Shelter your health... ...from emotional stress

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How to keep your immunity high in the midst of life's lows

A 52-year-old salesman, never "out sick" a day in his career, comes down with one flulike infection after another when new management threatens layoffs.

A 36-year-old mother discovers she has breast cancer less than a year after her baby is critically injured in a car accident.

Maybe these are coincidences. But when we hear of cases like these, we can't help but wonder whether severe or ongoing emotional stress can sap our health, perhaps by impairing the body's immune function.In fact, an amazing new discovery directly links emotions with the chemistry of the immune system. Meanwhile, other researchers are in the process of piecing together important clues to certain stress-coping skills that may help immunize our body against emotional assaults.
THE NEW MEDICAL FRONTIER

Scientists on the cutting edge of mind-body research liken the current skepticism among many physicians to that of nineteenth-century physicians when Louis Pasteur first introduced his germ theory. At that time, no one believed that microscopic enemies could invade our bodies and make us sick. It took decades before hand washing became common presurgical practice.

Candace Pert, Ph.D., a visiting professor at the Center for Molecular and Behavioral Neuroscience at Rutgers University in Newark, New Jersey, firmly believes that the emotional landscape represents today's newest frontier in health maintenance. Over the past two decades, she and her colleagues have blazed new territory--studying the biochemistry of emotions. What they've found is that emotions are not just in our heads.

"Our research shows that emotions are intimately connected with the entire physiology of the body," she says. "The chemical processes that mediate emotion occur not only within our brains, but also at many sites throughout the body--in fact, on the very surfaces of every single cell."
ANATOMY OF EMOTION

Early in her career, Dr. Pert discovered a way to measure chemical receptors on cell surfaces in the brain. These little vibrating molecules are like keyholes, to which certain chemicals hold the key. At this time, Dr. Pert was studying opiate receptors in the brain, which act as keyholes for opiate drugs like morphine and heroin. "The chemical binding of an opiate to its receptor is what creates the emotion of euphoria," Dr. Pert explains.

Soon after, it was discovered that the body makes its own opiates internally (called endorphins). Released during events such as childbirth and traumatic injury, endorphins serve as natural painkillers.

It wasn't long before a host of other receptors besides opiates were found in the brain, along with the natural chemicals called neuropeptides that fit them. Not all neuropeptides are associated with emotions as strong as euphoria."Some are more subtle," explains Dr. Pert.

These discoveries broke new ground. But what really shocked the scientific community was when researchers found endorphins in the immune system and began to find opiate and other receptors distributed in parts of the body outside of the brain.
THE IMMUNE CONNECTION

The most astonishing place where neuropeptide receptors popped up was the immune system.

Comprised of the lymph nodes, the thymus gland, spleen, bone marrow and immune cells, the immune system is the body's means of defense against infectious disease and cancer. (See "Where Emotions Commune With Your Immune System.") For many years, it was believed that this elaborate defense system operated independently of any other body system. But when opiate receptors were found on immune cells in the spleen and thymus, it became clear that the immune system must be connected to the nervous system, involving the brain in the control of the disease-fighting process.

"Why else would opiate receptors, which everyone knew could be found in the brain and had something to do with emotions, be on immune cells?" exclaims Dr. Pert.

Here was a mind-body connection that challenged the long-cherished notion that the immune system was independent of the nervous system. To Dr. Pert, the implication was crystal clear: Our mental and emotional states must directly impact the functioning of our immune systems, and in turn, our ability to fight disease.
THE STRESS FACTOR

Researchers today agree that the brain and immune system do indeed "talk" to one another, but exactly how--and which specific states of mind and mood affect our health--is a mystery just beginning to unravel.

Studies suggest that bursts of short-term stress or even undesirable emotion may bolster some aspects of immune function. When emotionally arousing situations become chronic and are experienced as inescapable, however, the immune system may falter and health problems arise.

When researchers from the University of California-Los Angeles recently examined the relationship between stressful life events and the development of colorectal cancer in more than 1,000 men, for example, they found that those with a history of severe work-related problems were five times more likely to get colorectal cancer than men without job difficulties. Other major stresses, such as changing residence, suffering the death of a spouse, divorce or being unemployed for longer than six months, also increased risk, but not as much. (The researchers were careful to screen out the influence of other factors like diet and exercise.)

"A serious occupational problem is one of the worst life events that can occur, because it's a more chronic stressor," explains lead researcher Joseph Courtney, Ph.D., UCLA epidemiologist. "A lot of times, people have to stay in jobs, keeping a smiling face whether they're happy or not."

Dr. Courtney explains that the colon in particular is sensitive to stress. "A lot of people appreciate the fact that if they're under stress, certain bowel habits may be negatively affected," he says. "It's one of the organs that translates mental stress into physiological dysfunction."

Dr. Pert concurs. "The same neuropeptides that are found in your brain and are associated with various emotional states also innervate every sphincter of your digestive system," she says. "When you see that, you are forced to come to the conclusion that the digestive tract is more than just a passive pipe."

Dr. Courtney's study did not measure changes in immune function, but evidence from both human and animal studies shows that stress has the potential to depress immunity, which may be one of the reasons why some people under stress are more susceptible to illness.

One of the best studies to show that chronic stress leads to depressed immune function involved 69 people who had been caring for spouses with Alzheimer's for an average of five years. In comparison with a similar group of noncaregiving adults, the caregivers showed decreases in three measures of cellular immunity. They were also ill for more days with respiratory-tract infections.

What's more, the caregivers who felt the most distressed by the dementia-related behavior of their spouses and who reported lower levels of social support suffered the greatest decline in immunity.

"It's not stress that really causes the problem, it's inappropriate responses to stress that put us at risk of depressed immunity and possible disease," says Nicholas Hall, Ph.D., director of the psychoimmunology division at the University of South Florida Psychiatry Center.
THE CONTROL FACTOR

In particular, if stress precipitates feelings of helplessness and powerlessness, increased susceptibility to sickness may result, researchers tell us.

Dr. Hall cites animal studies in which rats who have no control over intermittent electrical shocks develop tumors faster than those who have access to a turn-off switch.

In contrast, studies suggest that instilling people with a sense of personal control appears to have a profoundly positive impact on health. In a benchmark study conducted by Yale researchers, nursing-home residents who were encouraged to make decisions for themselves and given something outside themselves to take care of--in this case, a plant--became more active, more alert, happier and healthier than a similar group for whom the nursing staff did everything. In just a few weeks, the group with no control grew more debilitated, and a year and a half later, they were less likely to be alive.

That so simple a measure had any effect at all on the patient's health suggests how important increased control is, the researchers conclude.

"Different behaviors give different people a sense of control, but the important issue isn't whether you meditate or use imagery or do yoga," says George Solomon, M.D., professor of psychiatry at UCLA and a leader in mind-body research. "The critical variable is doing something to take active control of your own health process--the opposite of helplessness and fatalism."

Coping actively in the face of stress may buffer its ill effects in two basic ways. First, it helps by directly reducing the release of stress hormones such as cortisol and adrenaline, which suppress immune function. Second, it can give a person more energy to invest in healthy behavior, such as eating better, exercising and getting plenty of sleep--all of which are habits that can affect immunity and are likely to suffer during hard times.

"If a person has an inner sense of control--a sense that his own behaviors and attitudes play a role in his health--he's more likely to do things that help him be healthy and less likely to allow the stressor to get him down," explains Dr. Solomon.
THE POWER OF EXPRESSION

Unfortunately, it's in the midst of emotional turmoil that we're most likely to feel robbed of motivation, unable to take charge. One of the big problems with any kind of emotional trauma is that it affects every aspect of our being: who we are, financial issues, relationships with loved ones."The tendency when overwhelmedis to ruminate, obsessing on just oneor two concerns and losing sight of the big picture," explains James Pennebaker, Ph.D., professor of psychology at Southern Methodist University, Dallas, and author of Opening Up: The Healing Power of Confiding in Others (William Morrow and Co., Inc., 1990).

"We literally get stuck, bogged down by the weight of a single emotion like anger, sadness or whatever it is we're troubled by," he notes.

One of the most effective ways to pull ourselves out of the mire and regain a sense of control, however formidable it may seem at first, is to explore the full spectrum of our tumultuous thoughts and emotions.

In a series of studies Dr. Pennebaker has conducted over the years, people are asked to write about extremely traumatic events or about relatively trivial topics for 15 to 20 minutes a day for three to five consecutive days. Those who disclose traumatic experiences have fewer doctor visits during the months following. Immune function is also enhanced by such disclosure, noted in blood tests by the multiplication of certain white blood cells in response to invading organisms.

"When people write or extensively talk with somebody else, it allows them to put the different dimensions of their experience into a meaningful framework," says Dr. Pennebaker. "Once we do that, it's easier to move on and get past those events."
GET SUPPORT, GAIN CONTROL

Feeling support through the turbulent process is critical. Social support is considered one of the most powerful buffers against the ravages of stress. In fact, studies show that social isolation is as much a risk factor for mortality as smoking or high cholesterol.

The mere presence of others, however, doesn't necessarily reflect support. The quality and depth of interaction needs to be of a truly supportive nature. Yet many of us are reticent to discuss troublesome emotions with friends and family.

"There are all sorts of reasons why people actively avoid talking about their feelings," says Dr. Pennebaker. "We found in our own research with men who've been laid off that they don't like to bring it up around their spouses because they're afraid to worry their spouses."

"Handling your pain head on, dealing with the strong emotion and feeling supported while you do it are crucial during any kind of major life stress," says David Spiegel, M.D., psychiatrist and author of Living Beyond Limits: New Hope and Help for Facing Life-Threatening Illness (Times Books, 1993). In the book, Dr. Spiegel describes in detail his landmark study of women with advanced breast cancer, some who attended a weekly support group for one year after diagnosis and some who didn't.

Dr. Spiegel originally designed the study with the intent only of improving the women's psychological well-being. But much to his amazement, he found that the women who met in the support group lived an average of 18 months longer than those who did not.

"Studies like mine indicate that psychosocial variables such as social support and how one manages stress have an impact on survival," he says.

When Dr. Spiegel first organized the support group for the advanced-stage breast-cancer patients in his study, he was afraid that talking about their illnesses might make the women feel worse. Ironically, it did just the opposite.

"What we did in our support group was to help the women look their problems right in the eye and see what was scaring them," he says. "That helped them decide the parts of their circumstance they couldn't control and focus on the parts they could.

"Facing and sharing difficulties puts people in a more active stance in relationship to even very serious problems," he explains. "They say, `I may not live forever, this illness may shorten my life, but I'm going to take hold of how I spend the life I have.' "

One recent, dramatic study from UCLA suggests that not facing up may have dire consequences. Of 68 melanoma patients, those who minimized the importance and threat of cancer to their well-being at the onset of illness were the ones most vulnerable to recurrence and death from the disease years later.

"Where there appears to be a lack of concern about the disease and its possible effects, there is little motivation to improve coping skills and take the measures necessary to prevent further illness," says lead researcher Fawzy I. Fawzy, M.D., in explanation of his study.

Patients in Dr. Fawzy's study who were most likely to be disease-free and healthy five to six years later were those who had been randomly assigned to attend a six-week educational program shortly after diagnosis. In the meetings, participants received information about mela-noma, learned coping skills and stress-management techniques and developed camaraderie by sharing their concerns and feelings. Facing up cut the death rate by more than half; six years later, only 3 of the 34 in the educational program had died, compared with 10 deaths out of 34 patients under regular care.

"The support group helps you face directly things that are terribly threatening and gives a place where you can express strong feelings and feel supported," says Dr. Spiegel.

"People need to know that no matter how bad they feel, talking with someone can make them feel better," he says. "The group is a place you can go to feel better about feeling bad."

WHERE EMOTIONS COMMUNE WITH YOUR IMMUNE SYSTEM

Accumulating evidence is revealing that different emotional states can impact how well these various components of our immune systems function.

Lymph nodes: These small, bean-shaped organs located at the neck, armpits, abdomen and groin act as storage compartments for white blood cells.

Thymus: A sort of training ground for some white blood cells, called T cells. After being produced in the bone marrow, these cells migrate to the thymus, where they mature and hone their ability to fight off invading organisms.

Bone marrow: The soft tissue in the cavities of the bones where white blood cells (the body's defenders against invading organisms) are produced.

Spleen: A fist-size storage tank for white blood cells. Here mature blood cells wait until rallied to action.

Lymphatic vessels: White blood cells circulate through-out the body in blood vessels and in a body-wide network of channels called lymphatic vessels that link the lymph nodes and other immune organs.

DIAGRAM

To find a support group that meets your needs, check your newspaper or call a nearby hospital. To obtain the number of a program's national headquarters that can then direct you to a local chapter, or to get the number of a self-help clearinghouse near you (if one is available), call the American Self-Help Clearinghouse, at the St. Clares-Riverside Medical Center, (201) 625-7101, between 9 a.m. and 5 p.m., Monday through Friday EST. Or send a letter of request and a self-addressed stamped envelope to the National Self-Help Clearinghouse, Room 620, 25 W. 43rd St., New York, NY 10036.

PHOTO: A woman in distress.

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By Sharon Stocker

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