GP Health & Wellness

1. GP Health & Wellness Dr. Leon Massage

2. Common myths • Self-care is ‘selfish’ • Asking for help is a sign of weakness • You only practice stress management when you really need it • Being relaxed means lower performance or lack of commitment

3. Outline • The causes of stress • The consequences of stress • Stress, health and the mind-body connection • Strategies for lifestyle change • Stress management and relaxation techniques

4. Wellness spiral Wellness High level well-being Holistic focus Average well-being Conventional medical care Demonstrable pathology Illness

5. Stress and Performance NOT ALL STRESS IS BAD • No stress equals no performance • Inertia, procrastination etc • Some stress associated with higher performance • Too much stress leads to diminished performance • Burnout, inefficient, unable to prioritize, tense etc

6. The “fight or flight response” • A natural, necessary and appropriate physiological response to an exceptional situation • E.g. attack by a saber- tooth • Response is based on a clearly perceived threat • It is encoded into our physiology to preserve life • Changes include:

7. The “fight or flight response” Physiological Changes • Elevation of blood-pressure and heart rate • Diversion of blood-flow to muscles and away from the gut • Platelet adhesiveness (becoming ‘stickier’ to stop bleeding) • Short-term mobilisation of white-blood cells • Effects on inflammatory hormones (e.g. cortisol, cytokines, interleukins etc)

8. Stress response • ‘Fight or flight’ response is appropriate and life protecting providing: • It is only turned on when it needs to be • It is allowed to turn off when it is no longer needed • It is not prolonged • Mediated primarily via sympathetic and parasympathetic systems but interacts with every system

9. The stress of modern life • Tends to be chronic and prolonged • Increasing at an alarming rate • E.g. 45% increase over the last 30 years • Could be explained by increased awareness of stress and also more stressful and busy lives • Stress is cumulative • Stress reduces serotonin

10. The Stress Cycle • Chemical stressors • Emotional Stressors • Physical Stressors StressOverload • Social stressors • Environmental stressors • Family stressors

11. The Stress Cycle- short term effects • Behavioural– e.g. Over eating, excess alcohol • Physiological– e.g. Tachycardia, hypertension • Emotional– e.g. Anxiety, depression, hostility • Cognitive– e.g. Decreased concentration

12. The Stress Cycle- long term effects • Behavioural disorders – e.g. Obesity, alcoholism • Medical disorders – e.g. Hypertension, heart disease • Emotional disorders – e.g. Chronic anxiety, depression, phobias • Cognitive disorders – e.g. Memory problems, insomnia

13. Gender and the stress response • Men and women respond to stress differently • Men respond to stress through ‘fight or flight’ • Predominantly sympathetic arousal accentuated by testosterone • Women experience ‘tend and befriend’ response • Fight and flight moderated through oxytocin and other hormones • Secreted at times of bonding, nurturing, breast feeding and relationships • Male and female responses may have evolutionary and adaptive implications

14. Stress and Perception “Man is not disturbed by events, but by the view he takes of them.” Epictetus

15. Stress and perception • Mis-perception of stress can be • Imagination • E.g. worrying about future exams • Rumination • E.g. going over a past mistake • Exaggeration • E.g. blowing things out of proportion • Stress is eased by: • Focusing on the present • E.g. performing one action at a time • Clarifying perception • E.g. CBT, mindfulness, relaxation, information gathering

16. Physiological effects of stress reduction • Reduction in stress hormones • Reduction in blood pressure and heart rate • Reduction in cortisol levels • Reduction in serum cholesterol • EEG changes (increase in alpha and theta waves) • Reduction in epileptic seizure frequency • Changes in neurotransmitters: higher serotonin and dopamine • Improved immune function • Reduction of inflammation • Adjunct to therapy (CVD, cancer, chronic pain, asthma, diabetes)

17. PNI - Psychoneuroimmunology • The mind communicates with the immune system through the nervous (and endocrine) systems • 2 main methods of communication • Postal (blood-borne hormones) and cable (nerve fibres) services • Immune defenses include cellular (NK-lymphocytes) and humoral (immunoglobulins) immunity

18. PNI – clinical relevance • Lowered immune markers • Increased susceptibility to infections • An increased severity and progression of infections • Increased relapse rate of chronic and latent infections • Increased activity of inflammatory illnesses • Increased activity of autoimmune conditions • Poor response to immunisation • Effects on the activity of allergic conditions

19. Health promoting responses to stress • Adaptive Behavioural responses • Time management, Assertiveness training • Adaptive Physical responses • Nutrition, Exercise • Adaptive Emotional responses • Relaxation, meditation, CBT

20. Mind-Body interventions • Stress management • CBT • Mindfulness therapy • Psychotherapy • Family therapy • Meditation / relaxation exercises • Humour • Conditioning • Prayer

21. Long term effects of health promoting lifestyle responses • Behavioural Response Raised Self esteem, increased confidence • Physical Response  Improvement in health, improved immune response • Emotional Response  Improved mental health, ability to cope with stress

22. Psychosocial factors and CHD • “Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of CAD.” • Data relates CAD risk to 5 specific psychosocial domains • depression • anxiety • personality factors and character traits • social isolation • chronic life stress • Rozanski et al. Circulation 1999;99(16):2192-217

23. Is heart disease reversible? • Heart disease is reversible given the right conditions • Significant improvement possible in both the disease and quality of life. • People with already well established CHD given conventional medical management plus or minus an intervention (comprehensive lifestyle program) • As risk factors are synergistic so too should be positive interventions. • Ornish D. et al. Lancet 1990;336:129-133.

24. The Ornish Program • The program consisted of: • group support • stress management consisting of meditation and yoga • a low fat vegetarian diet • moderate exercise • stopping smoking • Stress was central to dealing with other risk factors

25. Results

26. Lifestyle change and CHD • 5 year follow-up of the Ornish program • Most of the original intervention group maintained changes • Outcome measures • angiographic changes • risk ratio for cardiac events • JAMA 1998;280:2001-7

27. What else can make us feel better? • Sunlight Increases serotonin • Exercise  Mops up stress hormones • Dark chocolate  Contains endorphins, antioxidant, anti-aging • Fish  Anticarcinogenic • Folic Acid  Suppresses dysplasia

28. GP Health & WellbeingQuestions & Discussion Dr. Leon Massage