Harvard Heart Letter

It's time to accentuate the positive

Positive thoughts and feelings may help your heart thrive.

Depression, social isolation, anxiety, hostility, emotional stress. When it comes to heart disease, the negative aspects of psychological functioning have gotten most of the attention. They have been shown to increase the chances of developing various sorts of cardiovascular disease, and they can make existing diseases worse. What about the flip side? Can happiness or an upbeat approach to life protect the heart and blood vessels?

Folk wisdom says yes. But there's precious little hard data to back up this notion. A small number of studies have demonstrated that positive thoughts or an optimistic outlook confer some protection. The latest contribution in this area looks at positive feelings.

Psychologists Laura Kubzansky of the Harvard School of Public Health and Rebecca Thurston of the University of Pittsburgh School of Medicine studied the impact of emotional vitality. This gauges a person's feelings of energy, sense of well-being, and ability to regulate his or her emotions.

The researchers crunched information collected between 1971 and 1975 from more than 6,000 initially healthy men and women taking part in the first National Health and Nutrition Examination Survey. Based on answers to six questions (see "Rating emotional vitality"), they classified each participant as having low, moderate, or high emotional vitality.

During the 15-year period following the health survey, 16.4% of people in the high emotional vitality group had a heart attack, developed angina or another form of coronary artery disease, or died of heart disease, compared with 19.5% in the low vitality group. Although that may not seem like a large difference, applied to the United States as a whole it could translate into thousands of fewer cases of heart disease or deaths each year.

Greater emotional vitality wasn't just a stand-in for less depression "" its benefits remained after the researchers took depression into account. Instead, it seemed to exert its own special effect.

How could feeling energetic, having a sense of well-being, or being on an even emotional keel guard the heart? By counteracting stress, emotional vitality could calm the stress-induced arousal of the nervous system that boosts heart rate, elevates blood pressure, and activates inflammation and other heart disease""promoting processes. Positive emotions might contribute to an individual's sense of control over his or her destiny, which has been associated with protection against heart disease. It might make it easier to make or use social connections. Then again, it could be that people with high emotional vitality are less likely to develop heart disease because they have healthier behaviors, like smoking less, exercising more, or controlling their weight.

Rating emotional vitality

Want to calculate your own emotional vitality score? These questions can help. Circle the number below each question that best represents how you feel.

Have you been waking up fresh and rested?

0 = None of the time;
1 = Rarely;
2 = Less than half of the time;
3 = Fairly often;
4 = Most every day;
5 = Every day

How much energy, pep, vitality have you felt on a scale of 0–10?

From 0 = No energy at all, listless to 10 = Very energetic, dynamic

How happy, satisfied, or pleased have you been with your personal life?

0 = Very dissatisfied;
1 = Somewhat dissatisfied;
2 = Satisfied, pleased;
3 = Fairly happy;
4 = Very happy;
5 = Extremely happy — could not be more pleased

Has your daily life been full of things that are interesting to you?

0 = None of the time;
1 = A little of the time;
2 = Some of the time;
3 = A good bit of the time;
4 = Most of the time;
5 = All of the time

Have you been in firm control of behavior, thoughts, emotions, feelings?

0 = No, and I am very disturbed;
1 = No, and I am somewhat disturbed;
2 = Not too well;
3 = Generally so;
4 = Yes, for the most part;
5 = Yes, definitely so

Have you been feeling stable and sure of yourself?

0 = None of the time;
1 = A little of the time;
2 = Some of the time;
3 = A good bit of the time;
4 = Most of the time;
5 = All of the time

Add up your points. A score of 0 to 22 indicates low emotional vitality; 2327 is medium emotional vitality; and 2835 is high emotional vitality.

Source: NHANES questionnaire, 19711975.

Focus on the good, not the bad

Your genes, early learning, and family and social environments set the stage for whether your outlook on life is essentially positive or negative. If yours is a bit on the negative side, don't despair. It isn't set in stone (or the legion of psychiatrists, psychologists, and other mental health counselors would be searching for work!) and working to improve it is actually one of the hottest trends in mental health.

This goes beyond the "power of positive thinking." It involves several different approaches. One is deliberately focusing on events or activities that give you pleasure and taking a mental snapshot to recall later and maybe jot down in a "gratitude journal" or share with others. Another is engaging in activities that call on your inherent strengths, either at work, home, or play. A third route entails applying your strengths to something outside yourself that helps you create meaning in your life. It could be religion, nature, art, volunteering, or something else.

Legendary songwriters Harold Arlen and Johnny Mercer had it right in the 1940s when they wrote: "You've got to accentuate the positive, eliminate the negative, latch on to the affirmative."