Mind-body Interventions: Is there Power in Positive Thinking?

1. Mind-body Interventions: Is there Power in Positive Thinking? SPARC Portland, Oregon April 16, 2011

2. 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

3. Making the Case • There are pathways by which positive emotions influence health and well-being • Let’s start with something more familiar

4. Early Medicine • Evolved as a search to eliminate disease in the individual • Early attempts to repel spirits by shamans with rituals …

5. Hippocrates’ Four Humors • Many diseases were thought to result from negativeemotions • That produced imbalance in bodily fluids or “humors”

6. Early Mind-body Research Focused on Negative Emotionsand Stress

7. Negative Emotions Anger Depression Disease Outcomes

8. Anger & Disease • Religious Orders Study • N = 851 clergy (average age = 75) • Suppressed anger and depression – both associated with increased death rates over 4-years, independent of age, sex, education, smoking, and obesity (Wilson, et al, 2003)

9. Hostility & Mortality • Women’s Health InitiativeCohort of 107,356 Womenfollowed 8 years • Cynical, hostile women hadan increased risk of death Most hostile - 63 deaths per 10,000 Least hostile - 47 per 10,000 • Later – news on the “optimists” (Tindle, et al., 2009, APS)

10. How do Negative Emotional states lead to Physical Health Outcomes? Three pathways: • physiological responses • maladaptive behaviors • aversive environments

11. NegativeAffect Physiological Responses It Affects all Systems Disease Outcomes

12. 1 Nervous system:fight, flight, freeze 2Musculoskeletal systemheadaches, muscle pain 3Respiratory systemasthma, inhibited breathing 4Cardiovascular systemcoronary heart disease 5 Endocrine system cortisol, epinephrine, glucose 6 Gastrointestinal systemacid reflux, nausea 7 Reproductive systemhormonal irregularities

13. Negative Affect --Brain Activity & Immune Function • Negative and positive states are associated electrophysiological measures of prefrontal brain activity • Negative states, particularly depression, associated with right-sided activation (Tomarken et al, 1992: Henriques et al, 1991)

14. Negative Affect –Brain Activity & Immune Function People with right-sided activation -- • Lower basal levels of NK cell activity • Greater decreases in NK function during natural stress of exam • Less rise in NK function to positive film clip • Lower antibody titres to an influenza vaccine Davidson, et al

15. Negative Affect What specific Pathways link negative affect and immune function - ? Evidence suggests: Hypothalamic-pituitary- adrenal (HPA) axis Cortisol - “stress hormone” Physiological Responses Disease Outcomes

16. NegativeAffect Maladaptive Behaviors Physiological Responses Disease Outcomes

17. 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

18. Negative Affect Maladaptive Behaviors Social Isolation Physiological Responses Disease Outcomes

19. Social Isolation and Mortality • N = 1123 male, 245 female CAD patients • 5 year survival rates Married or confidant 0.82 Unmarried, no confidant 0.50 • Unmarried, without confidant - Threefold increase in risk of death Cox adjusted hazard ratio = 3.34 (1.84-6.20) ( R. Williams, et al, JAMA, 1992)

20. Social Isolation and Cardiovascular Risk • N = 188 healthy men and 110 women from White Hall II (45-59 yrs) • Social isolation measured with the Close Person Questionnaire • Socially isolated men and women had higher waking cortisol levels and greater cortisol output over the day ( Grant, Hamer & Steptoe, 2009)

21. This Afternoon – Focus on Positive Emotions Impact on health Approaches to Intervention

22. Positive Affect Longevity ??

23. Findings from 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)

24. 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)

25. 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)

26. Conclusion “Finding such a strong association of written positive emotional expression to longevity indicates a need for research that sheds light on the underlying mechanisms and mediators responsible for and associated with this relationship.” (Danner et al, 2001)

27. Optimism & Mortality • Women’s Health InitiativeCohort of 107,356 Womenfollowed 8 years • Optimistic women hadan decreased risk of death Optimists - 46 deaths per 10,000 Pessimists - 64 per 10,000 (Tindle, et al., 2009, APS)

28. Psychological Well-being and Survival: Meta-Analysis Population Hazard Ratio p Healthy .82 p< .001 population (.76 - .89)(35 Studies) Disease .98 p< .030population (.95 – 1.0)(35 Studies) (Chida & Steptoe, 2008)

29. Positive Affect Physiological Responses Longevity

30. Positive Affect & Immune Function • Cohort of 1,149 faculty, high scores on positive affect were associated with fewer colds (Takkouche, et al., 2001) • Positive emotional style was associated, in dose response pattern, to lower risk of developing cold following viral challenge (Cohen, et al., 2003)

31. Positive Affect Health Behavior Physiological Responses Longevity

32. Positive Affect & Health Behaviors • People with higher life satisfaction engage in health-promoting behaviors • Physical activity • Reduced levels of smoking • Reduced alcohol intake • Healthier diet (Castro, 2002; Scheier & Carver, 1992)

33. Positive Affect Health Behavior Social Support Physiological Responses Longevity

34. Positive Affect & Social Support • People who report positive emotions receive more social support(Fredrickson, 1998) • Positive affect is associated with the number of people who provided help over a 12-month period (Eckenrode, et.al., 1988)

35. 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

36. 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)

37. Positive & Negative Affect Co-exist • The chronic stress of care-giving for a dying partner, • Positive affect and finding positive meaning, during care-giving, was associated with more rapid recovery during bereavement (Folkman, et al, 2001)

38. Positive & Negative Affect Co-exist • Survey of 150,046 adults, 140 countries • Affect & perceptions of physical health • Negative affect & health = -.29, p <.001 • Positive affect & health = .25, p <.001 (Pressman, et al, APS, March, 2009 • “Positive and negative affect are independently related to health, not opposite ends of a continuum”

39. 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

40. 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) MBSR IncreasesPositive States

41. 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)

42. General Stressor Coping Effectiveness Training (CET) Specific Stressor Changeable Aspects Unchangeable Aspects Problem-Focused Strategies Problem-solving Negotiation skills Communication skills Emotion-Focused Strategies Guided Imagery, Physical Activity, Humor PLUS Strategies to Enhance Wellbeing

43. Strategies to Enhance Well-being “BREATHE” Breathe: Take a deep breath, be present with yourself in the moment - Be aware in the current moment - Accept what is, not what “ought to be” - Suspend judgment Realistic Goals: Set realistic goals for this moment, hour and day, celebrate meeting them

44. Strategies to Enhance Well-being “BREATHE” Everyday events: Notice the positive moments in everyday life, - sunset, flowers recognize when things go right share these events with others

45. Strategies to Enhance Well-being “BREATHE” B - R - E - Acts of Kindness: Create positive events for others Turn it around: Reframe negative events, find the silver lining Honor strengths: Acknowledge your personal strengths

46. Strategies to Enhance Well-being “BREATHE” B - R - E - A - T - H End each day with gratitude: Note positive steps and all you are thankful for - Do positive accounting at the end of the day

47. Personal Growth Scale Items • I learned to be myself and not try to be what others want me to be • I learned to communicate more honestly with others • I learned to be open to new information and ideas • I learned to find more meaning in life * * * * * * 0 = Not at all 1 = Somewhat 2 = A Great Deal Parks, 2000

48. CHANGES Project HIV+ Men (N=199) CET-E (N=68) Coping Effectiveness Training (3 mo – 12 sessions) Enhanced Maintenance (9 mo – 18 sessions) CET-S (N=66) Coping Effectiveness Training (3 mo – 12 sessions) Standard Maintenance (9 mo – 6 sessions) MCC (N=65) Minimal Contact Control (12 months) Day-Long CET Workshop (in month 13) Intervention Groups Control Group

49. Coping Self-Efficacy Percent Change from Baseline to Post (3 months) 20% 14% 15% CET vs. MCC (p=.02) 10% 6% 5% 0% CET Groups (N=112) MCC (N=61) Changes Project

50. Positive States of Mind Percent Change from Baseline to Post (3 months) 10% 8% CET vs. MCC (p=.02) 5% 0% -1% -5% CET Groups (N=112) MCC (N=61) Changes Project