It is difficult to differentiate between “putting on a happy face” and firmly believed optimism. Cognitive Consistency Theory would argue that positive verbalizations, regardless of whether they are believed, would help reduce tension and improve health outcomes (Joule, 1993). However, “putting on a happy face” could be considered a type of repression and there is some evidence that repression leads to negative health outcomes. Cox and Mackay (1992) concluded that inability to express emotion was a significant risk factor in relation to cancer progression.
Jensen (1997) found that repressors (as measured by the Marlowe-Crowne Social Desirability Scale and the Short Form Taylor Manifest Anxiety Scale) were more likely to be found among subjects with a history of cancer than those in the healthy control group. Repressors were also more likely to be in the group where the cancer had advanced than were it had not, and the repressive personality style was also correlated with significantly shorter remissions. Depression can be considered the opposite of a “positive attitude,” as one of its predominant features is negative evaluation of events and people.
Depression has been found to have a negative effect on health-related factors. Kiecolt-Glaser et al. (1994) found depressed subject to have significantly poorer DNA repair than did subject who were not depressed (measured by he Minnesota Multiphasic Personality Inventory, Scale 2, depression). Inheret in Kobasa’s (1999) Hardiness Scale, discussed in Chapter II, is the expectation of optimistic cognitive appraisals in hardly individuals. Kobasa has also found hardy individuals to be more healthy (as measured by the Seriousness of illness Survey and a self-report symptoms checklist).
An intuitive leap, unfounded by research, would say that these individuals would also tens to heal better. Further research is needed in this area. The issue of control is also at least partially attitudinal. Participants struggle to regain control of their lives, and they believed they should be able to gain control of their attitudes. With the belief that they were responsible for their attitudes the participants could be very self-blaming if their attitudes were not positive. Often they recognized when they were frustrated about their poor attitudes, and that this frustration was a poor attitude in itself.
Once this layering of frustration about frustration began it was difficult to stop the process. The downward spiral ended when positive events occurred to break the pattern. The same effect, in reverse, also seemed to occur. At least three participants had a positive attitude about having a positive attitude. Another part of Active Participation was the desire by participants to know what to expect. They disliked having more pain or tiredness than expected. They wanted to know when they could exercise, when they could return to normal functioning and what problems they might encounter.