By Stephen Walker, Ph.D.

The Business Problem.

Business, municipal and non-profit organizations all experience costs associated with turnover.  Every position within an organization is expensive to replace, but the cost can be significant when considering a highly skilled technical employee, or astronomical should the loss come at the executive level.  The greater the investment an organization has in the training and productive work of an individual, the more costly to replace him or her.  Whether an individual is terminated for poor performance or lost through a health challenge or death…..costs are incurred.  Succession planning, cross training, and health screenings can be instrumental in reducing the damage done by such a loss, but many organizations fail to consider such things when planning strategically for their future.

Health challenges contribute additional costs which may include medical expenses, short or long term disability costs, and perhaps funeral costs should death take a key employee.  Loss attributable to heart attack and stroke is a common occurrence these days.  It is also one of the easiest to predict.  Heart disease will ultimately be the cause of death for half of us, and for those planning on retiring…it’s sobering to realize that a full 30% of us will never reach the age of sixty five.  Heart disease can be managed effectively if caught in time. Unfortunately the first cardiac symptom experienced by 71% of the population will be a heart attack, and, one out of every three of those will not survive.₁ Because the bottom line drives business, it might be worth considering how much it might cost your organization if you or some other vital employee were lost to a heart attack or stroke?

Assessing the Costs.

A loss will definitely trigger a ripple effect throughout the business. A few of the measurable outcomes can help determine the financial impact on your organization. Some person or position-specific factors will require a closer look, depending on the individual’s role in the organization. Whether technical, administrative or sales oriented every position will have administrative costs, the search for a suitable replacement, recruitment, education, training, and lost productivity.  It is also true that health insurance premiums may be impacted for the coming year since companies are rated based on the collective health history of their employees.  Perhaps the greatest loss is not even measurable.  Nobody can replace an individual whose personality or leadership boosted morale, touched the lives of many, and provided cohesion for the whole.

The Current Approach.

As of this writing, prevention is largely an afterthought for businesses and insurance carriers.  They tend to employ a ‘one size fits all’ approach emphasizing diet and exercise.  Some companies provide optional stress management classes for their employees.  Kaiser-Permanente encourages quarterly lipid profiles.  These efforts may be successful to a limited degree, but are rather conventional and not precise enough to consider the loss of a key person, or the cost of turnover. Basically screening programs and prospective measures neither identify who is at greatest risk nor do they equip them with the tools to help them remedy the problem.

Stress Management programs provide an excellent example. Stress, has long been known as a contributing factor in heart disease, but programs addressing this concern tend to be optional and limited to 1-2 hours once a year for those who self-select to attend.  Ironically, the most stressed employees often ‘trivialize’ the benefits of a stress management program, or feel that they are too busy doing productive work to attend.  Others may be in denial of the stress they are under and fail to understand their personal risk factors.  They view ‘cranky’ behavior as a fact of life and unavoidable.  Some pride themselves in giving ulcers not getting them.  The lack of consideration for their personal health aside, ‘team’ chemistry is impacted by such attitudes.

It is precisely this individual that needs a process for screening, and a personalized assessment of their risk factors….because they are least likely to do it for themselves.  As a business owner, your chief executive officers, highly trained experts and employees whose loss could severely interfere with the operations of your organization are of greatest concern. Are lipid profiles, stress treadmills, and other examples of the ‘one size fits all’ approach for risk assessment enough?  Not likely.

A proper screening for occupational stress would assess the degree to which chronic stress, anger, hostility, anxiety, depression, negative emotions and social isolation play into each individual’s risk profile. Research in this area has revealed a clear understanding as to how toxic emotions alter a person’s blood chemistry contributing to heart disease.₂ Cardiac psychology and effective stress assessments are only part of the solution. The key lies in the use of ‘stratified risk assessments’ and ‘targeted interventions’ which have grown out of the developing specialization of preventive cardiology. Dr. Harvey Hecht, Director of Preventive Cardiology at NY’s Beth Israel Hospital, asserted, “There is no doubt that President Clinton would have been identified as high risk 10 years ago — if he had undergone calcium scanning—and the odds are great that bypass surgery could have been avoided.”₃

‘The Best Medicine.’

A model program has been developed in recent years involving a notoriously high risk population; that of former NFL professional football players.  Although there is agreement that these athletes have a significantly reduced life expectancy, the exact age is somewhat in dispute (estimations ranging from 52 to early 60’s depending on the data source).  One thing that is clear is that heart disease is by far the biggest killer. ₄

This model intervention has been termed ‘The Best Medicine.’  Research supporting this kind of stratified risk assessment and targeted treatment regimen has been accruing over the past several years._5,6 This sample included 100 members of The Denver Bronco Football Club Alumni ranging in age from 35 to 61 years who were provided an opportunity and self-selected to participate in the study. With the support of several doctors lead by preventive cardiologist, Dr. Jeffrey Boone and program coordinator, Toni Standley, researchers, sponsoring agencies, venders and pharmaceutical manufacturers….the Bronco Alumni were provided a state-of-the-art intervention, have been treated proactively and continuously monitored since, utilizing the stratified risk assessment and a targeted intervention for each participant addressing every known indicator for heart disease in that patient. The protocols used in this research included both traditional and more progressive techniques for evaluating and treating heart disease (CAD). The research effort is ongoing.

Traditional patient intake information included age, family history, medical history, lifestyle risk factors, Framingham risk assessment, cardiac symptoms, history of medical procedures, situation specific blood pressure response, medication reviews, exercise patterns, health risk behaviors, smoking and obesity screening. Additional diagnostic testing included:

• Electron Beam CT Scan
• Treadmill Stress Test                     
• Stress Echocardiogram or Cardiac Ultrasound
• NMR, PLAQ test – LpPLa (2) screening
• Carotid IMT
• Aspirin Resistence Test
• Life Stress Assessments

These variables and others were utilized while tracking specific indicators of disease after a baseline heart health status was determined.  For those in good health, very few treatment measures were recommended beyond daily aspirin, exercise regimens, dietary adjustments, nutritional supplements, stress management and additional testing as needed.  Alumni presenting with data suggestive of progressive CAD were treated aggressively with medication management using statins, ace inhibitors, anti-inflammatory agents, platelet coagulation inhibitors and selective nutritional supplements in addition to recommended lifestyle changes.  No extensive procedures such as bypass grafting, angiography, or nuclear perfusion studies were deemed necessary amongst the treatment sample.

Results of this approach using a stratified risk assessment and targeted treatment regimen have been documented and monitored quarterly.  Thus far, at the end of one calendar year, the overall intervention has been significantly effective at reducing symptom indicators of CAD.₇ These interim results demonstrate how risk stratification is cost effective as a screening method.  Even more importantly, the targeted intervention for specific risk factors demonstrated unequivocally that the progression of heart disease can actually be reversed when patient specific treatment guidelines are proactively implemented.

Benefits of Early Detection and Treatment of CAD.

The cumulative research in this field is now able to identify with greater clarity how the disease progresses.  The crucial role is played by each person’s blood chemistry.  Not only is blood chemistry highly variable, it is influenced by diet, emotional reactions to stress, exercise (or lack of), dental health and a number of genetic and environmental factors.  Because the blood serves to transport hormonal messages, nutrients and waste products to and from specific organs in the body, it is also the carrier of other by-products that can be harmful to the cardiovascular system itself. Often referred to as metabolic syndrome, a process is engaged that progressively damages the lining of the blood vessels themselves (endothelial dysfunction).  Once compromised, inflammation sets in, frequently contributing to the coagulation of platelets sometimes causing clots to form.  Any or all of these steps can create unstable plaque and trigger a thrombosis….resulting in a heart attack or stroke.₈

In July 2006 the American Heart Association published guidelines for the early detection and treatment of the physical markers of heart disease through the SHAPE initiative.₉ SHAPE stands for ‘screening for heart attack prevention and education’ which summarizes the body of research and provides guidelines which recommend stratified risk assessments and targeted interventions.  Many of these tests and procedures are not covered by traditional insurance reimbursement formularies.  This reality places even more responsibility on our corporate citizens to take care of their own bottom line.

Unfortunately, our healthcare system tends to respond best to heart disease once a patient has had a heart attack, even though the patient’s quality of life and survivability may be compromised significantly after the fact. Once afflicted, these patients subsequently utilize a larger percentage of the total healthcare resources available.  Estimates in 2004 by the Center of Disease Control indicate the financial costs of heart disease at 396 billion dollars.₁₀ ‘The Best Medicine’ is one of a number of leading programs designed to lower the costs of heart disease by employing a stratified risk assessment and proactively addressing those causative factors.  At the very minimum, this approach saves lives by preventing the incidence of heart attack and stroke.

Risk Stratification as a Business Solution – The ROI.

The CFO of an organization considering this type of screening would likely determine the variables assessing the potential return on investment of a stratified risk assessment such as this. Because no two businesses or municipal organizations are exactly alike this return must be determined on a case-by-case basis. Models for assessing the cost of turnover have rarely been modified for such a purpose.  Even less frequently are they weighed against the direct costs of a prevention initiative.  Models exist for evaluating the cost benefit of sales training programs, or the effectiveness of an advertising campaign, but the process for assessing the ROI of a strategically designed health and wellness intervention requires a more specialized formula.

What to Measure?

One model for measuring costs of turnover was developed by Dr. Michael Mercer, consultant with The Mercer Group, in his book, Turning Human Resource Departments into a Profit Center.₁₁ It is designed for the expressed purpose of evaluating the costs of turnover within an organization.  His model provides a good baseline.  We have modified it to include both the direct costs of a heart attack or stroke, in addition to some variable costs including:

• Separation Costs
• Replacement Costs
• Training Costs
• Lost Productivity Costs
• Lost Business Costs
• Disability Costs
• Costs from Death of an Employee

In situations where key employees have died, been taken ill, or injured on the job there are likely to be additional costs to the organization. Companies that experience the loss of a highly trained employee are not only responsible for the replacement costs for that employee, they may also have to deal with some additional medical expenses and incidental costs. Some organizations, such as fire and police departments, have extraordinary costs associated with the burial, ceremonies, and replacement officer uniform costs. In recent years, higher deductibles and stop loss expense caps allow for the estimation of some of these additional cost factors, but they do little to address them. More responsibility is continuously being placed on the corporations themselves and each employee through ‘consumer driven health care plans’.₁₂ Companies that self-insure have the most incentive to employ stratified risk assessments and targeted treatment regimens.

A Case Study.

In January of 2006 a 55 year old Fire Chief completed his annual physical. The physical was normal except for an abnormal EKG, which was considered not diagnostically significant.  The Chief reported that he felt fine, had no experience of chest pain or any other symptoms of heart disease, and indicated he was unconcerned with the abnormal EKG. A few days later he was seen by a cardiologist who conducted a stress treadmill which also appeared abnormal. It was followed by a perfusion study. Circulatory impairments clearly existed.  The Chief stopped work

immediately and was placed on short-term disability. Subsequent angiography determined that the Chief’s problems were systemic and surgery was required immediately. He then received four coronary arterial bypass grafts, was hospitalized for 5 days and his duties were absorbed in-house by the Deputy Chief of Administration and the Assistant Chief of Operations for the department.

Unfortunately there were complications.  Two of the grafts failed and an additional procedure resulted in the placement of stents repairing the grafts.  After three days, the Chief was released from the hospital and again started phase I rehab. A month later, symptoms appeared requiring plural effusion studies and another hospitalization this time for an infection and mild pericarditis.  Intravenous antibiotics controlled the infection and he has been steadily improving since, first in rehab and now on his own.  Following his 56^th birthday, the Chief decided he should retire and was placed on permanent disability.

The financial aspects of this case-study incorporate the current outcome and costs of the incident as it impacted the organization, the chief, the insurance carrier, the department’s obligations in providing insurance, short-term disability, long-term disability, the costs of separation, and replacement costs as of this writing. A search is currently underway for his replacement.  The organization is using a headhunter to identify and recruit properly trained and experienced candidates.

In the eleven months since the ordeal began, the medical expenses realized by the Chief, the department, and the insurance carrier have reached $196,000.  The cost of lost productivity to the department was estimated at $47,420.  The organization anticipates replacement costs for recruitment and hiring of his successor to be between $40,000 and $45,000 depending on travel expenses, moving, and uniform costs. The total cost of this episode to the parties concerned has been conservatively estimated at $277,470 to date.  The stress incurred by those assuming additional responsibilities is not considered measurable, nor is the stress incurred by their families who were required to adjust to these extraordinary demands placed upon them.  The required yet unpaid overtime has not been calculated because those affected are salaried and exempt employees.

The costs of replacing that one employee could have funded a risk stratification screening for every employee and included a Life Stress Interview, EBCT heart Scan, blood lipid particle test (NMR), and a carotid IMT test for all 117 department employees…AND RETURNED $210,000 to the respective responsible parties.  Just the direct costs incurred by the department in lost productivity and replacement costs would have funded the SHAPE guidelines for every career and volunteer employee.  The peace of mind and the benefits experienced by every family, their children, and smooth operations of the organization….priceless.

Copyright  © 2007   Stephen E. Walker, Ph.D.

References:

1)       American Heart Association: Heart Disease and Stroke Statistics – 2006 Update. Dallas, Texas, American Heart Association, 2006.

2)       Rozanski, A, Blumenthal, J, Davidson K, Saab P, Kubzansky L, “The Epidemiology, Pathophysiology, and Management of Psychosocial Risk Factors in Cardiac Practice”, J Am Coll Cardiol 2005;45:5:637-651.

3)       Hecht, Harvey, “Aggressive Testing for and Treatment of Heart Disease and Stroke”, Seminar Procedings, Denver, Colorado, Nov.19, 2005.

4)       National Institute for Occupational Safety and Health Study in conjunction with the NFL Players Assn., Proceedings 1992.

5)       Bard, R., Kalsi, H., Rubenfire, M., Wakefield, T., Fex, B., Rajagopalan, S., & Brook, R., Effect of Carotid Atherosclerosis Screening on Risk Stratification During Primary Cardiac Disease Prevention, Am.Journal of Cardiology, Vol 93; 8: April 2004, 1030-1032.

6)       Yusuf S, Hawkin S, Ounpuu S, et al. “Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction in 52 Countries (The INTERHEART Study): Case-control Study. Lancet 2004;364:937-52.

7)       Boone, J. and Standley, T. Preliminary data – Denver Bronco Alumni Program to Eradicate Heart Disease and Stroke, September 2006.

8)       Berger, G., Hartwell, D., Wagner, D., “P-Selectin and Platelet Clearance”, Blood, Vol. 92:11, December 1998: pp. 4446-4452.

9)       Screening for Heart Attack Prevention and Education Taskforce – Guidelines published in the American Journal of Cardiology, July 2006.

10)    Center for Disease Control and Prevention, Preventing Chronic Diseases: Investing Wisely in Health – 2005 (Center for Disease Control and Prevention).

11)    Mercer, M., Turning Human Resource Departments Into a Profit Center., Castlegate Publishers, Inc., Barrington Il., 2005.

12)    Herzlinger, R., Consumer Driven Healthcare: Implications for Providers, Payors, and Policy Makers., Harvard University Press, Boston, 2004.

by Stephen E. Walker, Ph.D.

Have you ever thought about having a heart attack?  Well, maybe not directly, but your emotions and thought habits are probably effecting your health a lot more than you think.  Research is accumulating in medical journals that explain the relationship of emotions to blood chemistry, both good and bad, as doctors learn more about preventive cardiology, who is at risk and who is not.  In 2004, the cost of heart attacks and stroke assessed by the Center for Disease Control was set at $368 billion, on figures that included actual health care expenditures and the valuation of lost productivity from death and disability.

Negative Emotions – More Than Just a Bad Feeling

In a major review of research published in the Journal of the American College of Cardiology (2005), Alan Rozanski summarized developments that have implications for cardiologists and psychologists in the emerging specialization, cardiac psychology.  Rozanski offers a pervasive review of the literature that demonstrate how depression, anger, anxiety, marital stress, occupational stress, and certain personality characteristics serve as emotional catalysts that can hurry us along toward a heart attack¹.

This research does not make poor diet, smoking, or obesity any less precarious as William Roberts, editor-in-chief of the American Journal of Cardiology blames the diets of most Americans and him a proponent of cholesterol lowering medications and a supporter of EBCT heart scans to detect and track CAD years before someone experiences symptoms.²

Rozanski’s most compelling argument provokes a shift in how Doctors view the most common risk factor of heart disease, which is family history.  The research calls for a more comprehensive analysis of the “nature vs. nurture” origins of the disease and evidence is mounting that emotional reactivity sets the process in motion at a much younger age than was once thought.  How much of this disease process is attributable to a hereditary imprint?  How much comes from learned behavior? The implication of this research is remarkable when one considers those who try to limit their intake of meat, exercise regularly and otherwise maintain a healthy lifestyle.  Stress is the X factor, and one that implores us to manage our emotions as conscientiously as we might train physically and try to modify our diet.

The research explaining the mechanisms of this process has evolved over many years.  In summary, no one questions the fact that we often experience booms and crashes in our disposition.  But few understand how this process causes stress hormones to surge into our blood, prompting inflammatory agents to trigger swelling in the tissues of our coronary arteries.  This pattern is made worse when our blood thickens as platelets become sticky when emotionally stressed.  For diabetics this condition is already dangerous, but even those without diabetes should realize the process does damage.  It may go on quietly for many years until a little piece of unstable plaque ruptures resulting in a cardiac event in some unsuspecting victim.  In the United States every 4 minutes someone dies experiencing their very 1^st cardiac symptom.

Having practiced psychology for the past few decades it is clear to me that no one has a monopoly over the “negative emotions” marketplace, and that virtually all of us have a “bad day now and then”.  The problem becomes more pronounced when one examines research published by the Surgeon General in which mental illness was second only to cardiovascular conditions in a measure of years of life lost to premature death and years lived with a disability³.  It is sobering to think that there are many among us who have ‘never’ had a good day as far as emotions are concerned.

Personality Plays a Role – Wellness Vs. Illness

There is no controversy over the presence of a “genetic set point” we inherit from our blood relations.  There is no question that family history is a primary risk factor for heart disease, as well as many other disorders.  There is an emerging number of researchers that recognize how certain emotions trigger chemical shifts in the blood harmful to arterial walls ultimately contributing to injure the endothelial layer of the vessels.  Whether people have a family history of heart disease or not, it makes sense to consider how stress may impact our health.  It is incumbent on each of us to understand what we do or don’t do that helps to keep our heart healthy.

How many times have you heard people tell you to “relax” when you have appeared stressed?  What we do to relax can be quite telling because sparse relief exists in many of our diversions.  The most popular television shows in every market are the local news followed by no less than ten primetime crime dramas.  The family practice of watching television ‘to kickback and relax’ has exposed us to a nightly display of murder and mayhem that may have actually become the news in our neighborhoods, or dramatizations of it on every network.

A person’s prevailing psychological state is revealed through their “self-talk”.   This internal dialogue is significant in that it is likely to be ongoing and characteristic of how we actually experience emotion in our life.  It is sensible for us to examine the characteristics of that inner dialogue and the degree to which the chatter is encouraging, supportive, or optimistic as opposed to angry, caustic, blaming or negative.

Years ago cardiologists Meyer Friedman and Ray Rosenman began researching what was termed the “Type A” personality⁴.  Hundreds of research studies have examined this behavioral pattern and its component parts in the past 30 years.  Just when “anger and hostility” appeared to emerge as the most deleterious of the “type A” characteristics, other studies of depression, anxiety, and the absence of social supports made their mark in psychosomatic medicine as scientists continue to connect the dots.

Most recently a psychologist named Johan Denollet, from Tilburg University in the Netherlands, has given us an instrument that delves into emotional predispositions.  His research follows a line of investigation that examines both the physiological and psychological impact of negative emotions.  In addition, he is exploring the effects of social isolation ⁵.  This body of research has resulted in a characteristic profile called the “Type D” or distressed personality.  Try answering these questions for a brief examination of how negative emotions might factor into your own life.

Do you often make a fuss about unimportant things?

Do you often feel unhappy?

Are you often irritated?

Do you take a gloomy view of things?

Are you often in a bad mood?

Do you often find yourself worrying about something?

Are you often down in the dumps?

Reviewing your answers to these questions will reveal patterns in your own self-talk.  If you answered “yes” often, your emotions and corresponding behavior fits the negative emotions profile, and you are probably producing more stress hormones than are healthy for you.  Furthermore, if you tend to keep to yourself, not use social supports, and have difficulty making social contact or communicating with others, your risk is increased. This line of investigation indicates that a prevalent experience of negative emotions and the tendency toward social isolation intensifies your risk of heart disease. 

Choices – Sources of Help – Wellness vs. Illness

In my opinion, it is less important to determine whether these patterns of thinking and behaving are genetically inherited, because it is far more vital to focus on the choices we actually make to either avoid or proactively attend to the stressful triggers in our life.  Once we are aware of our patterns, it is helpful to “catch ourselves” making a negative choice.  If we tend to give in to the pattern, we might then “beat ourselves up over the mistake”, another interesting choice….and one that contributes to destructive though habits and routine over-reactions.

The making of conscious choices requires us to stay anchored in the “now” so that we can begin to practice a more positive attitude.  It’s important to exercise our  “thinking” in such a way that we begin to rewire our assumptions and to reconsider the degree of balance we see in our emotions.  The process of changing one’s emotional patterns is not only possible, but likely when a few basic principles are applied.

Dr. Douglas Jacobs, a Harvard psychiatrist who started the National Depression Screening to raise awareness of the disease reports that 6.3 million people received outpatient treatment for mood disorders in 1997.  Those taking antidepressant drugs had more than doubled from the decade before, while those receiving psychotherapy fell by more than 10 percent.  Jacobs attributes the shift to more PCP’s prescribing rather than actually counseling for depression, and added,  “These statistics don’t show that, still, over 60 percent of people who suffer from depression aren’t getting treated, nor, do the findings suggest patients are better served by medication, as opposed to psychotherapy.”  “One size doesn’t fit all.  For some patients, medication is effective.  For others, psychotherapy is effective.  And for the majority of patients, a combination is clearly the most effective and recommended treatment.”⁶

In many cases antidepressant medication is called for, but because these patterns may be so long standing, even genetically imprinted, psychotherapy may be a critical component to “consciously” reverse the trends in our thinking.  Cognitive-behavioral therapies are specifically designed to help one effectively shift both their focus and their behavior in a desired direction.

More recently “life-coaches” have appeared on the scene and are becoming more prevalent.  They offer Americans a variety of choices for obtaining helpful input.  Imagine a personal trainer whose purpose is to offer productive and helpful suggestions to keep one motivated and focused.  Supportive hypnotherapy, acupuncture, & massage can be valuable adjuncts, as well.

Short of turning outside for help, what else can we do?  Meditation training and prayer have been proven to reduce cardiovascular reactivity and help people achieve an overall sense of calm.  Prayer, contemplation methods and practices are one key transformative process for deepening our understanding of what’s meaningful in our life and how to pursue success.

I liken the mental discipline we use in preparation for a job interview as quite fitting when you consider a fresh look at skills we might use to structure our thinking more productively.  For example, we take the time to tailor our resume focusing on our strengths.  Concentration enables one to craft a good cover letter.  We are likely to dress well to make sure our appearance is good.  We think positive thoughts, we rehearse answering questions, we focus on the positive attributes we can bring to the job…..and we probably deemphasize personality characteristics that are less helpful during the interview.  We have to work at it, but like any other life skill…practice helps us develop in the desired direction.  The more we practice the better our performance.  Physiologically our nervous system adjusts to the routine, and our “characteristic” responses become patterned like any other habit.

Learning how to drive a car is a good example.  Initially we feel anxious, clumsy and uncoordinated, and we may or may not have confidence in our ability to learn.  In the beginning, it takes tremendous concentration and focused awareness to learn the motor skills involved in driving.  Over time and a significant number of repetitions we become more familiar with a variety of driving conditions and our experience of anxiety begins to subside.  By trusting the process of learning, and continuously practicing the skills involved, what was once frightening becomes routine.  Unfortunately, over the years driving becomes more second nature and lapses in concentration begin to cause concern.

The Protective Effects of Positive Emotions

Harmful thought patterns can be transformed in many ways but almost always a practice and disciplined focus will be required to be successful at shifting decades of programming.  Cognitive-behavioral psychotherapy, life coaching, personal ‘attitude’ training, hypnotherapy, acupuncture, massage, daily meditation, prayer, and contemplative practices are a few of the validated techniques available to us.

Left to our own devices, many of us don’t pursue such opportunities because we tend to highlight the low lights.  People have become expert “victims” and incessantly focus on how they’ve been done wrong by somebody or everybody often perseverating on who might do them wrong next.  The outcome of these routines have resulted in epidemic numbers of mood disorders, anxiety disorders and heart disease that has impacted virtually all of us in some way or another.

Mark Twain once said, “I’ve been through some terrible things in my life, and some of them actually happened.”  In my experience as a clinician, people sometimes embellish the details of a disaster more than they will seek “the gift that comes from the wound”.   Wounds require extra effort to process, examine and understand.  With this understanding comes the opportunity to consciously choose a positive interpretation from the experience.  I’ve been told, “Experience is what you get when you don’t get what you want.”  So, it indeed holds true that if we become skilled at how to emphasize the “lessons learned” and “corrective actions taken” from a tragedy or failure, we can realize an optimal understanding of the encounter and minimize our misfortune.

The body of research in sport and performance psychology is full of scientific articles that illustrate this same process applied to motivation, concentration training, stress management, and sport specific skills acquisition.  These things are guaranteed….if you practice a good attitude, you indeed will develop one.  Your genetic set point may not favor you as the ‘life of the party’, but the skill sets you learn and practice will aid in a shift of attitude and a lowering of your risk for disease.

Karen Mathews was recently honored with the American Psychological Association’s award for distinguished scientific applications in the literature of cardiac psychology.  Her research offers substantive data supporting the conclusion that “optimists are less likely to exhibit the common progression of CAD disease over time, than are pessimists”⁷.  This work is exemplary of a new direction in medical research that focuses on positive psychology.  Research of the protective effects positive emotions and the role effective coping skills might play in reducing your risk of heart disease is already underway.

Studies of professional, marital, interpersonal, and life enrichment activities are emerging as well.  Instruments in this research explore specific activities people employ that require effort yet promote joy, engage their curiosity and contribute to meaning in life.  Outcome measures suggest participants have more vitality and demonstrate greater flexibility on a variety of indicators. Traditional epidemiological research protocols and now meta-analytic research methods attempt to quantify and measure the protective effects of positive coping skills⁸.  Harvard psychologist Daniel Gilbert, who is a leader in this field wonders why scientists would want to study anything else?⁹

Want to give it a try?  Think about who you currently spend the most time with.  Put together a chart of those you consider the most positive and encouraging influences in your world and make it a point to get together more often.  Notice people who are kind, loving, competent leaders, avid students of something, those who show persistence, creativity, are open-minded, are likely to savor a beautiful scene or have a blessing to share.  They are in your world for a reason so take the time to discover all the good that can come from their contribution to your life.  Oh, and continue to practice, practice, practice.  These things are guaranteed….if you practice a good attitude, you indeed will develop one.

The most encouraging steps are currently being taken in the field of Positive Psychology as research investigates how “optimism, hope, joy, humor, love, laughter, curiosity, flexibility, warm & engaging relationships, kindness, beauty, open-mindedness, time spent with nature, “flow” states, contemplation, prayer, vitality, the ability to ‘savor’ an experience and other positive emotions contribute to potentially protective effects as monitored by blood chemistry and traditional epidemiological research.  Just as ‘how we think’ contributes to the development of patterns and habits, ‘who’ we interact with on a frequent basis is likely to have an influence on how we think.

The top 10 list of things you can do right now, to begin shifting the “emotional” momentum in your life:

1.  Log on to Dr. Martin Seligman’s Positive Psychology website: www.authentichappiness.org and take 2-3 inventories that measure your signature strengths & current level of happiness.

2.  Monitor carefully what you watch on TV and notice how you feel afterward.

3.  Go to a comedy club, or a funny movie and laugh out loud.

4.  Find a comic strip that you like to read, and follow it everyday.

5.  Listen to music that is relaxing and inspiring  (Chopin, Schubert, Bruce Springsteen)

6.  Make a list of the most “important” things in your life.

7.  Make a list of the most “important” people in your life…..tell them so.

8.  Think about the last time you were so captivated while doing something, you lost your sense of time completely.  Do it again.

9.  Intentionally gravitate toward folks who are curious, have a zest for life, are thankful, hopeful, optimistic, & loving.

10.  Practice modeling these same virtues for yourself, your coworkers, and your children.

Special bonus suggestion:  Take the time to meditate for 20 minutes everyday on your life’s blessings and those things you are thankful for.

Hence, the protective effects of positive psychology poses some interesting and difficult methodological concerns, yet the practice of these techniques and principles have had an undeniably positive effect on those subjects who employ them.  Won’t you give these methods and techniques a try?  The odds suggest you will feel better and you will encourage more positive patterns in your relationships as well.  At the very least, it will be more fun.

Copyright 2006 SE Walker

References:

1)       Rozanski, A, Blumenthal, J, Davidson K, Saab P, Kubzansky L, “The Epidemiology, Pathophysiology, and Management of Psychosocial Risk Factors in Cardiac Practice”, J Am Coll Cardiol 2005;45:5:637-651.

2)       Roberts, W, “Aggressive Testing for and Treatment of Heart Disease and Stroke”, Seminar Procedings, Denver, Colorado, Nov.19, 2005.

3)       Murray, CL, & Lopez, AD (Eds.) (1996).  The global burden of disease. A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard University.

4)       Friedman, M, & Rosenman, R., Type A Behavior and Your Heart. New York: Fawcett Crest Publishing, 1974, 85.

5)       Denollet, J, DS14: “Standard Assessment of Negative Affectivity, Social Inhibition, and Type D Personality”, Psychosom Med 2005; 67:89-97.

6)       Jacobs DG, ed. (1998). The Harvard Medical School Guide to Suicide Assessment and Intervention. San Francisco, CA: Jossey-Bass Publisher.

7)       Mathews, K, “Psychological Perspectives on the Development of Coronary Heart Disease”, Am Psycholgst 2005; 60:8:783-796.

8)       Gross JJ, “Antecedent and Response-focused Emotion Regulation: Divergent Consequesnces for Experience, Expression, and Physiology.” J Pers Social Psychol 1998; 74;224-37.  (and)   Bonanno GA, Papa A, O’Neil K, Westphal M, Coifman K, “The iImportance of Being Flexible; The Ability to Enhance and Suppress Emotional Expression Predicts Long-term Adjusment.” Psychol Sci 2004;15:482-7.

9)       Gilbert, D, Stumbling on Happiness, Knopf A, NY, 2005

Copyright 2006 SE Walker

Stephen E. Walker, Ph.D.

“My Goal is to help you achieve a more enriching and joyful life

Through better health and improved performance.”

Dr. Stephen Walker is a licensed healthcare professional who has served as a therapist, health psychologist, athletic & personal performance consultant for the past 31 years in the Rocky Mountain Region.  His research at the University of Colorado brought together the fields of psychology, integrative physiology, biofeedback and human performance in response to stress and recovery. His counseling practice focuses on the effective treatment of stress disorders, cardiac psychology and cognitive behavioral psychotherapy.

As a personal coach, Dr. Walker consults with individuals hoping to achieve peak performance utilizing the same methods employed by America’s best athletes, their coaches and sport psychologists. He has assisted many top performers in developing their use of mental conditioning skills in both sports and business. Outside of his consulting work, he is an accomplished public speaker and facilitator of clinics and workshops.

He is available by appointment with offices in Boulder and Denver at Colorado Heart Imaging in Cherry Creek and for consultations in your office, home or practice/training facility. Learn more at: www.drstephenwalker.com

Dr. Walker also serves as the Editor-in-Chief of Podium Sports Journal: The Journal of Mental Conditioning – www.podiumsportsjournal.com

You can contact him at:

Phone: 303.530.4439      Fax: 303.530.4643

Email: walker544@comcast.net