Two kinds of psychological factors influence personal health: health-relevant personality traits and health behaviour. Personality can influence health through relatively enduring traits that make some people particularly susceptible to health problems or stress while sparing or protecting others. The Type A behaviour pattern is an example. Because personality is not typically something we choose (“I would like a bit of that sense of humour and extraversion over there, please, but hold the whininess”), this source of health can be outside personal control. In contrast, engaging in positive health behaviours is something anyone can do, at least in principle.

Different health problems seem to plague different social groups. For example, South Asian Canadians, even those of healthy weight, are more likely to die from a heart attack earlier than the general population, and First Nations people are more susceptible to diabetes than are Asians or Europeans. Beyond these general social categories, personality turns out to be a factor in Canadians’ wellness, with individual differences in optimism and hardiness being important influences (Heart & Stroke Foundation, 2010).

Pollyanna is one of literature’s most famous optimists. Eleanor H. Porter’s 1913 novel portrayed Pollyanna as a girl who greeted life with boundless good cheer, even when she was orphaned and sent to live with her cruel aunt. Her response to a sunny day was to remark on the good weather, of course, but her response to a gloomy day was to point out how lucky it is that not every day is gloomy! Her crotchety Aunt Polly had exactly the opposite attitude, somehow managing to turn every happy moment into an opportunity for strict correction. A person’s level of optimism or pessimism tends to be fairly stable over time, and research comparing the personalities of twins reared together versus those reared apart suggests that this stability arises because these traits are moderately heritable (Plomin et al., 1992). Perhaps Pollyanna and Aunt Polly were each “born that way.”

An optimist who believes that “in uncertain times, I usually expect the best” is likely to be healthier than a pessimist who believes that “if something can go wrong for me, it will.” One recent review of dozens of studies including tens of thousands of participants concluded that of all of the measures of psychological well-being examined, optimism is the one that most strongly predicted a positive outcome for cardiovascular health (Boehm & Kubzansky, 2012). Importantly, the association between optimism and cardiovascular health remains even after statistically controlling for traditional risk factors for heart disease including depression and anxiety, suggesting that it is not just the absence of psychopathology, but the presence of positive expectancies for the future, that predict positive health outcomes. Does just having positive thoughts about the future make it so? Unfortunately not.

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Rather than improving physical health directly, optimism seems to aid in the maintenance of psychological health in the face of physical health problems. When sick, optimists are more likely than pessimists to maintain positive emotions, avoid negative emotions such as anxiety and depression, stick to medical regimens their caregivers have prescribed, and keep up their relationships with others. Among women who have surgery for breast cancer, for example, optimists are less likely to experience distress and fatigue after treatment than are pessimists, largely because they keep up social contacts and recreational activities during their treatment (Carver, Lehman, & Antoni, 2003). Optimism also seems to aid in the maintenance of physical health. For instance, optimism appears to be associated with cardiovascular health because optimistic people tend to engage in healthier behaviours like eating a balanced diet and exercising, which in turn leads to a healthier lipid profile (i.e., higher levels of high-density lipoprotein cholesterol that help to prevent buildup in your arteries, and lower triglycerides, which are the chemical form of fat storage in the body), which decreases the risk of heart disease (Boehm et al., 2013). So being optimistic is a positive asset, but it takes more than just hope to obtain positive health benefits.

The benefits of optimism raise an important question: If the traits of optimism and pessimism are stable over time—even resistant to change—can pessimists ever hope to gain any of the advantages of optimism (Heatherton & Weinberger, 1994)? Research has shown that even die-hard pessimists can be trained to become significantly more optimistic and that this training can improve their psychosocial health outcomes. For example, pessimistic breast cancer patients who received 10 weeks of training in stress management techniques became more optimistic and were less likely than those who received only relaxation exercises to suffer distress and fatigue during their cancer treatments (Antoni et al., 2001).

Some people seem to be thick-skinned, somehow able to take stress or abuse that could be devastating to others. Are there personality traits that contribute to such resilience and offer protection from stress-induced illness? To identify such traits, Suzanne Kobasa (1979) studied a group of stress-resistant business executives. These individuals reported high levels of stressful life events but had histories of relatively few illnesses compared with a similar group who succumbed to stress by getting sick. The stress-resistant group (Kobasa labelled them hardy) shared several traits, all conveniently beginning with the letter C. They showed a sense of commitment, an ability to become involved in life’s tasks and encounters rather than just dabbling. They exhibited a belief in control, the expectation that their actions and words have a causal influence over their lives and environment. And they were willing to accept challenge, undertaking change and accepting opportunities for growth.

Can just anyone develop hardiness? Researchers have attempted to teach hardiness with some success. In one such attempt, participants attended 10 weekly hardiness-training sessions, in which they were encouraged to examine their stresses, develop action plans for dealing with them, explore their bodily reactions to stress, and find ways to compensate for unchangeable situations without falling into self-pity. Compared with control groups (who engaged in relaxation and meditation training or in group discussions about stress), the hardiness-training group reported greater reductions in their perceived personal stress as well as fewer symptoms of illness (Maddi, Kahn, & Maddi, 1998). Hardiness training can have similar positive effects in university students, for some even boosting their GPA (Maddi et al., 2009).

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Even without changing our personalities at all, we can do certain things to be healthy. The importance of healthy eating, safe sex, and giving up smoking are common knowledge. But we do not seem to be acting on the basis of this knowledge. Currently 59.9 percent of Canadian men and 45.0 percent of Canadian women are overweight or obese (Statistics Canada, 2013b). The prevalence of unsafe sex is difficult to estimate, but currently in Canada it is estimated that of every 100 sexually active people, 30 will be found to have a sexually transmitted bacterial infection (chlamydia, gonorrhea, or syphilis). This rate is rising quickly (Public Health Agency of Canada, 2010). Another 71 300 people live with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), 25 percent of whom are unaware of their infection, which is usually contracted through unprotected sex with an infected partner (Public Health Agency of Canada, 2012). And despite endless warnings, 16 percent of Canadians still smoke cigarettes (Health Canada, 2013). What is going on?

Doing what is good for you is not necessarily easy. Mark Twain once remarked, “The only way to keep your health is to eat what you do not want, drink what you do not like, and do what you would rather not.” Engaging in health-promoting behaviours involves self-regulation, the exercise of voluntary control over the self to bring the self into line with preferred standards. When you decide on a salad rather than a cheeseburger, for instance, you control your impulse and behave in a way that will help to make you the kind of person you would prefer to be—a healthy one. Self-regulation often involves putting off immediate gratification for longer-term gains.

Self-regulation requires a kind of inner strength or willpower. One theory suggests that self-control is a kind of strength that can be fatigued (Baumeister, Heatherton, & Tice, 1995; Baumeister, Vohs, & Tice, 2007). In other words, trying to exercise control in one area may exhaust self-control, leaving behaviour in other areas unregulated. To test this theory, researchers seated hungry volunteers near a batch of fresh, hot, chocolate chip cookies. They asked some participants to leave the cookies alone but help themselves to a healthy snack of radishes, whereas others were allowed to indulge. When later challenged with an impossibly difficult figure-tracing task, the self-control group was more likely than the self-indulgent group to abandon the difficult task—behaviour interpreted as evidence that they had depleted their pool of self-control (Baumeister et al., 1998). The take-home message from this experiment is that to control behaviour successfully, we need to choose our battles, exercising self-control mainly on the personal weaknesses that are most harmful to health.

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Sometimes, though, self-regulation is less a matter of brute force than of strategy. Martial artists claim that anyone can easily overcome a large attacker with the use of the right moves, and overcoming our own unhealthy impulses may also be a matter of finesse. Let us look carefully at healthy approaches to some key challenges for self-regulation—eating, safe sex, and smoking—to learn what “smart moves” can aid us in our struggles.

In many Western cultures, the weight of the average citizen is increasing at an alarming rate. One explanation is based on our evolutionary history: In order to ensure their survival, our ancestors found it useful to eat well in times of plenty to store calories for leaner times. In postindustrial societies in the twenty-first century, however, there are no leaner times, and people cannot burn all of the calories they consume (Pinel, Assanand, & Lehman, 2000). But why, then, is obesity not endemic throughout the Western world? Why are people in France leaner on average than North Americans, even though their foods are high in fat? One reason has to do with the fact that activity level in France is greater. Research by Paul Rozin and his colleagues also finds that portion sizes in France are significantly smaller than in the United States, but at the same time, people in France take longer to finish their smaller meals. At a McDonald’s in France, diners take an average of 22 minutes to consume a meal, whereas in the United States, they take under 15 minutes (Rozin, Kabnick, et al., 2003). The fact that people in France are eating less food more slowly, may lead them to be more conscious of what they are eating. This, ironically, probably leads to lower french fry consumption.

Short of moving to France, what can you do? Studies indicate that dieting does not always work because the process of conscious self-regulation can be easily undermined by stress, leading people who are trying to control themselves to lose control by overindulging in the very behaviour they had been trying to overcome. This may remind you of a general principle discussed in the Consciousness chapter: Trying hard not to do something can often directly produce the unwanted behaviour (Wegner, 1994a, 1994b).

The restraint problem may be inherent in the very act of self-control (Polivy & Herman, 1992). Rather than dieting, then, heading toward normal weight should involve a new emphasis on exercise and nutrition (Prochaska & Sallis, 2004). In emphasizing what is good to eat, the person can freely think about food rather than trying to suppress thoughts about it. A focus on increasing activity rather than reducing food intake, in turn, gives people another positive and active goal to pursue. Self-regulation is more effective when it focuses on what to do rather than on what not to do (Molden, Lee, & Higgins, 2009; Wegner & Wenzlaff, 1996).

People put themselves at risk when they have unprotected vaginal, oral, or anal intercourse. Sexually active adolescents and adults are usually aware of such risks, not to mention the risk of unwanted pregnancy, and yet many behave in risky ways nonetheless. Why does awareness not translate into avoidance? Risk takers harbour an illusion of unique invulnerability, a systematic bias toward believing that they are less likely to fall victim to the problem than are others (Perloff & Fetzer, 1986). For example, a study of sexually active female university students found that respondents judged their own likelihood of getting pregnant in the next year as less than 10 percent, but estimated the average for other women at the university to be 27 percent (Burger & Burns, 1988). Paradoxically, this illusion was even stronger among women in the sample who reported using inadequate or no contraceptive techniques. The tendency to think “It will not happen to me” may be most pronounced when it probably will.

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Unprotected sex often is the impulsive result of last-minute emotions. When thought is further blurred by alcohol or recreational drugs, people often fail to use the latex condoms that can reduce their exposure to the risks of pregnancy, HIV, and many other STDs. Like other forms of self-regulation, the avoidance of sexual risk requires the kind of planning that can be easily undone by circumstances that hamper the ability to think ahead. One approach to reducing sexual risk taking, then, is simply finding ways to help people plan ahead. Sex education programs offer adolescents just such a chance by encouraging them, at a time when they have not had much sexual experience, to think about what they might do when they need to make decisions. Although sex education is sometimes criticized as increasing adolescents’ awareness of and interest in sex, the research evidence is clear: Sex education reduces the likelihood that adolescents will engage in unprotected sexual activity and benefits their health (American Psychological Association, 2005). The same holds true for adults.

One in two smokers dies prematurely from smoking-related diseases such as lung cancer, heart disease, emphysema, and cancer of the mouth and throat. Lung cancer alone kills more people than any other form of cancer, and smoking causes 80 percent of lung cancers. Although the overall rate of smoking in Canada is declining, new smokers abound, and many cannot seem to stop. University students are puffing away along with everyone else, with 10 to 18 percent of university students currently smoking (Health Canada, 2013). In the face of all the devastating health consequences, why do people not quit?

Nicotine, the active ingredient in cigarettes, is addictive, so smoking is difficult to stop once the habit is established (as discussed in the Consciousness chapter). As in other forms of self-regulation, the resolve to quit smoking is fragile and seems to break down under stress. And for some time after quitting, ex-smokers remain sensitive to cues in the environment: Eating or drinking, a bad mood, anxiety, or just seeing someone else smoking is enough to make them want a cigarette (Shiffman et al., 1996). The good news is that the urge decreases and people become less likely to relapse the longer they have been away from nicotine.

Psychological programs and techniques to help people kick the habit include nicotine replacement systems such as gum and skin patches, counselling programs, and hypnosis, but these programs are not always successful. Trying again and again in different ways is apparently the best approach (Schachter, 1982). After all, to quit smoking forever, you only need to quit one more time than you start up. But like the self-regulation of eating and sexuality, the self-regulation of smoking can require effort and thought. The ancient Greeks blamed self-control problems on akrasia (weakness of will). Modern psychology focuses less on blaming a person’s character for poor self-regulation and points instead toward the difficulty of the task. Keeping healthy by behaving in healthy ways is one of the great challenges of life.

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