Psychiatric TimesPsychiatric Times Vol 26 No 6
Volume 26
Issue 6

Despite their severe physical impairment, disability, and frequent medical complications, tetraplegic patients reported a very positive outlook on life, according to a recent study. In another, 63% of major lottery winners chose to con­tinue working full-time at their same jobs.

Despite their severe physical impairment, disability, and frequent medical complications, tetraplegic patients reported a very positive outlook on life, according to a recent study.1 In another, 63% of major lottery winners chose to continue working full–time at their same jobs.2

These study results appear counterintuitive, yet neuropsychiatrist Jeff Victoroff, MD, placed them in perspective during his recent presentation on happiness.3 Speaking to a packed audience at the US Psychiatric and Mental Health Congress, Victoroff, associate professor of clinical neurology and psychiatry at the University of Southern California, described the major biological and psychological factors associated with happiness and recommended interventions to increase happiness.

Victoroff began by distinguishing between 2 types of happiness. Hedonic happiness is pleasure at the moment (eg, eating a chocolate candy or experiencing the high of crack cocaine), while eudaimonic happiness is experiencing good feelings and an overall sense of contentment, peacefulness, and fulfillment. Eudaimonic well–being is measured by high positive affect, low negative affect (avoidance of negative thoughts), and life satisfaction.

Happiness or subjective well–being can be measured in various ways. Nevertheless, Victoroff emphasized the integrative work of Diener and colleagues,4 who pioneered the science of subjective well–being and who developed the first psychological instrument explicitly intended to assess overall life satisfaction.

Importance of happiness

The work of Lyubomirsky and others5 reveals the value of happiness, Victoroff said. The researchers, seeking to determine whether positive affect engenders favorable outcomes, reviewed 225 papers that incorporated cross–sectional, longitudinal, and experimental studies involving some 275,000 participants, along with several meta–analyses and numerous outcome measures. The principal findings, Victoroff said, were that happy people (ie, those reporting higher than average positive affect):

• Have more prestigious jobs at age 26 (if they had positive affect when they were 18)

• Have higher incomes later in life

• Live longer lives

• Have healthy habits

• Are less likely to get sick when exposed to a virus

• Have fewer accidents

“The evidence suggests that good lives lead to positive affect and that positive affect is a resource that engenders good lives,” Victoroff said.

Biology of happiness

“Much of happiness is genetically predetermined,” Victoroff said. He described a 1988 study by Tellegen and others6 in which the Multidimensional Personality Questionnaire was administered to 217 monozygotic and 114 dizygotic adult twin pairs who had been reared together and 44 monozygotic and 27 dizygotic adult twin pairs who had been reared apart. “The bottom line of that study,” Victoroff said, “is that about 50% of the variance in subjective well–being is genetic. That is almost identical to what we believe to be the amount of intelligence accounted for by genetic variation.”

For most, happiness is a stable trait throughout life, said Victoroff. He cited the work of Fujita and Diener7 who used 17 years of data from a large and nationally representative panel study in Germany involving 3608 individuals.

“Over long periods, there is modest stability in life satisfaction,” the authors said, but added that for some people (24%), life satisfaction does change, even in the “face of significant stabilizing factors, such as heritable disposition.”

Much of psychology has focused on negative emotions, such as fear, and their link with the amygdala, Victoroff explained. “Now,” he said, “researchers have found that positive affect activates the cingulate and hippocampus8 as well as the amygdala, accumbens, ventral striatum, and ventromedial prefrontal cortex.9 Also, greater left than right superior frontal activation is associated with both eudaimonic and hedonic well–being.

Victoroff believes that happy people exhibit different biology, citing a study by Ryff and associates.10 Using a small sample of older women, the researchers examined the empirical associations between measures of psychological well–being and ill–being using biomarkers, both neuroendocrine and cardiovascular. They found people with better social relationships weighed less, while those with higher depressive symptoms were heavier. Similarly, those with better social relationships had lower levels of glycated hemoglobin, while those with higher levels of negative affect, trait anxiety, and trait anger had higher levels of the same biomarker.

In addition, Victoroff said, those with a purpose in life had rising daily salivary cortisol, and those with a sense of autonomy had rising norepinephrine levels.

People with different personalities have different brain responses to identical stimuli, according to Victoroff. Canli and others,11 he said, found a correlation between extraversion and brain response to positive pictures. van Reekum and colleagues12 found that when exposed to negative pictures, happy people will turn on their anterior cingulate, turn off their amygdala, and evaluate the negative experience as less important.

Who is happy?

“We might argue as therapists that we see people who are distressed. But in fact, most people are happy,” said Victoroff. “There are several studies showing that the majority of people are in a mildly positive affective state most of the time. This may be an evolutionary adaptive bias permitting humans to get out of bed, despite looming mortality. And depression may be, in part, loss of the normal positivity bias.”

And what about the common conceptions, such as young adults are happier than older ones or that money makes people happy?

The World Values Survey II, which involved 60,000 respondents and was cross–cultural and cross–national, showed that life satisfaction scores were level between ages 18 and 90, Victoroff said. Mroczek and Spiro13 tracked changes in life satisfaction among 1927 men for over 22 years and found that life satisfaction peaked at age 65 and then declined. They also found significant individual differences in the rate of change.

Good emotional outcomes late in life, the NIH Cognitive and Emotional Health Project researchers reported, were linked with higher education, higher socioeconomic status, good health, better cognitive function, and good emotional support systems.14

Several studies have explored the effect of income on happiness, said Victoroff. “In 1974, economist Richard Easterlin published data which showed that happiness in the US did not increase despite huge increase in the average wealth after World War II.” Easterlin’s work was reconfirmed by Diener and Seligman.15

Conventional wisdom says that most major lottery winners would quit their jobs. Yet, Victoroff pointed to a study by Arvey and colleagues,2 who surveyed 177 persons who won the Ohio state lottery and whose winnings ranged from $20,000 to almost $5 million. Of the winners, 63% continued to work, 6% briefly quit working, 10% started their own businesses, and only 4% quit work altogether. Work, the researchers explained, provides comfort, structure, friends, and fulfillment.

Victoroff also cited studies that showed that:

• Social activity was positively and significantly related to subjective well–being

• Married people are generally happier than single or divorced people

• Religiosity is weakly associated with well–being

• Individuals who have goals such as commitment to family and friends or social and political involvement are more likely to have life satisfaction than those who seek career success or wealth

• Individuals with positive personalities tend to have higher levels of exercise motivation and exercise participation, which, in turn, improves their quality of life

• Excessive focus on trying to maximize happiness ultimately leads to unhappiness

Victoroff also provided some insight on a study that assessed the mental health of 2 groups of people with spinal cord injuries and a group of able–bodied people.1 Although the patients with high spinal cord injuries (damage above the T6 vertebra) had the worst level of physical functioning, their outlook toward life was not only very positive but better than that of less impaired patients and of able–bodied people. The authors suggested that successful coping after spinal cord injuries may be influenced by not only psychological adaptive reactions but by neurophysiological changes induced by the injury itself.

Having worked in a rehabilitation hospital, Victoroff said many paraplegic or quadriplegic patients he saw exhibited less distress than you might expect among patients with spinal cord injuries. Nonetheless, he emphasized that a substantial body of research has shown that disability more typically has a negative impact on well–being.

Happiness interventions

Victoroff stated that some evidence supports the benefits of:

• Going out of doors

• Helping and spending money on others

• Being sociable within one’s own comfort zone

• Meditating

• Expressing gratitude

• Recording positive events or personal strengths

He cited the work of Seligman and others16 who looked at the effectiveness of psychological interventions to increase individual happiness. In a randomized placebo–controlled study, researchers compared the results of 5 happiness exercises. For example, 1 exercise focused on expressing gratitude by writing and delivering a letter of thanks to a person who had been especially kind but had never been properly thanked. That exercise led to large positive changes among study participants that lasted for a month.

Victoroff pointed to the evidence of the benefits of regular exercise for lasting eudaimonic happiness. “There are relatively few interventions that we can do that are absolutely known to work, and one of them is getting patients to exercise, particularly aerobic exercise.” He went on to say, “Certainly, positive affect and personality correlate with exercise motivation and participation. But also, if you oblige people to exercise, encourage them and reward them for exercising, it increases their positive affect.”

Other potential factors affecting eudaimonic happiness, Victoroff said, may include hormone replacement therapy in women; marriage/affiliative security; breast feeding; using SSRIs in a subgroup of patients; cognitive–behavioral therapies; working toward a valued goal; and (possibly) mindfulness meditation or even repetitive transcranial magnetic stimulation (TMS).

The FDA last October approved TMS to treat depressed adults in whom 1 antidepressant medication has failed to work. Victoroff added that, “although the evidence of efficacy at present is rather weak, at least in some cases, it seems to lead to lasting benefits.”




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