mental health AIDS

Fall 2004 Newsletter / Volume 6, Issue 1

Tool Box

Gonzalez et al. (2004) studied a convenience sample of 61 men who have sex with men and 29 low-income, primarily ethnic minority women receiving highly active antiretroviral therapy (HAART) and found that better medication adherence was associated with greater perceived social support and with positive states of mind (PSOM)¹ , while higher depression scores were associated with nonadherence. The study showed as well that "PSOM was ... a significant mediator of the relationship between social support and medication adherence. Moreover, the relationship of PSOM to medication adherence was independent of depression, suggesting that PSOM represents more than the absence of depression ... [, and] that social support is related to medication adherence more through positive psychological processes than through negative ones" (p. 417).

How would this mechanism operate? Gonzalez and colleagues reason that "social support, through the stability, predictability, and control that it provides, may facilitate increases in PSOM in the support receiver. These positive factors may provide psychological resources to help HIV+ individuals cope successfully with the stressful aspects of taking HIV medication and may increase motivation to take medication as prescribed. These findings may be useful in the development of intervention strategies aimed at improving medication adherence among HIV+ individuals " (p. 417).

The Big O

While PSOM is a psychological "state" and therefore subject to change, a related positive psychological "trait" is optimism. According to Strassle, McKee, and Plant (1999), optimism "has been found to be negatively correlated with depression, anxiety, anger, perception of daily hassles, physical symptoms, and job burnout, and positively correlated with life satisfaction, positive physical and mental health, lower frequencies of mental disorder, and self-esteem ..." (pp. 191-192). With so many health advantages associated with optimism , "the ability to induce optimism in pessimistic individuals could have powerful implications for the mental and physical functioning of people managing the ongoing stress of a chronic illness" (Mann, 2001, p. 26).

In contemplating this prospect, it must be noted that there are two major theoretical models of optimism in the field: explanatory style optimism, which attributes negative events to external factors and relegates them to particular times or particular circumstances, and dispositional optimism, characterized by a general expectation of positive outcomes (Tomakowsky, Lumley, Markowitz, & Frank, 2001). "At this point, we know very little about how to either increase dispositional optimism, or decrease dispositional pessimism – and certainly many dispositional theorists would be pessimistic about change at this level" (Norem & Chang, 2001, p. 350). Nevertheless, some investigators have begun to explore ways of altering how people think about the future in an effort to modify this seemingly stable personality trait of dispositional optimism (Mann, 2001; see also sidebar).

Too Much of Good Thing?

Mann (2001) randomly assigned a racially- and ethnically-diverse sample of 40 low-income women living with HIV/AIDS and taking combination therapy to one of two conditions: writing about a "positive" future or not writing at all. Participants in the writing condition were instructed to write for a minimum of ten minutes twice weekly over a four-week period. These women received the following instructions:

You should write about a future in which you only have to take one pill each day for your HIV. When you sit down to write in the journal, I want you to think very hard about that future. What will that future be like? In what ways will that time be different than now? Think very hard about that future time, which is probably not so very far off. And then write about that time. Every day you can write about different aspect of that time. Or you can even repeat things if you need to. The important thing is that when you sit down for your ten minutes of writing, you should think for a little while about that time, so that it is clear in your head and fresh in your mind. And then write. (p. 27)

Among the women who scored low on a measure of optimism ², the writing intervention was associated with an increase in optimism, a trend toward increased medication adherence (based on self-report), and a reduction in distress from medication side effects in comparisons made with women who did not write. Importantly, the opposite effects were found among women who scored high on the optimism measure prior to writing about a positive future. Thus, Mann concludes that "dispositional optimism can be altered in a small but meaningful way" (p. 31) and that "a future-oriented writing intervention may be a promising technique to increase medication adherence and decrease symptom distress in pessimistic individuals [italics added]" (p. 26).

Not So Fast

Continued research on increasing optimism is clearly required. In the meantime, interventions must be conducted thoughtfully and, as Mann's research illustrates, assessment of baseline optimism, as well as a host of other variables, is critical.

Norem and Chang (2001) identify several key contexts to consider in understanding how optimism and pessimism serve the individual and contribute to emotional and behavioral outcomes. These include: the type of optimism/pessimism; their interface with other aspects of personality; the outcome variables being considered; and the specific interpersonal, social, cultural, and developmental contexts that serve as background for thoughts, feelings, and behavior. As an example, "defensive pessimists" (i.e., people with low expectations who engage in extensive reflection on all possible outcomes) perform better if allowed to maintain low expectations and to reflect prior to initiating a task. Research suggests that anxiety increases and performance is impaired if the reflective process is disrupted.

References

Gonzalez, J.S., Penedo, F.J., Antoni, M.H., Durán, R.E., Fernandez, M.I., McPherson-Baker, S., Ironson, G., Klimas, N.G., Fletcher, M.A., & Schneiderman, N. (2004). Social support, positive states of mind, and HIV treatment adherence in men and women living with HIV/AIDS. Health Psychology, 23 (4), 413-418.

Mann, T. (2001). Effects of future writing and optimism on health behaviors in HIV-infected women. Annals of Behavioral Medicine, 23 (1), 26-33.

Norem, J.K., & Chang, E.C. (2001). A very full glass: Adding complexity to our thinking about the implications and applications of optimism and pessimism research. In E.C. Chang (Ed.), Optimism & pessimism: Implications for theory, research, and practice (pp. 347-367). Washington , DC : American Psychological Association.

Pretzer, J.L., & Walsh , C.A. (2001). Optimism, pessimism, and psychotherapy: Implications for clinical practice. In E.C. Chang (Ed.), Optimism & pessimism: Implications for theory, research, and practice (pp. 321-346). Washington , DC : American Psychological Association.

Riskind, J.H., Sarampote, C.S., & Mercier, M.A. (1996). For every malady a sovereign cure: Optimism training. Journal of Cognitive Psychotherapy, 10 (2), 105-117.

Scheier, M.F., & Carver, C.S. (1985). Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychology, 4 (3), 219-247.

Strassle, C.G., McKee, E.A., & Plant, D.D. (1999). Optimism as an indicator of psychological health: Using psychological assessment wisely. Journal of Personality Assessment, 72 (2), 190-199.

Tomakowsky, J., Lumley, M.A., Markowitz, N., & Frank, C. (2001). Optimistic explanatory style and dispositional optimism in HIV-infected men. Journal of Psychosomatic Research, 51 (4), 577-587.

- Compiled by Abraham Feingold, Psy.D.

¹ "As a construct, PSOM is related to positive mood but is conceptually broader as it also includes one's ability to attain and appreciate positive experiences related to general well-being" (Gonzalez et al., 2004, p. 414).

² The Life Orientation Test (LOT; Scheier & Carver, 1985) was used to assess dispositional optimism in the form of generalized positive outcome expectancies. A 1994 revision of this instrument may be found at: http://www.psy.miami.edu/faculty/ccarver/sclLOT-R.html.

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