Journal of Research and Reflections in Education

June 2010, Vol.4, No.1, pp 42 -61

http://www.ue.edu.pk/jrre

Positive Thinking in Coping with Stress and Health outcomes:

Literature Review
Zarghuna Naseem & Ruhi Khalid
Abstract: This article reviews literature on positive thinking and its
effect on the appraisal of stress, coping and health outcomes. Positive
psychology is a new dimension that focuses on positive thinking,
positive emotions and positive behavioral qualities that enhance human
potential in various domains such as work, coping with stress and
health. By thinking positively, we perceive the stress as less
threatening, are able to cope with it effectively. Fredricksons broaden
and build theory of positive emotions was the theoretical framework for
this article. Papers studying positive thinking, positive emotions,
optimism, hope and wellbeing were included in the review. The
implications for counselors, educationists and the community at large
have also been discussed.
Keywords: positive thinking, positive emotions, optimism, stress,
coping and health

Introduction
This paper is an attempt to review the literature on positive thinking and its
effect on stress appraisal, coping and health outcomes. Positive thinking is looking at the
brighter side of situations, making a person constructive & creative. Positive thinking is
related with positive emotions and other constructs such as optimism, hope, joy and
wellbeing. McGrath (2004) defined positive thinking as a generic term referring to an
overall attitude that is reflected in thinking, behavior, feeling and speaking. Positive
thinking is a mental attitude that admits into the mind; thoughts, words and images that
are conducive to growth, expansion and success.
Negative thinking is thoughts that imply criticism or devaluation of self. These
thoughts dominate the perception of a depressed person. People who think negatively do
not expect things to go as planned therefore anticipating bad outcomes. Their coping with
daily stressors becomes dysfunctional and they develop psychological and physical health
problems. Historically, psychologists have been solely focused on negative mental states

JRRE Vol.4, No.1, 2010

leading to pathology and disorder. The influence of positive thinking, positive emotions
on life satisfaction, quality of life and health outcomes was generally neglected.
However the last few years have been marked by renewed interest in positive
psychology. Many researchers have examined the beneficial effects of positive thinking,
positive feeling, positive emotions and positive behavioral qualities on psychological as
well as physical well being (Fredrickson 2001; Seligman and Csikszentmihaly, 2000;
Taylor et el., 1992).
In this article the researcher has reviewed the cross-sectional, longitudinal and
experimental researches to find out whether positive thinking plays any role in the
appraisal of stress, effective coping strategies and wellbeing. Positive thinking, in this
article has been defined as frequent experience of positive emotions, optimism, hope and
happiness. The researchers theoretical framework was Fredricksons broaden and build
theory (1998, 2001) of positive emotions and Lazarus transactional model of stress
(Lazarus & Folkman, 1984). Fredricksons broaden and build theory (1998, 2001) of
positive emotions suggests that a critical adaptive purpose of positive emotions is to help
prepare the individual for future challenges. Following Fredricksons model,
Lyubomirsky (2005) suggested that people experiencing positive emotions seek to attain
new goals (See also Carver, 2003). Positive thinkers encounter circumstances with
optimism and if they encounter stressful situations they appraise it as controllable and use
coping strategies that are functional, efficient and problem focused. Positive thinkers feel
that life is going well, their goals are being met, and resources are adequate (Carver &
Scheier, 1998; Cantor et al., 1991).
According to Lazarus & Folkman (1984), stress does not exist in the event but
rather is a result of appraisal of the event that is producing stress. They asserted that the
primary mediator of person environment transaction was appraisal. Stress itself is not
important, but the meaning we give to the stressful situation determines the intensity of
stress. Positive thinkers will appraise the stressful situation as less threatening and cope
with it effectively compared to negative thinkers.

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Theoretical Background
Positive thinking is related with positive psychology. The phenomena of
positive psychology have been found in Greek and Eastern philosophy, the Bible,
historical accounts and linguistic origins of words which provide important information
about human strengths. Schimmel (2000) echoed that psychologists working on the
dimension of positive psychology should explore their roots as exemplified in ancient
philosophy and religious writings. Positive psychology also has its root in humanistic
psychology which focuses on uniquely human issues, such as self-actualization, hope,
love, health, creativity, nature, being, becoming, individuality, and meaning. Humanistic
psychology is well established as the first organized form of positive psychology. It
emerged in the 1950s as the third force in psychology in reaction to both behaviorism &
psychoanalysis. The discipline included Abrahim Maslow, Carl Roger, & Rollo May who
stressed on a phenomenological view of human experience, seeking to understand human
behavior by conducting qualitative research. It tended to look beyond the medical model
of psychology, in order to open up a non-pathologizing view of person.
Recently, American psychologists devoted its millennial issue to the emerging
science of positive psychology, positive character, and positive institutions (Seligman &
Csikszentmihalyi, 2000). In their review of different approaches to positive psychology,
Seligman and Csikszentmihalyi noted that the early incarnations of humanistic
psychology lacked a cumulative empirical base, and some directions encouraged self
centeredness such as narcissism, egoism and selfishness. The association of humanistic
discourse with narcissistic and overly optimistic worldviews is a misreading of
humanistic theory. In their response to Seligman and Csikszentmihalyi (2000), Bohart
and Greening (2001) noted that along with pieces on self-actualization and individual
fulfillment, humanistic psychologists have also published papers on a wide range of
social issues, such as the promotion of international peace and understanding, awareness
of the holocaust, the reduction of violence and the promotion of social welfare and justice
for all.

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Positive Thinking and Coping with Stress
There is a relationship between positive thinking and stress. Occurrence of daily
positive emotions serves to moderate stress reactivity (Anthony Ong, 2006). There is
evidence that stress leads to heart disease ( Rozanski, 1999),

infectious illness (

Biondiand, Zannion, 1997) and autoimmune disorders ( Affleck et.al., 1997). Positive
thinking and positive affect have been found to be related with distress reduction and
predicting healthy outcomes (Tugade & Fredrickson, 2004; Tugade, Fredrickson &
Feldman Barret, 2004). Positive emotions undo the effect of negative emotions on
cardiovascular function (Fredrickson, & Levenston, 1998). A study of coping with stress
following the September 11, 2001, attacks in the United States found that resilient
individuals were less likely to experience depression and more likely to report increase in
psychological growth after the attacks (Fredrickson, Tugade, Waugh, & Larkin, 2003).
Moreover, positive emotions experienced after the attack completely mediated the
relationship between resilience and coping variables. These moments of positive
emotions may be viewed as opportunities to replenish ones system, which has been
depleted by grief (Folkman & Moskowitz, 2000). A meta-analysis conducted by
Lyubomirsky and King (2005) about the benefits of frequent positive thinking, in terms
of positive affect, optimism, happiness, satisfaction with life and other related concepts,
found that positive affect engenders success across multiple life domains, including work
performance, social relationship, perception of self and others, sociability, activity,
physical wellbeing, coping, problem solving, creativity and health.
A number of constructs have been introduced in the coping literature to explain
the capacity of some individuals to maintain a positive out look during negative life
circumstances. Optimism (defined as attributional style, Seligman, 1991, or as general
positive expectancy , Carver & Scheier, 1991, 2001), extraversion (McCrae & Costa,
1986), sense of coherence ( Antonovsky, !988, 1993), hope (Synder,2000) and hardiness
( Maddi & Kobassa, 1991) all refer to general trait that are correlated with positive affect
and promote positive thinking during difficult circumstances and all have been related
with positive health outcomes (e.g., Maruta, Colligan, Malinchoc, & Offord, 2000;
Snyder, 2000). For example, research has demonstrated that optimistic individuals
remember potentially threatening health relevant information more than pessimists
(Aspinwall, 1998; Aspinwall & Brunhart, 1996). However, they use humor and positive
45

Naseem & Khalid

reframing instead of denial when coping with highly stressful events (Carver et al., 1993).
One possibility is that the effects of these constructs on positive moods mediate their
relation to physical health outcomes (Segerstorm, 2000). Although, these concepts differ
in a variety of ways but their correlations with positive affect are well established (Clark
& Watson, 1991). Carver and Scheier did a lot of research on optimists and pessimists.
Optimists are quicker to accept a challenge. They engage in more focused, active coping
when such efforts are likely to be productive. They are less likely to display signs of
disengagement or giving up (Scheier & Carver, 2001). Optimistic women used more
adaptive coping strategies and had lower level of perceived stress (Anne, 2007). Scheier
and Carver (1985) found that optimistic students coped well with difficult situations
during the semester and reported less physical symptoms. Optimistic women who were
pregnant were more likely to engage in constructive thinking than the pessimistic
ones (Park et al., 1997). Furthermore, constructive thinking also correlated
negatively with anxiety and positively correlated with a positive s t a t e of mind.
Litt, Tennen, Affelect, and klock (1992) examined the reactions of people whose
attempts in vitro fertilization were unsuccessful. Escape was used as a coping strategy by
pessimist, which in turn caused greater distress after the fertilization failure. Strategies for
maintaining positive emotions and positive thinking help buffer against stress (Folkman
& Moskowitz, 2000). Most researchers concerned with the issue of finding meaning in
adversity perceive it as a powerful human strength associated with the minimization of
harm to an individual physical ( Afflect, Tennen, Croog, and Levine, 1987) and
psychological health (e. g., Davis, Nolen-Hoeksema, & Larson, 1998).
Shiota (2006) observed the effect of positive coping strategies on daily stressors.
Dispositional use of positive emotions inducing coping strategy was mostly associated
with positive aspects of well being. Positive emotional granularity (PEG) is the tendency
to represent experience of positive emotions with precision and specificity. This exerts an
important influence on coping by making the individual more attentive to the situation at
hand. Therefore the person is more likely to scan coping options thoroughly and less
likely to respond spontaneously (Tugade & Fredrickson 2004). Positive thinking has been
effective during the resettlement stage of the immigration process. Cognitive strategies of
positive comparison and optimistic thinking were utilized by the immigrants to change
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the meaning of resettlement difficulties (Wong and Denial, 2007).
When studying negative effects (NA) and positive effects (PA) on coping,
studies have shown that individual high in NA prefer avoidant behavior (Bolger and
Zukerman, 1995; Bouchard, 2003). Other researches (Gunthert et al., 1999) have shown
positive correlation between NA and perceived stressfulness. Research has shown that
stress exposure varies with negative affectivity and gender (Bolger & Zukerman, 1995).
In Eaton and Bradleys study (2008) participants perception of stressfulness increased
with participants negative affectivity. NA predicted use of both emotion and avoidance
focused coping.
Evidences from a variety of sources show that happy people are more satisfied
with their jobs than unhappy people (Connolly & Viswesvaran, 2000). Positive effect at
work has been found to be directly associated with reduced absenteeism (George, 1989).
Positive thinkers appear to secure better jobs. In one study, employees high in
dispositional positive affect had jobs as rated by trained observers, that had more
autonomy, meaning and variety ( Staw, Stutton, & Pelled, 1994). In a meta-analysis of
27 studies of affect and job satisfaction, Connolly & Viswesvaran, concluded that 10%25% of the variance in job satisfaction was accounted for by measures of dispositional
effect. Employees high in dispositional effect receive relatively more favorable
evaluations from supervisors and others (Staw et al., 1994). In Staw and colleagues
study, managers of high positive effects employees of three Midwestern organizations
gave them higher evaluations for work quality, productivity, dependability, and
creativity. Staw and Barsade (1993) found that, as rated by objective observers, those
high in dispositional positive affect performed better on a manager assessment task.
Positive thinkers and happy, satisfied workers are more likely to be high performers on
the job and they are less likely to show absenteeism, turnover, job burnout, and
retaliatory behaviors (Donovan, 2000; Locke, 1975). For example positive mood at work
predicted lower withdrawal and organizational retaliation and higher organizational
citizenship behavior (Donovan, 2000).
Ferreira (2006) analyzed the role of coping in the relationship between work
stressors and psychological wellbeing in a sample of 464 bank employees. Work related
stressors correlated positively with psychological distress and psychosomatic complaints.
In Healy and Mckays study (2000) nurses work related stressors and coping strategies
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Naseem & Khalid

were studied and its impact on the nurses job satisfaction and mood disturbance was
estimated. Positive correlation was found between nurses stress and mood disturbance,
and a significant negative relationship between nurses stress and job satisfaction was
found. Job and non-work stress correlated positively with behavioral, cognitive, and
physiological reactions to stress as well as with negative emotionality (Hogan, Carlson, &
Dua, 2002).
Positive Thinking and Health
There are two broad benefits of thinking positively under a stressful situation.
For one, positive thinking will enable the person cope better. The other is that positive
thinking increases the likelihood of a good outcome. Optimism has been shown to relate
to higher levels of self reported vitality and mental health ( Achat, Kawachi, Spiro,
Demolles, & Sparrow, 2000) and lower levels of depression . There is also evidence that
positive thinking may provide a sense of control in certain situations and reduce the
incidence of depression (Taylor, 1983).
Positive thinking and cardiovascular diseases. The benefits of positive thinking
are evident in the studies of cardiovascular health, cancer, and other diseases. There is
mounting evidence that positive emotions and positive thinking have an important role to
play in protecting blood pressure, and other heart ailments (Affleck, Tennen, & Croog,
1987). Afflect and colleagues studied 287 men who suffered heart attacks; about half of
them reported that the heart attack led to a change in philosophy of life, including
becoming more in touch with their values. Others reported that they learned the values of
healthy lifestyles; 25% reported that they modified their ways of doing things so they
could enjoy life more. Optimists, who are positive thinkers, evidenced better physical
recovery immediately after coronary artery bypass surgery and up to 6 months post
surgery (Carver & Scheier, 1993). Optimism, positive thinking and self esteem, reliably
predicted sustained recoveries for those who had just undergone angioplasty (Helgeson &
Fritz 1999). In a study on male war veterans, optimists, having positive thinking, were
less likely to suffer from angina and heart attacks (Kubzansky, Sparrow, Vokonas, &
Kawacgi, 2001) and they evidenced higher level of pulmonary functions and slower rates
of pulmonary decline, a protective affect that is independent of smoking
(Kubzansky,Wright, Cohen, Weiss, Rosner, & Sparrow,2002). Recent theorizing,
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however, has noted that many of the health effects of dispositional optimism parallel
those predicted by positive emotions of hope ( Aspinwall & Leaf, 2002).
Positive thinking & cancer. Positive effect has been shown to have a direct
effect on the quality of life of cancer patients (Collins, Hanson, Mulhern, & Padberg,
1992) and to similar allergic reactions among healthy students (Laidlaw, Booth, & Large,
1996). Studies suggest that optimistic cancer patients have a better quality of life than
those who are pessimistic and feel hopelessness (Schou, Ekeberg & Rauland, 2005).
Carver et al., (1993) examined the ways women cope with treatment for early stage
breast cancer and found that optimism was associated with a pattern of reported
coping tactics that revolved around accepting the reality of the situation, placing as
positive a light on the situation as possible, trying to relieve the situation with humor,
and taking active steps to do whatever there was to be done. Cruess, Antoni, McGregor,
et al. (2000) encouraged 34 women who had just undergone surgery with breast cancer to
find meaning in the adversity. Results showed difference in cortisol; the treatment group
who received behavior therapy showed lower level of this immune suppressing hormone
in blood stream, than the control group.
Although many professional writers continue to extol the virtue of positive
thinking, other commentators have also suggested that general injunction upon patients
with cancer to think positively may have negative consequences, imposing a social or
psychological burden that they can not bear (McGrath, 2004; Rittenberg, 1995) or
causing them to feel guilty or worthless if things do not go well (De Reave, 1997).
Positive thinking and Immune Functioning. Individuals with attributes closely
related to positive thinking have also been found to show heightened immuno
competence. For example, in two separate investigations, humor was associated with
enhanced immune function in participants who were predisposed to use humor as a
routine coping device ( Dellion, Minchoff, & Baker, 1985). Further more, sense of
coherence ( Antonovsky, 1993) was associated with natural killer (NK) activity among
older adult facing the stress of relocation. These health benefits of positive thinking
extend to other health problems such as common cold & allergic reactions (Cohen,
Doyle, Turner, Alper, Ans, Skoner, 2002).
Positive emotions mediate the effect of coping with humor & immune system
functioning (Dillon, Minchoff, & Baker, 1985-1986). Those with greater tendencies to
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cope with humor report daily positive mood. Consequently, in response to stress, those
with greater propensities to cope with humor show increases in levels of salivary
immunoglobulin A (S-IgA), a vital immune system protein, which is body first line of
defense against respiratory illness (Dillon et al, 1985-1986). In an experience sampling
study, self report of positive emotions predicted increases in S-IgA levels, thereby
enhancing immune functioning (Stone, Valdimars-Dottir, Jandorf, Cox, & Neale, 1987).
Valdimarsdottir and Bovbjerg (1997) conducted a study on 48 healthy women and found
that women who reported more positive mood had higher level of NK cell activity than
women with less positive mood. Segerstrom, Taylor, Kemeny, et al. (1998) studied
changes in NK cell activity in 50 students. There was strong relation between situational
optimism and immune activity. In Penebaker, and Francis (1993) study students who
were optimistic about their success in coping with the stressors had an immune system
that was better prepared to engulf and destroy cancer cells than those who were not
optimistic.
Laboratory studies with rheumatoid arthritis patients examined the effect of
positive thinking on autoimmune processes. Some of the patients were shown a video. A
blood test was taken for changes in level of interleukin 6 (Il-6), a proinflamatory cytokine
associated with autoimmune disease process in rheumatoid arthritis. IL-6 level of patients
who saw the film, which induced positive thinking, was compared with the patients who
did not see the video. Increasing positive emotions in both studies reduced the production
of immune products responsible for inflammation, pain and damage to the bodys joints
(Yoshino, Fujimori, KOhda, 1996; Nakajima, Hiari, and Yoshino, 1999).
Positive mood and the release of endogenous opioids are both associated with
lower acute stress reactivity (Fredrickson and Levenson, 1998). Taylor et al. (1992)
studied positive emotions such as optimism and psychological well-being among a sample
of gay and bisexual men who were at risk of developing Acquired Immunodeficiency
Syndrome (AIDS). Optimism was associated w ith lower levels of distress. Distress was
measured by a composite index of negative affect and their specific concerns about the
disease were also studied.
Research studied the lives of 40 gay men who had tested positive for HIV
(Bower, Kemeny, Taylor, & Fehey, 1998; Folkman & Moskowitz, 2000). Men who
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found meaning in the death of their partner had a slower rate of decline in circulating
CD4 cells, which is a marker of disease progression. Also, men who found meaning in
the death of their partner, had a three year longer life span than those who found no
meaning (Bower et al., 1998). People who recently lost their partners to AIDS; provided
spoken narratives three times: 2 weeks, 1 month, and 1 year post bereavement. Those
who used positive words showed a greater positive morale and a less depressive mood
(Stein, Folkman, Trabasso, & Richards, 1997). In related researches, several studies
demonstrated that positive thinking promotes good health and resulted in fewer illness
related physician visits over the following months compared to control participants
(Penebaker, Mayne & Francis, 1997).
Positive thinking and longevity. Cohen and Pressman (2006) found association
between trait positive affect with mortality (longevity), morbidity (illness onset) and
reports of symptoms and pain. A research was conducted in (Danner, Snowdon, &
Friesen, 2001) Notre Dame, with 180 nuns, to find out the relationship between positive
thinking and longevity. The researcher estimated that nuns who had positive thinking
lived an average of 10 years longer (Danner et al., 2001). Cohen (2003) exposed the
subjects to a rhinovirus; that cause the common cold. Results showed that positive
thinkers were less likely to develop a cold even after being exposed to rhinovirus. The
symptoms were reported and monitored. There was a considerable evidence linking PA
to reports of fewer symptoms, less pain and better health (Cohen et al., 2003). However,
other research presents confusing results: Knapp and colleagues (1992) found that both
positive and negative mood states have remarkably similar effects on immune system
functioning, producing decreased lymphocyte production in response to mitogens.
Similarly, pleasant and unpleasant moods were found to produce the same effect on
natural killer cell activity (Futterman, Kemeny, Shapiro, & Fahey, 1994).
Folkman & Moskowitz, (2000) described three strategies that predicted higher
level of positive well being in their longitudinal study of care givers of partners with
AIDS. First positive reappraisal, second problem focused coping, and third the creation
of positive events. Similarly women who focused on the positives despite hazardous child
delivery and prolonged hospitalization post delivery, showed greater well being and this
also extended to the developmental wellbeing of their children (Affleck & Tennen, 1996).
In addition to promoting physical health, cultivating positive thinking and
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emotions is associated with psychological health (Fredrickson, 2000). Emmons &

McCullough (2003) assigned participants to one of three groups: (1) count your blessing
(2) List daily hassles or (3) control. People who counted their blessings, claimed to have
better health, by having fewer physical complaints, frequently exercising and more hours
of better quality sleep.
Positive thinking and resilience. Resilient people are characterized by positive
emotionality: they have zestful and energetic approaches to life, are curious and open to
new experiences (Block & Block 1980). They use optimistic thinking (Masten & Read,
2002) and humor (Masten, 2001) as ways of coping. Moreover, resilient people not only
cultivate positive emotions in themselves, but they elicit positive emotions in others close
to them, which creates a supportive social network to aid in the coping process (Demos,
1989). Tugate, Fredrickson, & Barret (2004) observed that high resilient subjects showed
faster cardiac recovery as compared to low resilient participants.
Indigenous Research
To the best of our knowledge a little research on positive thinking and related
topics such as positive affect, well being, and life satisfaction have been reported. Suhail
and Chaudry (2004) determined and compared the prevalence and predictors of happiness
and personal well-being in Pakistani sample with other countries. A sample of 1000
Pakistani people; age range 16-80, from various areas of Lahore was collected. Although
random sampling was not used, every 10th house in a street was included to reduce
personal bias. Demographic variables such as work satisfaction, social support and
marital satisfaction were measured using different scales to find out its relation to well
being and happiness. Personality traits such as introversion and extraversion were
obtained by administering an Extraversion/ Introversion Scale (EIS) of Eysenck
Personality Inventory (1953). The scale was adapted and made short and culturally fair.
Religiosity was measured by on 18 item scale (Suhail, & Akram, 2002) designed to find
out religious affiliation in Muslims.

Rosenberg self esteem scale (1965) was

administered to measure self perception and well-being. General well-being was

measured by two indicators: personal happiness and life satisfaction. Personal happiness
was measured by Faces scale (Andrews and Withey, 1976). Life satisfaction was
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measured by Ladder scale of General Well-being (LSWB).
The findings of the study were consistent with previous world wide reports, that
there is a majority of happy people. In Pakistan, 7 out of 10 rated themselves as being
happy; in spite of economic hard ships, social and political turmoil and unrest. The
predictors of psychological well-being such as social support, work satisfaction, income
level, religious affiliation and marital satisfaction accounted for 19% and 23% of
variance in happiness and life satisfaction. Positive affect was correlated with wealth.
Income was positively correlated with well being and life satisfaction.
Amjad & Misbah (1998) studied the effect of religious meditation on anxiety
level and well-being. Spiritual attitude measure questionnaire was developed by the
researcher using Quranic translations, sufi texts and commentaries. Eighteen volunteer
females were assigned for meditation for 40 days. Pre and post tests were taken for each
variable. A significant mean difference was found between the pre and post measures of
well-being and anxiety after the mediation. No significant mean difference was found on
life satisfaction scale. Results signified that happiness and well being can be increased
and anxiety can be decreased through religious interventions.
Malik & Rehman (2003) studied the effect of occupational stress on
psychological well-being and work motivation. Findings showed a negative correlation
between occupational stress and psychological well-being. Some researches identified the
stressors of Pakistani people and their coping strategies.
Conclusion
The review of experimental studies has shown that positive thinking effects the
appraisal of stress, which determines our coping strategies. Thus the evidence supports
the researchers conceptual model that positive thinking increases the ability to deal with
stressors effectively and causes many successful health outcomes. The results of this
review can be replicated in Pakistan where negativity due to illiteracy and poverty is
prevailing every where. Geopolitical situations in the country are alarming and people are
under constant strains of bomb blasts. In these circumstances there should be measures to
protect them from negativity. There are implications for educationists who wish to reduce
the stressors of their students by preparing them to face the challenges of teachinglearning situations and professional life. Educationists can initiate programs to cultivate
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positive thinking in their students. Positive thinking interventions should focus on how
learners can identify their strengths, adopt new practices and habits, and restructure their
lives in ways that allow for a stream of positive emotions and experiences. Further more,
many of the characteristics observed in positive thinkers can help them improve their
conditions as well as others. These findings can also be used by the counselors to reduce
their clients negativity by inducing positive thinking in them. Community members can
change negative perceptions of the people into positive ones to make them healthy and
productive citizens of Pakistan.

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Correspondence
Name: Zarghuna Naseem & Ruhi Khalid
Email: zar_naseem@yahoo.com

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