Psychological Effects on the Cardiovascular System Dick Jennings

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 The concept of stress and its physiological sequelae is the lay theory of behavioral medicine The concept of stress and its physiological sequelae is the lay theory of behavioral medicine How should we conceptualize the relationship?

Why we worry about stress..

Components of Stress Threat to well-being Threat to well-being Emotional reactions Emotional reactions Emotions alter physiology Emotions alter physiology Over time (and typically in combination with other factors), disease occurs Over time (and typically in combination with other factors), disease occurs

Idea/affect/motiv Central Nervous System Autonomic Nervous System Bodily States Environmental Events Endocrine System Immune System Motor/Action System Heart Vasculature Bodily State Feedback

Response Systems..

Netter (1962) CIBA collection of Medical Illustrations. Pp

Functional Responsivity of the Autonomic 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 STRESS?? STRESS??

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

Organized behavioral/autonomic action

Controversial translation of stressful thoughts to physiology

Stress 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)

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.

The Stress Experiment

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.

Issues in Cardiovascular Reactivity Generality over instances within individual, over stressors, over life span Generality over instances within individual, over stressors, over life span Variety of reactivity—cardiac, vascular, vagal, sympathetic…. Variety of reactivity—cardiac, vascular, vagal, sympathetic…. Source of reactivity—genetic, affect, stressors Source of reactivity—genetic, affect, stressors Person-Environment interaction Person-Environment interaction Activation or Recovery? Activation or Recovery?

From web SuperCourse

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

From Gianaros et al., Psychophysiology, 2005

From Gianaros et al., PSOM Med, 2005

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. Behavioral focus can ignore restorative processes responsive to bodily afference. Behavioral focus can ignore restorative processes responsive to bodily afference.

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.