Brain Mind and Behavior: Emotions and Health

dr. Jason Satterfield is assistant professor in the department of general internal medicine and he's also director of the behavioral science component in medical education and as well see in a minute that's a huge huge job he has to do he received his PhD from Penn State University or do am I saying that correct University of Pennsylvania sorry and and has many many interests many of which revolve around depression so how do we look at depression how does a depression affect illness and in fact that ties in nicely with what we learned about two weeks ago when dr. Hamilton showed us some data how people who just had a heart attack if they were also depressed it really affected how well they did so a doctor center-field knows all about those sorts of things as well in as we like to model this course on what our students in a medical school see and our students are very lucky that we're not just teaching them basic sciences but we also have faculty like dr. Jason Satterfield because as we are busy trying to take teach them all the techniques and all the anatomy and all the basic science in the end our students need to become not just technicians but really healers who understand our patients and so dr. Satterfield fields role as director of behavioral medicine is make sure this content and these skills are taught to the first-year students the second years that there are deers 240 years and also to the residents so if you encounter a really nice doctor who trained at UCSF you have to think thank dr. J sir centerfield so having said that let's go and listen to dr. centerfield hey thank you thank you and welcome to everyone tonight we're going to be talking about a fairly broad and I think fascinating field looking at the relationships between our emotions and our health we'll also be looking at different potential interventions to manage our emotions that we believe can have important health consequences just to give you a sense of where we're going to be going today I'll be talking for about a hour to hour and 15 minutes we'll have about 20 to 25 minutes for questions after that we're going to start off talking about some of the basics around emotions calibrating our language we'll do a quick run through some of the physiology how emotions affect our body will go through stress basics we're all I believe familiar with stress we know what it feels like we'll talk a little bit about how to cope with it and how it's related to disease we'll then look at some specific examples we'll look at stress and immune function we'll look at anger and cardiovascular disease and we'll look at depression and a number of different physical illnesses so first we should talk just a little bit about what our emotions we all have emotions in fact we believe that most animals have emotions at least in some rudimentary form I first wanted to distinguish the difference between emotions and feelings and I sometimes slip and use those two interchangeably but they're really different we think of emotions as fairly basic body based processes that are fairly old in terms of evolution they've evolved in fairly central centers of our brain called the limbic system and I'll be showing you some pictures of the limbic system in just a few moments and contrast feelings are something that involve higher cortical functions so there is an emotional charge there's a physical component to a feeling but there's also a cognitive overlay there's there's beliefs there's values there's ethics there's morality there's predictions about the future that's linked to memories in the past so it's really much more complex and we believe that only humans and some people would also say how your primates have feelings emotions though are really the basic building blocks that we're going to be talking about today so why would we have these basic building blocks we believe they're there for a reason their primary function is to communicate important information that helps us function in the world that information might be about our relationships with other people you love or are drawn to another person it might be about particular situations you are afraid of heights you're afraid of dogs so they actually push you away from those situations in an attempt to help you so we think of emotions as either pulling you closer to something or someone or they push you further away from something or someone sometimes they are absolutely adaptive and they are helpful they're right on the money our intuition is dead-on other times it's a misfire it's simply not a good use of energy it's a misinterpretation of a relationship or a situation we do believe that emotions are universal and by universal it means that regardless of the country in which you were born your education level your racial or gender background we all have these same sort of building blocks of emotions some of the work done by Paul Ekman who is also here at UCSF he's a psychiatrist this was work done in in the 60s and 70s where he actually began looking at facial expressions he took pictures of different facial expressions around the world to different cultures and asked people to tell him stories in their native language about what just happened to that person from the results of those studies in various different cultures he deduced that there are six primary emotions happiness surprise sadness anger disgust and fear now we obviously have much more complex emotions and certainly much more complex feelings than that he makes the analogy of of painting or of thinking about colors where we have a very small set of primary colors but you can blend those colors together in an almost infinite variety of different shades to create the the beauty of a painting or or the beauty of the emotional richness that we have in our relationships so I'm not going to show a lot of brain pictures I think it's much more interesting to tell stories about people and how our brains are working but just to give you a little bit of an orientation of when we talk about emotion sort of what's happening in the brain and where it might be happening some of you may have seen this already but just to remind you over here on the left hand side this is if you were facing your left the eyeballs would be about right here or so this is a picture of the outside over on the right hand side this is the a brain that has been made transparent on the outside we're looking through to the center the sort of golden colored areas are the limbic system and I just wanted to point out a couple of key areas in the limbic system the first I wanted to point out is the amygdala it's this little almond shaped structure here and I think of the amygdala as the brains homeland security system so it's meant to detect threats it's meant to be helpful to help you face dangers however the alerts are often so vague contain so little information that it gets everyone worried and you're not quite sure what to do about it so this is your amygdala absolutely functional at times absolutely dysfunctional and unhelpful at times right behind the amygdala we have the hippocampus the hippocampus is important for memory but also important for emotion based memories and the way I think of the hippocampus it's sort of like the keyboard that enters data into the computer so if you have an individual who has damage to their hippocampus they often are able to retain memories earlier in life but they're unable to lay down any new memories the keyboard to that computer has been broken so they're not able to enter any new data it's also important to remember that the hippocampus is situated right in the limbic system where which is really the the older more primitive seat of the emotions so a lot of those memories that the hippocampus is helped helping lay down in our brains are emotionally charged memories the thalamus is the last structure I wanted to point out it's this larger spherical structure in the center and I think of the thalamus as the sense sensory relay station so it's some copies divides and sends out different signals visual signals auditory signals to different parts of the brain what happens or we really have several different areas of our brain that try to interpret data both for emotions and also for other content we have our limbic system which has its own sort of quick and dirty fast response system and then we have our frontal lobes and really what makes humans humans are our frontal lobes we have these massive frontal lobes in comparison even to chimpanzees or other primates and the prefrontal cortex which sits about here is is probably the the youngest and the most advanced part of our brain in that part of our brain it's responsible for impulse control it's irresponsible for delayed gratification it's responsible for executive functioning for complex decision-making for really weighing through the pros and cons of a very complex difficult and probably emotionally charged decision it's important to remember that these systems don't don't operate in isolation so your limbic system which would be in the center here is very much in communication with your frontal lobes your frontal lobes are slower they're much more advanced they're much more complex but they're a little slower so a typical sort of emotional communication between the limbic system in the frontal lobes would be that blip of initial anger when someone say cut you off or yells at you for no good reason your frontal lobes then can either amplify that sensation of anger you start to imagine what you're going to say back or you start thinking about the last time they did it it amplifies the emotional sensation or the frontal lobes can dampen that emotional sensation her saying well probably wasn't directed at me maybe they had a bad day we're all just trying to get home after work and it really again sort of turns down the flame on the anger but it's that relationship that intercommunication between the limbic system in the frontal lobe that's important in helping us to understand why some emotions get bigger and why other emotions die out relatively quickly it's important to remember too that we can think about emotions not just as these physiologic constructs we can take some some pointers from the field of psychology and think about emotions as a body based process but also look at their interrelatedness to both thoughts and behaviors in other words the way you feel your emotions are going to affect the way that you think and by thinking that means what you remember what you selectively attend to that's in your present what you imagine might happen in the future the images that come to mind even the songs or or images that might come to mind they're affected by the way that you feel and vice versa your emotions also affect what you do so the behavioral choices that's what you do at work who you talk to how you spend your free time your hobbies even the my new activities from how long you take a shower to maybe the more planful activities like taking a vacation with friends but they're all interdependent with emotions thoughts and behaviors a psychologist would say yes we can physiologically change your emotions by giving someone a tranquilizer by giving someone an antidepressant but we can also change your emotions if we change the way a people a person thinks or if we change the way a person behaves changing the behavioral choices that they make a little bit later we'll talk about cognitive therapy and how it has been adapted that exact same triangle has been adapted to help people manage and change their moods if we explore a little bit further about the function of emotions they have different emotions they serve different purposes and they have different needs and general they cause us to approach or to move closer to someone or something or they push us further away but they're much more specific than that cognitive psychologists talk about the different cognitive themes behind some of the emotions and these are just a couple of examples a person tends to feel the emotion of anger when there is a perceived violation injustice or a frustration of their wish or desire that's usually the thought or the theme that's paired with the emotional sensation of feeling angry it's not to say you're right it's not to say that it's even particularly rational but if you were to pull out the cognitive content that's related to that feeling that's what it would be for happiness it's usually the perception or the expec of gain could be physical gain it could be emotional gain it could be a symbolic gain anxiety or fear is really two different things it's a perception of threat there's something dangerous that's out there coupled with the belief that you might not be able to face it so there's something dangerous out there and it might get me I can't run fast enough I can't fight it so you feel the anxiety or fear sadness is a perception that something of value has been or will be lost and we're not talking about clinical depression here we're talking about sadness or the everyday depression that that all of us feel the question still remains though about emotional triggers we've all had these emotions at some time or other we all may have very different set points some people may be intensely emotional some people might not be as emotional have sort of a more stoic presentation you may know some people that are very prone to anger some people that are very joyful and full of laughter some people that tend to be kind of prone to sadness the the Eeyore's of the world so the question then is is what is it about our environments or what is it about us that cause us to be drawn or to gravitate towards one emotion or the other so I thought we would just do a quick exercise I'm going to show you some pictures I have I think it's about six pictures or so I'm there just a various things and I want you to write down the emotion it evokes in you okay so there's no right or wrong answer I'll ask for a few volunteers when we finish the six pictures to share what you wrote down but just jot it down in the margins or on a piece of paper I'm going to show you six pictures and I want you to write down the emotion it evokes in you okay so here's picture number one so what emotion does picture number one evoke in you how do you how do you feel when you see that I just write that down and we'll come back to it picture number two what emotion does that evoke in you there's no right or wrong answer just about your experience picture number three what emotion does this evoke in you a picture number four what emotion does this evoke in you and picture number five it's always good around dinnertime right what emotion does this evoke in you hey we have one more picture number six what emotion does this evoke in you all right let's go back up to the top and let's see what folks had so how about some some volunteers just raise your hand and tell us what the emotion you wrote down for for this one yes and back happiness tenderness indifference okay yes in the back joy how about a fatigue is there a so it's a it's a fairly emotionally evocative picture but we still have a range from indifference to joy to happiness let's look at the second one a little bit different picture so what did people feel yes sadness fear what else 911 surprise help right so this sense of urgency there's there something that's that's going on confusion right so there's there's confusion sometimes when we show this picture we get annoyance because people think oh no no now I have to do something yeah yes the place what's your feeling so it's just what you're feeling your emotional experience so this is a picture actually from Marin County Breast Cancer Campaign and the tagline was women are dropping dead and no one cares so was meant to be certainly evocative hey we still have same stimulus or a range a range of responses from you guys how about with this one a little more ambiguous about what it is so why'd you feel what did you feel when you looked at this picture yes confusion curiosity yes Vegh it's fake okay uh it is vague what else fear uncertainty sadness so we have a pretty big range of different emotions we're all looking at the same picture here but we're feeling different emotions and I would say the physiological processes that are going in our bodies although fairly small these aren't super intense feelings those physiological processes are different this is a picture from an art therapy group and a psychiatric inpatient hospital and it's a patient who's clinically depressed and it was a pictorial representation of his depression it's actually a male figure sort of walking through this darkness how about this one anxiety fear worry humor so we're getting a range again looking at the same pictures but we're getting a range I'm getting a little more of an anxiety flavor from most people this is a picture from a social phobia workbook and it's meant to it's called scrutiny so people are supposed to feel self-conscious when they they look at that how about this one whenever I've shown this picture I usually get about 98% disgust but there's always 2% of something else and I wonder if it's here curiosity that's close yes awkward so there's a humor people see and maybe it's because she's kind of of grinning and laughing some people find it humorous most of us I think is kind of of gross and disgusting but this is a a high school science teacher and she was doing a demonstration for her high school science class about how bugs are our friends so not sure about the one going up her nose but and how about the the last one here so this is certainly more ambiguous what are the feelings intrigue fear surprise others interest interests yeah content so pretty big range of responses different emotions different physiologic signatures associated with those emotions our bodies are doing different things our limbic systems are doing different things same stimulus that's here what's happened is that whenever our environment gives us less data whenever whatever we're looking at or hearing is more ambiguous we have to insert more of our subjective selves into it we have to make our own read of what's going on we have our own interpretation based on partly that ambiguous stimulus but also partly on how we just happened to interpret it it's kind of like a Rorschach inkblot so the whole idea was based on the fact that the more ambiguous the stimulus the more of your personality you have to use to have a response to that stimulus this is actually a fairly well-known picture by Magritte called the healer and I won't interpret it I can interpret art however you want so the question was what emotion goes with with whimsy I would just say I don't know if it's an emotion or a feeling but in enjoyment pleasure so what we've done in just sort of a quick fun demonstration is to show that we can all experience the same stimuli in this case it's a set of slides it's a set of pictures we can have a very different emotional reaction and I would push that a little further to say that we might even have our own set of emotional habits our own leaps of faith that we make and trying to interpret different situations in our world some of us may leap to anger some of us may leap to pleasure some of us may leak to curiosity some of us may be sad some may be anxious it's not to say that it always happens that way but I think knowing your emotional habits is important in understanding why you get stressed or not in certain situations and in understanding your potential risk for disease if you're a person who's more prone to hostility or more prone to depression there may be different physiologic consequences as a result of that emotional habit so let's talk about what some of those consequences might be I first wanted to do just a quick run-through of some of the history of what I'm calling mind-body medicine and and the mind part of mind body includes emotions it includes cognition sort of the things we've been talking about already and I think in this day and age it's a fairly well accepted notion that the way you feel or the stress that you experience affects the way your body functions it makes sense your brain is an organ in your body all of your organ systems are connected so something's happening in your brain it's probably going to affect the rest of your body and vice versa with all of the other organ systems but it took a while for us to really get to that point where we're able to say I think with with fair fairly good certainty that we're beginning to understand how stress how the physiologic manifestations of stress affect our bodies how this story began to unfold I actually start back around world war 1 or as World War 1 was ending there was not at the time this concept of post-traumatic stress disorder or what eventually became shell shock there it just didn't exist at all this notion of mind affecting body wasn't something that was well accepted so as the soldiers began to come home from Europe to the UK and also to the United States that they had seen a lot of a fairly horrific conflict in combat a lot of them had post-traumatic stress disorder we didn't know what that was at the time unfortunately they were accused of malingering they were denied their benefits in the United States and in the UK they were actually charged with crimes and jailed for malingering there was a huge public outcry to this as you might imagine a lot of federal funds here and in Great Britain were pushed towards looking at what is this new malingering syndrome they eventually called it shell shock where they talked about how a physical a person's physicality their body could be intact but because of the psychological damage of war they were experiencing physiologic symptoms when they came back of course launched this whole field of study of looking at poke event what eventually became post-traumatic stress disorder through these different series of steps that I've outlined in the 30s we had Hans celje doing some of his seminal work looking at stress responses in rats he discovered them quite by accident he was an endocrinologist who happened to be a fairly terrible lab technician so he often dropped his rats he didn't feed his rats he was giving them injections and he would break the needle he was essentially a dope in the lab he discovered much to his surprise that all of his animals developed what he called a general adaptation syndrome they were essentially developing ulcers they were developing tumors they had enlarged thymus glands they had all of the effects of what we know as a chronic effects of stress fortunately for him the light bulb went on he was not charged with animal cruelty and he went on to really essentially found the field of mind-body medicine fast forward ahead to this day and age fortunately a lot of the groundwork done looking at the relaxation response or the opposite of stress the countr response to stress complementary and alternative medicine really coming into the forefront of our consciousness in the 90s and now we're using a term called integrative medicine we're finally lo and behold we're realizing that we need to not just talk about an individual as if they are a collection of cells but they are a human being with personalities with psychologies with emotions and with spiritualities even and we're realizing that in order to truly understand health of disease we need to understand the interrelationships of all of those let's take a moment just to review some of the basics of stress and why person a may be extremely stressed when person B in the exact same situation may be as a cucumber no stress whatsoever in order to understand those differences in responses it's important to know what's happening cognitively or sort of the middle step so first you have a potential stressor let's say that you have to study for an exam stressful for some people not stressful for others when an individual is told they have an exam a couple different things would happen they first make a primary appraisal does the test matter do exams really matter to I really care about my grades is this going to be a big deal or not the secondary appraisal is their estimation of their capacity to cope am i a good test taker do I know the material do I know how to study can I cope with this potential threat that's on the horizon it's the combination of primary and secondary appraisal that helps us understand who has a stress response and what magnitude stress response that's going to be if you believe it's a hugely important event your primary appraisal you have no resources to cope to cope with it you're going to have a fairly robust stress response and remember with a stress response we're not just talking about something that's physiologic we're also talking about changes in cognition when people are stressed they develop a sort of tunnel vision and cognitive and efficiency they have emotional responses they may become angry or irritable and may be behavioral consequences and we'll talk about some of those when we talk about stress and disease it's important to remember that there are three pathways that stress can be related to disease they are not mutually exclusive in fact I think all three of them are often at work so we have this experience of stress it can affect you through the direct physiologic effects and we're going to walk through two different stress response systems that can affect your body it can be health habits unfortunately when we are stressed we tend to do the exact opposite of what we need to do to counteract the negative effects of stress when people are stressed they sleep less they eat worse food they drink more alcohol they smoke more cigarettes they do less with their social supports so in general they're amplifying the negative effects of stress this last category here the health behavior effects I really think of that as medical compliance oftentimes people who may have been quite successful it's a managing their diabetes have a fairly substantial stressor that comes along and suddenly they stop checking their blood sugars they fall off their diet and they stop keeping their doctor's appointments and you may have all three of these pathways contributing to the advancement of their disease the physiologic effects health habits and health care or medical utilization so we mentioned I was going to talk about two different stress response systems these are the physiologic stress response systems one is relatively quick and dirty it's it's relatively short-lived the other is slower to start but lasts much longer so first I just want you to look over to your right so we're here on the right you have this stress or this perception of stress it starts in your brain you have to notice something you have your primary and your secondary appraisals you have the activation of what's called Sam or the sympathetic adrenal medulla assistan Sam the sympathetic adrenal medulla system and just think of this as the fight-or-flight response we've all had that before we've had that surge of adrenaline your heart rate goes up you feel a little tense you feel a little on edge your body is preparing you to either fight or flee very adaptive simple mechanism it can happen in an instant but it also fades fairly quickly on the left-hand side to your left we have something called the HPA axis that stands for hypothalamic-pituitary-adrenal axis so HPA axis it's much slower but it lasts a lot longer and instead of using adrenaline it uses a stress hormone called cortisol and we've all probably heard of cortisol before we need it it helps us to regulate our blood pressure and cardiovascular function it also helps us in storage and retrieval of energy but if you have too much cortisol and say prolonged stressful periods we also know that it can have negative health effects now let me just say one word about this unfortunate individual he has one adrenal gland it's in the center of his abdomen this is not anatomically correct your adrenals actually sit on top of your kidneys so you have two adrenal glands so this was just for the sake I think of making it a little more simple I know you've heard some about depression and cardiovascular disease and maybe some about stress and cardiovascular disease but I just want to walk through this map maybe in a little more detail of how those two stress response systems the sympathetic adrenal medulla system fighter flight and the HPA axis cortisol can be related to say having a heart attack now we know from the epidemiologic literature that there's a number of at first bizarre phenomenon that happen and really the only way we can explain them is to look at the relationship between psychological stress and cardiovascular disease some of those bizarre phenomenon are more heart attacks occur on Monday than any other day of the week there's no real good physiologic reason for that other than people tend to go to work on Mondays and there's a lot more work stress on Mondays there are more heart attacks and reports of chest pains following large stressful events if you look at the number of heart attacks in New York after 9/11 they actually skyrocketed if you look at the number of heart attacks or reported incidences of angina or chest pains they skyrocketed after the Loma Prieta earthquake so again there's no good physiologic reason for that unless we look at the relationship between stress and cardiovascular physiology so if you just move from left to right on this figure you start on the left with mental stress it can be real or imagined you're making your appraisals it causes the activation of the sympathetic adrenal medulla system that fight-or-flight activation of HPA you get cortisol you get a surge of catecholamines this is norepinephrine or adrenaline it causes an increase in heart rate causes an increase in blood pressure so your body's really gearing itself up to face this perceived threat now it's a little bit different though and a person who has pre-existing cardiovascular disease they already have a system that's damaged either their heart muscle has been damaged maybe they had a heart attack before their blood vessels may have been damaged they may have hardening of the arteries they may have already developed some some plaques or possible occlusions of their arteries that have narrowed or limited limits the amount of blood that can reach tissues in need what happens so here's our background factors here what happens is as the system is gearing up your heart's beating faster your blood pressure's going up cardiac demand is going up so your heart tissue just needs more oxygen to work harder unfortunately if you have this pre-existing disease either your vessels cannot dilate to increase supply to meet that demand or you may have something called paradoxical vasoconstriction and people who have diseased arteries can have that at time so instead of dilating they will actually constrict what's happening is your demand is going up up up supplies not meeting demand so your heart is starting to get starved for oxygen it's creating what's called an ischemic environment if you have an in skimming environment it causes more electrical instabilities your heart loses its rhythm it's a fairly complex and coordinated rhythm may have an arrhythmia they may they may have an arrhythmia that's here a ventricular fibrillation or their heart starts beating really quickly they're in there ischemic environment other things that might happen those plaques may actually rupture and break free they move further downstream and they completely block a particular vessel the story is getting worse and worse the pictures getting more graham the heart tissue is becoming more and more stars for oxygen eventually you have an outcome like a myocardial infarction or you have a heart attack where the oxygen supply is cut off and the muscle tissue actually starts to die as a consequence so the comment was about some preventive measures and especially if you are a person that has some of these background factors it's important to consult your primary care physician to consult your cardiologist and aspirin nitroglycerin there's a number of other things that you can take to try to counteract these effects to increase the supply that can meet the demand that may result from psychological stress there are ways to fight back you're right and we're going to go through some of those ways that's the relationship between stress and cardiovascular disease I wanted to talk a little bit about the relationship between stress and immunology and I wanted to talk about a relatively new field of psychoneuroimmunology or the relationship between how psychological states like emotions are related to how well our immune system functions and to do that we just need to do a quick run-through immunity very complex very elegant a system I think it is the unsung hero of medicine and of med schools but I want to just to not do it justice but to do a quick run through these two different systems that can be affected by both acute short-term stress or chronic stress so if we think about our immune system really our best immune organ is our skin so it's absolutely the best at keeping out pathogens so keeping out bacteria viruses fungi whatever it might be but things happen either we have mucous membranes that absorb a bacteria or we get a cut or a breach and our skin and what happens is on the left hand side we get these invading pathogens now we have a first line of defense these free-floating immune cells like natural killer cells or phagocytes that are fairly generic and fairly effective killers so they will kill anything that isn't identified as part of you this is part of what happens if you have an organ transplant that organ is not part of you and your immune cells start to try to kill that organ they're not particularly intelligent they just try to kill anything that's not labeled as you there are a few particles however that managed to slip through the first line of defense unfortunately the system is elegant system has a backup some of these cells actually break off parts of this pathogen they carry them back to our lymph nodes to our spleen to our thymus and they tell the second line defense here's what just invaded you guys get to work you need to start making some specific immune cells that kill seek out and kill just these pathogens so this is a much more specific but much slower backline immune system the downside of this is it takes three to seven days for the second line of defense to kick in so we have our first line defense those cells are already there they're already freely circulating they do most of the work but oftentimes this backline defense takes up to a week for it to kick in needs to adapt sales to specifically and more effectively kill these pathogens so if you want to look at the relationship between stress and immune function then you have to ask yourself does stress exert its effect on the frontline immunity or does it exert its accept its effects on the backline of immunity or maybe both of those so researchers have had all sorts of fun trying to figure out this relationship yeah so that's a good question so so the question was where two antibiotics where two antibiotics come in so antibiotics there's broad-spectrum antibiotics and there's very specific antibiotics depends on the type of bacteria that you have so usually there will be a screen of some sort to decide what type of bacteria you have and what family of antibiotics would be most important you take those antibiotics and I think of those antibiotics as more similar to backline defenses they are specifically designed or at least designed close enough to kill that specific bacteria that you've invaded for particular kinds of bacteria they just don't work at all you have to be prescribed the right antibiotic and you may have had the experience you took a full course of antibiotics didn't do that much good because it wasn't the right antibiotic to affect the pathogens that you actually had okay so researchers have had all kinds of fun trying to look at this relationship between stress and immune function one of the earlier studies done was by Sheldon Cohen and he wanted to start with this notion that stress makes you more susceptible to catching a cold and I think a lot of people believe that to be true but he wanted to test out whether or not that common-sense model is actually true or not so what he did was recruit about 400 subjects he got them to sign a consent form saying that they were willing to have a rhinovirus or a cold virus squirted up their nose and they were willing to fill out a bunch of questionnaires and personality measures he wanted to look at the relationship between how stressed are they when I squirt that virus up their nose and who goes on to catch a cold he also to try to control for as many external variables as possible he had them quarantined in a hotel room for up to three weeks depending on how long they're cold lasted so he didn't want them to be exposed to other viruses from other people squirt the virus up their nose lock them in their hotel room send them room service all the time so maybe wasn't that bad to be a subject in the study he also wanted to have a fairly objective measure of how severe the cold was subjective reports are important but he wanted to be more objective so he asked them to save all of their bodily secretions all of their mucus if they coughed anything up every time they blew their nose everything had to be saved and it was weighed and it was measured and they examined it for viral shedding or the number of viral particles that were in those different secretions so he had subjective reports but he also had some fairly objective albeit somewhat grotesque methods to be a little more precise what he found is pretty much what we knew already when we are really stressed we are more susceptible to catching a cold when we are really stressed the cold that we catch is more severe and it lasts a lot longer so yes indeed common sense again proves to be true a slightly different approach was used by the key cult glaziers Janus and Henry who are in Ohio they wanted to look at stress in wound healing of course it involves immune function involves inflammatory responses sort of a more sort complex level of looking at immune function and stress they went to students and they actually went to dental students and they got a relatively small sample of dental students that were willing to have a hole punched in their hard palate so that's a kind of a small but I would think somewhat painful injury a wound and then they would come back every day and they would measure how well that wound was healing and this is just a picture of the wound and the this is the center part hasn't healed yet and you can see the pink part that has actually healed already the idea was they would actually make two different wounds they were going to puncture their hard palate in the summer when there was no school no exams relatively little stress and then they were going to puncture their hard palate again right before exams at the end of the the fall semester a lot more stress they figured it would take a lot longer the thing that was clever about this study is that each subject can serve as his or her own control they've had two holes punch so they look to see how long did it take John's injury to heal in the summer versus how long did it take John's injury to heal when he was near exam time and they could compare every subject that way so this is what they found the dark bars are these are the number of days it took to heal the dark bars are low stress periods and the striped bars are high stress periods so you can see for every subject every single subject it actually took longer to heal when they were in a high stress period now for some of these like the subject here doesn't seem like a huge difference for others like this subject here here there's really a large difference between how long it took to heal now it doesn't take a lot to it strap elate this to say surgeries now there are wounds that are certainly inflected inflicted when a person has surgery I think one thing that we should be doing before a person goes to surgery is measuring their stress levels and if they're stressed putting them through some fairly effective and intensive stress reduction measures before the surgery and then after the surgery if we want to minimize the time it takes for them to heal in general the summary of the field of psycho nerium immunology is as follows short term or acute stress temporarily improves frontline immunity but it suppresses backline immunity and if you think of that from an evolutionary perspective if you're in a fight or flight situation and you get injured you get cut you get bitten you want that all your energy all of your limited resources up front to try to kill what are there pathogens about to invade your body you only have limited resources so you have to take that energy from the backline immunity to beef up your frontline defenses it's a different story though when we have chronic stress chronic stress is suppressed frontline immunity it also suppresses backline backline immunity our second line of Defense's our bodies really weren't made for these chronic stressful States that we find ourselves in in these modern times we were made for fighter flight we were not made for chronic nine to five stress day after day after day after day but that's what our bodies are trying to adjust to now now a completely different set of emotions but some something that I think is certainly related to stress and certainly has an important physiologic consequence is anger and in particular I want to talk about hostility but to do that I wanted to take a step even before that and talk about some of the research by Meir Friedman he's he's here up in the corner he is a cardiologist in San Francisco founded the Meyer Friedman Institute he actually had a rather tawny private practice I believe in Pacific Heights for cardiology patients saw a rather wealthy clientele he discovered type A personality quite by accident again he wasn't particularly interested in mind-body medicine he was interested in having nice furniture in his waiting room so he invited a furniture upholsterer to his waiting room he thought his chairs were looking a little worn in Polster ER took measurements and counted the chairs and was going to give an estimate gave him the estimate and said well you know dr. Freedman I don't mean to pry but I have to ask you what kind of patients do you see this is the most bizarre wear pattern on the chairs I mean it's it's not the top that's worn it's the front of the arms like someone's fidgeting their hands all the time it's the front of the seat like someone's bouncing their legs up and down all the time must really have some agitated people who come here Maya Freedman had the light bulb go off for him and he realized wow the guy's icy and it was mostly men that he saw in his practice the men that I see here are really kind of irritated and impatient and angry and driven and competitive what he eventually called for unknown reasons type a behavior pattern which he defined as a behavioral and emotional style mark by aggression an unceasing struggle to achieve more and more and less time often in competition with others he identified sort of three important elements to that easily aroused hostility time urgency and competitiveness so easily aroused hostility time urgency and competitiveness now since then there have been a number of studies trying to pull apart which of those factors are most important in terms of understanding its impact on our health and it seems like the only one that really carries any punch is easily aroused hostility so if you're a little urchin about time no worries if you're a little competitive no worries if you're someone who has easily aroused hostility or cynicism then you might want to pause so how do we measure hostility this is the cook medley hostility scale it's actually a much longer scale but I just wanted to give you a little bit of a flavor of some of the items these are all answered true or false first question is no one cares much what happens to you true or false I've often that people who are supposed to be experts who are no better than I true or false some of my family have habits that annoy me very much true or false people often disappoint me or it is safer to trust nobody now if we're honest I think we all get a few points on the cook medley hostility scale what's typically done in research studies is they will take the top 25 percent so the the quarter that scores the highest on the full measure and it's those individuals that they look at to see what the physiologic consequences of are of being hostile often there are actually over 2,000 studies now linking hostility to cardiovascular disease so clearly not going to present all of those but just wanted to give you a couple of studies that I thought were especially noteworthy one is by Karen Matthews this was published just a few years ago this one's noteworthy because she looked at such a young Sam 'pl she looked at students that were 18 to 30 years old now we don't think of cardiovascular disease and in people who were that age and in fact they didn't have cardiovascular disease but she knew that even at that age you might show some precursors for later cardiovascular disease and in particular she was interested in coroner a calcification so so laying up calcium deposits in your arteries which paves the way for hardening of the arteries later what she found is that hostility in about in 374 young students predicted calcification of their arteries ten years later so even in that young sample being high in hostility ten years later predicted calcification of their arteries and I would say if she followed them twenty years thirty years a lot of these same students would be the ones who are having heart attacks in their 40s and in their 50s this second study I thought was notable for a few different reasons there was a lot of racial and ethnic diversity it was a fairly long follow-up and they had some pretty dramatic findings it was a four and a half year a longitudinal prospective study of thirteen thousand white and african-american men and women they found that anger in the sample actually tripled the risk of having a heart attack or SCD a sudden cardiac death even after controlling for smoking diet weight all of the usual hypertension all of the usual risk factors so really it was this trait of anger that tripled the risk of having a heart attack now we're going to come back to treatment so if you are a person who has anger your amygdala just sends off lots of false alarms there is a way to treat that a major depression so we we've we've talked about stress we've talked about anger type A personality let's talk about depression remember that we think of major depression or clinical depression as a medical disease just like any other in order to be diagnosed with depression you have to have five of these nine listed symptoms most of the day nearly every day for two weeks so it's not having a bad day it's not having a few bad hours it's not being overwhelmed or stressed at work it really is this cloud that descends on an individual and stays there morning noon and night for at least two weeks and oftentimes much longer there are mood symptoms depressed mood irritable mood anhedonia is the inability to feel pleasure so people just don't get enjoyment out of things they used to enjoy there's a number of changes and body systems so your energy is off your sleep your appetite you may see weight changes and the way an individual moves changes many of my depressed patients will talk about depression feels like you're walking underwater just feel very slowed down or sometimes the opposite happens where they feel very agitated and very keyed up and you can actually feel it you can see it when you're sitting in the room with something just like that you see differences in concentration and memory changes in the way that people feel or think about themselves often feelings of worthlessness or guilt and you also see suicidal ideation and we actually I think talk about suicide far too little in this country it's like our dirty secret there are far more suicides than there are homicides yet homicides are what tend to make it on the news a little bit on the epidemiology of major depression and we will talk about treatment absolutely treatable the prevalence is about five percent or so and by point prevalence it means if I took a snapshot of this room right now we might see about five percent of people who would meet criteria for major depression doesn't discriminate on age education levels background or what-have-you lifetime prevalence is about double for women than it is in men some people would say that that's a function of our culture it's much more acceptable for women to say they're depressed women are also a lot more likely to go and to seek help when they're depressed men are a lot more likely to drink so oftentimes it will see men presenting with alcoholism when in fact the underlying causes is major depression we think of depression as a chronic disease now much like diabetes it is manageable I'm not sure if it's curable some people have one lifetime episode and that's it they restabilized they don't have anymore episodes but after you've had one episode you have about a 50/50 chance of having a second episode if you've had two episodes your risk of having a third episode is about 70 to 80% so it's almost like the disease picks up steam the way I think about it is is neurons that fire together wire together so you have that first episode there are these depressive pathways laid down each episode broadens those pathways and makes it easy to get depressed again there there is again there is treatment remember though we're not just thinking about this from a biomedical perspective the way you feel your depression also affects the way you think and it also affects your behavior the things that you do the reason depression can be so persistent and difficult to treat is something we call the three downward spirals for depression when a person is depressed it caused them to causes them to think more pessimistically they think of more negative things they're less kind to themselves as they think more negatively it makes them more depressed which makes them think more negatively which makes them more depressed and so on as they spiral down the same with activity levels as a person becomes depressed they don't enjoy things anymore they don't have the same amount of energy that they had before so they do less as they do less though there's less possibility for positive reinforcement there's less opportunities for social support so they get more depressed which makes them do less which makes them more depressed which makes them do less and the same thing with social context when a person is depressed oftentimes they're more irritable or they're more sensitive to feeling rejected or to feeling hurt so they withdraw and they isolate but that makes them more depressed so they isolate more which makes them more depressed and so on so if we want to treat depression we want to stop these downward spirals and in fact what we want to do is to try to reverse them and we can do those with medications or we can also do those with therapies that target thinking that target behavior or target social relationships before we talk about treatment though I just wanted to talk a little bit about depression in its relationship to diseases and I know you've heard some of the studies linking depression and cardiovascular disease before here's just a few other examples in Haynes is a National Health and Nutrition Examination Survey a fairly large survey over a number of decades looking at different risk factors for disease here we see that depression doubles the risk for high blood pressures in whites and triples the risk in african-americans it increases the risk of CHD that's coronary heart disease by 75% after controlling for other risk factors so if you have a person for who's depressed and you have a person who's hostile or cynical we're not sure if there's an additive effect but I would say that that person's risk I would guess that that person's risk is is even higher another interesting study this was again going way upstream that's called the precursor study looking at depression and medical students average age in medical students usually early into mid 20s we see that the depression and medical students predicted coronary heart disease and this is a heart attack an MI forty years later so even when they're depressed as medical students again those neurons that fire together wire together the pathways for depression are being laid down forty years later we're seeing a risk increased risk for heart disease and heart attack I won't go through all of these this again repeats what you've heard before a number of hospitalized patients you go to the hospital after a heart attack they meet criteria for clinical depression this is one in five meets criteria for clinical depression point prevalence for depressive symptoms so they may not have five of nine symptoms for at least two weeks but they have some depressive symptoms is much higher it's 40 to 65 percent I would say that part of any cardiac cardiac rehabilitation program needs to contain a fairly substantial depressive screen that needs to be repeated and if that person is depressed than they need to be treated for depression at the same time as being treated for cardiovascular disease this is depression and coronary artery bypass graft so this is a bypass surgery and again it's the same picture that we've seen before depression is an important variable in fact depression which many think of as sort of a soft variable is just as predictive of ejection fraction so that that's how much blood is being squeezed out of a particular part of your heart in us in a second the big question though so we look at depression we look at stress we look at anger we look at hostility can psychological interventions reverse this or can they prevent this harm from occurring in the first place and to start to think about those interventions first we have to go back to our model of stress remember we have the stressor we have our primary and secondary appraisals does it matter can I cope with it you have your stress response and then hopefully that's followed by an adaptive coping response and we think of coping in a couple of different categories we have a problem focus coping which is when you do something that directly tries to change the stressor so if the stressor is you have to take an exam an example of problem focus coping would be cracking open your textbook and studying for the exam but we also need a motion focus coping there are sometimes stressors that we can't change we can do absolutely nothing about them what we can change though is our emotional state so an example of emotion focus coping would be calling a friend going to a movie reading the novel watching American Idol what it whatever it might be that takes your mind off that stressful event so it decreases your thinking about it it decreases your stress response the most effective koper is someone who uses a mix of problem solving and emotion-focused coping and knows when to use what type of coping in general if it's a stressor that can be changed it's in your power to change it you want to use more problem-focused coping if it's something that you absolutely can do nothing about you probably want to go more in the emotion focused route there's a variety of stress management programs most of which work to some degree I think it's more a matter of finding what works for you it can be progressive muscle relaxation it could be meditation it can be breathing it can be exercise it can be all sorts of different interventions the more cognitive or psychological stress reduction programs tend to do a couple of different things most of them first train people to look at their appraisals so sometimes people who are chronically stressed are stressed out because they make mountains out of mole hills every stressor that comes along is seen as an enormous problem it's something that is hugely important to them so that's their primary appraisal so part of their stress management program would get them to make more accurate primary appraisals other people tend to underestimate themselves in their capacity to cope or they just don't use the coping resources that they have they don't turn to their family they don't turn to their friends so we get people to do a more realistic secondary appraisal of their capacity to cope in the coping resources they have and how to more effectively utilize those so really from the outset if a person is lowering our primary appraisals and increasing their secondary appraisals you've already gone some distance in helping them to manage their stress other examples would be finding what we call I call it a healthy diet of activities I think oftentimes we get unbalanced you spend too much time at work you spend too many time too much time worrying about the bills you forget that you need to enjoy time with friends you need to enjoy time with families you need to connect perhaps to your sense of spirituality but ideally you need a mix of things that give you a sense of accomplishment but also give you a sense of enjoyment and a sense of connection so just like in a healthy diet you need a mix of your different food groups for activities you need a mix a balance of those different activities other examples would be I mentioned the elicitation of social support medical management there are short-term medications which can help turn down the stress response that a person might be feeling exercise it and here I mostly mean aerobic exercise should not be underestimated it really helps us burn off our stress hormones remember we've talked about cortisol before exercise really helps us to reverse those negative physiologic effects of stress this study was done about a decade or so ago this was a study in North Carolina where it was a Stairmaster versus antidepressants and the antidepressant they used was an older one it was a tricyclic antidepressant called imipramine but the sample was randomized into two groups these were mild to moderately depressed so these weren't severely depressed folks half of them did a Stairmaster four to five days a week it was twenty to thirty minutes or so the other half had imipramine they measured adherence and then he also then sort of measured their improvement in mood over time what they found at the end of the study is there was actually no difference in terms of mood outcome for those two groups in the antidepressant group they had side effects of dry mouth and urinary retention and grogginess and drowsiness and so on in the exercise group the side effect was they felt more fit they felt more energetic and some of them had lost a little bit of weight so important to remember that exercise in and of itself can be a useful medical intervention if we go back to looking at IH is ischemic heart disease this is a randomized controlled trial of about a hundred people who have ischemic heart disease meaning that half of them are actually went into three different conditions a third of them went into an exercise group a third went into a stress management group and the others went into a usual care group they followed them for three years at the three-year follow up you see that the exercise group had a 21% recurrence of a cardiac event so they had another heart attack something else happened only 9% in the stress management group 30% in the usual care group usual care was going to the cardiologist taking a fistful of pills every day and so on so certainly helped in usual care verses nothing a little bit better in physical exercise pretty a huge difference only 9% in the stress management group went on to have a second event in in three years so how about the guy who has a problem with hostility or with cynicism is there a way to try to change that this is a fairly old study but again by Meyer Friedman who initiated the concept and research into type A personality it was a four and a half year randomized control trial of about a thousand guys who had had a heart attack they were assigned to three different groups they had a type a counseling group they had just sort of a generic group counseling kind of a bob newhart kind of group counseling and then they had a they had a usual care group and again this is the percentage of cardiac recurrence so lower numbers are better in the type-a group you had about a 13% recurrence versus 21% or 28% in the other two groups now I will say that treatment for type A personality something that hasn't really caught on and I'm not sure if health insurance companies pay for it the the group was a weekly two-hour group that actually met for a couple of years and if you can imagine the group so there's 10 angry competitive guys who are in pain they've just had a heart attack and they're being told things like always Drive in the slow lane let someone else cut ahead of you use the computer that's the slowest so intentionally creating exposures to situations that normally would make them mad and teaching them how to relax in the face of those frustrations but the process is really frustrating them a lot and teaching them how to deal more effectively with that that frustration it still had nonetheless pretty good outcomes if we're to turn to a more sort of systemic type of psychotherapy one kind is called cognitive behavioral therapy a lot of support for cognitive behavioral therapy or CBT for depression for anxiety for eating disorders for a number of different emotional problems and to understand CBT we have to go back to this triangle to this interdependence this relationship between emotions and thoughts and emotions and behaviors in the relationship between thoughts and behaviors since we can't reach in directly and just throw a switch to change the way that someone is feeling what we can do is look at how they're thinking is it fair is it balanced is there a different perspective they might be able to adopt or to look at the choices that they're making in terms of their behavior how are they spending their time do they have this healthy mix of behavior do they have social supports do they have relationships what are their stressors at their job their environment and so on we want to help a person feel less depressed you tackle one of these two areas in general CBT has a number of different stages and I'll just talk about CBT for depression where the first stage tends to focus more on what's called behavioral activation remember when people are depressed they become less active they're more socially isolated and withdrawn the first thing you want to do though is activate the patient so you want to enlist them as a participant this isn't the classic psychotherapy where the therapist just sort of sits there and looks very wise and says mmm-hmm this is active partnership where you roll up your sleeves together and say okay I have this idea that your behaviors affect the way that you feel but I don't want to tell you that I want us to look in your life and see if that's actually the way it's going to work so what I want to do is just for a day or two I want you to write down the things that you do you don't have to change anything if you stay in bed all day stay in bed all day if you watch old bad TV all day just watch old bad TV all day but write down what you do and at the end of the day I want you to rate your mood on scale of one to ten do that for a couple of days as many days as you want come back and see me and bring those results and what happens actually every time I've done this and I've done this with hundreds of patients is they bring back the results sometimes two or three days sometimes eight or nine days depending and they'll go you know what on days when I was more active my mood was better they have that light bulb go off and they realize it doesn't take a huge event they don't have to have a trip to Hawaii to improve their mood sometimes the change in activity is I chose to take a shower today and I felt better and if you're not depressed that may seem like oh come on you know what is that but even those simple behavioral choices in sum total we make hundreds of choices throughout the course of the day the sum total of those behavioral choices can have fairly profound effects on our mood once that light bulb goes off for that depressed patient they realize that they have some control depressions usually about thinking you have no control you feel hopeless suddenly they have hope they can start to make choices the next step then is oK you've discovered in your own life for you when you make certain choices you feel better let's make a couple of choices in advance do them and see what happens so you can see how this goes and they become more and more active they become less and less depressed the next stage is usually looking at thoughts we usually do behaviors first because it requires less concentration with thoughts they're actually capturing their thoughts writing down their thoughts and asking themselves the question is this helpful or is this hurtful not is it right or wrong or true or false or good or bad is this helpful the way I'm thinking about the situation or is it hurtful is this balanced it's not power of positive thinking it's not rose-colored glasses Pollyanna stuff it's like am I being fair am I remembering my past successes as much as I'm remembering my past failures so it's a combination of changing those behaviors here and changing those thoughts reversing those downward spirals and pulling a person out of depression yes CBT works for the alleviation of depression people then ask the next question all right if we treat depression either with pharmaco therapy or with talk there repiy does it help things like cardiovascular disease we know depression is related to cardiovascular disease can we reverse this whole chain of events that may be happened so this was a study called the enriched study they had CBT for depression social isolation in patients who had had a heart attack it was a number of different sites around the country UCSF was one of those sites much to their disappointment they found that there were no differences in terms of changes in cardiovascular outcomes yes they got less depressed yes they had better social supports but they didn't seem to be able to reverse that chain of events and it's unclear why that might have been number of other studies have looked at this you got to wonder who comes up with these acronyms this is the sad Heart Study the searcher Lane antidepressant heart attack recovery trial its Zoloft or it's an antidepressant they found that it reduced Seri serious cardiac events and post heart attack patients by 20% was not statistically significant though they had a small sample they were looking for much bigger effects so again that holy grail of showing that treating depression can actually reverse that change and decrease cardiovascular events doesn't seem to be true yet there are a couple of indirect pathways which may help we know that smoking and stopping smoking at any point can decrease your cardiovascular risk we know that treating depression actually makes it easier for people to stop smoking we also know that certain antidepressants actually decrease nicotine craving so there's some relationship there that we haven't quite teased apart yet so I hope you've seen through this sort of quick run through stress stress physiology through anger and hostility through depression and ultimately just a very quick peek at some of those treatments like stress reduction or cognitive behavioral therapy that yes indeed our emotions the physiologic consequences of our emotions are absolutely related to disease to most causes of morbidity and mortality but the good news is not only do we understand those relationships but we're starting to reverse them and I can guarantee you in the next decade there's going to be some exciting research that tells us how to do this even more effectively thank you so we have some time now for questions are there any questions okay so the question was whether there is data linking emotions to medical conditions other than cardiovascular disease that's the one we explain the most that's why we often talk about it another example would be cancer in people actually since the time of Hippocrates have been trying to prove that stress or certain types of personalities caused cancer we really haven't proven that yet we know that treating stress helps people cope with cancer and may help people recover I don't think we've shown that emotional states can actually cause a person to develop cancer there is I think a fairly well-established relationship between emotions and stress and immunity so if a person is stressed they're more likely to catch a bacterial related illness or a viral related illness the only way we could maybe tie that to cancer if someone is stressed their immune function is down they're more likely to say get an HPV infection we know that HPV human papillomavirus is related to things like cervical cancer so you could if you work the chain out long enough say that there's some relationship there there's another of other mind-body illnesses things like chronic fatigue fibromyalgia irritable bowel syndrome even exacerbations of asthma or a chronic obstructive pulmonary disease that we know can be related maybe not caused by emotions but certainly can be be worsened by emotional stress yes right so the the comment in the question was about what I would call the illogic of our current health insurance system where medical benefits and mental health benefits are often separated you have to go through even if you have say Blue Cross for your medical benefits your mental health benefits are most likely managed by a different company called United behavioral health different rules they limit treatment you only get a certain number of sessions so on and so on and so on it makes no sense medically biologically scientifically to separate out those benefits I think it's partly due to historic reasons I think psychiatry Wars wasn't particularly good at justifying their diagnosis of the treatments that they were provided they weren't particularly good at limiting the treatments when the treatments needed to be limited on the other hand I think a lot of it's about stigma and discrimination there's still a big stigma to mental illness even though your brain is an organ just like your heart or anything else there's still a stigma to it so people want to push it away you know out of sight out of mind hopefully at some point we'll see a rejoining of medical benefits and mental health benefits I don't see a champion pushing for that right now and the healthcare system is such a mess I think mental health is still kind of at the bottom of the barrel yeah so there's a lot I think of of what we know in terms of the the physiology sort of that the very clear sort of medical causes or Consequences of depression and I think it's getting harder and harder to say mental health and physical health are separate we're understanding more and more about the genetics of even the physiology of schizophrenia or of anxiety disorders so I think as our science progresses it's going to get more and more difficult to justify this this very archaic separation between medical what they call medical health and mental health it's actually one in the same it's just a different organ system it's your brain at your central nervous system that has some sort of imbalance that's affecting the rest of your body so my hope is that in my lifetime at some point we'll see sort of a rejoining of those ideas not quite sure how or when that will come about but I hope so yes sure so it's called dysthymia and it is a kind of a chronic low-grade depression so clinical depressions often time episodic so it lasts a few months six months might go away on its own come back again later go away come back dysthymia is a lower level and it tends not to go away it's there at least two years in fact and some people would even say it's a depressive personality instead of having five of nine symptoms you have to have three of the nine symptoms for at least two years with no period greater than six months when you were free of symptoms so that's really kind of the depressed person that's always kind of depressed but they're probably functional because it sits on a milder level so the question is can a pessimistic personality be more prone to that I think so in a there's certain strengths to being pessimistic a lot of good problem solvers are pessimistic pessimistic a lot of good artists you know have this effect of this emotional lability but yes I think it does make you more prone to depression so right behind you you know I've heard some some interesting theories about that I don't think we've really moved it to a human level it's more I wouldn't say it's people it's rat pups you know and baby mice and they they give them very stressful not really a childhood but very stressful childhoods and they see that there's greater sensitivity and their stress response system so like their HPA axis that's responsible for cortisol they get more are more likely to have elevated levels of cortisol if they've had an abusive childhood we there's been some similar stories in humans looking at adults who had abusive childhoods and they have are tend to have higher levels levels of cortisol and they're at greater risk for depression so there there is something that's going on I don't know if it's dopamine receptors or not I mean that might be part of the picture too so the question is a relationship between depression and autoimmunity and and autoimmune diseases things like lupus or asthma or when your body's immune system is actually too active in general you would think of depression as suppressing the immune system so I I don't know of a relationship between those two I know people tried stress reduction they tried treatment of depression there is certainly an overlap between things like fibromyalgia and depression but I really don't know the relationship between them are there gene based therapies for emotional disorders no I I don't think so I hope not it would even for genetic disorders that we're not real good with gene based therapies yet so I would really at this point I would worry about monkeying around with with something as complex as our emotion so so it's sort of a chicken and the egg issue where we see these relationships where fibromyalgia is a chronic neuromuscular disorder there are tender points where person feels extreme pain there there's a lot of sleep dysregulation it tends to co-occur with clinical depression that doesn't mean depression causes fibromyalgia or fibromyalgia causes depression it could be either way it might be that it's the sleep dysregulation that causes both of them to happen well we don't we don't really know right now all the way in back sort of the optimism gene or something aha you know they've certainly compared cohorts but you know you they use you know questionnaire studies and they follow them longitudinally over time and they've shown all sorts of interesting things with optimism you live long or you get less illnesses you make more money there's all sorts of things I don't think there's been a genetic study you know it hasn't been that long since we just first catalogue the human genome and we're still looking at really easy small chunks of it my guess would be something as complex as optimism it's going to be a while if we ever get to the point where we can sort of pull apart a genetic signature that helps us understand that sure sure so actually Marty Seligman wrote that book he was the guy I trained with it pen so I know it well and was one of the the research assistants on that project it was the Pens children's project and what they did was go to the West Philadelphia schools public school so it was low-income underprivileged kids they gave them a test measuring optimism or pessimism just a pen and paper test they then took the pessimistic kids and half of them just got like after school social hour and half of them had a kind of a cognitive behavioral therapy and they wanted to follow those kids over time and see if they could actually prevent depression behavioral problems improve their grades and so on and what they found was was not only did the study worked it worked actually much better than anyone had thought it would those kids and they picked 5th grade because they're right around pre-pubertal but about to go through a pretty crazy difficult awkward emotional transition and they wanted to try to inoculate them right before that happened they found that the kids who went through the intervention only did it prevent depression they had less behavioral problems they stayed in school they had less absenteeism they had better reports of health even so now the public school system in Philadelphia is funding a much bigger I guess dissemination of that program to all of their schools so that would be nice if you know if we're going to invest in education I think we have to invest in in teaching kids how to have relationships and teaching them how to better understand and manage their emotions so the kids were divided into two groups one had an after-school therapy basically like a cognitive therapy and the other group they just had they watch cartoons and TV and and hung out with adults there and they did that because they just wanted to control for the amount of attention and time that the kids were getting what they were doing during that time was quite different but they just wanted to have them both in a captive audience in the same place the same time so the one that had the therapy the cognitive behavior therapy did better so there's two things or there's really two chemicals we want to think of we want to think of cortisol but you also want to think of norepinephrine and the immune organs the lymph nodes and also the thymus are directly innervated by neurons that release norepinephrine so those immune organs can be either stimulated or they can be inhibited based on the firing of the sympathetic nervous system so I think of sympathetic nervous system but also cortisol in a more global level chronic higher levels of cortisol can suppress immune function right correct correct suppression of function yeah it is and I left that off and the the list I had Paul Ekman gave me his slides and that's oh that's from from Paul some people say contempt is different from anger there's sort of a different set of cognitions and feelings I think of it more as a feeling because it's not just that physiologic sensation of anger there's also this thought or this perspective of superiority I'm so much better than you you lowly worm I feel contempt for you it's it seems like a higher level higher cognitive function than a basic emotion for me but I've seen the list some times including that right looking at right left hemisphere in depression in terms of cause not really I mean there's one on some research done looking at prefrontal cortex so that's the brain right behind your forehead and looking at left versus right prefrontal activation and the simple answer is in general people who are angry or depressed you see if you're looking at say a PET scan or a functional MRI you see more activity in the right prefrontal cortex the person's laughing if they're happy if they're enjoying time with another person you see more activity and left prefrontal I think that's a little too probably a little too simple but you know that's that's what we have now people are doing studies like with meditation as a treatment for depression and they're seeing that when the person meditates they get more left prefrontal and less right prefrontal which kind of makes sense okay well thank you so much for your time and attention you


  1. 58:00
    1:05:20 CBT and Depression treatment overview

  2. USA! USA! USA! WOOT! (Sorry acting like a trump supporters when hes in a crowd)

  3. Love the info – thank you. Going forward, could you sharpen the focus on the slides for those of us who catch them on the web? Many of your offering feature slides too fuzzy to read online (even full screen), and the camera operator shifts back to the speaker far too quickly for us to compensate (or read at all, even if they had been perfectly clear). THANKS!

  4. I am always away from science..Dr Jason you so nicely explained…happened to see d video.. but so interesting couldn't exit watching full ..soooo informative..thanks

  5. Since doing my NLP training, I have been doing more and more research into brain structure and function, neurotransmitters and our senses. I find it fascinating to hear the latest scientific theories and know that putting this knowledge together with my NLP studies will make huge changes in both my own life and my clients.

  6. Which feeling (What you think about) meaningless pictures?

    – Stinky crying baby : annoyed, disgusted (love to be politically correct)
    – Bald man walking away : love (fear for some)

  7. Great talk. Jason's plethora of knowledge on the most mysterious creation on the planet blows me away.. So does his pager from 1995.

  8. Great information, i love psychology….

  9. Good info and I agree. I heal myself and others now I'm pain free.

  10. old out of date 2008. no microbiome. discard before this injures more people.

  11. It is not necessary to have preexisting heart problems in order to have a heart attack from stress or grief. There is a condition, that is becoming more well known in medicine, called Takotsubo Cardiomyopathy or Sress-Induced Cardiomyopathy and, in layman's terminology, Broken Heart Syndrome. Medical Doctors have discovered that there are many people who have all the identical symptoms of a heart diseased patient, however, there is nothing wrong with their arteries (no clots/plaque). The only things that separate them from patients who have issues with Heart Disease (past or present), is that they have/are experiencing a high amount of stress, anxiety, grief or trauma, and unlike the Heart patient, their heart has literally ballooned and is struggling to pump, due to the ballooning, which is also causing a Heart arrhythmia.

  12. Do you believe dirt + time = humans?

    What is the difference between Lucy and Bonobo?

    How did life originate?

    How did matter and energy originate?

    Please tell me the fossil that you think is the best evidence for dirt + time = humans.

    Please tell me the living organism that is the best evidence for dirt + man = time.

    Thank you very much!

  13. One word that sums up our whole world is 'stress' I've been studying the human mind for many years now and not one pill or psychologist can actually help you, it's the sad truth. The only person, who can help you, is YOU!  This is a very important topic to me because I want to help you feel good right now and every day. The one thing that was keeping me down for a long time, was stress. When something good came my way, I had so many doubts so I just gave in.
    Can you seem to fully recover from a broken relationship? Are you having trouble, trying to reach your full potential? Is stress making you feel frustrated and angrier? Can you sleep well or at all? Are you suffering from Anxiety, depression, insomnia? How are you trying to cope with your daily life?  These are a few topics that I want to talk with you about.
    This is a very touchy subject and I want you to be able to go through life living with a healthy mental state. I want you too feel good through a negative situation and turn it into a positive. I want you to change the way you think about your life.
    Start feeling confident!
    This is something that everyone can get into because the one thing we all have in common is stress. I'm going to share with you my personal strategies and stories that enabled me to become a better person for myself. No matter who you are, in your life you will encounter negative situations. But how are you really coping?  
    I want you to wake up with a smile on your face every morning and I want you to simply feel good about everything that is happening in your life as you work through real strategies, you can do in your own home. I actually care and want to support each and every one of you. I even added my personal email address so that you can email me and talk to me about the things that are worrying you because I want to help you get through these negative situations. I have even added a little segment down the bottom, for you to earn abit of cash whilst working at your day job that is totally free and simple to use if you don't believe my system works. I don't want to waste time for people.
    I have a lot to offer you guys.
    have a go

  14. No need to torture animals in order to know what ancient traditions already knew for thousand years….!

  15. Great Video, thank you!

    i was like a music orchestra with all emotions like anger, fear , worry , love , guilt etc..and i was curious to know more about it , because it was driving me crazy!

    my friend used to track my emotions using "emotional" iPhone app by lokesh which really gave startling reports and information and made me realize my own self now!

    Peace be upon you for sharing this Video!

  16. It would be a shame for you not to shed pounds when normal people melt fat so easily using Fat Blast Factor (Look it up on google).

  17. Hey there, have you come across "BELLYfatTACK yet? Simply copy-paste to the browser to visit this web address! On there you will find a helpful free video presentation by a longtime physician talking about the way to burn fat. This made it easier for Michele to burn her belly fat. Just give this a shot. Hopefully it will work for you too…

  18. Amazing speaker.

  19. This video teached me more things than 10 years of school

  20. Hey, have you considered Bellyfattack ? Simply search Google. There you will see an important free video by an established medical doctor teaching on how to reduce excess weight. It helped Andre to get rid of his tummy fat. Just give it a try. It might help you out as well…

  21. The speaker is distinctly American.

  22. Teaching people to be animals with cognition? So they can train themselves…as stepping stone maybe, but inherently wobbly and weak. Agree?

  23. Hey, have you come across " BellyFATtack " yet? Simply search on Google. On there you will discover a practical free video by a well-known medical doctor teaching about the way to burn unwanted fat. This made it easier for Bianca to burn her belly fat. Perhaps it will help you out also.

  24. Laughable idiot.

  25. Hi there, have you heard of "BellyFATtack"? Just search Google. On there you can find a valuable free video by a recognised doctor revealing the best way to lose excess weight. It helped Toni to get rid of his stomach fat. Perhaps it will help you out too.

  26. ugly nose-speaking brits

  27. Stress is just something you create on your own if you fight against circumstances because you believe that they are wrong. Physical exercise, education and healthy eating (vitamins,minerals) wont prevent stress, you are just able to deal with the pain for longer.

  28. I watched this video many times. this is really good.
    Check out my blog at augustinethh dot jux dot com

  29. Dianetics is the science of the mind. control your emotions

  30. Complexity is an excuse for the reality that academics can not define emotion because they have fallen in to the same trap as their predecessors in accepting a simplistic assumption that various discrete "emotions" exist when, in fact , the subjective experiences for which "emotion words" are applied mostly refer to sensations ,attitudes ,stresses ,and excitement and behavior. induced by experiencing emotion. It has nothing to do with retention of information.

  31. Because the human ability to retain any specific information consciously at any given time is vastly inadequate at comprehending the complexities involved. So, not that it is too complicated to explain to us, but rather that it is far too complicated for us to comprehend consciously within the moment and we are being reminded of this so as to try and encourage us to "keep an open mind" and absorb the information being given to us without making a judgement based upon a narrow understanding.

  32. This is what they should teach at HIgh School.

  33. Hello there, have you tried out "Belly Fat Quencher" (just do a Google search for it…)? There you will find a useful free video. This made it easier for Jennifer to get rid of her abdominal fat. It may help you too.

  34. Nice

  35. I watched this clip twice and took some notes. it was excellent and comprehensive. thank you very much for uploading.

  36. Hi there, have you heard of "Belly Fat Blaze" (just google it)? There you can watch a practical free video. This made it possible for Donna to burn her stomach fat. Perhaps it will help you out as well…

  37. Why the constant references to "complexity" by academics who lecture or write on the subject of emotion.? Do they mean it is too complex to explain to us or that, as they so often say of many medical conditions, emotions are "poorly understood" phenomena.? I see nothing new here – no specific definition of the term emotion is offered We are just asked to accept that there are categories and types of emotion ( varies from one theorist to another) which are functions of our genetic endowment.

  38. To be happy you need to know yourself, work like you don't need the money, have the right attitude, be honest, help others, and be thankful. See YouTube video "Happiness Simplified".

  39. vp8998 you are outdated. Years ago many of your criticisms of psychology and especially psychiatry had a lot if truth to it.

    Now mind body medicine and our recent knowledge have changed psychology into a discipline that is much more of a science.

    Forget a negativity and try to learn using recent developments in the field, such as what is in this video.

  40. Aside from the simple fact that we posses the self control to stop our negative thought patterns, psychology has its roots in 100% solid evil. To treat "hysteria", a made up disease with a "symptom" of not wanting to have sex, a disease which does not "exist" anymore, doctor's actually invented the dildo and caused forced over stimulation orgasms in married women. Psychology is not science. It has been responsible for thousands of deaths through experimental lobotomy. Please Research.

  41. @weestro7 yes stress really lowers the activity of natural-killer cells and causes the cancer cells to propagate and metastasize.


Leave a Reply

Your email address will not be published. Required fields are marked *