Academic Psychiatry

, Volume 42, Issue 1, pp 135–145 | Cite as

Hope Modules: Brief Psychotherapeutic Interventions to Counter Demoralization from Daily Stressors of Chronic Illness

  • James L. GriffithEmail author
Column: "Down to Earth" Academic Skills

Demoralization refers to the helplessness, hopelessness, confusion, and subjective incompetence that people feel when sensing that they are failing their own or other’s expectations for coping ([1] p. 14). Psychiatric patients often become demoralized when distress from daily stressors is added to that from symptoms of mood, anxiety, or psychotic disorders. Psychiatric patients commonly face pile-ups of stressors that can include unemployment, loss of social status, conflicted relationships, stigmatization, and stress from an uncertain future [2, 3]. Ensuing demoralization can foster avoidant coping, rather than the assertive coping necessary for meeting challenges [2]. As unsolved problems accumulate, a vicious cycle of worsening demoralization can begin. Self-neglect, reflected in unhealthy diet, sleep, exercise, or substance use, is a frequent consequence. Personal relationships often deteriorate, and adherence to treatment regimens decline. Suicide among patients with severe...



Kaethe Weingarten, Ph.D. and her Witnessing Project ( provided ongoing consultation and inspiration for this work. Lisa Catapano, M.D., Ph.D. collaborated with the author in an initial workshop presentation of the hope modules, “Teaching the “common factors” of psychotherapy with psychotherapeutic modules of evidence-based practices,” at the 2013 Annual Meeting of the Association for Academic Psychiatry in Charleston, SC, Oct 16–19, 2013.

Compliance with Ethical Standards

Ethical Considerations

IRB Review is not applicable for this study. There is no protected health information, and this study is HIPPA compliant.


The author states that there is no conflict of interest.

Funding Sources



  1. 1.
    Frank JD, Frank JB. Persuasion and healing: a comparative study of psychotherapy. 3rd ed. Baltimore, MD: Johns Hopkins Univ Press. 1991;14.Google Scholar
  2. 2.
    Kaite CP, Karanikola M, Merkouris A, Papathanassoglou EDE. “An ongoing struggle with the self and illness”: a meta-synthesis of the studies of the lived experience of mental illness. Arch Psych Nursing. 2015;29:458–73.CrossRefGoogle Scholar
  3. 3.
    Cavelti M, Rusch N, Vauth R. Is living with psychosis demoralizing? Insight, self-stigma, and clinical outcome among people with schizophrenia across 1 year. J Nerv Ment Dis. 2014;202:521–59.CrossRefPubMedGoogle Scholar
  4. 4.
    Shea SC. The practical art of suicide assessment. Hoboken, NJ: John Wiley. 2004;78–79.Google Scholar
  5. 5.
    Slavney PR. Diagnosing demoralization in consultation psychiatry. Psychosomatics. 1999;40:325–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Griffith JL, Gaby L. Brief psychotherapy at the bedside: countering demoralization from chronic medical illness. Psychosomatics. 2005;46:109–16.CrossRefPubMedGoogle Scholar
  7. 7.
    Griffith JL, Dsouza A. Demoralization and hope in clinical psychiatry and psychotherapy. In: Alarcon RD, Frank JB, editors. The psychotherapy of hope: the legacy of persuasion and healing. Baltimore, MD: Johns Hopkins Univ Press; 2012. p. 158–77.Google Scholar
  8. 8.
    Thurman H. Jesus and the disinherited. Boston: Beacon Press; 1976. p. 11.Google Scholar
  9. 9.
    Hillesum E. An interrupted life. New York: Henry Holt; 1983. p. 130.Google Scholar
  10. 10.
    Weingarten K. Reasonable hope: construct, clinical applications, and supports. Fam Process. 2010;49(1):5–25.CrossRefPubMedGoogle Scholar
  11. 11.
    Weingarten K. Hope in a time of global despair. In: Flaskas C, McCarthy I, Sheehan J, editors. Hope and despair in narrative and family therapy. New York: Routledge; 2007. p. 1–23.Google Scholar
  12. 12.
    Walsh F. Traumatic loss and major disaster: strengthening family and community resilience. Fam Process. 2007;46:2007–27.CrossRefGoogle Scholar
  13. 13.
    Southwick SW, Pietrzak RH, White G. Interventions to enhance resilience and resilience-related constructs in adults. In: Southwick SW, Litz BT, Charney D, Friedman MJ, editors. Resilience and mental health: challenges across the lifespan. New York: Cambridge University Press; 2011. p. 289–306.CrossRefGoogle Scholar
  14. 14.
    Wade A. Despair, resistance, hope: response-based therapy for victims of violence. In: Flaskas C, McCarthy I, Sheehan J, editors. Hope and despair in narrative and family therapy. New York: Routledge; 2007. p. 63–74.Google Scholar
  15. 15.
    Wade A. Small acts of living: everyday resistance to violence and other forms of oppression. Contemp Fam Ther. 1997;19:23–39.CrossRefGoogle Scholar
  16. 16.
    Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.Google Scholar
  17. 17.
    Uchino BN. Social support and physical health: understanding the health consequences of relationships. New Haven, CT: Yale University Press; 2004.CrossRefGoogle Scholar
  18. 18.
    Maddi SR. The story of hardiness: twenty years of theorizing, research, and practice. Consulting Psychology Journal: Practice and Research. 2002;54:173–85.CrossRefGoogle Scholar
  19. 19.
    Snyder CR, Taylor JD. Hope as a common factor across psychotherapy approaches: a lesson from the dodo's verdict. In: Snyder CR, editor. Handbook of hope: theory, measures, & applications. New York: Academic Press; 2000. p. 89–108.CrossRefGoogle Scholar
  20. 20.
    Weihs KL, Enright TM, Simmens SJ. Close relationships and emotional processing predict decreased mortality in women with breast cancer: preliminary evidence. Psychosom Med. 2008;70(1):117–24.CrossRefPubMedGoogle Scholar
  21. 21.
    Chochinov HM. Dignity therapy: final words for final days. New York: Oxford University Press; 2012.CrossRefGoogle Scholar
  22. 22.
    Arnsten A. Stress signaling pathways that impair prefrontal cortex structure and function. Nat Rev Neurosci. 2009;10:409–21.CrossRefGoogle Scholar
  23. 23.
    Eisenberger NI. An empirical review of the neural underpinnings of receiving and giving social support: implications for health. Psychosom Med. 2013;75:545–56.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Hornstein EA, Fanselow MS, Eisenberger NI. A safe haven: investigating social-support figures as prepared safety stimuli. Psychol Sci. 2016;27(8):1051–60.CrossRefPubMedGoogle Scholar
  25. 25.
    Fox MD, Snyder AZ, Vincent JL, Corbetta M, Van Essen DC, Raichle ME. The human brain is intrinsically organized into dynamic, anticorrelated functional networks. Proc Natl Acad Sci U S A. 2005;102:9673–8.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Laird AR, Fox PM, Eickhoff SB, Turner JA, Ray KL, McKay DR, et al. Behavioral interpretations of intrinsic connectivity networks. J Cogn Neurosci. 2011;23:4022–37.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Chen E, Miller GE, Lachman ME, Gruenewald TL, Seeman TE. Protective factors for adults from low-childhood socioeconomic circumstances: the benefits of shift-and-persist for allostatic load. Psychosom Med. 2012;74:178–86.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Eisenberger NI, Cole SW. Social neuroscience and health: neurophysiological mechanisms linking social ties with physical health. Nat Neurosci. 2012;15:669–74.CrossRefPubMedGoogle Scholar
  29. 29.
    Griffith JL, Kohrt BA. Managing stigma effectively: what social psychology and social neuroscience can teach us. Acad Psychiatry. 2016;40(2):339–47.CrossRefPubMedGoogle Scholar
  30. 30.
    Gonzales L. Deep survival—who lives, who dies, and why. New York: W.W. Norton; 2004.Google Scholar
  31. 31.
    Joiner TE, Orden KA, Witte TK, Selby EA, Ribeiro JD, Lewis R, et al. Main predictions of the interpersonal–psychological theory of suicidal behavior: empirical tests in two samples of young adults. J Abn Psychol. 2009;118(3):634–46.CrossRefGoogle Scholar
  32. 32.
    Cacioppo JT, Patrick W. Loneliness: human nature and the need for social connection. New York: W.W. Norton. 2008.Google Scholar
  33. 33.
    Brewer MB, Chen Y. Where (who) are collectives in collectivism? Toward conceptual clarification of individualism and collectivism. Psychol Rev. 2007;114(1):133–51.CrossRefPubMedGoogle Scholar
  34. 34.
    Noorani F. Hope modules. In: Building resilience in humanitarian workers. Google Sites; 2016. Accessed 22 Oct 2016.
  35. 35.
    Nguyen NP, Dendeluri S, Kocher E, Dyer A, May C. The refugee crisis in Greece: a psychiatric needs assessment. Research poster presentation at the 169th Annual Meeting of the American Psychiatric Association; Atlanta, GA. May 13-18, 2016.Google Scholar
  36. 36.
    Griffith JL. Neuroscience and humanistic psychiatry: a residency curriculum. Acad Psychiatry. 2014;38:177–84.CrossRefPubMedGoogle Scholar
  37. 37.
    Cuthbert BN, Insel TR. Toward the future of psychiatric diagnosis: the seven pillars of RDoC. BMC Med. 2013;11:126.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Argyris C, Putnam R, Smith DM. Action science. San Francisco: Jossey-Boss; 1985.Google Scholar
  39. 39.
    White M. Maps of narrative practice. New York: W.W. Norton; 2007.Google Scholar
  40. 40.
    Griffith JL, Griffith ME. Engaging the sacred in psychotherapy: how to talk with people about their spiritual lives. New York: Guilford Press; 2002.Google Scholar
  41. 41.
    Levinas E. Totality and infinity (A. Lingis, trans.). Pittsburgh, PA: Duquesne University Press; 1961.Google Scholar
  42. 42.
    Wampold BE. The research evidence for the common factors models: a historically situated perspective. In: Duncan BL, Miller SD, Wampold BE, Hubble MA, editors. The heart and soul of change. 2nd ed. Washington, DC: American Psychological Association; 2002. p. 49–82.Google Scholar
  43. 43.
    Sprenkle DH, Davis SD, Lebow JL. Common factors in couple and family therapy. New York: Guilford Press; 2009.Google Scholar
  44. 44.
    Norcross JC, editor. Psychotherapy relationships that work: therapist contributions and responsiveness to patients. London: Oxford University Press; 2002.Google Scholar
  45. 45.
    Padesky CA, Mooney KA. Strengths-based cognitive-behavioral therapy: a four-step model to build resilience. Clin Psychol Psychother. 2012;19:283–90.CrossRefPubMedGoogle Scholar
  46. 46.
    Conoley CW, Pontrelli ME, Oromendia MF, Del Carmen BB, Nagata CM. Positive empathy: a therapeutic skill inspired by positive psychology. J Clin Psychol. 2015;71(6):575–83.CrossRefPubMedGoogle Scholar

Copyright information

© Academic Psychiatry 2017

Authors and Affiliations

  1. 1.George Washington University School of Medicine and Health SciencesWashingtonUSA

Personalised recommendations