August 5, 2015

Can Encouraging Awe Decrease Inflammation?

This positive emotion may have the most health-promoting potential
We’ve all read that positive emotions have an effect on health, but which emotions have the most impact? In this study, researchers discovered that the emotion of awe had the greatest correlation with lowered inflammation.


Stellar JE, John-Henderson N, Anderson CL, Gordon AM, McNeil GD, Keltner D. Positive affect and markers of inflammation: discrete positive emotions predict lower levels of inflammatory cytokines. Emotion. 2015;15(2):129-133.

Design and Participants

In this paper the researchers present 2 studies. The first study included 94 freshman undergraduates from an American West Coast university who completed a questionnaire and provided a sample of oral mucosal transudate (OMT). The second study was of a multisession longitudinal design and included 119 freshman undergraduates from the same university. In the second study, participants completed a questionnaire on their home computers using a secure website and then went to the lab for a follow-up session where OMT was collected and another questionnaire was completed.

Outcomes Measures

In both studies interleukin-6 (IL-6) was measured using OMT. In the first study, the Positive and Negative Affect Schedule (PANAS) was used to determine emotional status. Researchers controlled for body mass index (BMI) because of the connection between obesity and increased inflammation. In the second study, Dispositional Positive Emotion Scale (DPES) and The Big Five Personality Inventory were added as outcomes measures in addition to PANAS and controlling for BMI.

Key Findings

In the first study, lower IL-6 was correlated with positive emotions. In the second study, the added measurement of positive emotions also correlated with lower IL-6. To dig deeper into the type of positive emotion that had the most significant impact on IL-6 levels, the researchers examined the 7 subscales of the DPES (awe, amusement, compassion, contentment, joy, love, and pride) and found that awe had the strongest correlation to lower levels of IL-6 compared to any of the other emotions. In fact, only the degree of awe was able to significantly predict levels of IL-6. When the OMT was taken in the second study, the participants who reported feeling the most awe, wonder, and amazement that day had the lowest levels of IL-6 (P<0.001). Joy, contentment, pride, and awe were all strongly correlated with lower levels of IL-6, but their ability to predict low IL-6 was not statistically significant. 

Practice Implications

This study provides a subtle refinement to our understanding of the impact of positive emotions on physical health. Most practitioners of integrative medicine are keenly aware of the link between positive emotions and various body functions, particularly immune function. What this study provides is a valuable new insight: Not all positive emotions are created equal. It also highlights an emotion that we rarely talk about. In fact, as Keltner and Haidt note, “psychology has had surprisingly little to say about awe.”1 Much of the research on emotions has primarily focused on very distinctive common negative expressions such as sadness, shame, fear, and anger or has often lumped all positive emotions into the general category of optimism or positive mood.
Based on this latest study, helping patients find ways to experience and express awe on a daily basis, even in the smallest doses, will likely have a positive impact on their health.
From a clinical perspective, this study sheds light on the potential of incorporating new ways to enhance an important positive emotion in patients—awe. Before focusing on promoting this emotion, however, it is important to point out that awe is often linked to feelings of social connectedness and social exploration. So from a practical perspective, physicians should encourage patients to become more socially engaged. This goal is especially important when dealing with older patients or those with depression. Here are some potential recommendations practitioners can make to their patients. 
  • Get connected online. Learning to use email, the Internet, and web-based social networks such as Facebook or Twitter can make a big difference in helping people feel more connected.
  • Encourage positive relationships. A person is never too old to learn how to be a better friend, parent, mentor, or listener. Personal development is a never-ending process. 
  • Join a club or church. In today’s world, there are always opportunities to find places to socialize that are positive and healthful.
  • Volunteer. There is perhaps no greater opportunity to feel connected than by finding a way to volunteer time and energy towards a greater good. It is perhaps the most powerful way of connecting to people outside of our deepest personal relationships.
The health benefits of increased socialization are significant. Many of these benefits may be related to fighting inflammation. Studies indicate that people who feel connected and have strong social relationships have lower levels of inflammatory cytokines.2 In patients with elevated inflammatory markers, it may be worthwhile to explore their present social network or help them find ways to create a stronger sense of social engagement. In addition, it seems clinically prudent to help patients discover which activities cause them to feel awe. Research shows that some of these awe-inspiring activities—such as listening to music,3 walking in nature,4 or being creative5—can have a positive impact on health. The research clearly supports the notion that practitioners should consider “prescribing” awe-inspiring activities as a part of their antiinflammatory protocol.
Trying to encourage optimism in patients is certainly a worthy clinical goal6,7; however, achieving that goal can sometimes be challenging, especially in patients with depression or those dealing with a recent loss. Nonetheless, every effort should be made to help patients develop a greater sense of optimism and positivity. In addition, based on this latest study, helping patients find ways to experience and express awe on a daily basis, even in the smallest doses, will likely have a positive impact on their health. 

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  1. Keltner D, Haidt J. Approaching awe, a moral, spiritual, and aesthetic emotion. Cogn Emot. 2003;17(2):297-314.
  2. Kiecolt-Glaser JK, Gouin JP, Hantsoo L. Close relationships, inflammation, and health. Neurosci Biobehav Rev. 2010;35(1):33-38.
  3. Novotney A. Music as medicine. J Am Psychol Assoc. 2013;44(10):46.
  4. Maller C, Townsend M, Pryor A, Brown P, St. Leger L. Healthy nature health people: “contact with nature” as an upstream health promotion intervention for populations. Health Promot Int. 2006;21(1):45-54.
  5. Stuckey H, Nobel J. The connection between art, healing, and public health: a review of current literature. Am J Public Health. 2010;100(2):254-263.
  6. Rasmussen HN, Scheier MF, Greenhouse JB. Optimism and physical health: a meta-analytic review. Ann Behav Med. 2009;37(3):239-256.
  7. Conversano C, Rotondo A, Lensi E, Della Vista O, Arpone F, Reda MA. Optimism and its impact on mental and physical well-being. Clin Pract Epidemiol Ment Health. 2010 May 14;6:25-29.