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
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
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
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
What do people really care about?
“Healthy
Lifestyles”
“Real Life”
Sleep
Sex
Stress
Exercise and
healthy diet
Preventive
screenings

6. 6 n= 1064
The “Unmentionables”

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
There’s no improvement, Henry.
Are you sure you have given up everything you enjoy?

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
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
Questions
1. Are people unmotivated?
2. Does pleasure and happiness
matter for health?

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
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
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
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
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
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
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
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
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
§ 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
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
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
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
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
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
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
Health Behavior Change
What if small steps
do not lead to
sustained behavior
change and health
habits?

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
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
Celebrate
Design with Pleasure: Amplifiers
Focus
PrimeReframe

32. 32
Celebrate
Design with Pleasure: Amplifiers
Reframe Prime
Focus

33. 33
Ingredients of Sensory Pleasures
Good
Sense+
Mindful
Attention+ Pleasure!=
What do you need for pleasure to happen?
Good
Stimulus

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
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
Celebrate
Design with Pleasure: Amplifiers
Focus
PrimeReframe

37. 37
YOU ARE HERE

38. 38
Amplifying Pleasure with Scarcity
The last piece of chocolate on earth…

39. 39
Celebrate
Design with Pleasure: Amplifiers
Focus
Reframe Prime

40. 40
The Power of Priming
Priming make us
more sensitive to
and aware of:
§ opportunities
§ events
§ interactions
§ triggers

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
What do you take for granted?

43. 43
What to call it?
§ “Priming Behaviors”
§ “Ripple Behaviors”
§ “Cascading Behaviors”
§ “Domino Behaviors”
§ “Keystone Behaviors”

44. 44
Design with Pleasure: Amplifiers
Focus
PrimeReframe
Celebrate

45. 45
Celebrating Unexpected Pleasures

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
Thank you…

48. 48
Healthy Pleasures: 5 Part Online Video Program
or
search
YouTube
for
“Healthy
Pleasures”

49. 49
Twitter @KPhealthyfun

50. 50
Resources for Happiness

51. 51
Can judge a book by it’s cover?

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).
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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
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
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Long-­‐Term
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American
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Sobel,
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and
Ornstein,
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;tle
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Sobel,
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The
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Wiseman,
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59
Seconds:
Think
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