Motivation and emotion/Book/2021/Optimism and physical health

Overview


The different perspectives of optimists and pessimists are illustrated in Figure 1. Optimists tend to expect a positive outcome in future events in the world. However, does optimism and pessimism affect our physical health? This chapter explores the relationship between optimism and physical health. It addresses key areas such as the physical origins of optimism within the brain, and how optimism can affect your physical health through adherence to health maintaining behaviours, treatment adherence and through coping habits and strategies. This chapter also shows the empirical evidence of optimism on physical health through the use of biomarkers, impacting on inflammatory markers and heart health. This chapter shows how a simple change in perspective can have a big impact on physical health for the better. Focus questions:
 * How does optimism actually affect the body?
 * How much optimism is too much optimism? Where do you think it is beneficial to draw the line?
 * How can optimism impact on an individual's coping?

Optimism vs pessimism
Optimism can be split into many different meanings depending on the model, such as dispositional optimism or an optimistic explanatory style. However, simply put optimism is the tendency to expect a positive outcome in future events for oneself, conversely, pessimism is expecting negative outcomes from future events (Creed et al., 2002). The optimist and the pessimist refer to people who are more inclined towards one of the extremes on an optimism-pessimism continuum consistently over time, where the optimist sees the world full of potential opportunities, and the pessimist sees only the potential dangers along the way (Hecht, 2013).

What many people don't realise is that there is two ways of viewing optimism and pessimism, as either unidimensional or bidimensional. Through a unidimensional perspective one can view optimism and pessimism on a continuum, with varying degrees of both optimism and pessimism in different situations (Hecht, 2013). This phenomena is more apparent within older adults than younger ones, one theory proposed is that younger adults see situations as more black and white (dualistic), whereas older adults tend to view the positives and negatives within a situation (Creed et al., 2002). However, through a bidimensional perspective optimism and pessimism are seen as separate constructs (Creed et al., 2002). Evidence suggests that even though these two constructs are regarded as mutually exclusive, they might not be. However, the scores of these constructs using the Life Orientation Test-Revised (LOT-R) may not show the full picture due to validity problems and not presenting a clear delineation of the relationships occurring between external variables and optimism/pessimism (Creed et al., 2002).

Dispositional optimism
The concept of dispositional optimism was developed by Scheier and Carver (1985) and refers to a generalised outcome expectancy that good things will happen to the individual, rather than bad things. This generally good outcome expectancy is correlated with widespread benefits in terms of psychological well-being, which is then mediated to physical well-being (Tomakowsky et al., 2001). This concept was based on the general model of behavioural self-regulation theory, this assumes that goal-directed behaviours are guided by a series of closed negative feedback systems, within both physical and social environments. These systems help to limit the discrepancies people have with their 'selves', disparities within the 'actual', 'ideal' and 'ought to be' self can cause self-discrepancies, which are associated feelings of guilt, self-contempt and uneasiness (Carver, C.S., & Scheier, M.F, 1998). The main instrument to measure this concept of optimism is a survey called the Life Orientation Test (LOT) and the Life orientation Test-Revised (LOT-R) (Tomakowsky et al., 2001). Dispositional optimism has also been related to better health outcomes, such as fewer physical health complaints, fewer influenza symptoms and better long-term and short-term recovery (Tomakowsky et al., 2001).

Explanatory style


Another model of optimism that exists is the explanatory style, which is a stable cognitively based variable of personality that reflects how people explain bad outcomes happening to them (Peterson & Seligman, 1984). This explanatory model is split into two styles, being pessimistic and optimistic. Within this concept there are three dimensions which dictate which explanatory style an individual has. These dimensions are the locus, or internality (the degree to which the individual perceives the outcome as personally responsible), stability (the degree to which an individual perceives the causes to be stable throughout time) and controllability (the degree to which the individual perceives to have control over the outcome) (Tomakowsky et al., 2001). An optimistic explanatory style tends to manifest itself as having external (not personally responsible), unstable (causes of the outcome can change) and controllable (causes of outcome can be brought under control) attributions, whereas pessimistic explanatory styles tend to manifest itself in internal, stable and uncontrollable attributions (Peterson & Seligman, 1984). An example of an optimistic explanatory style can be that an individual lost a spelling competition because of poor planning, whereas an example of pessimistic explanatory style is that an individual lost the competition because they weren't smart enough.

Explanatory styles came from a reformulated version of the learned helplessness model. This model refers to inappropriately passive behaviour due to an individual's inactivity, leading to failure of outcome control, researchers Abramson, Seligman, and Teasdale (1978) revised this model to then include attribution styles. Different methods for testing this explanatory style have been developed, including a self-report questionnaire, the Attributional Style Questionnaire (ASQ) and a qualitative interview or transcript method, the Content Analysis of Verbal Explanations (CAVE) technique (Tomakowsky et al., 2001).

Optimism vs delusion - Unrealistic optimism
Optimism is a very powerful tool that can be used to reduce the perceived threat of many circumstances, however, what happens when one possesses too much optimism, and how does it affect the individual?

Unrealistic absolute optimism is a term referred to when there is a tendency for people to have unrealistically positive risk assessments of situations when compared to an objective criterion, such as actual outcomes or actuarial risk assessments (e.g. biomarkers for physical health) (Jefferson et al., 2017). This type of optimism may have a big impact on the individual exhibiting this type of optimism, both beneficially and adversely. This is due to unrealistic optimism being shown to be beneficial to perceived physical health and hence, impacting on physical health too, though it has also been linked to adverse health effects, for example, optimism biases have been shown to reduce individual's self-protective actions and encourage avoidable injuries and illnesses (Weinstein & Klein, 1996).

However, unrealistic optimism can impact positively, as in conditions with uncertainty and risks, optimism can lead to better decision making through avoiding big mistakes and can contribute to survival and flourishment, having both cognitive and evolutionary benefits (Bortolotti & Antrobus, 2015). This was reinforced by a study on cancer patients and the impacts of unrealistic optimism, showing unrealistic optimism impacting on all aspects of the Health Belief Model (HBM) (severity associated with health problem, susceptibility to a disease, benefits and barriers of health behaviours), however, some have attributed this impact more towards perceived self-efficacy than unrealistic optimism (Clarke et al., 2000).

Physical health


Physical health is a very hard term to define due to its many concepts that it encompasses, it has been compared within the literature to be the equivalent of a fuzzy concept within psychological constructs, this is due to one single definition not being able to encompass the whole concept (Chang, 2001). Rather physical health should be viewed on multiple factors, such as complaints of illness and sickness, specific symptoms of disease, identifiable body damage, germ presence and restriction of daily activities which impacts on quality of life and finally longevity (Chang, 2001). Physical health within the literature can be measured with many metrics, however, it is most commonly measured using biomarkers and clinically identifiable diseases (Scheier & Carver, 2018).

Optimism effects on biomarkers


The relationship between optimism and physical health is complex, however, there is a growing body of literature linking psychosocial phenomena, such as optimism and pessimism, to physical health, through differences in biomarkers. In particular, Roy et al. (2010) found that individuals with a greater amount of optimism (as measured by the LOT-R) had lower levels of blood pressure and cortisol, whilst also showing faster cardiovascular recovery from acute increases in blood pressure in response to negative emotional stimuli. Conversely, a pessimistic disposition can evoke feelings such as guilt, self-contempt, and uneasiness, which can then lead to chronically higher cortisol levels (Roy et al., 2010). The mechanics behind these effects of optimism on biomarkers may be due to optimism's ability to down regulate the autonomic nervous system and hypothalamic-pituitary-adrenal axis, helping to reduce chronic inflammation and improve homeostasis. Participants within the Roy et al. (2010) study who scored higher on the LOT-R were also more associated with lower levels of interleukin-6, C-reactive protein, fibrinogen and homocysteine, which are all biomarkers of cardiovascular disease risk. This is reinforced by a meta-analysis of 15 studies, including over 220,000 participants, 12 out of the 15 studies showed evidence of a dose-response association between optimism levels and decreased clinical risk of cardiovascular events and all-cause mortality (Rozanski et al., 2019). Hence, there is a strong suggestive association between optimism and its positive effects on physical health

Alternatively, when looking at the relationship between pessimism and physical health the opposite is true, with a pessimistic explanatory style having the potential to affect an individual's physiology adversely. This was noted within a study investigating the relationships of explanatory styles and immune function, where participants were consistently interviewed over the course of 2 years, regarding life changes, stressors and health, as well as drawing blood samples of participants (Peterson & Seligman, 1987). This study found that a pessimistic explanatory style was indicative of increased immunosuppression, due to the increased number of suppressor cells among individuals with an external, stable and global explanation for bad events (Peterson & Seligman, 1987). A possible mechanism for this may be due to an individual's perception of uncontrollability within a situation, causing immunosuppression, however, evidence for this is still limited. Ikeda et al. (2011) also noted the differences in pessimistic and optimistic effects, with pessimistic orientations having not only higher levels of interleukin 6, but also having stronger effects than optimistic orientations on levels of inflammation. It may be that an orientation towards a pessimistic side may cause the increased inflammation in biomarkers and that may in turn make an optimistic orientation seem better than baseline biomarkers.

Though, another important question to ask is do these effects of optimism on physical health carry over time? The evidence for this question suggests that optimism does predict physical health distress over time when relevant medical variables and health baselines were measured and statistically controlled. This was illustrated within a study investigating the role optimism plays in women with breast cancer undergoing surgery, there was a significant inverse relationship between optimism and post-surgical physical and psychological distress at the 3, 6 and 12 month medical check-ups (Carver et al., 1994). Therefore, optimism appears to be a significant prospective predictor of distress during a stressful and traumatic time. However, limitations of this study include the sample selection itself, as all of these women came from relatively high socio-economic backgrounds and had very little ethnic diversity.

 {Optimistic participants within the Roy et al. (2010) study had lower biomarkers in all except:} - Homocysteine - Interleukin-6 - Fibrinogen + Ghrelin

{Optimism impacts on physical health over time} + True - False

{Which dimensions of explanatory style are responsible for immunosuppression} - Internal, unstable and local explanation + external, stable and global explanation

Physiological origins


Optimistic brain activity is apparent when looking at physiological brain activity, within the left hemisphere (LH) of the brain has been shown to produce high self-esteem and cheerful attitudes in individuals, as well as these individuals tending to focus on the positive aspects of a situation (Hecht, 2013). This means that the LH enables a more relaxed state for an individual, allowing optimistic thoughts to foster, this encourages a proactive mindset and initiative when encountered with life struggles (Hecht, 2013). The LH also mediates the experience of positive affect and reacts with positive emotion to rewards, additionally, being reinforced by them (De Pascalis et al., 2013). Conversely, activity within the right hemisphere (RH) leads to a more pessimistic view of events, and involves more mediation of fear and stress, this is due to the RH acting as a sort of alarm system for the brain and body, through activation of the sympathetic nervous system, being primed for sudden action, threat cues and survival (Hecht, 2013). This hemisphere is also conditioned to be sensitive to punishment, non rewards and innate fear stimuli (Hecht, 2013). This stark asymmetry within these hemispheres has been labelled as the brain activation system (BAS) and the brain inhibition system (BIS), with the LH fostering the BAS and the RH fostering the BIS. This connection of the BAS/BIS towards the physiological origins of optimism can be illustrated by electromagnetic tomography and functional magnetic resonance imaging (fMRI), showing not only higher BAS activation within the LH, specifically the middle frontal gyrus (BA11), but also higher metabolic activity within the frontal LH for individuals focusing on positive thinking strategies (De Pascalis et al., 2013; Hecht, 2013).

Coping - optimism effect mediated through coping
The link between optimism and physical health has been suggested by several researchers to be mediated through coping, specifically coping strategies used. Coping can be defined as cognitive or behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person (Nes & Segerstrom, 2006). There are also many types of coping strategies, with the main ones being problem-focused vs emotion-focused coping and approach vs avoidance coping (Nes & Segerstrom, 2006). The amount of stress placed upon an individual may affect the way in which they cope, and if they have the required resources to cope with the stressor successfully. Positive emotions such as hope and joy, which are associated to optimism may help with coping to stress, through causing an individual to persist in their coping strategies, even when events are highly stressful, rather than disengaging with the stressor and giving up (Scheier & Carver, 1985). Hence, coping has been noted as the reason for optimism being correlated with better adjustments during stressors.

Additionally, the fluidity between different coping strategies an optimistic individual uses depending on the stressor sets them apart. Nes & Segerstrom (2006) found that optimistic people tend to know and change their coping strategies depending on the controllable (e.g., academic stress) or uncontrollable (e.g., major health traumas) stressors faced to better adjust to the situation. However, significant correlations showed optimistic individuals generally tend to adopt a problem-focused or approach-centred coping behaviour towards a stressor (Nes & Segerstrom, 2006).

Researchers have also found that an optimistic explanatory style may also benefit an individual's ability to cope, and therefore, benefit their physical health. This theoretical underpinning can be explained by Bennett & Elliott (2002), illustrating that an optimistic explanatory style may impact on physical health due to the degree that an individual experiences feelings of helplessness, which ultimately is dictated by the 'controllability' dimension of the explanatory style. This then has a knock-on effect, impacting on an individual's coping behaviours, or lack thereof. Another study showed how an individual with a pessimistic explanatory style instead of an optimistic one is more likely to neglect basic coping behaviours, like self-health care, as they saw these coping behaviours as futile in delaying the onset of illness (Dykema et al., 1995). These neglected self-health care behaviours included proper sleep, nutrition and exercise, which are all factors known to improve physical health and functioning.

''Table 1. Illustrations of the ways of coping (adapted from Nes & Segerstrom, 2006).''

Health behaviours and treatment adherence and optimism


Optimism has been noted to have positive effects on the adherence to health behaviours and treatment. The literature indicates that greater optimism leads individuals into being more likely to engage in health-promoting behaviours (e.g., exercise and healthy eating) and treatment adherence (e.g., rehabilitation or medication adherence) and less likely to engage in unhealthy behaviours such as drugs or smoking (Scheier & Carver, 1992). This was seen within a study reviewed by Scheier & Carver (1992), whereby optimists and pessimists were compared and tracked their maintenance of health behaviours over a 5 year period. The results showed that optimistis were more likely to adhere to health maintenance behaviours, such as regularly taking vitamins and less likely to have unhealthy lunches, they were also more likely to be proactive in their treatment adherence (e.g., proactively enrolling in cardiac rehabilitation programs). This study was replicated by Robbins et al. (1991), within a large number of collegiate men and women, showing that optimists were positively related to be engaging in health-enhancing behaviours, even when adjusting for confounders. Results are consistent for many demographic groups, even when extrapolating this to older populations, as Steptoe et al. (2006) found that within a moderate sample size of 65 to 80 year old men and women, dispositional optimism was significantly related to strict health protective behaviours, such as brisk walking, not smoking and moderate alcohol consumption. Therefore, optimism has significant effects on individual's adherence to health protective behaviours and treatments, however, the mechanisms for this are still quite vague with several pathways being hypothesised.

One potential mechanism for the effects of optimism on treatment and health behaviour adherence may be that optimism increases one's perception of their capacity to take precautions. However, this mechanism is then strongly tied to the individual's general self-efficacy, where optimism serves as a potential mediator between one's objective and subjective physical health, depending on their general self-efficacy (Warner et al., 2011). This layout then has a great importance, as a resource for health behaviours, potentially predicting if an individual will adhere to a health behaviour or not. Though, health-specific optimism's role has only been validated when self-efficacy is very low within an individual, as it was found that for older self-efficacious adults that health-specific optimism made little difference on their adherence to health behaviours (Warner et al., 2011). Conversely, optimism was found to be very useful when an individual had self-doubts about about their competence to adherence, opening the way for optimism to affect perception of objective health and then objective health itself, due to one's judgement of ability. This conditional reliance on optimism has also been shown within a systematic review, whereby positive affect and subjective wellbeing had similar prospective connections to health outcomes as optimism did (Warner et al., 2011). Hence, this relationship between positive psychological constructs, including optimism, and health behaviour adherence may be a working mechanism underlying health and longevity, though more research is needed to confirm this.

 {Optimism can help individuals disengage from smoking and drinking alcohol} + True - False

{Optimism increases compliance to health maintaining behaviour} + True - False

Conclusion
In conclusion, optimism can be seen to affect physical health in many ways, with many concepts of optimism being formed to try and explain this concept in its entirety, from this different optimism models like dispositional optimism and an optimistic explanatory style have arisen. The physiological origins of optimism can be traced down to the activity within the left hemisphere, being shown to focus on the positive aspects of a situation, whilst the right hemisphere was found to be the opposite, this asymmetry between the two hemispheres can be referred to as the Brain Activation System and Brain Inhibition System. Optimism can have beneficial, but also aversive effects on physical health, through unrealistic optimism, which often incites a reduction in an individual's self-protective actions, facilitating avoidable injuries and illnesses. However, generally optimists are correlated to being more physically healthy than pessimists, which can be noted within biomarkers such as lower blood pressure and cortisol levels, faster cardiovascular recovery, reductions in chronic cardiovascular inflammation markers (such as interleukin-6 and homocysteine) and improved homeostasis. Optimism's impact on physical health is mediated through an individual's coping behaviour and strategy, however, optimism can also greatly affect an individual's adherence to treatments and heath maintenance behaviours, such as proper sleep, exercise and nutrition, which in turn can affect physical health. Therefore, an optimistic mindset within life can help boost physical health.