1. Psychological Stress—Impact on the Cardiovascular System Dick Jennings

2. Outline Systems translating psychology into changes in our bodies --somatic, autonomic, endocrine, immune Focus on autonomic nervous system --current anatomical/functional concepts --stress only one factor altering autonomic nervous output Behavioral Medicine and the cardiovascular system --cardiovascular reactivity --central origins of cardiovascular reactivity Concept of mind-body and health/disease

3. Behavioral Medicine Understand how psychological factors can influence the initiation, course, and outcome of disease (and health maintenance) Understand how psychological factors can influence the initiation, course, and outcome of disease (and health maintenance) The relationship between mind and body is a central concept The relationship between mind and body is a central concept Stress and its physiological sequelae have long been thought to influence the heart Stress and its physiological sequelae have long been thought to influence the heart

4. The path from psychosocial to illness Communication and coordination within our body is via the nervous, endocrine, and immune systems. Communication and coordination within our body is via the nervous, endocrine, and immune systems. The brain’s impact on these systems are the pathways from psychosocial to illness. The brain’s impact on these systems are the pathways from psychosocial to illness. Individual differences in behavior and biological characteristics impact these pathways and have been related to illness. Individual differences in behavior and biological characteristics impact these pathways and have been related to illness.

5. Controversial translation of stressful thoughts to physiology

6. Pathways to the Heart

7. Love?

8. Stomach ?

9. Netter (1962) CIBA collection of Medical Illustrations. Pp 164-165 Stress?

10. Psychoneuroendoimmuno anatomy and physiology Autonomic nervous system—sensing and motor system for viscera Autonomic nervous system—sensing and motor system for viscera Links to endocrine system—SAM and CORT Links to endocrine system—SAM and CORT Links to immune system Links to immune system Anatomic concept of central influences on viscera Anatomic concept of central influences on viscera Organized and integrated response supporting key behaviors Organized and integrated response supporting key behaviors

11. From Lane et al. (submitted) NIH artwork organized by Margaret Chesney

12. Sympathetic and Parasympathetic Sympathetic Sympathetic Activating/energy mobilizing Activating/energy mobilizing Thoracic cord to paravertebral ganglia—processing for organ specificity Thoracic cord to paravertebral ganglia—processing for organ specificity Engage endocrine system Engage endocrine system Norepinephrine transmitter..modulation via alpha and beta adrenergic receptors (co-release peptides, opiates, …..) Norepinephrine transmitter..modulation via alpha and beta adrenergic receptors (co-release peptides, opiates, …..) Parasympathetic Parasympathetic Conserving/energy restoring Conserving/energy restoring Cranial and sacral cord, Xth nerve—Vagus—synapse at end organ Cranial and sacral cord, Xth nerve—Vagus—synapse at end organ Relates to immune system in development and possible cytokine release Relates to immune system in development and possible cytokine release Acetylcholine transmitter…muscarinic and nicotinic receptors Acetylcholine transmitter…muscarinic and nicotinic receptors

13. From Lane et al. (submitted)

16. Organized behavioral/autonomic action

17. Functional Responsivity of the Nervous System Support for action— orienting, anticipating, exercising,thought Support for action— orienting, anticipating, exercising,thought Metabolism — salt/water balance, digestion, respiratory sinus arrhythmia Metabolism — salt/water balance, digestion, respiratory sinus arrhythmia Affect — fear, anger, grief, disgust Affect — fear, anger, grief, disgust We now know that patterned responses, as modulated by feedback, accomplish these functions. We question earlier ideas of en masse, autonomous or emergency action with antagonistic sympathetic and parasympathetic responses. We now know that patterned responses, as modulated by feedback, accomplish these functions. We question earlier ideas of en masse, autonomous or emergency action with antagonistic sympathetic and parasympathetic responses. What is normal/pathogenic/stressful? What is normal/pathogenic/stressful?

18. What is stress? Some biopsychosocial views. Darwin—changing environment leads to adaption. Stress? Darwin—changing environment leads to adaption. Stress? Cannon—physiological reactions maintain homeostasis. Stress? Defending homeostatic target range. Cannon—physiological reactions maintain homeostasis. Stress? Defending homeostatic target range. Selye (1946)—Stress as non specific damaging agents (external to person) inducing generalized, stereotypic reaction—General Adaptation Syndrome defines stress by the physiological reaction. Selye (1946)—Stress as non specific damaging agents (external to person) inducing generalized, stereotypic reaction—General Adaptation Syndrome defines stress by the physiological reaction. Selye—linear concept, non-psychological, non- behavioral. Stress required return to homeostasis not adaptation to new situation. Selye—linear concept, non-psychological, non- behavioral. Stress required return to homeostasis not adaptation to new situation. Holmes/Rahe—stress as disease of adaption (literal Selye—closer to Cannon) Holmes/Rahe—stress as disease of adaption (literal Selye—closer to Cannon)

19. Stress--continued Mason—patterns response of neuroendocrine system dependent upon situation Mason—patterns response of neuroendocrine system dependent upon situation Lazarus—an interactive (nonlinear) stress syndrome—threat, evaluation, coping, re- evaluation. Lazarus—an interactive (nonlinear) stress syndrome—threat, evaluation, coping, re- evaluation. Weiner—patterns of integrated action, biorhythms, dysregulation, taxonomic stress Weiner—patterns of integrated action, biorhythms, dysregulation, taxonomic stress McEwan—allostasis. The weight of adjustment. Separate systems that guide adjustment but may be overtaxed. McEwan—allostasis. The weight of adjustment. Separate systems that guide adjustment but may be overtaxed.

23. Cardiovascular Reactivity Individuals show changes in heart rate and blood pressure when exposed to brief laboratory stressors/challenges Individuals are reasonably consistent across time in the magnitude of these responses to stressors. These responses are associated with and predictive of cardiovascular disease. The brain may have something to do with this.

24. The Stress Experiment

25. From web SuperCourse

26. Jennings, Kamarck, Manuck, Everson-Rose, Kaplan, & Salonen, Circulation, 2005

27. From Gianaros et al. PSOM Med, 2005.

28. What we think we know Blood pressure reactivity contributes to atherosclerosis and hypertension Blood pressure reactivity contributes to atherosclerosis and hypertension Negative affect/hostility creates risk for heart disease Negative affect/hostility creates risk for heart disease BUT negative affect does not mediate reactivity/atherosclerosis relationship BUT negative affect does not mediate reactivity/atherosclerosis relationship Maintained heart rate variability, particularly after an event, is protective (but we don’t know about recovery from stress yet) Maintained heart rate variability, particularly after an event, is protective (but we don’t know about recovery from stress yet) See references in your handout

29. What we think we know (cont.) Daily stress is associated with significant cardiovascular symptoms— ischemia,endothelial dysfunction, arrhythmia Daily stress is associated with significant cardiovascular symptoms— ischemia,endothelial dysfunction, arrhythmia Work demands and/or job control associated with cardiovascular risk Work demands and/or job control associated with cardiovascular risk Social isolation/lack of social integration associated with cardiovascular risk Social isolation/lack of social integration associated with cardiovascular risk See references in your handout

30. What we need to know Influence of integrated patterns of endocrine, immune, and autonomic response and recovery on cardiovascular disease Influence of integrated patterns of endocrine, immune, and autonomic response and recovery on cardiovascular disease Control of these integrated patterns by brain systems Control of these integrated patterns by brain systems More precise knowledge of how chronic and acute stress reactions modulate each other More precise knowledge of how chronic and acute stress reactions modulate each other Genetic/environmental sources of integrated response patterns Genetic/environmental sources of integrated response patterns

31. Mind=Body Hypothesis Brain coordinates function of the whole organism Brain coordinates function of the whole organism Brain adjusts evolutionary mechanisms that, e.g., keeps the heart beating. Brain adjusts evolutionary mechanisms that, e.g., keeps the heart beating. Brain organizes/initiatiates behavior attempting to optimize reaching our biological and psychological goals Brain organizes/initiatiates behavior attempting to optimize reaching our biological and psychological goals Behavioral patterns—driving autonomic, motoric, endocrine and immune outputs-- can then disrupt regulation of peripheral bodily function. Behavioral patterns—driving autonomic, motoric, endocrine and immune outputs-- can then disrupt regulation of peripheral bodily function. Disruption of regulation encompasses control of both physiological activation and recovery processes. Disruption of regulation encompasses control of both physiological activation and recovery processes.

32. Idea/affect/motiv Central Nervous System Autonomic Nervous System Bodily States Environmental Events Endocrine System Immune System Heart Vasculature Bodily State Feedback Pathways