IDD-MH Prescriber Guidelines

IDD-MH Prescriber Guidelines

Funded by the WITH Foundation

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Foreword: The Importance of Hope as an Essential Part of Patient Care

Dan Tomasulo, PhD, MAPP, MFA

Many patients with intellectual and developmental disabilities and mental health needs (IDD-MH) have a history of being treated as if their presentation is “hopeless.” It is often assumed that these patients lack the resilience and character to work with the clinician to address clinical needs. This often leads to poor treatment approaches and outcomes because shared hope between the patient and the clinician is key. The cultivation of hope has been linked to psychological and physical well-being.1 From the very beginning, pioneers in mental health have seen hope as an essential ingredient that helps people feel better. During the treatment process, Freud2 himself thought his patients’ “expectations, colored by hope and faith” mostly explained treatment success or failure. Karl Menninger3 viewed hope as the essential ingredient of healing and encouraged psychology practitioners to study it. More recently, Irvin Yalom4, the celebrated existential and group therapist, identified the instillation of hope as a crucial factor in the therapeutic process. Today, Martin Seligman5, the “father of positive psychology,” and Chris Peterson6 have elevated hope as one of the 24 core character strengths that make human beings flourish. Additionally, Steven Maier7 and Martin Seligman offer specific research which suggests that hope arises when there is an expectation that future bad events will be temporary, specific, and manageable.

Other researchers, like Snyder8,9, Cheavens10, and Lopez11 suggest that hope involves having a pathway to achieve goals and the agency, or motivation, to reach these goals. Others, like Barbara Fredrickson12, understand hope as an exception, because unlike other positive emotions, it comes into play only when our circumstances are difficult or at least uncertain. And medical researchers such as Kaye Herth13 have found that hope and healing happens when there is sufficient support.

What emerges from the plethora of research is an understanding that hope plays an essential role in reducing risk for distress while facilitating both physical and mental well-being. To consider implementing a treatment plan without addressing the hope factor is to limit its potentiality. To illustrate hope’s central role in patient care and its relationship to well-being, consider the following 2020 study on hope and aging.

In the first-of-its-kind study, researchers affiliated with the Human Flourishing Program at Harvard University’s Institute for Quantitative Social Science investigated the link between hope and aging.14 They found older adults (average age 66) with higher degrees of hope were more likely to have better physical, psychological, and social well-being. Those with greater hope had reduced risks of cancer, chronic conditions, sleep problems, chronic pain, and death. They also reported increased positivity, higher life satisfaction, a greater sense of purpose, less psychological distress, and better social well-being. On the other hand, those with lower levels of hope or hopelessness had an elevated risk of anxiety, depression, and posttraumatic stress disorder (PTSD). Having hope may be the best protection against a more difficult tomorrow.

Below is a partial list of findings suggesting hope and its correlates are associated with improved outcomes:

  • Lower levels of perceived stress
  • Lower use of avoidance coping strategies
  • Fewer depressive symptoms
  • Less anxiety
  • Improve functioning in borderline personality disorder
  • Reduced post-traumatic stress disorder symptoms
  • Improved adaptive coping strategies
  • Reduced rumination
  • Less catastrophizing about pain
  • Diminished neuroticism
  • Improved executive function
  • Decreased impulsivity
  • Better sleep
  • Increased emotional stability
  • Improved adaptive coping strategies
  • Enriched interpersonal relationships
  • Better cardiovascular health
  • Lower risk of Alzheimer’s disease
  • Higher levels of well-being
  • More positive emotions
  • Greater resilience and coping skills during difficult times
  • Greater productivity
  • More compassion
  • Greater kindness
  • Fewer negative thoughts
  • Improved psychological adjustment
  • Better academic performance and achievement
  • Increased athletic performance
  • Greater coping skills for illness and loss
  • Improved social-emotional problem-solving
  • A longer, happier life



Beyond these findings is an applied aspect showing hope can be taught, facilitated, and cultivated.1 The power of hope to prevent illness and distress, enhance recovery from mental and physical illness, and promote longevity and well-being is well-established. Introduction of strategies to cultivate hope is essential to enhance the effectiveness of any interventions designed to enhance well-being while reducing suffering. This includes the mental health treatment of people with intellectual and developmental disabilities.

1 Tomasulo D. Learned Hopefulness: The Power of Positivity to Overcome Depression. New Harbinger Publications; 2020.

2 Freud S, Strachey J. The Psychopathology of Everyday Life. Penguin Books; 1975.

3 Menninger KA. The Human Mind. The Literary Guild of America; 1930.

4 Yalom ID. The Theory and Practice of Group Psychotherapy. Basic Books; 1970.

5 Seligman ME. Flourish: A Visionary New Understanding of Happiness and Well-being. Atria Paperback; 2013.

6 Peterson C, Seligman ME. Character Strengths and Virtues: A Handbook and Classification. Oxford University Press; 2004.

7 Maier SF, Seligman ME. Learned Helplessness at Fifty: Insights from Neuroscience. Psych Review. 2016; 123(4): 349.

8 Snyder CR. Hope theory: Rainbows in the mind. Psychol Inq. 2002; 13(4):249-275.

9 Snyder CR, LaPointe AB, Crowson JJ, Early S. Preferences of high-and low-hope people for self-referential input. Cogn Emot. 1998; 12(6):807-823.

10 Cheavens JS, Heiy JE, Feldman DB, Benitez C, Rand KL. Hope, goals, and pathways: Further validating the hope scale with observer ratings. J Positive Psychol. 2019; 14(4):452-462.

11 Lopez SJ. Making Hope Happen: Create the Future You Want for Yourself and Others. New York, NY: Simon and Schuster; 2013.

12 Fredrickson BL. Positive emotions broaden and build. Adv Exp Soc Psychol. 2013; 47:1-53.

13 Herth K. Abbreviated instrument to measure hope: development and psychometric evaluation. J Adv Nursing. 1992; 17(10):1251-1259.

14 Long KNG, Eric ES, Chen Y, Wilson MF, Worthington EIJ, VanderWeele TJ. The role of hope in subsequent health and well-being for older adults: An outcome-wide longitudinal approach. Global Epidemiology (2020):100018.