Psychological Effects on Psychological Effects on the Cardiovascular the Cardiovascular

SystemSystemDick Jennings Dick Jennings

Behavioral MedicineBehavioral Medicine

Understand how psychological Understand how psychological factors can influence the initiation, factors can influence the initiation, course, and outcome of disease (and course, and outcome of disease (and health maintenance)health maintenance)

The relationship between mind and The relationship between mind and body is a central conceptbody is a central concept

The concept of stress and its The concept of stress and its physiological sequelae is the lay physiological sequelae is the lay theory of behavioral medicinetheory of behavioral medicineHow should we

conceptualize the relationship?

Why we worry about stress..Why we worry about stress..

Components of StressComponents of Stress

Threat to well-beingThreat to well-beingEmotional reactionsEmotional reactionsEmotions alter physiologyEmotions alter physiologyOver time (and typically in Over time (and typically in

combination with other factors), combination with other factors), disease occursdisease occurs

Idea/affect/motiv

Central Nervous System

Autonomic Nervous System

Bodily States

EnvironmentalEvents

Endocrine System

Immune System

Motor/Action System

Heart

Vasculature

Bodily State Feedback

Response Systems..Response Systems..

Netter (1962) CIBA collection of Medical Illustrations. Pp 164-165

Functional Responsivity of the Functional Responsivity of the Autonomic Nervous SystemAutonomic Nervous System

Support for action— Support for action— orienting, anticipating, orienting, anticipating, exercising,thoughtexercising,thought

MetabolismMetabolism— — salt/water balance, digestion, salt/water balance, digestion, respiratory sinus arrhythmiarespiratory sinus arrhythmia

AffectAffect— — fear, anger, grief, disgustfear, anger, grief, disgust

STRESS??STRESS??

Sympathetic and ParasympatheticSympathetic and Parasympathetic

SympatheticSympathetic Activating/energy mobilizingActivating/energy mobilizing Thoracic cord to paravertebral ganglia—processing for organ Thoracic cord to paravertebral ganglia—processing for organ

specificityspecificity Engage endocrine systemEngage endocrine system Norepinephrine transmitter..modulation via alpha and beta Norepinephrine transmitter..modulation via alpha and beta

adrenergic receptors (co-release peptides, opiates, …..)adrenergic receptors (co-release peptides, opiates, …..) ParasympatheticParasympathetic Conserving/energy restoringConserving/energy restoring Cranial and sacral cord, Xth nerve—Vagus—synapse at end organCranial and sacral cord, Xth nerve—Vagus—synapse at end organ Relates to immune system in development and possible cytokine Relates to immune system in development and possible cytokine

releaserelease Acetylcholine transmitter…muscarinic and nicotinic receptorsAcetylcholine transmitter…muscarinic and nicotinic receptors

Organized behavioral/autonomic actionOrganized behavioral/autonomic action

Controversial translation of stressful thoughts to physiology

StressStress Darwin—changing environment leads to adaption. Darwin—changing environment leads to adaption.

Stress?Stress? Cannon—physiological reactions maintain Cannon—physiological reactions maintain

homeostasis. Stress? Defending homeostatic homeostasis. Stress? Defending homeostatic target range.target range.

Selye (1946)—Stress as non specific damaging Selye (1946)—Stress as non specific damaging agents (external to person) inducing generalized, agents (external to person) inducing generalized, stereotypic reaction—General Adaptation stereotypic reaction—General Adaptation Syndrome defines stress by the physiological Syndrome defines stress by the physiological reaction.reaction.

Selye—linear concept, non-psychological, non-Selye—linear concept, non-psychological, non-behavioral. Stress required return to homeostasis behavioral. Stress required return to homeostasis not adaptation to new situation. not adaptation to new situation.

Holmes/Rahe—stress as disease of adaption Holmes/Rahe—stress as disease of adaption (literal Selye—closer to Cannon)(literal Selye—closer to Cannon)

Stress--continuedStress--continued

Mason—patterns response of Mason—patterns response of neuroendocrine system dependent upon neuroendocrine system dependent upon situationsituation

Lazarus—an interactive (nonlinear) stress Lazarus—an interactive (nonlinear) stress syndrome—threat, evaluation, coping, re-syndrome—threat, evaluation, coping, re-evaluation. evaluation.

Weiner—patterns of integrated action, Weiner—patterns of integrated action, biorhythms, dysregulation, taxonomic stressbiorhythms, dysregulation, taxonomic stress

McEwan—allostasis. The weight of McEwan—allostasis. The weight of adjustment. Separate systems that guide adjustment. Separate systems that guide adjustment but may be overtaxed. adjustment but may be overtaxed.

The Stress ExperimentThe Stress Experiment

Cardiovascular ReactivityCardiovascular Reactivity

Individuals show changes in heart rate and blood pressure when exposed to brief laboratory stressors/challenges

Individuals are reasonably consistent across time in the magnitude of these responses to stressors.

These responses are associated with and predictive of cardiovascular disease.

The brain may have something to do with this.

Issues in Cardiovascular Issues in Cardiovascular ReactivityReactivity

Generality over instances within Generality over instances within individual, over stressors, over life individual, over stressors, over life spanspan

Variety of reactivity—cardiac, Variety of reactivity—cardiac, vascular, vagal, sympathetic….vascular, vagal, sympathetic….

Source of reactivity—genetic, affect, Source of reactivity—genetic, affect, stressorsstressors

Person-Environment interactionPerson-Environment interactionActivation or Recovery?Activation or Recovery?

From web SuperCourse

Quartile of SBP response

Mea

n C

aro

tid

IMT

(m

m)

0.80

0.82

0.84

0.86

0.88

0.90

0.92

0.94

0.96

0.98

1.00

1.02

1.04

1 2 3 4

Jennings, Kamarck, Manuck, Everson-Rose, Kaplan, & Salonen, Circulation, 2005

From Gianaros et al., Psychophysiology, 2005

From Gianaros et al., PSOM Med, 2005

Mind=Body HypothesisMind=Body Hypothesis

Brain coordinates function of the whole Brain coordinates function of the whole organismorganism

Brain adjusts evolutionary mechanisms Brain adjusts evolutionary mechanisms that, e.g., keeps the heart beating.that, e.g., keeps the heart beating.

Brain organizes/initiatiates behavior Brain organizes/initiatiates behavior attempting to optimize reaching our attempting to optimize reaching our biological and psychological goalsbiological and psychological goals

Behavioral patterns—driving autonomic, Behavioral patterns—driving autonomic, motoric, endocrine and immune outputs-- motoric, endocrine and immune outputs-- can then disrupt regulation of peripheral can then disrupt regulation of peripheral bodily function.bodily function.

Behavioral focus can ignore restorative Behavioral focus can ignore restorative processes responsive to bodily afference. processes responsive to bodily afference.

The path from psychosocial to The path from psychosocial to illnessillness

Communication and coordination Communication and coordination within our body is via the nervous, within our body is via the nervous, endocrine, and immune systems. endocrine, and immune systems.

The brain’s impact on these systems The brain’s impact on these systems are the pathways from psychosocial are the pathways from psychosocial to illness.to illness.

Individual differences in behavior and Individual differences in behavior and biological characteristics impact biological characteristics impact these pathways and have been these pathways and have been related to illness.related to illness.