Simple practices like mindfulness, a gratitude journal, and optimism training can improve several markers of cardiovascular health in a matter of weeks. A recent study found that these positive psychology interventions were consistently associated with improvements in blood pressure, inflammation, and other heart disease risk factors. Because some of the benefits appeared to be related to healthier behaviors, including better eating habits and increased physical activity, the researchers said continued reinforcement may be necessary to maintain progress over time.
Rosalba (Rose) Hernandez, professor of social work at the University of Illinois Urbana-Champaign, led the research team. The group reviewed the results of 18 randomized controlled trials that tested positive psychology and mindfulness interventions designed to improve physical or mental health.
How heart health programs worked
The programs varied widely in the way they were delivered. Some turned to structured phone sessions, journaling combined with brief check-ins, or digital tools such as apps and text messages. Others involved in-person interactive group meetings or hybrid approaches that combined face-to-face activities with online tools and virtual sessions.
Most programs included weekly sessions along with activities that participants did at home to reinforce what they had learned. Most lasted between six and 12 weeks.
The studies typically enrolled groups of 50 to 200 adults who already had an elevated cardiovascular risk, including uncontrolled hypertension, heart failure, or other health conditions. Participants were generally between 50 and 60 years old. Among studies that reported gender, women made up between 35% and 55% of participants.
“In hypertension and post-acute coronary syndrome cohorts, mindfulness-based programs delivered over an eight-week period reduced systolic blood pressure and decreased inflammatory markers such as high-sensitivity C-reactive protein and fibrinogen,” said Hernandez, a member of the American Heart Association. “A 12-week spirituality-based digital intervention achieved one of the largest reductions: reducing systolic blood pressure measured with a standard cuff by 7.6 points, and central systolic pressure, which is measured in the aorta as it leaves the heart, by 4.1 points.”
Finding the right “dose” of positivity
Previous research on positive psychology often did not clearly establish how often people needed to practice these techniques, or for how long, to gain health benefits, Hernandez said. His team wanted to determine what level of participation was most consistently associated with improvements in cardiovascular health.
The review showed that programs with more frequent contact with participants tended to produce the most reliable physiological benefits. Hernandez said this finding highlights the potential value of incorporating positive psychology strategies into long-term cardiovascular treatment and prevention.
The strongest behavioral changes came from an eight-week WhatsApp-based program that combined weekly sessions with daily microtasks. Participants were encouraged to be more physically active, improve their diet, and take their medications as prescribed.
Another program that incorporated motivational interviewing increased cardiac patients’ activity by 1,800 steps per day while improving medication adherence. In comparison, mindfulness programs improved physical activity and diet, but did not produce the same benefit on medication adherence, according to the study.
“The therapeutic dose that was most consistently related to improvements in blood pressure, inflammation and endothelial function was daily practice reinforced with weekly sessions for periods of eight to 12 weeks,” Hernandez said. “Therapeutic dosing typically involved high-frequency dosing during this period for short-term physiological benefits, while less intensive continuous contact may be necessary to maintain behavioral change.”
Mental health as part of heart care
The study was published in the journal Cardiology Clinics. Co-authors included University of South Florida social work professor Soonhyung Kwon; Alyssa M. Vela, professor of surgery and psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine; and Katharine S. Edwards, professor of cardiovascular medicine and of psychiatry and behavioral medicine at Stanford Medicine.
“The findings of this study also point out the importance of addressing mental and behavioral health for the prevention of cardiovascular diseases and the optimization of cardiovascular health,” Vela said. “This speaks to the need for routine screening and integration of cardiac behavioral medicine to enable access to important interventions.”
The findings contribute to a growing body of evidence connecting psychological well-being with cardiovascular protection. Traits and experiences such as optimism, positive affect, and gratitude have increasingly been associated with healthier hearts.
Previous research linked optimism to healthier hearts
The new work builds on an earlier study led by Hernandez, which found that people with the highest levels of optimism tended to have healthier hearts. That research was published in the journal Health Behavior and Policy Review.
That earlier study was funded by the National Institutes of Health and the National Center for Research Resources. It was co-written with preventive medicine professors Kiarri N. Kershaw, Juned Siddique, and Hongyan Ning, all of Northwestern University Feinberg School of Medicine; Donald M. Lloyd-Jones Professor of Preventive Medicine and Epidemiology at Boston University Chobanian and Avedisian School of Medicine; psychology professor Julia K. Boehm of Chapman University; professor of social and behavioral sciences Laura D. Kubzansky of the Harvard School of Public Health; and Distinguished Professor of Epidemiology Dr. Ana Diez Roux of Drexel University.