People Create Health: Effective Health Promotion is a Creative Process
Keywords:Treatment, health promotion, creativity, well-being, happiness, psychological resilience, personality, person-centered medicine, human development.
AbstractEffective health promotion involves the creative cultivation of physical, mental, social, and spiritual well-being. Efforts at health promotion produce weak and inconsistent benefits when it does not engage people to express their own goals and values. Likewise, health promotion has been ineffective when it relies only on instruction about facts regarding a healthy lifestyle, or focuses on reduction of disease rather than the cultivation of well-being. Meta-analysis of longitudinal studies and experimental interventions shows that improvements in subjective well-being lead to short-term and long-term reductions in medical morbidity and mortality, as well as to healthier functioning and longevity. However, these effects are inconsistent and weak (correlations of about 0.15). The most consistent and strong predictor of both subjective well-being and objective health status in longitudinal studies is a creative personality profile characterized by being highly self-directed, cooperative, and self-transcendent. There is a synergy among these personality traits that enhances all aspects of the health and happiness of people. Experimental interventions to cultivate this natural creative potential of people are now just beginning, but available exploratory research has shown that creativity can be enhanced and the changes are associated with widespread and profound benefits, including greater physical, mental, social, and spiritual well-being. In addition to benefits mediated by choice of diet, physical activity, and health care utilization, the effect of a creative personality on health may be partly mediated by effects on the regulation of heart rate variability. Creativity promotes autonomic balance with parasympathetic dominance leading to a calm alert state that promotes an awakening of plasticities and intelligences that stress inhibits. We suggest that health, happiness, and meaning can be cultivated by a complex adaptive process that enhances healthy functioning, plasticity and self-transcendent values. Health promotion is likely to have only weak and consistent benefits unless it is person-centered and thereby helps people to learn to live more creatively.
. Mezzich JE, Snaedal J, van Weel C, Botbol M, Salloum I. Introduction to person-centred medicine: from concepts to practice. J Eval Clin Pract 2011; 17:330-2.
. Mirowsky J, Ross CE. Education, personal control, lifestyle and health: A human capital hypothesis. Research on Aging 1998; 20:415-449.
. Schafer MH, Wilkinson LR, Ferraro KF Childhood (Mis)fortune, educational attainment, and adult health: contingent benefits of a college degree? Social forces 2013; 91:1007-1034.
. Bandura A, Health promotion by social cognitive means. Health Educ Behav 2004; 31:143-64.
. Ko LK, Turner-McGrievy GM, Campbell MK, Information Processing Versus Social Cognitive Mediators of Weight Loss in a Podcast-Delivered Health Intervention. Health Educ Behav.
. Fishbein M, Hennessy M, Yzer M, Douglas J, Can we explain why some people do and some people do not act on their intentions? Psychol Health Med 2003; 8:3-18.
. Smith-McLallen A, Fishbein M, Predictors of intentions to perform six cancer-related behaviours: roles for injunctive and descriptive norms. Psychol Health Med 2008; 13:389-401.
. Peele S, What works in addiction treatment and what doesn't: is the best therapy no therapy? Int J Addict 1990; 25:1409-19.
. Peele S, The limitations of control-of-supply models for explaining and preventing alcoholism and drug addiction. J Stud Alcohol 1987; 48:61-89.
. Amering M, Schmolke M. Recovery in Mental Health. New York: John Wiley & Sons, 2009.
. Rogers CR. On Becoming a Person: A therapist's view of psychotherapy. Boston: Houghton Mifflin, 1995.
. Fulford KW, Bringing together values-based and evidence-based medicine: UK Department of Health Initiatives in the 'Personalization' of Care. J Eval Clin Pract 2011; 17:341-3.
. Fulford KW. Ten Principles of Value-Based Medicine (VBM), In: Radden J, ed. The Philosophy of Psychiatry: A Companion. New York: Oxford University Press, 2004:205-234.
. O'Connor AM, Bennett CL, Stacey D, Barry M, Col NF, Eden KB, Entwistle VA, Fiset V, Holmes-Rovner M, Khangura S, Llewellyn-Thomas H, Rovner D, Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2009:CD001431.
. Kobau R, Sniezek J, Zack MM, Lucas RE, Adam B, Well-being assessment: An evaluation of well-being scales for public health and population stimates of well-being among US adults. Applied Psychology: Health and Well-being 2010; 2:272-297.
. Cloninger CR, Salloum IM, Mezzich JE, The dynamic origins of positive health and wellbeing. International Journal of Person-centered Medicine 2012; 2:1-9.
. Nigg CR, Burbank PM, Padula C, Dufresne R, Rossi JS, W.F. V, Laforge RG, Prochaska JO, Stages of change across ten health risk behaviors for older adults. Gerontologist 1999; 39:473-482.
. Prochaska JO, Velicer WF, Rossi JS, Redding CA, Greene GW, Rossi SR, Sun X, Fava JL, Laforge R, Plummer BA, Multiple risk expert systems interventions: impact of simultaneous stage-matched expert system interventions for smoking, high-fat diet, and sun exposure in a population of parents. Health Psychol 2004; 23:503-16.
. DiClemente CC, Delahanty JC, Fiedler RM, The journey to the end of smoking: A personal and population perspective. Am J Prev Med 2010; 38:S418-28.
. Cloninger CR, Cloninger KM, Person-centered Therapeutics. International Journal of Person-centered Medicine 2011; 1:43-52.
. Lambert MJ, Early response in psychotherapy: further evidence for the importance of common factors rather than "placebo effects". J Clin Psychol 2005; 61:855-69.
. Sexton TL, Ridley CR, Kleiner AJ, Beyond common factors: multilevel-process models of therapeutic change in marriage and family therapy. J Marital Fam Ther 2004; 30:131-49.
. Strupp HH, Hadley SW, Specific vs nonspecific factors in psychotherapy. A controlled study of outcome. Arch Gen Psychiatry 1979; 36:1125-36.
. Biglan A, Hayes SC, Pistorello J, Acceptance and commitment: implications for prevention science. Prev Sci 2008; 9:139-52.
. Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy. New York: Guilford Press, 1999.
. Hayes SA, Orsillo SM, Roemer L, Changes in proposed mechanisms of action during an acceptance-based behavior therapy for generalized anxiety disorder. Behav Res Ther 2010; 48:238-45.
. Castonguay LG, Goldfried MR, Wiser S, Raue PJ, Hayes AM, Predicting the effect of cognitive therapy for depression: a study of unique and common factors. J Consult Clin Psychol 1996; 64:497-504.
. Campbell-Sills L, Barlow DH, Brown TA, Hofmann SG, Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behav Res Ther 2006; 44:1251-63.
. Bach P, Hayes SC, The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. J Consult Clin Psychol 2002; 70:1129-39.
. 30. Bach P, Hayes SC, Gallop R, Long-term effects of brief acceptance and commitment therapy for psychosis. Behav Modif 2011; 36:165-81.
. Vowles KE, McCracken LM, O'Brien JZ, Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process. Behav Res Ther 2011; 49:748-55.
. Cloninger CR. Feeling Good: The Science of Well-Being. New York: Oxford University Press, 2004.
. Cloninger CR, The science of well-being: an integrated approach to mental health and its disorders. World Psychiatry 2006; 5:71-6.
. Cloninger CR, Zohar AH, Cloninger KM, Promotion of well-being in person-centered mental health care. Focus 2010; 8:165-179.
. Williams R, Fulford KW, Evidence-based and values-based policy, management and practice in child and adolescent mental health services. Clin Child Psychol Psychiatry 2007; 12:223-42.
. Cloninger CR, Zohar AH, Personality and the perception of health and happiness. J Affect Disord 2011; 128:24-32.
. Seligman ME. Flourish. New York: Free Press, 2011.
. McCraty R, Atkinson M, Lipsenthal L, Arguelles L, New hope for correctional officers: an innovative program for reducing stress and health risks. Appl Psychophysiol Biofeedback 2009; 34:251-72.
. McCraty R, Barrios-Choplin B, Rozman D, Atkinson M, Watkins AD, The impact of a new emotional self-management program on stress, emotions, heart rate variability, DHEA and cortisol. Integr Physiol Behav Sci 1998; 33:151-70.
. Cohn MA, Fredrickson BL, Brown SL, Mikels JA, Conway AM, Happiness unpacked: positive emotions increase life satisfaction by building resilience. Emotion 2009; 9:361-8.
. Fredrickson BL, The broaden-and-build theory of positive emotions. Philos Trans R Soc Lond B Biol Sci 2004; 359:1367-78.
. Pickett K, Wilkinson R. The Spirit Level: Why greater equality makes societies stronger. New York: Bloombury Press, 2009.
. Cloninger CR, Cloninger KM, Development of instruments and evaluative procedures on contributors to health and illness. International Journal of Person-centered Medicine 2012; 3:446-455
. WHO. Definition of Health: Preamble to the Constitution of the World Health Organization. New York: World Health Organization, 1946.
. Cloninger CR, Svrakic DM, Przybeck TR, A psychobiological model of temperament and character. Arch Gen Psychiatry 1993; 50:975-90.
. Diener E, Emmons RA, Larsen RJ, Griffin S, The Satisfaction With Life Scale. J Pers Assess 1985; 49:71-5.
. Diener E, Larsen RJ, Levine S, Emmons RA, Intensity and frequency: dimensions underlying positive and negative affect. J Pers Soc Psychol 1985; 48:1253-65.
. 48. Diener E, Lucas RE, Scollon CN, Beyond the hedonic treadmill: revising the adaptation theory of well-being. Am Psychol 2006; 61:305-14.
. Diener E, Wirtz D, Tov W, Kim-Prieto C, Choi H, Oishi S, Biswas-Diener R, New measures of well-being: Flourishing and positive and negative feelings. Social Indicators Research` 2009; 39:247-266.
. Josefsson K, Jokela M, Cloninger CR, Hintsanen M, Salo J, Hintsa T, Pulkki-Raback L, Keltikangas-Jarvinen L, Maturity and change in personality: Developmental trends of temperament and character in adulthood. Dev Psychopathol 2013; 25:713-27.
. Cloninger CR. Completing the psychobiological architecture of human personality development: Temperament, Character, and Coherence, In: Staudinger UM and Lindenberger UER, eds. Understanding Human Development: Dialogues with Lifespan Psychology. London: Kluwer Academic Publishers, 2003:159-182.
. Josefsson K, Cloninger CR, Hintsanen M, Jokela M, Pulkki-Raback L, Keltikangas-Jarvinen L, Associations of personality profiles with various aspects of well-being: a population-based study. J Affect Disord 2011; 133:265-73.
. Conrad R, Schilling G, Bausch C, Nadstawek J, Wartenberg HC, Wegener I, Geiser F, Imbierowicz K, Liedtke R, Temperament and character personality profiles and personality disorders in chronic pain patients. Pain 2007; 133:197-209.
. Zautra AJ, Johnson LM, Davis MC, Positive affect as a source of resilience for women in chronic pain. J Consult Clin Psychol 2005; 73:212-20.
. Otake K, Shimai S, Tanaka-Matsumi J, Otsui K, Fredrickson BL, Happy People Become Happier through Kindness: A Counting Kindnesses Intervention. J Happiness Stud 2006; 7:361-375.
. Davis MC, Building Emotional Resilience to Promote Health. Am J Lifestyle Med 2009; 3:60S-63S.
. 57. Frey BS, Happy people live longer. Science 2011; 331:542-3.
. Howell RT, Review: positive psychological well-being reduces the risk of mortality in both ill and healthy populations. Evid Based Ment Health 2009; 12:41.
. Howell RT, Kern ML, Lyubomirsky S, Health benefits: meta-analytically determining the impact of well-being on objective health outcomes. Health Psychology Review 2007; 1:83-136.
. Chinn S, A simple method for converting an odds ratio to effect size for use in meta-analysis. Stat Med 2000; 19:3127-31.
. Huppert FA, Whittington JE, Evidence for the independence of positive and negative well-being: implications for quality of life assessment. Br J Health Psychol 2003; 8:107-22.
. Abbott RA, Croudace TJ, Ploubidis GB, Kuh D, Richards M, Huppert FA, The relationship between early personality and midlife psychological well-being: evidence from a UK birth cohort study. Soc Psychiatry Psychiatr Epidemiol 2008; 43:679-87.
. Jokela M, Batty GD, Nyberg ST, Virtanen M, Nabi H, Singh-Manoux A, Kivimaki M, Personality and all-cause mortality: individual-participant meta-analysis of 3,947 deaths in 76,150 adults. Am J Epidemiol 2013; 178:667-75.
. Cloninger CR, How does personality influence mortality in the elderly? Psychosom Med 2005; 67:839-40.
. Abbott RA, Ploubidis GB, Huppert FA, Kuh D, Wadsworth ME, Croudace TJ, Psychometric evaluation and predictive validity of Ryff's psychological well-being items in a UK birth cohort sample of women. Health Qual Life Outcomes 2006; 4:76.
. Fava GA, Tomba E, Increasing psychological well-being and resilience by psychotherapeutic methods. J Pers 2009; 77:1903-34.
. Rosenstrom T, Jokela M, Cloninger CR, Hintsanen M, Juonala M, Raitakari O, Viikari J, Keltikangas-Jarvinen L, Associations between dimensional personality measures and preclinical atherosclerosis: The cardiovascular risk in Young Finns study. J Psychosom Res 2012; 72:336-43.
. Grucza RA, Goldberg LR, The comparative validity of 11 modern personality inventories: predictions of behavioral acts, informant reports, and clinical indicators. J Pers Assess 2007; 89:167-87.
. Pederson C, Seligman MEP. Character Strengths and Virtues: A handbook and classification. New York: Oxford University Press, 2004.
. Vernon PE. Creativity, In: Foss BM, ed. Modern Psychology Readings. First edn. Baltimore: Penguin, 1970.
. Sternberg RJ. The Nature of Creativity. Cambridge UK: Cambridge University Press, 1988.
. Csikszentmihalyi M. Flow and the Psychology of Discovery and Invention. Cambridge, UK: Cambridge University press, 1997.
. . Gabora L, Why blind-variation and selective-retention is an inappropriate explanatory framework for creativity: comment on "Creative thought as blind-variation and selective-retention: combinatorial models of exceptional creativity" by Prof. Simonton. Phys Life Rev; 7:182-3.
. Simonton DK. Creativity in Science: Chance, Logic, Genius, and Zeitgeist. Cambridge UK: Cambridge University Press, 2004.
. Sternberg RJ. A three-facet model of creativity, In: Sternberg RJ, ed. The Nature of Creativity. Cambridge UK: Cambridge University Press, 2004:125-147.
. Taylor CW. Various approaches to and definitions of creativity, In: Sternberg RJ, ed. The Nature of Creativity. Cambridge UK: Cambridge University Press, 2004:99-.
. Smith MJ, Cloninger CR, Harms MP, Csernansky JG, Temperament and character as schizophrenia-related endophenotypes in non-psychotic siblings. Schizophr Res 2008; 104:198-205.
. Cloninger CR, What makes people healthy, happy, and fulfilled in the face of current world challenges? Mens Sana Monogr 2013; 11:16-24.
. Krishnamurti J. The First & Last Freedom. Brockwood Park UK: Krishnamurti Foundation Trust, 1954.
. Krishnamurti J. The Awakening of Intelligence. New York: Harper and Row, 1987.
. Wilberg P. The Illness is the Cure: An introduction to life medicine and life doctoring, a new existential approah to illness. Whitstable, Great Britain: New Yoga Publications, 2012.
. Rimpau W. A Reader on Viktor von Weizsaecker's Why you get sick? Frankfurt on Main: Suhrkamp, 2008:341.
. Weizsaecker Vv. Social Disease and Social Recovery (Volume 8 of Collected Works, 1986). Frankfurt on Main: Suhrkamp, 1930.
. Garcia D, Two models of personality and well-being among adolescents. Personality and Individual Differences 2011; 50:1208-1212.
. Garcia D, Siddiqui A, Adolescents' psychological well-being and memory for life events: Influences on life satisfaction with respect to temperamental dispositions. Journal of Happiness Studies 2009; 10:407-419.
. Jaspers K. The Way to Wisdom: An Introduction to Philosophy. New Haven: Yale University press, 1954.
. Bradley RT, McCraty R, Atkinson M, Tomasino D, Daugherty A, Arguelles L, Emotion self-regulation, psychophysiological coherence, and test anxiety: results from an experiment using electrophysiological measures. Appl Psychophysiol Biofeedback 2010; 35:261-83.
. Carney RM, Blumenthal JA, Stein PK, Watkins L, Catellier D, Berkman LF, Czajkowski SM, O'Connor C, Stone PH, Freedland KE, Depression, heart rate variability, and acute myocardial infarction. Circulation 2001; 104:2024-8.
. Zohar AH, Cloninger CR, McCraty R, Personality and Heart Rate Variability: Exporing Pathways from personality to cardiac coherence and health. Open Journal of Social Science 2013; in press.
. McCraty R, Atkinson M, Tomasino D, Goelitz J, Mayrovitz HN, The impact of an emotional self-management skills course on psychosocial functioning and autonomic recovery to stress in middle school children. Integr Physiol Behav Sci 1999; 34:246-68.
. Ornish D, Lin J, Daubenmier J, Weidner G, Epel E, Kemp C, Magbanua MJ, Marlin R, Yglecias L, Carroll PR, Blackburn EH, Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol 2008; 9:1048-57.
. Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ, Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280:2001-7.
. Pischke CR, Frenda S, Ornish D, Weidner G, Lifestyle changes are related to reductions in depression in persons with elevated coronary risk factors. Psychol Health 2010; 25:1077-100.
. Rosenberg MB. Nonviolent Communication: A language of compassion. DelMar, CA: PuddleDancer Press, 1999.
. Gottman JM, Gottman JS, DeClaire J. Ten Lessons to Transform your Marriage. New York: Crown Publishers, 2006.
. Hilsenroth MJ, Cromer TD, Clinician interventions related to alliance during the initial interview and psychological assessment. Psychotherapy: Theory, Research, Practice, Training 2007; 44:205-218.
. Hilsenroth MJ, Peters EJ, Ackerman SJ, The development of therapeutic alliance during psychological assessment: patient and therapist perspectives across treatment. J Pers Assess 2004; 83:332-44.
. Ellermann CR, Reed PG, Self-transcendence and depression in middle-age adults. West J Nurs Res 2001; 23:698-713.
. Koenig HG, Pargament KI, Nielsen J, Religious coping and health status in medically ill hospitalized older adults. J Nerv Ment Dis 1998; 186:513-21.
. Smith TB, McCullough ME, Poll J, Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events. Psychol Bull 2003; 129:614-36.
. Ano GG, Vasconcelles EB, Religious coping and psychological adjustment to stress: a meta-analysis. J Clin Psychol 2005; 61:461-80.
. Pargament KI, Koenig HG, Tarakeshwar N, Hahn J, Religious coping methods as predictors of psychological, physical and spiritual outcomes among medically ill elderly patients: a two-year longitudinal study. J Health Psychol 2004; 9:713-30.
. Pargament KI, Koenig HG, Tarakeshwar N, Hahn J, Religious struggle as a predictor of mortality among medically ill elderly patients: a 2-year longitudinal study. Arch Intern Med 2001; 161:1881-5.
. Cloninger CR, Spirituality and the science of feeling good. South Med J 2007; 100:740-3.
. Frankl VE. Man's Search for Meaning. Boston: Beacon Press, 2006.
. Vaillant GE. The Wisdom of the Ego. Cambridge, MA: Harvard University Press, 1993.
. Eley DS, Cloninger CR, Walter L, Laurence C, Synnott R, Wilkinson D, The relationship between resilience and personality traits in doctors: implications for enhancing ell-being. PeerJ 2013; in press.
. Eley DS, Wilkinson D, Cloninger CR, Physician heal thyself, and develop your resilience. British Medical Journal Careers 2013.
. North CS, Abbacchi A, Cloninger CR, Personality and posttraumatic stress disorder among directly exposed survivors of the Oklahoma City bombing. Compr Psychiatry 2012; 53:1-8.
. Cloninger CR, Zohar AH, Hirschmann S, Dahan D, The psychological costs and benefits of being highly persistent: personality profiles distinguish mood disorders from anxiety disorders. J Affect Disord 2012; 136:758-66.
. Cicchetti D, Rogosch FA, Equifinality and multifinality in developmental psychopatology. Development and Psychopathology 1996; 8:597-600.
. Cloninger CR, Svrakic NM, Svrakic DM, Role of personality self-organization in development of mental order and disorder. Dev Psychopathol 1997; 9:881-906.
. Gandhi MK. The Words of Gandhi. New York: Newmarket Press, 1996.
. Gandhi MK. The Bhagavad Gita According to Gandhi. Berkeley, CA: Berkeley Hills Books, 2000.