Transcript Stress, Emotion and Health: From Society to the Individual

Biology of Resilience: Oxytocin, Positive
Adaptation, and Health
Laura D. Kubzansky, PhD, MPH
Harvard School of Public Health
Workshop on Advancing Integrative Psychological
Research on Adaptive and Healthy Aging
NIA / IPSR University of California, Berkeley
May 21, 2009
Psychosocial Distress vs.
Conventional Risk Factors for Acute
MI: The INTERHEART Study
Attributable
Risk =
32.5%
Psychosoc Index
Curr Smok
Alcohol
Exercise
Fruits/Veg
Abd Obesity
Hypertension
Diabetes
ApoB/ApoA-1
0
1
2
3
4
5
Relative Risk
From Yusuf et al. Lancet, 364:937-952, 2004
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Can Emotions Confer Resilience?
Emotional Vitality and CHD
Estimated Survival Function
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Low
Medium
0.95
High
0.9
0.85
0.8
0.75
0
2
4
6
8
10
12
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Person-Years of Follow Up
Adjusted for known coronary risk factors & depression
From Kubzansky & Thurston, Archives of General Psychiatry, 2007
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Informing the Agenda on Resilience
and Disease Prevention
• Positive factors are more than the absence of
negative factors
• Findings for positive and negative emotion
importance of regulating emotion
• Leads to a life course perspective on emotion
– Biologically basic
– Learning to regulate is a major developmental task
with consequences for later adaptation
– Patterns of response shaped by social processes
– Significant neurobiological component
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Emotional response patterns start early, are
shaped by social processes, and have cumulative
health effects over the life course
What is the underlying neurobiology?
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Neurobiological Underpinnings:
Oxytocin, Stress Buffering, & Resilience
Positive Social
Interaction
OXYTOCIN
RELEASE
• Inhibits stress-induced responsivity of
HPA axis
• Central regulator of attachment and
prosocial behavior
Attachment or
Bonding
Effective
Emotion
Regulation
OXYTOCIN
RELEASE
Sustained
Anti-Stress
Effects
& Growth
HEALTH
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Neurobiological Underpinnings:
Oxytocin, Stress Buffering, & Resilience
Research in progress…
• Established the Society & Health Psychophysiology
Laboratory
• Studying biological & behavioral effects of oxytocin
and social support on stress response in humans
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–
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Experimental methodology
Placebo-controlled double blind design
Manipulate oxytocin and social support
Measure cardiovascular, neuroendocrine, affective
responses in men and women
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Stress-Buffering Effects of Oxytocin
& Social Support: Preliminary Findings
Change in Systolic BP by Social
Support Condition
Change in Systolic BP by Oxytocin
Group
Alone
Friend
Placebo
Oxytocin
25
Change in SBP
Change in SBP
25
20
15
10
5
0
20
15
10
5
0
Baseline
Speech
Count
Study Interval
Baseline Speech
Count
Study Interval
From NIA R21: Biology of Resilience: Oxytocin, Social Relationships, and Health
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Stress-Buffering Effects of Oxytocin &
Social Support: Preliminary Findings
Placebo
Oxytocin
4
3
2
1
0
-1
-2
-3
Baseline
PostSpeech
Study Interval
PostCount
Change in Positive Affect
by Social Support Group
Change in Positive Affect
Change in Positive Affect
Change in Positive Affect
Score by Oxytocin Group
Alone
Friend
3
2
1
0
-1
-2
-3
Baseline
PostSpeech
PostCount
Study Interval
From NIA R21: Biology of Resilience: Oxytocin, Social Relationships, and Health
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Stress-Buffering Effects of Oxytocin &
Social Support: Preliminary Findings
Change in Negative Affect
by Social Support Group
Change in Negative Affect
Placebo
Oxytocin
1
0.5
0
-0.5
-1
-1.5
Change in Negative Affect
Change in Negative Affect
Score by Oxytocin Group
Alone
Friend
2
1
0
-1
-2
Baseline
Baseline
PostSpeech
Study Interval
PostCount
PostSpeech
PostCount
Study Interval
From NIA R21: Biology of Resilience: Oxytocin, Social Relationships, and Health
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Neurobiological Underpinnings:
A Cells to Society Approach
Link molecular / cellular information with higher
level adaptational processes …
• Molecular mechanisms underlying effects of
emotions
– How do these get laid down over time?
– Set up trajectories for future outcomes?
• Translate questions derived from population-based
research into experimental studies
– Elucidate mechanisms
– Address concerns of reverse causality or spuriousness
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Core Research Team
• Gail Adler, MD
• Jason Block, MD
• Markus Heinrichs, PhD
• Wendy Berry Mendes, PhD
• Research Assistants and Study MDs
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General Model of Emotion and Health
Social
Context
Personality
Benign
appraisal
Appraisal of
demands and
coping capabilities
Perceived
stress
Positive emotional
responses
Negative emotional
responses
Physiological
responses
(immune, ANS, HPA)
Disease
Processes
Behavioral
responses
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Distress and Incident CHD:
Prospective Epidemiologic Studies
Depression
Anxiety
Haines, 1987
Meta analysis, 2002
Williams, 2002
Mallon, 2002
Yasuda, 2002
Wassertheil-Smoller, 2004
Marzari, 2005
Rowan, 2005
Empana, 2005
Egede, 2005
Wulsin, 2005
Sundquist, 2005
Empana, 2006
Kamphuis, 2006
Thurston, 2006
Boyle, 2006
Bremmer, 2006
Sturmer, 2007
Eaker, 1992
Kawachi, 1994
Kawachi, 1994
Vogt, 1994
Kubzansky, 1997
Haines, 2001
Yasuda, 2002
Nicholson, 2005
Eaker, 2005
Albert, 2005
Ringback Weitoft, 2005
Thurston, 2006
Boyle, 2006
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8
0
1
2
3
4
5
Relative Risk
Relative Risk
From Kubzansky LD. Cleve Clin J Med, 74(Suppl 1):S67-S72, 2007.
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Pathways Between Emotion and CHD:
Cumulative Effects
• Biological pathways (direct effects)
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SNS, HPA activation
Electrical stability of the heart (HRV)
Platelet aggregation and thrombosis
Immune function/inflammation
• Social and behavioral pathways (indirect
effects)
– Health behaviors (smoking, physical activity)
– Coping resources
– Social relationships (emotions promote / disrupt)
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Benefits of Healthy Psychological
Functioning
• Flexibility
• Rapid recovery from negative experiences
• Enhanced resources
• Positive and negative emotions are not bipolar
ends of a continuum
• Capacity for managing emotions
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General Model of Emotion and Health
Social Environment
Physical Environment
Personality /
Temperament
Emotional
Responses
(positive or negative)
Behavioral
responses
Biological
responses
Health &
Disease
Neurobiology
Early Life
Adolescence
Adulthood
Later Life
Childhood Psychological Attributes
and Adult Physical Health
Adult Self-rated Health
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3
0.3
2
0.2
1
0.1
0
0
-1
0
1
2
3
Adult # illnesses
Adult SRH
Adult
0.4# illnesses
4
Childhood Distress
Adjusted for SES, sex, race/ethnicity, child health
From Kubzansky et al., Health Psychology, In press.
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