These include among other things the patients emotional well-being, understanding of their illness, general perception of their health and familial support. Giltay, et. al, (2004) examine the relationship between dispositional optimism and all-cause mortality. Their findings suggest that a protective relationship exists between dispositional optimism and health. The study specifically found that of 941 subjects, the number of deaths among individuals with a higher level of pessimism was much greater than among those with a more optimistic attitude. The results were adjusted fro behavioral factors that might impact mortality, including smoking and alcohol consumption, body mass index and other physiological factors.

Matthews, Raikkonen, Sutton-Tyrrell & Kuller (2004) find that optimistic patients are more likely to report a higher quality of life and engage "in more active coping and health promoting behaviors than people with pessimism" (p. 641). Their study of 209 middle aged women suggest that pessimists are more likely to show progression of carotid disease than optimists.

Other reports show that chronically ill patients who are optimistic are more likely to demonstrate resilience (De Ridder, Fournier & Bensing, 2004). A study of 50 patients with Multiple Sclerosis and Diabetes Mellitus shows that optimistic interpretation of health status leads to better self-care behavior in the long-term and a higher reported quality of life (De Ridder, Fournier & Bensing, 342).

There are some critics that suggest that overly positive attitudes can result in undue optimism with regard to treatment. This is more often the case with cancer research. Beadles, et. al (2004) conducted a study examining the effects of illusory optimism on cancer patients. Specifically the study examined 149 patients with advanced cancer. The study suggests that positive illusory beliefs regarding patient outcome result in a better quality of life as reported by patients, further supporting the notion that optimism is beneficial for treatment of even advanced stage illnesses.

Lee, et. al, (2003) hypothesize that an optimistic attitude benefits patients that face life-threatening conditions. Their study, conducted over six months, examines the relationship between patient expectation and outcome, as well as quality of life. The data resulting from the study suggest that an optimistic expectation may result in improved early survival rate post stem cell transplantation, though the results were not long lasting after an interval of six months.

Allison, Guichard, Fung & Gilain (2003) conducted a study of 101 cancer patients. The aim of the study was to investigate the hypothesis that pessimistic cancer patients had a greater risk of dying within 1 year of treatment than optimistic patients. The researchers conducted an observational study that concluded that dispositional optimism predicts a better chance for 1-year or more survival independent of any clinical variables.

A study conducted by the Global Parkinson' Disease Committee (2002) suggests that for Parkinson's patients, feelings of optimism impact patients resiliency and satisfaction with their quality of life and condition. The researchers analyzed patient's perception of quality of life using cross-sectional, randomized selection of patients. The study suggests that the three most impacting factors related to quality of life and resiliency include a patient's satisfaction with their understanding of the conditions, their "current feelings of optimism" and any depression they may have (p. 62).

Shifren (1996) conducted a study of patients with Parkinson's disease to determine the extent to which patients perceived disease severity is affected by their optimism. His results show that patients with more optimism demonstrated less need for assistance with basic functional and day-to-day tasks. Increased levels of optimism were also noted in patients on days with "decreased perceived disease severity," but also that continuing optimism decreased the patient's perception of their disease (p. 250).

Segerstrom (2005) points out that many studies are available where the results are mixed, indicating that optimism may be both negatively related to measures of immunity and health and positively related. His examination of naturalistic and experimental studies show that when stressors are difficult or the disease condition uncontrollable, optimism may negatively impact immunity; however, when stressors are straightforward and controllable, optimism may positively effect immunity (p. 200).

Some of the evidence supporting optimism and psychological factors impacting quality of life does support the idea that positive physiological changes can result from optimism and other psychological factors. Rozanski & Kubzansky (2005) cite evidence that supports positive psychological factors as protective against coronary artery disease. Their study explores many elements that promote positive well-being including vitality, emotional flexibility and coping flexibility. Further, through observational studies the researchers note that chronic stress and negative emotional states can "invoke a chronic stress response"...

48). The biological impairments may include stimulation of the sympathetic nervous system, increased heart rate and blood pressure. All of this information supports the importance of creating a positive, supportive and optimistic rather than pessimistic and stressful environment. The researchers also point out that there is new data suggesting that positive psychological factors including optimism may "diminish physiological hyper responsiveness and/or reduce adverse clinical event rates" (Rozanski & Kubzansky, 49).
It is important to note these studies also support many other elements aside from optimism that promote resilience. Factors cited include gratitude and altruistic behavior. Interestingly, of all the factors cited most did not have a direct link to a heightened sense of well-being aside from dispositional optimism. Further research is necessary in this area to expand on the observations made by these clinical researchers.

Can Optimism/Resiliency Be Taught?

Wilkes, O'Baugh, Luke & George (2003) suggest that it is important for cancer patients to adopt a positive attitude for present treatment outcomes. Further their studies show tat patients definitions of positive and negative attitudes and perceptions of quality of life are influenced by the care they receive. The researchers conclude that resiliency can be taught if nurses engage in optimistic behaviors with patients. Key to patient's perceptions in this case was a positive and supportive environment and a "pleasant environment" at the treatment center and at home (Wilkes, O'Baugh, Luke & George, 413).

Another study examining stroke patients suggest that patients can maintain high expectations and a positive outlook for recovery when caregivers provide good communication and encouragement (Wiles, Ashburn, Payne & Murphy, 842). Further the study suggests that while caregivers should encourage patients to be optimistic, they must also be realistic in their expectations to promote more active participation from patients and skill acquisition.

There is support for teaching resiliency and optimism in certain medical situations. Many liken mental optimism in health to mental preparation before a sporting event (Ramsden, 119). There are techniques taught for example, to women preparing for childbirth that help contribute to a successful outcome. These techniques include concentrating on an optimistic and positive birthing process, which includes pushing, and breathing successfully (Ramdsden, 119).

One of the more commonly cited cases that supports resiliency as a learned process is a case with for the treatment of Cancer. In 1986 Siegel describes a situation where a young boy was taught to imagine he had a video game in his head. He was then told to use the video game to use missiles to kill the cancer tumor in his brain. Several months later the tumor was gone, supporting the notion that visualization techniques and optimism can have positive effects on ones health (Ramsden, 119; Brudal, 1995).

Brudal (1995) suggests that health professionals must be trained to teach patients coping techniques to help them activate positive resources they can access. Further she suggests that patients need not only to be comforted, but also given an opportunity to create positive self-awareness.

Fournier, De Ridder & Bensing (2002) conducted a study to examine the role optimistic beliefs had on chronic diseases including multiple sclerosis and rheumatoid arthritis. Their findings suggest that even unrealistic beliefs may help patients confront uncontrollable diseases, particularly when self-care options are limited. There study however suggests that optimism is inherent in the person with the disease and may relate to patients perceived self-care choices and future abilities.

In another study by Fournier, De Ridder & Bensing (1999) the meaning of optimism is examined. The researchers concluded that optimism consists of three dimensions, including "outcome expectancies, efficacy expectancies and unrealistic thinking" (p. 304). It is unclear the extend to which each of these dimensions may be impacted by outside forces, including health care opinions and expectations regarding ones illness.

Upon examining multiple sclerosis patients, Finger (1998) finds that optimism and resilience result from an unconcerned and unrealistic expectation of patient's ongoing physical deterioration (p. 243). Further he suggests that some patients, particularly MS patients, tend to break into "uncontrollable laughing, even with no reason to be happy," suggesting that their state of mind is pre-determined rather than taught (p. 243).

Segerstrom (2005) investigates the effects of dispositional optimism, which he characterizes as "generalized positive expectations for the future"(p.195). He examines experimental and naturalistic studies concluding that evidence is available suggesting that optimism is more likely a consequence of the patients engagement during the healing process. Further, segerstrom suggests that conscientiousness, which he defines as "a personality facet related to engagement" accounts for the effects of mood…