The Effect Of Posıtıve Psychotherapy-Based Hope Placement Program On The Level Of Determınatıon Of Hope And Lıve Goals In Indıvıduals Dıagnosed Wıth Multıple Sclerosıs

Multiple Sclerosis (MS), causing damage to myelin sheath and axons; It is a chronic disease with diffuse demyelinating lesion of the Central Nervous System (CNS) that often affects young adults, progresses with attacks and remissions, and may bring about functional limitation, disability or decrease in quality of life (Ertekin et al., 2012; Kuşçu et al., 2012; Milanlıoğlu et al., 2014; Daniel et al., 2018). Although the exact etiology of Multiple Sclerosis is not known, it is thought that many genetic and environmental factors may be effective (Veauthier, 2015; Brownlee et al., 2016). Multiple Sclerosis is more common in women than in men (Mitchell et al., 2019). An average of 50 thousand individuals diagnosed with Multiple Sclerosis inTurkey, It is reported that there are more than 2.5 million worldwide (Evans et al., 2013; Kalıncık et al., 2013; Akdemir et al. 2017; Mitchell et al., 2019). According to the data of the Turkish Statistical Institute (TUIK, 2018), MS ranks sixth among the causes of death with 4.1%, and ranks first among the diseases that cause disability. As it can be understood from the high rates of disability and death, it is a disease that imposes great burdens on a person's life (Gümüş, 2018; Tuncay, 2018; Öz & Öz, 2019).

The chronic and irreversible nature of Multiple Sclerosis disease, the uncertainty and destructiveness of the disease process affect individuals physically over time, and can also cause many negative symptoms in terms of mental health. Studies have shown that MS disease; anxiety, depression, loss of life purpose, intense hopelessness and suicide (1-2-3-4).

Life purpose has been defined as struggling to achieve one's goals and creating meaning against existential neurosis. Goals reflect the meaning, goals, and life tasks that are central to the psychological well-being perspective. Kasser and Ryan (1996) defined Life Goals as long-term goals that an individual hopes to achieve. Emmons (1992) defined life goals as situations that individuals try to achieve through cognitive and behavioral strategies. If individuals have set goals for themselves in different branches, it can be said that individuals have clarified their life goals. Nair (2003) states that life goals are also affected by previous positive or negative experiences. Looking at the literature, it is seen that life goals are handled with different classifications. For example, Pesesschkian's (1996) classification of life goals can be cited in the context of positive psychotherapy. Pesesschkian states that people set life goals in the areas of body (via senses), achievement (through career-mind), relationship (through traditions) and spirituality (via intuition). According to Pesesschkian (1996), people benefit from the resolution of conflicts in life by trying to achieve the goals they set in these four areas. Having a life purpose increases the subjective well-being, life satisfaction and hope level of individuals 5).

According to the Turkish Language Association, hope, which is defined as "the feeling of trust arising from hope" and which indicates the feeling of having positive expectations for the future, positively affects mental health by giving people the feeling that they can cope with negative experiences that they may encounter in the future. Hopelessness, which is the opposite of hope, is a feeling that causes mental problems such as depression and suicide as well as negatively affecting the mental health of the individual and is a part of these clinical pictures. Despair was also approved as a nursing diagnosis by the North American Nursing Diagnostic Association in 1986. Hope, which is important for human life, is perceived as a healing factor that empowers people to cope with momentary difficulties and overcome grief, and paves the way for finding meaning in life.

Setting a life purpose has positive effects on hope. While a purposeful life increases the level of hope in people, it reduces hopelessness and causes the person to live a more meaningful life. The decrease or loss of hope and the purpose of life can cause significant problems for people. Negative symptoms such as depression, addiction or suicide may occur in people who have lost their life purpose and hope. In such cases, in addition to the biological treatment methods applied to the person, the application of psychosocial-based interventions allows the symptoms to be resolved more easily.