A Positive Psychology update from Dr. Martin E. P. Seligman:
From Flourish, 2011
Martin E.P. Seligman
In the mid-1980s, 120 men from San Francisco had their first heart attacks, and they served as the untreated control group in the massive Multiple Risk Factor Intervention Trial (acronymic MR FIT) study. This study disappointed many psychologists and cardiologists by ultimately finding no effect on CVD (CardioVascular Disease) by training to change these men’s personalities from type A (aggressive, time urgent, and hostile) to type B (easygoing).
The 120 untreated men, however, were of great interest to Gregory Buchanan, then a graduate student at Penn, and to me because so much was known about their first heart attacks: extent of damage to the heart, blood pressure, cholesterol, body mass, and lifestyle—all the traditional risk factors for cardiovascular disease.
In addition, the men were all interviewed about their lives: family, job, and hobbies. We took every single “because” statement from each of their videotaped interviews and coded it for optimism and pessimism.
Within eight and a half years, half the men had died of a second heart attack, and we opened the sealed envelope.
Could we predict who would have a second heart attack?
None of the usual risk factors predicted death: not blood pressure, not cholesterol, not even how extensive the damage from the first heart attack. Only optimism, eight and a half years earlier, predicted a second heart attack [i] : of the sixteen most pessimistic men, fifteen died. Of the sixteen most optimistic men, only five died.
This finding has been repeatedly confirmed in larger studies of cardiovascular disease, using varied measures of optimism:
Veterans Affairs Normative Aging Study. In 1986, 1,306 veterans took the Minnesota Multiphasic Personality Inventory (MMPI) and were tracked for ten years. During that time, 162 cases of cardiovascular disease occurred. The MMPI has an optimism-pessimism scale that reliably predicts mortality in other studies. Smoking, alcohol use, blood pressure, cholesterol, body mass, family history of CVD, and education were measured, as was anxiety, depression, and hostility, and all of these were controlled for statistically. Men with the most optimistic style had 25 percent less CVD than average, and men with the least optimism had 25 percent more CVD than average. This trend was strong and continuous, indicating that greater optimism protected the men, whereas less optimism weakened them.
European Prospective Investigation. More than 20,000 healthy British adults were followed from 1996-2002 during which 994 of them died, 365 of them from CVD. Many physical and psychological variables were measured at the outset of the study: smoking, social class, hostility, and neuroticism, for example. Sense of mastery was also measured by seven questions:
- I have little control over the things that happen to me.
- There is really no way I can solve some of the problems I have.
- There is little I can do to change many of the important things in my life.
- I often feel helpless in dealing with the problems of life.
- Sometimes I feel that I am being pushed around in life.
- What happens to me in the future mostly depends on me.
- I can do just about anything I really set my mind to do.
These questions capture the continuum from helplessness to mastery. Death from cardiovascular disease was strongly influenced by a sense of mastery. People high in mastery had 20 percent fewer CVD deaths than those with an average sense of mastery, and people high in a sense of helplessness had 20 percent more CVD deaths than average. This was also true of deaths due to all causes and—to a lesser extent but still significant statistically—of deaths from cancer.
How would you answer these four items answer on a 1-to-3 scale of agreement:
- I still expect much from life.
- I do not look forward to what lies ahead for me in the years to come.
- I am still full of plans.
- I often feel that life is full of promises.
Pessimism was very strongly associated with mortality, particularly when holding all the other risk factors constant. Optimists had only 23 percent the rate of CVD deaths of the pessimists, and only 55 percent the overall death rate compared to the pessimists.
In contrast, in the 1995 Nova Scotia Health Survey, a team of nurses rated the positive emotion (joy, happiness, excitement, enthusiasm, contentment) of 1,739 healthy adults.
Over the next ten years, participants with high positive emotion experienced less heart disease, with 22 percent less heart disease for each point on a five-point scale of positive emotion.
Optimism, in this study, strengthened people against Cardiovascular Disease when compared to the average person, just as pessimism weakened them compared to average.
Is depression the real culprit?
Pessimism, in general, correlates pretty highly with depression, and depression, in many studies, also correlates with cardiovascular disease. So you might wonder if the lethal effect of pessimism works by increasing depression. The answer seems to be no, since optimism and pessimism exerted their effects even when depression was held constant statistically.
Women’s Health Initiative. In the largest study of the relationship between optimism and cardiovascular disease to date, ninety-seven thousand women, healthy at the outset of the study in 1994, were followed for eight years. As usual in careful studies, age, race, education, religious attendance, health, body mass, alcohol, smoking, blood pressure, and cholesterol were recorded at the start.
Optimism was measured in yet another way by the well-validated Life Orientation Test (LOT), which poses ten statements such as:
“In unclear times, I usually expect the best,” and “If something can go wrong for me, it will.”
Importantly, depressive symptoms were also measured and their impact assessed separately. The optimists had 30 percent fewer coronary deaths than the pessimists. The trend of fewer deaths, both cardiac and deaths from all causes, held across the entire distribution of optimism, indicating again that optimism protected women and pessimism hurt them relative to the average. This was true holding constant all the other risk factors—including depressive symptoms.
Something worth living for. There is one trait similar to optimism that seems to protect against cardiovascular disease: ikigai. This Japanese concept means having something worth living for, andikigai is intimately related to the meaning element of flourishing as well as to optimism.
There are three prospective Japanese studies of ikigai, and all point to high levels of ikigai reducing the risk of death from cardiovascular disease, even when controlling for traditional risk factors and perceived stress.
Why optimists are less vulnerable to disease. How might optimism work to make people less vulnerable and pessimism to make people more vulnerable to cardiovascular disease? The possibilities divide into three large categories:
- Optimists take action and have healthier lifestyles.
- Optimists believe that their actions matter, whereas pessimists believe they are helpless and nothing they do will matter.
- Optimists try, while pessimists lapse into passive helplessness. Optimists therefore act on medical advice readily, as George Vaillant found when the surgeon general’s report on smoking and health came out in 1964; it was the optimists who gave up smoking, not the pessimists.
- Optimists may take better care of themselves.
- Even more generally, people with high life satisfaction (which correlates highly with optimism) are much more likely to diet, not to smoke, and to exercise regularly than people with lower life satisfaction. According to one study, happy people also sleep better than unhappy people.
- Optimists not only follow medical advice readily, they also take action to avoid bad events, whereas pessimists are passive.
- Optimists are more likely to seek safety in tornado shelters when there is a tornado warning than pessimists, who may believe the tornado is God’s will. The more bad events that befall you, the more illness.
- Social support. The more friends and the more love in your life, the less illness. George Vaillant found that people who have one person whom they would be comfortable calling at three in the morning to tell their troubles were healthier. John Cacioppo found that lonely people are markedly less healthy than sociable people.
- Happy people have richer social networks than unhappy people, and social connectedness contributes to a lack of disability as we age. Misery may love company, but company does not love misery, and the ensuing loneliness of pessimists may be a path to illness.
In conclusion we can see how having a positive attitude and staying optimistic can actually save your life.
What do you think?