Lifestyle Change for Happiness + Health Liana Lianov, MD, MPH, - - PowerPoint PPT Presentation

Lifestyle Change for Happiness + Health

Liana Lianov, MD, MPH, FACPM, FACLM

Chair, Positive Health and Happiness Science Committee, American College of Lifestyle Medicine

Check Your Knowledge-1

The following statements about stress and disease are true:

• A. The greatest impact of stress is that it complicates

individuals’ efforts to achieve and sustain healthy behaviors.

• B. Stress directly impacts physiologic factors, such as

blood pressure, but this link to disease is not as important as its impact on behavior change.

• C. The impact of stress on well-being is multifactorial and

complex and cannot be easily assessed and managed.

• D. Stress impacts disease through two key pathways: leads

to physiologic and interferes with health behavior change

Check Your Knowledge-2

The following statement about healthy lifestyles and emotional well-being is true:

• A. Mood can be improved through a plant-based diet,

physical activity, sleep, meditation, but not simply by spending time in nature.

• B. Persons who experience a positive mood are more likely

to choose fruits and vegetables for snacks.

• C. Spending at least 2.5 hours every day interacting on

social media boosts mood.

• D. Eating fruits and vegetables mainly impacts emotional

states with a few hours of consumption.

Check Your Knowledge-3

The following statements about treating mental health and promoting emotional well-being are true:

• A. When treating mental illness with traditional cognitive

behavioral therapy programs and medications, prescribing activities that boost positive emotions is not relevant.

• B. Treating mental illness makes neurological changes in

the same parts of the brain as activities that boost positive emotions and well-being.

• C. All patients need an emotional well-being plan,

regardless of concurrent mental illness.

• D. The main purpose of prescribing activities that promote

positive emotions is to mitigate depression affiliated with chronic diseases.

Learning Objectives

• 1. Describe the impact of emotional well-being
• n the prevention and treatment of lifestyle-

related diseases

• 2. Outline how positive emotion drives

behavior change, health and longevity

• 3. Cite key evidence-based interventions that

promote emotional well-being

• 4. Identify techniques for promoting emotional

well-being that can be applied in clinical settings

Key Messages

 Positive psychology = key to successful interactions between providers and their patients.  Emotional well-being and positive emotions drive healthy behaviors.  Emotional well-being has direct impact on physical well- being and longevity.  Activities that promote emotional well-being can be incorporated into clinical settings.

Learning Objectives

1.

• 1. Desc

scribe the i he impa pact o

• f em

emotional w wel ell-bei being

• n

n the pr he preven enti tion a and t trea eatm tmen ent o t of lifes estyle- rel elated ed di diseases ses

• 2. Outline how positive emotion drives

behavior change, health and longevity

• 3. Cite key evidence-based interventions that

promote emotional well-being

• 4. Identify techniques for promoting emotional

well-being that can be applied in clinical settings

Stress Trends

• 70% percent of primary care visits related to stress and
• lifestyle. (Feldman 2003)
• Stress in American adults has recently increased. (APA 2017)

Feldman M D. Behavioral Medicine in Primary Care, A Practical Guide, 2003. Stress in America: Coping with Change, Part 1, American Psychological Association (APA), February 15, 2017.

Stress/Lack of Emotional Well-Being and Disease

• The relationship = complex and multi-factorial. Two

pathways:

• Sympathetic nervous system response (fight or flight) is

increased.

• Patients overwhelmed by stress are less likely to engage in

healthy habits. (APA Stress in America 2017)

Cognitive and behavioral techniques and social support can attenuate the link of high stress and mental illnesses with chronic diseases.

Challenges to Achieving Emotional Well-Being and Health Behavior Change

• Ongoing stress– “cognitive clutter”
• Risky substance use
• Natural attention to negative events and emotions
• Social networks not supportive
• Social isolation/loneliness
• Lack of a sense of purpose and meaning
• Physical and cultural environment not supportive

Learning Objectives

• 1. Describe the impact of emotional well-being
• n the prevention and treatment of lifestyle-

related diseases 2.

• 2. Ou

Outline ne ho how po positive em e emotion dr drives es beh behavior cha hange, e, hea health a and l long ngevity

• 3. Cite key evidence-based interventions that

promote emotional well-being

• 4. Identify techniques for promoting emotional

well-being that can be applied in clinical settings

Pred edicti ting H Hea ealth th O Outcomes s fr from U Use o

• f

f Pos

• sitive W

Words on T

• n Twitter Ac

Across the US US

Depressed Happy Cardiovascular disease .33

• .22*

Heart disease deaths .40

• .46

All p’s except * p < .05

Ford MT, Tay, L & Diener E, 2015

Positive e Wor

• rds P

s Predict C CVD VD Mortal ality

U Penn Study on counties: Tweets predicted cardiovascular mortality: Controlling income and education

Better than the combined prediction of: smoking, diabetes,

• besity, hypertension, and six other predictors

Eichstaedt JC, et al., 2015, Psych. Science

Lifestyl yle and and Longevi vity: y: Y Year ars Gai Gained (4 4 studies, es, E Ed Diener er)

Mean Range Exercise 3.0 2.1 – 4.5 Smoking 6.8 2.3 – 11.5

• Subj. Well-Being

7.6 6.0 – 9.0

Diener E, 2018 Summit on Happiness Science in Health Care

Me Mediating Me Mechanisms ms: Why Ha Happi ppier er I Indivi vidua uals L Live L Longer er? ?

• Cardiovascular health (parasympathetic influence)
• Inflammation
• Immune system strength
• Telomeres
• Endocrine regulation
• Health behaviors

Diener E. Health Behaviors of Happier People (Replicating Across Nation)

Heal alth h Be Beha havi viors of

• f H

Happ appier P r Peop

• ple

(Repl plicating Ac Across N Nations)

• Exercise
• Don’t smoke
• Use seat belts
• Nutrition
• Less alcohol abuse

Diener E. 2018 Summit on Happiness Science in Health Care

Barbara Fredrickson at the Univ. of North Carolina:

• Positivity resonance increases heart rate variability

and improves vagal tone (summary in Love 2.0)

• Positive emotion (loving kindness meditation, positive

social interactions--micro-moments of connectivity) boost the parasympathetic, “tend and befriend” response

Physiologic Response

Positive E e Emot

• tion
• n

(B. Fr Fredr edrickso son’s s work rk)

• Forecasts behavioral engagement 15 months later.
• Builds nonconscious motivation or true, natural, non-

imposed desire for change – not an outer should.

• Is explained in the “upward spiral theory” –reinforcing

behaviors.

• Pleasant, intrinsic, natural emotions increase motivation and

positive health behaviors (Rice EL & Fredrickson B).

The Broaden-and-Build Theory

• f Positive Emotions

Fredrickson B. (1998). Review of General Psychology, 2, 300-319. Fredrickson B. (2001). American Psychologist, 56, 218-226. Fredrickson B. (2013). Advances in Experimental Social Psychology, 47, 1-53.

www.PositiveRatio.com www.PositivityResonance.com

The Upward Spiral Theory

• f Lifestyle Change

Fredrickson B. (2013). Advances in Experimental Social Psychology, 47, 1-53. Van Cappellen, Rice, Catalino & Fredrickson (2017). Psychology & Health, 33, 77-97.

Learn to manage the elephant in the brain!

The rider = the conscious, verbal, thinking, brain. The elephant = the automatic, emotional, visceral brain

Which Clinical Interactions Improve Health Outcomes?

• Patients of providers with a high motivational

interviewing-spirit score had greater weight loss.

Pollak KI, et al. Am J Prev Med 2010; 39(4); 321-328.

• Patients of clinicians rated with high empathy scores had

better control of HbA1C and LDL-C .

Hojat M, et al. Academic Med, 2011; 86(3):359-363.

Results of the Empathetic and Positive Clinical Interactions

• Confidence with behavior change
• Interactive cycle:
• Transference of positive mindset, improving patient’s mood

and open-ness

• Countertransference of positive mindset, improving

provider’s open-ness and ability to listen

• Consistent positive thoughts and behaviors can lead to

positive “neuro-sculpting” in both patients and providers

Positive psychology boosts emotional energy with physiology benefits and as a driver for behavior change. Start with: What is going well?

Learning Objectives

• 1. Describe the impact of emotional well-being
• n the prevention and treatment of lifestyle-

related diseases

• 2. Outline how positive emotion drives

behavior change, health and longevity 3.

• 3. Ci

Cite e key ey ev evidence-ba based i ed interventions ns t tha hat pr promote em e emotional w wel ell-bei being

• 4. Identify techniques for promoting emotional

well-being that can be applied in clinical settings

Plant Based Diet and Happiness

(nutritionfacts.org)

Eating fruits and vegetables can increase: Happiness Eudaimonic well-being (meaning, purpose) Curiosity Creativity One possible mechanism is via: Vitamin C, a cofactor in dopamine (“zest for life” neurotransmitter)

Conner TS, et al. Br J Health Psychol. 2015; 20(2):413-27.

Plant Based Diet and Happiness

(nutritionfacts.org)

Fruit and vegetable consumption associated with:

• Feeling calmer, happier and more energetic than normal
• Predicted positive mood the next day
• Amount needed for meaningful change:
• 7.2 daily servings of fruit
• 8.2 servings of vegetables

Being happier influences food choice: more likely to select the apple!

Fararouei M, et al. J Adolesc..2013; 36(6):1187-92. Fedorikhin, A, Patrick VM, . Journal of Consumer Research. 2010; 37(4) Gardner MP, et al. Journal of Consumer Psychology 2014; 24(3):320-335. Piqueras JA et al. BMS Public Health.2011; 11:443. White BA, Horwarth CC, Conner TS. Br J Health Psychol.2013; 18(4):782-98.

Mental Health and Physical Activity (PA)

• PA boosts mood—large body of literature.
• PA is comparable to cognitive therapy in impact on

depression—several studies (Rimer 2012).

• PA is slightly more effective overall when compared with

standard treatments, including medication (Clooney 2013).

Rimer J. Cochrane Database Syst Rev. 2012 July 11; 7. Cooney GM. Cochrane Database Syst Rev. 2013 Sep 12;9.

Sleep and Mood

• Univ. of Penn study:
• Subjects limited to 4.5 hours of sleep per night for one

week reported feeling more stressed, angry, sad, and mentally exhausted.

• Significant improvement in mood after return to longer

sleep patterns.

Dingles D. et al. Sleep. 1997; 20(4):267-277. Lopresti AL, J Affect Disord. 2013; 148(1):12-27.

Identifying and Adjusting Thoughts and Beliefs

• Monitor thought distortions
• Examine the evidence for and against the distortions
• Substitute with more realistic or optimistic interpretations

Cognitive Distortions

• All or nothing
• Catastrophizing
• Discounting the positive
• Overgeneralization
• Mind reading
• Fortune telling
• Should and must statements

Cognitive Behavioral Reframing is Neuro-sculpting

• A—Activating Event
• B—Beliefs (Thoughts about the Event)
• C—Consequences (Feelings)
• D—Dispute the Nonproductive or Negative Thoughts
• E—Expand Your View of the Situation/Reframe Thoughts

Positive Psychology

(Marti tin S Sel eligman)

• Scientific study of strengths and virtues that enable

individuals and communities to thrive

• Involves:
• Positive affect
• contentment with the past, happiness in the present,

hope for the future

• Individual virtues and strengths
• courage, compassion, integrity, curiosity, etc.
• Can accompany treatment of mental illness
• Focuses on producing happiness, not lessening misery

Egger G,. Lifestyle Medicine, Managing Diseases of Lifestyle in the 21st Century, 2011.

Positive Psychology Interventions

(Hendriks Meta-Analysis; Partial List in Order of Frequency)

• Gratitude
• Character strengths
• Positive goal setting
• Optimistic thinking
• Positive reminiscence
• Savoring
• Mindfulness
• Acts of kindness
• Forgiveness
• Meaningful activities
• 19 others: visualizing best possible self, cultivating sacred

moments, bibliotherapy, appreciation of beauty, etc.

Effect Sizes of Multimodal PPIs in Meta-Analysis

Preliminary Results (Hendriks, IPPA 2017)

Hendriks, et al 2017 Boiler, at al 2013 Sin & Lyubomirsky, 2009 Subjective Well-Being r=0.52 r=0.34 r=0.29 Psychological Well-Being r=0.27 r=0.20 Depression r=0.33 r=0.20 r=0.31 Anxiety r=0.21

• Average of 10 sessions over 8 weeks in clinical and nonclinical settings;

majority in self-help or group format; only one individual intervention

• Result: small, but significant effect size

The Five Pillars of Happiness: PERMA

POSITIVE EMOTIONS ENGAGEMENT

RELATIONSHIPS MEANING

ACCOMPLISHMENT

Seligman M. Flourish

• Expressing gratitude
• Savoring joys
• Learning to forgive
• Being mindful; meditating
• Practicing acts of kindness
• Aligning with one’s religion or spirituality
• Cultivating optimism
• Avoiding overthinking
• Achieving goals
• Developing healthy ways of coping
• Experiencing flow
• Having a sense of purpose and meaning
• Nurturing social relationships

Lyubomirsky S. The How of Happiness

What activities promote happiness?

Social Connection and Longevity

Harvard Study (Grant and Glueck)

• 75 year cohort study of Harvard students and inner city

Boston boys

• Single most important predictor of happiness and

longevity is having social connections

Social Media (SM) and Mood

• Study of 1,787 adults ages 19 to 32
• Highest quartile of SM use per week had

significantly increased odds of depression compared with lowest quartile

• adjusted odds ratio = 2.74

Lin L. et al. Depression and Anxiety 2016; 33:323-331.

Me ntal and physic al he alth is booste d whe n in pr

• ximity to natur

e !

Bratman GN. et al. Nature. 2015: 138:41–50.

Possible mechanisms: impact on BP, LDL, glucose, etc.

Learning Objectives

• 1. Describe the impact of emotional well-being
• n the prevention and treatment of lifestyle-

related diseases

• 2. Outline how positive emotion drives

behavior change, health and longevity

• 3. Cite key evidence-based interventions that

promote emotional well-being 4.

• 4. Iden

dentify techni hnique ques f for promoting ng e emotiona nal we well-being t that c can b be applied i in clinical setting ngs

Exercise: FITT

Frequency: four times each week Intensity: heart rate between 100 and 140 Time: at least 30 minutes each session Type: walking

The LM Prescription of the Future

Nutrition: TAF

Type: cruciferous vegetables such as broccoli, kale and Brussel sprouts Amount: 1 serving (1/2 cup cooked, 1 cup fresh) Frequency: once daily

Emotional Well-Being:

Gratitude: write down 3 people for whom you are grateful; Frequency: once a week Support: visit sister; Frequency: biweekly Meaning: volunteer at SPCA; Frequency: monthly

Positive Health Logic Model

Clinical/Health Care Settings

Positive Psychology Interventions

Healthy Lifestyle Behaviors Direct Physiologic Effects

Benefits:

Improved health outcomes Improved quality of life Decreased health care utilization Empowered, satisfied patients Lower provider burn-out Improved patient-provider relationships Increased longevity Longer independence of elders Enhanced social capital/volunteerism Decreased societal cost, e.g. violence, drug use

Community/ Preclinical Settings

Positive Psychology Interventions

Healthy Lifestyle Behaviors Direct Physiologic Effects

Collaboration

Positive psychology community Health care community Coaching with positive psychology Happiness Flourishing Positive health

• More translational research
• Better measurement tools
• Standard terminology
• Effective tools for interventions
• Training for providers
• Champions in all stakeholder groups

Advance collaboration between health care and positive psychology communities

Positive Psychology in Health Care Beyond Coaching Health Behaviors

Mental illness Treatment enhanced with positive psychology

Promoting Positive Psychology/EWB in Health Care

• Provide education and training for health care

teams on the critical role of EWB in health

• Develop effective and efficient tools, programs and

resources

• Prescribe these EWB resources
• Emphasize EWB interventions beyond mindfulness

and stress management techniques, as part of healthy lifestyle programs

• Personally practice EWB (provider health)

Summary: Lifestyle, Health and Happiness

• Emotional well-being (EWB) has

a key role in driving behavior, and improving mental and physical health and longevity.

• Positive mindset and empathy

in provider-patient interactions promotes EWB and health behavior change.

• Nutrition, physical activity, sleep,

cognitive techniques, and activities in the PERMA model promote EWB.

• Clinicians can promote EWB by

using and referring to tools and programs that address this key element of health.

lifes estylem emedici cine. e.org/su summit

Get involved with the movement to better integrate emotional well-being into health care

“Whe hen n I dare to b be p powerful, to to us use m e my s stren ength i in n the s e servi vice e of my v visi sion, then n it b bec ecomes s less ess an and l less ess i important whet ether I am am a afraid aid.” .” Audre re Lord rde

Thank you! Liana Lianov MD, MPH @HealthType @myhappyavatar act@lianalianovmd.com

Book Resources

• Hansen R. Hardwiring Happiness, The New Brain Science of Contentment,

Calm, and Confidence. Harmony Books, NY, 2013.

• Heath C, Heath D, Switch, How to Change Things When Change is Hard.

Broadway Books, New York, New York, 2010.

• Leahy, RL. Cognitive Therapy Techniques, A Practitioner’s Guide. The Guilford

Press, New York, New York, 2003.

• Lyubomirsky S. The How of Happiness, A New Approach to Getting the Life

You Want. Penguin Books, NY, 2007.

• Seligman, M. Flourish. Atria Books, New York, New York, 2012.

Websites/Programs

• Cognitive behavioral therapy (CBT) online: beatingthebluesus.com

by University of Pittsburgh Medical Center

• CBT programs from Australia (free online):
• Moodgym.anu.edu.au
• Ecouch.anu.edu.au
• CBT for insomnia online program: cbtforinsomnia.com
• Computerized CBT: ccbtmain.cbtprogram.com
• Computerized CBT evidence:

hsrd.research.va.gov/publication/esp/cognitive-EXEC.pdf

• Happiness and health: hsph.harvard.edu/news/magazine/happiness-

stress-heart-disease/ from Harvard TH Chan School of Public Health

• Positive Psychology Center, University of Pennsylvania:

ppc.saas.upenn.edu

• National Association of Cognitive-Behavioral Therapists:

nacbt.americommerce.com

• VIA Institute on Character: viacharacter.org