This review highlights consistent patterns in the literature associating positive affect (PA) and physical health. However, it also raises serious conceptual and methodological reservations. Evidence suggests an association of trait PA and lower morbidity and of state and trait PA and decreased symptoms and pain. Trait PA is also associated with increased longevity among older community-dwelling individuals. The literature on PA and surviving serious illness is inconsistent. Experimentally inducing intense bouts of activated state PA triggers short-term rises in physiological arousal and associated (potentially harmful) effects on immune, cardiovascular, and pulmonary function. However, arousing effects of state PA are not generally found in naturalistic ambulatory studies in which bouts of PA are typically less intense and often associated with health protective responses. A theoretical framework to guide further study is proposed.Keywords: positive affect, mortality, morbidity, health, emotions A cheerful heart is good medicine.-Proverbs 17:22Self-help books, popular magazines, and Sunday newspaper supplements have suggested for years that positive affect (PA) can improve people's health. However, this hypothesis has been relatively ignored in research on psychological predictors of health. For example, a search of PsycINFO revealed that there are over 20 times more studies on depression and health than there are on happiness and health. Although the recent interest in "positive psychology" has focused attention on the potential benefits of positive feelings (e.g., Seligman & Csikszentmihalyi, 2000), there has been little critical discussion of the evidence linking PA to physical health. In this article, we review the literature examining the association between measures of PA and markers of physical health status, examine the conceptual and methodological weaknesses in the existing literature, and discuss how PA could get "under the skin" to influence health.
PAWe define PA as the feelings that reflect a level of pleasurable engagement with the environment (Clark, Watson, & Leeka, 1989) such as happiness, joy, excitement, enthusiasm, and contentment. These can be brief, longer lasting, or more stable traitlike feelings. Although some use the terms affect, mood, and emotion to distinguish duration, these uses are not applied consistently in the literature, and thus we use these terms interchangeably. We, however, distinguish between studies using measures that assess more stable disposition-like PA, which we refer to as trait PA, and those measuring or manipulating relatively short-term bouts of positive emotions, which we refer to as state PA.To date, reviews examining associations between positive psychological constructs and health outcomes have been broad in scope, including traits such as self-esteem, extraversion, purpose, mastery, and optimism along with PA (Lyubomirsky, King, & Diener, 2005;Ryff, 2003;Salovey, Rothman, Detweiler, & Steward, 2000;Zautra, 2003). Hence, it has been difficult to separate t...