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Designing for Health and Happiness David S. Sobel, MD, MPH

Regional Health Education The Permanente Medical Group, Kaiser Permanente Northern California

Telephone: 510.987.3579, [email protected] Follow me on Twitter @KPhealthyfun

Healthy Pleasures

©The Permanente Medical Group 2014

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Questions

1.  Are people unmotivated? 2.  Does pleasure and happiness

matter for health? 3.  How can we design for

happiness and amplify pleasure?

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Are people unmotivated?

Consequences: §  Attempt to increase motivation §  Prescribing behavior change (i.e.

often failure) §  Frustration and cynicism

þ  But do we really know what motivates people?

þ  How can we make it easier for people to do what they already want to do?

þ  Have we identified and celebrated successes?

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Shifting the Curve

Target the Ready & Willing: Help people do what they already want to do.

Where to focus? Which curve can you shift?

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What do people really care about?

“Healthy Lifestyles” “Real Life”

Sleep

Sex

Stress

Exercise and healthy diet

Preventive screenings

6 n= 1064

The “Unmentionables”

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Pleasure and Passion: Missing Ingredients in Motivation

þ  understand whole person þ  screens for depression þ  align with intrinsic motivation þ  bright spot for clinicians

What do you Really Enjoy?

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There’s no improvement, Henry. Are you sure you have given up everything you enjoy?

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Types of Pleasures

Sensory Pleasures q  5 Senses

Non-Sensory Pleasures q  Achievement (competence*) q  Autonomy* q  Activity (process of activity, not outcome) q  Neuromuscular (arousal and relaxation) q  Esthetic (nature, beauty, etc.) q  Humor q  Social Pleasures (relatedness*)

Frijda, N. (2010). On the nature and function of pleasure. In M. L. Kringelbach & K. C. Berridge (Eds.), Pleasures of the brain (pp. 99–112). New York: Oxford University Press.

Biswas-Diener, R. Pleasure: An Initial Exploration. J of Happiness Studies, 2014. *Self-Determination Theory

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Finding Pleasure: Enjoyment as a Vital Sign

ü  List 10 activities that are fun for you. What brings you joy? What that makes you feel happy? It can be anything- walking the dog, talking with friends, working in the garden, listening to music, writing a letter to someone special, watching your children play, fixing a special meal…

ü  What prevents you from doing more of the things you really enjoy?

Pleasant Events Schedule

Peter Lewinsohn 320 items

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Questions


matter for health?

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Are Happier People Healthier?

"During the past 4 weeks, have you been a happy person?" “All things considered, how satisfied are you with your life?”

Siahpush Am J Health Promo 2008;23:18-26

§  People with higher happiness and life satisfaction 2 years later reported 50% better health and less long-term, limiting health conditions.

n=10,000

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Are Happier People Healthier?

A long-term study of nuns discovered that those who wrote autobiographies at a young age reflecting happiness, love and hope had a 2.5 time lower risk of dying than their gloomier counterparts.

Danner J Pers Soc Psych 2001;80:804-13

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Health Benefits of Happiness

Seven types of evidence are reviewed that indicate that high subjective wellbeing (such as life satisfaction, absence of negative emotions, optimism, and positive emotions) causes better health and longevity…. the evidence is clear and compelling.

Deiner, Applied Psych 2011

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SAVOR YOUR SENSES: In Touch

§  Infants (preterm and term) §  Pregnancy and childbirth §  Diabetic and asthmatic children §  Adolescent psychiatric patients §  Post-traumatic stress disorder §  Eating disorders §  Migraine headache and low

back pain §  HIV+ adults §  Breast cancer Touch Research Institute, University of Miami

School of Medicine Field TM Touch Therapy 2000.

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When looking at Nature:

§ More positive feelings § Reduced negative emotion §  Lower physiological arousal § Higher alpha brain waves § Quicker recovery from

stress

SAVOR YOUR SENSES: Nature vs. Urban

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Postsurgical patients in a room with a view of nature (vs. a brick wall) had:

ü less distress ü required less pain medication ü discharged 1 day sooner

“Nature-Deficit Disorder” -“No Child Left Inside” (R. Louv)

Ulrich R: Science 1984:224:420

SAVOR YOUR SENSES: Looking at Nature

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SAVOR YOUR SENSES: The Case for Wine (and Alcohol)

C 1–2 drinks per day for women C  2-4 drinks per day for men is associated with: §  18% lower total mortality §  30% lower risk of coronary heart

disease and type 2 diabetes §  higher “good” HDL cholesterol

.

Di Castelnuovo: Arch Intern Med 2006;166:2437, Koppes LL: Diabetes Care 2005;28:719, Mukamal KJ: JAMA 2010;303:2065

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Chocolate eaters may enjoy: §  27% lower relative risk of death and an extra year

of life (Lee I, BMJ 1998)

§  Lower blood pressure (Taubert D, Arch Intern Med. 2007)

§  47% lower mortality rate in men (Buijsse B: Arch Intern Med 2006)

§  35% less likelihood of hospitalization or death from heart disease in women over 70 (Lewis JR Arch Intern Med. 2010)

§  20% lower rate of stroke (Larsson, Neurology, 2012)

§  decreased insulin resistance, high HDL and lower LDL cholesterol, reduced blood platelet adhesion, protection arterial wall lining, etc (Corti R: Circulation, 2011)

SAVOR YOUR SENSES: Life is Sweet

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CENSORED

The risk of death in men who had sex twice or more a week is half that of men who had sex less than once a month.*

Davey Smith G: BMJ 1997;315(7123):1641-44

SAVOR YOUR SENSES: The Benefits of Sex

* After adjusting for age, social class, smoking, blood pressure, and existing heart disease

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§  Men taking a siesta were 30-50% less likely to have a heart attack

§  24,000 people over 6 years: §  Occasional nap: 12%

reduction in coronary mortality

§  Frequent naps: 37% reduction

Trichopoulas D: Lancet 1987;2:269 Naska, A: Arch Int Med 2007;167:296

PRACTICE HAPPINESS: Siestas

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Hearty Laughter Heart attack patients Rx: 30 min/day humor video

§  fewer irregular rhythms §  lower blood pressure §  lower stress hormones §  less medication §  one-fifth rate recurrent heart

attacks

Tan SA: Can J Cardiol 1997

PRACTICE HAPPINESS: Humor Matters

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Pets In the year following a heart attack, pet owners have one-fifth the rate of recurrent heart attack.

Friedmann E, Public Health Reports 1980;95:307

INDULGE IN ALTRUISM: Selfless Pleasures

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INDULGE IN ALTRUSIM

Giving Better than Receiving Mortality risk reduced by nearly half in seniors giving social support while increased in those receiving support.*

Brown SL Psych Sci 2003 * After controlling for age, gender, health status, socioeconomic

status, health behaviors, and personality

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Questions


matter for health? 3.  How can we design for

happiness and amplify pleasure?

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Think of a change you made…

q  Did your plan out and write down specific small steps and/or have feedback of performance data?

q  Did a major life event trigger an epiphany/breakthrough change?

q  Did you change because your environment required or invited the change?

q  Did you just change the behavior because it felt good?

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Roads to Behavior Change

§  Incremental Planned Change §  “Baby Steps” §  “Small Steps” §  “Simple Steps” §  “Tiny Steps” §  “Starter Steps” §  “Success Steps” §  “Mastery Experiences”

§  Breakthrough Change §  Environmental Change §  Pleasurable Change

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Health Behavior Change

What if small steps do not lead to sustained behavior change and health habits?

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Small Steps to Health

Small Steps

Sustained Health Habit

Improved Health

Small Steps

Success Experience

Improved Health

ü Confidence ü Optimism ü Self-Efficacy ü Mood/Affect ü Pleasure ü etc.

ü Exercise ü Healthy Eating ü Smoking ü Preventive Care ü etc.

Behavior Matters Mood Matters

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Segar M et al. Rebranding Exercise. International Journal of Behavioral Nutrition and Physical Activity 2011, 8:94. http://www.ijbnpa.org/content/8/1/94

Failure and Success

http://michellesegar.com/organizations/

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Celebrate

Design with Pleasure: Amplifiers

Focus

Prime Reframe

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Celebrate


Reframe Prime

Focus

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Ingredients of Sensory Pleasures

Good Sense + Mindful

Attention + Pleasure! = What do you need for pleasure to happen?

Good Stimulus

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PRACTICE HAPPINESS A Wandering Mind is an Unhappy Mind

What are you feeling, doing, and thinking right now?

2250 people Killingsworth, Gilbert: 2010. Science 330:932. www.trackyourhappiness.org

§ Mind wandering: 50% §  People happier when their mind

was NOT wandering during all activities, pleasant or unpleasant

§ What people are thinking is better predictor of happiness than what they are doing

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A Call to be Present

TELEPHONE RING Distraction? Interruption? or Call to be present?

(  First ring: Smile. Breathe. “Listen, listen. This wonderful sound brings me back to my true self.”

(  Second ring: Smile. Breathe. (  Third ring: Be fully present as you

answer. Thich Nhat Hanh, Peace is Every Step

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Celebrate


Focus

Prime Reframe

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YOU ARE HERE

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Amplifying Pleasure with Scarcity

The last piece of chocolate on earth…

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Celebrate


Focus

Reframe Prime

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The Power of Priming

Priming make us more sensitive to and aware of:

§  opportunities §  events §  interactions §  triggers

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What 3 things happened today that I am: §  grateful for? §  curious about? §  surprised by? §  learning something new?

Emmons RA, J Pers Soc Psych, 2003 Emmons RA, Thanks! 2007

Priming for Gratitude, etc.

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What do you take for granted?

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What to call it?

§  “Priming Behaviors” §  “Ripple Behaviors”

§  “Cascading Behaviors” §  “Domino Behaviors”

§  “Keystone Behaviors”

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Focus

Prime Reframe

Celebrate

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Celebrating Unexpected Pleasures

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Design with Pleasure

þ  Emphasize more proximal, immediate satisfaction, mood, and feelings

þ  Focus on present experience þ  Don’t be senseless (invite sensual pleasure) þ  Celebrate (even small) successes þ  Include unexpected surprises, delights þ  Change the focus/perspective/filters/frames þ  Identify “priming” and “cascading” behaviors

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Thank you…

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Healthy Pleasures: 5 Part Online Video Program

or search YouTube

for “Healthy Pleasures”

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Twitter @KPhealthyfun

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Resources for Happiness

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Can judge a book by it’s cover?

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Resources and References (1) Ben-‐Shahar, Tal: Happier: Learn the Secrets to Daily Joy and Las@ng Fulfillment. McGraw-‐Hill, 2007 Boronson, Mar;n: One Moment Medita@on. Winter Road Publishing, 2009. Burns, David: The Feeling Good Handbook. Morrow, 1989. David, Susan, et al. Oxford Handbook of Happiness. Oxford, 2013 Davis, Martha; Eshelman, E; McKay, M: The Relaxa@on & Stress Reduc@on Workbook. New Harbinger, 2008. Diener , Ed and Biswas-‐Diener, Robert . Happiness: Unlocking the Mysteries of Psychological Wealth. Wiley-‐Blackwell, 2008. Dunn EW, Akmin LB, Norton MI. (2008). Spending money on others promotes happiness. Science, 319,1687-‐89 Emmons RA, McCullough ME (Eds.) (2004). The Psychology of Gra@tude. Oxford Press. Emmons, RA (2007). Thanks!: How the New Science of Gra@tude Can Make You Happier. Houghton Mifflin Howell RT, et al: (2007). Health benefits: Meta-‐analy;cally determining the impact of well-‐being on objec;ve health outcomes. Health

Psychology Review 1(1),83-‐136 Kabat-‐Zinn, J: Wherever You Go There You Are: Mindfulness Medita@on in Everyday Life. Hyperion, 1994 Kringelbach, M (ed): Pleasures of the Brain. Oxford, 2010 Lyubomirsky, S . The How of Happiness. Penguin Press, 2008 Lyubomirsky, S . The Myths of Happiness: What Should Make You Happy, but Doesn't, What Shouldn't Make You Happy, but Does.

Penguin Press, 2013 McKay M, Davis M, and Fanning P: Thoughts and Feelings: The Art of Cogni@ve Stress Interven@on. New Harbinger, 2007. Neele, Daniel: Happiness: The science behind your smile. Oxford University, 2005.

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Resources and References (2) Ornstein, Robert and Sobel, David: Healthy Pleasures. New York: Addison-‐Wesley, 1989. Ornstein, Robert and Sobel, David: The Healing Brain. New York: Simon & Schuster, 1987. Pennebaker, James W. Opening Up: The Healing Power of Confiding in Others. Guilford Press, 1997. Posi;ve Psychology Center, University of Pennsylvania. hep://www.ppc.sas.upenn.edu/ Seligman, Mar;n: Authen@c Happiness, Free Press, 2004 Seligman, Mar;n: The Op@mis@c Child. Mariner, 2007. Seligman, Mar;n: Flourish. 2011. Sheldon KM, Lyubomirsky S: Is It Possible to Become Happier? (And If So, How?) Social and Personality Psychology Compass 1/1

(2007): 129–145, Siahpush M, Spieal M, Singh GK: Happiness and Life Sa;sfac;on Prospec;vely Predict Self-‐Rated Health, Physical Health, and the

Presence of Limi;ng, Long-‐Term Health Condi;ons. American Journal of Health Promo;on: September/October 2008;23:18-‐26.

Sobel, David and Ornstein, Robert: The Healthy Mind, Healthy Body Handbook (also published under the ;tle The Mind&Body Health Handbook), Los Altos, CA: DRx 1996.

Sobel, David: Rethinking Medicine: Improving health outcomes with cost-‐effec;ve psychosocial interven;ons. Psychosoma@c Medicine 57:234-‐244, 1995.

Sobel, David: The cost-‐effec;veness of mind-‐body medicine interven;ons. In The Biological Basis for Mind Body Interac@ons, Progress in Brain Research, Vol 122, E.A. Mayer and C.B. Saper (Eds.), Amsterdam: Elsevier Science, 2000:393-‐412.

Wiseman, Robert: 59 Seconds: Think a Li^le, Change a Lot. New York: MacMillan, 2009.