STRESS AND DISEASE: PSYCHOSOMATIC MEDICINE 101

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STRESS AND DISEASE PSYCHOSOMATIC MEDICINE 101

• Leonard L. Magnani, M.D., Ph.D.
• Medical Consultant and Staff Physician
• Alta California Regional Center

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Proverbs

• Good tidings strengthens bones--1624
• A depressed spirit will make bones wither
  --1722

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Mind? Body? Mind? Body?

• I have learned this It is not what one
• does that is wrong, but what one becomes as a
  consequence of it. Oscar Wilde
• In advanced biological systems, software slowly
  changes hardware (e.g., repressed anger hardens
  arteries) and hardware helps rewrite software
  (e.g., a fit, healthy and relaxed body promotes
  serene and joyful contemplation).

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Definitions Stress and Psychosomatic Disease

• Stressa reaction to a situation, not the
  situation itself not necessarily bad(Example
  Sky diving on an 80th Birthday vs. bailing out
  of a burning airplane?PTSD)
• Our focus Bad stress, the kind of reactions
  we wish would go away

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Bad Stress is Dis-Ease, and Responds to Treatment

• Inability to cope with environmental demands in a
  healthy (wholeness) way causes the
  fragmentation and disruption of our soma (body)
  and our thinking (psyche).
• This stressful situation makes many people who
  experience it, physically ill.
• By definition this reaction of stress has the
  potential to cause physical harm.

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So its all in my mind? (Mind?)

• Mind is an activity and the stress reaction is
  not all in your mind, in your thinking. (We
  term that hysteria, and its a mental illness.)
  
• Stress is a physical (physiological) response to
  undesirable situations or intrusive thoughts.
• If the thinking about a situation or event
  continues afterwards, stress becomes chronic.
• Chronic stress reactions may disrupt and control
  both a persons work and home life.

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Psychosomatic Diseases are Physical Diseases
Caused by Chronic Stress Reactions

• We can assert that,
• All human diseases have a psychosomatic
  component, one often overlooked.

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• Mind-body duality is really a mind-body blend.
• Thoughts impact physiology body sensations
  impact our thinking. We are conscious of only a
  very tiny fraction of our thoughts.
• All circuits must be replayed by the
  unconscious mind(the good, bad and ugly) or they
  are lost forever.
• Verbal and non-verbal representations of the past
  can promote or exacerbate harmful physiology.
• Automatic or conditioned responses to situations
  w/o any thoughtful reflection (mind) can promote
  illness.
• Noisy environments, rush hour traffic ? tight
  neck muscles and chronic headaches

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Normal Human PhysiologyThe General Adaptation
Syndrome(GAS)

• Stress reactions, and the diseases they are
  capable of creating, are a large part of what it
  means to be a human primate.
• (Its in our nature to get stressed out!)

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The Autonomic Nervous System Protects Us From
Danger

• 1. Sympatheticregulates arousalthe physiologic
  preparation to go into battle or to run and
  escape (fight or flight).
• 2. Parasympatheticregulates relaxation,
  recuperation, body temperature and waste
  management it prevents exhaustion.

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Neuroendocrinology The Brain Squeezes Those
Glands

• Hypothalamic-pituitary-adrenal (HPA) axis
• Hypothalamus sends corticotropin releasing
  hormone (CRH) to pituitary gland ? releases
  adrenocorticotropin hormone (ACTH) and
  beta-endorphins into blood stream ACTH
  stimulates adrenal cortex, which then releases
  cortisol, the king of steroids.

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Cortisol is what runs amok

• Cortisol, in low or healthy levels
• improves memory, learning reasoning
  speed,relaxes gut, helps utilize glucose for
  bursts of energy.
• Chronic high-level cortisol release produces
  disease
• Hypertension, cardiomyopathy and heart failure,
  digestive and ulcer disease, brain (hippocampal)
  impairment and cognitive/emotional problems it
  can cause diabetes and greatly accelerate
  atherosclerosis.
• Alpha baboons always die youngNewer research
  Smart beta baboons live the longest.

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Hypothalamic-Adrenal-Medullary System

• Hypothalamus stimulates arousal it causes
  adrenal gland to release adrenalin (epinephrine)
  and the other catecholamines.
• Epinephrine and norepinephrine ? heart rate, open
  lungs airways, ? blood supply of glucose and the
  sugars utilization, produces muscle toning,
  strength, and speed of movement.
• Excessive, chronic release of catecholamines ?
  blood vessel wall (musculares) thickens and high
  blood pressure and cardiac arrhythmias occur,
  with eventual depletion, exhaustion and collapse.

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A Few Examples of Psychosomatic (Stress
Exacerbated) Diseases
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The Cardiovascular System

• Anger (especially suppressed hostility)increases
  renin and heart enlargement.
• More left ventricular hypertrophy (LVH) in NYC,
  as well as more mitral valve prolapse (MVP).
• Arteriosclerosis, hardening of arteries, is
  accelerated by tension and stress relaxation
  slows it down.
• Suppressed anger and personality (type A or B)
  effect blood clotting and the risk for stroke or
  heart attack.
• Emotional stress can induce arrhythmias.

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• Mental Stress Can Induce
• Cardiac Instability 
• Mental stress such as anger recall and
  frustration can induce deadly EKG changes in
  patients with arrhythmic vulnerability. This can
  occur at much lower heart rates than with
  exercise, according to the results of several
  studies.

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American Heart Association on Stress and
Serious Heart Disease

• Individuals whos blood pressure spikes during
  stressful situations are six times more likely to
  have a heart attack (pulse may not change or
  might even slow down during mental stress).
• Even if mental stress-free for some time, this
  increased risk persists for 5-6 years.
• Hot responders or hyper-reactors are
  completely unable to judge their physical
  response to mental stress.

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Immunological DiseasesThe Stress response
diminishes immunity and increases histamine
release.

• Asthma increasesalong with resistance to
  asthmatic therapyas the stress response
  progresses (i.e., becomes chronic).
• Herpes simplex II occurs six times more in
  stressed populations recurrences correlate
  highly with an active stress life.

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More on the Immunological Impact

• Production of IGG and other beneficial
  immunoglobulins are reduced by chronic stress
  responses feeling distress from life
  situations triples the chance of catching a
  cold or even a Strep throat infection.
• Autoimmune disease antibodies and rheumatoid
  factor (IGM fraction) are increased by chronic
  stress.

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Neuroimmunoendocrinology

• Lymphocytes have receptors for endocrine
  complexes and for neurotransmitters.
• Increased cancer rates and increased rates of
  mononucleosis and chronic fatigue syndrome are
  found in the chronically stressed.
  
• Stress reduction augments chemotherapy.

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Gastrointestinal DiseasesThe Brain in
the Gut Responds to the Bloods Chemical
Messengers and the Vagal Nerve signals.
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Trouble in the Tunnel

• The chronic stress response disrupts the
  multi-wave transmission called peristalsis.
• Mildest problems constipation and sometimes
  irritable bowel syndrome some more serious
  problems from chronic stress are diverticulitis
  and very painful ulcerative colitis.
• Stomach acid production increase, combined with
  the inhibition of base secretion, is a result of
  chronic stress reactions? ulcers.

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The Gut and Stress Continued

• Gastroesophageal sphincter integrity is
  compromised by the stress response (GERD)
• Liver and pancreas are sensitive to many hormones
  and neurotransmitters insulin secretion,
  resistance, and body weight (fat storage,
  metabolism, and diabetes) are all influenced by
  the chronic stress response.

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Mental Illness May Be Induced Or Exacerbated By
Chronic Stress Responses
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Anxiety and Panic Attacks

• Anxiety is worsened by stress responses.
• Worries impact physiology body chemistry
  engenders worry.
• Panic attacks are sometimes caused by
  subconscious, stressful ideation, and sometimes
  by loss of control of normal physiology
  (inhibitory mechanisms) because of prior
  (conditioned from past experiences) chronic
  stress responses.

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PTSD

• Post traumatic stress disorder (PTSD) is
  worsened by patterns of chronic stress responses,
  which makes the individual more vulnerable to
  intrusive thoughts, to chronicpoor sleep/bad
  dreams, to hypervigilance, and a detachment from
  meaningful participation.
• There is a belief in the hopelessness of any
  future reality.

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Depression and Loss of Interest

• Depression is worsened by brain serotonin
  depletion caused by chronic stress responses.
• A very vicious cycle since low brain serotonin
  increases likelihood of a stress response
• Burn-out is a form of depression
• Very common among health care social workers
• Chronic stress response consumes fuel promotes
• Emotional exhaustion (loss of sense of
  accomplishment)
• Depersonalization, cynicism, rule rigidity,
  interpersonal conflicts, lost or frustrated
  ideals

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Some Other Diseases Influenced By
Psychosomatic Physiology
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Every Part of the Body is Hurt

• Seizures are inhibited by relaxation and
  stimulated by stress reactions.
• Fibromyalgia is very rare in those low in stress
  responses in the stressless ones, almost no
  micro-muscle trauma is found.
• Prostaglandins are increased and endorphins
  decreased by the biochemistry of chronic stress,
  which causes amplification (not attenuation) of
  chronic pain signals. Poor sleep hygiene plays
  an important part in this.

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• Back pain is more often promoted by stress
  responses than by morphological pathology, that
  is, MRI visualized spinal disease.
• Stress responses increase muscle spasm
  (armoring), they decrease spinal blood flow,
  and they cause CNS disassociation.
• Headaches of all kinds, vascular and muscle
  traction type, are stress response associated
  frequently, most vulnerable time is
  mid-exhaustion phase, long after the planes have
  all safely landed on the ground.

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Even Tissue Malignancies

• Some forms of cancer have been related to
  personality type
• Increase in these malignancies is found in
  thetype C personality, someone who represses
  all outward signs of emotion, all evidence of
  stress.
• Type A personality, while heart attack prone,
  does better with chemotherapy and cancer
  survival.

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How Stressed-Out Are We Now? Are We On Fire Or
In End-Stage Burn-Out? How Much Conflict Is
There In Our Lives? Is There Someone Whos On
Our Case or Out to get us?
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Take A Stress Test On These Tests, Chronic
High Scores Correlate With a Higher Incidence
of Physical Diseases
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Some Stress Tests That are Used

• Assess the degree of stress due to
  frustration and inhibition
• Assess our vulnerability to overload
• Assess our degree of perfectionism and/or
  self-righteousness
• Measure our compulsive, time-urgent, and
  aggressive behavioral traits
• Assess whether we are fixated on outcomes or are
  more process oriented

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Stress ManagementVarious Strategies and
Therapies That Treat Or Prevent Psychosomatic
Diseases
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Theres a Long List of Successful Strategies and
Therapies to Lessen Chronic Stress Responses

• Bio-feedback or progressive muscle exercises to
  relieve residual tension
• Depression and anxiety medicines
• Aerobic exercise programs
• Proven methods to improve sleep patterns
• Techniques that let cognitive therapy change the
  way we think and react
• Meditation methods to help us become mindful and
  relax
• Nutritional practices to physically replenish us
• Spiritual practices that feed our inner spirit

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Cognitive Therapy Works!(Alone, With a
Therapist, or in a Self-Help Group)
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Be Your Own Therapist

• Journal and log daily write down what works
  and what doesnt what provokes the stress
  response, or, most importantly, how a different
  interpretation of events might have produced a
  less stressful response. Record in writing all of
  the antecedents step-by-step events that
  produced the stress chemistry.

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Say It Aloud Say It Often!

• Affirmations, repeated very frequently,really
  can change biochemistry.
• Our erroneous beliefs and maladaptive behaviors
  are often invisible to ourselves they must be
  shared.
• Sessions with a therapist or support group often
  lead to a life-long freedom from our narrow,
  tunnel vision.
• All situations can be placed in more than one
  frame.
• But always, theres a first and most important
  question What part do I play in all this?
• STOP BLAMING OR SHOULDING ON YOURSELF

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Relaxation Techniques Are A Vital Part Of Stress
Management
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Relaxation Techniques Work!

• Progressive visualization has three steps
• Relaxing with peaceful imagery
• Engendering peaceful images and the images of
  the stressful situation at the same time
• Thinking about peaceful and relaxing images
  while immersed in a real life stress response
  situation
• Progressive muscle traction followed by
  progressive muscle relaxation exercises produce
  lasting reductions in intensity/frequency of
  stress responses.
• Yoga has 5000 years of proven
  benefits.

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Its the Breathing

• Deep breathing is a powerful tool. The most
  conscious act is forced exhalation focus on
  inhalation and let the diaphragm be stretched by
  the outward pull of the abdominal wall muscles.
  Inhale very deeply exhale slowly.
• This drastically alters sympathetic tone.
• Conscious control of heart rate (pulse) and
  fingertip temperatures can be mastered by
  everyone it just takes some practice.

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Meditation Journey vs. Destination

• Meditation is enhanced by deep breathing listen
  to our chattering monkey brain,just listen.
  Focus on breathing, a mantra, a candle flame,
  flower, favorite photograph, etc. Dont fight
  the river.
• No matter what relaxation technique is used, even
  sitting in a hot tub, assume a body or hand
  position thats easy to duplicate when in
  situations producing stress responses it returns
  us to the warmth even then.

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Nutrition And Body Weight Can Amplify Or
Attenuate The Stress Response
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High Glycemic DietMore Stress

• Sugar is the primordial drug. Unfortunately,
  chemical highs have hidden costs.
• Insulin homeostasis promotes relaxationinsulin
  excess (resistance) increases stress response.
• Vitamins are coenzymes (they are not food) they
  require good nutrition or they are worthless.
• We need to eat more (often) low fat protein in
  the morning is beneficial simple carbohydrates
  (white tan food, desserts, etc.) are a bane of
  good nutrition.

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Gentle Exercise (Like Walking) Modifies The
Stress Response And Lessens Psychosomatic Illness
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No Pain, Still Much to Gain!

• A progressive build-up of muscle mass changes our
  metabolism. All the organs benefit.
• Taking control and accomplishing bodily changes
  increases self-assertiveness and self-esteem.
  Just take a few steps a day.
• Physical conditioning changes stress arousal
  triggers, diminishes volatility, lengthens lives.

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Sleep Deprivation, Even If At Low Levels,
Enhances The Stress Response. Good Sleep
Hygiene Helps Combat Against Psychosomatic
Illness.Good Sleep Good Health
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How To Improve Each Nights Sleep

• Stop or cut in half use of alcohol, nicotine,
  and caffeine none after 5 pm.
• Discuss all your medications with your doctor,
  including non-prescription (herbal) products.
• No napping. Keep bedtimes and wake up times the
  same, seven days a week.
• Never go to bed hungry, or on full stomach.
• Institute pre-bedtime, 30-minute relaxation
  periods, away from the physical bedroom.

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More on good sleep..

• Exercise is a great benefit to help with sleep
  aerobic, but at least 4 hours before bedtime.
• Bedroom is for sleep only.
• No TV, no music, no lying in bed worrying or
  making plans.
• Get out of bed, write worry or to do list in
  the kitchen, then leave it there for a morning
  look.
• Never allow yourself to see the clock dial while
  in bed.

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Spirituality Is In The Journey, The Wanting And
Actively Searching For Something More, Much
More Than Oneself. It Is A Lifelong Process,
Not An Attribute To Acquire Or Possess.
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The Power of Prayer

• Prayer lessens the stress response it helps to
  request serenity derived from acceptance, and
  the courage to really commit to the needed
  changes, one step at a time (small bites).
• Healing power of prayer is well-documented
  biochemical changes produced by systematic prayer
  depend on continuation of the practice. Access
  to real spiritual strength atrophies if not
  exercised daily. (The Practice)

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Batteries Not Included Stress Reduction
Requires A Practice, A Daily Routine Whose
Purpose Is To Protect Our Minds and Bodies From
Our Biggest Enemy, Ourselves.