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 on 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 of em emotional w wel ell-bei being on 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 on 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 of f Pos ositive W Words on T on Twitter Ac Across the US US Depressed Happy Cardiovascular disease .33 -.22* Heart disease deaths .40 -.46 All p’s except * p < .05 F ord MT, Tay, L & Diener E, 2015

Positive e Wor ords 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, obesity, 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 of H Happ appier P r Peop ople (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

Physiologic Response 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

Positive E e Emot otion on (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 of Positive Emotions www.PositiveRatio.com www.PositivityResonance.com 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.

The Upward Spiral Theory of 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 on 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.