Monterey MindBody Guarneri no pics · • Stress can cause coronary vasoconstriction and increased platelet stickiness that promote clot formation. • Type A behavior, depression,

Mind-Body ConnectionMimi Guarneri MD FACC

ObjectivesObjectives

• Review the science of the mind-body connection and the link between the stress response and cardiovascular disease.

• Identify ‘mind-body’ techniques that have been shown to improve cardiovascular health.

• Understand how to incorporate these strategies into primary patient care.

“Of the ten leading causes of illness and death in the U.S., seven could be greatly reduced if the following lifestyle habits were modified - alcohol abuse, lack of exercise, poor diet, smoking, and unhealthy maladaptive responses to stress and tension.”

Former U.S. Surgeon GeneralJulius B. Richmond, M.D.

“The chief and primary cause of … the very rapid increase of nervousness is modern civilization, which is distinguished from the ancient by these five characteristics: steampower, the periodical press, the telegraph, the sciences and the mental activity of women.”

American Nervousness, Its Causes and Consequences, George M. Beard, 1881

So What Is Stress?So What Is Stress?Stress can be defined as a state one experiences when there is a mismatch between perceived demands and our perceived ability to cope.

Stress can be acute or chronic.

American Institute of Stress

StressStress

75 to 90% of all visits to health care providers result from stress-related disorders.

50 years ago, a method for the quantification of representative life-changing events was developed by Drs. Rahe and Holmes.

43 Life43 Life--Changing Events Changing Events were given weights that represented the average amount of life change and readjustment required by persons in order to accomplish adaptation!

Dr. Rahe’s next study, of 67 fellow physicians, found ranges of Illness Risks from LCU values:

0 - 150 LCU = 0% of illness151 - 300 LCU = 30% illnesses301 - 500 LCU = 50% illness

• Response

• Perception

• Initiating Event

• Effect

The Stress ResponseThe Stress Response

• We have over 1400 chemicals reactions that occur in our body as a result of stress.

• For the purpose of this lecture we will talk about three key stress hormones:– Adrenaline– Aldosterone– Cortisol


STRESS AND CORONARY STRESS AND CORONARY HEART DISEASEHEART DISEASE

• Stress can cause coronary vasoconstriction and increased platelet stickiness that promote clot formation.

• Type A behavior, depression, anxiety, hostility, stressful life change events have all been linked to CHD.

• Stress increases homocysteine, CRP and fibrinogen, all of which are associated with increased risk for CHD.

• Stress causes deep abdominal fat deposits which secrete inflammatory cytokines that promote insulin resistance and the cardiovascular complications of metabolic syndrome


• Stress causes atrial fibrillation, the most common sustained arrhythmia as well as ventricular fibrillation, the leading cause of sudden death.

• Stress causes Takotsubo cardiomyopathy, also referred to as “Broken Heart Syndrome”. This “myocardial stunning” is due to severe left ventricular contractile dysfunction that frequently mimics a massive myocardial infarction.

• Stress contributes to and/or aggravates the standard Framingham risk factors of cholesterol, smoking, and hypertension, as well as diabetes and obesity.

• Stress can precipitate and/or worsen congestive heart failure.


• Stress reduces heart rate variability, an objective, accurate and sensitive measure of coronary disease and a powerful predictor of sudden death.

• Stress reduces resistance to infections. Infections have increasingly been incriminated as inciting inflammation as well as destabilizing plaque by the formation of complexes that block the vasa vasorum.

• Severe stress can cause myocardial infarction in the absence of significant atherosclerosis. This is due to direct damage from norepinephrine secretion at nerve endings in heart muscle that produce a characteristic contraction band lesion resulting from coagulative myocytolysis.(Broken Heart Syndrome)

STRESS MECHANISMS THAT PROMOTE ATHEROSCLEROSIS

HPA=Hypothalamic‐Pituitary Adrenal AxisSNS=Sympathetic Nervous System

Enhanced coagulation

Trophic effects

High Renin Angiotensin

High bloodpressure

Tachycardiaarrhythmia

Abnormallipids

Insulinresistance

Weightincrease

Sympathetic

Parasympathetictone


Psychosocial Factors and CAD

• Chronic and acute psychological stress• Negative emotional states(depression,

hostility, anxiety, anger)• Social ties, social support, social conflict

• All of these have increased morbidity and mortality in CV disease

The Los Angeles County Coroner reported a sharp increase (5x) in cardiovascular disease related sudden deaths on the day of the Northridge earthquake.NEJM 1996;334:413-419

25% increase in myocardial infarction admissions in London on the day of the match when England lost to Argentina in penalty shootout during 1988 World CupBMJ 2002;325:1439-1442.

2.3 fold increase in ventricular tachyarrhythmias during the month after 9/11 in 200 New York area patients with implantable cardioverter-defibrillators relative to other months between May 2001 and October 2002. J Am Coll Cardiol 2004;44:1261-1264

27

Warning SignsWarning Signs

• Loss of focus and mental clarity

• Lack of ability to relax and sleep• Loss of self esteem

• Feeling tired and on edge/Anger

• Loss of focus and mental clarity

• Lack of ability to relax and sleep• Loss of self esteem

• Feeling tired and on edge/Anger

29

Anger and MIAnger and MIAnger and MI

• 1623 heart patients tracked• “What happened the two hours before

your MI?”• Anger increased risk of MI by 230%

– Mittleman et al, Circulation, 1995, vol. 92

2000 Lifestyle Advantage

• (1) I am quick tempered.

• (2) I have a fiery temper.

• (3) I am a hotheaded person.

• (4) I get angry when I am slowed down by others’ mistakes.

• (5) I feel annoyed when I am not given recognition for doing good work.

• (6) I fly off the handle.

• (7) When I get angry, I say nasty things.

• (8) It makes me furious when I am criticized in front of others.

• (9) When I get frustrated, I feel like hitting someone.

• (10) I feel infuriated when I do a good job and get a poor evaluation.


Those with the most anger have the highest death rates

Anger and Cardiac DeathAnger and Cardiac Death

Williams et al, Circulation 2000, vol. 101

• Patients with implantable cardioverter-defibrillators (ICDs)

• In the 15 minutes preceding shock, high anger level preceded 15% of events compared with 3% of control periods (P<0.04; odds ratio, 1.83; 95% confidence intervals, 1.04 to 3.16).

• Other mood states (anxiety, worry, sadness, happiness, challenge, feeling in control, or interest) did not differ.

• CONCLUSIONS: Anger can trigger ventricular arrhythmias in patients with ICDs.

• COMMENT: This study shows that angry episodes trigger ventricular tachycardia, and once again identifies the need for including stress management techniques and group support in the lifestyle modification program.

– Lampert R, Joska T, Burg MM, et al. Emotional and physical precipitants of ventricular arrhythmia. Circulation. 2002;106:1800-5.

Anger and VTAnger and VT

• 3873 men and women in the Framingham Offspring Study, were examined and monitored for 10 years for the incidence of CHD, AF, and total mortality.

• After controlling for age, diabetes, hypertension, history of myocardial infarction, history of congestive heart failure, and valvular heart disease trait-anger symptoms of anger and hostility were predictive of 10-year incidence of AF in men.

• None of the psychosocial variables were related to the 3 outcomes in women.– Eaker ED, Sullivan LM, Kelly-Hayes M, et al. Anger and hostility predict the

development of atrial fibrillation in men in the Framingham Offspring Study. Circulation. 2004;109:1267-71.

Anger and AAnger and A--FibFib

Magnitude Of Depressive Symptoms Post Myocardial Infarction And Frequency Of

Cardiovascular Deaths

BDI=Beck Depression Inventory, ranging from no depressive symptoms (BDI <5) to moderate or severe (BDI ≥19). A Correlation can be seen even with mild symptoms (BDI 5‐9)

FRAMINGHAM RISK FACTOR RATIOS FOR MEN

Clinical Depression Greater Than Standard Risk Factors

DepressionDepression

• 218 patients followed for 18 months post MI.

• 75% of the post-MI deaths are related to depression in the next 6 months.

• This was independent of other risk factors.– Frasure-Smith et al, JAMA 1993, vol. 91

This effect was negated when people felt socially supported

– Frasure-Smith et al, Circulation, 2000 vol. 101


Social Support, Depression, Social Support, Depression, and Cardiac Death Ratesand Cardiac Death Rates

• 4493 men and women > 65 years old

• No CAD at baseline

• Followed for 6 years

• Used a modified CESD

• Every increase of 5 points = 15% increased risk

• Those with the highest depression scores had a 40% higher CAD rate and a 60% higher death rate.


Depression and HealthDepression and Health

Ariyo AA, Haan M, Tangen CM, Rutledge JC, Cushman M, Dobs A, Furberg CD. Circulation 2000 Oct 10;102(15):1773-9.

• Don’t do as well when they have surgery• 2 fold increase in outpatient mortality • 5 fold increase in death after a heart attack• And tend to not follow through with nutrition,

exercise, and medication recommendations

•

Those Who have Those Who have Depression and CADDepression and CAD

Michael Collins, 31st Annual Southwest Heart Symposium, 8/23/02

• Study evaluated HRV in patients with a recent MI. • Three hundred eighty acute MI patients with depression and 424 acute MI

patients without depression• 24-hour ambulatory electrocardiographic monitoring after hospital

discharge• 4 indices of HRV were significantly lower in patients with depression than

in patients without depression, despite other variables associated with low HRV (age, sex, diabetes, and present cigarette smoking)

• CONCLUSIONS: We conclude that greater autonomic dysfunction is a plausible mechanism linking depression to increased cardiac mortality in post-MI patients.

Is Autonomic Dysfunction Is Autonomic Dysfunction a Mechanism?a Mechanism?

Carney RM, Blumenthal JA, Stein PK, et al. Depression, heart rate variability, and acute myocardial infarction. Circulation. 2001;104:2024-8.

Caregivers took an average of 24% longer than well-matched controls to heal the same small, standardized wound.

Kiecolt-Glaser, Marucha, Malarkey, Mercado, & Glaser: Lancet, 1995

Stress Slows Stress Slows Wound HealingWound Healing

41

0

2

4

6

8

10

12

14

16

DA

YS

TO

HE

AL

VACATION EXAMS

Marucha, Kiecolt-Glaser, & Favagehi: Psychosomatic Medicine, 1998

Days to heal for each of the 11 students. No student healed as rapidly during exams, with the average student taking 40% (3 days) longer

Antibody Responses to Influenza Vaccine:Caregivers vs. Controls

Kiecolt-Glaser, Glaser, Gravenstein, Malarkey, Sheridan: Proceedings of the National Academy of Sciences, USA, 1996Replication with caregivers published by Vedhara et al. in Lancet, 1999

Accelerated Telomere Shortening in Accelerated Telomere Shortening in Response to Life StressResponse to Life Stress

• 58 premenopausal women• Caregivers of chronically ill children versus controls

How do they perceive stress in their lives? Does stress impact health by affecting the rate of cellular aging?Telomere length and the enzyme telomerase were measured

Elissa S. Epel, Elizabeth H. Blackburn, Jue Lin, Firdaus S. Dhabhar, Nancy E. Adler, Jason D. Morrow,and Richard M. Cawthon

Perceived psychological stress – and the number of years of caring for their chronically ill children – was associated with shorter telomere length and less telomerase activity providing the first indication that stress may have an impact on telomere maintenance

Accelerated Telomere Shortening in Accelerated Telomere Shortening in Response to Life StressResponse to Life Stress

Elissa S. Epel, Elizabeth H. Blackburn, Jue Lin, Firdaus S. Dhabhar, Nancy E. Adler, Jason D. Morrow,and Richard M. Cawthon

• Accelerated aging (Kerr et al., 1991; Namiki, 1994)• Brain cell death (Kerr et al., 1991; Sapolsky, 1992)• Impaired memory and learning (Kerr et al., 1991; Sapolsky, 1992)• Decreased bone density; increased osteoporosis (Manolagas, 1979)• Reduced muscle mass (Beme, 1993)• Reduced skin growth and regeneration (Beme, 1993)• Impaired immune function (Hiemke, 1994)• Increased blood sugar (DeFeo, 1989)• Increased fat accumulation around waist / hips (Marin, 1992)

Chronic stress = excess cortisol = accelerated aging

High Cortisol : Low DHEAHigh Cortisol : Low DHEA

• Low position in social hierarchy• Severe significant trauma – childhood abuse,

battlefield assault, other significant trauma• Alienation/harassment/bullying• Chronic illness• Pain• Lack of control – ‘man in a box’• Loss of job• Heavy physical work

Chronic Negative Chronic Negative StressorsStressors

What about adverse childhood events?What about adverse childhood events?

• Vince Fellitti conducted a series of studies looking at adverse childhood events and disease in midlife.

• What the ACE research shows is the more trauma a child faces such as fighting and hitting among parents, parents in jail , sexual abuse, etc. the higher the risk of major illness as well as drug and alcohol abuse.

• 126 male Harvard students, 1952 - 1954• Followed for 35 years• Outcome - Incidence of Significant Illness (CAD, Cancer,

HTN, Ulcer, ETOH abuse etc…)• Variable: Relationship with Father and Mother

– Very close– Warm and friendly– Tolerant– Strained and cold

The Harvard Mastery The Harvard Mastery of Stress Studyof Stress Study

• If relationship with mother was:• Tolerant or strained - 91% had significant health issue• Close and Warm - 45% had significant health issue

• If relationship with father was:• Tolerant or strained - 82% had significant health issue• Warm and close - 50%

• If relationship with both parents was:• Strained - 100% incidence of significant health risk• Warm and close - 47% had a significant health risk

Russek, L. and G. Schwartz - J. of Behavioral Med. 1997, 20: 1-13

The Harvard Mastery The Harvard Mastery of Stress Study Outcomesof Stress Study Outcomes

• Healthy behaviors like nutrition and exercise develop in childhood.

• Coping styles develop in childhood - anger, optimism, self esteem.

• Spiritual values and practices are developed in childhood.

Researcher Conclusions Researcher Conclusions on Likely Contributorson Likely Contributors

• Stress is almost always an emotional reaction to a situation.

• Stress impacts your ability to think clearly, respond appropriately, and perform at your best.

• Your stress level directly impacts how you feel at the end of the day, your health, and your relationships.

Stress isStress is……

Resilience

The capacity to prepare for, recover from, and adapt in the face of stress, challenge or adversity.

•It’s especially important for preventing stress build‐up and wasted time and energy.

•You can learn how to accumulate and store resilience.

Dimensions of Resilience

Physical Emotional

SpiritualMental

• Physical flexibility• Endurance• Strength

• Emotional flexibility• Positive feelings• Self‐regulation• Relationships• Ease instead of resistance

• Mental flexibility• Attention span• Optimistic world view

• Incorporating multiple points of view

• Spiritual flexibility

• Commitment to core values

• Tolerance

• Exercise: Preferable in Nature• Guided Imagery• Meditation• Biofeedback• Prayer• Practice Appreciation and Gratefulness• Forgiveness• Don’t Make Assumptions• Get Plenty of Sleep • Avoid Excess Caffeine• Practice Effective Communication• Love and Social Support

Enhancing ResiliencyEnhancing Resiliency

Adyashanti said “Suffering happens between the ears. Everything else is just a situation.”

And of course Mark Twain said“I have suffered a great many misfortunes most of which never happened.”

Stress isStress is……

• Response

• Perception

• Initiating Event

• Effect


IgA and Mother TeresaIgA and Mother Teresa

• Students watched a film on Mother Teresa’s activity or an emotionally neutral film.

• On average salivary IgA increased in those who saw the Mother Teresa film, but a few had decreased IgA production!

• The students were then asked to write a story about a photo of a couple on a park bench.

• Those whose stories showed themes of distrust, manipulation or abandonment had lower IgA responses to the Mother Teresa film.

• Those same students had had significantly more illness over the previous year.

Perception and Projection Perception and Projection Were the Keys!Were the Keys!

McClelland, DC and C. Kirshnet, Psychology and Health, 1988,2:31-52

• Change your environment

• Change how you react and perceive your environment

The Researchers Concluded The Researchers Concluded That That PerceptionPerception Was the KeyWas the Key

Perception is Everything

How Do We Neutralize How Do We Neutralize the Stress Responsethe Stress Response

• Breathing controls the nervous system. With each inhalation, the HR increases.

• With each exhalation, the heart rate slows down.

• Heart Focus• Heart Breathing• Heart Feeling

A Path to PeaceA Path to Peace

• Don't just think positive. Feel positive. Just recall a positive or fun time in life and attempt to re-experience it. And sustain that positive feeling for about 20 seconds.

• When you catch your mind wandering, gently focus your breathing back through the heart and reconnect with feelings of care or appreciation.

RememberRemember

Renewing Emotions

Positive emotions and attitudes create neurochemicals that regenerate your system and offset energy drain.

• Increased longevity • Increased resilience to adversity• Improved memory

• Improved problem‐solving• Increased intuition and creativity

• Improved job performance and achievement

• Key indicator of autonomic function• Low HRV indicates high sympathetic and

parasympathetic tone = high cardiac risk• High HRV indicates low sympathetic and

parasympathetic tone = low cardiac risk• Decreases with age• Low HRV is predictive of MI and sudden death

Circulation, 1996;93: 1043-1065

Heart Rate Variability (HRV)Heart Rate Variability (HRV)

CoherenceFacilitates Brain

Function

Heart Rhythms Directly Impact Physical and Mental Performance

The heart signals especially affect the brain centers involved in strategic thinking, reaction times, social awareness and the ability to self‐manage.

IncoherenceInhibits BrainFunction

Coherence Improves Brain Functions

Improved Mental Function:

• Decision‐making

• Ability to focus, process information and solve problems

• Reaction times and coordination

• Long and short‐term memory

• Academic Performance

Meta Analysis of 3129 Individuals from Government and Health Service Organizations

Assessment: POQA

Meta Analysis: Stress Symptoms

Staff Turnover Reductions

Reduction in Staff Turnover

0

5

10

15

20

25

30

35

40

Duke UniversityHealthEMS

Sierra Providence Swedish Medical Center Delnor CommunityHospital (overall)

Delnor CommunityHospital (HeartMath

Cohort)

Customer

% S

taff

Turn

over

40% ‐ 71% reduction in medical errors

• Blood Pressure in Hypertensive Employees (HP)20% reduction in diastolic and systolic blood pressure

• Diabetes (LifeScan division of J&J)30% increase in quality of life metrics; 1.1% reduction in HbA 1c in Type 2 diabetes (1% HbA 1c reduction = 35% reduction in microvascular damage)

• Congestive Heart Failure (Stanford Hospital)• Heart Arrhythmias (Kaiser Permanente)

75% of the patients had significantly fewer episodes of atrial fibrillation and 20% were able to stop medication altogether

• Asthma (Robert Wood Johnson Medical School)Over 50% of patients experienced a decrease in airway impedance,symptom severity and medication consumption

Study ResultsStudy Results

Research Shows that Heart Rate Variability can be Modified by Prayer

• A mantra is a sacred word, chant, or sound that is repeated to promote relaxation and cultivate inner peace

• It could be the repetition of a word like Shalom, Rama, or many others

• The word mantra in its most literal sense means to free from the mind.

MantraMantra

Both practices:• Decreased sympathetic tone• Synchronized respiratory and c-v cycles• Improved HRV

HRV, Mantras, HRV, Mantras, & Rosary Prayer& Rosary Prayer

Luciano Bernardi et al. BMJ 2001;323:1446-1449 (22-29 December)

77

• When walking or jogging• While waiting in lines or stalled in traffic• When you feel angry or anxious• When you feel upset or afraid• When you are falling to sleep

I ask my patients to repeat I ask my patients to repeat their mantra:their mantra:

The skillful, sustained, applied use of attention

MeditationMeditation

• A meditation practice may be formal or informal.

• For example; TM teaches the cultivation of a meditation practice 20 minutes two times per day.

MeditationMeditation

An informal meditation practice can be done throughout the dayWe call it taking a mini moment

Take 5 deeper, longer breathsTake 5 deeper, longer breaths

Feel the Energizing and Relaxing EffectFeel the Energizing and Relaxing Effect

This aliveness and centeredness is your peak performance zone

RESETBREATHE

Mini MomentMini Moment

• Treatment of hypertension in older African Americans (n=127) age 55-85 with:– Meditation, or– progressive muscle relaxation (body scan), or – lifestyle education

• Results:– Meditation reduced systolic pressure by 10.7 mm Hg

and diastolic pressure by 6.4 mm Hg – Progressive muscle relaxation lowered systolic

pressure by 4.7 mm Hg and diastolic pressure by 3.3 mm

– Lifestyle education had no significant effect

RCT 1995 to Assess the Impact RCT 1995 to Assess the Impact of TM in AA with HBPof TM in AA with HBP

Hypertension. 1995 Nov;26(5):820-7.

0 1 2 3 4 5 6 7 8 9 100

50

TM

HE

RR= 0.53, (95% CI 0.30 -0.95, p = .03)50

60

70

80

90

100

YEARS

Cum

ulat

ive

Prop

ortio

nEv

ent-

free

Schneider R, Nidich S, Kotchen J, Kotchen T, Grim C, Rainforth M, Gaylord- King C, Salerno J. Effects of Stress Reduction on Clinical Events in African Americans with Coronary Heart Disease: A Randomized Controlled Trial. Circulation. 2009;120:S461

Effects of TM on Mortality, Effects of TM on Mortality, MI, and StrokeMI, and Stroke

85

Meta Analysis I

American Journal of Hypertension, 21:310-316, 2008

86

Decreased Anxiety

Journal of Clinical Psychology, 1989. 45(6): 957–974

87

Decreased Insulin Resistance in Heart Patients

Archives of Internal Medicine 166: 1218–1224, 2006

Stress Reduction in the Secondary Prevention of Cardiovascular DiseaseRandomized, Controlled Trial of Transcendental Meditation and Health Education

in African AmricansRobert H. Schneider, MD FACC AHA Nov. 2012

• Follow-up of 5.4 years, there was a 48% risk reduction in the primary end point in the TM group (hazard ratio, 0.52; 95% confidence interval, 0.29–0.92; P=0.025).

• The TM group also showed a 24% risk reduction in the secondary end point (hazard ratio, 0.76; 95% confidence interval, 0.51–0.1.13; P=0.17).

• There were reductions of 4.9 mmHg in systolic blood pressure (95% confidence interval −8.3 to –1.5 mmHg; P=0.01) and anger expression (P<0.05 for all scales). Adherence was associated with survival.

•Telomerase activity was significantly greater in retreat participants than in controls at the end of the retreat (p<0.05). •Increases in Perceived Control, decreases in neuroticism, and increases in both Mindfulness and Purpose in Life were greater in the retreat group (p<0.01).

Intensive Meditation Training, Intensive Meditation Training, Immune Cell Telomerase Activity, Immune Cell Telomerase Activity,

and Psychological Mediatorsand Psychological Mediators

The Science of Connection

The Science of Connection

What’s Love Got to Do with It?

What’s Love Got to Do with It?

1.0

0.9

0.8

0.7

0.6

0.50 1 2 3 4 5

Year of Follow-up

Unmarried/No ConfidantMarried/ConfidantMarried/No ConfidantUnmarried/Confidant

Esti m

ated

Sur

viva

l Pro

babi

lity

92

• 10,000 Men, without angina, with 3 or more risk factors for CAD• Followed five years for onset of angina• Asked: Does your wife show you her love?• Outcome: Those who answered “yes” had 50% lower rate of

anginal onset than those who answered “no.”– Madalie, JH and U Goldbourt, American Journal of Medicine, 1976, 60(6): 910-21

• Similar study with ulcer onset showed 1/2 the ulcers in men who are shown love.

– Meladie, JH et al, American Journal of Epidemiology, 1992,136(10):1280-87

““Does your wife Does your wife show you love?show you love?””

• 1,400 men and women post cardiac catheterization

• Variables: “Are you married?” and “Do you have someone you can confide in?”

• People who were not married and had no close confidant had over three times the death rate of the other groups over 5 years (15% vs. 50%).

Married with Married with Heart DiseaseHeart Disease

Williams, RB et al, JAMA 1992, 267(4):520-24

Yet another study conducted in Britain looked at the relationship,

unhappy marriages, and heart disease.

• 9011 British civil servants were studied.• This study included 6114 men and 2897 women.• They were followed for 12 years.

Marriage?Marriage?

Unhappy marriages led to 34% more coronary events regardless of gender and social status.

Arch Intern Med. 2007;167:1951-1957

Marriage?Marriage?

• The researchers found that Optimism is clearly linked to happier & more satisfying romantic relationships.

• They concluded that this was due to greater cooperative problem solving.

Assad KK, Donnellan MB, Conger RD., Optimism: an enduring resource for romantic relationships.J Pers Soc Psychol. 2007 Aug;93(2):285-97.

Does Optimism Help?Does Optimism Help?

Another study reported in the Journal of Personality and Social Psychology in 2006

Demonstrated that optimistic couples– Resolve conflict faster– See the other as supportive– Live up to the others ideals

Is it just that optimists see the positive? Is their glass half full?

Srivastava S, McGonigal KM, Richards JM, Butler EA, Gross JJ., Optimism in close relationships: How seeing things in a positive light makes them so. J Pers Soc Psychol. 2006 Jul;91(1):143-53.

Does Optimism Help?Does Optimism Help?

Could That Explain Why Optimists Live Longer?

• 999 men and women over 9 years divided into four groups based on their level of optimism.

• Optimists had a 55 percent lower risk of death from all causes, and a 23 percent lower risk of cardiovascular death.

So clearly optimism is good for relationships and good for your health

Up to this point we have been focusing on intimate relationships with parents and partners.

Now lets broaden the conversation a bitand look at social networks

Community and disease risk:Roseto, PA

hts, smoking betes prevalence mmunities

• Lower incidence of MI than surrounding communities before the 1970’s

• Before the 1970’s:– Three generation households were prevalent– High degree of religiosity and traditional values

• After the 1970’s:– Break up of multigenerational households– Decreasing church attendance– Increasing mobility– MI prevalence equal to surrounding communities

Egolf, BJ et al, American J of Public Health, 1992, 82(8): 1089-92

Predictors of MI in Roseto, PA50 Years Prevalence Shift

• 276 healthy volunteers given rhinovirus containing nasal drops, all were shown to shed virus.

• The study evaluated 12 different types of social relationships - parental, childhood, groups etc.

• Those who had the least number of positive relationships developed cold symptoms 4 times more frequently.

– Cohen, S et al, JAMA, 1997, 277:1940-44

Connection and Connection and the Common Coldthe Common Cold

• Patients: post surgical removal of malignant melanoma

• Intervention: 6 week support group• Outcome, 5 years later:

– control group - 13 recurrences,10 deaths– Intervention group - 7 recurrences, 3 deaths

Fawzi, FI et al, Archives of General Psychiatry, 1993, 50:681-89

Support Groups in Melanoma

• A study of 700 older adults• Those who gave love and

support to others had significantly fewer health issues.– Depner, CE and Ingersoll-Dayton,

Psychology and Aging, 1988,3:348-57

It Is Better To Give It Is Better To Give Than To Receive Than To Receive

Florence Nightingale Florence Nightingale on Spiritualityon Spirituality

“The needs of the spirit are as crucial to health as those individual organs which make up the body.”

A sense of connection with the source of ultimate meaning

•Spirituality includes connection with self, others, nature, and a higher power•This connection helps an individual make sense of their life

SpiritualitySpirituality

“The HUMAN HEART has a hidden want which science cannot supply.”

-Sir William Osler, M.D.

”A religion of some kind is as essential to the mind as air is to respiration.“

Benjamin Rush Found a “Hidden Want” in Religion

• 90% of people believe in a higher being.

• 94% regard their spiritual and physical health as equally important.

• 96% of FP believe that spiritual well-being is a factor in health.

Spirituality in MedicineSpirituality in Medicine

Mueller PS, et al. Mayo Clinic Proc. 2001;76:1225-35

A metaanalysis published in 2000 in the J of Health Psychology

Reviewed 42 studies of nearly 126,000 people found that highly religious persons had a 29% higher odds of survival compared with less religious persons. The authors could not attribute the association to confounding variables or to publication bias.

McCullough ME, Hoyt WT, Larson DB, Koenig HG, Thoresen C. Religious involvement and mortality: a meta-analytic review Health Psychol. 2000;19:211-222.

Spirituality in MedicineSpirituality in Medicine

• 5286 adults were followed for 28 years.• Those who attended religious services at least once

per week had a 23% reduction in mortality.• Adjusted for age, sex, ethnicity, education, baseline

health status, body mass index, health practices, and social connections.

Religion & MortalityReligion & Mortality

Strawbridge WJ, Cohen RD, Shema SJ, Kaplan GA. Frequent attendance at religious services and mortality over 28 years. Am J Public Health. 1997;87:957-961

Further data from the Mayo clinic may have the answer to why spiritualty active people live longer

• Religious attenders: – Have lower blood pressures– Have greater compliance with medication– Exercise more– Eat healthier diets– Quit smoking more readily– More likely to use preventive medicine services



Religious attenders:-Lower systolic and diastolic BP-Greater compliance with medication-Exercise more-Eat healthier-Quit smoking more readily

Religion and Heart DiseaseReligion and Heart Disease

Mueller, PS et al, Mayo Clinic Proc.2001;76:1225-35

The Mayo Clinic data also found that• Religious individuals:

– Are more accepting of death– Have less depression & anxiety– Are less likely to abuse alcohol & drugs– Are less likely to commit suicide



Yes No Yes NoYes Yes No No

25

20

15

10

5

0

% D

ead

Groupparticipation:Religious strengthand comfort:

Percentage of Patients Dying Within 6 Months of Heart Surgery



A 23-year prospective study of 10,059 male Israeli civil servants and municipal employees found that Orthodox Jewish men had a 20% decreased risk of fatal coronary heart disease (CHD) compared with nonreligious men adjusted for age, blood pressure, lipids, smoking, diabetes, body mass index, and baseline CHD.


Goldbourt U, Yaari S, Medalie JH. Cardiology. 1993;82:100-121.

Another Israeli study:

Demonstrated that secular Jews had a higher chance of having a first heart attack when compared with Orthodox Jews, adjusted for age, ethnicity, education, smoking, physical activity, and body mass index.

Friedlander Y, Kark JD, Stein Y. Int J Cardiol. 1986;10:33-41.


• Strong social support system• Increased hope, love, contentment• Optimism• A Belief in the Divine plan

• All of these are associated with lower catecholamines and cortisol.

WhatWhat’’s the Secret Ingredient?s the Secret Ingredient?

MimiGuarneriMD.com

Documents

Monterey MindBody Guarneri no pics · • Stress can cause coronary vasoconstriction and increased platelet stickiness that promote clot formation. • Type A behavior, depression,