In the 17th century bridge construction demanded workers dive to great underwater depths with the introduction of caissons (a chamber, usually of steel but sometimes of wood or reinforced concrete, used in the construction of foundations or piers in or near a body of water). The air in the chamber is kept under pressure great enough to prevent the entrance of water, while shafts through the bulkhead permit the passage of workers, equipment, and excavated material between the bottom and the surface. Workers frequently suffered from caisson’s disease (the “bends”) and were treated in metallic vessels large enough to hold people and strong enough to hold air under pressure. These vessels, combined with newly-developed air compressors, resulted in the enabled treatment of patients with hyperbaric air decompression. This represented the first reports of decompression sickness; the caisson workers assumed a bent posture (the “bends”) to help relieve the pain caused by nucleation of accrued nitrogen in their joints as they emerged from depths of up to 70 feet.

Conventional western medicine uses HBOT to treat the following:

Uncontrolled Decompression during Diving: results in one of two types of decompression sickness (DCS).

*DCS I involves only the extremities (arms/legs) and the joints
*DCS II involves the central nervous system (brain/spinal cord)

Treatment involves recompressing the patient in 100% oxygen, followed by controlled decompression using data developed by the U.S. Navy.

Carbon Monoxide Poisoning: This colorless, odorless gas passes readily through alveoli (lung tissue air sacs) into the blood where it binds tightly to oxygen-carrying proteins in the blood (hemoglobin). Carbon monoxide also locks up the energy factory machinery (cytochrome system) inside each cell’s mitochondria. This prevents our bodies from being able to use oxygen. The use of HBOT to treat carbon monoxide poisoning is controversial. It is used to prevent/treat the development of neurologic injury in patients with severe exposure to this deadly gas. Usually, patients undergo one or two 90-minute treatments at 2-3 atmospheres (2-3 times the atmospheric pressure at sea level).

Difficult Wounds: Chronic, non-healing wounds are found in a variety of clinical patients. Recent data has supported the use of HBOT in the treatment of non-healing wounds caused by irradiation. There is less data to support the use of HBOT in other clinical settings. However, HBOT is often recommended in patients with difficult clinical problems. For example, diabetes mellitus and vascular disease are notorious for late complications of non-healing wounds. Amputation of an infected lower leg is the end result in many unfortunate cases. These patients have been shown, recently, to benefit from HBOT. One study showed decreased major amputation rate in diabetic patients who underwent HBOT (30 daily 90-minute treatments at 2-3 atmospheres).

Soft Tissue Infections: with anaerobic bacteria had a lower mortality rate in patients who underwent hyperbaric oxygen therapy, according to one study. Another study showed HBOT to have no benefit in these infections. According to one author (Sheridan), HBOT seems a reasonable adjunct to surgery, if it can be safely administered without delaying standard treatment (surgery and antibiotics). Treatment would consist of 90-minute treatments at 2-3 atmospheres once or twice daily.

Alternative Medicine

Stroke: Although HBOT is used conventionally in the United States, its use is reportedly higher in other countries. Stroke patients in Germany may undergo this form of treatment according to David Hughes, D.Sc. of the Hyperbaric Oxygen Institute. Hughes states that HBOT has decreased the aftercare costs for stroke patients in Germany by as much as 71%. As recent as 1995, one French study (Nighoghossian) showed that HBOT may be helpful in the treatment of ischemic stroke. But more recent investigations (Rusyniak et al) have shown that HBOT “does not appear to be beneficial and may be harmful in patients with acute ischemic stroke”.

Peripheral Vascular Disease and Chronic Wounds: Hughes also claims that HBOT is used in France for peripheral vascular disease (PVD); which can be caused by atherosclerosis, arteriosclerosis, and diabetes, and others. PVD oftentimes results in poor wound-healing and chronic ulcers (most often on/around the foot and ankle). HBOT is not part of routine, conventional wound care for diabetic foot ulcers. It may, however, be considered for some patients. The American Diabetes Association recognizes HBOT as a potential adjunctive therapy for complex limb-threatening diabetic foot wounds unsuitable for revascularization procedures.

Multiple Sclerosis: Dr. Hughes also states that HBOT is used in Great Britain to treat Multiple Sclerosis (MS). Based on an unpublished article from 1993 by D. Perrin, Hughes cites that more than 25,000 MS patients have benefited from HBOT. But, according to Kleijnen, patients who have chronic progressive or chronic stable multiple sclerosis showed no consistent positive effects to HBOT (results based on Expanded Disability Status Score [EDSS] and the Functional Status Score). An earlier study by Kindwall (1991) treated patients in accordance with protocols that reported to produce a benefit in multiple sclerosis. Investigators were unable to substantiate any useful long-term effect of hyperbaric oxygen therapy.

Oxygen may be classified as an element, a gas, and a drug. Oxygen therapy is the administration of oxygen at concentrations greater than that in room air to treat or prevent hypoxemia (not enough oxygen in the blood). Oxygen delivery systems are classified as stationary, portable, or ambulatory. Oxygen can be administered by nasal cannula, mask, and tent. Hyperbaric oxygen therapy involves placing the patient in an airtight chamber with oxygen under pressure.

Purpose

The body is constantly taking in oxygen and releasing carbon dioxide. If this process is inadequate, oxygen levels in the blood decrease, and the patient may need supplemental oxygen. Oxygen therapy is a key treatment in respiratory care. The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury. Breathing prescribed oxygen increases the amount of oxygen in the blood, reduces the extra work of the heart, and decreases shortness of breath. Oxygen therapy is frequently ordered in the home care setting, as well as in acute (urgent) care facilities.

Some of the conditions oxygen therapy is used to treat include:

* documented hypoxemia
* severe respiratory distress (e.g., acute asthma or pneumonia)
* severe trauma
* chronic obstructive pulmonary disease (COPD, including chronic bronchitis, emphysema, and chronic asthma)
* pulmonary hypertension
* cor pulmonale
* acute myocardial infarction (heart attack)
* short-term therapy, such as post-anesthesia recovery

Oxygen may also be used to treat chronic lung disease patients during exercise.

Hyperbaric oxygen therapy is used to treat the following conditions:

* gas gangrene
* decompression sickness
* air embolism
* smoke inhalation
* carbon monoxide poisoning
* cerebral hypoxic event

Helium-oxygen therapy is a treatment that may be used for patients with severe airway obstruction. The combination of helium and oxygen, known as heliox, reduces the density of the delivered gas, and has been shown to reduce the effort of breathing and improve ventilation when an airway obstruction is present. This type of treatment may be used in an emergency room for patients with acute, severe asthma.

Description
Oxygen delivery (other than mechanical ventilators and hyperbaric chambers)

In the hospital, oxygen is supplied to each patient room via an outlet in the wall. Oxygen is delivered from a central source through a pipeline in the facility. A flow meter attached to the wall outlet accesses the oxygen. A valve regulates the oxygen flow, and attachments may be connected to provide moisture. In the home, the oxygen source is usually a canister or air compressor. Whether in home or hospital, plastic tubing connects the oxygen source to the patient.

Oxygen is most commonly delivered to the patient via a nasal cannula or mask attached to the tubing. The nasal cannula is usually the delivery device of choice since it is well tolerated and doesn’t interfere with the patient’s ability to communicate, eat, or drink. The concentration of oxygen inhaled depends upon the prescribed flow rate and the ventilatory minute volume (MV).

Another delivery option is transtracheal oxygen therapy, which involves a small flexible catheter inserted in the trachea or windpipe through a tracheostomy tube. In this method, the oxygen bypasses the mouth, nose, and throat, and a humidifier is required at flow rates of 1 liter (2.1 pt) per minute and above. Other oxygen delivery methods include tents and specialized infant oxygen delivery systems.

TYPES OF OXYGEN DELIVERY SYSTEMS. The types of oxygen delivery systems include:

* Compressed oxygen—oxygen that is stored as a gas in a tank. A flow meter and regulator are attached to the oxygen tank to adjust oxygen flow. Tanks vary in size from very large to smaller, portable tanks. This system is generally prescribed when oxygen is not needed constantly (e.g., when it is only needed when performing physical activity).
* Liquid oxygen—oxygen that is stored in a large stationary tank that stays in the home. A portable tank is available that can be filled from the stationary tank for trips outside the home. Oxygen is liquid at very cold temperatures. When warmed, liquid oxygen changes to a gas for delivery to the patient.
* Oxygen concentrator—electric oxygen delivery system approximately the size of a large suitcase. The concentrator extracts some of the air from the room, separates the oxygen, and delivers it to the patient via a nasal cannula. A cylinder of oxygen is provided as a backup in the event of a power failure, and a portable tank is available for trips outside the home. This system is generally prescribed for patients who require constant supplemental oxygen or who must use it when sleeping.
* Oxygen conserving device, such as a demand inspiratory flow system or pulsed-dose oxygen delivery system—uses a sensor to detect when inspiration (inhalation) begins. Oxygen is delivered only upon inspiration, thereby conserving oxygen during exhalation. These systems can be used with either compressed or liquid oxygen systems, but are not appropriate for all patients.

Preparation

A physician’s order is required for oxygen therapy, except in emergency use. The need for supplemental oxygen is determined by inadequate oxygen saturation, indicated in blood gas measurements, pulse oximetry, or clinical observations. The physician will prescribe the specific amount of oxygen needed by the patient. Some patients require supplemental oxygen 24 hours a day, while others may only need treatments during exercise or sleep. No special patient preparation is required to administer oxygen therapy.

Patient education

SELECTING AN OXYGEN SYSTEM. A health care provider will meet with the patient to discuss the oxygen systems available. A system recommendation will be made, based on the patient’s overall condition and personal needs, as well as the system’s ease of use, reliability, cost, range of oxygen delivery, and features. The health care provider can give the patient a list of medical supply companies that stock home oxygen equipment and supplies. The patient can meet with home care representatives from these companies to evaluate the product lines that best fit his or her needs. Patients in the home setting are directed to notify the vendors when replacement oxygen supplies are needed.

OXYGEN SAFETY. Patients will receive instructions about the safe use of oxygen in the home. Patients must be advised not to change the flow rate of oxygen unless directed to do so by the physician.

Oxygen supports combustion, therefore no open flame or combustible products should be permitted when oxygen is in use. These include petroleum jelly, oils, and aerosol sprays. A spark from a cigarette, electric razor, or other electrical device could easily ignite oxygen-saturated hair or bedclothes around the patient. Explosion-proof plugs should be used for vaporizers and humidifier attachments. The patient should be sure to have a functioning smoke detector and fire extinguisher in the home at all times.

Care must be taken with oxygen equipment used in the home or hospital. The oxygen system should be kept clean and dust-free. Cylinders should be kept in carts, or have collars for safe storage. If not stored in a cart, smaller canisters may be lain on the floor. Knocking cylinders together can cause sparks, so bumping them should be avoided. In the home, the oxygen source must be placed at least 6 ft (1.8 m) away from flames or other sources of ignition, such as a lit cigarette. Oxygen tanks should be kept in a well–ventilated area. Oxygen tanks should not be kept in the trunk of a car. “No Smoking—Oxygen in Use” signs should be used to warn visitors not to smoke near the patient.

Special care must be given when administering oxygen to premature infants because of the danger of high oxygen levels causing retinopathy of prematurity, or contributing to the construction of ductus arteriosis. PaO2 (partial pressure of oxygen) levels greater than 80 mm Hg should be avoided.

Patients who are undergoing a laser bronchoscopy should receive concurrent administration of supplemental oxygen to avoid burns to the trachea.

Insurance clearance

The patient should check with his or her insurance provider to determine if the treatment is covered and what out-of-pocket expenses may be incurred. Oxygen therapy is usually fully or partially covered by most insurance plans, including Medicare, when prescribed according to specific guidelines. Usually test results indicating the medical necessity of the supplemental oxygen are needed before insurance clearance is granted.

Travel guidelines

Traveling with oxygen requires advanced planning. The patient needs to obtain a letter from his or her health care provider that verifies all medications, including oxygen. In addition, a copy of the patient’s oxygen prescription must be shown to travel personnel. Home health care companies can help the patient make travel plans, and can arrange for oxygen when the patient arrives at his or her destination. Patients cannot bring or use their own oxygen tanks on an airplane; therefore the patient must leave his or her portable oxygen tank at the airport before boarding. Oxygen suppliers can pick up the oxygen unit from the airport if necessary, or a family member can take it home.

Aftercare

Once oxygen therapy is initiated, periodic assessment and documentation of oxygen saturation levels is required. Follow-up monitoring includes blood gas measurements and pulse oximetry tests. If the patient is using a mask or a cannula, gauze can be tucked under the tubing to prevent irritation of the cheeks or the skin behind the ears. Water-based lubricants can be used to relieve dryness of the lips and nostrils.

Risks

Oxygen is not addictive and causes no side effects when used as prescribed. Complications from oxygen therapy used in appropriate situations are infrequent. Respiratory depression, oxygen toxicity, and absorption atelectasis are the most serious complications of oxygen overuse.

A physician should be notified and emergency services may be required if the following symptoms develop:

* frequent headaches
* anxiety
* cyanotic (blue) lips or fingernails
* drowsiness
* confusion
* restlessness
* slow, shallow, difficult, or irregular breathing

Oxygen delivery equipment may present other problems. Perforation of the nasal septum as a result of using a nasal cannula and non–humidified oxygen has been reported. In addition, bacterial contamination of nebulizer and humidification systems can occur, possibly leading to the spread of pneumonia. High-flow systems that employ heated humidifiers and aerosol generators, especially when used by patients with artificial airways, also pose a risk of infection.
Normal results

A normal result is a patient that demonstrates adequate oxygenation through pulse oximetry, blood gas tests, and clinical observation. Signs and symptoms of inadequate oxygenation include cyanosis, drowsiness, confusion, restlessness, anxiety, or slow, shallow, difficult, or irregular breathing. Patients with obstructive airway disease may exhibit “aerophagia” (air hunger) as they work to pull air into the lungs. In cases of carbon monoxide inhalation, the oxygen saturation can be falsely elevated.

The study shows that those patients who complained of nightmares during the week following the suicide attempt were three times more likely to attempt to take their own life again, regardless of gender or psychiatric diagnosis, such as depression or post-traumatic stress syndrome.

“Those who were still suffering from nightmares after two months faced an even greater risk. These people were five times more likely to attempt suicide a second time,” says author of the thesis, Registered Nurse Nils Sjöström.

Other sleeping difficulties do not increase risk of repeat suicide attempts

It is normal for patients that have attempted suicide to suffer from sleeping difficulties. Some 89 percent of the patients examined reported some kind of sleep disturbance. The most common problems were difficulty initiating sleep, followed by difficulty maintaining sleep, nightmares and early morning awakening. Nils Sjöström has also examined the possibility of there being an increased risk of repeat suicide attempts if the patient has difficulty falling asleep, difficulty sleeping during the night, or wakes up early in the morning. However, the result did not indicate any increased risk.

“The results show how important it is for healthcare staff to highlight the significance of nightmares in the clinical suicide risk assessment,” says Nils Sjöström.

“The Sleep and Human Health Institute has a history of groundbreaking work, and this study will be an important advancement in understanding the relationship between Insomnia and Sleep Apnea,” said David P. White, M.D., Chief Medical Officer, Philips Respironics. “We know there are many skeptics who insist Chronic Insomnia is largely a psychological problem, but recent studies on certain patients have already shown that continuous positive airway pressure (CPAP) therapy or upper airway surgery significantly decreases insomnia.”

Unlike other studies that investigated patients at sleep centers, the new research will examine randomly selected patients seeking care at their primary care clinics. This approach provides data much closer to what goes on in the general population compared to sleep center cohorts.

“This opportunity will clarify whether Sleep Apnea is a common problem often overlooked in Chronic Insomnia patients,” declared Dr. Barry Krakow, principal investigator and medical director of the Sleep & Human Health Institute. “We’ll be using the latest respiratory technology to more accurately measure breathing, and we hypothesize that more than half of these Chronic Insomnia patients will suffer from previously undiagnosed Sleep Apnea.” Dr. Krakow is also medical director of Maimonides Sleep Arts and Sciences, a co-sponsor of the research.

In the summer of 2006, Ardath and I continued our transcontinental odyssey. I bicycled from Times Square to Cape Spear, Newfoundland –– the furthest point east on the North American continent. Last summer we followed U.S. Highway 101 along the northwest coastline from San Francisco to Vancouver, British Columbia. The total distance traveled in the bicycle tour so far is approximately 6,500 miles –– more than one-quarter of the circumference of the planet.

On July 24, 2008 I am continuing my ride around the world with the Eclipse 2 with AutoSAT Technology, Personal Ambulatory Oxygen System by SeQual Technologies Inc. The ride starts in San Francisco to San Diego, CA. Thus, we will have taken the oxygen tour from coast-to-coast and border-to-border. Already the bicycle tour has made history. No one has done what my wife and I have done with the support of corporate businesses. Now we have before us a wonderful opportunity to accomplish an impressive, around-the-world, oxygen-powered, bicycle tour. We stand ready to represent SeQual Technologies in this venturesome and far-ranging opportunity. For more information on the Sequal Eclipse Concentrator

Thank you.

Mark Junge

Not long ago, saying goodnight to his mom and dad was nearly impossible for 3-year-old Rhett Lamb. In a case that baffled doctors, Rhett was awake nearly 24 hours a day.

“His body would give out but his mind wouldn’t; he’d still be awake,” said Rhett’s mom, Shannon Lamb. “He’d still be alert. It was extremely scary.”

One of the side effects of Rhett’s lack of sleep was bad behavior.

“He was in a bad mood all the time,” Lamb said. “He couldn’t play, he didn’t interact with other children. His frustration level was so high, and it just kept getting worse and worse and worse. He couldn’t communicate with anyone. It was heartbreaking.”

Rhett’s temper got so bad he would hit his mother, even giving her black eyes.

“He would hit you, he would bite you, he would head butt you and anything else around him, and you didn’t know from one minute to the next what was going to happen,” she said.

Rhett’s dad David Lamb said, “It was like he was losing his mind and there was nothing we could do to help him.”

The Lambs, who live in St. Petersburg, Fla., arranged opposite work shifts so one of them could stay home and take care of Rhett.

“You get to the point where you can’t function anymore and you can’t think straight, and you get up in the morning and you take a shower to go to work and you drive to work and you’re a robot,” Shannon Lamb said. “You are an absolute robot. And then you dread coming home ’cause you know it’s the same thing.”

Finally, a Diagnosis
After dozens of doctors’ visits and years of conflicting opinions, Rhett was finally diagnosed with a rare brain condition called chiari malformation.

Chiari malformation is a neurological disorder in which the bottom part of the brain, the cerebellum, descends out of the skull and crowds the spinal cord, putting pressure on both the brain and spine, causing a number of symptoms, including sleeplessness.
Once diagnosed, doctors were able to perform a risky surgery that offered a 50-50 chance Rhett would be able to sleep normally for the first time

Rhett Up to Speed
Dr. Gerald Tuite, a pediatric neurosurgeon at All Children’s Hospital in St. Petersberg, made an incision from the base of Rhett’s skull to the top of his neck to remove bone around the brain stem and around the spinal cord, producing more space and reducing the pressure.

The surgery was a success. Rhett was finally able to sleep through the night, and his behavior improved dramatically.

Welcome to the happiness frenzy, now peaking at a Barnes & Noble near you: Last year 4,000 books were published on happiness, while a mere 50 books on the topic were released in 2000. The most popular class at Harvard University is about positive psychology, and at least 100 other universities offer similar courses. Happiness workshops for the post-collegiate set abound, and each day “life coaches” promising bliss to potential clients hang out their shingles.

In the late 1990s, psychologist Martin Seligman of the University of Pennsylvania exhorted colleagues to scrutinize optimal moods with the same intensity with which they had for so long studied pathologies: We’d never learn about full human functioning unless we knew as much about mental wellness as we do about mental illness. A new generation of psychologists built up a respectable body of research on positive character traits and happiness-boosting practices. At the same time, developments in neuroscience provided new clues to what makes us happy and what that looks like in the brain. Not to be outdone, behavioral economists piled on research subverting the classical premise that people always make rational choices that increase their well-being. We’re lousy at predicting what makes us happy, they found.

It wasn’t enough that an array of academic strands came together, sparking a slew of insights into the sunny side of life. Self-appointed experts jumped on the happiness bandwagon. A shallow sea of yellow smiley faces, self-help gurus, and purveyors of kitchen-table wisdom have strip-mined the science, extracted a lot of fool’s gold, and stormed the marketplace with guarantees to annihilate your worry, stress, anguish, dejection, and even ennui. Once and for all! All it takes is a little gratitude. Or maybe a lot.

But all is not necessarily well. According to some measures, as a nation we’ve grown sadder and more anxious during the same years that the happiness movement has flourished; perhaps that’s why we’ve eagerly bought up its offerings. It may be that college students sign up for positive psychology lessons in droves because a full 15 percent of them report being clinically depressed.

There are those who see in the happiness brigade a glib and even dispiriting Pollyanna gloss. So it’s not surprising that the happiness movement has unleashed a counterforce, led by a troika of academics. Jerome Wakefield of New York University and Allan Horwitz of Rutgers have penned The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder, and Wake Forest University’s Eric Wilson has written a defense of melancholy in Against Happiness. They observe that our preoccupation with happiness has come at the cost of sadness, an important feeling that we’ve tried to banish from our emotional repertoire.

Horwitz laments that young people who are naturally weepy after breakups are often urged to medicate themselves instead of working through their sadness. Wilson fumes that our obsession with happiness amounts to a “craven disregard” for the melancholic perspective that has given rise to our greatest works of art. “The happy man,” he writes, “is a hollow man.”

Both the happiness and anti-happiness forces actually agree on something important—that we Americans tend to grab superficial quick fixes such as extravagant purchases and fatty foods to subdue any negative feelings that overcome us. Such measures seem to hinge on a belief that constant happiness is somehow our birthright. Indeed, a body of research shows instant indulgences do calm us down—for a few moments. But they leave us poorer, physically unhealthy, and generally more miserable in the long run—and lacking in the real skills to get us out of our rut.

Happiness is not about smiling all of the time. It’s not about eliminating bad moods, or trading your Tolstoy-inspired nuance and ambivalence toward people and situations for cheery pronouncements devoid of critical judgment. While the veritable experts lie in different camps and sometimes challenge one another, over the past decade they’ve together assembled big chunks of the happiness puzzle.

What is happiness? The most useful definition—and it’s one agreed upon by neuroscientists, psychiatrists, behavioral economists, positive psychologists, and Buddhist monks—is more like satisfied or content than “happy” in its strict bursting-with-glee sense. It has depth and deliberation to it. It encompasses living a meaningful life, utilizing your gifts and your time, living with thought and purpose.

It’s maximized when you also feel part of a community. And when you confront annoyances and crises with grace. It involves a willingness to learn and stretch and grow, which sometimes involves discomfort. It requires acting on life, not merely taking it in. It’s not joy, a temporary exhilaration, or even pleasure, that sensual rush—though a steady supply of those feelings course through those who seize each day.

There has been real progress in understanding happiness and how to get it. Here are the greatest hits, as it were, that jump out from the research.

Some People Are Born Happy
Some lucky souls really are born with brighter outlooks than others; they simply see beauty and opportunity where others hone in on flaws and dangers. But those with a more ominous orientation can alter their outlook, at least to a point. They can learn to internally challenge their fearful thoughts and negative assumptions—”she thinks I’m an idiot,” “I’m going to get fired,” “I’ll never be a good mom”—if not eliminate them altogether. Engaging in positive internal dialogue is actually a mark of the mentally healthy.

Getting What You Want Doesn’t Bring Lasting Happiness
You think happiness would arrive if you were to win the lottery, or would forever fade away if your home were destroyed in a flood. But human beings are remarkably adaptable. After a variable period of adjustment, we bounce back to our previous level of happiness, no matter what happens to us. (There are some scientifically proven exceptions, notably suffering the unexpected loss of a job or the loss of a spouse. Both events tend to permanently knock people down a notch.)

Our adaptability works in two directions. Because we are so adaptable, points out Sonja Lyubomirsky, a professor of psychology at the University of California, Riverside, we quickly get used to many of the accomplishments we strive for in life, such as landing the big job or getting married. Soon after we reach a milestone, we start to feel that something is missing. We begin coveting another worldly possession or eyeing a social advancement. But such an approach keeps us tethered to the “hedonic treadmill,” where happiness is always just out of reach, one toy or one notch away. It’s possible to get off the treadmill entirely, Lyubomirsky says, by focusing on activities that are dynamic, surprising, and attention-absorbing, and thus less likely to bore us than, say, acquiring shiny stuff.

Pain Is a Part of Happiness
Happiness is not your reward for escaping pain. It demands that you confront negative feelings head-on, without letting them overwhelm you. Russ Harris, a medical doctor-cum-counselor and author of The Happiness Trap, calls popular conceptions of happiness dangerous because they set people up for a “struggle against reality.” They don’t acknowledge that real life is full of disappointments, loss, and inconveniences. “If you’re going to live a rich and meaningful life,” Harris says, “you’re going to feel a full range of emotions.”

The point isn’t to limit that palette of feelings. After all, negative states cue us into what we value and what we need to change: Grief for a loved one proves how much we cherish our relationships. Frustration with several jobs in a row is a sign we’re in the wrong career. Happiness would be meaningless if not for sadness: Without the contrast of darkness, there is no light.

Mindfulness Brings Happiness
Mindfulness, a mental state of relaxed awareness of the present moment, marked by openness and curiosity toward your feelings rather than judgments of them, is a powerful tool for experiencing happiness when practiced regularly. “If you bring mindfulness to bear on negative feelings, they lose their impact. Just let them be there without struggling against them, and you’ll eventually feel less anxiety and depression,” Harris says. Don’t banish your negative feelings, but don’t let them get in the way of your taking productive actions, either.

Happiness Lies in the Chase
Action toward goals other than happiness makes us happy. Though there is a place for vegging out and reading trashy novels, easy pleasures will never light us up the way mastering a new skill or building something from scratch will.

And it’s not crossing the finish line that is most rewarding; it’s anticipating achieving your goal. University of Wisconsin neuroscientist Richard Davidson has found that working hard toward a goal, and making progress to the point of expecting a goal to be realized, doesn’t just activate positive feelings—it also suppresses negative emotions such as fear and depression.

Yes, Money Buys Happiness—At Least Some Money and Some Happiness
Money does buy happiness, but only up to the point where it enables you to live comfortably. Beyond that, more cash doesn’t boost your well-being. But generosity brings true joy, so striking it rich could in fact underwrite your happiness—if you were to give your wealth away.

Happiness Is Relative
Whether or not we are keeping up with the Joneses—a nagging thought known as status anxiety—affects how happy we are. Some are more obsessed with status than others, but we’re all attuned to how we’re doing in life relative to those around us. To stop status worries from gnawing at your happiness, choose your peer group carefully. Owning the smallest mansion in a gated community could make you feel worse off than buying the biggest bungalow in a less affluent neighborhood.

Options Make Us Miserable
We’re constantly making decisions, ranging from what to eat for dinner each night to whom we should marry, not to mention all those flavors of ice cream. We base many of our decisions on whether we think a particular preference will increase our well-being. Intuitively, we seem convinced that the more choices we have, the better off we’ll ultimately be. But our world of unlimited opportunity imprisons us more than it makes us happy. In what Swarthmore psychologist Barry Schwartz calls “the paradox of choice,” facing many possibilities leaves us stressed out—and less satisfied with whatever we do decide. Having too many choices keeps us wondering about all the opportunities missed.

Happiness Is Other People
Positive psychologist Chris Peterson, a professor at the University of Michigan, says the best piece of advice to come out of his field is to make strong personal relationships your priority. Good relationships are buffers against the damaging effects of all of life’s inevitable letdowns and setbacks.

Do Your Happiness Homework

You can increase positive feelings by incorporating a few proven practices into your routine. Lyubomirsky suggests you express your gratitude toward someone in a letter or in a weekly journal, visualize the best possible future for yourself once a week, and perform acts of kindness for others on a regular basis to lift your mood in the moment and over time. “Becoming happier takes work, but it may be the most rewarding and fun work you’ll ever do,” she says.

Happiness Hinges on Your Time Frame
Feeling happy while you carry out your day-to-day activities may not have much to do with how satisfied you feel in general. Time skews our perceptions of happiness. Parents look back warmly on their children’s preschool years, for example. But Daniel Kahneman of Princeton University found that childcare tasks rank very low on the list of what makes people happy, below napping and watching TV. And yet, if you were to step back and evaluate a decade of your life, would a spirited stretch of raising children or a steady stream of dozing off on the couch each day in between soap operas illustrate a “happier” time? Evaluate your well-being at the macro as well as the micro level to get the most accurate picture of your own happiness.

You’re Wrong About What Will Make You Happy and You’re Wrong About What Made You Happy
Harvard psychologist Daniel Gilbert discovered a deep truth about happiness: Things are almost never as bad—or as good—as we expect them to be. Your promotion will be quite nice, but it won’t be a 24-hour parade. Your breakup will be very hard, but also instructive, and maybe even energizing. We are terrible at predicting our future feelings accurately, especially if our predictions are based on our past experiences. The past exists in our memory, after all, and memory is not a reliable recording device: We recall beginnings and endings far more intensely than those long “middles,” whether they’re eventful or not. So the horrible beginning of your vacation will lead you astray in deciding the best place to go next year.

Gilbert’s take-away advice is to forgo your own mental projections. The best predictor of whether you’ll enjoy something is whether someone else enjoyed it. So simply ask your friend who went to Mexico if you, too, should go there on vacation.

Happiness Is Embracing Your Natural Coping Style
Not everyone can put on a happy face. Barbara Held, a professor of psychology at Bowdoin College, for one, rails against “the tyranny of the positive attitude.” “Looking on the bright side isn’t possible for some people and is even counterproductive,” she insists. “When you put pressure on people to cope in a way that doesn’t fit them, it not only doesn’t work, it makes them feel like a failure on top of already feeling bad.”

The one-size-fits-all approach to managing emotional life is misguided, agrees Julie Norem, author of The Positive Power of Negative Thinking. In her research, the Wellesley professor of psychology has shown that the defensive pessimism that anxious people feel can be harnessed to help them get things done, which in turn makes them happier. A naturally pessimistic architect, for example, can set low expectations for an upcoming presentation and review all of the bad outcomes that she’s imagining, so that she can prepare carefully and increase her chances of success.

Happiness Is Living Your Values
If you aren’t living according to your values, you won’t be happy, no matter how much you are achieving. Some people, however, aren’t even sure what their values are. If you’re one of them, Harris has a great question for you: “Imagine I could wave a magic wand to ensure that you would have the approval and admiration of everyone on the planet, forever. What, in that case, would you choose to do with your life?”

Once you’ve answered honestly, you can start taking steps toward your ideal vision of yourself. You can tape positive affirmations to your mirror, or you can cut up your advice books and turn them into a papier mache project. It doesn’t matter, as long as you’re living consciously. The state of happiness is not really a state at all. It’s an ongoing personal experiment.