“What is happiness?” Dori Carlson, OD, MAL, FAAO, asked in her presentation, “Promoting the Happiness Advantage in Your Office” at Optometry’s Meeting. She described happiness as a combination of positive experiences, meaning, pleasure, and engagement, and explained how modern society tends to praise “toxic productivity and promises joy in exchange for working too much.” Once we achieve X, she said, we think we’ll be happy, but the science shows that happiness breeds success. She outlined Shawn Achor’s 7 principles of positive psychology that fuel success and performance at work from his book, The Happiness Advantage. Dr. Carlson applied these ideas to office culture, resilience, staff retention, and effective productivity in eyecare practices.

Principle 1: Happiness Fuels Success

Happiness is actually a precursor to success, she said. It creates an “upward spiral” in which positive emotions contribute to new skills and achievements, which in turn reinforce happiness. According to Achor’s research, she cited, the brain performs 31% better when positivity increases in the present moment than when it is in a negative, neutral, or stressed state. Sales performance also improves by 37% and physicians become 19% faster and more accurate in diagnoses. “Your intelligence, creativity, and energy levels rise,” Dr. Carlson said.

This idea is supported by several studies, she continued. A 2005 meta-analysis titled “The Benefits of Frequent Positive Affect: Does Happiness Lead to Success?” found that happy employees had higher work performance ratings, lower turnover, and fewer absenteeism problems at work, in addition to higher-quality friendships and relationships as well as better physical health and longevity.¹

Another study evaluated doctors’ decision-making and attitude. They were divided into 3 groups: 1 group was “primed” to be happy by receiving candy, 1 group read neutral medical statements, and 1 group received no intervention. Dr. Carlson explained physicians in the positive group produced correct diagnoses more quickly and more creatively than those in the control groups.² She used this example to discuss whether improved workplace well-being and flexibility for health care workers could influence clinical performance.

Specifically, she suggested several strategies to train the brain toward improved positivity, including meditation, exercise, acts of kindness, learning new skills, anticipating enjoyable experiences, and spending money on experiences rather than material items. Even watching a favorite movie could increase endorphin levels by 27%, she said.

To apply these ideas to optometric practices, Dr. Carlson provided several recommendations. For regular staff meetings, she suggested beginning staff meetings with motivational readings, assigning a “Chief Happiness Officer” among office staff, incorporating gratitude exercises into morning huddles, and using words of affirmation. Project teams led by positive managers performed 31% better than teams led by less positive managers, she said, citing another published study.³

Principle 2: The Fulcrum and the Lever

In Achor’s second principle of the Happiness Advantage, the fulcrum and the lever, Dr. Carlson explained, the fulcrum is your mindset and your belief system that dictates how your perceive and interpret your reality. The lever is your actions, habits you build, and how your mindset impacts them. “Even a small change in mindset (moving the fulcrum just a little) can make a big difference in how effective your efforts (the lever’s power) are,” she said. We can focus on pain, negativity, stress, and uncertainty, or on gratitude, resilience, hope, optimism, and meaning—which leads to the placebo effect, she said.

Research has shown that placebos can be approximately 55% to 60% as effective as medications such as aspirin or codeine for pain control.⁴ A study of hotel housekeeping staff even showed that when half of the staff was informed of how much exercise they got while cleaning, that half of employees lost weight and their cholesterol levels decreased.⁵ “Mental state can matter more than actual activity,” Dr. Carlson said.

Principle 3: The Tetris Effect

Indeed, Dr. Carlson continued, if our brains get stuck in a pattern that focuses on stress, negativity, and failure, we can set ourselves up to fail. But, she said, if we retrain our brains to see patterns of possibility instead, we can find opportunities.

“Let’s say a clinic team often deals with complaints from patients,” Dr. Carlson explained. “If the staff starts meetings by reviewing only problems [such as billing, selling, full schedules or schedules that aren’t full enough, prior authorizations, patient flow, and others], their brains become wired to expect more problems (negative Tetris pieces). But if the leader starts each meeting by asking everyone to share 1 positive patient interaction or small win from the week, the staff begins to see more good moments in their work. Over time, they don’t just spot issues—they notice opportunities to connect, solve problems creatively, and celebrate progress.”

Principle 4: Falling Up

Falling up means finding paths in the brain that help us cope with and ultimately learn from failures to move forward and become happier and more successful because of those failures, Dr. Carlson said. She suggested challenging limiting influences—even in our own heads—and beliefs, such as with high-end frame sales, and learning from experiences to propel us forward.

Principle 5: The Zorro Circle

It’s easy for our brains to get overwhelmed and hijacked by emotion during periods of stress, she said. But, by focusing on small, manageable goals, we can achieve larger ones. "The Zorro Circle" as a concept refers to small circles of control, or these manageable goals that make up the larger picture of what we want to achieve. For example, adding new technology such as retinal imaging, IPL, dark adaptation testing, or changing electronic health record systems can be overwhelming initially. “The easiest way to implement these kinds of changes with less stress on everyone is to tackle bite-sized pieces in your circle of control: Try using the new technology on one person a day. Once you’ve mastered that, start adding to it,” she suggested.

Principle 6: The 20-Second Rule

The 20-second rule may help to tackle those smaller, more manageable tasks, Dr. Carlson continued. “Willpower only lasts so long,” she said. “When it fails, we drop back to old habits, but when we make small energy adjustments, we can replace bad habits with good ones.” She explained how habits are formed—our brains are wired to make “short cuts” so we don’t have to think about how to do tasks we do often. Twenty seconds is the magic amount of time: To build a good habit, make it take 20 seconds easier.  To get rid of a bad habit, make it take 20 seconds longer or harder. The 20-second rule, therefore, is meant to remove the extra effort of building a new habit. Practices may find benefits from automating appointment reminders and intake forms, or setting up each exam room identically so no one has to think about where things are located from room to room.

Principle 7: Social Investment

Finally, social networks can be one of the greatest predictors of success, happiness, and health, Dr. Carlson explained. A Harvard study followed 268 men over decades since 1938. The researchers found that the men who had strong social connections with family, friends, and among their communities lived longer, healthier, and happier lives. Deep, supportive, and reliable relationships protected both physical and mental health into old age, whereas loneliness was as harmful to health as smoking or alcoholism.⁶ Other studies since have supported these findings.^7-10

In the practice, Dr. Carlson said, staff can stay focused longer with more energy when they are encouraged to socialize face-to-face. The more social cohesion, she explained, the better the results of their work.

Additional Takeaways

“This is the first step for leaders who want to creative a positive mindset in the midst of setbacks,” Dr. Carlson said, and encouraged attendees to take steps over the following 3 weeks to begin retraining their brains toward positivity. She suggested writing down 3 things to be grateful for daily, journaling about positive experiences, meditating, exercising, and doing daily acts of kindness toward others—such as expressing gratitude or praise to friends, family, or coworkers.

You can start with something as simple as a smile, she concluded: “Our emotions are contagious. Within 33 milliseconds, your brain translates the emotions you see on someone else’s face and inclines you to mirror them. Mirror neurons in the brain are next to the motor neurons, so copied feelings can lead to copied actions.”¹¹

References

1. Lyubormirsky S, King L, Diener E. The benefits of frequent positive affect: does happiness lead to success? Psychol Bull. 2005;131(6):803-855. doi:10.1037/0033-2909.131.6.803
2. Estrada CA, Isen AM, Young MJ.Positive affect facilitates integration of information and decreases anchoring in reasoning among physicians. Organ Behav Hum Dec. 1997;72(1):117-135.
3. García-Buades ME, Peiró JM, Montañez-Juan MI, Kozusznik MW, Ortiz-Bonnín S. Happy-productive teams and work units: a systematic review of the 'happy-productive worker thesis'. Int J Environ Res Public Health. 2019;17(1):69. doi:10.3390/ijerph17010069
4. Pardo-Cabello AJ, Manzano-Gamero V, Puche-Cañas E. Placebo: a brief updated review. Naunyn Schmiedebergs Arch Pharmacol. 2022;395(11):1343-1356. doi:10.1007/s00210-022-02280-w
5. Crum, Alia J., and Ellen J. Langer. Mind-set matters: Exercise and the placebo effect. Psychol Sci. 2007;18(2):165-171.doi:10.1111/j.1467-9280.2007.01867.x
6. Massachussetts General Hospital, Harvard Medical School. Harvard second generation study, publications. 2015. Accessed June 1, 2026. https://www.adultdevelopmentstudy.org/publications
7. Harms W. Study shows lonely people at greater risk of hypertension. The University of Chicago Chronicle. March 28, 2006. Accessed June 1, 2026. https://chronicle.uchicago.edu/060330/lonely.shtml
8. Wickramaratne PJ, Yangchen T, Lepow L, et al. Social connectedness as a determinant of mental health: A scoping review. PLoS One. 2022 Oct 13;17(10):e0275004. doi: 10.1371/journal.pone.0275004. Erratum in: PLoS One. 2024 Nov 15;19(11):e0314220. doi: 10.1371/journal.pone.0314220
9. Berkman LF, Leo-Summers L, Horwitz RI. Emotional support and survival after myocardial infarction. A prospective, population-based study of the elderly. Ann Intern Med. 1992;117(12):1003-1009. doi:10.7326/0003-4819-117-12-1003
10. Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet. 1989 Oct 14;2(8668):888-91. doi: 10.1016/s0140-6736(89)91551-1
11. Enticott PG, Johnston PJ, Herring SE, Hoy KE, Fitzgerald PB. Mirror neuron activation is associated with facial emotion processing. Neuropsychologia. 2008;46(11):2851-2854. doi:10.1016/j.neuropsychologia.2008.04.022