Happier people are often healthier people, and not just because their good health improves their mood. A growing body of observational research suggests that people who are more optimistic, less hostile, and more satisfied in youth are less likely to develop chronic diseases decades later. Similar studies also suggest that in later stages of adulthood, mental states can influence health events ranging from the minor to the life threatening.

None of this research would be particularly useful if mental outlook were a fixed quality that individuals could not improve or modify. Enter the "positive psychology" movement, which contends that people can learn optimism and happiness at any age. Until fairly recently, psychological study tended to focus solely on mental disorders, such as depression and anxiety, at the expense of inquiry into whether people without disorders could improve the positive mental states, such as happiness, strength, and hope, that make life worth living. Recent work in positive psychology has investigated the factors that distinguish happy from less happy people. Those insights can be helpful for people who want to boost their joy factor, though there isn't much evidence yet about which methods work best long term.

Grounded in scientific research, positive psychology should be distinguished from the kind of mind-over-matter thinking that promised that mental affirmations could cure cancer or warned that people "can't afford the luxury of a negative thought." People with a positive mental outlook are not in a good mood all of the time. But they do have the skills to talk themselves out of a bad mood rather than prolonging it, to take a self-affirming view of both negative and positive events, and to become absorbed in challenging activities. Clinical experience suggests there are practical methods you can use to brighten your mental outlook.

Dozens of studies have correlated a positive mental outlook with various health outcomes. For example, there's evidence that people who are happier or more optimistic:

• Have stronger immunity. Researchers in 2003 assessed the emotional styles of 334 healthy volunteers, then administered a squirt of rhinovirus (a germ that causes colds) in the nose of each participant. Those who scored high on measures of energy, happiness, and relaxation were significantly less likely to develop colds, regardless of their health practices.
• Are less likely to die of chronic disease. A decade-long study of some 400 men with HIV found that those who scored highest on a scale that measured positive feelings were less likely to die at any point during the study-regardless of the extent of their illness or use of antiretroviral drugs. A few studies have yielded similar findings for cancer patients.
• Live longer. In a landmark study released in 2000, scientists at the Mayo Clinic analyzed the records of 839 patients who had been given psychological tests 30 years earlier. Those who scored highest on a scale of pessimism were roughly 20 percent more likely to die prematurely than were optimists. In a 2001 study, older adults who were hopeful about the future had a significantly lower death rate (11 percent) over the seven-year study period than those who said they weren't hopeful (29 percent), even after researchers adjusted for age, smoking, and health status.

On the flip side, people who are depressed, stressed, angry, or distressed tend to fare poorer. In addition to having an increased risk of heart disease (see next section), they:

• Get sick-or feel sick-more often. Data from one long-running, 30-year study show that, compared with optimistic people, pessimists have a higher risk of physical and mental problems.
• Have more dental problems. A 2003 Harvard University analysis of more than 42,000 men in the Health Professionals Follow-Up Study found that those who scored highest on an anger questionnaire were 72 percent more likely to develop periodontitis (gum disease) than those who scored lowest.
• Heal slower from surgery. A small New Zealand study in the journal Psychosomatic Medicine found that patients who were worried before undergoing hernia surgery reported slower, more painful recoveries than those who were less worried. The stressed patients also scored significantly lower on an objective marker of recovery: the levels of the repair protein interleukin-1 in their wound fluid.
• Are more likely to get Alzheimer's disease. In a December 2003 study in the journal Neurology, involving nearly 800 older people, those most prone to psychological distress-including anxiety, anger, depression, and feelings of helplessness-were twice as likely to develop Alzheimer's as those who were least prone to such feelings.

The mechanism through which troubled psychological states can influence health is clearest within the cardiovascular system. Substantial research has tied hostility, anger, impatience, and stress to increased heart risk; somewhat lesser evidence suggests that depression and social isolation may also harm the heart.

High levels of emotional stress, particularly anger, cause a surge in certain hormones, such as adrenaline and cortisol, that prepare your body to face an emergency. That surge causes physiological changes that can, in turn, trigger a heart attack or stroke, especially in people whose arteries are already clogged. Mental duress may also contribute to the development of disease by encouraging unhealthy lifestyle choices that increase heart risk-such as drinking, smoking, overeating, and not exercising.

Negative emotions may begin to affect risk factors as early as one's teens. In a study of more than 3,300 people published in The Journal of the American Medical Association, hostile and impatient young adults were nearly twice as likely as their mellower peers to develop hypertension over a 15-year period.




Thus far there has been little research into whether individuals can change their mental outlook and, if so, whether this improves their health. In the book "Authentic Happiness," University of Pennsylvania psychology professor Martin Seligman, Ph.D., argues that our overall level of happiness depends on three factors: inborn tendencies, circumstances, and factors under our control.

Research suggests that we're born with a hardwired emotional profile, or "happiness thermostat." This is a base state of happiness, a "fixed and largely inherited level to which we invariably revert," writes Seligman. The base state may persist despite strokes of fortune or misfortune. For example, one study shows that over time, winners of large lottery prizes are no happier than non-winners. And people paralyzed after spinal-cord injuries wind up only slightly less happy, on average, than individuals who aren't so affected, according to Seligman. One's personal happiness range also appears largely independent of material wealth or other "comfortable life" factors. As long as a person's basic economic needs are met, money has surprisingly little effect on happiness.

Life events can trigger or protect against certain inborn tendencies, such as a tendency toward depression or anxiety. And some circumstances-such as extreme poverty, the death of a child, or caring for a relative with Alzheimer's disease-do have a long-range depressing effect on happiness levels.

While it may not be possible to modify your genetic inheritance or control your external circumstances, it may be possible to modify your mental outlook and response to life events. For example, clinical trials have tested the ability of meditation and other behavioral interventions to reduce hostility in heart patients; they've found that these techniques not only reduce measures of hostility but also may lower blood pressure and possibly reduce the risk of heart-attack recurrence.

Here are some of the ways psychologists believe that you can increase your happiness quotient, and perhaps simultaneously improve your health.




Both your thinking and your activities affect your mental state. Thought patterns may be more amenable to change and control than many of us realize. Just as you can interrupt an overtalkative friend, you may be able to interrupt your own negative thoughts and interpretations of the world and substitute more positive ones, using what psychologists call "self-talk." Gaining a measure of control may take persistence and perhaps professional counseling, but the mood improvement may be substantial.

• Rewrite your past. Research has shown that our memories seem to be mood-related. In other words, when you're in a bad mood, it's easy to remember all your other problems and grievances against the world, while when you're in a good mood, it's easy to recall other good times. So a conscious effort to dwell on good recent and long-term memories may have a powerful effect on your daily mood. Such simple measures as cultivating a sense of gratitude by "counting your blessings" each day may help amplify positive memories. So may efforts to celebrate small victories and achievements-even something as simple as patting yourself on the back. And forgiving and forgetting unpleasant experiences may help mute those memories.
• Project a brighter future. What do you say to yourself when you misplace your keys? If what springs to mind is "I'm an idiot," then you're interpreting the bad event as something permanent and universal, a pessimistic view likely to decrease your happiness. The remedy is to argue yourself into a more optimistic explanation: "I'm not stupid. There are many things I do well. I'm just tired and stressed today."
  
  When it comes to responding to positive events, however, the opposite approach is best. If, for example, you've gotten a compliment or a promotion at work, it's OK to generalize. Instead of thinking "I'm just lucky" or "That last report must have impressed the boss," tell yourself, "This is a reward for all my talent, leadership ability, and hard work."
• Improve the present. Making room in your day for more genuinely rewarding activities is another important tactic. A lasting source of happiness comes from entering a state of "flow," in which you're so absorbed in an activity that you lose your self-consciousness and even awareness of time. That occurs most readily when you're actively engaged, either mentally or physically, in activities that use favorite skills and are challenging enough to ward off boredom, but not so difficult that you become anxious.
  
  Research amassed over the past two decades by Mihaly Csikszentmihalyi, Ph.D.--who coined the "flow" concept and currently serves as a professor of psychology at Claremont Graduate University--and his colleagues shows that activities that foster lasting happiness tend to involve creativity, exploration, imagination, strategy, and discovery.
  
  Too often people "get trapped in life doing things that we think we have to do even if we don't like them," says Csikszentmihalyi. "We give up the things we enjoy and end up with a very thin life." To change that, you need to seek out fulfilling activities. Consider one you really enjoyed doing years ago, perhaps painting, reading, gardening, or traveling, but gave up as the pressures of adult life took over. Also think about something you've never had a chance to do, such as learning another language, going on an archaeological dig, or starting an antique-car rehabilitation service in your garage, suggests Csikszentmihalyi. Sample a range of activities you never considered before, consulting the local paper or a nearby community center for ideas. Sign up for a day trip to a nearby ghost town or state park; join a hiking club; tour your city's architectural landmarks. Or volunteer to teach others something you already know: That, Csikszentmihalyi says, may bring the best fulfillment there is.

Along with increasing positive thinking and activities, it's important to have tactics for dealing with the stresses of modern life. The way you manage your response to stressful events can either strain or help protect your health.

Anger and hostility are among the most dangerous responses to stress because they strain the cardiovascular system and can prompt reckless and destructive behavior. Taming those emotions involves reasoning with yourself and determining whether your rage is called for and, if so, how to deal with it constructively. Redford Williams, M.D., director of the Behavioral Medicine Research Center at Duke University, recommends asking yourself the following questions when someone does something that makes you angry:

1. Is this important?

2. Is anger appropriate in this situation?

3. Is there anything I can do to modify the situation?

4. Would it be worthwhile to have a confrontation?

If you answered yes to all four questions, you need to practice assertion: Find a constructive way to ask the offending person to change his or her behavior, whether it's a friend who just insulted you, a store clerk who says you can't return an item, or a spouse who tells you to run an errand when you're exhausted. Stay calm and rational as you make a specific request for the outcome you desire.

However, if you answered no to any of the four questions, it may pay to avoid a confrontation and use techniques to quiet your emotions. Talking to yourself ("Hey, this isn't that important!"), exercising, breathing deeply, consciously relaxing your muscles, and seeking support by talking to a friend are some options.

Acting out your feelings for the sake of catharsis is not recommended. "Punching a bag, yelling and screaming, hitting something-these types of things do nothing but make you more likely to behave aggressively afterward," Williams says. In one study, subjects who were verbally insulted and then opted to vent their anger on a punching bag acted more aggressively later than those who declined to punch.

While a variety of techniques have the proven potential to help people cope with stress, more studies are needed to determine which techniques work best, for whom, and for how long. To put together your own portfolio of coping strategies, consider drawing from the following areas:

• Meditation, relaxation training, yoga, tai-chi. These all involve "mindfulness," the art of concentrating on the present moment and tuning out external factors.
• Cognitive training. A therapist or an adult education course may be able to help you learn to thwart a stress reaction (pounding heart, quick breathing, increased blood pressure) by reasoning with yourself and changing your thought processes. One commonly recommended cognitive tool is "thought stopping," in which you interrupt your worry or anger by literally telling yourself to stop, either aloud or under your breath.
• Social support. Club membership, religious or civic activities, volunteer work, or just a few close friends can help protect you from the effects of stress on the body. Animal support counts too: Researchers at the State University of New York at Buffalo found that overall, people with a pet had lower stress levels than those who did not own a pet.
• Exercise. People who get regular aerobic exercise have lower levels of stress hormones and smaller increases in heart rate and blood pressure under mental duress. Exercise works as a long-term antidote as well as a quick stress fix.
• Treatment options. Chronic anger, hostility, and unhappiness may reflect a serious underlying problem, such as depression or an anxiety disorder. In those cases, individual or group therapy and/or drug therapy may be indicated.

There is much observational evidence linking mental outlook to health outcomes. At this point, however, most strategies for improving mental outlook are based only on clinical experience. It's not yet clear whether it's possible for most people to improve their happiness levels, and, more important, if doing so can have a positive impact on their health.

There is, however, fairly good evidence that frequent hostility and anger can stress the cardiovascular system. Learning to cope better with stress has been shown to help lower blood pressure and decrease the risk of heart disease.

People interested in measures to boost their mental outlook should consider the following:

• Cultivate positive feelings by focusing on good memories rather than bad, seeking activities that provide engaging experiences, and learning to use an optimistic explanatory style.
• Create personal strategies for coping with stress, such as mindfulness practices (e.g. meditation), cognitive techniques, social support, and exercise.
• Seek professional help if your negative emotions and outlook seriously interfere with functioning or life satisfaction.

• A range of free self-tests to assess optimism, happiness, and other positive emotions are available on www.authentichappiness.org, the companion Web site to Martin Seligman's book. You'll need to provide an e-mail address and demographic information to register. Results are confidential.
• The Web site www.williamslifeskills.com provides an overview of programs, workshops, and other resources to help people build strong relationships and overcome anger and other negative emotions.