Can Having a Happier Outlook on Life Make Us Healthier?

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A psychological intervention called "ENHANCE"—which is a comprehensive 12-week program designed to boost subjective well-being (SWB) and promote sustainable happiness—may have a positive effect on self-reported physical health, according to a new study. This paper (Kushlev et al., 2020) was published on June 24 in the journal Psychological Science.

The findings of this randomized clinical trial suggest that having a happier outlook on life might make people healthier. Notably, the team of researchers from the U.S. and Canada also found that either online or in-person participation in the Enduring Happiness and Continued Self-Enhancement (ENHANCE) program were equally effective.

"Prior studies have shown that happier people tend to have better cardiovascular health and immune-system responses than their less happy counterparts," first author Kostadin Kushlev said in a July 22 news release. "Our research is one of the first randomized controlled trials to suggest that increasing the psychological well-being even of generally healthy adults can have benefits to their physical health."

Kushlev is an assistant professor of psychology at Georgetown University and director of The Digital Health and Happiness Lab. He conducted this research with colleagues at the University of British Columbia and the University of Virginia.

Senior author Ed Diener of UVA, the University of Utah, and the Diener Education Fund describes this program on his website:

"The goal of ENHANCE is to teach social skills, ways of thinking, and understanding [of] one's values and strengths as means of increasing life satisfaction, meaning, and enjoyment of life, and as well as reducing stress and depression."

ENHANCE (Kushlev et al., 2016) takes a three-pronged approach to helping people overcome challenges and obstacles on their path to enduring happiness:

1. Learning 10 principles of sustainable happiness.
2. Engaging in activities that apply these principles.
3. Developing habits that integrate these principles into your daily life.

The sample for the latest clinical trial involved a cohort of 155 adults (aged 25 to 75) who were randomly assigned to a wait-list control group or chosen to participate in the ENHANCE program. This positive psychological intervention is designed to improve subjective well-being by progressively addressing aspects of one's "Core Self," "Experiential Self," and "Social Self" while following a week-by-week schedule. As the authors explain in the news release:

"The first three weeks of the program focused on the 'Core Self,' helping individuals identify their personal values, strengths, and goals. The next five weeks focused on the 'Experiential Self,' covering emotion regulation and mindfulness. This phase also gave participants tools to identify maladaptive patterns of thinking. The final four weeks of the program addressed the 'Social Self,' teaching techniques to cultivate gratitude, foster positive social interactions, and engage more with their community."

As mentioned, these weekly modules were either led by a trained clinician in-person (prior to the COVID-19 pandemic) or completed remotely using a customized online platform.

"Each module featured an hour-long lesson with information and exercises; a weekly writing assignment, such as journaling; and an active behavioral component, such as guided meditation," the authors said.

Of note: None of the modules specifically encouraged or promoted healthier lifestyle choices related to physical activity, sleep, or diet; the focus was solely on using evidence-based tools to improve SWB.

In general, participants who received the ENHANCE intervention reported higher levels of subjective well-being and fewer sick days than wait-list controls throughout the 12-week program. Additionally, three months after each participant completed the ENHANCE program, those who had participated in this positive psychological intervention (either in-person or online) reported fewer sick days than randomized participants who had been put on the waiting list.

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"Our findings add to the growing body of evidence that happiness not only feels good, but it is good for other outcomes including physical health," Kushlev said in a Georgetown news release. "This program cannot treat mental health issues, but it may serve as a useful tool of prevention. In recent years, there has been a greater focus in the medical sciences towards prevention, not just treatment."

The researchers are optimistic that the ENHANCE program can be scaled to reach a wide range of people using the online platform.

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