Outsmarting Stress, Enhancing Resilience, and Optimizing Health in - - PowerPoint PPT Presentation

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

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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 disease with potions or elixirs created 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 found to 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 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

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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)

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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 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

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• 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

Stress Affects Cell Aging: Telomere Length

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Negative Affect Disease Outcomes

Physiological Responses

What specific pathways link negative affect and immune function?

Evidence suggests:

Hypothalamic-pituitary-adrenal (HPA) axis

Cortisol - “stress hormone”

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Negative Affect Disease Outcomes

Physiological Responses Maladaptive Behaviors

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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

• utcomes such as CHD

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Negative Affect Disease Outcomes

Physiological Responses Maladaptive Behaviors Social Isolation

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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

• utput 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)

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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)

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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

• ur 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 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)

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Positive Affect

Physiological Responses

Longevity

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Impact of Stress Positive affect?

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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)

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Positive Affect Longevity

Physiological Responses Health Behavior

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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

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Positive Affect Longevity

Physiological Responses Health Behavior Social Support

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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)

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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 Increases Positive 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)

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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)

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Keys to Outsmarting Stress

“BREATHE”

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Breathe: Take a deep breath, be present

with yourself in the moment

“BREATHE”

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Realistic Goals: Set realistic goals

for this moment, this hour and this day

“BREATHE”

 and celebrate meeting them!

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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”

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Turn negatives around:

 Reframe negative events  Find the silver lining  Power of the positive

“BREATHE”

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“BREATHE”

Humor

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“BREATHE”

Humor

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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

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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,

• ptimize your health,

and improve the quality of your life

Facing Cancer Together - a program of Cancer Support Community East Tennessee

Thank you!

Debra Sullivan Beth Hamil Kathleen Williams Denise Stillman Sherry 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