SF: The Hope TherapyDr Jen Unwin

BSc, MSc, PsyD, CPsychol, AFBPsSSouthport & Ormskirk NHS Trust

j.unwin@nhs.net

“HOPE is what makes us strong. It is why we are here. It is what we fight with when all else is lost.” - Pandora

Overview

• The importance of hope• The placebo effect = hope• Can we define and measure

hope?• What kinds of hope make a

difference?• Solution focused brief therapy

and hope• What next?

Positive Psychology: Hope as a major component of wellbeing and adjustment to adversity-Seligman

Wellbeing: High hope individuals have higher wellbeing and self reported ‘health’ (synonymous?)

Morbidity: High hope individuals are less likely to get ill and more likely to cope well if they do-Snyder 2002

Mortality: High hope people live longer-happy nun Study A million anecdotes-’The Anatomy of Hope: how people

prevail in the face of Illness’ Dr J Groopman 2009

The Importance being Hopeful

A prospective study of positive adjustment in N= 99 lower limb amputation patients over 6 months Including variables previously suggested to relate to

outcome in cross sectional studies (type and cause of amputation, age, gender, disability, social support, coping style)

Hope at the start of rehabilitation was the only variable to explain significant variance in positive mood outcomes 6 months after lower limb amputation

Unwin, Kacperek & Clarke (2009)

Levine et al (1981)The percentage of post-op patients who reported pain relief followingPlacebo (39%)4 mg morphine (36%)

Kahn et al (2008)79% of placebo responders in anti-depressant trials do not relapseKaptchuk et al (2013)Open label placebos work for IBS patients-no deception needed!

The Placebo EffectLatin: placēbō, "I shall please"

Dr Frank developed his understanding that all psychotherapies make effective use of certain common principles, including a healing rationale, hope, mastery, and a caring therapeutic relationship

Frank (1975)The perception that one can reach desired goals Snyder (2002)The belief that one can find pathways to desired goals and the agency (motivation) to use those pathways Scioli (2009)Four Linked Sub-networks : mastery, attachment, survival, spirituality

Can we define Hope?

On line cross sectional questionnaire study of N=207 university staff and students

Measures of goal focused hope, spiritual hope, satisfaction with life and positive affect

Goal focused hope and spiritual hope are not correlated.

Goal focused hope is an independent predictor of wellbeing but spiritual hope is not.

Spiritual hope has a buffering effect when goal focused hope is low.

Unwin & Dickson (2010)Goal focused hope, spiritual hope and wellbeing

Hope SF

Desired Goals

Agency thinking

Pathways thinking

Iterative

SF & Hope

The Living Well ProjectA co-constructed wellbeing course for patients with long-term health conditions, facilitated by patient tutorsFive sessions based on SF principlesUncovering each person’s:Desired wellbeing goalsStrengths and resources (agency)Weekly small steps (pathways)

Can an SF intervention increase Hope?

  N Mean Sig

Hope 1 

30 28.17 >.01Hope 2 

30 33.75

Positive mood 1 

27 33.37 >.01

Positive mood 2 

27 35.15

Subjective Wellbeing 1

28 4.83 >.01Subjective Wellbeing 2

28 6.73

Living Well pilot data

Hope is central to human flourishing Hope is about a confidence that one can reach one’s

desired future Solution focused therapy concentrates on enhancing

the research-identified key cognitive components of hope

Much more research to be done-which therapies are best at enhancing hope, does wellbeing improvement mirror rising hope? How can we maximise hope enhancement in our work?

Should we re-name SFBT ‘Hope Therapy’?

Conclusions

Billington, Simpson, Unwin, Bray, & Giles (2008). Does hope predict adjustment to end-stage renal failure and consequent dialysis? British Journal of Health Psychology, 13, 4, 683-700.

Frank & Frank (1993). Persuasion & Healing. JHU Press. Scioli & Biller (2009). Hope in the Age of Anxiety. OUP. Snyder (2002). Hope Theory: Rainbows in the mind.

Psychological Inquiry 13(4): 249-275. Unwin & Dickson (2010). Goal focused hope, spiritual hope and

well-being. Social Scientific Study of Religion, 21, 161-174. Unwin, Kacperek, & Clark (2009). A prospective study of

positive adjustment to lower limb amputation. Clinical Rehabilitation, 23, 1044-1050.

References and Resources