Two kinds of psychological factors influence personal health: health-relevant personality traits and health behavior. 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 behavior pattern is an example. Because personality is not typically something we choose (“I’d like a bit of that sense of humor and extraversion over there, please, but hold the whininess”), this source of health can be outside personal control. In contrast, engaging in positive health behaviors is something anyone can do, at least in principle.

Different health problems seem to plague different social groups. For example, men are more susceptible to heart disease than are women, and African Americans are more susceptible to asthma than are Asian or European Americans. Beyond these general social categories, personality turns out to be a factor in wellness, with individual differences in optimism and hardiness important influences.

Optimism

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). Does just having positive thoughts about the future make it so? Unfortunately not.

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. 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 behaviors like eating a balanced diet and exercising, which in turn decrease 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.

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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).

Hardiness

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? In one study, a group of stress-resistant business executives reported high levels of stressful life events but had histories of relatively few illnesses compared with a similar group of executives who succumbed to stress by getting sick (Kosaba, 1979). The stress-resistant group (labeled 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 environments. And they were willing to accept challenge, undertaking change and accepting opportunities for growth.

Can anyone develop hardiness? In one study, 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 (whose members engaged in relaxation and meditation training or in group discussions about stress), the participants in 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 college students—for some, even boosting their GPA (Maddi et al., 2009).

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 don’t seem to be acting on the basis of this knowledge. At the turn of the 21st century, 69% of Americans over 20 are overweight or obese (National Center for Health Statistics, 2012). The prevalence of unsafe sex is difficult to estimate, but 20 million Americans contract one or more new sexually transmitted diseases (STDs) each year (Satterwhite et al., 2013). And despite endless warnings, 21% of Americans still smoke cigarettes (Pleis, Lucas, & Ward, 2009). What’s going on?

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Self-Regulation

Doing what is good for you is not necessarily easy. Engaging in health-promoting behaviors 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.

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 behavior 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 participants in the self-control group were more likely than those in the self-indulgent group to abandon the difficult task—suggesting that they had depleted their pool of self-control (Baumeister et al., 1998). The take-home message is that to control behavior successfully, we need to choose our battles, exercising self-control mainly on the personal weaknesses that are most harmful to health.

Eating Wisely

In many Western cultures, the weight of the average citizen is increasing alarmingly. 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 in order to store calories for leaner times. In postindustrial societies in the 21st century, however, there are no leaner times, and people can’t burn all of the calories they consume (Pinel, Assanand, & Lehman, 2000). But why, then, are people in France leaner on average than Americans even though their foods are high in fat? One reason has to do with the fact that activity level in France is greater. Another is 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. Right now, Americans seem to be involved in some kind of national eating contest, whereas in France, people are eating less food more slowly, perhaps leading 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 doesn’t 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 behavior 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 behavior (Wegner, 1994a, 1994b). 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. 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).

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Avoiding Sexual Risks

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 doesn’t awareness translate into avoidance? Risk takers harbor 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 college students found that respondents judged their own likelihood of getting pregnant in the next year as less than 10%, but they estimated the average for other women at the university to be 27% (Burger & Burns, 1988).

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. 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.

Not Smoking

One in two smokers dies prematurely from smoking-related diseases such as lung cancer, heart disease, emphysema, and cancer of the mouth and throat. Although the overall rate of smoking in the United States is declining, new smokers abound, and many can’t seem to stop. College students are puffing away along with everyone else, with 20% of college students currently smoking (Thompson et al., 2007). In the face of all the devastating health consequences, why don’t people quit?

Nicotine, the active ingredient in cigarettes, is addictive, so smoking is difficult to stop once the habit is established (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. In the months following 9/11, for example, cigarette sales jumped 13% in Massachusetts (Phillips, 2002). And for some time after quitting, exsmokers 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’ve been away from nicotine.

Psychological programs and techniques to help people kick the habit include nicotine replacement systems such as gum and skin patches, counseling 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. Keeping healthy by behaving in healthy ways is one of the great challenges of life (see Other Voices box).

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