Thursday Thoughts #31: Positive Affect


As the old saying goes “No situation can’t be made worse by guilt.” Guilt occasionally gets piled on patients – by others or by themselves – for having gotten cancer or some other evil because they didn’t have the right (positive) mind set.

Last week in Thursday Thoughts #30 I examined the effects of negative affect. I reported on a clinical trial with 230 patients that filled out a mood questionnaire before going to the operating room for invasive image-guided procedures such as angioplasties or kidney drainages. Those who had high negative affect fared worse than those with low negative affect. They had significantly more adverse events in terms of unstable blood pressure and breathing than those who scored low on negative affcet. Based on this data, one could deduce that extra positive attitude would be a great thing. But is it?

Research on positive affect and outlook is more complicated than might appear at first sight. For assessment, many studies use the PANAS – the Positive Affect Negative Affect Schedule [1]. It is brief questionnaire. Patients are asked to rank 10 questions reflecting negative affect and 10 questions reflecting positive affect on a 1-5 scale with “1 = Very slightly/Not at All” to “5 = Extremely.” The questions rating positive affect address feelings of being interested, excited, strong, enthusiastic, proud, alert, inspired, determined, attentive, and active.

In the same study in which we looked at the negative affect, we also examined the effect of positive affect with the PANAS. Surprisingly, a high positive affect didn’t do patients any good in terms of adverse events.

What complicates things is that the PANAS considers negative and positive affect as independent from each other. Positive affect elements reflect motivating goal-directed behaviors geared towards actively doing something with one’s feelings [2]. Negative affect features are described more as the reflecting, apprehensive, vigilant type. They include sentiments such as feeling distressed, upset, guilty, scared, hostile, irritable, ashamed, nervous, jittery, and/or afraid. There can be people having combinations of high negative and high positive affect at the same time. For example, someone can be full of hostility and be very enthusiastic about expressing it. In our patient sample, 57% of patients who had high positive affect also had high negative affect. One can safely conclude that negative affect overrides the benefits of the positive affect, at least in the procedure room.

A meta-analysis of prospective studies showed positive affect associated with reduced mortality in the long-run. This held true mainly for healthy populations at the start of the observation period; less so for populations who were already sick [3]. There also is concern about publication bias, implying that studies finding a positive association may be more likely to be published [3, 4]. Another study then showed that after controlling for the effect of negative affect, physical health mainly influenced subsequent positive affect, but positive affect did not influence subsequent physical health [5]. In plain words: the odds of feeling positive are greater when one is healthy than when one is sick, and positive thoughts alone do not determine future health.

The bottom line is this: There is no need to make yourself feel guilty if you don’t engage in your medical experiences with unbridled enthusiasm. The key is not to be negative or hostile. That can kill you if you are unlucky and your medical team cannot handle your impaired processing of physical and environmental stimuli.

There is, however, good news from the study. You can reduce the risk of your negative emotions when you are treated by a procedure team trained in Comfort Talk® techniques. You can also check out our free Comfort Talk® app before you have your next procedure and reframe your mind set when you need it.



  1. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 1988;54:1063-70.
  2. Watson D, Wiese D, Vaidya A, et al. The two general activation systems of affect: Structural findings, evolutionary considerations and psychobiological evidence. J Personality Soc Psych 1999;76:820-38.
  1. Chida Y, Steptoe A. Positive psychological well-being and mortality: a quantitative review of prospective observational studies. Psychosom Med 2008;70:741-56.
  2. Pressman SD, Cohen S. Does positive affect influence health? Psychol Bull 2005;131:925-71.
  3. Finch JF, Baranik LE, Liu Y, et al. Physical health, positive and negative affect, and personality: A longitudinal analysis. J Res Pers 2012;46:537-45.





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