0
Designing for Health and Happiness
David S. Sobel, MD, MPH
Regional Health Education
The Permanente Medical Group, Kaiser ...
2
Questions
1.  Are people unmotivated?
2.  Does pleasure and happiness
matter for health?
3.  How can we design for
happi...
3
Are people unmotivated?
Consequences:
§  Attempt to increase motivation
§  Prescribing behavior change (i.e.
often fai...
4
Shifting the Curve
Target the Ready & Willing:
Help people do what they already want to do.
Where to focus? Which curve ...
5
What do people really care about?
“Healthy
Lifestyles”
“Real Life”
Sleep
Sex
Stress
Exercise and
healthy diet
Preventive...
6 n= 1064
The “Unmentionables”
7
Pleasure and Passion:
Missing Ingredients in Motivation
þ  understand whole person
þ  screens for depression
þ  align...
8
There’s no improvement, Henry.
Are you sure you have given up everything you enjoy?
9
Types of Pleasures
Sensory Pleasures
q  5 Senses
Non-Sensory Pleasures
q  Achievement (competence*)
q  Autonomy*
q  ...
10
Finding Pleasure: Enjoyment as a Vital Sign
ü  List 10 activities that are fun for
you. What brings you joy? What
that...
11
Questions
1.  Are people unmotivated?
2.  Does pleasure and happiness
matter for health?
12
Are Happier People Healthier?
"During the past 4 weeks, have you been a happy person?"
“All things considered, how sati...
13
Are Happier People Healthier?
A long-term study of nuns
discovered that those who wrote
autobiographies at a young age
...
14
Health Benefits of Happiness
Seven types of evidence are reviewed
that indicate that high subjective
wellbeing (such as...
15
SAVOR YOUR SENSES: In Touch
§  Infants (preterm and term)
§  Pregnancy and childbirth
§  Diabetic and asthmatic chil...
16
When looking at Nature:
§ More positive feelings
§ Reduced negative emotion
§ Lower physiological arousal
§ Higher ...
17
Postsurgical patients in a room
with a view of nature (vs. a brick
wall) had:
ü less distress
ü required less pain me...
18
SAVOR YOUR SENSES: The Case for Wine
(and Alcohol)
C 1–2 drinks per day for women
C 2-4 drinks per day for men
is ass...
19
Chocolate eaters may enjoy:
§  27% lower relative risk of death and an extra year
of life (Lee I, BMJ 1998)
§  Lower ...
20
CENSORED
The risk of death in men who
had sex twice or more a week
is half that of men who had
sex less than once a mon...
21
§  Men taking a siesta were
30-50% less likely to have a
heart attack
§  24,000 people over 6 years:
§  Occasional n...
22
Hearty Laughter
Heart attack patients
Rx: 30 min/day humor video
§  fewer irregular rhythms
§  lower blood pressure
§...
23
Pets
In the year following a
heart attack, pet
owners have one-fifth
the rate of recurrent
heart attack.
Friedmann E, P...
24
INDULGE IN ALTRUSIM
Giving Better than Receiving
Mortality risk reduced by nearly half in seniors giving social support...
25
Questions
1.  Are people unmotivated?
2.  Does pleasure and happiness
matter for health?
3.  How can we design for
happ...
26
Think of a change you made…
q  Did your plan out and write down
specific small steps and/or have
feedback of performan...
27
Roads to Behavior Change
§  Incremental	
  Planned	
  Change	
  	
  
§  “Baby	
  Steps”	
  
§  “Small	
  Steps”	
  
...
28
Health Behavior Change
What if small steps
do not lead to
sustained behavior
change and health
habits?
29
Small Steps to Health
Small Steps
Sustained Health
Habit
Improved
Health
Small Steps
Success
Experience
Improved
Health...
30
Segar M et al. Rebranding Exercise. International Journal of Behavioral Nutrition and Physical
Activity 2011, 8:94. htt...
31
Celebrate
Design with Pleasure: Amplifiers
Focus
PrimeReframe
32
Celebrate
Design with Pleasure: Amplifiers
Reframe Prime
Focus
33
Ingredients of Sensory Pleasures
Good
Sense+
Mindful
Attention+ Pleasure!=
What do you need for pleasure to happen?
Goo...
34
PRACTICE HAPPINESS
A Wandering Mind is an Unhappy Mind
What are you feeling, doing, and
thinking right now?
2250 people...
35
A Call to be Present
TELEPHONE RING
Distraction? Interruption? or
Call to be present?
(  First ring: Smile. Breathe. “...
36
Celebrate
Design with Pleasure: Amplifiers
Focus
PrimeReframe
37
YOU ARE HERE
38
Amplifying Pleasure with Scarcity
The last piece of chocolate on earth…
39
Celebrate
Design with Pleasure: Amplifiers
Focus
Reframe Prime
40
The Power of Priming
Priming make us
more sensitive to
and aware of:
§  opportunities
§  events
§  interactions
§  ...
41
What 3 things happened
today that I am:
§  grateful for?
§  curious about?
§  surprised by?
§  learning something n...
42
What do you take for granted?
43
What to call it?
§  “Priming Behaviors”
§  “Ripple Behaviors”
§  “Cascading Behaviors”
§  “Domino Behaviors”
§  “K...
44
Design with Pleasure: Amplifiers
Focus
PrimeReframe
Celebrate
45
Celebrating Unexpected Pleasures
46
Design with Pleasure
þ  Emphasize more proximal, immediate satisfaction,
mood, and feelings
þ  Focus on present exper...
47
Thank you…
48
Healthy Pleasures: 5 Part Online Video Program
or	
  search	
  
YouTube	
  
for	
  
“Healthy	
  
Pleasures”	
  
49
Twitter @KPhealthyfun
50
Resources for Happiness
51
Can judge a book by it’s cover?
52
Resources and References (1)
Ben-­‐Shahar,	
  Tal:	
  Happier:	
  Learn	
  the	
  Secrets	
  to	
  Daily	
  Joy	
  and	...
53
Resources and References (2)
Ornstein,	
  Robert	
  and	
  Sobel,	
  David:	
  Healthy	
  Pleasures.	
  New	
  York:	
 ...
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  1. 1. Designing for Health and Happiness David S. Sobel, MD, MPH Regional Health Education The Permanente Medical Group, Kaiser Permanente Northern California Telephone: 510.987.3579, david.sobel@kp.org Follow me on Twitter @KPhealthyfun Healthy Pleasures ©The Permanente Medical Group 2014
  2. 2. 2 Questions 1.  Are people unmotivated? 2.  Does pleasure and happiness matter for health? 3.  How can we design for happiness and amplify pleasure?
  3. 3. 3 Are people unmotivated? Consequences: §  Attempt to increase motivation §  Prescribing behavior change (i.e. often failure) §  Frustration and cynicism þ  But do we really know what motivates people? þ  How can we make it easier for people to do what they already want to do? þ  Have we identified and celebrated successes?
  4. 4. 4 Shifting the Curve Target the Ready & Willing: Help people do what they already want to do. Where to focus? Which curve can you shift?
  5. 5. 5 What do people really care about? “Healthy Lifestyles” “Real Life” Sleep Sex Stress Exercise and healthy diet Preventive screenings
  6. 6. 6 n= 1064 The “Unmentionables”
  7. 7. 7 Pleasure and Passion: Missing Ingredients in Motivation þ  understand whole person þ  screens for depression þ  align with intrinsic motivation þ  bright spot for clinicians What do you Really Enjoy?
  8. 8. 8 There’s no improvement, Henry. Are you sure you have given up everything you enjoy?
  9. 9. 9 Types of Pleasures Sensory Pleasures q  5 Senses Non-Sensory Pleasures q  Achievement (competence*) q  Autonomy* q  Activity (process of activity, not outcome) q  Neuromuscular (arousal and relaxation) q  Esthetic (nature, beauty, etc.) q  Humor q  Social Pleasures (relatedness*) Frijda, N. (2010). On the nature and function of pleasure. In M. L. Kringelbach & K. C. Berridge (Eds.), Pleasures of the brain (pp. 99–112). New York: Oxford University Press. Biswas-Diener, R. Pleasure: An Initial Exploration. J of Happiness Studies, 2014. *Self-Determination Theory
  10. 10. 10 Finding Pleasure: Enjoyment as a Vital Sign ü  List 10 activities that are fun for you. What brings you joy? What that makes you feel happy? It can be anything- walking the dog, talking with friends, working in the garden, listening to music, writing a letter to someone special, watching your children play, fixing a special meal… ü  What prevents you from doing more of the things you really enjoy? Pleasant Events Schedule Peter Lewinsohn320 items
  11. 11. 11 Questions 1.  Are people unmotivated? 2.  Does pleasure and happiness matter for health?
  12. 12. 12 Are Happier People Healthier? "During the past 4 weeks, have you been a happy person?" “All things considered, how satisfied are you with your life?” Siahpush Am J Health Promo 2008;23:18-26 §  People with higher happiness and life satisfaction 2 years later reported 50% better health and less long-term, limiting health conditions. n=10,000
  13. 13. 13 Are Happier People Healthier? A long-term study of nuns discovered that those who wrote autobiographies at a young age reflecting happiness, love and hope had a 2.5 time lower risk of dying than their gloomier counterparts. Danner J Pers Soc Psych 2001;80:804-13
  14. 14. 14 Health Benefits of Happiness Seven types of evidence are reviewed that indicate that high subjective wellbeing (such as life satisfaction, absence of negative emotions, optimism, and positive emotions) causes better health and longevity…. the evidence is clear and compelling. Deiner, Applied Psych 2011
  15. 15. 15 SAVOR YOUR SENSES: In Touch §  Infants (preterm and term) §  Pregnancy and childbirth §  Diabetic and asthmatic children §  Adolescent psychiatric patients §  Post-traumatic stress disorder §  Eating disorders §  Migraine headache and low back pain §  HIV+ adults §  Breast cancerTouch Research Institute, University of Miami School of Medicine Field TM Touch Therapy 2000.
  16. 16. 16 When looking at Nature: § More positive feelings § Reduced negative emotion § Lower physiological arousal § Higher alpha brain waves § Quicker recovery from stress SAVOR YOUR SENSES: Nature vs. Urban
  17. 17. 17 Postsurgical patients in a room with a view of nature (vs. a brick wall) had: ü less distress ü required less pain medication ü discharged 1 day sooner “Nature-Deficit Disorder” -“No Child Left Inside” (R. Louv) Ulrich R: Science 1984:224:420 SAVOR YOUR SENSES: Looking at Nature
  18. 18. 18 SAVOR YOUR SENSES: The Case for Wine (and Alcohol) C 1–2 drinks per day for women C 2-4 drinks per day for men is associated with: §  18% lower total mortality §  30% lower risk of coronary heart disease and type 2 diabetes §  higher “good” HDL cholesterol . Di Castelnuovo: Arch Intern Med 2006;166:2437, Koppes LL: Diabetes Care 2005;28:719, Mukamal KJ: JAMA 2010;303:2065
  19. 19. 19 Chocolate eaters may enjoy: §  27% lower relative risk of death and an extra year of life (Lee I, BMJ 1998) §  Lower blood pressure (Taubert D, Arch Intern Med. 2007) §  47% lower mortality rate in men (Buijsse B: Arch Intern Med 2006) §  35% less likelihood of hospitalization or death from heart disease in women over 70 (Lewis JR Arch Intern Med. 2010) §  20% lower rate of stroke (Larsson, Neurology, 2012) §  decreased insulin resistance, high HDL and lower LDL cholesterol, reduced blood platelet adhesion, protection arterial wall lining, etc (Corti R: Circulation, 2011) SAVOR YOUR SENSES: Life is Sweet
  20. 20. 20 CENSORED The risk of death in men who had sex twice or more a week is half that of men who had sex less than once a month.* Davey Smith G: BMJ 1997;315(7123):1641-44 SAVOR YOUR SENSES: The Benefits of Sex * After adjusting for age, social class, smoking, blood pressure, and existing heart disease
  21. 21. 21 §  Men taking a siesta were 30-50% less likely to have a heart attack §  24,000 people over 6 years: §  Occasional nap: 12% reduction in coronary mortality §  Frequent naps: 37% reduction Trichopoulas D: Lancet 1987;2:269 Naska, A: Arch Int Med 2007;167:296 PRACTICE HAPPINESS: Siestas
  22. 22. 22 Hearty Laughter Heart attack patients Rx: 30 min/day humor video §  fewer irregular rhythms §  lower blood pressure §  lower stress hormones §  less medication §  one-fifth rate recurrent heart attacks Tan SA: Can J Cardiol 1997 PRACTICE HAPPINESS: Humor Matters
  23. 23. 23 Pets In the year following a heart attack, pet owners have one-fifth the rate of recurrent heart attack. Friedmann E, Public Health Reports 1980;95:307 INDULGE IN ALTRUISM: Selfless Pleasures
  24. 24. 24 INDULGE IN ALTRUSIM Giving Better than Receiving Mortality risk reduced by nearly half in seniors giving social support while increased in those receiving support.* Brown SL Psych Sci 2003 * After controlling for age, gender, health status, socioeconomic status, health behaviors, and personality
  25. 25. 25 Questions 1.  Are people unmotivated? 2.  Does pleasure and happiness matter for health? 3.  How can we design for happiness and amplify pleasure?
  26. 26. 26 Think of a change you made… q  Did your plan out and write down specific small steps and/or have feedback of performance data? q  Did a major life event trigger an epiphany/breakthrough change? q  Did you change because your environment required or invited the change? q  Did you just change the behavior because it felt good?
  27. 27. 27 Roads to Behavior Change §  Incremental  Planned  Change     §  “Baby  Steps”   §  “Small  Steps”   §  “Simple  Steps”   §  “Tiny  Steps”   §  “Starter  Steps”   §  “Success  Steps”   §  “Mastery  Experiences”     §  Breakthrough  Change   §  Environmental  Change   §  Pleasurable  Change  
  28. 28. 28 Health Behavior Change What if small steps do not lead to sustained behavior change and health habits?
  29. 29. 29 Small Steps to Health Small Steps Sustained Health Habit Improved Health Small Steps Success Experience Improved Health ü Confidence ü Optimism ü Self-Efficacy ü Mood/Affect ü Pleasure ü etc. ü Exercise ü Healthy Eating ü Smoking ü Preventive Care ü etc. Behavior Matters Mood Matters
  30. 30. 30 Segar M et al. Rebranding Exercise. International Journal of Behavioral Nutrition and Physical Activity 2011, 8:94. http://www.ijbnpa.org/content/8/1/94 Failure and Success http://michellesegar.com/organizations/
  31. 31. 31 Celebrate Design with Pleasure: Amplifiers Focus PrimeReframe
  32. 32. 32 Celebrate Design with Pleasure: Amplifiers Reframe Prime Focus
  33. 33. 33 Ingredients of Sensory Pleasures Good Sense+ Mindful Attention+ Pleasure!= What do you need for pleasure to happen? Good Stimulus
  34. 34. 34 PRACTICE HAPPINESS A Wandering Mind is an Unhappy Mind What are you feeling, doing, and thinking right now? 2250 people Killingsworth, Gilbert: 2010. Science 330:932. www.trackyourhappiness.org §  Mind wandering: 50% §  People happier when their mind was NOT wandering during all activities, pleasant or unpleasant §  What people are thinking is better predictor of happiness than what they are doing
  35. 35. 35 A Call to be Present TELEPHONE RING Distraction? Interruption? or Call to be present? (  First ring: Smile. Breathe. “Listen, listen. This wonderful sound brings me back to my true self.” (  Second ring: Smile. Breathe. (  Third ring: Be fully present as you answer. Thich Nhat Hanh, Peace is Every Step
  36. 36. 36 Celebrate Design with Pleasure: Amplifiers Focus PrimeReframe
  37. 37. 37 YOU ARE HERE
  38. 38. 38 Amplifying Pleasure with Scarcity The last piece of chocolate on earth…
  39. 39. 39 Celebrate Design with Pleasure: Amplifiers Focus Reframe Prime
  40. 40. 40 The Power of Priming Priming make us more sensitive to and aware of: §  opportunities §  events §  interactions §  triggers
  41. 41. 41 What 3 things happened today that I am: §  grateful for? §  curious about? §  surprised by? §  learning something new? Emmons RA, J Pers Soc Psych, 2003 Emmons RA, Thanks! 2007 Priming for Gratitude, etc.
  42. 42. 42 What do you take for granted?
  43. 43. 43 What to call it? §  “Priming Behaviors” §  “Ripple Behaviors” §  “Cascading Behaviors” §  “Domino Behaviors” §  “Keystone Behaviors”
  44. 44. 44 Design with Pleasure: Amplifiers Focus PrimeReframe Celebrate
  45. 45. 45 Celebrating Unexpected Pleasures
  46. 46. 46 Design with Pleasure þ  Emphasize more proximal, immediate satisfaction, mood, and feelings þ  Focus on present experience þ  Don’t be senseless (invite sensual pleasure) þ  Celebrate (even small) successes þ  Include unexpected surprises, delights þ  Change the focus/perspective/filters/frames þ  Identify “priming” and “cascading” behaviors
  47. 47. 47 Thank you…
  48. 48. 48 Healthy Pleasures: 5 Part Online Video Program or  search   YouTube   for   “Healthy   Pleasures”  
  49. 49. 49 Twitter @KPhealthyfun
  50. 50. 50 Resources for Happiness
  51. 51. 51 Can judge a book by it’s cover?
  52. 52. 52 Resources and References (1) Ben-­‐Shahar,  Tal:  Happier:  Learn  the  Secrets  to  Daily  Joy  and  Las@ng  Fulfillment.  McGraw-­‐Hill,  2007   Boronson,  Mar;n:  One  Moment  Medita@on.  Winter  Road  Publishing,  2009.   Burns,  David:  The  Feeling  Good  Handbook.  Morrow,  1989.   David,  Susan,  et  al.  Oxford  Handbook  of  Happiness.  Oxford,  2013   Davis,  Martha;  Eshelman,  E;  McKay,  M:  The  Relaxa@on  &  Stress  Reduc@on  Workbook.  New  Harbinger,  2008.   Diener  ,  Ed  and  Biswas-­‐Diener,  Robert  .  Happiness:  Unlocking  the  Mysteries  of  Psychological  Wealth.  Wiley-­‐Blackwell,  2008.   Dunn  EW,  Akmin  LB,  Norton  MI.  (2008).  Spending  money  on  others  promotes  happiness.  Science,  319,1687-­‐89   Emmons  RA,  McCullough  ME  (Eds.)  (2004).  The  Psychology  of  Gra@tude.  Oxford  Press.   Emmons,  RA  (2007).  Thanks!:  How  the  New  Science  of  Gra@tude  Can  Make  You  Happier.  Houghton  Mifflin   Howell  RT,  et  al:  (2007).    Health  benefits:  Meta-­‐analy;cally  determining  the  impact  of  well-­‐being  on  objec;ve  health  outcomes.  Health   Psychology  Review  1(1),83-­‐136   Kabat-­‐Zinn,  J:  Wherever  You  Go  There  You  Are:  Mindfulness  Medita@on  in  Everyday  Life.  Hyperion,  1994   Kringelbach,  M  (ed):  Pleasures  of  the  Brain.  Oxford,  2010   Lyubomirsky,  S  .  The  How  of  Happiness.  Penguin  Press,  2008   Lyubomirsky,  S  .  The  Myths  of  Happiness:  What  Should  Make  You  Happy,  but  Doesn't,  What  Shouldn't  Make  You  Happy,  but  Does.   Penguin  Press,  2013   McKay  M,  Davis  M,  and  Fanning  P:  Thoughts  and  Feelings:  The  Art  of  Cogni@ve  Stress  Interven@on.  New  Harbinger,  2007.   Neele,  Daniel:  Happiness:  The  science  behind  your  smile.  Oxford  University,  2005.  
  53. 53. 53 Resources and References (2) Ornstein,  Robert  and  Sobel,  David:  Healthy  Pleasures.  New  York:  Addison-­‐Wesley,  1989.   Ornstein,  Robert  and  Sobel,  David:  The  Healing  Brain.  New  York:  Simon  &  Schuster,  1987.   Pennebaker,  James  W.  Opening  Up:  The  Healing  Power  of  Confiding  in  Others.  Guilford  Press,  1997.     Posi;ve  Psychology  Center,  University  of  Pennsylvania.  hep://www.ppc.sas.upenn.edu/   Seligman,  Mar;n:  Authen@c  Happiness,  Free  Press,  2004   Seligman,  Mar;n:  The  Op@mis@c  Child.  Mariner,  2007.   Seligman,  Mar;n:  Flourish.  2011.   Sheldon  KM,  Lyubomirsky  S:    Is  It  Possible  to  Become  Happier?  (And  If  So,  How?)  Social  and  Personality  Psychology  Compass  1/1   (2007):  129–145,     Siahpush  M,  Spieal  M,  Singh  GK:  Happiness  and  Life  Sa;sfac;on  Prospec;vely  Predict  Self-­‐Rated  Health,  Physical  Health,  and  the   Presence  of  Limi;ng,  Long-­‐Term  Health  Condi;ons.  American  Journal  of  Health  Promo;on:  September/October   2008;23:18-­‐26.     Sobel,  David  and  Ornstein,  Robert:  The  Healthy  Mind,  Healthy  Body  Handbook  (also  published  under  the  ;tle  The  Mind&Body   Health  Handbook),  Los  Altos,  CA:  DRx  1996.     Sobel,  David:  Rethinking  Medicine:  Improving  health  outcomes  with  cost-­‐effec;ve  psychosocial  interven;ons.  Psychosoma@c   Medicine  57:234-­‐244,  1995.   Sobel,  David:  The  cost-­‐effec;veness  of  mind-­‐body  medicine  interven;ons.  In  The  Biological  Basis  for  Mind  Body  Interac@ons,   Progress  in  Brain  Research,  Vol  122,  E.A.  Mayer  and  C.B.  Saper  (Eds.),  Amsterdam:  Elsevier  Science,  2000:393-­‐412.   Wiseman,  Robert:  59  Seconds:  Think  a  Li^le,  Change  a  Lot.  New  York:  MacMillan,  2009.  
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