What Are the Secrets to Long-term Happiness, Health and Wellbeing?

Recently I’ve begun taking an interest in a field called public health. The World Health Organisation has defined public health as:

“The art and science of preventing disease, prolonging life and promoting health through the organized efforts of society” — Acheson, 1988

As time has gone on, there have been some studies that have helped public health to become less of an art and more of a science.

My favourite two public health studies are:

  1. The Longevity Project (also known as ‘The Terman Study’)
  2. The Harvard Study of Adult Development (also known as ‘The Grant Study’)

What makes these studies exceptional is their duration (80+ years) and the willingness of their participants to continue to be regularly assessed throughout their entire lives. Called prospective longitudinal studies, they both give us a rare chance to actually see which factors contribute to later illness or long-term health and well-being.

I aim to share these groundbreaking findings with you.

youth-active-jump-happy-40815.jpeg

The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom.” — Isaac Asimov

 

1. The Longevity Project

Over 1,500 of the most promising and brightest boys and girls were initially recruited in 1921 by the Psychologist Lewis Terman. He died in 1956, but the study continued for decades afterwards. All participants were born around the year 1910 and were studied for over 80 years to figure out who would live the longest and why.

Although each of the children was considered to be potentially gifted at the time, not all of them lived long and happy lives. Fortunately, the extensive data of these subjects has been intensely assessed and analysed for over twenty years at The University of California, Riverside.

The significant findings of the study have been summarised in the 2011 book “The Longevity Project: Surprising Discoveries for Health and Long-Life from the Landmark Eight-Decade Study” by Howard Friedman and Leslie Martin. I listened to this audiobook recently, and was quite surprised with some of their key results:

smilies-bank-sit-rest-160739.jpeg

The 10 TRUTHS of Longevity:
  1. It is important to live honestly
    • “A key part of one of the healthy paths is called ‘The High Road.’ Such an individual has good friends, meaningful work and a happy, responsible marriage. The thoughtful planning and perseverance that such people invest in their careers and relationships promote long life naturally and automatically, even when challenges arise.”
  2. Do NOT send your children to school at an earlier age than their peers
    • “Starting formal schooling at a very early age turned out not to be a great idea for most. Children need unstructured play time, and they need to get along with their peers; starting out young seemed to alienate them.”
  3. Illness is NOT random
    • “Those that live longer are often healthier throughout their years and (managed to) avoid serious ailments altogether.”
    • “Those who are healthier tend to be happier, and those who are happier tend to be healthier.”
    • “It’s never too late to choose a healthier path. The first step is to throw away the lists and stop worrying about worrying.”
    • “Thinking of making changes as taking ‘steps’ is a grand strategy, You can’t change major things about yourself overnight. But making small changes, and repeating those steps, can eventually create that path to longer life.”
  4. Good marriages lead to better health, especially for men
    • “Marriage is only health-promoting for men who are well-suited to marriage and have a good marriage. For others, it is more complicated.”
    • “Women who stayed single, were widowed or got divorced often thrived more than women who were married to troublesome husbands.”
    • “Men who stayed divorced were at really high risk for premature mortality.”
  5. Divorce during childhood predicts early death in adulthood
    • “The single strongest social predictor is parental divorce, as it often pushes the child into many unhealthy directions, including heavier drinking and smoking, less education, lower career achievements and a greater risk of later divorce themselves.”pexels-photo-541518
  6. Follow the long-term recommendations that are right for you
    • “The long-lived did not find the secret to health in broccoli, medical tests, vitamins or jogging. Rather they were individuals with certain constellations of habits and patterns of living. Their personalities, career trajectories and social lives proved highly relevant to their long-term health, often in ways we did not expect.”
    • “You need to make changes that will be sustainable in the long term. We say, if you don’t like jogging, don’t jog! Instead, begin doing things that you really enjoy and can keep up, like a walk at lunchtime with a friend or vigorous gardening.”
    • “The usual piecemeal suggestions of relax, eat vegetables, lose weight and get married are lifesaving for some, but neither effective or economical for many.”
    • “Some of the minutiae of what people think will help us lead long, healthy lives, such as worrying about the ratio of omega-6 to omega-3 fatty acids in the foods we eat, actually are red herrings, distracting us from the major pathways. When we recognise the long-term healthy and unhealthy patterns in ourselves, we can begin to maximise the healthy patterns.”
  7. Conscientiousness is the most critical personality factor for longevity
    • “Conscientiousness is very important. Unconscientious boys, even bright ones, are more likely to grow up to have poor marriages, to smoke more, to drink more, achieve less education, be relatively unsuccessful at work, and die younger.”
    • “Conscientious people stay healthier and live longer for three reasons:
      1. They do more things to protect their health.
      2. They are biologically predisposed to be healthier, and
      3. They tend to end up in healthier situations and relationships.”
  8. Working hard can be useful for you
    • “Those who worked the hardest often lived the longest…especially if they were involved in meaningful careers and were dedicated to things and people beyond themselves.”
    • “It was clear that working hard to overcome adversity or biting off more than you can chew—and then chewing it—does not generally pose a health risk. Striving to accomplish your goals, setting new aims when milestones are reached, and staying engaged and productive is exactly what those heading to a long life tend to do. The long-lived didn’t shy away from hard work; the exact opposite seemed true.”
  9. Resilience is protective for health
    •  “Depending on the circumstances, a traumatic event such as parental divorce could actually contribute to a longer life, if the child learned to be resilient.”
    • “Resilience is important, and can be achieved via a sense of personal accomplishment, strength of character and maturity.”
    • “Combat veterans are less likely to live long lives, but surprisingly the psychological stress of war itself is not necessarily a major health threat. Rather, it is a cascade of unhealthy patterns that sometimes follows. Those who find meaning in a traumatic experience and are able to reestablish a sense of security about the world are usually the ones who return to a healthy pathway.”
  10. Human connection is important
    • “Having pets can improve well-being, but they do not help people live longer, and are not a substitute for friends.”
    • “People who feel loved and cared for report a better sense of well-being.”
    • “The clearest health benefit of social relationships comes from being involved with and helping others.”
    • “It is important to be well-integrated into your community.”
    • “Connecting with and helping others is more important than obsessing over a rigorous exercise program.”
    • “The groups you associate with often determine the type of person you become — healthy or unhealthy.”

mario-luigi-figures-funny-163114.jpeg

2. The Harvard Study of Adult Development

The study began in 1938, and the goal of this longitudinal prospective study was to identify predictors of healthy ageing in real time. For 79 years, it has examined the lives of 268 physically and mentally healthy Harvard college sophomores from the classes of 1939-1944 until their death, including eventual US President John F. Kennedy. It has also incorporated many of their offspring as well as 456 disadvantaged inner-city youths who grew up in Boston between the years of 1940 to 1945.

Earlier this year, I listened to the 2012 audiobook by George Vaillant, titled “Triumphs of Experience.” He was the previous director of the study.

The primary research findings include:
  1. “Alcoholism is a disorder of great destructive power.”
    • Alcoholism precedes marital difficulties and is the leading cause of divorce, with 57% of the divorces being traced to alcoholism.
    • Alcoholism can also lead to the later development of depression and neurosis.
    • Alcoholism is the most significant predictor of early death alongside cigarette smoking.
  2. “Above a certain level, intelligence doesn’t matter”
    • There is no significant difference in income earned by men with an IQ of 110-115 when compared with men who have an IQ higher than 150.
  3. “Ageing liberals have more sex.”
    • While political ideology has no significant impact on life satisfaction overall, the most liberal men continue to have an active sex life into their 80s, whereas conservative men are more likely to cease having sex by the age of 68.
  4. “For good or ill, the effects of childhood last a long time.”
    • A warm childhood relationship with the mother predicts greater financial earning later in life ($87,000 more in comparison to males who had uncaring mothers), greater effectiveness at work later in life, and a three times lower risk of dementia in old age.
    • A warm childhood relationship with the father predicts lower rates of anxiety and pessimism during adulthood, increased life satisfaction later in life, reduced difficulties in letting others get close and greater enjoyment of vacations throughout life.
  5. “It is not any one thing for good or ill—social advantage, abusive parents, physical weakness—that determines the way children adapt to life, but the quality of their total experience.”
    • This essentially means that what goes right during childhood tends to matter much more than what goes wrong.
    • If bad things happen, as long as they are outweighed by the good, you are more than likely to still turn out okay.
    • “Bleak childhoods were not always associated with bleak marriages.”
    • “Restorative marriages and maturing [psychological] defences” are “the soil out of which resilience and post-traumatic growth emerge.”
  6. “People really can change, and people really can grow. Childhood need be neither destiny nor doom.”
  7. Even the death of a parent was relatively unimportant predictively by the time the men were fifty; by the time they were eighty, men who had lost parents when young were as mentally and physically healthy as men whose parents had lovingly watched them graduate from high school.
  8. Prudence, forethought, willpower, and perseverance in junior high school were the best predictors of vocational success at age fifty.”
  9. “All of the fifty-five Best Outcomes had gotten married relatively early and stayed married for most of their adult lives. Proportionately three times as many of the Best Adjusted men enjoyed lifelong happy marriages as the Worst.” 
    • The effect of marriage was even starker for the inner-city men of the Glueck Study: “two-thirds of the never-married were in the bottom fifth in overall social relations, 57 percent were in the bottom fifth in income, and 71 percent were classified by the Study raters as mentally ill.”
    • “It turned out that happy marriages after eighty were not associated either with warm childhoods or with mature defences in early adulthood—that is, you don’t have to start out ‘all grown up’ to end up solidly married.”
  10. “It was the capacity for intimate relationships that predicted flourishing in all aspects of these men’s lives.” or in other words – “Happiness is love. Full stop.”
    • Spouses mutual dependence on each other was associated with happy and healthy marriages. At age eighty-five, 76% of the men still alive said that their marriages were happy.
    • “The majority of the men who flourished found love before thirty, and that was why they flourished.”

For more information, see the latest director of the study Robert Waldinger talk about the key findings from the Harvard Study of Adult Development. His TED talk has over 16 million views at this time of publication:

I hope that you find these highly significant findings as fascinating as I do. They really do highlight the benefits of investing in ambitious public health studies such as these two.

They also give us the best scientifically supported indicators yet of the paths that you want to go down or the changes that you need to make if you’re going to live a happy, healthy and long-life.

 

Dr Damon Ashworth

Clinical Psychologist

 

 

Advertisements

Trauma – What is it and what can we do about it?

A Traumatic Experience?

It was a Saturday night when I was 16 years old. I had a couple of my basketball friends stay over, and we decided to venture out around 10:30pm to meet up with some other friends a few streets away.

I grew up in what I felt was a safe neighbourhood in the North-East suburbs of Melbourne, and had been out plenty of times this late at night with my brother to go and get some food.

We didn’t think that we would be out long, so I didn’t tell my parents where we were going. We crept out the back door and meandered down the road.

When we reached the bottom of the street a shiny silver sedan with blue underlighting pulled up, and a group of older teenagers asked us if we knew of any parties in the area. We said that we didn’t, and kept walking, thinking that they were friendly enough.

They slowly started reversing the car with us as we continued down the street and said: “What do you guys think of the car?”

My taller friend, impressed with the blue lighting, replied: “Yeah, pretty sweet!”

“Do you want it?” the other guy continued.

“Wouldn’t mind a car like that,” my friend replied.

Suddenly the mood changed.

“How about this…” the guy stated, as the ignition was turned off and he and his four mates climbed out of the car. “You three versus us five, you beat us, and you can have it!”

Two of them began smacking extended cylindrical objects that looked like trolley bars into their hands as they approached us.

“We don’t want any trouble, and we definitely don’t want to fight you!” I interjected, speaking up for the first time as I tried to de-escalate the situation. “My friend was just trying to give you guys a compliment!”

That was the last thing that I remember saying before I felt my head jolt back with a thud from the force of a fist that connected with my nose and mouth. I didn’t even see it coming.

My two friends backpedalled, turned, and started to sprint back up the hill towards my house as soon as I was hit. Blood began gushing from my nose. Before the five guys could get another punch in, I ran with my friends, flew over the fence into my backyard and straight back inside where we locked the door, gasping for air while my heart beat out of my chest.

I was scared, but also relieved, because it could have been a lot worse. The bleeding eventually slowed down, and luckily my nose didn’t seem broken, and my teeth were still intact. I was sore for the next few days with a delicate nose and cut and swollen lips, but within a week, my physical appearance was back to normal.

Psychologically, I wasn’t quite the same after the incident. I was irritable and more emotional. I kept getting flashbacks of the event intruding into my mind during the day, and couldn’t believe that something like this could have happened to me in my neighbourhood. I had nightmares in the month after the incident of being jumped, attacked or chased by a group of guys in the dark.

I was annoyed that my friends hadn’t tried to back me up but understood why running was the smarter decision given the circumstances. I was also furious that the police said that there was nothing that could be done about it without any further identifying information. It didn’t seem fair, and the world no longer seemed safe, especially if I was walking at night, and especially if a car came past.

As the months went by things settled a lot more, and I was back to feeling pretty good during the day and sleeping well at night. Some lingering symptoms persisted for a while that I can now see were a direct result of this physical assault. The main ones were an elevated startle response, or being “jumpy” in response to sudden movements or loud noises and a greater sense of hypervigilance and being “on guard” when I was out at night. I also had the annoying habit of diving behind bushes or hiding behind trees whenever I saw headlights or heard a car approaching at night.

I had no idea why I did these things initially, and would even say that I was joking to my friends when I ran for cover whenever a car came by. But I still did it, and deep down feared that the same event would happen again, with an even worse outcome this time.

It was only after I started to study Psychology at university, and particularly trauma that I was able to make sense of my reactions in the aftermath of this event. I was then able to research and understand how to overcome trauma and challenged myself so that the physical assault impacted me less over time.

Through sharing this experience, I am hoping that those who have been through any traumatic experiences might be able to identify with these symptoms and experiment with the strategies that I have personally found helpful, so that they may too get long-term relief from the trauma that they have suffered.

What is Trauma?

cristian-newman-67308.jpg

The Diagnostic and Statistical Manual for Mental Disorders (DSM-V) describes a traumatic experience as exposure to an event that involves death, serious injury (actual or threatened), or sexual violence (actual or threatened). It usually creates intense feelings of helplessness, horror, or fear in the individual. It is mostly direct exposure to an event that causes trauma, but can also be caused by witnessing an incident that happened to someone else. Other forms of trauma include indirect exposure by hearing about a close friend or family member being exposed to trauma, or through extreme or repeated exposure to aversive details of an event, typically through professional duties, such as first responders to a fatal crash site, or repeated exposure to information of child abuse.

Trauma can create long-standing changes in the brain. Imaging studies have shown heightened brain-stem activity, which controls the fight-or-flight (or freeze) system. This is the brain’s inbuilt survival mechanism. Imaging studies also show increased amygdala activation, which floods the body with feelings of fear. Both of these changes can be quite effective in keeping people safe in times of imminent danger because they allow individuals to scan the environment and react quickly to anything that is perceived to be dangerous.

The problem is that once these areas of the brain become overreactive, they will respond to anything that is potentially similar to a traumatic experience from the past, without first trying to accurately assess the actual level of threat. This makes it more difficult to respond in a calm, rational manner in an individual’s everyday life.

The hippocampus, an area of the brain that is responsible for memory, can also be severely affected by traumatic events. The more extreme, unexpected and inconsistent an event is with previously held beliefs about themselves, the world or other people, the harder it is for the brain to fully process and integrate this experience. Some of it remains unprocessed or “stuck”, which then reduces the capacity to move on from the traumatic event and process and integrate subsequent information that is taken in by the senses.

Re-experiencing symptoms, such as flashbacks and nightmares, are thought to be the brain’s attempt to correctly process and integrate the traumatic experience. As scary as this can be, it generally does help in healing and resolving trauma symptoms over time. Unfortunately, with Post-traumatic stress disorder (PTSD), the brain continues to be unable to fully process and integrate what has taken place. This can lead to devastating consequences and severe functional impairment for the individual that is suffering from the condition, especially if they don’t understand the symptoms or what to do with them when they occur.

How to Best Respond to Each Cluster of Trauma Symptoms:

everton-vila-140207.jpg

There are four clusters of symptoms that indicate that a person is suffering from an acute stress reaction in the first month after exposure to a traumatic event or a post-traumatic stress reaction after a month. Even if you do not have all of these symptoms, it can still be helpful to know what is occurring at the time when you do experience these symptoms after trauma and what you can do about it.

A: Intrusion symptoms – This includes intrusive memories, traumatic nightmares, dissociative reactions, such as flashbacks, and marked physiological reactivity and intense or prolonged distress after exposure to trauma-related stimuli or reminders.

When these intrusive symptoms occur, our brain rushes back to the past and starts to think and feel the same way that it did when the traumatic event was taking place. The mind feels that it is in imminent danger, and the initial feelings of intense helplessness, horror or fear come rushing back in.

What I have found to be most effective when this occurs is a process called grounding, as it helps me reconnect with my senses at the moment, and brings my brain back from the past to the present.

Next time an intrusive symptom occurs, ask yourself the following:

  1. What are five things that I can see right now?
  2. What are four things that I can touch/feel right now?
  3. What are three things that I can hear right now?
  4. What are two things that I can smell right now?
  5. What is one thing that I can taste right now?

Once you are reconnected with the present, ask yourself “Am I safe right now?” If you are in danger, remove yourself from the situation. If not, then you are not at risk of harm and instead need to focus on reducing your distress and physiologic reactivity through self-soothing activities.

The more that these activities can engage you and your senses at the moment, the better, as it will help you to continue to feel present and safe. Grounding must occur first though, or the brain will want to stay in a hypervigilant state to protect you from the perceived threat, even if the danger is only a memory in your head.

B: Avoidance – Persistent avoidance of distressing external (people, places, conversations, activities, objects or situations) and/or internal (thoughts or feelings) reminders of the trauma

Avoidance of any reminders of the trauma in the first month after the incident is actually a good thing, as it can lower your arousal levels and reactivity, assisting your recovery.

Ongoing avoidance of these reminders, particularly after month, is not recommended, however, and may prevent a full recovery. Chronic avoidance prevents processing and integration of the traumatic event and sometimes means that people begin to avoid more and more things that may seem dangerous when they are logically quite safe.

Gradual exposure to the things that you fear (as long as they are relatively safe) is essential in the treatment of any anxiety disorder, including PTSD. I have gone through the steps of how to do this in my first article titled “Feel the Fear and Do It Anyway”. I personally followed these steps to challenge myself to get outside at night more and stop hiding when cars came past. It did get more comfortable with each time as I realised that my fear of being attacked was much higher than the actual probability of it occurring (it’s never happened again).

Also, remember that we cannot entirely run away from our thoughts and feelings. Acceptance and Commitment Therapy teaches Defusion and Expansion skills to help us better manage our thoughts and emotions. Research shows that these are more effective long-term strategies than continually avoiding internal reminders of trauma through drugs and alcohol, emotional eating, meaningless distractions or by keeping busy all the time (which only tires you out further and makes you more likely to feel out of control and react emotionally).

C: Negative alterations in cognitions and mood –  including inability to recall key components of the trauma, persistent and distorted negative beliefs and expectations about oneself, others or the world, or blame of self or others for causing the traumatic event or its consequences, persistent negative emotions, including anger, fear, horror, impending doom, guilt and shame, diminished ability to experience positive emotions, as well as loss of interest and engagement in previously important activities, and feeling isolated, alienated, detached or estranged from others. 

Exposure-based treatments, particularly cognitive processing therapy is essential for addressing the extreme shifts in cognition and beliefs that can take place after trauma, particularly if they are preventing you from doing the things that you used to enjoy.

Writing about how your beliefs and feelings have changed or explaining these changes to a friend that you can trust can help you feel more connected and better in time, but should be done in collaboration with a therapist if you are concerned about how you may react.

If I ever felt disconnected, which happened occasionally, I found any movement to be the best strategy to reconnect. This could be playing sport, doing yoga or Pilates, weight lifting, walking or running outside, or even dancing. Anything that helps you get out of your head and into your body or the world around you (as long as it is safe).

D: Alterations in arousal and reactivity – trouble falling asleep or staying asleep, difficulty concentrating, feeling jumpy or easily startled, and being super alert or watchful. 

Learning emotional regulation and distress tolerance skills are both critical to managing arousal levels, which then diminishes reactivity.

Emotional regulation skills include adequate rest, recovery, leisure and socialising, or ensuring that things are in the right balance. Too much work and stress without sufficient breaks will slowly increase our arousal levels over time. Ensuring that we minimise caffeine and alcohol intake, eat a healthy well-balanced diet and get a consistent 7 hours of sleep each night also help us to lower our arousal levels and better regulate our emotions.

Distress tolerance skills include relaxation and mindfulness skills, as well as a distraction at times. By practising these on a regular basis when you are feeling calmer, it then becomes easier to implement them when you are most distressed so that things do not become too overwhelming for too long and you are able to not panic and calm yourself down.

Diagnosis of PTSD and Recommended Treatments

tyler-lastovich-215214.jpg

All four symptom clusters must be present to a significant degree and cause significant distress or functional impairment to warrant a diagnosis of PTSD.

If you are concerned that you may be suffering from PTSD from a trauma that you experienced more than a month ago, please complete the Post-traumatic Checklist for the DSM-V (PCL-5) questionnaire, which can be accessed for free online. If you score above 38 on this checklist, I encourage you to visit your GP or primary care physician to discuss the matter further and collaboratively decide on which treatment path you would like to go down.

Sometimes a referral to a Psychologist and/or Psychiatrist will be important to give you the best chance of making a full recovery.

It is important to realise that the most effective psychological therapies for trauma all include some element of exposure (imaginal and/or in vivo) to the traumatic experience. This could be though trauma-focused cognitive behavioural therapy (CBT), Cognitive Processing Therapy (CPT), or Eye Movement Desensitisation and Reprocessing (EMDR) Therapy. All are considered first-line approaches for treating PTSD in Australia (NHMRC, 2007), and should be recommended before pharmacological interventions, or alongside antidepressants (SSRIs) if sufficient benefits are yet to have been obtained through psychotherapy alone.

Even 8-12 sessions of 60-90 minutes of therapy are usually sufficient in treating PTSD. Any co-morbid issues can then be addressed in further treatment once the PTSD symptoms have subsided.

Traumatic events can change the brain and the way that we respond to situations afterwards. Often the brain can heal itself over time, especially if we are engaging in the right strategies. If it doesn’t, useful psychological help is available, and it can make a big difference in helping you to heal and grow.

You can also check out my new podcast discussing the main symptoms of PTSD and how they can be managed.

 

Dr Damon Ashworth

Clinical Psychologist