Linking Social & Behavioral Linking Social & Behavioral Sciences with Biology Sciences with Biology

Jessica KitchenJessica Kitchen

EPI 6181EPI 6181

Wednesday, April 2, 2008Wednesday, April 2, 2008

OverviewOverview Description of PsychosomaticsDescription of Psychosomatics History & Background InformationHistory & Background Information Theoretical ApproachesTheoretical Approaches Introduction to Mind-Body Introduction to Mind-Body The MindThe Mind The Limbic SystemThe Limbic System The Mind-Body PathwayThe Mind-Body Pathway Hypothalamic-Pituitary-Adrenal Axis (HPA)Hypothalamic-Pituitary-Adrenal Axis (HPA) Sympathetic-Adrenal-Medulla Axis (SAM)Sympathetic-Adrenal-Medulla Axis (SAM) Link between Social Status & Physiological Link between Social Status & Physiological

ResponsesResponses

PsychosomaticsPsychosomatics

Psychosomatics = A branch of Psychosomatics = A branch of psychiatry that looks at the psychiatry that looks at the relationship between emotional and relationship between emotional and physical healthphysical health: can feelings & : can feelings & emotions influence physical health?emotions influence physical health?

Psychosomatic: ‘psyche’ = soul and Psychosomatic: ‘psyche’ = soul and ‘soma’ = body‘soma’ = body

Background InformationBackground Information

HysteriaHysteria• Seen as an “imaginary disease”Seen as an “imaginary disease”• In Greek "hysteria" = uterusIn Greek "hysteria" = uterus• Believed the uterus could detach and Believed the uterus could detach and

move throughout the body and move throughout the body and hysterical symptoms would emanate hysterical symptoms would emanate from wherever the uterus was lodgedfrom wherever the uterus was lodged

By the 17th & 18th centuries the By the 17th & 18th centuries the disorder was recognized as being disorder was recognized as being associated with emotional causationassociated with emotional causation

HistoryHistory Johann Christian August Johann Christian August Heinroth introduced the Heinroth introduced the

term ‘psychosomatic’ in 1818 to describe the term ‘psychosomatic’ in 1818 to describe the notion of the mind being capable of enticing both notion of the mind being capable of enticing both mental and physical illness mental and physical illness

Sigmund Freud believed that hysterical Sigmund Freud believed that hysterical symptoms resulted from undischarged symptoms resulted from undischarged “memories” connected to “physical and “memories” connected to “physical and psychological” traumapsychological” trauma

Franz Alexander tried to Franz Alexander tried to establish a linkestablish a link between between physiology and Freudian theory (early 20physiology and Freudian theory (early 20thth century)century)• Emotion Emotion leadsleads to physical illness as a result of prolonged to physical illness as a result of prolonged

overarousal of the autonomic nervous systemoverarousal of the autonomic nervous system• Identified that unconscious wishes and infantile desires Identified that unconscious wishes and infantile desires

in the “psychic stimuli” precipitate specific physiological in the “psychic stimuli” precipitate specific physiological responsesresponses

HistoryHistory

Adolf Meyer introduced psychobiologyAdolf Meyer introduced psychobiology;; emphasized that biological, psychological emphasized that biological, psychological and social factors all contribute to disease and social factors all contribute to disease (early 20(early 20thth century) century)

Cannon (1927) mapped the anatomic and Cannon (1927) mapped the anatomic and chemical pathways chemical pathways showing how different showing how different emotions produced patterns of emotions produced patterns of physiological alterations physiological alterations

Pavlov’s dogsPavlov’s dogs demonstrated how visceral demonstrated how visceral somatic organs could respond to mental somatic organs could respond to mental signalssignals

Theoretical approachesTheoretical approaches Psychophysiology – focuses on how Psychophysiology – focuses on how

emotion, thoughts etc. modify the emotion, thoughts etc. modify the physiological response to a stimulusphysiological response to a stimulus• SelyeSelye noted that the stress response is noted that the stress response is

dependent on the nature, the intensity and the dependent on the nature, the intensity and the individualindividual’’s previous experience with that s previous experience with that stimulusstimulus

Psychoanalytical Approaches – noted that Psychoanalytical Approaches – noted that stress produces a general effectstress produces a general effect; ; attempted to explain why a particular attempted to explain why a particular organ was affected in under certain organ was affected in under certain circumstances circumstances

Theoretical approachesTheoretical approaches Cognitive Theories – evaluated the links Cognitive Theories – evaluated the links

between stress, personality and copingbetween stress, personality and coping• Martin (1985) identified the alexithymic Martin (1985) identified the alexithymic

personalitypersonality:: Inability to identify stressful situations and express Inability to identify stressful situations and express

emotions, leading to inability to modify and copeemotions, leading to inability to modify and cope Oriental Theories – oriental medicine Oriental Theories – oriental medicine

attempts to restore balance of the “ki” attempts to restore balance of the “ki” energy, which regulates somatic and energy, which regulates somatic and psychosocial aspectspsychosocial aspects

Other approaches include Sociological, Other approaches include Sociological, Family Family Systems theorySystems theory etc. etc.

IntroductionIntroduction

StimulusStimulus →→ InterpretationInterpretation →→ Emotional response Emotional response →→ Biological Biological responseresponse

Our physiological reaction to an Our physiological reaction to an event is dependent on our perception event is dependent on our perception and interpretation of it and interpretation of it • i.e.i.e. itsits predictability, controllability, predictability, controllability,

implicationsimplications

The MindThe Mind

Three levels:Three levels:• Awareness - the ability to perceive and Awareness - the ability to perceive and

respond to stimulirespond to stimuli • Conscious mind - our emotional reactions to Conscious mind - our emotional reactions to

those stimuli and our intelligent behaviourthose stimuli and our intelligent behaviour • Self-conscious mind - knowing that one knowsSelf-conscious mind - knowing that one knows

Philosophical problem: the mind has no Philosophical problem: the mind has no direct access to the body, mediated direct access to the body, mediated through the brainthrough the brain

The Limbic SystemThe Limbic System

Part of the brain that translates ideas and Part of the brain that translates ideas and affects into feelings and emotionsaffects into feelings and emotions

Structurally it is Structurally it is composedcomposed of an upper of an upper and lower circuit, which bridge the and lower circuit, which bridge the neocortex (thinking brain) to parts of the neocortex (thinking brain) to parts of the endocrine system endocrine system

Upper circuit appears to be involved in Upper circuit appears to be involved in feeling states, while the lower circuit is feeling states, while the lower circuit is involved in emotional states specific to involved in emotional states specific to survival (flight or fight response)survival (flight or fight response)

The Limbic SystemThe Limbic System

Functions of the limbic system include:Functions of the limbic system include:• OlfactionOlfaction• Arousal, motivation, etc.Arousal, motivation, etc.• Coding in laying down new memoriesCoding in laying down new memories• Emotional responses, learning and higher Emotional responses, learning and higher

control over exchanges between the body and control over exchanges between the body and the external world through emotionsthe external world through emotions

• Regulation of homeostasis through the Regulation of homeostasis through the autonomic and endocrine systemsautonomic and endocrine systems

Body-Mind PathwayBody-Mind Pathway

Stimuli are recognized and processed in Stimuli are recognized and processed in the neocortex (thinking brain)the neocortex (thinking brain)

The limbic system interprets and perceives The limbic system interprets and perceives thesethese stimuli as stressful or not (emotional stimuli as stressful or not (emotional response)response)• SuggestionSuggestion that emotions are stored in body as that emotions are stored in body as

peptides or receptors, and resulting emotions peptides or receptors, and resulting emotions are due to binding are due to binding

Results in a physiological response Results in a physiological response through the endocrine systemthrough the endocrine system

Body-Mind PathwayBody-Mind Pathway

HPA AxisHPA Axis Hypothalamic-pituitary-adrenal Hypothalamic-pituitary-adrenal ((HPA) HPA) axis axis part of part of

neuroendocrine system, controls reactions to neuroendocrine system, controls reactions to stress and regulates various body processesstress and regulates various body processes

Amygdala, hippocampus and hypothalamus Amygdala, hippocampus and hypothalamus (lower circuit of limbic system) facilitate (lower circuit of limbic system) facilitate activation of HPA axis, which leads to the release activation of HPA axis, which leads to the release of cortisol of cortisol

Prolonged high levels of cortisol have been Prolonged high levels of cortisol have been associated with suppressed immune function, associated with suppressed immune function, depression and may facilitate central adiposity, a depression and may facilitate central adiposity, a risk factor for coronary heart disease and risk factor for coronary heart disease and diabetes diabetes (Cohen S. et al. 2006)(Cohen S. et al. 2006)

HPA AxisHPA Axis

SAM AxisSAM Axis

Sympathetic-adrenal-medulla (SAM) axis Sympathetic-adrenal-medulla (SAM) axis part of the sympathetic nervous system, part of the sympathetic nervous system, responsible for initiating fight or flight responsible for initiating fight or flight responseresponse

Stress stimulates nerves that directly Stress stimulates nerves that directly innervate the adrenal medulla, releasing innervate the adrenal medulla, releasing norephinephrine and epinephrine norephinephrine and epinephrine

ResultsResults in increased heart rate, increased in increased heart rate, increased blood flow to muscles and blood flow to muscles and diverted blooddiverted blood flow from digestive system, flow from digestive system, inhibitedinhibited salivary flow, salivary flow, dilateddilated pupils etc. pupils etc.

SAM AxisSAM Axis

Link between Social Status & Link between Social Status & Physiological ResponsesPhysiological Responses

Sapolsky et al. (1997) showed baboons of higher Sapolsky et al. (1997) showed baboons of higher rank had greater cortisol suppression, rank had greater cortisol suppression, suggestingsuggesting more effective glucocorticoid negative feedbackmore effective glucocorticoid negative feedback

Steptoe & Marmot noted that cardiovascular Steptoe & Marmot noted that cardiovascular reactivity is generally greater in lower SES reactivity is generally greater in lower SES individuals (confounding by stressor individuals (confounding by stressor characteristicscharacteristics, or hostility, etc.?), or hostility, etc.?)

Lupien, et al. Lupien, et al. (2000) showed lower SES children (2000) showed lower SES children had higher salivary cortisol levels than higher SES had higher salivary cortisol levels than higher SES childrenchildren

Cohen et al. (2006) found higher SES was Cohen et al. (2006) found higher SES was associated with lower levels of cortisol and associated with lower levels of cortisol and epinephrine, independent of race, age, gender epinephrine, independent of race, age, gender and body mass and body mass

Link to DiseaseLink to Disease

Chronic stress Chronic stress →→ chronic HPA & SAM chronic HPA & SAM activation:activation: • May increase other risk factors (abdominal May increase other risk factors (abdominal

obesity, immune functioning, insulin obesity, immune functioning, insulin resistance)resistance)

• May disrupt normal homeostatic processes May disrupt normal homeostatic processes resulting in abnormal physiological functioning resulting in abnormal physiological functioning

• May have long-term effects on the immune and May have long-term effects on the immune and cardiovascular systems, increasing risk of cardiovascular systems, increasing risk of disease and leading to more rapid progression disease and leading to more rapid progression once established (Adler, N. & Ostrove, J, 1999)once established (Adler, N. & Ostrove, J, 1999)