Outsmarting Stress, Enhancing Resilience, … and Optimizing Health in Today’s World Margaret A. Chesney, PhD Professor of Medicine, UCSF Cancer Support Community East TN June 1, 2019 Facing Cancer Together - a program of Cancer Support Community East Tennessee
Overview There are pathways by which positive emotions influence health and well-being Positive emotions are not the inverse of negative emotions Can positive emotional states be increased and maintained? Tools you can use Facing Cancer Together - a program of Cancer Support Community East Tennessee
Making the Case There are pathways by which positive emotions influence health and well-being Let’s start with something more familiar Facing Cancer Together - a program of Cancer Support Community East Tennessee
Early Medicine Evolved as a search to eliminate disease in the individual Early attempts to repel spirits by shamans with rituals … Facing Cancer Together - a program of Cancer Support Community East Tennessee
Early Medicine … or eliminate disease with potions or elixirs created by the alchemist Facing Cancer Together - a program of Cancer Support Community East Tennessee
Hippocrates’ Four Humors Many diseases were thought to result from negative emotions Negative emotions produced imbalances in the four bodily fluids or “humors” Facing Cancer Together - a program of Cancer Support Community East Tennessee
Flash Forward to 1970s Friedman & Rosenman – Type A behavior pattern as “coronary-prone” Anger, hostility and depression were found to increase risk for cardiovascular disease Facing Cancer Together - a program of Cancer Support Community East Tennessee
Research Began to Focus on Stress and Negative Affect Facing Cancer Together - a program of Cancer Support Community East Tennessee
Stress: Some stress is “good” “Good” stress = Challenge You perceive the stress, but it does not exceed your resources Facing Cancer Together - a program of Cancer Support Community East Tennessee
Stress: There is also “bad” stress “ Bad” stress = Threat You perceive the stress, but exceeds your resources for coping and endangers your well-being Facing Cancer Together - a program of Cancer Support Community East Tennessee
Stress Negative Affect What is meant by negative affect? Anger – arises in situations that are perceived as unjust. Anger has physiological concomitants that are more sustained if the anger is not expressed Depression – produced by a loss of support or reinforcement, associated with reduced activity levels, sometimes thought of as anger turned inward Facing Cancer Together - a program of Cancer Support Community East Tennessee
Negative Emotions Disease Outcomes Facing Cancer Together - a program of Cancer Support Community East Tennessee
Anger & Disease Religious Orders Study N = 851 clergy (average age = 75) Suppressed anger and depression – both were associated with increased death rates over 4-years (independent of age, sex, education, smoking & obesity) (Wilson, et al, 2003) Facing Cancer Together - a program of Cancer Support Community East Tennessee
How do Negative Emotional states lead to Physical Health Outcomes? Three pathways: Physiological responses Maladaptive behaviors Aversive environments Facing Cancer Together - a program of Cancer Support Community East Tennessee
Negative Affect Negative Affect Impacts Physiological all Systems Responses Disease Outcomes Facing Cancer Together - a program of Cancer Support Community East Tennessee
1 Nervous system: fight, flight, freeze 2 Musculoskeletal system headaches, muscle pain 3 Respiratory system asthma, inhibited breathing 4 Cardiovascular system coronary heart disease 5 Endocrine system cortisol, epinephrine, glucose 6 Gastrointestinal system acid reflux, nausea 7 Immune system Natural Killer cells, B & T cells 8 Reproductive system Facing Cancer Together - a program of Cancer Support Community East Tennessee
Stress Affects Cell Aging: Telomere Length Stress shortens length of telomeres – non-coding sequences, capping ends of DNA A “senescence clock” (Blackburn, 1978) Stress also lowers telomerase -- key enzyme that prevents telomere shortening and promotes cell resilience Facing Cancer Together - a program of Cancer Support Community East Tennessee
Negative Affect What specific pathways link negative affect and immune function? Physiological Evidence suggests: Responses Hypothalamic-pituitary-adrenal (HPA) axis Cortisol - “stress hormone” Disease Outcomes Facing Cancer Together - a program of Cancer Support Community East Tennessee
Negative Affect Physiological Maladaptive Responses Behaviors Disease Outcomes Facing Cancer Together - a program of Cancer Support Community East Tennessee
Depression & Health Behaviors Depression has been associated with poor health behaviors such as heavy alcohol use, sedentary behavior, and lower adherence to care In turn, these behaviors potentiate adverse health outcomes such as CHD Facing Cancer Together - a program of Cancer Support Community East Tennessee
Negative Affect Physiological Maladaptive Social Responses Behaviors Isolation Disease Outcomes Facing Cancer Together - a program of Cancer Support Community East Tennessee
Social Isolation and Cardiovascular Risk N = 188 healthy men and 110 women from White Hall II (45-59 yrs.) Socially isolated men and women had higher waking cortisol levels and greater cortisol output over the day* Previous study in Duke University showed that socially isolated men and women with CAD are at a 3.34 fold risk of mortality** (*Grant, Hamer & Steptoe, 2009 ** Williams et al, 1992) Facing Cancer Together - a program of Cancer Support Community East Tennessee
Today – Focus on New Strategy Positive Emotions Impact on health Approaches to Intervention Facing Cancer Together - a program of Cancer Support Community East Tennessee
Positive Affect Longevity ?? Facing Cancer Together - a program of Cancer Support Community East Tennessee
The Nuns Study 180 Catholic nuns Handwritten autobiographies Composed when nuns were 22 yrs of age Scored for emotional content Related to survival during ages 75-95 (Danner et al, 2001) Facing Cancer Together - a program of Cancer Support Community East Tennessee
Nun with Low Positive Emotion “I was born on September 26, 1909, the eldest of seven children, five girls and two boys…My candidate year was spent in the Motherhouse, teaching Chemistry and Second Year Latin at Notre Dame Institute. With God’s grace, I intend to do my best for our Order, for the spread of religion and for my personal sanctification.” (Danner, Snowdon, & Friesen, 2001) Facing Cancer Together - a program of Cancer Support Community East Tennessee
Nun with High Positive Emotion “God started my life off well by bestowing upon me a grace of inestimable value….The past year which I have spent as a candidate studying at Notre Dame College has been a very happy one. Now I look forward with eager joy to receiving the Holy Habit of Our Lady and to a life of union with Love Divine.” (Danner, Snowdon, & Friesen, 2001) Facing Cancer Together - a program of Cancer Support Community East Tennessee
Nun’s Study Results Emotion Cox proportional hazard Positive - 1.4 (-2.3, -0.6) *** Negative - 0.7 (-1.5, 0.2) None - 0.1 (-0.9,0.7) Positive emotional content predicted survival (later mortality) six decades later (Danner et al, 2001) Facing Cancer Together - a program of Cancer Support Community East Tennessee
Optimism & Mortality Women’s Health Initiative Cohort of 107,356 Women followed 8 years Optimistic women had an decreased risk of death Optimists - 46 deaths per 10,000 Pessimists - 64 per 10,000 (Tindle, et al., 2009, APS) Facing Cancer Together - a program of Cancer Support Community East Tennessee
Positive Affect Physiological Responses Longevity Facing Cancer Together - a program of Cancer Support Community East Tennessee
Impact of Stress Positive affect? Facing Cancer Together - a program of Cancer Support Community East Tennessee
Positive Affect & Immune Function Positive emotional style was associated, in dose response pattern, to lower risk of developing cold following viral challenge (Cohen, et al., 2003) Cohort of 1,149 faculty, high scores on positive affect were associated with fewer colds (Takkouche, et al., 2001) Facing Cancer Together - a program of Cancer Support Community East Tennessee
Positive Affect Physiological Health Responses Behavior Longevity Facing Cancer Together - a program of Cancer Support Community East Tennessee
Positive Affect & Health Behaviors People with higher life satisfaction are more likely to engage in health-promoting behaviors Physical activity Reduced levels of smoking Reduced alcohol intake Healthier diet (Castro, 2002; Scheier & Carver, 1992) Facing Cancer Together - a program of Cancer Support Community East Tennessee
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