Mind/Body HealthRRCC Holistic Health

Spring 2011

Psychoneuroimmunology“The study of the intricate interaction of

consciousness (psycho), brain and central nervous system (neuro), and the body’s defense against external invasion and internal aberrant cell division (immunology)”

Immune function can be classically conditioned

Just about every illness is influenced by how we think and feel- at least, if not caused by itPsychological factors can modulate the stress

response and trigger it

AnatomyCNS linked to bone marrow, thymus, spleen,

lymph nodes- immune tissues laced with nerve fibers

Changes in the brain and spinal cord affect immune response, and vice versa

WBC’s respond to neurochemicals and produce them

Emotions trigger hormone releaseEpi, norepi, endorphins, GC’s, prolactin, growth

hormoneActive immune cells send signals to CNS

Social SupportTransient stressors- less CV response when

friend presentHigher GC levels among stepchildren

And in lonely peopleThe more social support, the lower the resting

cortisol levels in women with metastatic breast CA

Social isolation- 2-5x greater risk of CVDMore active SNS (higher BP, more clotting)And more likely to die younger once dz present

For ethnic minorities, the fewer members of your group in the neighborhood, the higher the risk of mental illness, psych hospitalization, and suicide

Social SupportThe fewer social relationships, the shorter

the life expectancy, the worse the impact of diseasePartnership, friends and family, church and other

group relationships protectiveEffect at least as large as smoking, HTN,

obesity, and exerciseFor the same illness (and age, gender, health

status, etc), 2 ½ times the risk of death in the most isolated people versus the most connected

Confound- isolated people less likely to take meds, more likely to smoke, drink, etc.But effect still there when these are controlled for

Social SupportBeing cared for and loved, shared intimacyBeing esteemed and valuedSharing companionship, communication, and mutual

obligations with others, belongingInformational supportPhysical or material assistance

Social resources Social network- size, durability, intensity, and frequency

of social contacts Social relationships- existence, number, and type Social support- type, source, number, and quality of

resources

Help thy brother’s boat across, and lo!Thine own has reached the shore.

-Hindu proverb

Social SupportCVD patients after MI

2 or more sources of support- 12% died in hospital 1 source- 23% died No sources- 38% Men and women, controlling for severity of MI, other dz,

traditional risk factors, depression“The higher the dose, the greater the effect”Pregnancy

Teen moms with little support- more birth complications and 4x the neonatal complications

Female emotional support during delivery C-section rates from 18% to 8% Epidural 55% to 8% Labor 2 hours shorter Decrease in prolonged hospitalization of infants

Social support- 10% problems bonding with infant, vs. 55%Touch- the most powerful predictor of child abuser is not

history of abuse, it’s deprivation of healthy touch

Type A Personality“Every affection of the mind that is attended with

either pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart.”William Harvey, 1628

Neutral or ambiguous situation seen as stressful

5 characteristicsFree-floating hostilityInsecurity of status- accomplishment to hide itHyperaggressiveness- domination at all costsTime urgencyDrive to self-destruction- need for release

Type A PersonalityHostility the most important- increase in mortality

across all diseases, not just CVDAge, weight, BP, chol, smoking controlled forCorrelation in 10 US cities btw hostility and CVD

mortalityWithout hostility, competition, aggression, and

impatience don’t create the CVD riskAt least as much CVD risk as smoking or

cholesterolMore predictive of early first MI

Diet and smoking more important when olderHostility tends to drive away social support, but SR

also activated more oftenReducing hostility reduces CVD risk

Type A PersonalityToxic core

Hostility- deep-seated anger waiting to flare Anger, irritability, and resentment with little reason Antagonism and disagreeableness

Anger- particularly if unexpressedCynicism- mistrust of others, negative view of lifeSuspiciousness- constant need to be on guardExcessive self-involvement- “I, me, mine”

BP increases with references to self Twice as often in type A speech

Inflexible addiction to work Workaholism- people who love to work, usually not hostile Type A- work to get recognition and approval

Type A PersonalityStress physiology

Increased catecholamines- microvascular drainage in vessel walls, allowing cholesterol to seep in

Increase in arterial spasmIncreased BPStickier plateletsAll leading to oxygen imbalance in the heart

PsychologyLinks to neurochemistry of depressionLower marriage quality in type A

Half the angina in high-CVD-risk Israeli men with loving support from wives

Weaker social support networks

Type A PersonalityAt least as strong a CVD risk factor as smoking,

cholesterol, high BPAlso synergistic

Type A with another risk factor = 4x increased risk Two other risk factors = 8x risk

Type A men age 39-49 have 6.5x increased MI riskType A women 3-7x the risk

Also a risk factor for ulcer, asthma, rheumatoid arthritis, thyroid dzAnd headache, cancer, genital herpes, vision problemsA general disease-prone condition

To heal, transform the hostility and cynicism while retaining the assertive, active characteristics

Type D PersonalityD for “distressed”Also linked to CVD

Increased cardiac death riskIncreased risk of another MIIncreased mortality by 4x among CVD patients

Experiencing negative emotions over time and in a variety of situationsAnger, anxiety, depression, worry, hopelessnessBypass patients who are depressed at the time of

surgery more than twice as likely to die in the next 5 years

Inability to express feelings to others- suppressing negative emotionsSocial inhibition

Type C PersonalityGalen- 2nd century- “melancholic” women more

prone to breast CA than “sanguine”Study of CA patients

Fastest-growing tumors in “consistently serious, overcooperative, overly nice, overly anxious, painfully sensitive, passive, apologetic” patients Never express negative emotion “Rock of stability,” not assertive, “I’m fine” Appear happy, in control

Slower-growing tumors in pts who have better coping

Type C PersonalityType C melanoma patients thicker, more

aggressive tumors, worse prognosisReaction to initial diagnosis- higher mortality in…

Women who were stoicMen who were helpless or hopeless

Melanoma pts more likely than healthy controls or CVD pts to repress emotion

More wbc’s at CA site in melanoma pts who could express emotion

Collapse of usual coping style, overwhelmed with emotions they couldn’t resolve

Type C PersonalityLonely, emotionally repressed people (in one study)

developed CA 16x more often than those who expressed feelings freely

Breast CAHelpless-hopeless response- 20% 5-year survival

Also “stiff upper lip”Denying the problem- 80% survival at 7 years

50% at 12 years“Fighting spirit”- do everything possible to recover

80% survival after 12 yearsLife events

Bleak childhood- lonely, isolated, unsafe, tense with parentsStrong emotional commitment as adultsObject of commitment taken away- CA 6-8 months later

Rheumatoid Arthritis PersonalityAutoimmune attack on collagen in jointsTwin study- RA twin “seeks out” stressful situation

Unhappy marriages, put up with abuse without arguingPoor ability to express angerMoody, easily upset, nervous, tense, worried

Healthy twin- happy marriages, OK to argue and express emotionPeople who like people, enjoy life

Solomon- could predict 100% who had RA based on watching them assert themselves in hostile situation

Immunoregulatory ratio (Helper T cells and suppressor T cells) disturbed in RA

Endorphins deficient in RARA personality traits in turn compromise the immune

system

Other Personality TypesUlcer personality

Same stress in ulcer pts, but perceive it as more severe Expected the worst, felt more threatened

Excessive dependency on othersFragile under stress, not resilient (break not bend)

Asthma personalityAnxiety, powerlessnessAngry and hostile but weak and out of controlReady to strike out at others

Diabetic personalityDecreased alertnessApathyDepressionImmaturity, passivity, masochism

The Common ColdStress decreases salivary and mucosal

antibodiesStress = 3x the chance of getting a cold

with equal exposure to virusProlonged social stressors the greatest risk

Stress 4x as likely to precede an infection as to follow it

Infection in 20% of low-stress families in one study50% in high-stress families

AIDSHuman wbc’s in petri dish more likely to be

infected with HIV in the presence of GC’sNorepi enhances viral entry into wbc’s and

replication once thereGiven same amount of HIV, faster decline and

higher mortality ifDenial as coping styleMinimal social supportSocial inhibition- elevated SNS activityOther stressors, particularly loss of loved one

Lifestyle risk factors confound here

Chronic PainEmotion influences the anterior cingulate

cortex, the brain’s pain centerMind-body Tx effective in chronic pain

100 patients given mind-body Tx 10 weeks- pain, but less anxiety, depression,

hostility 1 year- pain and other Sx improve

36% fewer clinic visits, continued drop in second year

As much as 95% of back pain psychogenicEmotion makes muscles tense

Other ConditionsAllergies and asthma- heightened immune

reaction, tied to emotional factorsArthritis- false niceness, suppressed emotion,

avoiding emotional supportRA- history of emotional upheaval

Turmoil, conscientiousness, fear of criticism, poor self-image

Anger turned inwardCavities- meditation decreased bacteria in saliva

Gum disease tooUlcer- hostility, resentment, guilt associated

with increased stomach acid

Other ConditionsIrritable bowel syndrome

Worriers, anxiety and depression linkedNagging concerns, other stress-related problems

PregnancyLow birth weight and prematurity associated

with stressful events, particularly in last trimester

Sexual dysfunction- emotional stress causes CNS to reduce testosteroneLoss of desire in both men and women

Type B PersonalityLack of time urgency

Attention to present taskNot bored or eager to move onOn schedule most often, but not frenzied about itPatientContemplative, sees whole more than partsValues present and past as much as future

Ability to relinquish controlDelegation, working as part of a teamCelebrates differencesInspiring leaders- encourage creativity in others

Type B PersonalityHigh self-value, internal locus of control

Love of self based on being, not accomplishmentsSelf-acceptanceValue regardless of achievementFailure doesn’t collapse or damage personalityWork for success not as competition-based

No free-floating hostilityNo finding fault necessary to bolster egoAccepts trivial errors of othersEnjoys empowering othersRarely feels tense or makes others tenseObjectivity, ability to empathizeFeeling and expressing affection in intimate

relationships

Stress ResilienceStress buffers

Social supportControlPhysical fitnessSense of humorSelf-esteemOptimismEffective coping

styleHardiness

Personality traits associated with the lowest frequency of illness

Stress responseBaseline as energized

calm, state of choiceActivation including

equilibrium and equanimity- maintaining awareness even when crazed and stressed

Stress Resilience In catastrophe, denying and

minimizing do help In lesser troubles, find hope,

protectively and rationally Look for hope of improvement

But don’t deny the possibility of stasis Hope for the best, prepare for the

worst Control in the present, not past and

future Fix when appropriate

Seeking predictable, accurate information

Unless too soon, too late, unnecessary, or overwhelming

Outlet for frustration Benign to others

Social support- felt sense of warmth and affiliation

Disease-resistant behaviorAerobic exerciseRelaxation- at least 15

minutes a dayLimit refined sugarsLimit stimulantsMore consistent

health habits in general, appropriate health-protective behavior when needed

In the face of strong winds, let me be a blade of grass.In the face of strong walls, let me be a gale of wind.

-Quaker saying

Stress ResilienceHardiness- Suzanne Kobasa- three C’s (plus two

more)Commitment- curiosity and involvement in life events

Deep, abiding interest in life Ideal greater than oneself

Control- power of response to influence events Control of self and reactions to situations

Challenge- seeing change as exciting chance for growth Confidence, self-determination, eagerness Active coping style, expecting positive outcome

Coherence- pervasive, enduring, dynamic feeling that inner and outer environs are predictable and that things will usually work out as well as can be expected

Community- “plays well with others”

Relaxation and Fight-or-Flight Qualities of the Fight or Flight

Response Increased heart rate

Increased blood pressureIncreased respiratory rateHigher pulse rateIncreased oxygen consumptionIncreased blood lactateIncreased muscle tensionRapid production of cortisol Production of noradrenaline

Unconsciously elicitedStress inducingOuter focus of attentionEyes wide openInvoluntaryExternal stimulusSurprise, unpredicted, stimulusUnplannedActive internal dialogNarrowing or focusing of attentionSensory Physical activityPhysical movementFrom non-movement towards movementUnlearnedElicited by loud noiseBuilds unhappinessIncreases rate of agingHelps the individual survive and evolveMost excitation of consciousnessReady for most effortRepeated elicitation may lead to use of narcotics and drugsExperience of being at odds with environmentAttitude of resistance

Qualities of the Relaxation Response

Decreased heart rateDecreased blood pressure

Diminished respiratory rateLower pulse rate

Decreased oxygen consumptionDecreased blood lactate

Decreased muscle tensionReduction of cortisol

Reduction of noradrenaline Consciously elicited

Stress releasingInner focus of attention

Eyes shutVoluntary

Internal stimulusDaily routine or habit as stimulus

PlannedQuiet, silent internal dialog

Expansion of attentionSenses transcended

Mental activityPhysiology at rest

From movement towards non-movementLearned

Elicited by subtle sound then silenceBuilds happiness

Decreases rate of agingHelps the individual progress and evolve

Least excitation of consciousnessLeast effort

Repeated elicitation diminishes need to use drugs

Experience of being at one with environmentAttitude of acceptance