0:00

You're listening to Road to Resilience. I'm Jon

0:02

Earle. My guest today is Dr. Alan

0:05

Rozanski. He's a Cardiologist at Mount Sinai St.

0:07

Luke's in New York City. Dr. Rozanski

0:10

specializes in preventative cardiology, which

0:12

means he helps patients prevent things like heart

0:14

attacks, and as you might expect,

0:17

he's big on exercise and healthy eating. But

0:20

some of his advice, well , it might strike you as a bit

0:22

unusual. That's because Dr. Rozanski

0:24

doesn't just ask his patients to eat well, he

0:27

also encourages them to think well. Researchers

0:30

have found that optimists tend to be healthier

0:32

than pessimists, like a lot healthier, and

0:35

the link is now clearer than ever, thanks to

0:37

a new paper that Dr. Rozanski published last

0:40

week. The paper brings together almost

0:42

20 years of research on the link between

0:44

optimism and cardiovascular health, and

0:46

the results were pretty surprising, even to him.

0:49

In our conversation, Dr. Rozanski talks

0:51

about what optimism really means, why

0:54

it has such a big impact on health, and

0:56

how pessimists can learn to see the glass half-full.

0:59

Dr. Rozanski, welcome to Road to Resilience.

1:01

Thank you.

1:02

What is optimism?

1:03

Optimism is a belief that the future

1:06

will go well for me. It's an expectation

1:09

and anticipation that good things will

1:11

happen. Pessimism is the opposite.

1:13

And how are optimists different than pessimists?

1:16

It's very interesting. Not only do they have a

1:19

greater belief in the future, but they have certain

1:21

core processes that we've identified

1:24

over time. They tend to solve problems

1:26

better, they handle adversity

1:29

better, and they also have

1:31

better ways to soothe themselves when things

1:33

aren't going well for them.

1:35

So I think it's important to make this distinction between

1:37

realistic optimism and blind

1:39

optimism. What is the difference between

1:41

those two things?

1:44

So that's a very good question. When

1:46

you look at optimists, even though

1:48

the way we measure it is looking at the

1:51

belief about the future, we see

1:53

that they have a core belief that I can handle

1:55

the things that are coming my way. And the

1:58

Pollyannish optimism has nothing to do with

2:00

that.

2:01

Yeah. I think that's a common misconception though. And

2:04

that's certainly one that I grew up with. I grew up thinking that

2:06

optimists are starry-eyed and

2:08

pessimists are hard-boiled and realistic.

2:10

Right, right.

2:11

When in fact neither has a monopoly

2:13

on realism.

2:15

Well, realism is always just,

2:17

what are the thoughts you're having? But

2:19

there is this misconception

2:22

as you say in terms of optimism.

2:24

So let's

2:27

jump into some of the science now. How

2:29

do we know that optimism is good for us?

2:32

What are some of the studies that have come out that have

2:34

told us that there's a connection between health and optimism?

2:37

Optimists live longer, they have

2:39

less heart disease. We've identified

2:41

pathophysiological mechanisms by which

2:43

this occurs, and it's a very robust

2:45

relationship.

2:45

And not just heart disease, right

2:48

?

2:48

Not just heart disease, relationship between heart

2:50

disease, strokes, all course mortality

2:52

, infectious disease, even

2:55

dementia.

2:56

So there's a connection, in other words,

2:58

between believing that the future is

3:00

going to be good, believing that you can shape

3:02

it, and your actual

3:05

physiological health?

3:07

Absolutely. This is true. This

3:09

is true.

3:10

Okay, so let's get into why. What is

3:12

the connection? What's the mechanism that

3:14

connects optimism and health?

3:15

Okay, that's a very good question. This is

3:18

how the science has progressed over the last 15

3:20

years and it's been interesting to follow. We

3:23

see that optimists have better

3:26

coping skills than pessimists, and

3:29

you can break it down. First of all, they're better

3:31

at problem solving, they'll figure

3:33

out the problems better, they'll anticipate

3:35

them and so forth. Second, they're better

3:38

at emotional soothing or emotional

3:40

problem solving if you will. So if a problem

3:43

comes their way , they're more likely

3:45

to feel engaged by it. The pessimist

3:48

is more likely to engage in wishful thinking

3:50

or avoidance and so forth. So this

3:52

avoidance versus approach is

3:54

an aspect of this process

3:56

as well. And optimists are

3:58

better at evoking social support, getting

4:03

help. They tend to be more popular anyway,

4:05

but they're better at engaging all of

4:07

these different ways of coping.

4:10

What you're saying, if I'm understanding you correctly, it sounds

4:12

like being an optimist and feeling

4:14

like the future is good and feeling like you have control

4:16

over the future leads somebody

4:19

to engage in behaviors like,

4:22

maybe being physically fit, maybe having lots

4:24

of friends, that are

4:26

more obviously in my mind at least correlated

4:28

with health.

4:29

That's true, but it's hard to say

4:31

what's the cart and what's the horse there .

4:33

Okay, say more.

4:34

That's why I emphasize that an optimist,

4:36

although we don't measure it on the scales, is

4:39

someone who also believes I can handle the things

4:41

coming my way. There's one

4:44

other important distinction between optimists

4:47

and pessimists, which from a medical

4:49

point of view as a physician really fascinates

4:51

me. It seems that optimists are

4:53

more proactive. In other words,

4:56

they not only think they're going to

4:58

have a better future, they're better at anticipating

5:00

their problems which may come their way and

5:02

taking proactive steps beforehand

5:05

to do it, or what we call proactive

5:07

coping. And this probably explains

5:09

something very interesting, that we see

5:12

that optimists engage in better

5:14

health behaviors. They're more likely to exercise,

5:17

they're less likely to smoke, they have better diets,

5:19

they watch their weight better. And that is

5:22

by the way, one of the key mechanisms

5:24

, perhaps the most important

5:26

mechanism, but certainly one of the key mechanisms by why

5:29

optimists actually have better health, live

5:32

longer, have less heart disease.

5:34

So it isn't necessarily the optimism itself, it's

5:36

the things that follow from optimism that

5:39

makes somebody healthier?

5:40

Yes, yes, that's true. It's not

5:42

just positive thinking. It's positive thinking

5:44

that promotes positive behaviors.

5:46

Yeah.

5:47

Important link.

5:48

Yes. Are

5:50

there also biochemical

5:52

explanations? So

5:55

does being positive or being optimistic

5:57

release certain chemicals in the brain, for example,

6:00

that have a positive effect on

6:02

the health of the body and the mind?

6:03

That's a great question. So

6:06

the science has really progressed in this regard

6:08

as well over the

6:10

last number of years. First of all, when we look at optimists

6:13

versus pessimists and we look at various biochemical

6:15

measures, we find that optimists tend

6:17

to have better metabolic function,

6:20

less likely to have insulin resistance, less

6:22

likely to have inflammation. Pessimism

6:25

is the opposite. There's even a couple of studies

6:27

in terms of some things that we measure in terms

6:29

of aging that suggests that optimists do

6:32

better in that regard as well. Now,

6:34

then the question becomes why? So

6:37

it could be that -- we know in general, by the way,

6:39

that when people are happy versus depressed,

6:41

when people are quite depressed, the

6:44

whole body goes haywire. People,

6:46

when they're depressed, they develop high cortisol

6:49

levels and norepinephrine levels -- these are the

6:51

stress hormones and these are chronically

6:54

elevated. And as a result of that, you

6:56

see almost every bodily system going awry,

6:59

more insulin resistance, more diabetes,

7:01

more hypertension and so forth. So

7:05

this might be common to

7:07

the psychological factors. For example,

7:09

optimists tend to be happier people. Is

7:11

it the happiness that produces it? Is it something

7:14

else? We can't sort that out, but

7:16

what we do see is that it's not just

7:18

the behaviors, but there are these biochemical

7:21

benefits from being optimistic as well.

7:23

Are you an optimist?

7:25

I tend to be an optimist.

7:28

Were you born that way?

7:31

I don't know the answer to that. We know

7:34

that there are actual studies done

7:36

where they've taken twins who

7:38

were, they were twins, but t hey w

7:40

ere separated at birth, so they were able to look

7:42

in a certain way. They grew up in different environments

7:44

a nd through this -- and I don't know how

7:46

they arrived to this -- they estimate

7:49

that optimism is about 25

7:50

percent genetic.

7:52

Only 25.

7:53

Only 25 percent.

7:55

Wow. I'm surprised to hear that.

7:55

Well, when

7:58

you think about it, isn't it true though,

8:00

how you're nurtured as a child -- the warmth

8:03

of your parents, the confidence they instilled. We

8:05

can't yet sort out all of these factors, this is

8:08

an important area for future study, but

8:10

it's not just that it's genetic. People would

8:13

think it's that way. But one of the

8:15

reasons we think of it that way is because

8:17

our habits are so habitual, they

8:20

come to define us. So we

8:22

start to think, "Oh, I was always that way."

8:26

Let's talk about your study. What was the question

8:28

you were hoping to answer?

8:30

So the study of optimism in

8:32

terms of its relationship to heart disease is

8:34

actually just quite new. The first

8:37

study was only published about 18 years ago,

8:39

but over the last five to 10 years,

8:41

there's been a proliferation of studies. So

8:44

we decided to do what doctors

8:46

do when you have finally enough data,

8:48

which is what we call a meta-analysis, where we look

8:50

at the overall effect

8:53

of all of these studies and we're trying to

8:54

-- what's the reproducibility of the studies?

8:57

What's the magnitude of effect? What

8:59

are the confounders? And that was the basis

9:01

of this study.

9:02

And what did you find?

9:03

We found something extraordinary

9:05

-- that the relationship

9:07

between optimism

9:09

or pessimism and heart disease is quite profound,

9:11

it's quite robust. Almost all the studies showed

9:14

the same findings and the magnitude

9:16

was quite substantial. We saw that there

9:18

was about a 35 percent reduced

9:20

risk of having a heart

9:22

attack, stroke, cardiac death in

9:25

people who rated themselves

9:27

positively as opposed to negatively. To

9:30

put that in perspective, that's a very

9:32

substantial effect, a medical

9:35

effect, similar to what we see with other

9:37

risk factors, even things like such as

9:39

hypertension.

9:40

So it's not slight, it's robust?

9:41

It was robust and it

9:43

was seeing reproducibly in

9:46

all these studies. The other

9:48

fascinating factor was that we

9:50

looked and analyzed what we would

9:52

call a dose-response relationship.

9:54

That if you have more optimism,

9:57

you have better health, and more optimism

9:59

than that even better health. And that's exactly what we found.

10:02

So that tells you that it's not just whether

10:05

you're optimistic or pessimistic, but how much

10:07

do you have?

10:08

So we have this insight now, we know that

10:10

optimism has a big impact on

10:12

cardiovascular health. What

10:15

do we do with that now?

10:16

Right. How do we turn pessimists into

10:19

optimists? In

10:21

answering the question, we have to establish

10:24

two key things. One is that there's

10:26

no one size that fits all. No two

10:29

people have the same fingerprints. So what

10:31

might work for one person might not work

10:33

for another. The other

10:35

thing that I think is a key

10:37

question in answering this question is: Do

10:40

you believe you can change?

10:43

People can change. But your

10:46

belief about that is very important.

10:49

Okay , so what are these interventions? What

10:51

could you do? So, number one

10:53

is getting pessimists

10:56

to focus on goals that

10:58

they can work on, and you work

11:00

with them to gain success.

11:03

Let's figure out what's the problem? If I have problem with

11:05

time management, well what are

11:07

some techniques we can use? And

11:09

you build that up step by step. Okay,

11:12

so that's one basic

11:14

approach. Now there's a second

11:17

approach, really working with the power of

11:19

positive thinking, because when

11:21

we think positively, we

11:23

feel better, it gives us more energy,

11:25

more agency to what we do. However,

11:29

try going to a pessimist, a true pessimist,

11:31

and tell him, "Just think positive

11:34

thoughts." It's not going to

11:36

work. It's going to be counterproductive. So

11:38

how do you work with that? So

11:40

the key here is whatever positive

11:43

thoughts you're trying to get them to work with,

11:45

there has to be credibility on

11:48

their part. They have to have affirmations

11:51

that they can sign onto. So

11:55

the interesting thing there is you don't have to attack

11:57

the area where their most weakest in, find another

12:00

area where they can adopt more positive thoughts.

12:03

Where we like to start is in the area

12:05

of gratitude. Gratitude is something

12:08

that isn't inherently logical to

12:12

people. When we hear

12:14

it, we say, "Oh yeah." But we just pay lip

12:16

service to it. It's actually something hard

12:18

to do because you have to overcome the lip

12:20

service, but you can do it. And

12:22

when you start to feel more grateful, it

12:25

starts to engender positive feelings.

12:28

And then you start to get

12:30

on the road and say, "Hey, I

12:32

have a little bit more perspective. I've crowded out

12:34

the negative feelings." The way

12:38

I would think of it is this -- we talk about

12:40

the glass half-full, half-empty, right?

12:42

That's the thing about optimism versus

12:44

pessimism. The gratitude

12:47

approach would be, "Well, thank

12:49

God there was a glass there! Oh, thank

12:51

God, I can see the glass, I got

12:53

eyes to see them! Oh, I

12:55

can lift the glass! I have a hand that

12:57

can do it. Oh, you know what? Just because

12:59

it's half-full means I can put some more stuff in here. Maybe I'll

13:01

put some juice in!" So you can

13:04

work with them, and this is something

13:06

that is -- and there's medical data

13:08

about the benefits of gratitude. So

13:10

once you come in through the back door, they get

13:14

more interested in working with their thoughts

13:16

in general. So that's a second approach.

13:20

So there's that little keyhole to positive thinking through gratitude.

13:23

That's right. That's right.

13:24

So what's the third thing?

13:25

The third thing is,

13:28

working on getting patients

13:31

to understand the

13:33

pessimists, the negative thoughts

13:35

that they're having and getting them to change them.

13:37

Okay? So you

13:39

don't start off by just getting them to dispute it

13:41

right away. The first thing you want to do is get

13:43

them to just see, recognize, "Oh,

13:46

I'm having that thought." That already

13:49

is very powerful

13:52

because very often when we recognize, it

13:54

gives us now a choice in the matter. The

13:56

second stage of that would be, well, now

13:58

that you recognize it, you

14:00

don't have to trust it, you can

14:03

dismiss it if you want, or you can just say, "There could

14:08

be another way to look at it." That already

14:10

builds more power.

14:13

And then the third step is actually teaching them to

14:15

reframe, to say there

14:17

is another way to look at it, and

14:20

the reframes

14:22

themselves have to

14:24

come over time, but people can be taught how

14:26

to do that better and better. So

14:28

that's really the three approaches

14:29

to this, and

14:32

they're relevant to people who want to

14:34

change in any way in their lives.

14:36

So how do you integrate these

14:38

insights into your practice?

14:40

Right, so this

14:43

science is new. We haven't

14:47

integrated this into a program here yet,

14:49

but I think this is an exciting new

14:52

opportunity for us. We did

14:56

suggest in this paper we just published

14:58

that this is a really great

15:01

setting in cardiac rehab to do. And

15:03

I think that there will be more buzz about this.

15:05

And I think that, not just

15:09

based on our study, but on other studies that have come

15:11

out, I could see that in many group settings

15:13

that this will be applied. I think

15:16

it can be applied by individual practitioners

15:18

as well.

15:19

If you had to speak directly

15:21

to a listener, what would be

15:24

the three action items

15:26

that you could impart to them for

15:29

either moving from a pessimist to more

15:31

of an optimist or becoming even more optimistic?

15:33

Where should they start?

15:34

I would

15:38

say first that people like

15:40

to think in terms of their health, in terms of whether

15:42

I'm exercising, having

15:44

a good diet. We don't think much

15:46

about our thoughts, they're so intimate

15:48

to us, but we don't think about it in terms

15:50

of what's the quality of my thinking? Am

15:53

I a person who broods? Do I get resentful?

15:55

Do I get regretful? There's many

15:57

aspects of this. What's the quality of

16:00

my thinking? Okay. A big

16:02

part of that is, how do I feel about

16:04

the future? If you

16:07

feel you don't feel as positive

16:09

as you should, then I'd say the

16:11

next thing is just start with this thought recognition.

16:14

Start to recognize what

16:17

the pessimistic thinking is, and once you

16:20

do that and you want to do that,

16:23

it puts you on the road to eventually

16:26

dismissing these thoughts and reframing.

16:29

And then ultimately, look, optimists

16:32

believe they can handle their future. So

16:34

it's about dealing with your problems

16:36

and saying, "How can I be more successful?"

16:40

How has studying optimism

16:42

changed your life? What practices have

16:44

you adopted?

16:46

I realized I do need

16:48

to take time out to stop during

16:50

the day and just think and reflect. We're

16:53

so tempted -- What's the image that we have

16:55

today of someone who's at the bus

16:57

stop? That they're looking down at their cell

16:59

phone. It means that they're just

17:01

connected to something external. We've stopped

17:05

self-reflecting, so we don't have that ability

17:08

to meditate and see upon ourselves.

17:10

So this work made me realize I

17:13

can't be one of those people. I do need

17:15

to carve out time to just think, to

17:17

meditate. And in general, I think that we all can

17:20

always improve on the quality of our thinking. So I

17:23

give it time.

17:26

Dr. Alan Rozanski is a Professor of Medicine at the Icahn

17:28

School of Medicine at Mount Sinai. He's

17:31

been at Luke's for 29 years.

17:34

Road to Resilience is a production at the Icahn

17:36

School of Medicine at Mount Sinai. This

17:38

episode was produced by Katie Ullman and me,

17:40

Jon Earle. Justin Gunn

17:42

shot the video, and Ilana

17:44

Nikravesh told us about Dr. Rozanski's work. Dorie Klissas and

17:48

Lucia Lee are the executive producers of the show.

17:51

From all of us here, thanks for listening. We'll

17:54

see you next time.

17:55

I've been here at Mount Sinai St. Luke's for 29

17:57

years, I run the Nuclear Cardiology

17:59

Stress Testing Program, I'm the

18:01

head of the uh , I have

18:04

to remember my title.

18:06

Let me get this microphone a little closer to you .