Optimism and Health

Optimism is typically defined by psychologists as (1) having a generally positive view of the future, (2) attributing negative life events to factors unlikely to cause problems again, or (3) estimating one’s personal chances of experiencing specific negative outcomes to be low (and positive outcomes high). Traits related to optimism include hardiness (the tendency to appraise stresses as challenges), self-efficacy (a belief in one’s ability to effect positive outcomes), internal locus of control (feeling in control of what happens to oneself), and hope (a belief in one’s ability to achieve goals, combined with planned strategies to achieve those goals). This entry discusses various definitions of optimism, their relation to health, and explanations for this link.

Dispositional Optimism

Dispositional optimism is usually measured by the Life Orientation Test (LOT), which includes items such as, “In uncertain times, I usually expect the best.” Michael Scheier, Charles Carver, and others have shown that dispositional optimists experience relatively better physical health, report fewer illness symptoms, cope more effectively with stress, recover more quickly from surgery, are better able to deal with illness, are less likely to need rehospitalization, and have better survival rates following serious disease. The association between dispositional optimism and these outcomes holds even when taking into account other related traits such as neuroticism, and holds not only for self-reported outcomes, but also for more objective measures of those outcomes. The link has been demonstrated in a wide variety of different samples, including HIV-infected men, adult-daughter caregivers, and patients with head and neck cancer.

Attributional Style

Two methods have been used to measure attributional style. In the Attributional Style Questionnaire (ASQ), participants imagine experiencing a negative event and then report what they would consider to be the major cause. Then they evaluate whether this cause has something to do with them (internal vs. external dimension), whether it affects other personal outcomes (specific vs. global dimension), and whether it can be considered to be a temporary aberration (unstable vs. stable dimension). The second method is to subject written essays to a procedure (Content Analysis of Verbatim Explanations, or CAVE) that assesses each of the foregoing dimensions. When responses in either of these methods suggest an external, specific, and unstable attribution, the person is said to have an optimistic explanatory style. On the other hand, individuals who make internal, global, and stable attributions for negative events are said to have a pessimistic explanatory style, and tend to be more prone to depression. Optimism scores based on explanatory style are positively (though moderately) correlated with scores on the LOT.

Christopher Peterson and Lisa Bossio, in their 1991 book on optimism and health, reviewed several studies linking an optimistic explanatory style with positive health outcomes including general health (based on patient ratings or physician ratings), illness symptoms, illness onset, physician visits, illness susceptibility, immune system functioning, survival times following cancer diagnosis, survival times following heart attack, completion of rehabilitation programs, and longevity. Some work suggests that the globality and stability dimensions may be more important than the internality dimension.

Event-Specific Optimism

The third common method of assessing optimism is to ask people to estimate their chances of experiencing one or more outcomes. Estimates of absolute risk are usually made on verbal scales (e.g., “How likely are you to get cancer”) or numerical scales (e.g., “What is the percentage chance you will get cancer?”). Paul Windchitl and Gary Wells showed that verbal scales are more reliable because of people’s difficulty in working with numbers. Often people are also asked to compare their risk with that of the typical person (comparative risk). Individuals who rate their absolute or comparative risk as low are defined as optimistic.

Nathan Radcliffe and William Klein, among others, found that optimism defined in this way is related to lower actual risk, less anxiety and worry, greater attention to health risk information, higher frequencies of health-promoting behavior, and better coping. Some studies (such as one by Karina Davidson and Kenneth Prkachin) linked such optimism with poorer health practices and less attention to risk information, but often these studies defined optimism based on estimates for a number of different health problems (increasing the chance that some estimates are inaccurate; see next section), or they measured optimism and health at the same time (opening the possibility that optimistic risk estimates reflect rather than cause health behavior). It is possible to be optimistic on one scale and not on another; for example, Isaac Lipkus and his colleagues found that women tend to be pessimistic about their breast cancer risk when measured on an absolute scale, yet optimistic when measured on a comparative scale. Comparative optimism is often not correlated (or only modestly correlated) with dispositional optimism, which may be due to the specificity of comparative optimism to a particular life event.

Importance of Accuracy

Whether optimism promotes good health may depend on whether the beliefs underlying that optimism are accurate. One cannot easily assess the accuracy of a dispositionally optimistic orientation (because it is not based on specific predictions that can be verified), yet it is possible to verify the accuracy of a person attribution for a negative event or that person’s prediction of whether an event will happen. No research has examined the accuracy of attributions (which is not surprising, given that identifying the multiple causes of an event is a largely subjective exercise), yet much work has looked at the accuracy of predictions. As explained in a paper by Alexander Rothman, William Klein, and Neil Weinstein, this research shows that people often (1) overestimate small numerical risks, such as HIV risk, and underestimate large risks, such as the risk of getting divorced; (2) consider the chances of experiencing both high and low risks to be lower than that of the typical person, meaning that many people are unrealistically optimistic because not everyone can have below-average risk; and (3) overestimate the risk of other people experiencing health problems. Whereas people are unrealistically optimistic about their chances of having a health problem, Hart Blanton and his colleagues showed that people are unrealistically pessimistic about how well they would cope with the problem if they experienced it.

The question of whether biased optimistic beliefs are beneficial to health is a controversial one. Some studies show that even when optimistic beliefs are unrealistic, they may lead to the same positive health consequences noted earlier. For example, in a study by Shelley Taylor and colleagues, HIV-seropositive men considered their risk of getting AIDS to be lower than did HIV-seronegative men, a belief that was clearly biased. Yet the seropositive men also were engaging in more health-promoting behavior. On the other hand, a study by Nathan Radcliffe and William Klein showed that people who are unrealistically optimistic are less likely to be taking measures to reduce their (relatively higher) risk, and are less attentive to new risk information. Based on the evidence so far, unrealistic optimism may be particularly beneficial when it is mild, when it concerns a proximal threat, and when it motivates one to achieve the outcomes about which one is optimistic. David Armor and Shelley Taylor reviewed several studies consistent with such a conclusion.

How Does Optimism Promote Health?

Michael Scheier and Charles Carver found that dispositional optimism helps individuals cope with potential stressors, such as by using problem-focused strategies and by persisting in anxiety-provoking situations, which in turn enhances immune functioning and well-being. The trait is also associated with better health habits such as vitamin intake and exercise and nondefensive responses to health threats. People with an optimistic explanatory style seem to exhibit less negative affect and fewer depressive tendencies, possess better levels of social support, respond better to stress, set realistic and reachable goals, persevere at difficult tasks, bounce back well from setbacks, have immune systems that are more responsive to antigens, and have better health habits. In reviewing these possible reasons for the effect of optimism, Christopher Peterson and Lisa Bossio emphasized that no one mechanism is thought to be more powerful than the others—they seem to act together. It is unclear whether optimism exerts most of its influence on the onset or the course of an illness, or both.

Conclusion

The evidence suggests that optimism—defined in various ways—is associated with better physical health, and this link may be attributable to a variety of different factors including better health habits and coping strategies. Despite these findings, optimism still seems to influence health less strongly than family history, past health history, and other traits such as hostility and neuroticism. This is important because anecdotal evidence—such as the story of Norman Cousins, who maintained he cured his cancer by being positive—has a firm place in popular culture. An exaggerated belief in the power of optimism could lead to the blaming of ill people for their condition, and social support centered on “staying positive” might fail to help ill patients cope with their feelings. Nevertheless, the research suggests that programs designed to increase optimism, such as those that help people to attribute negative outcomes to external, specific, and unstable factors, may promote better health. As Christopher Peterson and Lisa Bossio noted, early attempts at this approach have been promising.