Mind Matters

by Sherry Dale, MSW, RSW

Spring 2008

 

If you are experiencing infertility, you have likely often been advised to “Think positive!” and “Be optimistic!” If you don’t (or can’t) muster up optimism or positive feelings, if you have an emotionally dark day, you may worry that you may be sabotaging your treatment.

 

In order to examine whether optimism and positivity are, indeed, necessary for positive fertility treatment outcomes, let’s look at what these two things are. Optimism is not the same as positive thinking. “Being optimistic” is about our expectations, and may indicate our general approach to life. “Thinking positive” is about our thoughts.

 

First, let’s discuss optimism. There are two types: dispositional and situational. Dispositional optimism is the general expectation that good things will happen. Situational optimism is the expectation that a specific situation will turn out in a positive way. These two types of optimism are not the same, and are only modestly correlated.¹ Dispositional pessimism describes the tendency to generally expect bad things to happen rather than good things, while situational pessimism involves expecting a certain situation to go badly. The origins of optimism and pessimism are not clearly understood.

 

Optimists and pessimists view their lives in very different ways.

 

Optimists…tend to see their troubles as transient. … They tend to see problems not as reflections of the misbegotten character of their life but as aberrations to be quickly set aside or overcome. They sense problems as essentially controllable. When bad things happen, they expect to do something about them, and they greet misfortunes as challenges. . .optimists tend to see each problem as specific to the situation at hand, not as characteristic of life in general.

 

[Pessimists] tend to assume that their troubles are permanent. When something goes wrong, they think that it will last forever, and they overlook any light at the end of the tunnel. They also think that their difficulties undermine everything they do. … that they have little or no influence over their troubles. When they are presented with new challenges, they tend to throw up their hands in surrender, quickly giving in to defeat and even despair.²

 

Some researchers, however, question whether pessimism is in fact the opposite of optimism. “It is possible for people to expect both good things and bad things to be plentiful and therefore appear both optimistic and pessimistic simultaneously.”³ This suggests that it is possible to be both optimistic and pessimistic, to expect both good and bad in life.

 

What might be defined as “situational pessimism” could also be seen simply as being aware of the statistical chances of success. If a couple is aware that their fertility treatment has a 35% success rate, heading into it with the awareness that there is a good chance they won’t conceive could be called “realism” rather than “pessimism.” They may be hopeful that they will fall into the 35% success category while being aware of the possibility that they will instead be one of the 65% who do not conceive. They may be generally optimistic, but not expect good outcomes in certain situations.

 

Does optimism lead to better health outcomes? Some studies do indicate that optimists have more positive outcomes with certain types of health problems, while others do not see a connection.⁴ Some research indicates that optimism can predict good outcomes for a while, but that these effects change if the health issue does not resolve quickly.⁵ It is possible that optimists, expecting good outcomes, persist at their treatment longer, while pessimists give up sooner.

 

The correlation between optimism and good health outcomes is not at all clear or consistent. However, whether or not optimists enjoy physical health benefits, they may feel better emotionally in relation to their stressor or health problems.^6,7 A researcher in this area says, “The effects of optimistic beliefs on physical health indicators and outcomes are not as consistently positive as are their effects on mental health. . . In numerous studies, the more positive people expected their futures to be, the better their mood, the fewer their psychiatric symptoms, and the better their adjustment to diverse situations…”⁶

 

I was unable to find any research linking optimistic attitude with better pregnancy rates from infertility treatment. In fact, one study found optimistic IVF patients did not have higher embryo quality than pessimists.⁸ There is, however, some evidence that optimistic IVF patients suffer less emotionally than pessimists when they do not conceive from their treatment. Researchers found that optimistic infertility patients experienced less anxiety, but not less depression than pessimists.⁹ Another study indicated that women who scored high in dispositional optimism (“Good things usually happen to me”) were less emotionally distressed after unsuccessful IVF, but those who were situationally optimistic (“This treatment cycle will work,”) were not less upset when they did not become pregnant through their IVF.¹⁰

 

Second, let’s discuss thinking positively. Many people have been captivated recently by the message in the book The Secret, which says through the “law of attraction,” what we think about is what we get. The book says, “Thoughts are magnetic, and thoughts have a frequency. As you think, those thoughts are sent out into the Universe, and they magnetically attract all like things that are on the same frequency. Everything sent out returns to the source. . . The law of attraction says like attracts like, and so as you think a thought, you are also attracting like thoughts to you. . . the law of attraction simply gives you whatever it is you are thinking about.”¹¹ If you think of disappointing fertility treatment results, The Secret claims that is what will occur. If instead, you think about a positive pregnancy test, that is what will come to be.

 

Long before The Secret was the book The Power of Positive Thinking, which states, “…if you think in negative terms you will get negative results. If you think in positive terms you will achieve positive results.”¹²

 

Critics of The Secret point out that its assertions and principles are scientifically untested. Many are concerned that the book’s message is intrinsically self-blaming. One writer stated:

[According to The Secret] If bad things happen to you, it's all your fault. As surely as your thoughts bring health, wealth and love, they are also responsible for any illness, poverty or misery that comes your way. That isn't just implied, it's spelled out: “The only reason why people do not have what they want is because they are thinking more about what they don't want than what they do want.”¹³

Some people going through infertility may take comfort in visualizing and thinking about themselves pregnant or holding their child. But if they follow the “think positive” message and do not end up successfully pregnant, they may feel that their negative outcome was due to a failure in the way they were thinking. This may add to their distress and disappointment.

When we discuss optimism and positive thinking, it’s important to distinguish between attitudes, thoughts and feelings. Thoughts and attitudes are in our minds - feelings are in our hearts and bodies. Our feelings simply are what they are - we do not choose them. Almost everyone experiencing infertility feels sorrow, worry, fear, loneliness, and despair at some point.

 

In our society, we see these painful emotions as “negative” and weak, and we do our utmost to distance ourselves from them by dismissing or ignoring them, distancing and distracting ourselves from them. People often ask me how they can “get rid of” the painful feelings their infertility gives them. They may be discouraged to hear that the feelings will simply be what they are until they run their course. I encourage them to use their energy to tolerate the emotions rather than battling or disowning them – to “ride the wave” rather than fight it.

 

In her wonderful book The Wisdom of Dark Emotions, Miriam Greenspan says:

 

Emotional suffering…is not a sign of mental disorder or illness. It’s a universal fact of life… A culture that insists on labeling suffering as pathology, that is ashamed of suffering as a sign of failure or inadequacy, a culture bent on the quick fix for emotional pain, inevitably ends up denying both the social and spiritual dimensions of our sorrows. . . Their purpose is not to make us miserable, drive us crazy, or shame, weaken, or defeat us, but to teach us about ourselves, others, and the world, to open our hearts to compassion, to help us heal and change our lives.¹⁴

 

Though it does not appear that being optimistic or thinking positively is necessary in order to achieve pregnancy through treatment, they may help you feel less distressed. If thinking in positive ways brings you comfort, great. If you are generally a pessimistic person, it is possible to learn how to be generally more optimistic. A counselor can assist you to reframe your expectations and come to expect better outcomes.¹⁵ When thinking positive thoughts, or cultivating optimism, it may be helpful to make these thoughts and attitudes more general and less specific. Thinking, “We’re going to be OK no matter how our treatment goes” may be more comforting than, “This IVF is going to get me pregnant.”

 

Don’t worry if your thoughts and attitudes are not always positive or optimistic as you navigate infertility. You are not causing your own negative outcomes if you have dark thoughts. No matter what you think, you will often feel worried, upset or sad about your infertility. Attend to your emotions by acknowledging them and accepting them.

1. Pais-Ribeiro, J., Martins da Silva, A., Meneses, R.F., & Falco, C. (2007). Relationship between optimism, disease variables, and health perception and quality of life in individuals with epilepsy. Epilepsy and Behavior, 11, 33-38.

2. Gunderman, R.B. (2007). The virtues of optimism. Journal of the American College of Radiology. 4(3):189-91.

3. Kubzansky, L.D., Kubzansky, P.E., & Maselko, J. (2004). Optimism and pessimism in the context of health: bipolar opposites or separate constructs? Personality and Social Psychology Bulletin 30(8), 943-956.

4. Smith, T.W. & MacKenzie, J. (2006). Personality and risk of physical illness. Annual Review of Clinical Psychology, 2, 435-467.

5. Segerstrom, S.C. (2004). Optimism and immunity: Do positive thoughts always lead to positive effects? Brain, Behavior, and Immunity, 19, 195-200.

6. Wrosch, C. & Scheier, M.F. (2003). Personality and quality of life: The importance of optimism and goal adjustment. Quality of Life Research, 12(Suppl. 1), 59-72.

7. S.C., Taylor, S.E., Demeny, M.E., & Fahey, J.L. (1998). Optimism is associated with mood, coping, and immune change in response to stress. Journal of Personality and Social Psychology, 74(6), 1646-1655.

8. Lee, A., Duckworth, A.L., Elkind-Hirsch, K.E., Seligman, M.E., & Scott, R.T. Jr. (2006). Negative Emotion Predicts Poor Outcome in Poor Prognosis IVF Patients. Paper presented at the American Society of Reproductive Medicine, October 247, 2006, New Orleans.

9. Bleil, M.E., Pasch, L.A., Gregorich, S.E., Katz, P.P., Millstein, S.G., & Adler, N.E. (2007). Dispositional Optimism and Psychological Adjustment to Fertility Treatment. Paper presented at the American Society of Reproductive Medicine, October 17, 2007, Washington, D.C.

10. M.D., Tennen, H., Affleck, G., & Klock, S. (1992). Coping and cognitive factors in adaptation to in vitro fertilization failure. Journal of Behavioral Medicine, 15(2), 171-187.

11. Byrne, R. (2006). The Secret. New York: Atria Books.

12. Peale, N.V. (1952). The Power of Positive Thinking. New York: Simon & Schuster.

13. Watkins, T. (2007, April 8). Self-help’s slimy “secret”. The Washington Post, p. BO1.

14. Greenspan, M. (2004). Healing Through the Dark Emotions: The Wisdom of Grief, Fear, and Despair. Boston: Shambalah.

15. Beck, A.T., Freeman, A., & Davis, D.D. (2004). Cognitive Therapy of Personality Disorders. 2^nd Ed. New York: Guildford.