression. It is not likely that a person who is generally optimistic is depressed.

Given this, it is important to consider the aspects of optimism, which this study attempts to elucidate for us. Overall, this study does show us that optimism is not purely just “thinking positively,” but instead, as the authors describe it, optimism is truly “a multifaceted construct,” and each facet can have different effects on mood.

In their introduction, the authors offer reasons they think this study would be useful. They explain that a limitation of past research on optimism is that most studies have a single measure of optimism, even though it is a multidimensional concept. The authors also criticize past work for relying too much on self-reporting, because self-reports are subject to each volunteer’s own subjective or idiosyncratic sensibilities. Study interviews are used in this study. These are scales that attempt to equalize this effect among participants and avoid participant bias. Finally, the authors critique past work that has primarily focused on the relationship of optimism only to depression, and not to other conditions (eg, anxiety).

Overall, this study does show us that optimism is not purely just ‘thinking positively,’ but instead, as the authors describe it, optimism is truly ‘a multifaceted construct,’ and each facet can have different effects on mood.

Understandably, the relationship found in this study between optimism and psychological and physical health outcomes appears complex, with marked differences worth noting among what the authors call the 4 “optimism dimensions”:

Positive expectations (PEs)

PEs explain the view that one’s future will be positive and that one’s general situation or character is overall in a better position than another person’s would be, given the same situation. In this study, the authors revealed that those with PEs had, as expected, a reduced risk for onset of major depression as well as lower levels of depressive symptoms, even after controlling for initial depressive episodes and symptoms, respectively. PE was the dimension most consistently associated with lower depression symptoms and lower risk for major depressive disorder, corroborating past research in both adults and children. This study also found that PEs can buffer the negative effects of high life stress levels on depressive symptoms.

Inferential style (IS)

A person with an optimistic IS is predisposed to see positive events as the default situation, and negative events as temporary anomalies. In other words, he expects good things to occur normally. In contrast, pessimistic people see negative events as the default. In this study, the authors were surprised that the IS dimension did not predict depression (which they suspected might be due to the underpowered setup of this particular study).

Sense of invulnerability (SI)

A person with SI expects negative outcomes to occur more often to others than to themselves. In this study, the presence of SI was associated with decreased risk for anxiety symptoms, even in the presence of high life stress. Interestingly, and surprisingly to the authors, this dimension also seemed to confer greater risk for physical health symptom complaints (not less risk).

Overconfidence (O)

Overconfidence is the inclination to consider one’s abilities and traits better than they really are, and often better than other people’s. Overconfidence did show correlation with anxiety and depression, but these did not predict changes in physical maladies.

So, does optimism really prevent and lessen both psychological and physical illness? And, as healthcare practitioners, how can we best use a patient’s optimism to support his or her healthcare goals?

In short, when it comes to depression, a person who thinks about herself as inherently protected (not vulnerable) and thinks about the world as generally a good place tends to be happier, have less depression, and better able to weather periods of high stress effectively. It stands to reason that these are attributes that can use enhancement for depression-prone patients. This study showed an association among these constructs of optimism with reduced risk for onset of major depression and lower levels of depressive symptoms.

It also needs to be noted that those who believe themselves to be more invincible are more likely to endure physical complaints, possibly because they really don’t think something bad will happen to them. This makes sense; if you are the kind of person that doesn’t think it can happen to you, you tend not to be preventive about things (you don’t check your blood pressure, you continue to smoke). These patients may need more education regarding the vulnerability of everyone to disease, and how good healthcare can prevent adverse outcomes. Of course, we have to watch which patients we expose to this rhetoric, since such emphasis on possible adverse outcomes can exacerbate the anxiety of an already anxious patient. While optimism has clear advantages, appropriate “pessimism” may also confer protections by motivating patients to seek health-promoting behaviors and care.

Also of interest, the authors suggest that positivity begets positivity. In this line of thinking, optimism not only buffers the effects of life stress on health outcomes, but it might also increase the likelihood of future positive events while lessening the occurrence of negative ones, in a manner akin to a self-fulfilling prophecy.

In the author’s words, this fascinating study “finds partial support for prospective relationships between different conceptualizations and mental and physical health outcomes.” While this is not a groundbreaking statement, it does confirm what we seemed to already know.

Limitations

The final number of participants included in the prospective phase was 96, while the original sample size was 464. Because of the small sample size, the authors dubbed these prospective findings as “exploratory” and in need of replication, which is a fair statement.

Perhaps most disappointing, this small prospective sample did not allow a better examination of the relationship between optimism dimensions and clinically significant anxiety. The authors noted that prior studies focused only on depression; unfortunately, this study discussed factors that affected depression. Given that 18% of the population deals with some form of anxiety, elucidating the relationship between optimism and anxiety further would have been helpful. Also, the majority of the participants were female, which may suggest that the findings may not apply to men as readily.

About the Author

Peter Bongiorno, ND, LAc, is President of the New York Association of Naturopathic Physicians and has private practices in New York. Peter trained at Bastyr University and researched at Yale University and the National Institutes of Health before medical school. He authored How Come They’re Happy and I’m Not? The Complete Natural Guide to Healing Depression for Good (Red Wheel) and the practitioner-guide Holistic Therapies for Anxiety and Depression (WW Norton). His upcoming book Put Anxiety Behind You: The Complete Drug-Free Program was released at the end of 2015. Visit drpeterbongiorno.com, www.3UNeed.com, InnerSourceHealth.com and join him on twitter @drbongiorno for naturopathic mental health updates.