Why doctors should look for ways to prescribe hope

Some new research suggests that people with heart conditions have better outcomes when they are more hopeful and optimistic. Hopelessness, on the other hand, is associated with a significantly higher risk of death.

The findings build upon decades of fascinating research into the phenomenon of the placebo effect. Our beliefs and expectations about a medicine (or a sham treatment) can change the way it works. The placebo effect’s “evil twin,” the nocebo effect, is just as powerful—negative thinking has been linked to real symptoms.

Researchers are still trying to understand the connection between body and mind, and how our thoughts can influence our physiology. In the meantime, many are developing ways to harness it in hospital settings. Is it possible for a doctor to prescribe hope?

Alexander Montasem, a lecturer in psychology at the University of Liverpool, is trying to find an answer to that question. In his latest study, Montasem and his colleagues focused on people with cardiovascular disease.  The team reviewed all published research into the link between hope and heart health outcomes in such individuals.  Montasem’s team found 12 studies that fit the bill. All told, these studies included over 5,000 people. And together, they found that high hopefulness was associated with better health outcomes: less angina, less post-stroke fatigue, a higher quality of life, and a lower risk of death. The team presented its work at the British Cardiovascular Society meeting in Manchester earlier this week.

It’s obvious our thoughts and beliefs can play an enormous role in our health and well-being. What’s less clear is exactly how it happens. Scientists have made some progress—there’s evidence that a range of brain chemicals, including the body’s own opioids, are involved in both the placebo and nocebo effects. But the exact mechanisms remain something of a mystery.

In the meantime, researchers are working on ways to harness the power of positive thinking. There have been long-running debates over whether it is ever ethical for a doctor to deceive patients to make them feel better.  A more ethical approach might be to find ways to build patients’ hope, says Montasem. Not by exaggerating the likely benefit of a drug or by sugar-coating a prognosis, but perhaps by helping them work on their goals, agency, and general outlook on life.

Some early research suggests that this approach can help. Laurie McLouth at the University of Kentucky and her colleagues found that a series of discussions about values, goals, and strategies to achieve those goals improved hope among people being treated for advanced lung cancer.  These approaches could also be helpful for all of us, even outside clinical settings.  Setting and pursuing our personal goals are one of the ways to remain hopeful.  The minute we give up [on pursuing] our goals, we start falling into hopelessness.

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