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SF Therapy: How Hope Can Make Us Strong
- 1. SF: The Hope Therapy Dr Jen Unwin BSc, MSc, PsyD, CPsychol, AFBPsS Southport & Ormskirk NHS Trust j.unwin@nhs.net
- 2. “HOPE is what makes us strong. It is why we are here. It is what we fight with when all else is lost.” - Pandora
- 3. 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?
- 4. 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
- 5. 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)
- 6. Levine et al (1981) The percentage of post-op patients who reported pain relief following Placebo (39%) 4 mg morphine (36%) Kahn et al (2008) 79% of placebo responders in anti-depressant trials do not relapse Kaptchuk et al (2013) Open label placebos work for IBS patients-no deception needed! The Placebo Effect Latin: placēbō, "I shall please"
- 7. 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
- 8. 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?
- 9. 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
- 10. Hope SF Desired Goals Agency thinking Pathways thinking Iterative SF & Hope
- 11. The Living Well Project A co-constructed wellbeing course for patients with long-term health conditions, facilitated by patient tutors Five sessions based on SF principles Uncovering each person’s: Desired wellbeing goals Strengths and resources (agency) Weekly small steps (pathways) Can an SF intervention increase Hope?
- 12. N Mean Sig Hope 1 30 28.17 >.01 Hope 2 30 33.75 Positive mood 1 27 33.37 >.01 Positive mood 2 27 35.15 Subjective Wellbeing 1 28 4.83 >.01 Subjective Wellbeing 2 28 6.73 Living Well pilot data
- 13. 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
- 14. 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
Editor's Notes
- I’m a clinical Psychologist who works in health settings some of you may have come across my colleagues Dominic Bray, Vicky Bliss & Suzi CurtisWe work with people in health settings who have mislaid their hope
- A belief that things will get better ‘a light at the end of the tunnel’ is all it takes. But what about when hope is gone? 30% of people in hospital are depressed. This is a well established finding. We have focused much research on studying hopelessness. Working in an acute hospital I was struck by the amazing resilience of people in the worst circumstances. 70% - the majority are not depressed they are hope..fulOne chap found himself more hopeful after loosing his arm in an explosion-ask me later. This paper is an attempt to summarise some of my thinking from the last 8 or so years on the topic of hope and why I believe that solution focused therapy is THE hope therapy.
- I shall be discussingThe importance of hope-no one would disagree but what is the evidence?I’m going to may a slight excursion into the topic of the placebo effectThe attempts for much finer minds than mine to define and measure hope (dad!)What kinds of hope make a difference to wellbeing?How do hope research findings map on to SFBT?Where next?
- Cross sectional study with a student and Dominic demonstrating the importance of hope in adjustment to renal diseaseMy own first study-seemed important not to do a cross sectional study and to have adequate powerSo it seems that hope is pretty important it getting us through challenging experiences.
- Another way that we can study the important effects of hope is through placebo research. In placebo trials the effect is HOPE. A belief that things will get better. As most of you know the effect can be very large indeed. And can also be long lasting. In meta analyses has been shown to have a genuine lasting effect in pain conditions. Patients randomized to the open-label placebo group were given a typical prescription medicine bottle of placebo pills with a label clearly marked “placebo pills” “take 2 pills twice daily.” They were told that other people had benefitted in placebo trials.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3008733/
- Of course this relates above all to psychotherapies. There is no medicine. There is only hope. And there is also nothing new under the sun. We know that all the major types of therapy are effective to some extent. Jerome Frank (a psychiatrist) devoted his career to understanding what made effective helping and the placebo effect. His book was published in 1961. I commend it to you. I read it in 1986. then unfortunately trained to be a CP. And took a very long excursion away from simplicity!
- So coming on to how to define hope. I’m sure you’ll appreciate that people have devoted lifetimes to this so apologies for the brevity of this summaryFrank and snyder. Scioli-just not simple enough!There seem to be two key and different conceptualisations of hope in the literature goal focused and spiritual (feeling empowered/protected by a spiritual force or presence)
- My second studyRecently replicated and currently a further replication with a clinical sample fibromyalgia patientsTo summarise so far hope is important in a range of outcomes A little bit of hope/placebo goes a long way!A useful and useable conceptualisation of hope is Snyders agency/pathways model and seems to relate to meaningful outcomesSo let’s have a closer look at hope and SF
- Pretty simpleHope: having desired goals -approach goals, being able to visualise a pathway to those goals, have the confidence and motivation to pursue those pathways. Solution focused therapy: uncovering and re connecting to desired goals and preferred futures, uncovering and re-discovering a sense of agency and ability, noticing oneself moving towards the desired future and imagining the next step. Both iterative-each element re-inforcing the other. Hope theory was a theory without a practice and SF is a practice without a theory. For me there could not be a better match than hope theory and the associated research and SF therapy as an intervention. Its wonderfully parsimoniousSF interventions should logically increase hope and I have a tiny bit of data on that so far
- From our local version of the expert patient programme co constructed with LTC patients and based on SF principles. 5 week programme facilitated by patients themselves. Can talk about measures etc if people want to find me afterSWB is a 10 point scale