Assessing state optimism: A comparison of two validated measures in three prospective cardiac cohorts

Optimism, broadly defined as the tendency to expect positive outcomes, is associated with better recovery, lower rehospitalization rates, and reduced mortality following acute coronary events (DuBois et al., 2015), as well as reduced risk of developing heart failure (Kim et al., 2014).

Most studies rely on the 6-item Life Orientation Test–Revised (LOT-R) (Scheier et al., 1994), a dispositional (trait) measure of optimism with limited sensitivity to within-patient fluctuations over time (Shimomura et al., 2024). Adjusting the timeframe of the LOT-R items to “right now” did not affect response variability over time (Huffman, Legler, et al., 2019). The 7-item State Optimism Measure (SOM) was developed to capture momentary (state) optimism (Millstein et al., 2019), demonstrating greater sensitivity to within-person changes compared to the LOT-R (Hoeppner et al., 2024).

We compared the SOM to LOT-R in persons with heart disease to determine which instrument better captures state changes in optimism after cardiac procedures and/or after receipt of an intervention hypothesized to improve optimism. We hypothesized the SOM would show more change than the LOT-R, as it is designed to capture state, rather than trait, optimism.

We analyzed data from three prospective cardiac cohorts: two randomized controlled pilot trials of a positive psychology-motivational interviewing (PP-MI) intervention to increase cardiac health behaviors, compared to an educational counseling control or usual care, in patients with (1) New York Heart Association II-III heart failure (REACH-III) or (2) post-acute coronary syndrome (ACS; PEACE-IV) (Celano et al., 2020; Huffman, Feig, et al., 2019). Data were collected at baseline, post-intervention (12 weeks), and follow-up (24 weeks). The two intervention studies (PP-MI vs control) were merged into a single analytic sample because there were no intervention effects on LOT-R scores. Separately, the third study enrolled patients hospitalized with a primary cardiac diagnosis and assessed optimism at index hospitalization and two weeks later without intervention.

At each timepoint, participants completed the LOT-R (α=0.78) (Scheier et al., 1994) and the SOM (α=0.92–0.96) (Millstein et al., 2019), introduced by the stem “Please answer the following items based on how you feel right now, that is, at the present moment using the scale below” (see Supplemental Table 1 for the full scale). Total scores were standardized to z-scores, and absolute within-person change between assessments was calculated for each instrument. Because the distribution of change scores was not normal, we compared their magnitudes using two-sided Wilcoxon signed-rank tests (α=0.05). All analysis was done in Stata 17 (StataCorp, College Station, TX).

Across all three cohorts (n=224), participants were middle-aged to older adults (mean age 66.3 years), 36.6% were female, and 87.7% identified as White (see Supplemental Table 2 for cohort-specific details). In the REACH III heart failure trial, 45 patients were randomized (42 at week 12, 39 at week 24), and in the PEACE IV post-ACS trial 47 participants were randomized (39 at week 12, 35 at week 24). In the observational cardiac cohort 132 patients completed the baseline survey (103 at week 2).

Overall, neither instrument demonstrated superior sensitivity to shifts in optimism (Table 1).

Table 1:

Comparison of State Optimism Measure (SOM) and Life Orientation Test–Revised (LOT-R) Responsiveness Across Cardiac Cohorts.

Cohort & Interval	N	SOM Δ z-score (mean ± SD; median)	LOT-R Δ z-score (mean ± SD; median)	Wilcoxon z	p-value
REACH III + PEACE IV 0–12 weeks	81	2.28±5.77; 2	2.15±4.50; 2	0.82	0.41
REACH III + PEACE IV 0–24 weeks	73	2.15±5.92; 1	2.41±4.89; 2	0.71	0.48
Observational Baseline–2 weeks	103	0.28±5.45; 0	0.48±3.72; 0	–0.75	0.46

Contrary to our hypothesis, neither the SOM nor the LOT-R demonstrated superior sensitivity to optimism shifts in our cardiac cohorts. This may reflect SOM characteristics: the “Right now” cue appears only in the general instructions and in item 2 (“Right now, I expect things to work out for the best”); six of its seven items (e.g., “I am feeling optimistic about my future”) still permit broad, trait-like interpretation, and only item 4 (“I feel that something good will happen today [in the next 24 hours]”) explicitly anchors responses to the short term. Thus, while the SOM employs a distinct instruction cue to elicit present-term responses, at the item level both the SOM and the LOT-R rely heavily on general-outlook phrasing, which may underpower detection of subtle, transient optimism shifts.

To better capture momentary optimism, future instruments could narrow both recall frames and item content. A 24-hour SOM could anchor every item to “today” or “the next 24 hours” and could focus on specific domains (e.g., mood, health, career). Ecological momentary assessment, using several ultra-brief prompts delivered multiple times per day, could map real-time optimism dynamics (Shiffman et al., 2008).

Our single-center design, largely homogeneous sample population in terms of race/ethnicity, the heterogeneity of combined intervention and observational cohorts, and modest sample sizes limit generalizability and statistical power. Future studies should assess whether a 24-hour variant of the SOM is more dynamic than existing measures of optimism.