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The Heart is a Guide

written by Genevieve Douglass 11 February 2013

Genevieve Douglass, MAPP '10, is a positive psychology coach living in New York City. She considers her work to be helping individuals find their authentic selves. Read more on her web site. Full bio.

Her articles are here and here (with Shannon Polly).

Valentine’s Day is upon us, the time of chocolate and red hearts. This association of love and hearts got me wondering. What do we know about the heart and positive emotion?

Positive Emotion and Cardiovascular Health

Studies have found associations between positive emotions and improved immune function, lower risk of diabetes, lower risk of hypertension, and increased lifespan. But only in the past few years have researchers studied the relationship between positive emotion and cardiovascular disease in healthy subjects.

Karina W. Davidson and colleagues found that higher levels of positive affect were protective against 10-year incident coronary heart disease. In 1995, trained nurses interviewed 1,739 Nova Scotians with no prior history of heart disease. These interviews were videotaped and then coded for positive affect, defined as a combination of smiling during the interview and positive responses to questions about affect. Later, looking at ten years of health data, they found a 22% coronary artery disease risk reduction for a difference of one point of positive affect on a 5-point scale.

This is in line with work by Barbara Fredrickson and Robert Levenson. In 1998, they found that participants who smiled spontaneously were able to relieve their hearts more quickly of cardiovascular changes brought on by watching a sad film.

“Let my soul smile through my heart and my heart smile through my eyes, that I may scatter rich smiles in sad hearts.” ~ Parahahansa Yogananda

In a 2012 review of the research on psychological well-being and cardiovascular disease, Boehm and Kubzansky report that “optimism is most robustly associated with reduced risk of cardiovascular events.” They also found that cardiovascular health was more consistently associated with hedonic well-being than eudaimonic well-being. Hedonic well-being is usually measured with scales of life satisfaction, levels of positive and negative emotion, and happiness, whereas eudiamonic well-being typically involves measurements of purpose in life, personal growth, self-acceptance, autonomy, and environmental mastery. The authors suggest that this disparity may come from scarcity of research on eudaimonic well-being and heart health.

While these findings only show associations and not a causal link, it doesn’t mean there isn’t one. Countless intervention studies have shown that stress and depressive symptoms can be reduced with increased positive emotion and increased optimism, which gives reason to think that positive interventions could also affect cardiovascular health. Cardiac vagal tone is one physiological measure that is already being used in positive intervention research.

Cardiac Vagal Tone

“It is very important to generate a good attitude, a good heart, as much as possible. From this, happiness in both the short term and the long term for both yourself and others will come.” ~ Dalai Lama

Jonathan Haidt has described the feeling of elevation as a warm, tingly feeling in the chest. Dacher Keltner suggests that this is due to the massive number of oxytocin receptors in the vagus nerve, which wraps around the heart and other internal organs and serves as a key component of the parasympathetic nervous system maintaining the resting state of internal systems.

The functioning of the vagus nerve, “which regulates heart rate in response to safety and interest,” according to Bethany Kok, can be measured with vagal tone. Vagal tone is a measure of variability in heart rate associated with respiratory patterns. Kok and Barbara Fredrickson have found that vagal tone and positive emotions seem to influence each other in a reciprocal, upward spiral fashion over time. High vagal tone has been associated with greater positive emotionality, optimism, and emotion regulation. People that already have high vagal tones show greater gains over time from experiencing positive emotions.

In a recent experiment, Kok and colleagues specifically looked at how social connection might affect vagal tone. Participants attended a one-hour class on loving-kindness meditation weekly for six weeks. Loving kindness meditation involves cultivating feelings of love and compassion for the self and others. For 61 days, participants reported how much time they participated in meditation or spiritual activities, they rated their emotions for the day, and they rated how connected they felt in three social interactions of the day. Their vagal tone was tested before and after the intervention.

Participants who had strong baseline vagal tone showed higher increases in positive emotion over the course of the study. Greater positive emotions was associated with individuals seeing themselves as more socially connected, and as positive emotion and social connection increased, so did vagal tone. In sum, Kok and colleagues found that positive emotions, positive social connections, and physical health all influence each other.

Awareness of Heartbeat

“The most beautiful things in the world cannot be seen or even touched, they must be felt within the heart.” ~ Helen Keller

Also fascinating is some new research on the awareness of heartbeat. Back in the late 1990s, Barbara Fredrickson investigated body image. She posited that poor internal awareness as measured by awareness of heartbeat was the result of self-objectification. Some new research has come out supporting this claim.

Vivien Ainley and Manos Tsakiris explored how awareness of heartbeat might relate to body image. The researchers asked 50 female students between the ages of 19 to 26 to count their heartbeats by listening to their bodies. They then were asked to rate themselves on the objectification test developed by Barbara Fredrickson’s team 1998, in which participants ranked 5 body attributes and 5 competence attributes (e.g., energy, strength) in importance to their physical self-concept. The results showed that women who have more internal awareness of their bodies tend to think of their bodies less as objects than women who are less internally aware. From my own standpoint, internal awareness might fall into a mindfulness category, while less objectification might be akin to self-compassion.

In a 2011 experiment, researchers found a different way of connecting the inner and outer awareness of the body. They asked people to count their heart beats to determine their interoceptive awareness, and then determined their external body awareness by showing a rubber hand being touched as the participant’s own unseen hand is touched. Those who were less affected by the touching of the hand tended to have more accurate awareness of their heart.



Altogether, this research is telling us that the heart is an important organ in our emotions and our self-awareness. I’m looking forward to seeing how this research unfolds. Considering how frequently the heart and emotions are mentioned together in a sentence, I’d be very surprised if there wasn’t a lot of truth to it. Maybe seeing little heart-shaped candies and red roses everywhere this week can remind us to see things a little more optimistically and to check in with our own heart beats. I’ll leave you with a quotation.

“Your vision will become clear only when you look into your heart … Who looks outside, dreams. Who looks inside, awakens.” ~ Carl Jung


Ainley, V. & Tsakiris, M. (2013) Body Conscious? Interoceptive Awareness, Measured by Heartbeat Perception, Is Negatively Correlated with Self-Objectification. PLoS ONE 8(2): e55568. doi:10.1371/journal.pone.0055568

Boehm, J. K. & Kubzhansky, L. D. (2012). The heart’s content: the association between positive psychological well-being and cardiovascular health. Psychological Bulletin, 138(4), 655-691. Abstract.

Davidson, K., Mostofsky, E. & Whang, W. (2010). Don’t worry, be happy: positive affect and reduced 10-year incident coronary heart disease: The Canadian Nova Scotia Health Survey. European Heart Journal, 31 (9): 1065-1070. doi: 10.1093/eurheartj/ehp603

Fredrickson, B. L., & Levenson, R. W. (1998). Positive emotions speed recovery from the cardiovascular sequelae of negative emotions. Cognition and Emotion, 12,191–220.

Fredrickson, B. L. (2013). Love 2.0: How Our Supreme Emotion Affects Everything We Feel, Think, Do, and Become. Hudson Street Press.

Haidt, J. (2006). The Happiness Hypothesis: Finding Modern Truth in Ancient Wisdom. New York: Basic Books.

Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine : a publication of the Society of Behavioral Medicine, 40, 218-227.

Keltner, D. (2009). Born to Be Good: The Science of a Meaningful Life. New York: W. W. Norton & Co.

Kok, B. E., Coffey, K. A., Cohn, M. A., Catalino, L. I., Vacharkulksemsuk, T., Algoe, S. B., Brantley, M., & Fredrickson, B. L. (in press). How positive emotions build physical health: Perceived positive social connections account for the upward spiral between positive emotions and vagal tone. Psychological Science.

Oveis, C., Cohen, A. B., Gruber, J., Shiota, M. N., Haidt, J., & Keltner, D. (2009). Resting respiratory sinus arrhythmia is associated with tonic positive emotionality. Emotion, 9, 265-270.

Tsakiris, M., Tajadura-Jiménez, A., & Costantini, M. (2011). Just a heartbeat away from one’s body: interoceptive sensitivity predicts malleability of body-representations. Proceedings of the Royal Society B, DOI: 10.1098/rspb.2010.2547. Brief review in Science News.

Photo Credits
All via Compfight with Creative Commons licenses
Chocolate hearts courtesy of prima_stella
Smile through my eyes courtesy of AmUnivers
Hearts together courtesy of jordandouglas
Calm heart, inner awareness courtesy of fanz
candy heart courtesy of tanakawho

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Cris Popp 11 February 2013 - 8:35 pm

Hi Genevieve,

Thank you for your article. There is a school of meditation that involves focusing on your heart – I think it comes from the Sufi tradition. Puran Bair in his book “Living from the Heart” describes it.

I’m a little bit confused by the section of your article ” Those who were less affected by the touching of the hand tended to have more accurate awareness of their heart. ” – Surely it is not a good thing to be less affected by touch?

Does this suggest that the more awareness you have of your internal self the less you have of your skin?

Cheers, Cris

Genevieve Douglass 11 February 2013 - 9:35 pm

Hi Cris,

Sorry for the confusion — Seeing the rubber hand be touched created the illusion for some that the hand was part of their body. Those who were less accurate in detecting their heartbeat were more likely to be swayed by the illusion, which suggests that how well you are in touch with your body internally can affect your perception of it externally.

And interesting about the Sufi meditation. Thank you for making that connection. I haven’t heard of it, but I’m fascinated by various types of meditation.

Oz 12 February 2013 - 4:08 am

Another way to look at this is: no vagal tone – no upward spiral.

The question then becomes what increases vagal tone. Think exercise, sleep, vegetarian diet, omega 3s, slow breathing….

By the way, chanting “banana” to yourself may also increase vagal tone. Transcendental Meditation is just reciting a mantra like the word “banana.” See, for example: http://www.ncbi.nlm.nih.gov/pubmed/16772250

Senia 12 February 2013 - 2:21 pm


What a rich conglomeration of articles. Lovely. Thank you.
Incredible the interaction of physical and emotional, isn’t it? Thanks for more clarification about it.

I have a question – which is the cause and which the effect? In your reading of these articles, do you think it’s cyclical – physical and emotional influencing each other, or do you think one generally precedes the other?

Kathryn, on editing, beautiful choice of picture for this article with the Tibetan monastery.


Genevieve Douglass 12 February 2013 - 3:12 pm


Thanks for the good questions. I don’t know whether it is cyclical, but that does seem to be what Fredrickson is thinking. Having a strong vagal tone seems to cause greater increases in positive emotion (it sounds a lot like a muscle — as you build up a muscle it’s easier and easier to strengthen it), and with increases in positive emotion and social connection, there were increases in vagal tone.

Since smiling is an expression of positive emotion and can also cause positive emotion, it probably affects your heart to smile, even when you aren’t initially feeling happy. (Though, I believe there’s also some research showing that “service industry” smiles can have detrimental effects, so, there’s important nuance there.)

I came across a study a few years ago (but couldn’t find it again) on vagus nerve stimulation in epileptic patients, and it mentioned that patients reported improvements in mood, so it seems pretty likely that these are reciprocally related. It seems like an optimism intervention study would be a good place to start, since optimism is so robustly related to vagal tone.

Thanks for the stimulating question, Senia.

Oz 12 February 2013 - 8:07 pm

Senia – Vagal tone is a measure of self control so the muscle analogy is very appropriate given Roy Baumeister’s perspectives.

Senia 13 February 2013 - 2:19 am

That’s pretty cool when the entire body works together like that if it is in fact cyclical between the different parts – physical, emotional, etc. Thanks, Genna!

Cris Popp 13 February 2013 - 2:21 am

Hi Genevieve,

Thanks for the clarification. Bair’s meditation was quite powerful although I now prefer ‘observing the mind’ (and my god there is a lot of rubbish in there *lol*) and “loving kindness .. well at least for now 🙂


Cris Popp


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