The President’s Report from George Guthrie

Happiness Science in Health Care

by: George Guthrie, MD, MPH, FAAFP, FACLM, CDE

May 2018

Liana Lianov, MD, MPH, FACPM, FACLM, a past president of the American College of Lifestyle Medicine, has been very interested in how emotional health affects health.  After attending a number of related conferences and reviewing the literature, she identified a compelling body of evidence supporting the connection. This led to a reasonable desire (even passion) to integrate this field into the field of lifestyle medicine. The result: Liana becoming the founding chair of ACLM’s Happiness Science and Positive Health Committee just a few short months ago, her establishing within ACLM the Liana Lianov Fund for Happiness Science, and her committee producing the inaugural Summit on Happiness Science in Health Care.

As I write this, I am on a plane flying back from Austin, Texas, where an impressive convening of positive psychology experts shared cutting-edge research, joined by nearly 100 ACLM leaders and lifestyle medicine thought leaders and decision makers representing many facets of our health care industry. 

The two-day summit commenced on Sunday evening, May 6, 2018 in a state-of-the-art auditorium, part of the new Dell Medical School on the University of Texas campus in Austin, Texas. Lianov’s co-chair for the meeting was Dell Medical School’s Carrie Barron, MD, an associate professor in the Department of Psychiatry.

Dr. Lianov opened the summit by noting how health care is beginning to incorporate positive psychology into health coaching and how some health care innovators are offering interventions to promote emotional well-being. She posited that this summit aims to kick-start a movement to increase the use of these interventions in health care. She emphasized that the emotional well-being element should be added to lifestyle medicine as a key modality of the field, along with healthy nutrition, physical activity, sleep, avoiding risky substance use, and stress management. Since emotional well-being needs to be customized for significant engagement and impact, she suggested that perhaps making such an addition would result in the next phase of lifestyle medicine: lifestyle medicine 3.0 (that parallels the concept of health 3.0)—almost a decade after the JAMA publicationon the lifestyle medicine core competencies.

The first speaker was Ed Diener, PhD, professor of psychology at the University of Virginia, the University of Utah, and Senior Scientist for the Gallup Organization.  He made a strong case for the importance of positive psychology in effecting health and stated that the supporting data was “clear and compelling.” We were introduced to the importance of this element for both patients and caregivers. The finding that 30% of nurses quit within the first two years after graduating was shocking. Physician burnout and suicide are significant and growing challenges, while the health care system was identified as a major culprit. We were encouraged to learn that he and his psychologist wife are now doing research on applying a free, web-based, 10 module program to address these challenges, both in health care workers and patients. It is called ENHANCE and is available for free on the web. Early research bodes favorably for the whole program. He is now in the process of identifying which modules are the most beneficial for which personalities or problems.

On Monday morning we heard from Dean Ornish, MD, recipient of ACLM’s 2015 inaugural Lifetime Achievement Award, about the importance oflovein medicine, the power of forgiveness and connection and compassion in improving health outcomes. 

We then heard from Barbara Fredrickson, PhD, of the University of North Carolina, one of the foremost researchers into the effects of fostering daily positive emotions. It was fascinating to hear that simple “acts of kindness” for someone else actually improved gene expression in such a way as to decrease inflammation. We also learned of positivity resonance, a phenomenon in which spouses with increased synchronous heart rate variability are more highly likely to have a satisfying relationship and have significant decrease in chronic disease. Not only that, but friendly casual interactions, such as might occur at the grocery store cashier or a fellow customer, have also shown definite health benefits. Many of us were completely unaware of this research and found it fascinating, wanting to incorporate it into our personal lives, in our patient interactions, and into the health systems in which we work. One practical intervention that Dr Fredrickson has found effective for improving a patient’s emotional health is to simply give a patient a prescription to watch her TED Talk with instructions to put what they learned into practice. 

Michael Steger, PhD, a counseling psychologist from Colorado State University, reminded us that “purpose, meaning, and coherence”are necessary for humans to flourish and cited evidence that when those in the C suite feel that what they do is meaningful the sense of meaning is passed on to the employees and then on to customers.  When we sense meaning in our lives, the documented physiologic benefit list is long and includes, among other things, decreased use of the health system, lower inflammation, and healthier lifestyle choices.

The rest of the day was spent looking at three areas of happiness medicine intervention: health systems, at the patient clinical interface, and finally at the community level. These were each approached with a 15 minute presentation by someone with experience in the field, and then a moderated panel-audience discussion looking to identify practical ways to bring emotional well-being into common use.

Prior to the conference, participants were queried as to what term would be best to describe this field within lifestyle medicine. The preferred term seemed to be emotional well-being. There were many excellent networking opportunities and likely collaborations that emerged. Everyone I spoke with expressed appreciation for the summit gathering and pleasure with the outcome. You are likely to hear more about this in the future.

The ACLM leadership greatly appreciates what Dr. Lianov has done and continues to do to bring this new and important dimension into the core of evidence-based lifestyle medicine practice. She is working with interested panelists, ACLM members and others to turn the presentations and discussions at the summit into a summary paper that lays out a few highlights from the evidence for positive psychology, defines its relevance to a spectrum of stakeholders, and lays out suggested strategies for effectively incorporating it into the everyday practice of lifestyle medicine, other medical fields, health care systems, and our communities.

Expect to hear more about emotional well-being, emotional resilience, and emotional vitality in coming ACLM conferences and communications. ACLM will let our members know when the planned white paper synopsis of this inaugural summit is published. ACLM also hopes to provide in-depth summaries of the positive psychology literature in a future paper and on our website.

From what I have learned during this conference I am certain that applying these principles in the lives of caregivers and their supporting staff will significantly improve their quality of life, while also improving the health of our patients, decreasing the cost of health care, all while making the world a better place.