Is There an Equation for Happiness?

Wouldn’t it be nice if there was a mathematical equation that could predict and explain happiness? We could tweak the numbers and get happy! Sounds pretty far-fetched, right?

Actually this equation exists. It looks like this:

Happiness-equation

 

 

A researcher named Robb Rutledge, at the Max Planck University College London Centre for Computational Psychiatry and Aging Research, developed this equation. It figures that such an equation would be developed at an institution whose name is 12 words long! Rutledge developed this equation based on outcomes from a smart phone app called The Great Brain Experiment. The data was derived from 25,189 players of the app, a pretty good sample size!

Let me explain this equation to you. I will leave out the weird Sigma symbols and the small w constants, and just explain the letters.

Basically, happiness depends on CR which stands for Certain Rewards or safe choices plus expectations associated with risky choices (EV, expected value), and the difference between the experienced outcome and the expectation which is called a reward prediction error (RPE).

So the key idea is that happiness doesn’t so much depend on how things are going, but how they are going compared to your expectations. Let’s use an example. You make plans to go to a new restaurant with your sweetie. You looked up the restaurant on various restaurant review sites, and it gets very positive reviews. You go to the restaurant and the meal is very good, but not quite as good as the reviews suggest. Your happiness decreases. Or you go to a restaurant that has mediocre reviews, and it’s actually pretty good. Your happiness goes up.

This may be why online dating is so difficult. People build up very high expectations of their potential date, based on photoshopped or out-of-date photographs, as well as email or chat communications that may represent an unrealistically positive view of the other person. When they meet the person their expectations are higher than reality, and they experience disappointment and unhappiness.

So the way to be happier is to have low expectations? Some researchers have suggested this is why Danish people are so happy. The Danes have a pretty good life, but they have lower expectations than people in many other countries, thus a higher level of happiness.

The only problem with this idea is that many choices in our life take a long time to reveal how they will work out, such as marriage and taking a new job or moving to a new city. Having higher expectations for these slow-to-reveal choices probably increases happiness, at least allows the person to hang in with the decision long enough to find out how it will work out.

In general, accurate expectations may be best. Of course the challenge is how to have accurate expectations.  Reading both negative and positive reviews of a restaurant or a product may help with this. But there’s no site that reviews your marriage or your current job so those kind of choices may be more of a challenge.

The same researchers also looked at brain scans and figured out that it appeared that dopamine levels reflect happiness changes, higher dopamine comes from increased happiness and lower dopamine comes from disappointment.

There are some practical implications from this research.

  1. For choices that have immediate feedback such as a restaurant or a movie, temper your expectations. Maybe read more negative reviews so that your expectations are lower for the event. Then you can be pleasantly surprised when the restaurant or the movie is better than expected. This also applies to online dating.
  1. For choices that you don’t get quick feedback about such as long-term decisions like marriage or a job, have reasonably high expectations., Or at least try to have realistic expectations.
  1. Lower other people’s expectations of shared choices rather than hyping the choices. For example, let’s imagine you have recently seen a movie that you loved. Don’t tell your friends it was the best movie you’ve ever seen and that it will change their lives, instead tell them it was a pretty good movie and leave out all details. Same with restaurants, cars, and other choices that we make. Downplay rather than overhype.

Now I have to go because I have reservations at that new five-star restaurant after which I’m going to that wonderful new film, and then I’m moving to Denmark! Wish me luck.

Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

Dealing with Conflict Over Typical Home Neatness/Cleanliness Issues: The Houzz Interview and Some Other Thoughts

I was recently interviewed for the site Houzz, which is a web site and online community about architecture, interior design and decorating, landscape design and home improvement. In an article, A Therapist’s Guide to Dealing With Conflict at HomeI was interviewed by Mitchell Parker, a writer for Houzz.

He asked me to comment on that age-old problem when people live together of neatness/sloppiness and cleanliness/messiness. How can people get along?

I suggest you read his article which really quite nicely captures my thinking about these issues. In a nutshell, it’s all about communication. It’s not the dirty dishes that create conflict, it’s the failure to communicate about the dirty dishes in ways that resolve the problem.

Most importantly, I discussed the fallacy of the moral high ground in neatness and cleanliness. I admit I might be a bit biased on this issue, living closer to the moral low ground, but the argument is that there is no moral high ground in terms of these issues. Because our culture often values neatness and cleanliness, in arguments the neat person always takes the moral high ground, “I am the one who’s right therefore you should change.” Needless to say this doesn’t usually result in any positive progress on the issue.

I prefer to think of these issues as aesthetic preferences. Just as one person might prefer abstract art on the wall, while another person might prefer realistic paintings, messiness versus neatness is really an aesthetic preference. Handling it this way usually leads to better outcomes in conflicts over these issues. If two people come at the neat/messy conflict from a position of having differing preferences as opposed to “shoulds”, it is more likely that they can come to some sort of negotiated compromise which will be workable.

And treating these differences as preferences has another advantage as well. It usually leads to much more respectful communication about these issues. If a neat person recognizes that their need for neatness is simply a preference, they will not demonize their partner who is messy, calling them a “slob” or a “pig”. In a similar way, if the messy person recognizes that their disorder is a preference, they won’t label their partner as obsessive or a “neat freak.” This makes it much easier to discuss the differences.

The key issue is to apply a sort of flowchart to these issues. The flowchart looks like this:

1.Identify what each of you wants in terms of your home environment. Recognize that these are aesthetic preferences, and not moral shoulds.

2.Identify the ideal state that you would prefer, and also identify a less than ideal but okay state. It’s the latter that you will most likely end up with.

3. Discuss the differences, and see if there is a workable compromise. Sometimes the compromise will not be a simple meeting in the middle, but will instead involve a trade-off. For instance, if one person prefers an impeccably clean house, but the other person is not willing to spend the time and effort to do this, the couple could agree that they will hire someone to come in weekly to clean the house. Or the neater person might clean the house, but the other person agrees to do other life maintenance tasks such as paying the bills, parenting tasks, gardening tasks, or house maintenance tasks. Things don’t have to be perfectly split down the middle, it’s just important that they feel fair.

4. In looking at these differences it’s also useful to see what people are able to do, and what they are willing to do. Willingness and being able to do something are completely different things. As hard as it is to believe, (for the neat person), many messy people actually do not have the ability to be ordered and neat. This seems hard to believe. After all, can’t anybody fold their clothing and put it away? Can’t anybody put a dish in the dishwasher? And of course the answer is yes, technically, but in practice, especially over time, many people lack the skills.

Think of it this way. Technically anybody should be able to exercise every single day of their life and also eat healthy. We all know how to eat healthy and how to exercise. But how many people actually succeed on a daily basis? Very few. We are willing but not very able.

5. Which brings me to my next issue that of willingness. Even if we are technically able to do something, we might not always be willing to spend the time and energy doing it. Time and energy are a zero-sum game. We only have 16 hours of conscious time each day, and actually most of us have far fewer free hours, with work, parenting, relaxation, and other priorities.

Cleaning and organizing takes time and energy, and while some people feel the time and energy is well rewarded others do not. In my interview, I suggested a market-based way of assessing willingness. Although I was speaking somewhat tongue-in-cheek, I suggested that if one partner wants the other to do something they offer to pay them. If I want my partner to wash the dishes instead of leaving them in the sink, what am I willing to pay on a daily basis? And what price would they require to be willing to do this?

This is more of a mental exercise than an actual exchange of dollars. But I know for myself if my partner asked me what it would be worth for me to keep every surface in my home perfectly cleared every single day, I would set the price very high, something like $500 a day. That is because it would take a lot of conscious work in order to keep every surface clear. And it would take perhaps an hour or two every day. My price represents my perceived value for the change.

And then my partner could decide if that was worth it. After all, we make these kinds of evaluations all the time. If our not so new car gets scratched in a parking lot, most of us choose not to spend a lot of money to have it fixed. We accept the scratches and live with them.

6. What it comes down to is very simple. If you want your partner to change some house related behavior, first try to assess their ability and willingness to do so. If they are able and willing then you can try to get them to change their behavior. This will require ongoing discussions and work, and will not be easy.

Or you can outsource the problem. If you don’t like cleaning toilets and you can’t get your partner to do that, pay someone to clean your toilets. Most of us do this in other realms without any issues. We pay car mechanics to fix our cars, we pay gardeners to cut down our trees, and we often pay tutors to help our kids learn.

Finally, you can accept the difference. Acceptance is probably the most powerful tool in dealing with these conflicts. Acceptance frees you to stop wasting energy being angry or trying to change your partner. I’m reminded of one of my favorite quotes, “Never try to teach a pig to sing, it frustrates you and annoys the pig.”

I started this post thinking I would just point to the interview that I did on house, but discovered that I wanted to elaborate on some of the concepts that I discussed during that interview.

Good luck to all of you, these can be difficult issues, and the key thing is to remember to be gentle, loving, and respectful in your communications about these differences. Nobody gets divorced over dishes in the sink, they get divorced because of the way they interact around dishes in the sink.

I’m off to straighten up, or maybe not?

 

Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

Why You Should Never Read Online Illness or Medication Forums, and Why You Should be Skeptical of Google Search Results as Well

The first thing many people seem to do when they get a diagnosis of a physical or a mental illness is to go to the internet and search on that illness. Patients who are prescribed medications do the same. Often the search results lead to internet forums. These forums consist of user-generated content that usually is not moderated or edited by any professional. Anyone can post on these forums. This seems reasonable, right? But in this article I’m going to tell you why, for the most part ,you should avoid reading these forums. And I will also tell you why you should be skeptical of Google search results regarding any illness.

When people read on forums about their illness or medication, they get scared. Many of the forum posts will say that your illness leads to awful and dire outcomes, and that the medications prescribed to you will make you depressed, addicted, or crazy.

For instance, I often treat tinnitus patients. Samplings of the forums that cover tinnitus suggest that most of the people who post on these forums are completely miserable and suffering terribly from their tinnitus.

So what’s the problem here? Isn’t this useful information? Can’t patients learn something interesting and helpful from these forums?

Unfortunately, Internet illness forums often present a distorted, grim, and negative impression of most illnesses and most medications. Why is this? The main reason is because of selection and sampling bias. The groups of people who post on illness forums are not a representative sample of people with a particular illness. Let’s use tinnitus as an example. If you read the tinnitus forums you would assume that everybody with tinnitus is anxious and depressed about it.

But actually, we know from research studies that roughly 20% to 40% of the population experience tinnitus symptoms from time to time. We also know that roughly 2% of people who have tinnitus symptoms suffer psychologically. So the data from research suggests that a small subset (2%) of people who have tinnitus symptoms suffer anxiety and depression as a result of their tinnitus. Most people (98%) with tinnitus symptoms do not suffer significantly or they have adapted over time and gotten over their suffering.

But the forums are full of posts from the people who suffer the most. People who don’t suffer don’t spend their time posting. And people who have overcome their suffering also don’t post. So reading the forums gives a tinnitus patient a distorted and scary view of the experience of tinnitus.

The other problem in reading internet information about illnesses is the way that Google Search ranks and orders search results. When you search on tinnitus, what you might not realize is that Google presents pages in order of popularity, not in order based on how accurate or scientific they are. Sites that are clicked on more frequently will rise up in the Google search results and sites that are clicked on less frequently will fall down. When you do a Google search people typically click on the most shocking and scary links. “Tinnitus caused by alien abduction” will get a lot of clicks even though it may represent a site run by a single person who claims to have been abducted by aliens. Thus the alien abduction tinnitus site will move up in the Google rankings.

Boring scientific sites fall down in the search rankings. That’s because they have scientific names that don’t encourage people to click on the links.

So how can patients get accurate information about their illness or about medication treatments?

One way is to search within scientific and medical sites. For instance, Medscape is an excellent website that offers medical articles about almost every illness. WebMD is another site more designed for lay people, which also offers good information. If you want to search scientific articles you can use the PubMed search engine which searches published research articles.

Let’s do a Google search on tinnitus. Overall, the 1st page of Google results is pretty representative of medical and scientific sites. But the 3rd listing titled “In the news”, is an article “Martin McGuinness tells of misery living with tinnitus,” from the Belfast Telegraph. Pretty grim, you think, misery!

But if you actually clicked through to the article you would get a very different impression because Martin McGuinness actually says that “it had a limited impact on day-to-day life and work and that family, friends and work colleagues were very supportive.… It does not limit me in a professional or personal capacity.” This is a much more positive view than suggested by the title and the Google link.

This is a great example of why the Internet is dangerous. The headline is what’s called click bait, a link that falsely represents the actual page, which is designed to attract people’s clicks.

Forums about medication are also problematic. Many psychiatric medications can have side effects. For most people these side effects are minimal or tolerable and are overbalanced by the benefits of the medications. For a minority of patients, the side effects are not minimal and these are the patients who are over-represented in most Internet medication forums. Also, on an Internet forum you never really know all of the medications the person is taking, the accurate dosages, as well as their underlying illness.

There is one more problem with reading about illnesses on the Internet. It’s one that particularly disturbs me. Many websites, even websites that purport to be objective, actually are selling something. They may be selling a supplement or vitamin, or an e-book or some other kind of program to treat an illness. Obviously, to increase sales, these commercial websites will paint a distorted negative picture of any illness or condition. They may also disparage other more traditional and scientifically validated treatments or drugs. In general, you should be skeptical of any information that comes from a website that sells products or services.

To review:

  1. Take Google search results with many grains of salt. Remember that Google orders search results by popularity not by accuracy.
  2. Beware of Internet illness and medication forums. By and large, they are populated with an unrepresentative sample of illness sufferers, the ones who suffer the most and cope the least well. Reading them will depress you and make you anxious.
  3. If you want to get information about your illness or potential treatments, utilize established and reputable medical and psychological information sites. An exhaustive list of best medical sites can be found at: the Consumer and Patient Health Information Site. Some of the good medical sites include MedscapeWebMD, and MayoClinic. Some of the best sites for mental health information include PsychCentral, NIMH , American Psychiatry Association, American Psychology Association .
  1. Finally, remember that a very large percentage of websites are actually selling something, and be skeptical of information from these sites.

In conclusion, suffering any illness or condition is unpleasant and sometimes scary. Don’t make it worse by consuming information on the Internet in a random way. Be skeptical and selective and remember that Google is not always your friend. Often a good physician or good psychologist can give you clear and balanced information.

 

Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

Good News! You May Be Getting More Sleep Than You Think, Especially If You Suffer Insomnia!

The Wall Street Journal today had a very interesting article about how people with insomnia tend to greatly underestimate how much sleep they get and overestimate how long it takes them to fall asleep. They also overestimate how often they wake up at night.

Roughly 30% of adults have some insomnia each year. About 10% of people have chronic insomnia which means that you have trouble sleeping three times a week or more. According to the Journal article, 42% of insomniacs who actually slept the normal amount (6 hours or more) underestimated how much they slept by more than an hour. I looked up the research article which was published in Psychosomatic Medicine. According to this research, insomniacs who slept six hours or more typically showed a profile of high depression and anxiety and low coping skills according to psychological testing.

What’s also interesting is that even though insomniacs may be sleeping six or more hours a night, there does appear to be some real differences in their brainwave activity compared to good sleepers. Even though they are asleep, their brains are more active, which may account for why they perceive their sleep to be less than it really is.

Another interesting factoid was that normal people tend to overestimate how much sleep they get. Most people when asked how much sleep they get will answer between seven and eight hours, but they are actually getting six hours. That’s why people tend to be so sleep deprived. For most people six hours is not enough sleep to feel really good.

So what’s the answer to this sleep estimating dilemma? It turns out there is a very simple answer. The two gold standards for measuring sleep are brainwave measurements and activity measurements. While brainwave measurements are difficult to come by in the home, activity measurements are very easy and inexpensive to obtain. Many of the current fitness tracker’s have a sleep tracking function. For instance, according to my Xiaomi Mi Band, which cost me the grand sum of $15, last night I was in bed for seven hours and 58 minutes, and got three hours 20 minutes of deep sleep and four hours and 38 minutes of light sleep. I was awake for one minute. (Yes, I know, please don’t hate me all you insomniacs!)

For insomniacs who worry about how much sleep they are getting, I recommend buying a fitness tracker and wearing it every night. The best ones automatically track sleep without having the requirement that you push a button to activate sleep mode. This is pretty important as most people forget to press the button. I have been pretty happy with my Xiaomi Mi Band, which you can buy directly from the company  but I’m sure there are other brands of fitness trackers which offer similar features.

Also, as I’ve written about previously here and here, cognitive behavioral therapy for insomnia (CBT-I) may also improve the quality of sleep as well as the quantity. Some studies show that CBT-I improves people’s ability to accurately estimate their sleep time, and it also may calm  the over-activity of the brain that occurs when insomniacs sleep.

So here’s the executive summary for all of you sleep-deprived folks:

1. If you are an insomniac who is anxious and depressed, then you are probably getting more sleep than you think. Buy a fitness tracker with a good sleep tracking function, and you will see how much sleep you are actually getting.

2. If you want to improve the quality of your sleep, either practice meditation or see a CBT psychologist for CBT-I, as both of these interventions seem to lower the activity of the brain during sleep, which will improve your perception of your own sleep.

3. If you consistently feel anxious or depressed, consider getting some cognitive behavioral therapy for these problems, as they may contribute to sleep difficulties.

I’m off to bed now and hope I don’t have insomnia now that I’ve written about it!

 

Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

Cognitive Behavioral Therapy for Insomnia (CBT-I) Outperforms Drugs for Insomnia

The New York Times today had an excellent article The Evidence Points to a Better Way, which summarized what I have written about before. Cognitive behavioral therapy for chronic insomnia (CBT-I) kicks the butt of drug therapy!

One study compared CBT with a common sleeping pill called Restoril and found that the CBT treatment led to larger and longer lasting improvements in sleep. Another study found that CBT treatment outperformed the drug Ambien, and that CBT alone was even better than CBT plus Ambien combined.

Even more impressive are the results of a large meta-study which was published today. This meta-study, which combined data from 20 clinical trials and involved over 1000 patients with chronic insomnia showed that CBT I resulted in these patients falling asleep 19 minutes faster and having 26 minutes less wakefulness during each night on average. The actual study is protected by a pay wall, but the summary results are here.

One might question the clinical relevance of these outcomes. Does falling asleep 19 minutes faster really make that much of a difference? Does sleeping an extra 26 minutes a night make patients feel better the next day? As a good sleeper, I don’t really know the answer to these questions.

But I suspect that the biggest impact of CBT-I is in affecting the person’s perception of control over sleep. One of the horrible things about chronic insomnia is that patients feel out of control in terms of their sleep. They worry tremendously about the impact of loss of sleep on their ability to function the next day. It is this worry cycle that actually can create insomnia.

So I suspect that even though the effects were durable but modest, that the overall treatment made a large difference in how people felt. There is a big difference between taking 45 minutes to fall sleep and 20 minutes to fall sleep. And I suspect that sleeping an extra 26 minutes a night actually does make a difference. I know that I feel much better on eight hours of sleep as opposed to 7.5 hours of sleep.

When I work with patients on CBT-I one of the things I work on is helping the patient lower their anxiety about the impact of sleep restriction. As crazy as it sounds, one of the interventions I typically use is to have the patient stay up all night and go to work the next day. Although they are typically very tired, they discover that they can focus and function, maybe not at 100% but at an adequate level, maybe 75% or so. This lowers a lot of the anxiety about insomnia, since even a bad night of insomnia typically leads to quite a bit more sleep than staying up all night.

Other than the time and energy that a patient must invest in learning CBT-I skills, there are no side effects of cognitive behavioral therapy for insomnia. All sleeping medications have significant side effects the most troubling of which involve impaired cognition and coordination during the night and the following day. This impaired coordination and cognition leads to increased falling in the elderly, and probably also leads to an increase in automobile and other accidents. Because drug companies don’t want studies done on this issue, there are relatively few studies, but one study in Norway found that there was a doubling of traffic accidents among patients who took a variety of sleeping pills. Another study that compared 10,000 sleeping pill users to 23,000 nonusers found that the sleeping pill users were five times more likely to die young than nonusers.

So what does this mean to the person suffering insomnia? It means that you should avoid taking sleeping medications, and get cognitive behavioral therapy for insomnia. This kind of therapy typically does not take very many sessions. I teach the basic skills of CBT-I in about 4 to 6 sessions, and typically the entire course of CBT-I takes less than 10 sessions. There are also options for CBT- I online and even apps that run on your phone. One such app that runs on both android and iPhone is called CBT-I Coach. This app was developed with your tax dollars as part of a large Veterans Administration insomnia treatment program, and is excellent.

It’s getting late, so rather than have to experiment with any of these treatments, I’m off to bed…

Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.