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date: 24 January 2018

Hope and Depression

Abstract and Keywords

This chapter examines the relationship between hopeful thinking and major depressive disorder. Hope is a positive psychology construct that comprises goals, agency thinking, and pathways thinking and has been associated with psychological and physical well-being and psychosocial outcomes. Depression is inversely correlated with hope and is characterized by a host of symptoms and psychological correlates, including feelings of sadness, negative self-talk, amotivation, and difficulties in problem-solving and concentrating. This chapter explores the empirical evidence regarding the relationship between hope and depression, including the relationship between the subcomponents of hope (i.e., pathways and agency thinking) and the biological (e.g., neural reward systems) and cognitive (e.g., executive functioning) correlates of depression. In addition, the evidence for hope as a viable route for remediating depressive symptoms is reviewed, and future directions are proposed.

Keywords: hope, depression, goals, pathways thinking, agency thinking, positive psychology

Major depressive disorder (MDD) is a highly prevalent mental disorder and a serious public health problem that is strongly correlated with substantial psychosocial impairment. Prevalence data show that approximately 18.8 million adults in the United States (i.e., 9.5% of the entire adult population) suffer from depression in a given year (Beck & Alford, 2009). Globally, the World Health Organization estimates that 350 million people are affected by depression, and depression is now the leading cause of disability worldwide (World Health Organization, 2015). A substantial number of depressed individuals do not receive treatment; current estimates suggest that between a third and half of depressed individuals in developed nations are untreated, and upwards of 76% of depressed individuals in less developed countries receive treatment (Lépine & Briley, 2011).

Depression is characterized by negative mood (e.g., sadness), anhedonia, negative self-concept, self-punitive wishes, feelings of guilt or worthlessness, hopelessness, changes in sleep or eating patterns, and changes in activity level (Beck & Alford, 2009). In addition, depression is a major risk factor for both attempted and completed suicide (Qin & Nordentoft, 2005). Depression is associated with a host of impairments in learning, memory, and cognition; for example, individuals with MDD tend to show generally negative biases in their thinking style (Alloy & Abramson, 1999; Alloy et al., 1999, 2000, 2006; Blackburn, Jones, & Lewin, 1986), greater deficits in learning and episodic memory (McDermott & Ebmeier, 2009), greater negative bias in memory (Joormann, Teachman, & Gotlib, 2009; Williams et al., 2007), a greater tendency toward a ruminative thinking style (Nolen-Hoeksema & Morrow, 1991; Thomsen, 2006), and greater difficulty shifting their attention between tasks (Murphy et al., 1999). Together, these symptoms are relevant to the relationship between hope and depression, which we explore in this chapter.

A number of theories have been proposed to characterize the experience of depression (for a review, (p. 210) see Ritschel, Gillespie, Arnarson, & Craighead, 2013), most of which can be categorized as behavioral, cognitive, or biological. In general, these theories have not only articulated a hypothesis about the etiology of depression but also have formulated the bases for developing targeted treatments for depression. For example, behavioral theorists propose that depression results from the cycle created from an insufficient reinforcement system and increasing levels of behavioral withdrawal. By extension, behavioral therapies target avoidant behaviors and are designed to help depressed individuals more readily come into contact with environmental rewards. Similarly, biological theorists propose that depression results from deficiencies or alterations in functioning of various aspects of the central nervous system (e.g., the serotinergic system), and biological interventions for depression are designed to remediate these deficiencies.

For the purposes of the present discussion, cognitive conceptualizations of depression are most relevant, as hope is generally thought of as a cognitive construct (but see Cheavens & Ritschel [2014] for a discussion of whether hope is better characterized as a cognition or an emotion). Broadly speaking, cognitive theorists propose that distorted cognitions (e.g., “I’ll never pass this test”; “She’s canceling dinner plans because she doesn’t like me”) and unhealthy schemas or basic beliefs about the self (e.g., “I’m unloveable”; “I’m powerless”) are the cornerstone of the depressive experience (Beck, Rush, Shaw, & Emery, 1979). By extension, cognitive therapy was designed to help patients identify and modify these distorted thoughts and beliefs about themselves as the primary route to improving depression (Beck, 1995). Several cognitive constructs are relevant to the relationship between depression and hope. In the next section, we explore the links between helplessness, hopelessness, and depression, as these constructs set the stage for a framework for thinking about the relationship between specific aspects of depression and how they relate to hope theory.

The Helplessness and Hopelessness Theories of Depression

As a robust literature has shown, depression is intricately related to the constructs of helplessness and hopelessness. In the 1970s, Seligman (1975) proposed the learned helplessness theory of depression (see also Peterson & Seligman, 1993), in which they hypothesized that individuals become depressed because they see their personal situations as futile and they see themselves as incapable of bringing about desired change. Seligman proposed that individuals who are prone to depression are those whose attributional styles (i.e., the way a person explains a situation to him- or herself) are global, stable, and internal; that is, depressed people tend to view themselves negatively across situations (global), believe that their situation and inability to overcome situations will not change (stable), and believe that they are the cause of their aversive situation (internal). Numerous studies support this theory across a range of populations. In a meta-analysis of 104 studies involving nearly 15,000 adult participants, Sweeney, Anderson, and Bailey (1986) found that this attributional style was reliably and significantly linked to depression. The same results have been found in youth samples; Gladstone and Kaslow (1995) conducted a meta-analysis of 28 studies involving 7,500 children and adolescents and found a significant relationship between depression and internal, stable, and global attributions about negative outcomes.

In the 1980s, Abramson and colleagues (1989) reformulated the learned helplessness theory of depression and renamed it the hopelessness theory of depression. According to this theory, individuals with a negative cognitive style are more vulnerable to the development of depressive symptoms when faced with negative life events. More specifically, hopelessness depression is a subtype of depression wherein hopelessness is “an expectation that highly desired outcomes will not occur or that highly aversive outcomes will occur coupled with an expectation that no response in one’s repertoire will change the likelihood of occurrence” (Abramson et al., 1989, p. 359). Abramson and colleagues proposed that hopelessness is a proximal and sufficient cause (rather than a symptom) of depression. In addition, they placed a greater emphasis on the importance of the outcome to the individual (i.e., negative outcomes in events that are not important to the individual are not likely to lead to depression) and to the inferences people draw about the causes and consequences of negative events. A number of studies have provided support for the hopelessness theory of depression in both adult and youth samples (see Hankin, Abramson, & Siler, 2001; Liu & Alloy, 2010).

Although these theories have their differences, they share several key elements that are relevant to the relationship between hope and depression. First, the empirical data borne out of studies of helplessness and hopelessness support the notion that depression is associated with negative outcomes of (p. 211) life events, particularly when the outcome is important to the person. Second, merely the perception or expectation of a negative outcome is sufficient for a negative mood induction. In other words, the way a person talks to him- or herself about real or imagined outcomes is critical—perhaps even more so than the actual situations or outcomes themselves. Third, depressed people have a difficult time generating ways to change the negative outcome that they wish to avoid, instead perceiving that the outcome is a foregone conclusion. As we discuss in the next section, each of these three elements map directly onto the hope construct.

Hope Theory

Hope theory is a cognitive construct comprising three distinct yet interrelated components: goals, pathways thinking, and agency thinking (see Geraghty, Wood, & Hyland [2010] for an analysis of the distinction between the components of hope). According to Snyder’s model (Snyder et al., 1991), goals are the mental end points of all purpose-driven behavior. Goals may be approach- or avoidance-oriented; that is, one can have a goal to move toward a particular outcome that is not currently in place (e.g., a promotion at work), or one can have a goal to move away from an aversive outcome or status (e.g., to quit smoking). Goals can differ in their degree of difficulty, ranging from the easily attainable (e.g., going outside once a day) to the nigh impossible (e.g., winning an Olympic medal). Six distinct goal domains have been articulated: social relationships (e.g., friendships), romantic relationships, family life, academics, work, and leisure activities. In comparison to low hopers, high hopers tend to have a greater number of goals across a number of these domains, set approach rather than avoidance goals, and set goals that are just slightly out of reach, rather than being too easy or completely unattainable (Averill, Catlin, & Chon, 1990; Snyder et al., 1991).

Pathways thinking is the ability to develop routes or strategies to achieve goals. Although only one pathway is technically required for goal attainment, people often encounter obstacles as they pursue their goals and must generate a new pathway. As a first step in this process, people must first accurately perceive that they have encountered a goal blockage. Next, they must be able to correctly evaluate whether a new route is needed; if so, they must be able to generate a new route, disengage from the previous route, and continue their goal pursuit. Early studies of hope theory demonstrated that high hopers tend to be able to generate multiple routes to getting what they want. In addition, they tend to be better than low hopers at mobilizing a secondary route if the primary route is blocked (Irving, Snyder, & Crowson, 1998; Snyder et al., 1991).

Agency thinking comprises the motivational aspect of the hope construct; it is the self-talk that individuals engage in as they work toward their goals. Agency thinking, which overlaps with Bandura’s (1982) concept of self-efficacy, reflects a person’s belief about his or her ability to be successful and to reach goals. Higher hope individuals tend to engage in positive, self-referential agency thinking (e.g., “I can do it”) and to be able to remain positive in their self-talk when they encounter a goal blockage (Irving et al., 1998). Moreover, they gravitate to positive statements and examples of self-talk more generally. In a series of studies conducted by Snyder, LaPointe, Crowson, and Early (1998), participants were given the choice of listening to prerecorded messages that were either positively or negatively valenced in general (Study 1) or that contained messages of successful versus unsuccessful goal pursuit (Study 2). As compared to low hopers, high hopers preferred the audiotapes containing positive and successful messages.

Hope can be conceptualized as both a state and a trait variable. Snyder (2002) posited that people’s goal-related learning history is particularly relevant to their trait hope and approach to goal pursuits; that is, a person with a history of successful goal pursuits is more likely to have higher dispositional hope, generally positive affect, and an approach to goals that is marked by curiosity, openness, and enthusiasm. Conversely, a person with a history of unsuccessful goal pursuits is more likely to have lower levels of dispositional hope, poorer affect, and an approach to goals that is marked by doubtfulness, disinterest, or hopelessness. At a trait level, individuals who are considered “high hopers” are those who set numerous goals across multiple life domains and who demonstrate high levels of both agency and pathways thinking. Trait level hope is associated with general life satisfaction and overall well-being. By comparison, state hope describes positive affect as it occurs in a more concentrated time span; however, Mascaro and Rosen (2005) found that state hope and meaning in life (i.e., a trait variable) were positively correlated as well.

A robust literature has demonstrated that hope and emotion are closely related (for a review, see Cheavens & Ritschel, 2014). Three points bear mentioning for the current discussion. First, goal (p. 212) attainment is associated with increases in positive affect, whereas goal blockage or failure is associated with increases in negative affect (Jones, Papadakis, Orr, & Strauman, 2013). In fact, Snyder and colleagues (1991) proposed that merely the perception of goal stagnation or failure is sufficient to prompt negative affect. Moreover, higher hope has been shown to relate not only to better short-term positive affect (i.e., a state variable) but also to better subjective and psychological well-being more generally (i.e., a trait variable). That is, over the long term, repeated goal successes or failures appear to be related to more consistent positive or negative moods, respectively. Second, hope appears to be a protective factor in the face of life stressors (e.g., environmental or health-related stressors). For example, in a sample of survivors of Hurricane Katrina, higher hope was protective against posttraumatic stress disorder, and hope moderated the relationship between avoidant coping and psychological distress (Glass, Flory, Hankin, Kloos, & Turecki, 2009). Third, hope has been shown to be inversely correlated with a number of measures of psychopathology (Snyder et al., 1991), including major depression.

Depressive Symptomatology: Relevance to Hope Theory

Depression is characterized by a host of symptoms and psychological correlates, including pervasive feelings of sadness, anergia, negative self-talk, amotivation, and difficulties in problem-solving and concentrating. Conceptually, all nine of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition; American Psychiatric Association, 2013) criteria for MDD can be conceptualized through the lens of hope theory (see Cheavens, 2000; Snyder, 1994). In fact, the depression literature shows that many individuals can point to some sort of triggering event (real or perceived) that preceded the onset of their depression. Viewed through the lens of hope theory, these triggering events can be conceptualized as goal blockages. For example, losing an important relationship is a common trigger for depression. Such a loss could be considered a blockage for a person who has a goal of having a happy, successful marriage. Alternatively, being passed over for a promotion at work could be considered a blockage for a person who has a goal of climbing the corporate ladder. In theory, the blockage of a particularly important goal or numerous blockages that occur across a range of goals could produce more pervasive feelings of sadness, worthlessness, or even suicidality. Because the three components of hopeful thinking are interrelated (Snyder et al., 1996), the emotion that results from a goal blockage is likely to impact a person’s agency and pathways thinking negatively as well. As feelings of sadness become more pervasive in the context of major depression, people generally experience reductions in their motivation and energy to pursue goals. Both of these symptoms are theoretically linked to agency thinking. Specifically, when individuals are depressed and lose interest in activities they typically enjoy, or when they experience reductions in the psychological or physical energy needed to sustain movement toward goals, it makes sense that their motivation to engage in goal pursuit decreases accordingly.

The research literature on depression and its behavioral and biological correlates supports the theoretical relationship between the components of hopeful thinking and depressive symptomatology. With regard to the relationship between goal pursuit and emotion, numerous studies have shown that depression is associated with a disruption of reward systems in the brain (Forbes, 2009; Naranjo, Tremblay, & Busto, 2001; Russo & Nestler, 2013). Studies using functional magnetic resonance imaging have found an association between depression and hypoactivation of the promotion system, which results in reduced enjoyment in trying to complete approach goals and a reduction in reward sensitivity even when goals are achieved (Klenk, Strauman, & Higgins, 2011).

With regard to agency thinking, reductions in interest (i.e., anhedonia), energy, and motivation are cardinal symptoms of major depression, and plentiful evidence has demonstrated that depression is associated with these symptoms (Watson, Clark, & Carey, 1988; Clark & Watson, 1991). In comparison to their nondepressed peers, depressed individuals show evidence of reductions on measures of the behavioral activation system, which is an approach-based positive reinforcement system; conversely, depressed individuals show increases in measures of the behavioral inhibition system, which is associated with avoidance behaviors and threat sensitivity (Kasch, Rottenberg, Arnow, & Gotlib, 2002; Pinto-Meza et al., 2006; Vergara & Roberts, 2011). Depressed individuals also have strong tendencies to engage in negative self-talk (Blackburn, Jones, & Lewin, 1986; Olinger, Kuiper, & Shaw, 1987; Weissman & Beck, 1978); in fact, cognitive behavioral therapy (CBT), which is the most well-studied treatment for major depression, is based on (p. 213) the premise that changing this negative self-talk is effective in treating depression (Beck, Rush, Shaw, & Emery, 1979).

Depression is also characterized by numerous cognitive deficits, including impaired executive functioning and slower processing speed (Snyder, 2013). These symptoms can be theoretically linked to pathways thinking, which requires an individual to follow a stepwise plan to achieve a goal. Executive functioning is defined as “higher-level cognitive processes, which control and regulate lower-level processes (e.g., perception, motor responses) to effortfully guide behavior towards a goal, especially in non-routine situations” (Snyder, 2013, p. 81). In a recent meta-analysis, Snyder reported that patients with major depression show significant impairments across a range of neuropsychological tests of executive functioning and that these results hold even after controlling for the processing speed deficits that also are a hallmark of depression. Of particular relevance to the current discussion, results showed that depressed patients have greater difficulties than healthy controls with shifting (i.e., the ability to flexibly move back and forth between tasks), inhibition (i.e., the ability to override an immediate response, which is critical to one’s ability to think before acting), updating (i.e., the ongoing monitoring, adding, and subtracting of items in one’s working memory), and planning (which includes the ability to formulate goals, identify a sequence of steps for goal achievement, and monitor progress toward goals). Clearly, deficits in these skill domains are related to pathways thinking and one’s ability to devise alternate routes in the face of goal blockage.

Empirical Studies of the Relationship Between Hope and Depression

Numerous studies have demonstrated an inverse relationship between hope and depression (for a review, see Alacron, Bowling, & Khazon, 2013). To date, this relationship has been examined in college students (e.g., Chang & DeSimone, 2001; Feldman & Snyder, 2005; Geiger & Kwon, 2010; Mathew, Dunning, Coats, & Whelan, 2014), individuals who have suffered a traumatic injury (Elliot, Witty, Herick, & Hoffman, 1991; Peleg, Barak, Harel, Rochberg, & Hoofien, 2009; Strom & Kosciulek, 2007), individuals with chronic illness (Lynch, Kroenck, & Denney, 2001), middle school students (Ashby, Dickson, Gnilka, & Noble, 2011), parents of children with intellectual disabilities and chronic illnesses (Lloyd & Hastings, 2009; Venning, Eliott, Whitford, & Honnor, 2007), spouses of individuals with obsessive-compulsive disorder (Geffken et al., 2003), and general community samples (Chang, Yu, & Hirsch, 2013).

Research to date indicates that the strength of the relationship between hope and depression varies as a function of both time and symptom intensity. Thimm and colleagues (2013) found that currently depressed individuals have lower levels of hope than both previously depressed individuals whose symptoms are in remission and individuals who have never experienced depression. Furthermore, previously depressed individuals in remission had lower levels of hope than never depressed individuals. In a multiwave longitudinal study conducted with college students, Arnau and colleagues (2007) found that higher levels of hope (and, specifically, the agency component of hope) predicted lower depression scores at one-month follow-up. In addition, they found that depression was unrelated to later levels of hope, suggesting that hope may be a trait variable that is unaffected by the occurrence of major depressive episodes. Given that this study was conducted with a sample of college students (rather than a sample of clinically depressed individuals), further research on this question is needed.

Some studies have found important distinctions between depressed and nondepressed individuals regarding goal pursuit. Dickson, Moberly, and Kinderman (2011) compared depressed individuals to a sample of people who had never experienced depression and found that depressed individuals generate just as many goals as their peers but tend to be more pessimistic about the possibility that they will achieve their goals. In addition, the depressed group felt that they had significantly less control over the outcome of their goal pursuit compared to controls. Depressed individuals also tend to create less specific goals and generate less specific reasons for why a goal was or was not accomplished (Dickson & Moberly, 2013), and they report lower intrinsic motivation for approach goals (Winch, Moberly, & Dickson, 2015). Depressed individuals also are more likely than nondepressed individuals to seek out situations and pursue goals that will lead to increased experiences of sadness (Millgram, Joormann, Huppert, & Tamir, 2015). Finally, conflicting evidence has emerged on the topic of whether the number and type of goals set is impacted by depression; some studies have found that depressed individuals do not differ from nondepressed individuals in terms of the number of approach and avoidance goals they set (Dickson & Moberly, 2013; Dickson, Moberly, & Kinderman, (p. 214) 2011); however, other studies have found that depressed individuals generate more avoidance goals than nondepressed individuals (Vergara & Roberts, 2011). Given the correlation between low hope and depression, it should be noted that these findings are counterintuitive vis à vis early studies by Snyder and colleagues (1991), in which they reported that low hopers generate fewer goals than high hopers (note, however, that the low hopers in those studies did not meet full criteria for major depression).

Several studies have examined hope as a moderator or mediator between risk factors for or correlates of depression and depressive symptomology. For example, Hirsch, Sirois, and Lyness (2011) found that hope moderates the relationship between functional impairment (i.e., difficulty performing daily activities due to physical illness) and depression in older adults, even after controlling for illness burden and cognitive status. In another study, Hirsch, Visser, Chang, and Jeglic (2012) found that hope moderates the relationship between depression and suicidal ideation in Caucasian and Latino college students; results showed that hope did not moderate this relationship in African American students.

A robust literature has demonstrated that both rumination and perfectionism are significant risk factors for depression, both in terms of depression severity (Donaldson & Lam, 2004) and likelihood of relapse or recurrence (Michalak, Hölz, & Teismann, 2011). Rumination is the tendency to think perseveratively about one’s problems or symptoms in a passive way that does not involve active problem-solving and is a well-known risk factor for the development, maintenance, and recurrence of major depression (for a review, see Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008). Rumination is tightly related to other depressive constructs, such as negative cognitive style, neuroticism, pessimism, perfectionism, and hopelessness, although studies have shown that rumination is an independent construct that is strongly correlated with depression even after controlling for all of these variables. The tendency to ruminate has been shown to exacerbate depressed mood and is predictive of elevated levels of depressive symptoms (Just & Alloy, 1997; Morrow & Nolen-Hoeksema, 1990; Papageorgiou & Wells, 2003).

Recent studies have shown that hope moderates the relationship between rumination and depression. In a sample of college students, Geiger and Kwon (2010) found that individuals with high hope experienced lower levels of depression in the presence of high rumination compared to individuals with low hope. Hope was not found to impact the relationship between rumination and depression at low levels of rumination. Building on these findings, Tucker and colleagues (2013) found that both hope and optimism moderate the relationship between rumination and suicidal ideation, even after controlling for depressive symptomatology. In a sample of Chinese college students, Sun and colleagues (2014) found that rumination was not a significant factor in depressive severity for students in the high-hope group; conversely, students in the low-hope group with high levels of rumination endorsed more significant levels of depression. In fact, Sun and colleagues propose that rumination may differ fundamentally in high-hope individuals than in low-hope individuals in that high hopers may be able to leverage perseverative thought to mobilize their own problem-solving abilities.

Perfectionism is another construct that is strongly related to major depression. Trait perfectionism creates a greater vulnerability for depression and can worsen symptoms of depression (Enns & Cox, 1999; Hewitt & Flett, 1990; Hewitt, Flett, & Ediger, 1996). Studies examining the impact of hope on the relationship between perfectionism and depression found that high levels of maladaptive perfectionism increase depression except in the presence of high levels of hope in both middle school students (Ashby et al., 2011) and college students (Mathew et al., 2014). More specifically, Mathew and colleagues found that while agency and pathways thinking both mediated the relationship between perfectionism and depression, pathways thinking had a larger impact on maladaptive perfectionism and depression and agency thinking had a larger impact on adaptive perfectionism and depression.

Hope also has been studied as a protective factor against the emergence of depression in the wake of negative or stressful life events (see Cheavens & Ritschel, 2014). Studies have found that high hope reduces levels of depression when experiencing mild or moderate life events (e.g., failing an exam, time-limited illness) or serious life events (e.g., severe physical disabilities, traumatic brain injury) in both college students and general adult populations (Elliot et al., 1991; Peleg et al., 2009; Visser, Loess, Jeglic, & Hirsch, 2013). More specifically, hope has been shown to serve a protective effect against depressive symptoms for individuals who have suffered a stroke (Gum et al., 2006), been diagnosed with end-stage renal failure (Billington, Simpson, Unwin, Bray, & Giles, 2008), experienced low to moderate levels of peer victimization (Cooley & (p. 215) Ritschel, 2012), and recently given birth (Thio & Elliott, 2005). Two particularly interesting findings have emerged from this research. First, high levels of pathways thinking after a physically-disabling event is correlated with lower levels of depression independent of time, whereas high levels of agency thinking as a protective factor diminishes as more time passes after the life event (Elliot et al., 1991). That is, positive self-talk as it relates to goal attainment appears to be less effective for the prevention of depression following serious physical injury than is the ability to derive multiple routes to goal attainment. Second, compared to high levels of optimism, high hope is a greater predictor of lower levels of depression following serious physical disability (Chang et al., 2013; Peleg et al., 2009).

Hope-Based Interventions

Several hope-based interventions have been developed, and results have demonstrated that hopeful thinking can be taught (Berg, Snyder, & Hamilton, 2008; Cheavens, Feldman, Gum, Michael, & Snyder, 2006; Curry, Maniar, Sondag, & Sandstedt, 1999; Klausner et al., 1998; Rolo & Gould, 2007). Improvements in hope have been shown to be associated with improvements on a range of different outcomes, including life satisfaction, academic achievement, and self-worth (Davidson, Feldman, & Margalit, 2012; Marques, Lopez, & Pais-Ribeiro, 2011). The majority of these interventions were designed to improve hopeful thought in individuals without identified psychopathology (e.g., athletes, students). To our knowledge, only two studies have investigated changes in depression following a hope-based intervention. Klausner and colleagues examined a hope-building intervention conducted in group format with older adults with major depression. Patients were randomized to either the hope group or a reminiscence group and were treated for 11 weeks. Results showed that patients in the hope group demonstrated significant increases in overall hope scores and had significant reductions in depression, hopelessness, anxiety, and disability over the course of treatment.

In a second study, Cheavens and colleagues (2006) investigated the effects of a hope-building intervention that was delivered over eight weeks in a group setting to individuals without psychopathology. The intervention was not designed to target depression; however, over half of the sample (n = 32 treatment completers) met criteria for a psychiatric diagnosis, with depression and anxiety scores in the clinically significant range on relevant measures. Participants were randomized to either the hope group or a wait-list control. Compared to the control condition, results showed that participants in the hope group had greater reductions in anxiety and increases in self-esteem, meaning in life, and agency thinking. In addition, results showed trends toward significant increases in overall hope scores and decreases in depressive symptoms (p = .07). These findings are noteworthy given that the original intent of the study was to evaluate whether hopeful thinking could be taught in the absence of psychopathology and thus did not include any materials specific to depression or anxiety; the results suggest that hope-based interventions that directly target depression may be even more effective in ameliorating depressive symptoms.

A confluence of factors would suggest that a hope-based intervention developed explicitly for the treatment of depression makes sound theoretical sense. First, as we have reviewed in this chapter, the hope literature shows that hope and depression are inversely correlated, that hopeful thinking can be taught, and that improvements in hope appear to be related to reductions in depressive symptoms. Second, a type of treatment for depression called problem-solving therapy (PST; Nezu, Nezu, & Perri, 1989) has been shown to be effective in the treatment of depression (Bell & D’Zurilla, 2009). The underlying principles of PST map onto the tenets of pathways thinking: the focus of the treatment is on helping patients develop more adaptive problem-solving skills as well as more adaptive attitudes toward problem-solving. Third, CBT (Beck, Rush, Shaw, & Emery, 1979) is perhaps the most well-known and well-studied treatment for depression. The underlying principles of CBT map onto the tenets of agency thinking: CBT focuses on helping patients identify distorted cognitions and learn to talk to themselves in healthier, more effective ways. Thus, empirically supported treatments exist that focus on helping patients develop routes to solving their problems as well as more effective ways to talk to themselves. The benefit of developing a novel treatment is that a hope-based intervention would (a) tie together the principles of both PST and CBT, (b) include an explicit focus on goals and goal development across a variety of life domains, (c) help patients develop future-oriented goals and thinking skills, and (d) focus on building strengths rather than focusing more exclusively on a patient’s weaknesses or deficits, as is typically the case in treatments for psychological disorders (see Seligman, 2002).

(p. 216) Conclusion

An ample literature shows that depression is strongly related to each of the three components of hopeful thinking. Difficulties with goal-setting and attainment have been shown to precede the onset of major depression, and negative emotions also have been shown to follow goal blockage; thus, goals and emotions are cyclically linked and appear to have reciprocal influences on one another. In addition, depressed individuals have difficulty generating routes to goals, rerouting in the face of goal blockage, and talking to themselves in ways that promote positive movement toward goals. By extension, hope theory offers a lens through which to view the onset and maintenance of depression. Recent studies suggest that hope theory may offer a novel route for the treatment of depressive symptoms. The hope construct as a treatment strategy theoretically fuses existing empirically supported treatments for depression into a cogent package that could help compensate for deficits in executive functioning and enable depressed individuals to re-engage with pleasant activities and pursue their goals in a value-consistent way. Individuals suffering from major depression would very likely benefit from help in setting a more diverse set of goals across a range of life domains, improving their ability to generate multiple viable pathways to goal attainment, and improving their self-talk as it specifically occurs in the context of goal pursuit and goal blockage. A focus on hopeful thought as an intervention strategy would serve a dual benefit: ameliorating the symptoms of depression (i.e., decreasing sadness) as well as bolstering well-being and meaning in life (i.e., improving happiness).

Future Directions

  • Can a hope-based intervention that directly targets depressive symptoms be developed and tested with a clinical population? Does such an intervention remediate depressive symptoms?

  • What is the impact of a hope-based intervention on preventing relapse in major depression? Does hope confer a protective advantage?

  • What is the long-term relationship between hope and depression? Do additional depressive episodes erode hope over time?

  • Does hope moderate the relationship between clinically significant depression and known cognitive correlates of depression, such as executive functioning?

  • In trials of existing treatments for depression (e.g., CBT, antidepressant medication), does baseline hope predict outcomes in depressed individuals? That is, are higher hope individuals more likely to be classified as treatment responders?


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