Download - Outsmarting Stress, Enhancing Resilience, · There are pathways by which positive emotions influence health and well-being ... Anger has physiological concomitants that are more sustained

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


Making the Case


Let’s start with something more familiar


Early Medicine

Evolved as a search to eliminate disease in the individual

Early attempts to repel spirits by shamans with rituals …


Early Medicine

… or eliminate diseasewith potions or elixirscreated by the alchemist


Hippocrates’ Four Humors

Many diseases were thought to result from negative emotions

Negative emotions produced imbalances in the four bodily fluids or “humors”


Flash Forward to 1970s

Friedman & Rosenman –Type A behavior pattern as “coronary-prone”

Anger, hostility and depression were foundto increase risk for cardiovascular disease


Research Began to Focus on Stress and Negative Affect


Stress: Some stress is “good”“Good” stress = Challenge

You perceive the stress, but it does not exceed your resources


Stress: There is also “bad” stress“Bad” stress = Threat

You perceive the stress,but exceeds your resources for coping and endangers your well-being


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


Negative Emotions

Disease Outcomes


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?


Negative Affect

Disease Outcomes

Physiological Responses

Negative Affect Impacts all Systems


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


Negative Affect

Disease Outcomes


What specific pathwayslink negative affect andimmune function?

Evidence suggests:

Hypothalamic-pituitary-adrenal (HPA) axisCortisol - “stress hormone”


Negative Affect

Disease Outcomes


MaladaptiveBehaviors


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


Negative Affect

Disease Outcomes


MaladaptiveBehaviors

SocialIsolation


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


Positive Affect

Longevity ??


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)


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)


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)


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


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)


Positive Affect

Longevity


HealthBehavior


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


Positive Affect

Longevity


HealthBehavior

SocialSupport


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)


Making the Case




Tools you can use


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)


Making the Case




Tools you can use


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)


Keys to Outsmarting Stress

“BREATHE”


Breathe: Take a deep breath, be present with yourself in the moment

“BREATHE”


Realistic Goals: Set realistic goals for this moment,

this hour and this day

“BREATHE”

and celebrate meeting them!


Everyday events: Notice the positive moments in everyday life, sunset, flowers share these events with others

recognize when things go right

“BREATHE”


Acts of Kindness Create positive events for others

“BREATHE”


Turn negatives around: Reframe negative events Find the silver lining Power of the positive

“BREATHE”


“BREATHE”

Humor


“BREATHE”

Humor


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


Keys to Outsmarting Stress

“BREATHE”


Making the Case



Can positive emotional states be increased and maintained – YES!

Tools you can use – “BREATHE”


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


Thank you!

Debra SullivanBeth HamilKathleen WilliamsDenise StillmanSherry Lomax Katherine Chyka

All of YOU, who generously gave your Saturday to join us!
