Date Published: September 30, 2019
A new study has found that optimists have a substantially reduced risk of cardiovascular events and premature death compared to pessimists. Lead author Alan Rozanski, MD, cardiologist at Mount Sinai St. Luke’s, explains why optimists are healthier than pessimists, what optimism really means, and how to start seeing the glass half-full.
You're listening to Road to Resilience. I'm Jon Earle. My guest today is Alan Rozanski, MD. He's a Cardiologist at Mount Sinai St. Luke's in New York City. Dr. Rozanski specializes in preventative cardiology, which means he helps patients prevent things like heart attacks, and as you might expect, he's big on exercise and healthy eating. But some of his advice, well, it might strike you as a bit unusual. That's because Dr. Rozanski doesn't just ask his patients to eat well, he also encourages them to think well. Researchers have found that optimists tend to be healthier than pessimists, like a lot healthier, and the link is now clearer than ever, thanks to a new paper that Dr. Rozanski published last week. The paper brings together almost 20 years of research on the link between optimism and cardiovascular health, and the results were pretty surprising, even to him. In our conversation, Dr. Rozanski talks about what optimism really means, why it has such a big impact on health, and how pessimists can learn to see the glass half-full. Dr. Rozanski, welcome to Road to Resilience.
Dr. Alan Rozanski: 01:01
What is optimism?
Dr. Alan Rozanski: 01:03
Optimism is a Optimism is a belief that the future will go well for me. It's an expectation and anticipation that good things will happen. Pessimism is the opposite.
And how are optimists different than pessimists?
Dr. Alan Rozanski: 01:16
It's very interesting. Not only do they have a greater belief in the future, but they have certain core processes that we've identified over time. They tend to solve problems better, they handle adversity better, and they also have better ways to soothe themselves when things aren't going well for them.
So I think it's important to make this distinction between realistic optimism and blind optimism. What is the difference between those two things?
Dr. Alan Rozanski: 01:44
So that's a very good question. When you look at optimists, even though the way we measure it is looking at the belief about the future, we see that they have a core belief that I can handle the things that are coming my way. And the Pollyannish optimism has nothing to do with that.
Yeah. I think that's a common misconception though. And that's certainly one that I grew up with. I grew up thinking that optimists are starry-eyed and pessimists are hard-boiled and realistic.
Dr. Alan Rozanski: 02:10
When in fact neither has a monopoly on realism.
Dr. Alan Rozanski: 02:15
Well, realism is always just, what are the thoughts you're having? But there is this misconception as you say in terms of optimism.
So let's jump into some of the science now. How do we know that optimism is good for us? What are some of the studies that have come out that have told us that there's a connection between health and optimism?
Dr. Alan Rozanski: 02:37
Optimists live longer, they have less heart disease. We've identified pathophysiological mechanisms by which this occurs, and it's a very robust relationship.
And not just heart disease, right?
Dr. Alan Rozanski: 02:48
Not just heart disease, relationship between heart disease, strokes, all course mortality, infectious disease, even dementia.
So there's a connection, in other words, between believing that the future is going to be good, believing that you can shape it, and your actual physiological health?
Dr. Alan Rozanski: 03:07
Absolutely. This is true. This is true.
Okay, so let's get into why. What is the connection? What's the mechanism that connects optimism and health?
Dr. Alan Rozanski: 03:15
Okay, that's a very good question. This is how the science has progressed over the last 15 years and it's been interesting to follow. We see that optimists have better coping skills than pessimists, and you can break it down. First of all, they're better at problem solving, they'll figure out the problems better, they'll anticipate them and so forth. Second, they're better at emotional soothing or emotional problem solving if you will. So if a problem comes their way, they're more likely to feel engaged by it. The pessimist is more likely to engage in wishful thinking or avoidance and so forth. So this avoidance versus approach is an aspect of this process as well. And optimists are better at evoking social support, getting help. They tend to be more popular anyway, but they're better at engaging all of these different ways of coping.
What you're saying, if I'm understanding you correctly, it sounds like being an optimist and feeling like the future is good and feeling like you have control over the future leads somebody to engage in behaviors like, maybe being physically fit, maybe having lots of friends, that are more obviously in my mind at least correlated with health.
Dr. Alan Rozanski: 04:29
That's true, but it's hard to say what's the cart and what's the horse there.
Okay, say more.
Dr. Alan Rozanski: 04:34
That's why I emphasize that an optimist, although we don't measure it on the scales, is someone who also believes I can handle the things coming my way. There's one other important distinction between optimists and pessimists, which from a medical point of view as a physician really fascinates me. It seems that optimists are more proactive. In other words, they not only think they're going to have a better future, they're better at anticipating their problems which may come their way and taking proactive steps beforehand to do it, or what we call proactive coping. And this probably explains something very interesting, that we see that optimists engage in better health behaviors. They're more likely to exercise, they're less likely to smoke, they have better diets, they watch their weight better. And that is by the way, one of the key mechanisms, perhaps the most important mechanism, but certainly one of the key mechanisms by why optimists actually have better health, live longer, have less heart disease.
So it isn't necessarily the optimism itself, it's the things that follow from optimism that makes somebody healthier?
Dr. Alan Rozanski: 05:40
Yes, yes, that's true. It's not just positive thinking. It's positive thinking that promotes positive behaviors.
Dr. Alan Rozanski: 05:47
Yes. Are there also biochemical explanations? So does being positive or being optimistic release certain chemicals in the brain, for example, that have a positive effect on the health of the body and the mind?
Dr. Alan Rozanski: 06:03
That's a great question. So the science has really progressed in this regard as well over the last number of years. First of all, when we look at optimists versus pessimists and we look at various biochemical measures, we find that optimists tend to have better metabolic function, less likely to have insulin resistance, less likely to have inflammation. Pessimism is the opposite. There's even a couple of studies in terms of some things that we measure in terms of aging that suggests that optimists do better in that regard as well. Now, then the question becomes why? So it could be that -- we know in general, by the way, that when people are happy versus depressed, when people are quite depressed, the whole body goes haywire. People, when they're depressed, they develop high cortisol levels and norepinephrine levels -- these are the stress hormones and these are chronically elevated. And as a result of that, you see almost every bodily system going awry, more insulin resistance, more diabetes, more hypertension and so forth. So this might be common to the psychological factors. For example, optimists tend to be happier people. Is it the happiness that produces it? Is it something else? We can't sort that out, but what we do see is that it's not just the behaviors, but there are these biochemical benefits from being optimistic as well.
Are you an optimist?
Dr. Alan Rozanski: 07:25
I tend to be an optimist.
Were you born that way?
Dr. Alan Rozanski: 07:31
I don't know the answer to that. We know that there are actual studies done where they've taken twins who were, they were twins, but they were separated at birth, so they were able to look in a certain way. They grew up in different environments and through this -- and I don't know how they arrived to this -- they estimate that optimism is about 25 percent genetic.
Dr. Alan Rozanski: 07:53
Only 25 percent.
Wow. I'm surprised to hear that.
Dr. Alan Rozanski: 07:55
Well, when you think about it, isn't it true though, how you're nurtured as a child -- the warmth of your parents, the confidence they instilled. We can't yet sort out all of these factors, this is an important area for future study, but it's not just that it's genetic. People would think it's that way. But one of the reasons we think of it that way is because our habits are so habitual, they come to define us. So we start to think, "Oh, I was always that way."
Let's talk about your study. What was the question you were hoping to answer?
Dr. Alan Rozanski: 08:30
So the study of optimism in terms of its relationship to heart disease is actually just quite new. The first study was only published about 18 years ago, but over the last five to 10 years, there's been a proliferation of studies. So we decided to do what doctors do when you have finally enough data, which is what we call a meta-analysis, where we look at the overall effect of all of these studies and we're trying to -- what's the reproducibility of the studies? What's the magnitude of effect? What are the confounders? And that was the basis of this study.
And what did you find?
Dr. Alan Rozanski: 09:03
We found something extraordinary -- that the relationship between optimism or pessimism and heart disease is quite profound, it's quite robust. Almost all the studies showed the same findings and the magnitude was quite substantial. We saw that there was about a 35 percent reduced risk of having a heart attack, stroke, cardiac death in people who rated themselves positively as opposed to negatively. To put that in perspective, that's a very substantial effect, a medical effect, similar to what we see with other risk factors, even things like such as hypertension.
So it's not slight, it's robust?
Dr. Alan Rozanski: 09:41
It was robust and it was seeing reproducibly in all these studies. The other fascinating factor was that we looked and analyzed what we would call a dose-response relationship. That if you have more optimism, you have better health, and more optimism than that even better health. And that's exactly what we found. So that tells you that it's not just whether you're optimistic or pessimistic, but how much do you have?
So we have this insight now, we know that optimism has a big impact on cardiovascular health. What do we do with that now?
Dr. Alan Rozanski: 10:16
Right. How do we turn pessimists into optimists? In answering the question, we have to establish two key things. One is that there's no one size that fits all. No two people have the same fingerprints. So what might work for one person might not work for another. The other thing that I think is a key question in answering this question is: Do you believe you can change? People can change. But your belief about that is very important. Okay, so what are these interventions? What could you do? So, number one is getting pessimists to focus on goals that they can work on, and you work with them to gain success. Let's figure out what's the problem? If I have problem with time management, well what are some techniques we can use? And you build that up step by step. Okay, so that's one basic approach.
Now there's a second approach, really working with the power of positive thinking, because when we think positively, we feel better, it gives us more energy, more agency to what we do. However, try going to a pessimist, a true pessimist, and tell him, "Just think positive thoughts." It's not going to work. It's going to be counterproductive. So how do you work with that? So the key here is whatever positive thoughts you're trying to get them to work with, there has to be credibility on their part. They have to have affirmations that they can sign onto. So the interesting thing there is you don't have to attack the area where they’re weakest in, find another area where they can adopt more positive thoughts. Where we like to start is in the area of gratitude. Gratitude is something that isn't inherently logical to people. When we hear it, we say, "Oh yeah." But we just pay lip service to it. It's actually something hard to do because you have to overcome the lip service, but you can do it. And when you start to feel more grateful, it starts to engender positive feelings. And then you start to get on the road and say, "Hey, I have a little bit more perspective. I've crowded out the negative feelings."
The way I would think of it is this -- we talk about the glass half-full, half-empty, right? That's the thing about optimism versus pessimism. The gratitude approach would be, "Well, thank God there was a glass there! Oh, thank God, I can see the glass, I got eyes to see them! Oh, I can lift the glass! I have a hand that can do it. Oh, you know what? Just because it's half-full means I can put some more stuff in here. Maybe I'll put some juice in!" So you can work with them, and this is something that is -- and there's medical data about the benefits of gratitude. So once you come in through the back door, they get more interested in working with their thoughts in general. So that's a second approach.
So there's that little keyhole to positive thinking through gratitude.
Dr. Alan Rozanski: 13:23
That's right. That's right.
So what's the third thing?
Dr. Alan Rozanski: 13:25
The third thing is, working on getting patients to understand the pessimists, the negative thoughts that they're having and getting them to change them. Okay? So you don't start off by just getting them to dispute it right away. The first thing you want to do is get them to just see, recognize, "Oh, I'm having that thought." That already is very powerful because very often when we recognize, it gives us now a choice in the matter. The second stage of that would be, well, now that you recognize it, you don't have to trust it, you can dismiss it if you want, or you can just say, "There could be another way to look at it." That already builds more power. And then the third step is actually teaching them to reframe, to say there is another way to look at it, and the reframes themselves have to come over time, but people can be taught how to do that better and better. So that's really the three approaches to this, and they're relevant to people who want to change in any way in their lives.
So how do you integrate these insights into your practice?
Dr. Alan Rozanski: 14:40
Right, so this science is new. We haven't integrated this into a program here yet, but I think this is an exciting new opportunity for us. We did suggest in this paper we just published that this is a really great setting in cardiac rehab to do. And I think that there will be more buzz about this. And I think that, not just based on our study, but on other studies that have come out, I could see that in many group settings that this will be applied. I think it can be applied by individual practitioners as well.
If you had to speak directly to a listener, what would be the three action items that you could impart to them for either moving from a pessimist to more of an optimist or becoming even more optimistic? Where should they start?
Dr. Alan Rozanski: 15:34
I would say first that people like to think in terms of their health, in terms of whether I'm exercising, having a good diet. We don't think much about our thoughts, they're so intimate to us, but we don't think about it in terms of what's the quality of my thinking? Am I a person who broods? Do I get resentful? Do I get regretful? There's many aspects of this. What's the quality of my thinking? Okay. A big part of that is, how do I feel about the future? If you feel you don't feel as positive as you should, then I'd say the next thing is just start with this thought recognition. Start to recognize what the pessimistic thinking is, and once you do that and you want to do that, it puts you on the road to eventually dismissing these thoughts and reframing. And then ultimately, look, optimists believe they can handle their future. So it's about dealing with your problems and saying, "How can I be more successful?"
How has studying optimism changed your life? What practices have you adopted?
Dr. Alan Rozanski: 16:46
I realized I do need to take time out to stop during the day and just think and reflect. We're so tempted -- What's the image that we have today of someone who's at the bus stop? That they're looking down at their cell phone. It means that they're just connected to something external. We've stopped self-reflecting, so we don't have that ability to meditate and see upon ourselves. So this work made me realize I can't be one of those people. I do need to carve out time to just think, to meditate. And in general, I think that we all can always improve on the quality of our thinking. So I give it time.
Dr. Alan Rozanski is a Professor of Medicine at the Icahn School of Medicine at Mount Sinai. He's been at Luke's for 29 years. Road to Resilience is a production at the Icahn School of Medicine at Mount Sinai. This episode was produced by Katie Ullman and me, Jon Earle. Justin Gunn shot the video, and Ilana Nikravesh told us about Dr. Rozanski's work. Dorie Klissas and Lucia Lee are the executive producers of the show. From all of us here, thanks for listening. We'll see you next time.
Dr. Alan Rozanski: 17:55
I've been here at Mount Sinai St. Luke's for 29 years, I run the Nuclear Cardiology Stress Testing Program, I'm the head of the uh, I have to remember my title.
Let me get this microphone a little closer to you.