Finding hope can feel miraculous when wrestling with the endless challenges of any chronic illness, including depression.

At the end of a long week struggling to help others I ran across an article by a psychiatrist who has thought long and hard about the sources of hope, and felt the wonderful sense of renewal that hope brings to the beleaguered.

James Griffith, the chair of psychiatry at George Washington University (GWU) School of Medicine, described his work developing brief intervention modules that help patients practice hope in demoralizing life situations and that can be taught to trainees and other mental health clinicians. His work on the subject was published in an article in Academic Psychiatry (July 2017).

He gave a presentation on the subject at the Institute on Psychiatric Services meeting in October 2017 in New Orleans.

Griffith has identified 14 practices in the psychotherapy literature that help to create hope. These practices relate to one of four types of coping (problem solving and goal seeking, activating a core identity, emotion regulation, and relational coping). The first step is to identify your particular type of coping.

Identify Your Coping Style

Think for a moment about time in the past when you faced significant adversity.

Do this right now as you’re reading this post.

  • When did this occur?
  • Where were you? What were you doing?
  • Who else was there?
  • What was happening that made this so awful?
  • How did you feel inside? What words best described how you felt?

Now let yourself remember this situation vividly. Notice what you feel and where you feel it inside your body.

Next ask yourself how it was that you coped with the adversity.

Griffith suggests that you probably used one or more of these coping strategies, and that most people have a coping style that they predominantly use when dealing with stress. 

Problem Solving Coping

Problem solving coping involves thinking about a desired future or goal and then coming up with options for getting there (pathways thinking). Thinking through the steps and developing a plan. And then activating thoughts and attitudes that create a sense of confidence in your ability to make changes despite adversity (agency thinking). So that along the way, when you run into unexpected challenges, you use a “shift and persist” approach (change the plan and keep moving) rather than retreating into passivity.

Emotion Regulation

Emotion regulation focuses on managing negative emotions that can lead to hopelessness: specific strategies for relieving pain, nausea, insomnia,and other emotional distress; ways of coping with uncertainty about the future; and active ways of enhancing emotion regulation (yoga, meditation, spiritual practices, exercise).

Activating a Core Identity

People generally think of their core identity in one of three ways: an internal, personal identity; a family, team or small group  identity; or a collective identity (belonging to a large group defined by gender, age, ethnicity, religion, political party, or some other defining characteristic). Activating this core identity means focusing on thoughts and behaviors that strengthen that sense of identity. For example, focusing on the values that lie at the heart of a personal identity or strengthening a sense of connection to a small group or collective.

Relational Coping

Relational coping focuses on creating stronger family or close friendship relationships; embracing a family/team/work group role, or developing modeling or mentoring relationships, or relationships that involve helping others.

Activate Your Coping Style

Griffiths suggests that the best way of coping with stress when you are feeling overwhelmed is to focus on your strengths, the coping style you are most comfortable with. Here is an example of the process…

A 55-year-old woman, recently hospitalized for a suicide attempt was facing multiple stressors. She was losing her home to foreclosure. Her dog, her long-term companion, had recently died. She had adult children but rarely saw them due to their work schedules.While depression contributed to her despair, she was also demoralized by harsh circumstances, grief, and loneliness.

She thought about a past challenge and remembered her grief when her father died as her worst time. When she thought about her father now, she remembered that he would have told her: “You are strong and a fighter. You are the glue that kept the family together, and that shouldn’t stop now.” After his death, she had turned to her children for emotional support.

This is an example of relational coping. 

Her solution focused on strengthening her relationships with her children by getting in touch with them and letting them know about the challenges she was facing and at the same time to focusing on the sense of self worth that she experienced from her father’s description of her value in the family. 

References

Griffith JL. Hope Modules: Brief Psychotherapeutic Interventions to Counter Demoralization from Daily Stressors of Chronic Illness. Acad Psychiatry. 2017 Jul 27. doi: 10.1007/s40596-017-0748-7. [Epub ahead of print] PubMed PMID: 28752229.