The Role of Hope in Treatment and Specific Interventions to Build Hope

Good Studio/AdobeStock

THE BECK INSTITUTE

Hope can be defined as the capacity to recognize how one can achieve their goals, coupled with the belief that they have the motivation and agency to do so. Hope is an essential aspect of resilience—the ability to bounce back from adversity and maintain well-being even in the face of challenges. In practice, hope serves as a catalyst for change in therapy, making it more likely that patients will actively participate in the therapeutic process and feel empowered to implement newly learned skills. For many individuals, entering therapy can be daunting. They may be overwhelmed by despair and convinced that their pain will never subside. As mental health clinicians, we must demonstrate that there is a possibility for change, conveying realistic hope that the patient can improve.

How Does a Cognitive Behavior Therapist Instill Hope in Patients?

Cognitive behavior therapy (CBT) has traditionally been focused on symptom reduction, problem-solving, and skill-building. But contemporary approaches to CBT recognize the importance of recovery-oriented goals, which emphasize a broader vision of well-being and life satisfaction. These goals include helping individuals align their lives with their values and aspirations, and fostering feelings of purpose, empowerment, safety, well-being, competence, and control. Helping patients see that their current difficulties are not insurmountable—and that they can not only recover, but thrive—is essential for success.

One of the key challenges when working with patients—especially those who have struggled with mental health issues for a long time—is that many enter therapy with an entrenched belief that no treatment can help them. Cognitive therapists provide psychoeducation, emphasizing how the treatment has been demonstrated to be effective in managing the patient’s condition.

Old Idea: "Nothing can help me."
New Idea: "Maybe this treatment can help."

Providing a concrete treatment plan also goes a long way in creating hope. Transparency about the process of therapy helps demystify the process and shows the patient that mental health treatment is not just an abstract idea, but a well-defined, purposeful plan based on decades of research.

Old Idea: "I don’t understand how this therapy will work."
New Idea: "This treatment plan makes sense."

Being vigilant about patient skepticism and addressing it openly helps patients move from hopelessness to tentative optimism, and finally, to a more engaged attitude toward treatment. Offering them a “Plan B” and showing patients that there are always alternatives to try if one approach does not work can also keep the door open to hope.

Old Idea: "If this therapy doesn’t work, nothing will."
New Idea: "My provider has a Plan B."

Another powerful way to build hope is to normalize the difficulties patients face. Depression, anxiety, and other mental health conditions can leave individuals feeling isolated and convinced that they are fundamentally flawed. Therapists can help patients recognize that their struggles are not unique to them and that others have successfully navigated similar challenges. This normalization fosters a sense of solidarity and possibility.

Old Idea: "There’s something terribly wrong with me."
New Idea: "Other people have struggled with similar issues and have found a way through. Maybe I can, too."

By helping patients set concrete, specific goals, therapists give them something tangible to work toward. Breaking down large problems into manageable pieces makes the process feel less overwhelming and encourages hope for change.

Old Idea: "My problems are too big to solve."
New Idea: "I can tackle these problems one step at a time with the help of my therapist."

What Does the Research Say About Hope?

Research consistently supports the idea that hope plays a critical role in mental health treatment. Several studies underscore the importance of hope in improving treatment outcomes across a range of mental health conditions. Gallagher et al found that hope is a significant source of resilience, especially for patients dealing with anxiety.¹ The study demonstrated that CBT can increase hope in patients, providing a transdiagnostic mechanism of change across various anxiety disorders. Leite et al conducted a systematic review on hope theory and its relationship to depression. They found that higher levels of hope are associated with better therapeutic outcomes in treatment for depression.² Savaş and Luo et al both highlight the role of hope in reducing depression and anxiety in patients facing significant health challenges, such as cancer and chronic illness.^3,4 These findings reinforce the importance of hope in both managing symptoms and improving quality of life.

Brief Interventions to Build Hope

Psychiatrists and other professionals can support patients who are receiving medication or undergoing medical treatments by integrating these short interventions to build hope into their interactions with patients.

1. In addition to collecting information about the patient’s difficulties and struggles, ask the patient about the best period of their lives. Find out why it was the best and how long it lasted. Be sure to ask the patient about important relationships, interests, or hobbies they had during this time, and how they overcame challenges and adversity. Exploring their accomplishments, positive relationships, and internal and external resources can help reframe their perspective and remind them of their personal strengths and their ability to overcome hardship.
2. Elicit the patient’s values and aspirations. Values are defined as longstanding beliefs that have shaped individuals’ choices and behaviors; aspirations are the big, important desires individuals have for themselves and their lives. Ask questions like:
   1. What is most important to you in life? [Or what was most important before you became depressed]?
   2. What do you want for your life?
   3. How do you want to be?
   4. What are your hopes and dreams for the future?
   5. What would it say about you to [have achieved your aspiration]?
   6. How would it make you feel to [have achieved your aspiration]?
   7. What can you do this week to get that same feeling?
3. Help the patient plan and participate in activities and experiences that increase their sense of accomplishment, pleasure, well-being, connectedness, spirituality, creativity, or control. Setting small, manageable goals that align with the patient's values and aspirations can enhance feelings of hope and provide a sense of progress. These experiences could be as mundane as getting out of bed, going for a walk, cooking dinner, raking the leaves, helping a friend, or doing laundry. When the patient reports to you that they have completed the discussed activity, help them draw meaning from the experience by asking questions like:
   1. Isn’t it great that ____________?
   2. How was [doing _____________] connected to your values or aspirations?
   3. What does it mean or say that _________?
   4. What does it say about you? Your life? Your future?
   5. How did it feel as/after you were ______?
   6. Can you imagine the experience as if it’s happening now?
   7. What effect did remembering this experience have on your mood?
4. In the beginning of each encounter with the patient ask, “When were you at your best this week? When did you feel even a little bit better?” Encourage patients to recognize and celebrate even the smallest positive changes in their thoughts and behaviors. By focusing on successes, no matter how small, patients can begin to see that change is possible and that they can achieve their goals. Reinforcement is key here. Even small accomplishments deserve acknowledgment, as they offer evidence that the treatment is working and that recovery is possible.

A Note on Assertive Hopelessness

Some patients may resist hope because they believe that their provider cannot understand the depth of their pain. Others may fear that hope will lead to greater disappointment if they fail to meet their goals. Patients who assertively reject hope may believe that hopelessness provides them with certain advantages, such as escaping the effort and hard work of therapy, avoiding disappointment, and protecting themselves from potential failure. Providers can help these patients explore the advantages and disadvantages of hope and the advantages and disadvantages of hopelessness. Through this exploration, patients can come to adopt a realistic and helpful belief like, “Embracing hope may require effort and risk, but it also provides the opportunity for change, growth, and improvement.”

Concluding Thoughts

Hope is a powerful and essential element in the therapeutic process, particularly in CBT. By cultivating hope early in treatment, clinicians can help patients engage in the recovery process. Research consistently supports the importance of hope in improving outcomes across a range of mental health and health conditions, including depression, anxiety, and chronic illness. By utilizing specific interventions to foster hope, clinicians can help their patients navigate challenges with greater resilience and confidence.

Dr Beck is president of Beck Institute for Cognitive Behavior Therapy in Bala Cynwyd, Pennsylvania, and a clinical professor of psychology in psychiatry at the University of Pennsylvania in Philadelphia. Ms Fleming is the communications manager for the Beck Institute for Cognitive Behavior Therapy.

References

1. Gallagher MW, Long LJ, Phillips CA. Hope, optimism, self-efficacy, and posttraumatic stress disorder: A meta-analytic review of the protective effects of positive expectancies. J Clin Psychol. 2020;76(3):329-355.

2. Leite ACAB, Garcia-Vivar C, Neris RR, et al. The experience of hope in families of children and adolescents living with chronic illness: a thematic synthesis of qualitative studies. J Adv Nurs. 2019;75(12):3246-3262.

3. Savaş E. Effectiveness of the WomenCan CBT program on depression, anxiety, and hope: a pilot study. KADEM Kadın Araştırmaları Dergisi. 2024;10(2):553-580.

4. Luo SX, van Horen F, Millet K, Zeelenberg M. What we talk about when we talk about hope: a prototype analysis. Emotion. 2022;22(4):751-768.