Character Strengths and Health: Research Summary – Part 1.
Ryan Niemiec, Psy.D., Education Director, VIA Institute on Character, Cincinnati, Ohio (left); Alina Yarova, MPH, Vice President, Positive Health and Wellness Division, International Positive Psychology Association (IPPA), New York, New York (right).
Corresponding Author: Alina Yarova, E-mail: firstname.lastname@example.org
In 2000, Christopher Peterson and Martin Seligman kicked off a large-scale study looking across history, nations, and cultures to answer the question: “What is best about human beings?” The three-year project culminated in the VIA Classification of Character Strengths, designed to measure 24 ubiquitous strengths (Peterson & Seligman, 2004). Over the past 15 years, the popularity of this descriptive work and the science surrounding it has flourished. As of 2018, there are over 400 scientific studies of strengths involving the VIA Classification, thousands of studies on individual character strengths, hundreds of thousands of monthly visitors to the VIA Institute on Character website (the nonprofit organization advancing the science of character) and over 6 million people globally who have taken the VIA Survey.
There has been substantial interest in basic and applied research on character strengths in various disciplines, most prominently in the organizational context and in education; however, far less within the health domain. That said, there are notable exceptions. We will review the current body of research and application of character strengths in the health domain, offering a condensed summary. For purposes of scope, we will limit our review to the physical domain of health among healthy and unhealthy populations. We will then outline practical implications and offer future directions.
We will target four areas of study: general correlational work with the entire set of 24 character strengths, studies of individual strengths, interventions using strengths as part of a broader program, and physician and patient-provider research.
General Character Strengths Findings
Examining the 24 character strengths as a group, researchers have noted which strengths are correlated with specific physical health behaviors and outcomes. All character strengths except humility and spirituality were associated with multiple health behaviors, including substance avoidance, cardio-respiratory fitness, and overall perceived health. (Proyer, Gander, Wellenzohn, & Ruch,, 2013). Another study found that individuals with a history of physical illness bear a reduced toll on life satisfaction if they are high on strengths of bravery, kindness, and humor (Peterson, Park, & Seligman, 2006). A study examining patients with traumatic brain injury found that character strengths showed unique value in predicting physical health and disability (Hanks et al, 2014).
Several studies have established similar links among children and adolescents. Chaves and colleagues studied a population of children with a life-threatening illness, finding that higher benefit-finding and character strengths (love and gratitude) predicted positive changes in life satisfaction over time, and in turn, positive emotions predicted changes in benefit-finding over time (Chaves, Hervas, Garcia, & Vazquez, 2016). In a study examining a granting-a-wish intervention, children had increased levels of strengths, life satisfaction, positive emotions, and less nausea compared to a waitlist control group (Chaves, Vazquez, & Hervas, 2016). Character strengths have been associated with lower levels of overall sexual behaviors among African American adolescents (Ma et al., 2008). Leontopoulou and colleagues found that good physical and mental health were positively related to, and reliably predicted different aspects of, both well-being and character strengths in a group of Greek university students. (Leontopoulou & Triliva, 2012).
Several character strengths, studied individually, have likewise shown a connection with health outcomes. Gratitude has been linked with increased positive mood, life satisfaction, vitality, optimism, and spirituality, and decreased depression and envy (McCullough, Emmons, & Tsang, 2002). The gratitude practice of counting blessings has led to increases in well-being among those with neuromuscular disease (Emmons & McCullough, 2003). This practice has also led to fewer physical symptoms among adolescents (Froh, Sefick, & Emmons, 2008).
The relationship between the character strength of hope (optimism) and health has likewise been established. Hope was a significant predictor of medication adherence among asthma patients aged 8 to 12 years (Berg, Rapoff, Snyder, & Belmont, 2007).
The character strength of love was the focus of a 17-year longitudinal study examining the effects of compassionate love among people living with HIV. Giving compassionate love to others and offering compassionate love toward oneself both predicted survival (Ironson et al, 2017).
A study examining fairness (justice) and telomere length in African Americans from Detroit, Michigan, revealed that while telomere length was negatively associated with chronological age, a belief in personal justice mediated such an effect for older subjects, suggesting that perceptions of justice/injustice could be protective from the negative health effects of race-based social adversity (Lucas et al., 2017).
Examples of other strengths linked with positive health outcomes include humor (Beckman et al., 2007), zest (Ryan & Frederick, 1997), kindness (Fredrickson et al., 2008), forgiveness (Toussaint, Shields, Dorn, & Slavich, 2016), spirituality (Hussain, 2010), curiosity (as reported in Kashdan ), and self-regulation (Moffitta et al., 2011).
Programs and Interventions
A number of programs have infused character strengths into interventions designed to help a particular population improve health outcomes. These have ranged from medical patients in industrialized nations to children in impoverished areas.
In randomized controlled trials involving thousands of girls in poverty in India, girls who received a curriculum that incorporated strengths exhibited significantly greater physical and psychosocial health benefits in comparison to those who received a similar curriculum without character strengths as well as controls (Leventhal et al., 2015, 2016).
A program in Kenya placed character strengths development at the core of a community-based program for youth in under-resourced primary school communities. When youth learned about and reflected on their character strengths publicly, their health and hygiene habits/behaviors increase in frequency, in addition to several other (Fialkov, Haddad, & Gowan, 2017).
Patients suffering from acute coronary syndrome benefitted from a phone intervention that included identifying and using a signature strength. Another study of cardiac patients combined the use of three strengths (gratitude, hope, and kindness) and found that patients experienced increases in health-related quality of life compared to a relaxation group and controls (Huffman et al., 2011, 2016).
Additional healthcare settings that have found benefit from character strengths interventions include rehabilitation (Bertisch et al., 2014; O’Donnell, 2013); psychiatric settings (Huffman et al., 2014); Veteran’s Administration (Kobau et al., 2011);and university wellness coaching programs (Larcus, Gibbs, & Hackmann, 2016).
Physicians and the Patient-Provider Relationship
In recent years, there has been a growing emphasis on physician well-being as the prevalence of stress and burnout has increased in the healthcare system, particularly in the United States. Positive health is an emerging area of study (Seligman, 2008) that can address these concerns (Niemiec, 2014).
In a convenience sample of 9,472 physicians who took the VIA Survey online, the highest strengths were honesty, judgment, fairness, kindness, and love (VIA Institute on Character, 2017b). These results speak to physicians viewing themselves as authentic and truth-telling, along with providing a balance of fair-minded critical thinking and heart-based caring. The lowest strengths were spirituality, self-regulation, bravery, humility, and zest.
Several studies have looked at medical students and resident physicians. Virtues education (using the six VIA virtues of courage, wisdom, temperance, humanity, transcendence, and justice) was integrated into the curriculum at The University of Queensland-Ochsner in New Orleans. At the conclusion of the program, students self-reported improved understanding of the virtues in their medical practice (Seoane et al 2016). A 2017 study by Hausler and colleagues looked at the use of signature character strengths at work among medical students and resident physicians, finding the use of strengths to be linked with well-being and mental health but not with physical health (Hausler et al 2017).
Several studies have examined patients’ strengths profiles with implications for enhancing the patient-provider relationship: Australian Army Special Forces operators and support personnel (Gayton et al 2016) and among patients with different chronic conditions (Mirkovic et al, 2016).
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