The health benefits of positive thinking

Can a positive attitude extend one’s life, and, if so, can such attitudes be fostered even in those not naturally disposed to it? Despite the absence of any conclusive evidence, the hints are tantalizing enough that researchers from Massachusetts General Hospital (MGH) and Harvard Medical School want to find out. ‘A lot of the long-term research says that if you’re an optimist, you’re more likely to have better health,’ says Jeff Huffman, an associate professor of psychiatry at Harvard Medical School. ‘But, and this is the point, let’s say you’re not an optimist — can we turn you into one? Can we promote that and teach that in a way that has any lasting effect? And will it really work to improve health? It’s a big and open question.’

Research over recent decades has shown that exercise is the closest thing we have to a miracle drug against threats such as cancer, heart disease, and diabetes. Consequently, Huffman launched the Cardiac Psychiatry Research Program (CPRP) 12 years ago as a way to curb the anxiety and depression that heart disease can set off. The best chance for a positive outlook to affect health is by promoting exercise, Huffman says. He began by treating patients in the cardiac unit at MGH, quickly discovering that his fears of being unwelcome there were unfounded. Doctors and nurses recognized patients’ psychiatric needs and were glad to see Huffman attending to them.

The CPRP combines exercises designed to promote positive psychology in the hospital’s cardiac and diabetes patients with techniques known to change behaviour, such as goal- setting, to encourage patients to adhere to medication regimens, improve their diets, and become more active. ‘We tried it on some patients with heart disease and they really liked it. Since then, we’ve not just been studying observable connections between positive psychological states and heart disease, but also more active methods of promoting and cultivating these positive psychological states,’ Huffman said.

CPRP patients can now continue with it even after they have left hospital. Before discharge, they attend an in-person training session and receive a manual with eight to sixteen weeks of daily tasks, including writing letters of gratitude, performing acts of kindness, and reflecting on past successes. Participants also receive weekly phone calls from one of the program’s trainers, who reviews the previous week, reinforces the positive message, and encourages exercise and other goals. ‘What we’ve learned so far — small but important steps — is that if we teach patients how to identify the good things in their life, they feel better, with increased happiness, decreased anxiety, decreased depression, and better outcomes’ Huffman said. ‘We feel pretty confident about that’.

Pankaj Shah joined one of the CPRP’s studies last October, after finding himself in an operating room getting stents placed in the arteries around his heart. At 51, he was carrying 95 kilos on a 152-centimetre frame, having largely given up exercise after graduating from college and joining the working world. Not until his forties, however, did he give up smoking. And then there was a family history of heart disease. Shah, who was awake for the procedure, remembers something of a revelation in the operating room. When he was asked to participate in the study, he didn’t hesitate. Since then, he’s lost about 18 kilos. His exercise void has been filled with long weekend walks and four-hour bike trips. ‘I’m feeling more at ease with myself,’ Shah said. ‘I used to think, ‘Why would people climb Mount Everest?’ Now I know. I never had that feeling in 51 years. I’m discovering a person I never knew existed inside my body.’

Sceptics might look at Shah’s transformation as that of a man who heard a loud and clear rumble of mortality. And Huffman, for his part, wouldn’t disagree with that. He says there are two standard responses to his work. One is that it’s bound to work. ‘How can it not help people to feel happier and experience more self-esteem? You don’t need to do a study about that.’ And then another other group of people is saying: ‘This is nonsense. These are people with a real disease, what are you doing having them write letters of gratitude?’ Huffman himself reserves judgement. He says that promoting people’s happiness and optimism simply seems like a good idea. However, he also says that while there are observational studies to support its positive impact, he admits that he doesn’t actually know if this can be done in a sustainable way. It is an unknown.’

A clinical outcome would represent an exciting development in the battle to promote a healthier society, Huffman believes. Unlike expensive drugs and medical equipment, the techniques are relatively cheap and easy to deploy. The ultimate goal, as he sees it, is not just to increase exercise levels, but ‘to have the downstream effects of having fewer cardiac events, being hospitalized less, of reduced health care costs. If we can achieve that and, in so doing, reduce health care costs, that would be amazing.’