Outsmarting Stress, Enhancing Resilience,
… and Optimizing Health in Today’s World
Margaret A. Chesney, PhDProfessor of Medicine, UCSF
Cancer Support Community East TNJune 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
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Early Medicine
Evolved as a search to eliminate disease in the individual
Early attempts to repel spirits by shamans with rituals …
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Early Medicine
… or eliminate diseasewith potions or elixirscreated by the alchemist
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Hippocrates’ Four Humors
Many diseases were thought to result from negative emotions
Negative emotions produced imbalances in the four bodily fluids or “humors”
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Flash Forward to 1970s
Friedman & Rosenman –Type A behavior pattern as “coronary-prone”
Anger, hostility and depression were foundto increase risk for cardiovascular disease
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Research Began to Focus on Stress and Negative Affect
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Stress: Some stress is “good”“Good” stress = Challenge
You perceive the stress, but it does not exceed your resources
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Stress: There is also “bad” stress“Bad” stress = Threat
You perceive the stress,but exceeds your resources for coping and endangers your well-being
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Stress Negative AffectWhat 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
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Negative Emotions
Disease Outcomes
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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
Three pathways:
Physiological responses Maladaptive behaviors Aversive environments
How do Negative Emotional states lead to Physical Health Outcomes?
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Negative Affect
Disease Outcomes
Physiological Responses
Negative Affect Impacts all Systems
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1 Nervous system:fight, flight, freeze
2 Musculoskeletal systemheadaches, muscle pain
3 Respiratory systemasthma, inhibited breathing
4 Cardiovascular systemcoronary heart disease
5 Endocrine system cortisol, epinephrine, glucose
6 Gastrointestinal systemacid reflux, nausea
7 Immune systemNatural Killer cells, B & T cells
8 Reproductive system Facing Cancer Together - a program of Cancer Support Community East Tennessee
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 shorteningand promotes cell resilience
Stress Affects Cell Aging: Telomere Length
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Negative Affect
Disease Outcomes
Physiological Responses
What specific pathwayslink negative affect andimmune function?
Evidence suggests:
Hypothalamic-pituitary-adrenal (HPA) axisCortisol - “stress hormone”
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Negative Affect
Disease Outcomes
Physiological Responses
MaladaptiveBehaviors
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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
Disease Outcomes
Physiological Responses
MaladaptiveBehaviors
SocialIsolation
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Social Isolation and Cardiovascular Risk
N = 188 healthy men and 110women from White Hall II (45-59 yrs.)
Socially isolated men and women had higherwaking 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
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Positive Affect
Longevity ??
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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)
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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)
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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)
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Optimism & Mortality
Women’s Health InitiativeCohort of 107,356 Womenfollowed 8 years
Optimistic women hadan decreased risk of death
Optimists - 46 deaths per 10,000Pessimists - 64 per 10,000
(Tindle, et al., 2009, APS)Facing Cancer Together - a program of Cancer Support Community East Tennessee
Positive Affect
Physiological Responses
LongevityFacing 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
Longevity
Physiological Responses
HealthBehavior
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Positive Affect & Health Behaviors
People with higher life satisfaction are more likely to engage in health-promoting behaviors
(Castro, 2002; Scheier & Carver, 1992)
Physical activity Reduced levels of smoking Reduced alcohol intake Healthier diet
Facing Cancer Together - a program of Cancer Support Community East Tennessee
Positive Affect
Longevity
Physiological Responses
HealthBehavior
SocialSupport
Facing Cancer Together - a program of Cancer Support Community East Tennessee
Positive Affect & Social Support
People who report positive emotions receive more social support (Fredrickson, 1998)
Positive affect is associated with a higher number of people who provided help over a 12-month period
(Eckenrode, et.al., 1988)
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
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
Positive & Negative Affect Can Co-exist
Under chronic stress
Expected: many individuals report high levels of negative affect
Unexpected: some report high levels of both positive and negative affect
(Folkman, et al, 2001; Diener, et al, 1985; Wortman, et al 1987)Facing Cancer Together - a program of Cancer Support Community East Tennessee
Positive & Negative Affect Co-exist
While care-giving for an ill partner is stressful
Research also shows that many caregivers also experience positive affect find positive meaning, during care-giving
(Folkman, et al, 2001)
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
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
MBSR IncreasesPositive States
Mindfulness-based Stress Reduction (MBSR) interventions focus on reducing distress and enhancing well-being
N = 60, depressed individuals
Randomized to MBSR vs. waiting list
MBSR resulted in significant decreases in perceived stress and increases in positive affect
(Nyklicek & Kuijpers, 2008)Facing Cancer Together - a program of Cancer Support Community East Tennessee
Other Positive Affect, Coping,Stress Management Interventions
Combined Positive Affect and Self-Affirmation Intervention (Mary Charlson et al.)
Cognitive Behavioral Stress Management (CBSM) (Antoni et al)
Coping Effectiveness Training – Combines aspects of mindfulness & problem-solving
(Chesney, Folkman, et al)
Facing Cancer Together - a program of Cancer Support Community East Tennessee
Keys to Outsmarting Stress
“BREATHE”
Facing Cancer Together - a program of Cancer Support Community East Tennessee
Breathe: Take a deep breath, be present with yourself in the moment
“BREATHE”
Facing Cancer Together - a program of Cancer Support Community East Tennessee
Realistic Goals: Set realistic goals for this moment,
this hour and this day
“BREATHE”
and celebrate meeting them!
Facing Cancer Together - a program of Cancer Support Community East Tennessee
Everyday events: Notice the positive moments in everyday life, sunset, flowers share these events with others
recognize when things go right
“BREATHE”
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Acts of Kindness Create positive events for others
“BREATHE”
Facing Cancer Together - a program of Cancer Support Community East Tennessee
Turn negatives around: Reframe negative events Find the silver lining Power of the positive
“BREATHE”
Facing Cancer Together - a program of Cancer Support Community East Tennessee
“BREATHE”
Humor
Facing Cancer Together - a program of Cancer Support Community East Tennessee
“BREATHE”
Humor
Facing Cancer Together - a program of Cancer Support Community East Tennessee
End each day with gratitude Note positive steps and all you are thankful for
Do positive accounting
at the end of the day
“BREATHE”
Keep a Gratitude
Diary
Facing Cancer Together - a program of Cancer Support Community East Tennessee
Keys to Outsmarting Stress
“BREATHE”
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
Positive emotions are not the inverse of negative emotions
Can positive emotional states be increased and maintained – YES!
Tools you can use – “BREATHE”
Facing Cancer Together - a program of Cancer Support Community East Tennessee
With these Tools You Can Increase Positive Affect
You can purposefully take the “high road”There still will be low roads
But, by putting your mind to it, you can take positive actions
That build your resilience, optimize your health,
and improve the quality of your life
Facing Cancer Together - a program of Cancer Support Community East Tennessee
Thank you!
Debra SullivanBeth HamilKathleen WilliamsDenise StillmanSherry Lomax Katherine Chyka
All of YOU, who generously gave your Saturday to join us!
Facing Cancer Together - a program of Cancer Support Community East Tennessee