Having studied hope for many years, in 2006 I contacted Susan McNeil, director of AIDS Services for the Monadnock Region (ASMR) in New Hampshire to see if she and her agency were interesting in a collaborative study. I had spent almost ten years developing a new theory of hope as well as a new questionnaire to measure this complex but vital emotion. I proposed that we investigate whether hope, as assessed with this new tool, might be associated with self-report measures of health, and even more importantly, to immune functioning.
Fortunately, Susan was more than willing to help. In fact, she was thrilled at the prospect of tracking the hope levels of her clients, and exploring the potential impact on their emotional and physical wellbeing.
In February of 2006 we gave 16 clients at ASMR a packet of questionnaires, including the hope measure, several health questions as well as several other questionnaires. Because some wonder (erroneously) if hope is equivalent to denial, I asked a case manager, blind to the other data (hope, health, etc.) to rate each client on a scale of 1 to 5, with 1 being the least in denial about their illness and 5 being the most in denial. I also asked the case manager to rate each client on a similar 1-5 commitment scale, where 1 meant the client was not committed to managing their illness and 5 meant the client was totally committed. We also tracked the number of doses of HIV medication clients were taking and conversely, how many doses there were missing.
At the start of the study, and then again at 8 months and 24 months we also recorded CD4 blood levels. CD4 is an immune system cell. Sometimes called a "master cell", it helps to regulate other cells in the immune systems, and is thus considered one of the most important biological markers to monitor in someone affected with HIV.
We found that higher hope scores were associated with a stronger commitment to manage one's illness and lower perceived denial (again, as rated by the case manager).
Those with higher hope scores reported greater overall health, greater satisfaction with their physical abilities, and a higher energy level. These are important findings but one can always questions the validity of self-reports. Fortunately, we also had the biological data, the CD4 values.
We found that higher hope scores were correlated with higher CD4 values at the start of the study. This is nice but still not a good enough finding because one could question if a higher CD4 value is impacting hope or vice versa. So then we looked at hope scores taken at the start of the study in relation to CD4 levels obtained 8 months later and 24 months later. Again we found a positive and statistically significant relationship.
Still not satisfied, we did a final series of analysis to assess the robustness of our findings. At the start of the study we had given a measure of neuroticism. We also recorded how long they had the disease, and monitored how many doses they were taking or missing.
We re-ran our statistics, looking at the correlation between hope and CD4 values, after mathematically extracting any potential confounding role that might be played by a neurotic personality disposition, level of drug compliance, or years with HIV. And the results were virtually the same, higher hope scores were still associated with higher levels of CD4.
To put these findings in context, consider that the low hope clients, on average, never achieved a CD4 level of 600 (the lower end of normal) while the high hope clients never went below 600. When we take into account the size of the statistical relationship, it suggested that nearly 40 percent of the variability in immune functioning was associated with hope scores.
A final caveat: The kind of hope of which I write, research, and promote, is not a passive, magical panacea. My "hope" is not to be confused with wishful thinking or denial. My hope is an active, empowered, open, connected, liberated emotion. This kind of hope is more complex, and requires a greater investment to cultivate, but the rewards will be real, tangible, and possibly even life-altering. (It is noteworthy that the higher hope individuals in our study also missed fewer doses. Another indication of the active, engaged hope of which I write.)
Note: I reported these findings in my recent book, Hope in the Age of Anxiety (see below). However, given that today is World AIDS Day is seemed relevant and appropriate to include it for this blog.
Dr. Anthony Scioli is a leading authority on the topic of hope. He is the author of Hope in the Age of Anxiety (September 2009, Oxford University Press), and has another forthcoming book, The Power of Hope, that will be published by Health Communications Inc. (February, 2010). He is professor of clinical psychology at Keene State College as well as a member of the graduate faculty at the University of Rhode Island. Dr. Scioli has served on the editorial board of the Journal of Positive Psychology and currently serves on the editorial board of the new APA journal, Psychology of Religion and Spirituality.