New Evidence That Therapy Can Make You Happier thumbnail

New Evidence That Therapy Can Make You Happier

What are the interventions that are supposed to make us happier? What doesn’t work? And if something does work, how much good does it do?Pixabay

In “All Eyes on Me,” a song from his new Netflix special Inside, the musician-comedian Bo Burnham pauses to ask, “You want to hear a funny story?” He tells us that, five years ago, he quit performing live because, while on stage, he’d experience severe panic attacks. He spent that time trying to improve himself mentally instead. “And you know what? I did,” Burnham says. He got better. “So much better, in fact, that in January of 2020, I thought, ‘You know what, I should start performing again.’” He’d been a kind of recluse. It was time to rectify that, he says. “And then, the funniest thing happened…” 

Which was, of course, the pandemic. Inside—the whole of which is shot in a single room—is partly a commentary on how lockdowns and life online affected his emotional wellbeing. Interestingly, though, the global health emergency goes unmentioned. Burnham, here and there, only vaguely alludes to it. Yet he’s clear—or at least, the character he plays is clear—that the point of producing Inside was to keep busy, to stave off feelings of depression and thoughts of suicide, a struggle he hardly endured alone. A recent longitudinal study of an international group of participants found that, from April to September 2020 depressive symptoms, as well as suicidal thoughts and behaviors, rose significantly (though acute stress went down).

There is no secret to happiness, no bliss-bringing epiphany.

But what, you might wonder, does that mental health care actually consist in? What are the interventions that are supposed to make us happier? What doesn’t work? And if something does work, how much good does it do? 

Fortunately, the answers to these questions were meticulously considered in a recent meta-analysis published in Nature Human Behavior. The size of this “systematic review” is gigantic compared to most individual experiments. Led by Joep van Agteren, of the South Australian Health and Medical Research Institute, the researchers merged the findings of 393 randomized controlled trials, which included 53,288 research participants. Some of these participants had mental illnesses, physical illnesses, or neither (the “non-clinical” population). It’s good to look at many studies at once, and see if there is a general trend, especially when “effect sizes” are small. (Wearing a scarf, on a cold day, for example, has a small effect on your feeling of warmth compared to wearing a parka.) It turns out that, yes, some interventions do work.

By “intervention,” the researchers don’t mean self-help, or what someone can do for themselves. They mean what a person (such as a therapist) can do to increase the happiness of others. Aside from its obvious benefits, successful happiness interventions are also linked to improved development, health, and longevity. Some interventions focus on building commitment to change, creating a sense of hope, and a focus on acceptance as opposed to control in one’s life. These methods are broadly known as Acceptance and Commitment Therapy, and have a small-to-moderate significant effect on happiness. 

Cognitive behavioral therapy, a popular method used in talk therapy, attempts to improve happiness by changing thoughts—to stop thinking patterns that lead to unhappiness, and to learn emotional-regulation skills and how to appraise events in, or aspects of, life in a more positive way. Some of it is inspired by Stoic wisdom. It had a small-to-moderate effect when applied to people who have a mental illness, but appears to have no significant effect on the general population. 

One approach that fared particularly well is one of the hardest to describe: the multi-component positive psychology intervention. Positive psychology researchers focus on how people who aren’t suffering from any mental disorders or deficiencies can thrive, intellectually and emotionally. Typically, an intervention of this sort will be a package of exercises, some of which might focus on character strengths, emotions like gratitude, the idea of savoring, and prompts to count blessings. Although it has a small effect overall, its effect size was larger than those studies that used only a single positive-psychology intervention. So targeting happiness with multiple approaches is helpful.

One of the largest effects came from mindfulness-based interventions. Mindfulness involves training to focus attention on one’s immediate sensory situation, breath, or some visualization, and to let go of thinking about other places, the past or the future. It had small-to-moderate effects for physically ill and non-clinical populations, but had a moderate to large effect on those with mental illness. However, reminiscence interventions, which focus on reviewing episodes from one’s past and integrating them into a more positive mindset, also had a small positive effect, even though it is anti-mindful. 

Unfortunately, none of the 16 categories of intervention showed a large effect. The effects of the best ones—mindfulness-based and multi-component positive-psychology interventions—were moderate at best. 

Fortunately, none of them seem to make things worse. But we need to remember that this meta-analysis, as well as the studies that it looked at, use aggregate data. That is, they average responses across many people. Although this is really important for finding whether something works in general, it hides underlying variation: Something might be really good for some people, in some situations, and useless (or perhaps even harmful) for others in other situations. Just because it has a small effect, on average, doesn’t mean it won’t have a large effect (or no effect, or even a negative effect) on a particular individual at a particular time. Even mindfulness has its dangers.

One example of an intervention that the analysis showed didn’t do any good was “three good things.” The idea is that writing or thinking about three good things that happened to you over a, typically recent, period, and reflecting on why those things occurred, could boost subjective well being. Others included expressive writing and imagining your best possible self.

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It’s tempting to think that, for any subject, a meta-analysis can offer the final word. Yet as the authors point out again and again, many of the studies used in the meta-analysis were of low quality, which should decrease our confidence somewhat in the truth of the findings. Still, therapists and others whose job it is to help people suffering from unhappiness will find these results are of practical interest. 

And luckily for those who don’t want therapy, there is a lot of science about what you can do to affect your own happiness. Knowing what reliably reduces your happiness is a start. Things like having a fraught relationship with your co-worker, boss, or spouse, chronic stress, and having little control in your life. 

What makes people happier? Money and exercise, definitely, but the largest effect comes from spending time with friends and loved ones—even for introverts. It is the single best thing you can do to make yourself happier and healthier. Being socially isolated brings on a host of problems. I should note that the pandemic did not enforce social isolation for most people, because the kinds of interactions that are meaningful can happen over the phone or on video calls. This is why you might have heard some people urging others to say “physical distancing,” not “social distancing.” Interaction on social media, however, is not enough.

The meta-analysis most of all underscores that there is no secret to happiness, no bliss-bringing epiphany. It doesn’t work that way. As social psychologist Jonathan Haidt notes, in The Happiness Hypothesis: Finding Modern Truth in Ancient Wisdom, we should think of improving happiness as something we practice. In “Shit,” a song from Inside about feeling that way, Burnham sings, “Staring at the ceiling and waiting for this feeling to go away—but it won’t go away.” 

Well no shit. Being happier is about changing your habits—how you live your life, how you think, and how you approach situations. This takes effort over time. The trick is making it a part of your daily life. 

Jim Davies is a professor at the Department of Cognitive Science at Carleton University. He is co-host of the award-winning podcast Minding the Brain. His new book, Being the Person Your Dog Thinks You Are: The Science of a Better You, came out in February 2021.

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