If hope is so powerful, can it be built? Or are some people simply born hopeful and the rest of us out of luck?

This is where this series turns. For the rest, we move from what hope does to how you can build it. And we start where the science says we must—inside the brain. Because the answer to “can hope be built?” is not a matter of opinion or inspiration. It is a matter of anatomy. And the anatomy says: yes.

Hope has an address

Ask where hope lives and the sentimental answer is something like “in the eyes of a child.” The scientific answer is less poetic and far more useful: hope has actual addresses in the human brain.

One caveat first, because it is the brand of this newsletter. Whenever anyone calls a brain region the “center” for something, a neuroscientist somewhere winces, because it oversimplifies an organ we are nowhere near fully understanding. The brain is the most complex and interconnected organ in the body, and decades of rigorous research have still not mapped it the way we can map the heart or a kidney. So hold what follows as a working model, not a finished diagram.

With that said, researchers have identified three regions of the brain that work together to do the things hope requires—envisioning goals, finding routes, and summoning persistence. Think of them as the anatomy of hope.

The first is the prefrontal cortex, behind your forehead. Among many other jobs, it is deeply involved in planning, goal selection, and problem solving—which in Hope Theory terms is to say, in goalpower and waypower.12 It actively holds a representation of your goal and the means to reach it, and it signals the rest of the brain to turn that plan into action.

The second is the dorsal raphe nucleus, a tight cluster of neurons deep in the brainstem and a hub for serotonin signaling. Here is the counterintuitive part: under prolonged, uncontrollable stress, this region does not go quiet—it ramps up, and that surge can tilt the brain toward passivity and the behavioral fingerprint of helplessness. Crucially, when a stressor is controllable, the prefrontal cortex can send a braking signal that quiets it.

The third is the anterior midcingulate cortex, a bridge connecting thought, emotion, and movement—and the seat of something like willpower. A 2020 review in Cortex called it the “tenacious brain,” describing it as the hub that performs the cost-benefit math of is this worth it?—and, critically, that keeps you recommitting to the effort over and over.3 Each time you persist rather than quit, this region rewards you with more attention and energy to stay “locked in.”

The will to persevere, switched on like a light

If brain wiring still feels abstract, consider one of the more vivid findings in modern neuroscience.

In 2013, a Stanford team led by Josef Parvizi was using surgically implanted electrodes to map the brains of patients with severe epilepsy, trying to locate where their seizures originated.4 When they delivered a small electrical charge to the anterior midcingulate cortex, one fully awake patient described, out loud and in the moment, the feeling of driving into a storm he had to push through: “you have to keep going forward… push harder, push harder, push harder to try and get through this.”

The feeling was so striking and unexpected that the team repeated the procedure in a second patient, who reported the same pairing of foreboding and fight: “I knew I had to fight to make it… I can’t give up.”

The researchers had gone looking for seizures. What they found was the will to persevere, sitting in identifiable tissue, switched on by an electrical impulse.

The honest reading is not “scientists found the hope button.” It is something more modest and more reassuring: the drive to push through hard things is not a personality accessory some people happen to own. It is preinstalled hardware, present in all of us.

The experiment that reversed itself

The deepest piece of this story is also the most surprising, because it is a case of two scientists overturning their own famous work nearly fifty years later.

In 1967, Martin Seligman and Steven Maier ran a landmark experiment that became gospel in psychology for five decades.5 (A warning: the method involved shocking dogs and probably would not pass an ethics review today; I will keep the description brief.) Animals that first experienced shocks they could not escape later failed to escape shocks they easily could—they simply lay down and endured it. The conclusion was “learned helplessness”: creatures, including humans, learn from repeated, uncontrollable setbacks that nothing they do matters, and so they stop trying. For half a century, this was one of the dominant scientific explanations for passivity and despair.

Then, in 2016, the same two scientists published a neuroscience update that flipped their own interpretation on its head.6 Maier had retrained from psychology into neuroscience, and once he could map the underlying brain circuitry, the original story ran in reverse.

Here is the reversal, and it is the heart of this letter. Helplessness is not what gets learned. Under severe, uncontrollable threat, shutdown is the brain’s default—driven by that brainstem stress circuitry ramping up. What actually gets learned is control. When your actions reliably change an outcome—when you discover, even once, that there is a way out—your prefrontal cortex builds a kind of control map and sends a top-down signal that puts the brakes on the shutdown response.

Seligman gave it a name in the title of his memoir: The Hope Circuit. The upshot is worth reading twice. Helplessness is what shows up by default when control is absent. Hopefulness—the lived sense that my actions can change what happens next—is what gets learned when the brain repeatedly experiences exactly that. And once learned, it generalizes: future stressors stop automatically triggering collapse, not because life got easier, but because your brain now holds evidence, written into its circuitry, that effort can matter.

That learning—of pathways and agency, in the most literal biological sense—is what makes hope trainable.

Your brain is not finished

There is one more belief to dismantle: that somewhere in adulthood the brain sets like concrete and you become, permanently, whoever you already are. That is simply false.

The brain is plastic—malleable, changeable, across the entire lifespan. Neuroplasticity is its capacity to rewire itself in response to experience, forming and strengthening connections, and possibly even generating new neurons into adulthood (though the latter remains actively debated).7 This is not a hopeful slogan; it is a collection of findings that overturned the old “fixed brain” model.

The most charming proof comes from London. To earn a license, the city’s traditional taxi drivers must memorize more than 26,000 streets and landmarks—a brutal exam called “The Knowledge.” When researchers scanned their brains, the region responsible for spatial memory was measurably larger than in non-drivers.8 They were not born that way. Years of daily use was linked with growth in that part of the brain.9

You do not need to memorize a roadmap to use the principle. A region of the brain that you exercise can get stronger. And the working theory across this research is that the same is true of the hope circuit: the more you practice pushing through rather than shutting down, the more you fortify the very wiring that makes pushing through possible. Even brief, consistent training—mental and physical—has been associated with measurable changes in these pathways.101112 Neuroplasticity, you might say, is an anatomical version of a growth mindset.

The man who lost his future, and got it back

No honest tour of the brain skips Phineas Gage. In 1848, an explosion drove a tamping iron through the railroad foreman’s skull, destroying much of his frontal lobes—and with them, much of his prefrontal cortex. He survived, astonishingly, but he was changed. Damage to that planning machinery left him, in the clinical phrase, with a kind of myopia for the future—unable to make plans, trapped in the present, unable to turn drive into organized, forward-looking action.13 In the Hope Theory language of this series, Gage had lost the brain hardware for goalpower and waypower. His anatomy for hope was, quite literally, crushed.

But the story does not end with the injury, and that is the entire point. The record here is thin. No one ever examined Gage’s brain, and historians have had to reconstruct his later years from a handful of surviving documents. And what those documents show is a man who got better. He regained the ability to think minutes, then weeks, then months ahead. About four years after the accident he was driving stagecoaches—waking on schedule, harnessing horses, navigating routes, managing passengers and billing—work that demands exactly the future-planning his injury had stolen.14 The best explanation modern neuroscience can offer is neuroplasticity: his brain gradually relearned future orientation, and with it, his capacity to hope.

Set his story beside Seligman’s dogs and you see the same machinery from two directions. The dogs learned helplessness through their experience; Gage acquired it through damage to the “hardware” of his brain. In both, the default under uncontrollable threat is shutdown—unless higher control can devise an escape and applies the brakes. The dogs could be taught control. Gage’s brain had to rebuild the capacity for it. Both did.

What this means for you

So, can hope be built? The neuroanatomy answers plainly. You come preinstalled with the parts: a prefrontal cortex to find a way, an anterior midcingulate cortex to keep you going, and brainstem systems that drive the freeze response but can be reined in once the brain detects control. The system is there. It simply has to be switched on and strengthened—by use.

I want to be careful here, because this is the letter most prone to overreach. A brain region lighting up on a scan does not “prove hope works”; mechanism earns plausibility, while the outcomes I covered in earlier letters earn the claim. Much of the foundational circuit work began in animals, and the human brain remains, as every neuroscientist will happily remind you, a puzzle magnificently not-yet-solved. These are working models.

But the through-line is solid, and it is the most important thing I can tell you in this entire series: hope is not a fixed trait you were issued at birth in a fixed amount. It is a skill, supported by circuitry that is built to change. Some of us start with more than others. None of us is stuck where we started.

That is the biological permission slip for everything that follows. In the coming letters, we move from why hope is trainable to how you train it—the specific, evidence-based practices that strengthen the circuit. Because the take-home message of the neuroscience is the same one written under a 175-year-old story of a man with an iron rod through his brain who learned to hope again: change is possible.

— Dr. T

The relationship between childhood adversity and adult suffering was graded, linear, and unforgiving. The more ACEs a person had endured, the higher their risk, decades later, of heart disease, diabetes, cancer, obesity, depression, and addiction. Not a little higher. Remarkably, measurably higher, in close to a straight line. Childhood trauma writes itself onto the adult body.

And yet. Risk is not destiny. Plenty of people who carry the heaviest ACE scores do not just survive—they go on to build stable, healthy, even flourishing lives. Which is the question this letter is about, and it is the hardest test hope will face in this entire series: when a person has been handed the worst, what separates the ones who rebuild from the ones who don’t? A growing body of research keeps arriving at the same answer. At some point, the ones who rebuild learned how to hope.

How trauma erodes hope

First, it is worth understanding why trauma damages hope in the first place, because it is not what most people assume. Traumatized kids do not sit down and rationally conclude that the future is bleak. Hope erodes through biology and psychology, not choice. Researchers have mapped at least three mechanisms.

The first is rumination—the mind replaying painful events on a loop. People with high ACE scores are far more likely to get caught in repetitive negative thinking, and rumination itself predicts lower hope.2 If your mental bandwidth is consumed reliving a painful past, you have little left to imagine a better future.

The second is attachment. A child who learns early that the adults who were supposed to protect them cannot be counted on tends to believe you can’t rely on anyone, including yourself. That core belief, formed before you can even name it, quietly argues against setting ambitious goals or expecting to reach them.

The third is toxic stress, and it connects directly to the mechanisms I described in The Biology of Hope. A child living in sustained fear exists in chronic survival mode, and when the brain is braced for the next threat, the prefrontal cortex—the seat of planning, goal-setting, and generating routes forward—takes a back seat. It is hard to chart a path to the future when your nervous system is busy surviving the present. The same stress machinery that wears on a heart can wire a developing brain away from hope.

Hope can be rebuilt

Here is the turn. Adversity erodes hope—but hope can be rebuilt, even in the people who have been hurt the most. And we know this because researchers have rigorously studied this.

Chan Hellman and his colleagues at the University of Oklahoma worked with one of the most vulnerable groups imaginable: 229 children who had witnessed violence in their own homes, among other adversities. Nearly 80 percent had ACE scores of four or higher—the threshold above which health risks climb sharply. The intervention was a weeklong program, built explicitly on Hope Theory and tailored to these kids, that did exactly what the science prescribes: counselors worked with them on setting goals, generating pathways, and building agency. Not therapy. Hope training. Before and after, the children completed a validated hope measure, and after a single week, their hope had risen significantly—with parallel gains in grit, self-control, and curiosity, as if hope had unlocked capacities that had been dormant.3

That is a small study, and a week is a short time. But the more sobering evidence comes from a far larger dataset, and it concerns the worst possible outcome. Drawing on survey data from nearly 10,000 adolescents, Hellman’s group examined depression, self-reported suicide attempts, and hope.4 The question was whether hope changes how tightly depression and suicide attempts travel together. It did. Among adolescents with low hope, depression was strongly associated with suicide attempts; among those with high hope, that association was roughly halved. Hope did not make depression vanish, and it did not make risk disappear. But it functioned like a shock absorber against the heaviest of consequences.

The implication is striking enough that the researchers raised it themselves: perhaps teaching the specific skills of hope—goals that matter, routes around obstacles, small wins that build agency—belongs among our front-line tools for kids who have been through the worst. Early adversity does not have to end in tragedy.

When the worst happens to adults

Trauma is not only a childhood story, and neither is recovery.

Start with a reassuring fact most people get wrong. We tend to assume that catastrophe usually breaks people for good. The data say otherwise. In a 2018 analysis of 54 separate studies of people facing what we might call “lifequakes”—the death of a loved one, accidents, disasters, serious illness—more than 80 percent followed one of two paths: resilience (little lasting disruption) or recovery (a spike of distress, then a return to baseline). Chronic, unremitting distress was the exception, not the rule.5 Sometimes humans are tougher than we tend to think.

And hope is part of why. A meta-analysis of 154 studies tested whether positive expectancies—hope, optimism, and coping self-efficacy—were associated with the severity of post-traumatic stress after trauma. Higher positive expectancies tracked with lower PTSD symptoms, and the strongest associations of all were for hope and coping-specific self-efficacy.6 (I will flag, as always, that this evidence bundles hope with its near cousins; the researchers found hope to be among the strongest of them.)

And hope helps people bounce back. When researchers studied musicians during the pandemic—when live music essentially shut down and they were at risk of losing their livelihood—it was hope, not mindfulness, that predicted resilience and engagement over time.7 Mindfulness helps you sit with the present. Hope keeps you moving toward a different future.

The transformative power of a new story

There is something beyond simply recovering from trauma, and it has a name. The psychologists Richard Tedeschi and Lawrence Calhoun coined the term post-traumatic growth8 for a phenomenon that sounds almost paradoxical: some people emerge from catastrophe not merely intact but changed for the better—with deeper purpose, richer relationships, and a compassion often turned outward into service. Hope can be the catalyst that lets a person transmute pain into growth rather than only endure it.

No one understood this more profoundly than the Austrian psychiatrist Viktor Frankl, who refined his philosophy of hope across three years in Nazi concentration camps.9 Frankl concluded that even amid unimaginable suffering, a person retains one freedom no captor can take: the freedom to search for meaning in what is happening. As long as you keep searching, he believed, you are practicing hope—and the search itself is sustaining.

Part of how we do that is through the story we tell about our own lives. The mythologist Joseph Campbell noticed that cultures the world over tell a single underlying story—the hero’s journey. An ordinary person is forced from their comfortable world, faces trials and an ordeal that nearly breaks them, perseveres, and returns transformed. Strip it to its skeleton and it is oddly familiar: set a goal, choose a path, face obstacles, overcome them, keep going. The one-word version of the hero’s journey is hope.

And this is not merely a charming metaphor. In a set of eight studies, researchers found that people who were guided to see their own lives as resembling a hero’s journey reported a greater sense of meaning—and that deliberately “re-storying” a life in those terms could increase it.10 How we narrate what happened to us shapes whether we are battered victims of circumstance or the protagonists of a comeback. One of my favorite sayings is: there is no better story than a comeback story.

The hardest test, and the turn ahead

So here is where the first eight letters in this series have brought us. Hope is associated with a healthier heart, a measurably altered biology, a longer and sharper life, stronger performance at work and in school—and now, in the place it matters most, the capacity to rebuild a life after our darkest days.

The honest caveats hold, as they have throughout. Much of this evidence is observational. ACEs raise risk but do not seal fate. Hope is not a cure, and it does not erase what happened; it is, at once, a shield against the lasting damage of adversity and a means of building something better despite it.

But notice what changed in this letter. For seven letters, I showed you what hope predicts. Here, for the first time, I showed you hope being built—229 traumatized children, a one-week very intentional intervention, a measurable rise in hope. If hope can be deliberately taught to kids who have survived the worst, then the question that has been waiting underneath this entire series finally moves to center stage. Not whether hope matters. We have settled that. The question is how you build it.

That is what the rest of this series is about. And we will start inside the brain, with the neuroscience that makes hope trainable in the first place. That is where we go next.

Hope is an anchor. And it can be forged.

— Dr. T

If you or someone you know is struggling or in crisis, help is available. In the U.S., call or text 988 (the Suicide and Crisis Lifeline), available 24/7.

Four times more engaged. Not because they were smarter. Because they had more hope.

I have spent my career as a physician-scientist, but also as an educator—a professor of medicine who has spent decades teaching medical students and resident physicians-in-training in lectures and at the bedside of patients. And the single most important thing I have learned about teaching is something that science now confirms with unusual strength of association: what a learner believes about their own future, and what their teacher believes about them, helps shape what they can become. Here are the data.

The teacher who didn’t know

The most famous experiment in this field began with a quiet deception—aimed not at the students, but at their teachers.

In the late 1960s, Harvard psychologist Robert Rosenthal and his colleague Lenore Jacobson went to an elementary school in a low-income South San Francisco neighborhood. At the start of the year, they gave all the children a standardized aptitude test. Then they handed each teacher a list: the names of the roughly 20 percent of students who, according to the test, were poised for dramatic intellectual growth in the coming year—the “bloomers.”

Over the next eight months, those flagged students did, in fact, post significantly larger gains on IQ testing than their classmates—especially among the youngest children.2

Except the test had identified nothing. The “bloomers” had been chosen completely at random. There was no real difference between them and their classmates—except one: their teachers believed that there was. The children never knew they’d been flagged. The only thing that changed was what the teachers expected—and, as a result, how they taught. The expectation became the reality.

That finding is now known as the Pygmalion effect, after the sculptor in Ovid’s Metamorphoses who carved a statue so perfect he fell in love with it, and it came to life. The idea has been retold ever since—most famously in George Bernard Shaw’s play Pygmalion, which became My Fair Lady—because something in us believes that one person’s belief can help transform another.

Now, the honest accounting, because this study has been romanticized into something it was not. It does not show that belief turns any sham into prophecy, or that calling a child a genius will make them one. The original study drew real methodological criticism, and the effect sizes vary considerably across ages, settings, and how outcomes are measured. What the careful research supports is narrower, and more useful: teacher expectations shape teacher behavior, which shapes a student’s academic self-concept—what the child comes to believe about their own ability—which can shape the child’s performance. A 2019 study of nearly 1,500 middle-schoolers showed exactly this chain: higher teacher expectations predicted higher later math achievement, and the students’ academic self-concept was one of the pathways connecting the two.3

And it is not only children. In a 1982 experiment, researchers told some instructors of Israeli military trainees that certain recruits had unusually high “command potential.” The recruits had, again, been chosen at random. By the end, the trainees whose instructors expected more of them scored dramatically higher on objective tests and assessments of leadership skills.4 What the preponderance of data points to is that, at every age, we may rise or sink to meet the faith others place in us.

Parents: “I believe in you” is not enough

Here is the part that matters most, and it is where hope separates itself from its look-alikes.

Telling a child “I believe in you” feels supportive. But on its own, it is just cheerleading—and cheerleading is closer to optimism than to hope. It is a belief in a good outcome with no plan attached. As I have argued throughout this series, optimism without agency is just wishing.

Compare two sentences a parent or teacher might say. The first: “I believe in you.” The second: “I believe you can do this, and I am going to help you figure out how, and help you stick with it until you get there.” The first is a sentiment. The second is hope—a goal, a pathway, and the willpower to stay on the path, handed to a child in a single sentence. The difference between them is the difference between wishing a student well and actually impacting what they do.

This is also where hope gets confused with its academic cousins, so let me sort them plainly. “Growth mindset,” from Stanford’s Carol Dweck, is the belief that ability can improve with effort—closest to the agency piece of hope. “Grit,” from University of Pennsylvania’s Angela Duckworth, is sustained perseverance toward long-term goals—closest to willpower. Both are real, and both are essentially components of the larger structure. As you have seen earlier in this series grounded in Hope Theory, hope is the construct that contains all three at once: a goal worth reaching, the pathways to reach it, and the will to keep going. That is why, when researchers measure it, hope predicts so much.

What the student’s own hope predicts

The Pygmalion studies are about the belief of the adult in the room. But what about the hope inside the student?

A meta-analysis of forty-five studies, encompassing more than 9,000 students, examined the link between hope and academic achievement. One point matters before the result: these studies measured hope with Rick Snyder’s Hope Scale—the will-and-the-ways definition I described in How Hope Actually Works—not vague positivity. Students with higher hope had higher grade point averages, and the connection was strongest among elementary, middle, and high school students, when belief in oneself may be most foundational.5

Then there is the data from the Gallup Student Poll, which is what produced the number I opened with. Across millions of responses from students in grades five through twelve, hope tracked with nearly everything on which schools are measured. Compared with their least hopeful peers, the most hopeful students were 2.8 times more likely to report excellent grades, 3.1 times more likely to strongly agree they do well in school, 4.1 times more likely to be engaged, and 2.2 times less likely to say they miss a lot of school.6 All told, the researchers estimated that hope accounts for roughly 13 percent of the variance in students’ academic success.7

Thirteen percent, from a single, trainable cognitive process (way of thinking), sitting alongside everything else we pour into education—the curriculum, the funding, the technology. Hope is not a substitute for any of those. But it is a measurable, independent contributor that many schools do not address at all.

The kids who need it most

Two more things about this body of research are worth holding onto.

The first: hope can be built. Hope is not a fixed trait a child either has or lacks; it is a way of thinking that can be taught, modeled, and strengthened—which is the whole premise of where this series is heading. A parent or teacher who consistently pairs high expectations with concrete pathways, with ways around the obstacles, and with the steady support to keep going is, in effect, running a hope intervention.

The second is easy to miss, but look again at where Rosenthal ran his study: a school in a low-income neighborhood. The children who responded most powerfully to a teacher’s belief were precisely the ones the system tended to expect the least of. That is the pattern across much of this research. Hope is not only an advantage for the already-advantaged; it can matter most for the children facing the steepest odds, the ones for whom a single adult’s belief is most likely to have an impact. Hope does not erase the very real barriers of poverty and disadvantage. But of all the things we might give a struggling child, a credible, structured belief that the future can be better, and that they play a vital role in making it so, can be among the most powerful.

The teacher you remember

Almost everyone can name one. A teacher, a coach, a mentor who believed in them before they believed in themselves—and somehow that belief became a self-fulfilling prophecy. That is not sentiment. That is the Pygmalion effect, remembered from the inside.

The honest caveats apply here as everywhere in this series: this evidence is observational, the effect sizes vary, and belief is not magic. Expectations work through what adults actually do, and what students come to believe about themselves.

But the through-line is hard to miss. The most important thing a great teacher, parent, or mentor gives a child is not the answer to the problem. It is hope—belief, plus viable pathways, plus the will—installed early enough to compound for a lifetime.

So far in this series, hope has been linked with better health, longevity, and performance at work and school. But the real test of hope is not how it performs when life is going well. It is what it does when a person faces the worst that life can deliver. That is where we go next.

Hope is teachable. So let’s teach it.

— Dr. T

That is the backdrop for something my co-author Anthony Mazzarelli, MD and fellow leaders at our health system started, called the “5 at 5.” Every weekday at five o’clock, anyone in the organization could join a videoconference, and the leaders would walk through five things about COVID: the newest data, what we were learning, what was changing operationally. The facts mattered. But that is not why it worked.

It worked because, in a moment when nothing felt secure, gathering at the same time each day became an anchor to hold on to. It told thousands of frightened people that someone was watching the storm, making sense of it, adjusting course. There were hands on the wheel. It was, more than anything, a daily glimmer of hope.

I kept a journal during those early weeks in the ICU. Some of it is hard for me to re-read now. In one entry, one of my kids asks me, straight out, if I was afraid of dying. After one “5 at 5” call, I wrote about the thing this whole letter is really about: Fear spreads like a virus, but so does hope.

Which raises a question that sounds almost too soft to ask in a business setting: can something like hope actually be an asset at work? The evidence says yes—and not vaguely.

“Hope is not a strategy.” Actually, it is.

You have probably heard the old saying “hope is not a strategy.” It gets attributed to the great football coach Vince Lombardi, among others, and it is usually deployed to dismiss hope as wishful thinking—the opposite of a hard-nosed plan.

But by now in this series, multiple steps into the science of hope, you know that hope is not wishful thinking. It is the opposite. It is futurecasting a vivid goal, plus developing the pathways to reach it, plus the agency to stay on the path and keep going—which is to say, hope is necessary for every strategy. In fact, it is the underlying structure of success.

Defining objectives is goalpower. Developing the routes to hit them and navigating around obstacles is waypower. Maintaining the drive to push through those obstacles is willpower. A business plan with no belief that it can succeed, and no will to execute it, is just a document. Hope is how that document becomes reality.

I want to be careful here, because the workplace is where this kind of language gets slippery. “Positive psychology” at work is a crowded field of overlapping terms: optimism, engagement, self-efficacy, resilience, and a bundle that researchers call “psychological capital,” or PsyCap. These are related, and I will label which is which as we go. But hope is the one with agency built into its definition—not just the belief that things will be good, but the conviction that you can do something about it. That is why it shows up so consistently when researchers measure what actually moves performance.

And the cynical reflex, that the hard-bitten pessimist is the smartest person in the room, turns out to be backwards. In research spanning roughly 200,000 people across thirty countries, those who held more cynical beliefs scored, on average, lower on measures of cognitive ability and competence, not higher. Researchers named it the “Cynical Genius Illusion.”1 Cynicism feels like intelligence. The data say it isn’t.

What followers actually want

Here is the finding that should reorganize how we think about leadership.

In 2025, the Gallup Organization published a study called the Global Leadership Report: What Followers Want. Researchers surveyed more than 30,000 adults across fifty-two countries, and asked two simple questions. First: which leader has had the most positive influence on your daily life? It could be anyone—a boss, a parent, a coach, a teacher, a religious or political figure. Second: name three words describing what that person contributes to your life.2

Two things came back. The first: the leader who matters most is almost always local. The vast majority of people named someone in their own orbit—a manager, a mentor, a family member—not a famous or distant figure. Influential leadership is personal.

The second is the one I cannot stop thinking about. When researchers coded the thousands of words people used to describe their most positive leaders, four themes rose to the top. Number four was stability. Number three, compassion. Number two, trust. And number one, far and away, was hope. In fact, more than half of all the coded attributes were expressions of hope: leaders who made people believe the future could be brighter and that there was in fact a path to get there.

Sit with that. Out of everything a person might value in a leader—intelligence, decisiveness, charisma, expertise—the single most common thing people actually named was hope. Napoleon, of all people, put it in four words two centuries ago: “A leader is a dealer in hope.” The data now back that up. Hope is the number-one thing followers want from the people who lead them. And this is not Pollyanna-like wishful thinking or burying one’s head in the sand. It is the eyes-wide-open confrontation of the brutal facts ahead, as the Stockdale Paradox demands—and, despite them, the conviction that we will make it through.

The asset that shows up in the numbers

What followers want is one thing. What hope actually does to performance is another, and this is where it stops being inspirational and becomes quantifiable.

Shane Lopez, working with Gallup, estimated that hope accounts for roughly 14 percent of the variation in workplace productivity.3 Not engagement in the abstract—productivity. And as I described earlier in this series, in How Hope Actually Works, a meta-analysis of 45 studies and more than 11,000 employees found that high-hope workers were about 28 percent more likely to be successful at work, and about 44 percent more likely to report good health and well-being, compared to their low-hope peers.4

Underneath those headline numbers is a consistent texture. Higher-hope employees are rated by their supervisors as more creative.5 Higher-hope managers generate more, and higher-quality, solutions to problems.6 Higher-hope workers earn stronger performance reviews7 and are more resistant to burnout—which matters most, the research suggests, precisely in the hardest jobs: child-abuse pediatricians, child-welfare workers, caseworkers, and emergency responders.8

It even shows up in your bank account. A longitudinal study following more than 25,000 Australian adults found that moving from the lowest to the highest level of hope (measured here as the absence of hopelessness) was associated with substantially higher disposable household income a decade later, on the order of 30 percent of the median.9 And when financial shocks hit—bankruptcy, major losses—the blow to life satisfaction was nearly twice as large for the “totally hopeless” as for the “totally hopeful,” who also recovered faster. Hope did not prevent the storm. It was a shock absorber that kept people functional until it passed.

Leading with hope

If hope is what people want from leaders, and hope is what drives performance, then the most important thing a leader does may be to supply it.

Consider two managers handling the same situation: an employee asks for something—a resource, a raise, a change—and the answer, for now, is no. The first manager simply says “the higher-ups said no,” and the employee walks away feeling unseen and powerless. The second says: “I raised it with senior leaders, and I can’t get it done right now. But here are the changes we need to make for it to happen. I will stay on this, and we will get there, together.” Same outcome. Completely different effect. The second employee leaves with a path and a reason to keep investing. That is hope, administered very intentionally.

And it is not just “bedside manner” for the workplace. A 2024 study of 347 employees in the U.S. and U.K., published in the European Management Journal, traced the actual chain: when employees felt strong organizational support, they saw more workable routes to their goals (hope-pathways), which fed a stronger sense of agency (hope-agency), which fed commitment, which produced more “going above and beyond” behavior at work. The striking part: when the researchers statistically accounted for hope, the direct connection between feeling supported and giving extra effort vanished.10 Hope was not a nice byproduct. It was the mechanism.

The leadership lesson is not that hope guarantees victory. Colin Powell, who knew something about leading under pressure, called optimism a “force multiplier,” and he was right. A leader who can turn fear into a credible sense of direction can get a team to hold the line far longer than the raw odds would predict. Not by denying the difficulty, but by giving people a route through it.

Hope is contagious

Let me close where I started, with what I learned in those pandemic weeks: fear spreads like a virus, but so does hope. That turns out to be the whole point. Hope in a workplace is not a private trait each person carries alone—it spreads, downward from leaders and outward across teams, the same way fear does.

As always, here are the honest caveats. Much of this evidence is observational and cross-sectional; a good deal of it measures hope alongside its cousins—optimism, engagement, psychological capital—and I have flagged that where it matters. None of it says hope substitutes for competence, capital, or a sound plan.

But put it together and the conclusion is hard to dodge. Hope is the most-wanted attribute in a leader, a measurable contributor to productivity, a predictor of creativity and income and resilience, and the mechanism underneath employee commitment. It is not the soft thing you get to after the real work. It is a vital part of the real work.

Which raises one more question. If hope does all of this for adults in the workplace, what does it do for children in the place where they spend their formative years—the classroom? That is where we go next.

Hope is a business strategy. Deploy it, with purpose.

— Dr. T

Let me put the question the way the Yale epidemiologist Becca Levy does, because it is sharper than “do you feel positive?” What do you believe about your own aging? Not aging in general, and not what you think about “old people.” When you picture yourself at seventy, or eighty, or ninety, what do you see? Someone sharp, engaged, still contributing? Or someone foggy, frail, essentially waiting around to die?

Your answer may be one of the most important health predictions you will ever make. And the reason why turns out to be hope—pointed at your future self.

Seven and a half years

Levy has spent decades studying what she calls “age beliefs”: our expectations about what our own aging will be like. In a landmark study, she and her colleagues followed 660 people aged fifty and older for up to twenty-three years. They measured each person’s beliefs about aging at the start, then tracked, over time, who lived and who died.

People with more positive beliefs about their own aging lived an average of seven and a half years longer than those with negative beliefs.1 That advantage held up even after accounting for factors like age, sex, socioeconomic status, loneliness, and baseline physical health. To put the magnitude in perspective: that is a longevity benefit comparable to exercising regularly, keeping your cholesterol and blood pressure in check, or not smoking. Their beliefs about aging, measured decades earlier, predicted whether they would live to watch their grandchildren graduate.

Through the lens of the framework I laid out in How Hope Actually Works, this is not mysterious at all. Positive age beliefs are simply hope, applied to your future self. If you believe later life can hold growth, meaningfulness, and vitality, you keep goals worth pursuing into old age (goalpower); you believe there are multiple potential routes to stay healthy and engaged (waypower); and you stay motivated to take care of yourself, because you believe the future self you are investing in is worth it (willpower). Levy found something that makes the connection almost literal: the longevity advantage was partly explained by “will to live,” which is Hope Theory’s willpower component, applied to survival itself.

One honest note on language. Levy’s “age beliefs” are their own validated measure, not the Hope Scale by another name. But they are hope’s near relative—expectation plus agency aimed at your own future—and Levy herself frames the results in those terms. I will keep flagging which is which, the way I always do.

Living longer is only part of it

Here is the thing about extra years: they only matter if they are years worth having. Which is why Levy’s most compelling work is not about lifespan at all. It is about healthspan, i.e., the number of years you stay healthy, sharp, and independent. And it is where the findings stop being merely impressive and start being hard to believe.

Start with the brain. In a study of 4,765 older adults who were dementia-free at the outset, positive age beliefs significantly lowered the risk of going on to develop dementia. But the remarkable part involves the people who carried the apolipoprotein E (APOE) ε4 gene variant, which is the single strongest genetic risk factor for Alzheimer’s disease. Among those high-risk carriers, the ones with positive age beliefs were 50 percent less likely to develop dementia than the carriers with negative age beliefs.2 Read that again: hope about aging was associated with cutting a major genetic risk of Alzheimer’s roughly in half.

How could a belief reach brain tissue? Levy went looking. Using the Baltimore Longitudinal Study of Aging, she measured age beliefs in dementia-free people and then followed them for decades with yearly MRI brain scans and, eventually, brain autopsies. Those who had held more negative age beliefs years earlier showed steeper loss of volume in the hippocampus, the brain’s memory hub, and at autopsy had greater accumulation of the amyloid plaques and neurofibrillary tangles that are the signatures of Alzheimer’s.3 The likely route is the one we traced in the last letter: decades of expecting decline is a form of chronic hopelessness, and chronic stress drives inflammation and neurodegeneration. The belief may reach the brain the same way it reached the artery.

And lest this sound like fate sealed by your attitude at fifty—it isn’t. In a 2023 study, Levy examined older adults already living with mild cognitive impairment, the uneasy zone between normal aging and dementia. Those with more positive age beliefs were about 30 percent more likely to recover normal cognition—and they recovered up to two years sooner—than those with negative beliefs.4 Even after decline had begun, hope was associated with healing.

It is not just Levy, and not just hope

A single researcher, however careful, is never enough. So look at whether the signal holds in other hands. Here I have to switch labels honestly, because these studies measured optimism, hope’s close cousin, rather than hope itself.

In a University of Michigan study of 4,624 seniors, optimism was independently associated with 48 percent lower odds of developing cognitive impairment over four years.5 In a Harvard study following roughly 33,000 women, the more optimistic ones had a 23 percent greater likelihood of “healthy aging”—staying alive and free of chronic disease, disability, and cognitive impairment.6 A companion Harvard study of men and women found a 24 percent greater likelihood of the same.7

Every one of those measured optimism, not hope, and I am labeling them as such. But as I explained in Hope and Your Heart, the two travel together so tightly at the population level that when you find a benefit in highly optimistic people, hope was almost certainly in that group too. Different research teams, different populations, the same signal.

Adding life to years

And the benefit is not only about how long you live or whether your brain holds up. It also shows in how the years actually feel. Here, the evidence is specifically about hope, not optimism.

Harvard researchers drew on the Health and Retirement Study, a large, nationally representative sample of U.S. adults over fifty, to ask what higher hope predicted in the years that followed.8 Comparing the most hopeful with the least, higher hope was associated with measurably healthier behavior and mood downstream: about a 13 percent higher likelihood of frequent physical activity, and about a 12 percent lower likelihood of sleep problems. The most hopeful also went on to report higher life satisfaction, a stronger sense of purpose, less depression, less loneliness, and better social connection. Hope did not just track with staying alive; it tracked with the texture of the life being lived.

Put it together with Levy’s longevity and brain findings and the picture is not really about death at all. It is about the quality of the years in between. Hope does not just add years to your life. It adds life to your years.

The pill you would take

Let me be honest about what this evidence is and isn’t, because that honesty is the whole point of The Hope Effect series. These are observational studies. They establish powerful, durable, repeatedly-replicated associations, carefully adjusted for confounders. But an association is not a guarantee, and none of this proves that becoming more hopeful will, by itself, hand you a specific number of extra years. What the data show is that hope tilts the probabilities, dramatically, in the right direction.

And none of this is about denial. It is not pretending aging has no losses, or smiling at a hard diagnosis. It is about holding a credible belief that your later years can still be meaningful, engaged, and vital—because that belief, it turns out, is biologically active.

Here is how my co-author and I like to frame it. If a pharmaceutical company put a pill on the market that might give you seven and a half extra years of life, and cut your risk of Alzheimer’s roughly in half, you would take it without a second thought. So would I. The associations in the published evidence suggest that hope might behave something like that pill. The difference is that you cannot buy it, and no one can prescribe it for you. You build it.

Which raises the question this whole series has been walking toward. We have seen that hope is associated with healthier hearts, less chronic stress and systemic inflammation, and longer and brighter lives. But does it do anything for the parts of life we spend awake and working: the office, the team, the classroom? That is where we go next.

The preponderance of evidence supports that hope can be a type of preventive medicine. Apply liberally.

— Dr. T

To begin answering that, I want to take you to a battlefield.

During World War II, an American anesthesiologist named Henry Beecher ran out of morphine. Wounded soldiers kept arriving, and the supply was gone. So Beecher did something desperate: he injected them with plain saline—salt water—and told them it was morphine. To his astonishment, many of the men calmed, and their pain eased, as though they had received the real drug.1 Beecher had stumbled onto the modern study of the placebo effect. And the lesson buried in that field, decades later, is the foundation of this entire letter: belief is not separate from biology. Belief is biology.

Belief is biology

For two centuries, doctors assumed a placebo “worked” by fooling the mind—a harmless trick, a bit of theater. That assumption was wrong. The treatment may be fake, but the response is physically real, and we can now watch it happen.

The cleanest demonstration came in 1983. Researchers gave people a placebo for pain, and for those who responded—whose pain genuinely dropped—they then administered naloxone, a drug that blocks the body’s opioid receptors. If the placebo relief had been “just psychological,” blocking opioid receptors should have done nothing. Instead, the pain came back.2 The placebo had been working by triggering the brain’s own opioid system—its endorphins, the same chemistry behind a runner’s high. Block the chemistry, and you block the relief. Belief had set off a measurable biochemical cascade.

The same fingerprint shows up across body systems. In Parkinson’s patients, placebos can trigger measurable dopamine release in the brain.3 In people with a dust-mite allergy, those who expected an (inert) treatment to calm their skin had smaller, less angry hives—their immune response visibly shifted on the strength of expectation alone.4

Here is the part that makes most physicians (myself once included) want to roll their eyes. It still works when you remove the deception entirely. In "open-label" placebo studies, patients are told outright that the pill is inert. But how that's said turns out to matter enormously. "Just take this fake pill. Maybe it'll help, I don't really know" is not the same intervention as a warm, confident clinician saying: "This is a sugar pill. It contains no active medicine—and it can help anyway, because the mind is powerful. I've seen it work."5 In a 2024 randomized trial, adults with chronic back pain given an open-label placebo not only reported less pain; their functional brain scans showed objective changes that mirrored the relief.6 In another study, young people in Germany learning to drive who took open-label placebos before a notoriously difficult driving exam had markedly less anxiety and failed at a rate about 40 percent lower than the control group.7 They knew the pills were inert. It worked regardless.

Two honest guardrails, because this is exactly where popular writing about the mind tends to run off the road. First: the placebo response modulates symptoms and physiology—pain, anxiety, inflammation, blood pressure—it does not dissolve tumors or cure infections. Belief is powerful; it is not magic. Second: how the placebo is delivered matters enormously. In work from Alia Crum’s lab at Stanford, an inert cream calmed an allergic reaction far more effectively when the clinician applying it was compassionate, confident, and competent than when they were cold and dismissive.8 The biology responds not just to the pill, but to the trust around it.

The housekeepers

If belief can move the body directly, it can also move the body the long way around—by changing what we do. And the most striking demonstration of that involved no pill at all.

In a 2007 study, Crum and Ellen Langer studied 84 hotel housekeepers—people whose workdays are already full of physical labor. One group was simply told the truth: that the vacuuming, scrubbing, and lifting they did all day already met the Surgeon General’s recommendations for exercise. The other group was told nothing. Both groups were asked not to change their routines. Four weeks later, the informed group had lost weight, trimmed their waistlines, and lowered their blood pressure. The control group showed no change.9 The only thing that had changed was what they believed about their own activity.

This is where the biology meets the framework I laid out in How Hope Actually Works. The active ingredient here is agency—the belief that your condition is something you can influence, and that you have a role in making it so. That belief changes behavior in small, compounding ways: the housekeepers almost certainly moved with a little more vigor, perceived their effort as less of a burden, carried less stress about it. Hope works partly by changing physiology directly, and partly by changing what you do, which then changes physiology.

We see the behavioral half of this everywhere in the data. There is a well-documented “healthy adherer” effect: in a meta-analysis of roughly 20,000 people, those who reliably took their pills had a markedly lower death risk—even when the pills were placebos.10 The pill did nothing. The kind of person who believes the plan will work, and follows it, tends to follow the rest of the plan too—the appointments, the diet, the walking. Belief becomes behavior, and behavior becomes biology.

(One quick anecdote, because I can’t resist it. At the 1997 Tour de France, a cyclist asked his trainer for a performance-enhancing injection before a brutal stage. The trainer, uneasy, secretly filled the syringe with sugar water. The cyclist rode the race of his life and credited the shot. The trainer later wrote: “There is no substitute for self-belief.” I tell that as a story, not as evidence—but it rhymes with everything the controlled studies show.)

The route to the artery

Now back to the debt I owe you from last time: the actual physical path from a state of mind to a diseased artery. We can trace a good part of it, and it runs through the body’s stress machinery.

When stress becomes chronic, a system called the HPA—hypothalamic-pituitary-adrenal—axis keeps flooding the bloodstream with cortisol. Over time, abnormal cortisol patterns are associated with higher risk of cardiovascular disease, metabolic syndrome, immune problems, and more. Across many human studies tracking cortisol, people higher in hope and optimism tend to show a healthier profile: lower overall cortisol, more normal daily cortisol rhythms, and faster cortisol recovery after a stressor. Hopelessness and pessimism track with the opposite—the dysregulated, wear-and-tear pattern.11 Hope does not delete stress from your life; it changes how your body carries it.

There is a second branch. The autonomic nervous system runs on a seesaw between the sympathetic (“fight or flight”) and parasympathetic (“rest and digest”) systems. One way to read that seesaw from the outside is heart rate variability—the small, healthy variation in time between heartbeats, which the smartwatch on your wrist now estimates. Higher variability generally signals a flexible, resilient nervous system; a sharp drop signals strain.

A Swiss study captured this with eerie precision. Researchers monitored heart rate variability in champion chess players during tournament games. When a player’s position on the board turned objectively hopeless—checkmate looming, no viable path forward—their heart rate variability dropped sharply.12 The collapse of a path forward, registered in the heart, in real time. Hopelessness, it turns out, is associated with low heart rate variability; hope may be a way to protect it.

Put the pieces together and the route from the last letter stops being mysterious. Hopelessness is associated with HPA-axis dysregulation and sympathetic overdrive; that pattern is associated with higher blood pressure; and higher blood pressure, sustained over years, is one of the surest paths to the thickened, diseased arteries we saw predicted by hopelessness in men and in women. A belief about the future reaches the artery by way of cortisol, blood pressure, and the autonomic nervous system. Not magic. Plumbing.

What mechanism settles, and what it doesn’t

So does this show that hope causes better cardiac outcomes? No—and I promised I would keep saying so. What understanding the mechanism does is something subtler and genuinely important: it removes the main reason to dismiss the association. When skeptics see that hopeful people live longer, the reflex is, “Correlation. Something else explains it.” But once you can show a plausible biological pathway—belief altering the opioid system, the immune response, cortisol, blood pressure—the association stops looking like a coincidence and starts looking like cause and effect waiting to be confirmed. Plausibility is not proof. It is what turns a curious correlation into a serious hypothesis.

One honest note on the evidence, the same one I always owe you: much of the cortisol and nervous-system research measured hope and optimism together, or optimism alone. I have flagged it as such. The placebo and mindset studies, by contrast, are about belief and expectation specifically—the cognitive raw material of hope.

We have now seen that hope predicts cardiac outcomes, and that there is real biology underneath. Which points to a question bigger than any single disease. If hopelessness wears the body down through cortisol and blood pressure, day after day, year after year—then what does its opposite do over a lifetime? Does hope actually help you live longer? Live better? That is where we go next week.

— Dr. T

Researchers at Duke had followed 2,818 patients who had been hospitalized with a heart attack or the threat of one, and who had all undergone cardiac catheterization. Before discharge, the patients answered a set of questions measuring their hope for recovery. Then the researchers waited, and looked at who was still alive seventeen years later. The gap between the patients most hopeful for recovery and least hopeful for recovery was so large that my first thought was that it had to be a mistake.

So I did what skeptics do: I went looking for the error. I called Duke to reach the lead author, John Barefoot, and learned he had died only a few months earlier, at eighty-one. That did not stop me. I tracked down his colleagues, and I even found the psychologist who had designed the original recovery expectations survey. I wanted someone to tell me the finding was soft. No one did.

That study was a large part of why The Hope Effect series exists. Let me show you what was in the graph.

The curve

The paper was titled “Recovery expectations and long-term prognosis of patients with coronary heart disease,” published in 2011 in the Archives of Internal Medicine (now JAMA Internal Medicine).¹ The questions the patients answered were plain ones: Do you think you will ever fully recover? That your life will be back to normal? That you can still have a long and healthy life? In other words: how much hope did they have for their recovery?

The raw numbers: about 55 percent of the patients in the highest-hope quartile were alive seventeen years later. Among the patients in the lowest-hope quartile, only about 15 percent were. Over nearly two decades, survivors among the most hopeful outnumbered those at the opposite extreme by roughly three to one.

Here is the part that stopped me. After adjusting for the factors a cardiologist would insist on (age, the severity of the heart attack, functional status, other medical conditions, social support at home, and even depression), hope for recovery remained an independent predictor of survival.

I want to give you an honest frame of reference for that magnitude, and an honest caveat in the same breath. A cornerstone of standard treatment at the time of a heart attack is aspirin, which makes blood platelets less sticky; its absolute mortality benefit is a little over 2 percent, and it is rightly considered essential, evidence-based care.2 The hope effect observed here looks far larger. But, and this matters, you cannot directly compare the two. Aspirin’s benefit comes from randomized controlled trials that allow inference of cause and effect. The Duke study is observational: it shows a powerful, durable association, adjusted for confounders, but it cannot “prove” that hope itself did all the work. What it earns is the word predicts, not causes. I will hold that line through every discussion of research in this series.

When my trainees smirk at the idea that hope belongs in the domain of cardiology, this is the graph I show them. More than once, the response has been: “It can’t be real.” And my answer is the same every time: if you don’t believe this one study, I have plenty more.

The dark mirror

Here are some more.

If hope tracks with better survival, we have to ask the other half of the question: does hopelessness track with worse outcomes? A real test of the hypothesis looks in both directions. And if hopelessness does track with harm, in measurable biological mechanisms and outcomes, then we are no longer talking about something decorative. In the first letter in this series, Does Hope Really Matter?, I described a study in which hopelessness predicted faster thickening of the arteries in middle-aged men, at a magnitude the lead researcher compared to a pack-a-day smoking habit. That was not a fluke of one cohort.

The same association turns up in women. In the Study of Women’s Health Across the Nation—the SWAN heart study, researchers found that hopelessness was associated with greater carotid atherosclerosis (the same arterial thickening) in women.3 Two very different cohorts, the same fingerprint.

It reaches mortality directly, too. In a separate analysis of patients with coronary artery disease, a measure of hopelessness independently predicted death from cardiac causes—the finding behind a word that has since attached itself to the research literature: cardiotoxic.4 Not a metaphor. A measured (and independent) association with dying.

And it appears upstream of disease, in the machinery that produces it. Hopelessness has been shown to predict the development of high blood pressure. In a study of Finnish men, high levels of hopelessness predicted the new onset of hypertension over four years.5 A separate 24-year follow-up study found the same direction of association between hopelessness and blood pressure over the long run.6 That is a clue we will chase later in this series, because high blood pressure is a plausible physical route from a state of mind to diseased arteries.

Hope on one side, predicting survival. Hopelessness on the other, predicting vascular disease, high blood pressure, and death. The same axis, examined from both ends.

A necessary distinction

Now I have to be careful with you, because this is exactly the place where popular writing about the mind and the body tends to cheat.

Everything above measured hope or hopelessness specifically. But a great deal of the cardiac evidence—and it is substantial—measured optimism, which is not the same thing. Optimism is the belief that the future will be good. Hope, as I described in How Hope Actually Works, includes that belief and adds pathways thinking and agency: the goal, the routes, and the will to stick to a route, even when it gets hard. Optimism is a building block of hope, not a synonym for it.

Conflating the two is a real methodological error—serious enough that researchers have a (pejorative) name for it, “construct creep.” So I am not going to call optimism studies “hope studies.”

But here is what makes the optimism evidence relevant rather than off-topic: the two constructs are distinct, yet they are not independent. It is possible for an individual person to be a high-hope pessimist or a low-hope optimist; you can be high or low on either or both.

However, at the population level, hope and optimism tend to travel together. When researchers compared the dispositional version of Snyder’s hope scale with the standard optimism measure, they found a very strong correlation, about 0.80.7 So when a study reports that highly optimistic people had better cardiac outcomes, even though it did not measure hope directly, a substantial number of high-hope people were almost certainly in that optimistic group. The researchers measured optimism. But hope was in the room.

Even optimism is good for your heart

With that label firmly attached, look at how consistent the optimism evidence is.

In about 300 patients undergoing coronary artery bypass surgery, higher optimism was independently associated with a 50 percent lower risk of being readmitted to the hospital in the six months after the operation.8 In a study of 664 people hospitalized for a first heart attack, high optimism was independently associated with a 33 percent lower risk of death over the following two decades.9 And in roughly 2,389 patients with persistent chest pain after a stent procedure, those with low expectations for returning to a normal life had about a 40 percent higher risk of needing rehospitalization or another artery-opening procedure over time, compared with those who had high expectations for recovery.10

Step back from the individual studies and the picture only gets steadier. Across multiple systematic reviews and meta-analyses pooling hundreds of thousands of people, optimism has been associated with fewer cardiovascular events and roughly a 13 to 15 percent lower risk of death from any cause.11 Different research teams, different populations, the same range.

Every one of those studies measured optimism, not hope. I am labeling them precisely. But given how tightly the two travel together, hope was almost certainly along for the ride.

What the heart knows

So here is the honest accounting I promised in the subtitle.

Strip out every optimism study, hold them to the side, and the hope-specific evidence still stands on its own: hope for recovery predicting survival after a heart attack; hopelessness predicting arterial disease in men and in women, predicting cardiac death, predicting the onset of high blood pressure. Then add the optimism evidence back, correctly labeled, and it does not replace that core. It amplifies it, pointing in the very same direction across hundreds of thousands of additional people.

The link between the mind and the heart is real and it is measurable. What it is not, yet, is explained. An association, however durable, is not a mechanism. How could something as abstract as an expectation about the future reach something as physical as a coronary artery? The hypertension studies were a hint. In next week’s letter, I will take apart the biology: what actually happens in the body between a belief and an outcome.

For now, the data say something a cardiologist a generation ago might have dismissed out of hand: what you believe about your recovery is part of your recovery. The mind is not merely a bystander to what’s going on in the body. The evidence is clear: as far as your heart is concerned, hope matters.

— Dr. T

Most of us carry a milder version of the same armor. We say it to each other constantly: don’t get your hopes up. The logic is self-protection—if you never let yourself hope, disappointment can’t find you. But notice the premise buried inside that advice: that hope is something that happens to you. A wish you release into the universe, which fate then grants or denies.

And the grammar of everyday English is in on the camouflage. Notice that when we use hope as a verb, we are usually wishing about things beyond our control: I hope it doesn’t rain. I hope they pick me. But when we use it as a noun, it suddenly carries weight: he lost hope. She found hope again. We instinctively treat hope as something a person can possess—and losing it as a serious event. Our instincts are right.

What the noun names is a real capacity—one with nothing owed to luck, fate, or jinxes. Over the last three decades, science has taken that capacity apart and identified its working parts. And once you can see the parts, you can start to build them.

The framework hiding in plain sight

In 1994, University of Kansas psychologist Charles “Rick” Snyder published The Psychology of Hope: You Can Get There from Here, in which he pulled hope apart and introduced a framework he called Hope Theory.1 The book never received the attention it deserved in its day. But its central insight may matter more today than the day it was printed: hope is not a feeling, a wish, or a desire. It is a way of thinking that drives action.

Last week I wrote that hope is not something we wait for, it is something we do. Hope Theory is the machinery behind that sentence. Specifically, hope is a cognitive process with three distinct, identifiable components. I call them the three powers.

The three powers

Goalpower (aka futurecasting): Wishful thinking pictures the destination—the garage full of Ferraris, the infinity pool. No judgment here; there is nothing wrong with a imagining life better than it is today. But hope does something more: it converts desire into a concrete goal. The goal can be aspirational (something good you want to happen) or aversive (something bad you want to avoid). Either way, what matters is that it is meaningful enough to inspire commitment—and the more specific and vivid the goal, the more effectively it motivates action.

Waypower (aka pathways thinking): the ability to generate viable routes (note: plural!) to reach that goal. From the outside, success looks like a straight line. It almost never is. It is a zig-zag of snags, detours, and trips back to the drawing board. Waypower means expecting that. You might have to get off the train and take the bus; you might have to get off the bus and walk. If you expect an easy path, the first roadblock can end the pursuit. If you expect roadblocks, rerouting around them is simply part of the plan.

Willpower (aka agency): the sustained motivation to stay on the path. People often equate willpower with self-denial, like skipping dessert. That is not what this is. Willpower here is the commitment to stay on the path, keep marching toward a desired outcome, and to bounce back from failure, over and over. It is the energy that converts the map into miles. And its absence has a name. Researcher Chan Hellman points out that the opposite of hope is not pessimism, and it is not even hopelessness—it is apathy: the absence of goal-directed energy.2

Snyder called the last two components “the Will and the Ways” of hope. You need both. A goal without a route is a wish. A route without the will to follow it is just a plan.

The four beliefs

Put into practice, high-hope individuals share four key beliefs:3

1. The future will be better than the present (optimism).

2. I play a role in how my future unfolds (agency).

3. There are multiple ways to get there (pathfinding).

4. There will be obstacles (anticipating).

Notice two things about that list. First, optimism is on it—as one ingredient of four. That is the relationship I described last week: hope begins where optimism stops, but it begins with it. Second, look at belief number four. Expecting obstacles is not pessimism creeping in at the edges—it is part of hope itself. Realistic acknowledgment of the challenges ahead, and the expectation of having to navigate around (or over) them, is precisely what separates authentic hope from blind optimism.

Not just taxonomy

A fair question at this point: is this framework just tidy relabeling? Three boxes with clever names? The test of a scientific construct is whether measuring it predicts something real. Hope passes that test, and here is the part that makes the chain airtight: Snyder did not stop at theory. He and his colleagues built validated instruments directly from these components—the Adult Hope Scale, the State Hope Scale, and the Children’s Hope Scale—whose items map onto pathways and agency. So when the studies below measured “hope,” they were measuring the triad of Hope Theory, not a vague feeling of positivity.

In a 2012 Johns Hopkins study, 174 adults admitted for inpatient rehabilitation—after spinal cord injury, stroke, amputation, or major orthopedic surgery—completed Snyder’s Hope Scale and a standard measure of positive mood during the first days of their stay. Three months after discharge, hope at admission was an independent predictor of functional recovery—mobility, occupational engagement, reintegration into the social community. General cheerfulness was not. After adjustment for age, sociodemographics, and length of stay, a 3 percent increase in the hope measure predicted a 4 percent increase in social reintegration.4 The machinery predicted recovery; the mood did not.

In the workplace, a meta-analysis co-authored by Shane Lopez—a psychologist who trained under Snyder and became a senior scientist at Gallup—combined 133 effect sizes from 45 studies totaling more than 11,000 employees, nearly all using Snyder-framework measures. Its title is borrowed from Snyder himself: “Having the will and finding the way.” Translated into plain terms, high-hope employees were about 28 percent more likely to be successful at work, and about 44 percent more likely to report good health and well-being, compared to their low-hope peers.5

And in education, a meta-analysis of 45 studies encompassing more than 9,000 students—roughly 85 percent of which used Snyder’s domain-general hope scales—found that higher hope was associated with higher grade point averages, with the link strongest among elementary, middle, and high school students, when belief in oneself may be most foundational.6

Across these three domains—physical recovery, work, school—one framework, one family of instruments. The honest caveat, as promised: these are observational studies that report associations, statistically adjusted but not randomized. What they license is the word predicts, not the word causes. But a construct that predicts who recovers, who thrives at work, and who succeeds in school is not just taxonomy. It is a signal.

When every path closes

There is a hard case the framework has to face, and I want to name it now even though it deserves its own essay. Sometimes waypower fails honestly: every once-viable route to the goal closes down and is truly gone. The dream requires a set of circumstances that no longer exist. The answer in that moment is not more willpower thrown against a wall. It is re-goaling—the deliberate, often painful choice of a new and different goal still worth walking toward. It can require radical acceptance, and a period of grieving the original vision is normal. Shane Lopez put it in six words: “Re-goaling is where hope meets courage.”7 We will spend a full essay there in the weeks ahead.

Keep chiseling

One last thing about 1994. The same year Snyder’s book quietly appeared, a movie about hope quietly flopped at the box office before becoming one of the most beloved films ever made. In The Shawshank Redemption, Andy Dufresne has a vivid, concrete goal—freedom, “a warm place with no memory.” He has a pathway no one else can see, and a chisel. And he has agency measured in decades: he chisels at the wall of his cell, at night, for nineteen years. His friend Red, meanwhile, speaks for the other side of the ledger: “Hope is a dangerous thing; it can drive a man insane.” Goalless, pathless, Red sabotages his own parole hearings—until Andy’s escape activates something in him. Get busy living, or get busy dying.

Stephen King sets his stories in prisons for a reason, and the metaphor lands squarely on the science: low hope is a prison of the mind. High hope is how we set ourselves free. The three powers are not personality traits issued at birth. They are skills—and in the essays ahead, I am going to show you the evidence for exactly how they are built.

Keep chiseling.

— Dr. T

Except that it does—and that connection is the reason The Hope Effect series exists. The theologian Emil Brunner wrote: “What oxygen is to the lungs, such is hope to the meaning of life.” I deliver oxygen for a living, and I am going to use this Substack to show you that Brunner’s metaphor is not poetry. What oxygen does for a body—what it makes possible, and what collapses without it—hope does for a life. And that turns out to be something you can measure and build.

I did not always believe that. On rounds in my ICU, I ask my medical students and resident physicians (trainees) a question: Do you think hope really matters? I get a range of answers. I also get some eye rolls. I understand the eye rolls, because I was trained the same way. Doctors are taught to be precise, and hope can seem fuzzy around the edges—the thing people reach for when the data run out. For me, demanding evidence is an occupational requirement: 150 publications, most of them in the field of resuscitation science. When I hear a claim, my reflex is to ask for the data, and then to look for what’s wrong with the data.

The author Maurice Lamm captured the strange double-mindedness most of us carry about this subject: “We know in our bones that hope is everything. In the back of our minds we worry it is nothing at all.”

I decided to settle that tension the only way I know how. With evidence.

The third question

This is the third time my colleague Anthony Mazzarelli, MD and I have gone looking for an answer to a question that sounds soft until you lay out all the data.

In our first book, Compassionomics, the question was: does compassion really matter—or is it just a nice-to-have, like a cherry on top of the sundae? We reviewed hundreds of studies and found that compassion moves the needle in measurable ways, for patients and for the people who care for them.

In Wonder Drug, the question moved outside the hospital walls: does serving others really matter—for your health, your relationships, even your livelihood? Again, hundreds of studies said yes. And again, a much stronger signal in the data than we expected.

Now the question is hope, and it is the broadest of the three. The science of compassion was about how we treat one another. The science of serving others was about how we live our lives. Hope sits upstream of both—it shapes how a person faces nearly everything in front of them. So although I am a physician-scientist and this story starts in a hospital, this is not a medical project. It is about a human capacity that leaves fingerprints all over medicine because it leaves fingerprints nearly everywhere.

Hiding in plain sight

Here is what surprised me most. The evidence on hope was not hard to find because it was thin. It was hard to find because it was scattered in so many different domains.

Study after study, published in premier journals, like Science and The New England Journal of Medicine, and conducted at places like Harvard and Stanford, has documented real effects of hope on outcomes that matter. These are not obscure papers. But each one stood siloed in its own field. A cardiologist’s finding never met an education researcher’s. A study of healthy aging never sat beside a study of the workplace. Some of this work is fifty years old and not fully digitized—it lives in bound volumes in the basements of university libraries, spines cracked open for what may have been the first time in decades.

No one had connected them. So that became the project: not to discover something new, but to assemble what already existed and ask what the full body of evidence says when you finally analyze it altogether. One study at a time, these findings made ripples. Assembled—and I say this as someone who keeps the whole collection in a great big nerdy spreadsheet—they appear to be a tidal wave. The same signal, with striking consistency: hope tracks with better outcomes, and hopelessness with worse ones, across domains that have nothing to do with each other on the surface.

In health and healing, where hope predicts physical recovery in ways that survive adjustment for the potentially confounding factors a scientist would insist on. In aging, where people’s beliefs about their own future track with how they actually age. In the workplace, where hope behaves like measurable performance and leadership variables, not just a poster in the break room. In education, where it predicts how students perform and persist. And in personal resilience, where it helps explain who rebuilds after the worst day of their life—and who doesn’t.

When the same variable keeps surfacing in cardiology, classrooms, boardrooms, and recovery from setbacks, you are not looking at a quirk of one field. You are looking at something upstream from them all.

The darker half of the evidence

Honesty requires showing the other side, because it is the strongest proof that hope is not decorative. If hope were merely emotional, its absence would merely be emotional. It isn’t.

Hopelessness is dangerous in ways you can measure. In a Finnish cohort study of 942 middle-aged men, hopelessness was independently associated with 19 percent greater progression of carotid atherosclerosis (thickening of the arteries) over four years1—a magnitude the lead researcher compared to what you see between a pack-a-day smoker and a nonsmoker.2 In cardiology, hopelessness has earned the label cardiotoxic.3 That word is not a metaphor.

And this is not confined to the sick. In the CDC’s most recent Youth Risk Behavior Survey, 40 percent of U.S. high school students reported persistent feelings of sadness or hopelessness, up double digits from a decade earlier.4 Economists now track “deaths of despair” as a category of its own.5 A great many people, young and old, have quietly concluded that the future will not be better than the present, and that they are powerless to change it.

Hold on to that second clause. It matters more than the first, and it points directly at the way back. Because the antidote to hopelessness is not comfort, and it is not distraction. The antidote to hopelessness is hope itself—and hope, it turns out, is not what most people think it is.

What hope actually is

Most people hear hope and picture wishing: positive thinking, manifesting, the reassurance that everything will work out. That caricature of hope is exactly why serious people roll their eyes at the word—and they are right to roll their eyes at that. But it is not what the science points toward.

The definition I work from comes from Chan Hellman, one of the leading researchers in this field: hope is the belief that the future will be better than the present, and that we play a vital role in making it so.6

The belief that things will improve—that part alone is optimism, and optimism leaves your agency out of the picture entirely. You may wish for good weather; you cannot do anything about the weather. Hope begins where optimism stops: it selects a goal, multiple routes to the goal, and leverages your willpower to get there. Belief plus action. In this framework, hope is not something we wait for, it is something we do.

That distinction is why hope belongs in a scientific domain and not just a greeting card. Hellman puts it plainly: hope is a cognitive process, a way of thinking rather than a feeling—and “if hope is a way of thinking, then it can be taught.”7

And it is why I opened this series at the head of a bed in my ICU. Brunner’s oxygen metaphor is more precise than he may have known. By itself, oxygen cures nothing. It does not clear the pneumonia or reverse the sepsis. But it sustains. It keeps a person alive long enough for everything else to work, long enough for something to change. Not sufficient, but necessary. Hope operates exactly the same way. It guarantees nothing. But without it, the odds of a good outcome may collapse.

The questions worth asking

One more honest admission. When I started, the big question was the title of this essay: does hope really matter? That turned out to be the easy one, because the signal in the data was clear quite early. The questions that kept me up at night were better: When does hope matter, and when doesn’t it? When it matters, how much does it matter? Does hope have a dose? How do you measure it? And the one that changes everything if the answer is yes: can you build it?

Those are the questions The Hope Effect series exists to answer—domain by domain, study by study, citations in plain view, with honesty about what each study can and cannot tell us. And where a study measured a cousin of hope—optimism, expectations, beliefs about aging—I will say so plainly, because in this field, letting one construct’s evidence masquerade as another’s is how trust gets broken. I am not going to oversell it. I won’t need to.

What follows in this newsletter is not what we think, nor what we believe—it is what we found. Each week I will lay out the case and the data behind it, and you can make up your own mind.

Goethe said it in seven words: “Wishing is not enough; we must do.”

Let’s begin.

— Dr. T