to the importance of optimism and hope in the face of health challenge. Positive expectations have been shown to predict better health after heart transplantation (Leedham et al., 1995); optimists have also been documented to show quicker recovery from coronary bypass surgery and have less severe anginal pain than pessimists (Fitzgerald et al., 1993). In men who are HIV-positive, optimism has been shown to predict disease course and mortality. Such men who were asymptomatic and did not have negative expectations showed less likelihood of symptom development during the follow-up period (Reed et al., 1994). Importantly, HIV-positive men with unrealistically optimistic beliefs about their own survival actually lived longer (Reed et al., 1994). Those who were able to find meaning in their loss of a close partner maintained CD-4 T helper cells over the follow-up period and were less likely to die (Bower et al., 1998). Thus, optimism and meaning are resources that may preserve not only mental but also physical health (Scheier and Carver, 1992; Taylor et al., 2000). On the other hand, unrealistic optimism in specific situations may encourage actions that create unwanted risks of injury and disease (e.g., Avis et al., 1989; Svenson, 1978; Weinstein, 1998), and these possibilities must also be part of future agendas.
Other factors contributing to differential survival profiles include social and emotional support. Group psychotherapy programs that promote social support and emotional expression among women with breast cancer show multiple effects: reductions in anxiety and depression as well as increased survival time and lower rates of recurrence (Spiegel et al., 1998; Spiegel and Kimerling, in press). Survival after myocardial infarction also has been significantly associated with emotional support, even after controlling for severity of disease, comorbidity, and functional status (Berkman et al., 1992). The negative role of emotional factors in survival processes has been demonstrated with anger in the context of coronary heart disease (Kawachi et al., 1996) and depression among postmyocardial infarction patients (Frasure-Smith et al., 1993). Future studies are needed to document the replicability and pervasiveness of these effects.
Recent research shows that promoting the positive can help prevent relapse of depression, a central challenge for clinicians involved in the treatment of this disorder (Fava et al., 1998; Fava, 1999). This is particularly relevant to the residual phase of depression, when major debilitating symptoms have subsided but well-being is not fully regained. During this period the risk for relapse is especially high. To promote full recovery, “well-being therapy” was implemented—a cognitive behavioral approach designed to increase awareness of and participation in positive aspects of daily life. Those participating in treatment showed dramatically higher remission profiles over a two-year period compared to those receiving standard clinical treatment. This underscores the need to promote positive