Examining Hope as a Transdiagnostic Mechanism of Change Across Anxiety Disorders and CBT Treatment Protocols (2019), Gallagher et al.

James Morris-Lent

James Morris-Lent

Senior Member (Voting Rights)
Examining Hope as a Transdiagnostic Mechanism of Change Across Anxiety Disorders and CBT Treatment Protocols
Matthew W.Gallagher Laura J.Long AngelaRichardson Johann D’Souza James F.Boswell Todd J.Farchione David H.Barlow
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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.
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Oh man.

sci-hub:
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https://sci-hub.tw/https://www.sciencedirect.com/science/article/abs/pii/S0005789419300681

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University of Houston press release
http://www.uh.edu/news-events/stories/2019/october-2019/101419-hope-anxiety-gallagher.php
 
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I struggle with the whole first sentence about what they think hope is and how they tie it into personal goal setting.
More about tying it into CBT framework, swapping these negative thoughts for hopeful ones?

There are some extraordinary people who are able to hold onto a sense of hope, who have absolutely no control over their environment, or freedom to pursue personal goals and cannot change that by positive thoughts: people with terminal illness, prisoners of conscience, people in concentration camps, war zones and refugees.


and surprise, surprise people were more hopeful soon after they could talk to someone rather than being in a waiting list.
 
Hope - the idea that things will change and change for the better - is directly in contrast to much human experience. To use CBT to get people to believe things will change for the better in the face of all evidence and without giving them anything which will help that hope to be realised seems the height of unethical behaviour.
 
Since when is hope (or hopefulness) defined as "a trait that represents the capacity to identify strategies or pathways to achieve goals and the motivation or agency to effectively pursue those pathways" ? There must be a more accurate word to describe the construct that they're trying to measure.
 
The "Adult State Hope Scale" used:

https://booksite.elsevier.com/9780123745170/Chapter 3/Chapter_3_Worksheet_3.5.pdf

_________________________
6 questions on a 1-8 scale
(Definitely False | Mostly False | Somewhat False | Slightly False | Slightly True | Somewhat True | Mostly True | Definitely True)

1. If I should find myself in a jam, I could think of many ways to get out of it
2. At the present time, I am energetically pursuing my goals
3. There are lots of ways around any problem that I am facing now
4. Right now, I see myself as being pretty successful
5. I can think of many ways to reach my current goals
6. At this time, I am meeting the goals that I have set for myself

_________________________

Honestly this seems like a comically poor representation of hope.

Hope is 'do you feel that the future will be good?' or whatever.
 
If we're considering this as a way to monitor and assess ME/CFS patients it makes no sense at all, but the paper refers to anxiety disorders so... for me it makes sense.I think CBT can be really useful for anxiety. I've only ever experienced minor anxiety in the past (eg. around the time of starting a new job) and never had a panic attack or anything serious. It does make sense that when people's anxiety improves, they become more hopeful. Real hope in my experience is not goal orientated but more of a general feeling of wellness and feeling generally good about what the future might bring and one's ability to cope with whatever it will bring. When you feel more robust, you feel more hopeful.
 
Trish said:
Sounds like Medieval religion...

I've deleted the rest of this post, as it broke the no religion rule...
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@Trish, I went there too.

One could self talk and say, my life is awful, but I hope for a better time later, muuuch later...



Hope as defined in the Pocket Oxford English Dictionary:" 1 a feeling of expectation and desire for something to happen. 2 a person or thing that gives cause for hope." Etc.

Meaning 2 seems circular - a person who gives hope so they are hope?

Maybe as in "He/she is the hope of the nation."

I note that point 1 is not saying one is hoping for something good to happen, just something to happen.

My significant other's input here: the BPS crowd hope they can keep getting government money to do this "research".




Cheshire said:
Isn't hope a major component of all the therapies that are based on a kind of "coué method" ? And we've known since the 19th century it doesn't last.
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I think you are right, @Cheshire, hope is involved in BPS therapies. But I would extend this to most if not all therapies. I've been very hopeful about some physiological therapies, especially after seeing objective tests that indicated problems that could have potential remedies.
 
@James Morris-Lent That Hope Scale is farcical. As if every problem that people face, whether they are sick or well, has loads of solutions and we just have to be clever enough to figure them all out and make a choice between the options.

Anyone who has read many of my serious posts will be surprised to learn that I am, at heart, an optimist. I have been training myself over most of my adult life to be a pessimist though, because my optimistic hopes have been dashed so many times that it is less mentally damaging for me to have no hope about many things and then to be pleased when or if my pessimism turns out to be misplaced.
 
James Morris-Lent said:
1. If I should find myself in a jam, I could think of many ways to get out of it
2. At the present time, I am energetically pursuing my goals
3. There are lots of ways around any problem that I am facing now
4. Right now, I see myself as being pretty successful
5. I can think of many ways to reach my current goals
6. At this time, I am meeting the goals that I have set for myself
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These criteria do sound a bit strange but remember: they are designed for people with ANXIETY not ME.

People with anxiety often see themselves as needing to reach impossibly high standards imposed on them by others. They develop very black and white thinking around this - ie 'either I achieve perfection or I am a failure'. This can lead to paralysing inertia. Bearing this in mind, these criteria do make a bit more sense - ie. if somebody sees themselves as 'pretty successful' it means that they have gone beyond that black and white binary of perfection or failure. If they are actively pursuing goals it may mean they've loosened up and relaxed and no longer paralysed by the fear of failure. If they are able to set goals for themselves, it may mean that they are no longer terrified by what they perceive to be other's unattainable expectations - and that they have intrinsic rather than extrinsic motivation. Similarly, if they can see that there are many way to approach a problem, they are probably more open to different possibilities rather than fixating on there being only one way and being afraid of not managing it. Creatively responding to problems is healthy and is something that anxiety can prevent.

I agree that CBT shouldn't be used to convince people who have severe social/physical impediments that everything is ok. It shouldn't be used to persuade people that they need to solve their own problems regardless of how realistic that is. And it shouldn't be used to suggest that cognitions and behaviour are the sole cause of every illness. BUT for those people for whom anxiety is the key issue, it can be very helpful. I personally don't want to criticize every aspect of CBT just because it has been used wrongly for ME, there are so many people with mental health issues these days who can really benefit from it.

[edited for grammar - tired!]
 
I'm not sure how one can define hope as a general thing. People typically hope for specific things or at least within strict constraints. Some people hope for the end of the world, others for a promotion so they stick it to Jim from accounting. I would assume most serial killers are hoping for that one easy victim to cross their path.

No idea how people think they can measure or distinguish hope for beneficial things from hoping for bad things. Or to quantify it in any meaningful way.

Psychology is seriously resembling more and more like religion over time. So much woo and cheap aphorisms.
 
'Hope' as a concept seems too abstract. Also, it seems rooted in superstition, such as hoping someone gets better from a fatal illness or some such. It's akin to praying. Goes against pragmatism, which, is more valuable because it's more realistic.

'Hope' as a concept seems idealistic, juvenile.

I would posit that wishing (aka hoping) is usually employed for something that is not going to happen.
Or 'weak hope' is knowing that something is likely to occur, and therefore one is really positive about that happening.

I'd prefer 'thinking positively' about a situation, rather than employing 'hope.' Less emotion, and more thinking involved.

I agree that psychology has run out of good ideas.
 
Hope 'n Change? Ah believe that term is taken. (very short pause, then) Ah can loan you that phrase, now do you have any young ladies whose, ahh, pain ah can feel?
 
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