By Eva R. Serber, Ph.D., Licensed Psychologist and Associate Professor, Division of Bio-behavioral Medicine, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina | March 20, 2019

All patients seek healthcare to “feel better.” This may be both from a physical health perspective as well from a mental or emotional health perspective. Helping patients “feel better” has significant benefits to the patients’ daily life and their overall satisfaction with life and longevity.

Historically, the predominant research has focused on the impact and reduction of negative emotional states such as, anger, depression, anxiety. These clinical trials and evidence-based treatments are effective and beneficial for giving patients better quality of life. Since the 1980s, there has slowly been mounting evidence and proponents for positive psychology and a increased focus on strengthening and building the following positive elements:

• Emotions: happiness, joy, peace, gratitude and hope
• Traits: love, courage, creativity and integrity
• Institutions: meaning and purpose, community service, leadership, civility and responsibility (Seligman & Csikzentmihalyi, 2000; Seligman, 2002).
   

Positive emotions are on separate continuums from negative emotions, and have shown in the research to be deserving of their own focus and applied interventions to our patients. It is the notion of focusing on strengths and boosting positive tenets, focusing on pursuing values and promoting what “feels good,” and adding satisfaction to life in areas that can be improved upon or made greater. All of this serves the overarching pursuit of “adding to life” — not ridding or remediating less than satisfying areas of life. This is particularly poignant for our sick patients with chronic, lifelong conditions. These patients are not being treated for a cure, but rather a recovery to a “new normal” and maintenance of as good of health as possible.

Mounting evidence shows that those who are happier live longer and bounce back from adversity easier (resilience). Studies that have examined happiness (or positive constructs, specifically) have shown that their effects are stronger than the detrimental effects of negative states or traits. Positive emotions have been shown to reduce patients’ experience of symptomatology and mortality risk; influence autonomic function, respiration and hemodynamics; improve immune system functioning; and reduce the stress hormone response. Similar to negative emotions (e.g., depression and anxiety), positive emotions have direct and indirect effects on health: directly through physiological mechanisms, and indirectly through health behaviors (e.g., adherence, diet, physical activity) (Pressman et al., 2019).

Much of the positive psychology research and intervention studies have been among cardiovascular disease, showing rate of incident heart disease reduced with increased positive affect score (Davidson et al., 2010), reduced death, rehospitalization, disease progression and even reduced arrhythmia risk in long QT syndrome (Cohen & Pressman, 2006;  Davidson et al., 2010; Giltay et al., 2006;  Kubzansky et al., 2001; Middleton & Byrd, 1996; Scheier et al., 1989, 1999;  Sears, Serber, et al., 2004; Tindle et al., 2009). Less has been done with pulmonary patients, and yet, the research there still demonstrates positive outcomes from increasing positive emotion. Positive emotion has displayed an inverse relationship with breathlessness; sense of humor was associated with improved wellbeing; and in a sample of lung cancer patients, positive emotion was associated with adaptive social functioning, fewer emotion-based role limitations and less bodily pain, over and above negative emotion (Benzo et al., 2016; Hirsch et al., 2012; Lebowitz et al 2011).

There are several positive emotion-enhancing activities that can be added into your practice of cardiovascular and pulmonary patients that can further facilitate their recovery to recent event and exacerbation, and improve their outcomes of cardiopulmonary rehabilitation. For one, physical activity is considered a positive emotion-enhancing activity. Participation in cardiopulmonary rehabilitation is also a positive emotion-enhancing activity, because patients’ engagement in something meaningful and valuable to them helps to improves their health and, oftentimes, their independence. Patients then start to feel productive and accomplished (all positive tenets).

Adding to their healthcare regimen, staff and providers can encourage patients to “identify three things that went well each day and reflect on why they occurred” (Three Good Things). This could counter when patients are feeling like much is going wrong. Another activity is to “Identify one strength, and how the patient applied it each day (Strengths). Focusing on strengths each possess can be helpful for those who are discouraged and take on a feeling “weak”/“less than” role because of their illness.

We all love to smile. Smiling feels good. Finally, research is starting to show what we “know”: Smiling is good for the mind, body and soul.