In the present study, it was hypothesized that chronic and relapsing nature of a disease may initiate and perpetuate pessimistic thinking in the patients. Such patients, who develop helplessness and hopelessness, may, in turn, poorly adhere to the management plan. This will consequently lead to inferior treatment outcome and, as a result, aggregation of the disease. Thus, the patient may enter a vicious cycle, which has profound negative impact on his life. The phenomenon, which Seligman called ...