Researchers ask why optimism is associated with health, pessismism with disease

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Carolyn Butler
Washington Post Staff Writer
Tuesday, January 12, 2010

So, be honest: Is that glass half-full or half-empty?

Personally, I tend toward the latter, though I secretly long to be one of those Pollyannas who always look on the bright side of things and can remain hopeful through a family crisis, two hours of downtown gridlock or any other challenge. In fact, my New Year's resolution for '10 is to be more positive. (Meanwhile, the pessimist in me is well aware that studies have shown that roughly 80 percent of those who make such pledges give them up by Valentine's Day.)

My hope is that positive thinking will make me not only happier but healthier, in the long run. A recent study published in the journal Circulation showed that a sunnier outlook on life is associated with a lower risk of heart disease and mortality. The research, which tracked more than 97,000 women older than 50 for eight years, found that optimists were 9 percent less likely to develop heart disease and 14 percent less likely to die from any cause than their pessimistic counterparts. Those with a high degree of "cynical hostility" were 16 percent more likely than all others to die during that same period.

"This is really consistent with a number of other studies in the past, with the strongest findings in the realm of coronary heart disease: There is good evidence to suggest optimism is protective and that pessimism seems to be detrimental, when it comes to the development of disease and future outcomes," says Laura Kubzansky, an associate professor at the Harvard School of Public Health who has focused on these issues. "But what's a little less clear is what the mechanisms are, or how that protective effect occurs."

Not surprisingly, environment seems to play some role in the equation. In this study, for example, socioeconomic status was strongly tied to level of optimism: The women with the most-positive outlook on life tended to be wealthier, more educated, in better shape and less likely to smoke or to be overweight. "It's not shocking that out of all the factors we looked at, socioeconomic status was the most related to attitude, but even after controlling for that, attitude was still related to health, so there's something else going on," says lead author Hilary Tindle, an internist and assistant professor of medicine at the University of Pittsburgh.

Tindle says several factors are probably at play.

One of the possibilities most interesting to scientists is that your psychology has a direct effect on physiology, impacting blood pressure, heart rate, stress hormone levels and immune function, all of which can contribute to disease and mortality. For example, a study published last year in the journal Brain, Behavior and Immunity found that higher levels of pessimism are linked to unfavorable changes in inflammatory markers and white blood cells.

Tindle and her co-authors found that optimistic types are more likely to engage in healthy behaviors such as eating well, exercising more and smoking less; they're also more likely to have better social relationships, something that has been associated with positive health outcomes.

Finally, there is some evidence that optimistic women tend to adhere more strictly to medical advice and treatment plans. The study "confirms what a lot of physicians intrinsically know and experience over and over again, in that the patients who see the world from a more positive view tend to be better patients," observes cardiologist Elizabeth Klodas, author of "Slay the Giant: The Power of Prevention in Defeating Heart Disease." "They are more adherent to their regimen, actually take your advice and follow it, and are much more enthusiastic about making the lifestyle changes that are so critical for cardiovascular disease prevention, whether primary or secondary, after you've had an event; they are just better partners in care."

However, Klodas does raise concerns about the link between optimism and better health: "Is it the chicken or the egg? Are you a better patient because you have an intrinsic optimistic attitude, or do you become more optimistic because your outcomes are better because you're following a regimen that's actually helping you get better?"

The study's authors, too, acknowledge that questions remain. "On the one hand it seems intuitively obvious, but we're not there yet in terms of the evidence we need in order to say optimism causes better health outcomes," says Tindle. "All we can say now is that optimism is associated with better health outcomes, but without following people over a lifetime, we can't say which came first."

Although further research is necessary (and underway), Tindle stands firm in her belief that a poor outlook on life is detrimental to health. "The totality of evidence . . . points to the fact that sustained negativity is toxic to health, and I would absolutely say that it's important for people to try to reduce the amount of it in their lives."

Coming from a long line of devoted pessimists, I can't help but wonder how possible it is to revamp your attitude and fill that half-empty glass.

Though genetics do come into play, you're not necessarily destined for a life of doom and gloom, says James Maddux, a psychology professor at George Mason University. "It's not a matter of having an optimistic or pessimistic gene, it's matter of having a brain or nervous system wired more toward the optimistic or pessimistic end, with a lot of room for learning and exerting control over your own outlook of life," he explains. "We're really talking about a continuum with high optimism on one end and low optimism or high pessimism on the other end, and people fall somewhere in between. And probably from time to time, depending on the situation, we move back and forth between some range that's set by our DNA."

Maddux and other experts suggest a variety of techniques for moving toward the sunnier side of that spectrum, from cognitive behavioral therapy and lifestyle changes such as sleeping more and making additional time for friends, to relaxation techniques such as meditation and yoga.

"These things do not directly impact optimism, per se, but may make it easier to view the world through a happier, more optimistic lens and increase the general sense of positive feelings," says Harvard's Kubzansky. "There's a lot of room to maneuver; I'm very optimistic about that. We do come into the world with an inherent tendency, but then there's room to shape it."

Yet she acknowledges that it's hard work: "There are lots of ways to achieve it, but I don't think any are trivial. . . . Different people may get there differently, but at some level there needs to be a commitment on their part to figure out 'What are my habitual ways of thinking, and how can I change them so other things become habitual?' There has to be concerted effort and thought put into how you're going to make meaningful change. That said, I think it can definitely be done."

Still, Klodas isn't ready to start prescribing an attitude shift to her cardiology patients just yet. "There are many positives to being more positive, but based on this research, we still don't know for sure whether an attitude change will actually impact health outcomes," she says, although she remains, well, optimistic that proof is on the way. "I hope somebody does a study and shows it, because it would be really nice to work on. I would much rather try to help somebody get a better attitude than prescribe another pill."


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