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The Relationship Between Happiness and Health; Strategies for the 21st Century.

“Laughter is the Best Medicine”

No one would argue that there is some element of truth to the above chiché. When we are happy, in general, we feel healthy and vice versa. Similarly, when you are not in optimum health, this can negatively affect your outlook on life and again vice versa (this is known as reverse causation and we will refer to it later). Is there a precise relationship between these two and with all the illnesses that are now being recognised to have stress, anxiety or depression as a contributing factor, can we afford to ignore our own happiness? Is there any way we can take control back of our own happiness in thereby positively influence health? We explore the current evidence and strategies.

The difficulties in assessing a link

A number of problems are posed when trying to assess the relationship between health and happiness the most significant being how does one establish a relationship between two parameters that don’t have objective qualities.

The Oxford English Dictionary defines happiness as:

‘the state of feeling or showing pleasure or contentment’.

The World Health Organisation definition of health is:

‘A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’

Parameters such as height, weight, heart rate, blood pressure even your blood cholesterol are easy to quantify but how can one objectively measure health or happiness which are both primarily subjective experiences.

Another difficulty arises from reverse causation. If the two factors are so tightly interlinked it can be unclear which parameter influences which, i.e. is it unhappiness that causes ill health or vice versa. The time frames for each can be unclear as both poor health or a period of prolonged unhappiness or even depression can have an insidious onset.

Questionnaires are often used in these studies to attempt to quantify these experiences but it is recognised that these are a poor and unrepresentative surrogate measure.

The evidence for a relationship

A meta-analysis (systematic review of 62 scientific publications) that involved over one million participants demonstrated that self-perception of well-being was a protective factor for mortality, i.e. those who felt happier (in general) lived longer [1].

A landmark retrospective (looking back at past data, in this case, the journals of nuns) study of nuns found those with a cheerier outlook in early life lived longer. What increases the strength of the study is the heterogeneity (similarities) in the population [2]. Nuns typically live similar lifestyles so any differences in outcome (in this case their longevity) can be reduced to a smaller number of variables such as outlook and personality traits. The authors concluded that the positive emotional content in early-life autobiographies was strongly associated with longevity 6 decades later.

Stress and depression have both independently been linked with a number of conditions affecting almost every single organ system including but not limited to:

High blood pressure, headaches, coronary heart disease, palpitations, stroke, gastric ulcers, gastrointestinal disturbances, sexual dysfunction, diabetes and obesity[3].

In a significant study that made it to the front page of the British Medical Journal in April 2019 [4], found the risk of developing heart disease was over 60% greater in siblings who had stress disorders (including anxiety and post-traumatic stress disorder. Again, as this was a sibling study, a number of external factors would have been controlled for increasing the power of this study.

However, as the effects of unhappiness can affect health detrimentally, feelings of happiness have been shown in multiple studies to have a positive impact on various aspects of health and the following list is not an exhaustive, nor the referenced articles. Many more articles are available in the peer-reviewed literature for those interested but the following publications are a good starting point.

Happiness protects the heart.

A 2005 paper demonstrated a correlation between happiness and a lower heart rate and blood pressure and happiness measures and this correlation was present and could be extrapolated to the participants’ blood pressure at three years follow-up. Hypertension (elevated blood pressure) is a recognised risk factor for a wide range of health conditions[5].

In fact, multiple studies exist in the literature on the effects of happiness on coronary artery disease and its sequelae – angina or heart attack or heart failure which can manifest as breathlessness or leg swelling.

Happiness enhances the immune response.

Of the studies in the peer-reviewed literature. Most correlate happiness and optimism with enhanced immune function. Perhaps the most interesting is a 2003 study in which 354 volunteers aged between 18 and 54 were inoculated with the cold virus (‘Rhinovirus’ via nasal drops). A ‘positive emotion style’ was associated with a reduced risk (three times less compared with the less happy group) of developing a cold as well as reduced reporting of cold symptoms[6].

A study published in 2006 looked at the immune response of 81 students given the Hepatitis B vaccination. This vaccination is commonly given to students in healthcare professions and high antibody levels measured after vaccination indicate a healthy immune system. In this study, happy students were twice as likely to have antibody titres in the ‘high’ range compared with their less happy counterparts[7].

Happiness modulates the stress response.

Stress causes the release of a number of neurotransmitters and hormones in the body. One of the most widely studied of these is the hormone cortisol. It is often known as the stress hormone. Multiple studies have found cortisol levels to be lower in those with a happier or more positive affect.

A 2005 paper published by Steptoe et al. found that cortisol levels were a third lower in individuals with a happy affect when subjected to stressful tasks in a laboratory environment [8]. Interestingly, these effects were seen also at long term follow-up when Steptoe and his team measured serum cortisol levels in the two groups and found the happier individuals had levels 20% lower[5].

Happiness helps you sleep.

A study of 736 men and women aged between 58 and 72 showed a negative correlation between positive affect and sleep-related problems [9]. The differences are shown to be highly significant statistically (the strength of this study is also aided by the relatively large number of participants recruited).

Happiness alters your perception of pain.

Many studies exist in the medical literature on the effects of affect and pain, especially chronic pain. It is clear from these studies that a negative affect will contribute negatively to an individuals’ perceptions of pain. A 2013 study of 1018 patients with osteoarthritis (wear and tear causing pain) of the knee joint found that those patients with a positive affect walked on average 711 steps more per day, that equated to 8.5 percent compared with those without a positive affect [10].

“Happiness does not come from without, it comes from within.” – Helen Keller

As well as this famous quote from Helen Keller, there is, the famous parable that ‘all happiness comes from within’. If this is true, is there anything we can do in the 21st century to put the odds of a happier life more in our favour.

In eastern traditions such as Buddhism and Hinduism, it has long been held that the thinking mind is responsible for a lot of the unhappiness, discontent and ‘suffering’ we experience. Of the levels of mind, the ‘thinking’ mind is constantly producing a stream of unconnected and often incoherent thoughts. One or more of these thoughts are then grasped by the ‘intellectual’ mind and formulates a coherent thought. It is this thought that propels us in our daily life but the background chatter of the ‘thinking’ mind. In these traditions, it is also felt that the thinking mind has been elevated to a status in the way in runs our lives much higher than it deserves and in fact, it should be relegated to the same status as a sense organ.

The authors propose three strategies available immediately to everyone, free of charge and in most cases, minimally disruptive to your lifestyle. They are secular practices that do not belong to any religion, nor do they require you to be religious to practice them. They are presented in order of mainstream popularity and acceptability; the effects of these techniques, however, are synergistic – i.e. the effects of one method will greatly enhance the effect of another method.

1. Mindfulness

2. Meditation

3. Self-inquiry

Mindfulness.

There are many definitions for Mindfulness from many sources but perhaps the most useful one is as follows:

The self-regulation of attention with an attitude of curiosity, openness and acceptance.

If broken down, the practice is simple. Instead of attention by default going to thoughts, the attention goes on all else but. This may be the visual perceptions, the sounds, the smells, the body sensations all in that present moment. This sounds incredibly easy, doesn’t it? The mind, however, has other ideas and frequently presents these unnoticed and unchallenged. The key is to change ones’ attitude and to remember to shift the attention onto awareness of the present moment and away from thoughts of the past and anxieties of the future. A number of apps and integrations into wearable devices are becoming increasingly available to remind us to have that mindful moment but they key is to become mindful 100% of the waking day and this is where the following two strategies come into their own.

Meditation.

Again, there are many definitions from many traditions and other sources but in essence, meditation is focussed attention. Attention is something that is not ‘taught’ in a conventional sense at any stage of ones’ attention but is one of the keys to life. Anything can be an object (or ‘anchor’) in meditation but the most commonly employed is the breath.

The simplest and most effective method is to simply watch the breath without altering it. Give it your full attention and learn everything about it. The sounds it makes, the way it feels against your nostrils, airways. The way it makes your chest and abdomen move.

Very early on in the practice, it becomes clear that it easy to become ‘lost in thought’ but that recognition is vital. This recognition, becoming aware of being lost in thought and returning to the anchor, in this case, the breath has been likened to doing a ‘biceps curl for the brain’. This frequent recognition early on in the practice of meditation is thought to be responsible in changes in grey and white matter density on functional MRI scans in participants starting a practice of meditation [11,12].

Many mindfulness teachers including Andy Puddicombe believe sitting meditation is an integral part of a mindful lifestyle. Most meditation teachers feel that just twenty minutes per day is sufficient for most working adults. Although you don’t need to meditate to enjoy the fruits of mindfulness, you will be enjoying them much sooner if you incorporate it as part of a daily practice.

Self-inquiry

This is the least known of the three techniques but perhaps the most efficacious. It has its origins rooted in most eastern and western traditions Buddhism, Advaita Vedanta philosophy in Hinduism, Sufiism in Islam in the East as well as the Christian contemplative traditions in the West. These traditions explain the origins of the unruly thinking mind with the development of speech and identity. At first, it is recognised that thoughts arise and subside but somewhere in the process of infantile development, the thinking mind, instead of running in the background being called upon when required, runs in the foreground of consciousness, remaining subtly and unchallenged. Early in the process of learning meditation it this layer of ‘running commentary’ of thoughts is recognised. Some meditators believe that it is necessary to have a certain ‘stillness’ mind that only meditation can bring before practicing self-inquiry others believe that the practice itself brings about ‘stillness’ as follows:

Thoughts arise spontaneously and if left alone will subside spontaneously. If the thinking mind is running in the foreground these thoughts if unchallenged can and often, in this modern world, dictate our day to day activity.

The practice, and normally it begins with the negative thoughts, is to ask when the thought arises:

“To whom does this thought arise?”

It seems simple enough and the thinking mind seems to deliver its answer quite quickly but with the stillness of an experienced meditators mind, the conscious processes underlying this question are explained:

When this question is asked or the question

“On whose behalf is this thought arising?” or

“Who is aware of this thought?” or simply

“Who am I?”, the mind sinks its attention away from any objects of thought, perceptions of the world or sensations of the body in an attempt to answer a question it is rarely if ever asked. This technique is often taught as a self-help technique as just the mere asking of the question “Who is aware of these thoughts?” when experiencing a negative thought or emotion immediately creates a space between the individual and what they are experiencing. If the mindful can then put their attention on that space rather than the experience, much of the unhappiness can be staunched.

The answering of the question appears to take quickly, instantly but practiced over time, a greater stillness and awareness develops and this process becomes significantly more potent. It can then be used with all thought, including positive thoughts.

Although it is impossible to eliminate thoughts completely, these three techniques allow you to develop a greater awareness of them and through that a quietening and control over them. The increasing stillness through the quietening of the mind brings a sense of inner peace and happiness that has been recognised by spiritual practitioners for millennia but is now being brought into the mainstream.

Article by: Vikas Pandey MD FRCS DipBSoM and Annie Parry MA ADMP UK

For more information visit www.pandey.healthcare or email info@pandey.healthcare

For free guided and unguided meditations go to www.pandey.healthcare/meditation

Vikas Pandey is a consultant surgeon working in the field of emergency and vascular surgery. He is based at West Hertfordshire Hospitals NHS Trust. He also teaches meditation nationally and is based in Harley Street, London.

Annie Parry is now based as an experienced and qualified spiritual director and retreat facilitator in Worcestershire and consults in the west midlands and London.

She became focused very early in her career to an interest and subsequent commitment to prioritizing the facilitation of inner and outer congruence, and attentive to dissolving the violence of duality, and its potential damage  to the health and happiness of those caught up in it.

Ostensibly, Annie was a professional in the world of theatre and dance, however during this  time her work included a post in Jerusalem tutoring at the Hebrew University, teaching young Israeli soldiers Classical ballet, and living alongside Palestinian students, and listening to their stories over supper in the evenings. This was to shape her life’s work.

Later years saw her as a Movement Psychotherapist, and clinical lead for an NHS Arts Psychotherapy specialist team for young adults struggling with self harm and suicidal behaviours. Highest value was given to facilitating the unifying undercurrents of emotional, spiritual, and intellectual freedom, via mindful and meditative practice.

She has tutored and supervised from foundation students  to  post graduates in various Uk universities, the most recent being Worcester.

Further Reading:

The Headspace Guide to Mindfulness and Meditation. 10 minutes can make the difference. Andy Puddicombe. Hodder Paperbacks

The Miracle of Mindfulness. Thich Nhah Hanh. Rider.

When Things Fall Apart: Heart Advice for Difficult Times – Pema Chodron. Element Books

The Power of Now – Eckhart Tolle. Mobius

Loving What Is: Four Questions That Can Change Your Life – Byron Katie. Rider

References:

1. The Impact of Subjective Well-being on Mortality: A Meta-Analysis of Longitudinal Studies in the General Population. Martín-María NM, Miret M. Caballero FF, Rico-Uribe LA, Steptoe A; Chatterji S, Ayuso-Mateos JL. Psychosomatic Medicine: June 2017 – Volume 79 – Issue 5 – p 565–575

2. Positive Emotions in Early Life and Longevity: Findings from the Nun Study. Danner DD, Snowdon DA, Wallace VF. Journal of Personality and Social Psychology, 2001, Vol. 80, No. 5, 804-813

3. Stress, Psychiatric Disorders, and Cardiovascular Disease. Bacon S. British Medical Journal 2019; 365: I1577

4. Pessimistic explanatory style is a risk factor for physical illness: A thirty-five-year longitudinal study. Peterson, Christopher; Seligman, Martin E.; Vaillant, George E. Journal of Personality and Social Psychology, Vol 55(1), Jul, 1988: 23-27.

5. Positive Affect and Biological Function in Everyday Life. Steptoe A, Wardle J. Neurobiology of Ageing 2005; 26(S1): 108-112

6. Emotional style and susceptibility to the common cold. Cohen S, Doyle WJ, Turner RB, Alper CM, Skoner DP. Psychosomatic Medicine. 2003 Jul-Aug;65(4): 652-7.

7. Trait positive affect and antibody response to hepatitis B vaccination. Marsland AL, Cohen S, Rabin BS, Manuck SB. Brain Behav Immun. 2006 May;20(3): 261-9.

8. Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes.Andrew Steptoe, Jane Wardle, and Michael Marmot. Proc Natl Acad Sci U S A. 2005 May 3; 102(18): 6508–6512.

9. Positive affect, psychological well-being, and good sleep. Steptoe A, O’Donnell K, Marmot M, Wardle J. J Psychosom Res. 2008 Apr;64(4): 409-15.

10. When it hurts, a positive attitude may help: The association of positive affect with daily walking in knee OA: the MOST Study. White DK, Keysor J, Neogi T, Felson DT, LaValley M, Gross KD, Niu J, Nevitt M, Lewis CE, Torner J, Fredman L. Arthritis Care Res (Hoboken). 2012 Sep; 64(9): 1312–1319.

11. Change in Brainstem Gray Matter Concentration Following a Mindfulness-Based Intervention is Correlated with Improvement in Psychological Well-Being. Singleton O, Hölzel BK, Vangel M, Brach N, Carmody J, Lazar SW. Front Hum Neurosci. 2014 Feb 18;8:33.

12. Mechanisms of white matter changes induced by meditation. Tang YY, Lu Q, Fan M, Yang Y, Posner MI. Proc Natl Acad Sci U S A. 2012 Jun 26;109(26):10570-4

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