1. Linking Social & Behavioral Sciences with Biology Jessica Kitchen EPI 6181 Wednesday, April 2, 2008

2. Overview Description of Psychosomatics Description of Psychosomatics History & Background Information History & Background Information Theoretical Approaches Theoretical Approaches Introduction to Mind-Body Introduction to Mind-Body The Mind The Mind The Limbic System The Limbic System The Mind-Body Pathway The 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 Responses Link between Social Status & Physiological Responses

3. Psychosomatics Psychosomatics = A branch of psychiatry that looks at the relationship between emotional and physical health: can feelings & emotions influence physical health? Psychosomatics = A branch of psychiatry that looks at the relationship between emotional and physical health: can feelings & emotions influence physical health? Psychosomatic: ‘psyche’ = soul and ‘soma’ = body Psychosomatic: ‘psyche’ = soul and ‘soma’ = body

4. Background Information Hysteria Hysteria Seen as an “imaginary disease”Seen as an “imaginary disease” In Greek "hysteria" = uterusIn Greek "hysteria" = uterus Believed the uterus could detach and move throughout the body and hysterical symptoms would emanate from wherever the uterus was lodgedBelieved the uterus could detach and move throughout the body and hysterical symptoms would emanate from wherever the uterus was lodged By the 17th & 18th centuries the disorder was recognized as being associated with emotional causation By the 17th & 18th centuries the disorder was recognized as being associated with emotional causation

5. History Johann Christian August Heinroth introduced the term ‘psychosomatic’ in 1818 to describe the notion of the mind being capable of enticing both mental and physical illness Johann Christian August Heinroth introduced the term ‘psychosomatic’ in 1818 to describe the notion of the mind being capable of enticing both mental and physical illness Sigmund Freud believed that hysterical symptoms resulted from undischarged “memories” connected to “physical and psychological” trauma Sigmund Freud believed that hysterical symptoms resulted from undischarged “memories” connected to “physical and psychological” trauma Franz Alexander tried to establish a link between physiology and Freudian theory (early 20 th century) Franz Alexander tried to establish a link between physiology and Freudian theory (early 20 th century) Emotion leads to physical illness as a result of prolonged overarousal of the autonomic nervous systemEmotion leads to physical illness as a result of prolonged overarousal of the autonomic nervous system Identified that unconscious wishes and infantile desires in the “psychic stimuli” precipitate specific physiological responsesIdentified that unconscious wishes and infantile desires in the “psychic stimuli” precipitate specific physiological responses

6. History Adolf Meyer introduced psychobiology; emphasized that biological, psychological and social factors all contribute to disease (early 20 th century) Adolf Meyer introduced psychobiology; emphasized that biological, psychological and social factors all contribute to disease (early 20 th century) Cannon (1927) mapped the anatomic and chemical pathways showing how different emotions produced patterns of physiological alterations Cannon (1927) mapped the anatomic and chemical pathways showing how different emotions produced patterns of physiological alterations Pavlov’s dogs demonstrated how visceral somatic organs could respond to mental signals Pavlov’s dogs demonstrated how visceral somatic organs could respond to mental signals

7. Theoretical approaches Psychophysiology – focuses on how emotion, thoughts etc. modify the physiological response to a stimulus Psychophysiology – focuses on how emotion, thoughts etc. modify the physiological response to a stimulus Selye noted that the stress response is dependent on the nature, the intensity and the individual’s previous experience with that stimulusSelye noted that the stress response is dependent on the nature, the intensity and the individual’s previous experience with that stimulus Psychoanalytical Approaches – noted that stress produces a general effect; attempted to explain why a particular organ was affected in under certain circumstances Psychoanalytical Approaches – noted that stress produces a general effect; attempted to explain why a particular organ was affected in under certain circumstances

8. Theoretical approaches Cognitive Theories – evaluated the links between stress, personality and coping Cognitive Theories – evaluated the links between stress, personality and coping Martin (1985) identified the alexithymic personality:Martin (1985) identified the alexithymic personality: Inability to identify stressful situations and express emotions, leading to inability to modify and cope Inability to identify stressful situations and express emotions, leading to inability to modify and cope Oriental Theories – oriental medicine attempts to restore balance of the “ki” energy, which regulates somatic and psychosocial aspects Oriental Theories – oriental medicine attempts to restore balance of the “ki” energy, which regulates somatic and psychosocial aspects Other approaches include Sociological, Family Systems theory etc. Other approaches include Sociological, Family Systems theory etc.

9. Introduction Stimulus → Interpretation → Emotional response → Biological response Stimulus → Interpretation → Emotional response → Biological response Our physiological reaction to an event is dependent on our perception and interpretation of it Our physiological reaction to an event is dependent on our perception and interpretation of it i.e. its predictability, controllability, implicationsi.e. its predictability, controllability, implications

10. The Mind Three levels: Three levels: Awareness - the ability to perceive and respond to stimuliAwareness - the ability to perceive and respond to stimuli Conscious mind - our emotional reactions to those stimuli and our intelligent behaviourConscious mind - our emotional reactions to those stimuli and our intelligent behaviour Self-conscious mind - knowing that one knowsSelf-conscious mind - knowing that one knows Philosophical problem: the mind has no direct access to the body, mediated through the brain Philosophical problem: the mind has no direct access to the body, mediated through the brain

11. The Limbic System Part of the brain that translates ideas and affects into feelings and emotions Part of the brain that translates ideas and affects into feelings and emotions Structurally it is composed of an upper and lower circuit, which bridge the neocortex (thinking brain) to parts of the endocrine system Structurally it is composed of an upper and lower circuit, which bridge the neocortex (thinking brain) to parts of the endocrine system Upper circuit appears to be involved in feeling states, while the lower circuit is involved in emotional states specific to survival (flight or fight response) Upper circuit appears to be involved in feeling states, while the lower circuit is involved in emotional states specific to survival (flight or fight response)

12. The 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 control over exchanges between the body and the external world through emotionsEmotional responses, learning and higher control over exchanges between the body and the external world through emotions Regulation of homeostasis through the autonomic and endocrine systemsRegulation of homeostasis through the autonomic and endocrine systems

13. Body-Mind Pathway Stimuli are recognized and processed in the neocortex (thinking brain) Stimuli are recognized and processed in the neocortex (thinking brain) The limbic system interprets and perceives these stimuli as stressful or not (emotional response) The limbic system interprets and perceives these stimuli as stressful or not (emotional response) Suggestion that emotions are stored in body as peptides or receptors, and resulting emotions are due to bindingSuggestion that emotions are stored in body as peptides or receptors, and resulting emotions are due to binding Results in a physiological response through the endocrine system Results in a physiological response through the endocrine system

14. Body-Mind Pathway

15. HPA Axis Hypothalamic-pituitary-adrenal (HPA) axis part of neuroendocrine system, controls reactions to stress and regulates various body processes Hypothalamic-pituitary-adrenal (HPA) axis part of neuroendocrine system, controls reactions to stress and regulates various body processes Amygdala, hippocampus and hypothalamus (lower circuit of limbic system) facilitate activation of HPA axis, which leads to the release of cortisol Amygdala, hippocampus and hypothalamus (lower circuit of limbic system) facilitate activation of HPA axis, which leads to the release of cortisol Prolonged high levels of cortisol have been associated with suppressed immune function, depression and may facilitate central adiposity, a risk factor for coronary heart disease and diabetes (Cohen S. et al. 2006) Prolonged high levels of cortisol have been associated with suppressed immune function, depression and may facilitate central adiposity, a risk factor for coronary heart disease and diabetes (Cohen S. et al. 2006)

16. HPA Axis

17. SAM Axis Sympathetic-adrenal-medulla (SAM) axis part of the sympathetic nervous system, responsible for initiating fight or flight response Sympathetic-adrenal-medulla (SAM) axis part of the sympathetic nervous system, responsible for initiating fight or flight response Stress stimulates nerves that directly innervate the adrenal medulla, releasing norephinephrine and epinephrine Stress stimulates nerves that directly innervate the adrenal medulla, releasing norephinephrine and epinephrine Results in increased heart rate, increased blood flow to muscles and diverted blood flow from digestive system, inhibited salivary flow, dilated pupils etc. Results in increased heart rate, increased blood flow to muscles and diverted blood flow from digestive system, inhibited salivary flow, dilated pupils etc.

18. SAM Axis

19. Link between Social Status & Physiological Responses Sapolsky et al. (1997) showed baboons of higher rank had greater cortisol suppression, suggesting more effective glucocorticoid negative feedback Sapolsky et al. (1997) showed baboons of higher rank had greater cortisol suppression, suggesting more effective glucocorticoid negative feedback Steptoe & Marmot noted that cardiovascular reactivity is generally greater in lower SES individuals (confounding by stressor characteristics, or hostility, etc.?) Steptoe & Marmot noted that cardiovascular reactivity is generally greater in lower SES individuals (confounding by stressor characteristics, or hostility, etc.?) Lupien, et al. (2000) showed lower SES children had higher salivary cortisol levels than higher SES children Lupien, et al. (2000) showed lower SES children had higher salivary cortisol levels than higher SES children Cohen et al. (2006) found higher SES was associated with lower levels of cortisol and epinephrine, independent of race, age, gender and body mass Cohen et al. (2006) found higher SES was associated with lower levels of cortisol and epinephrine, independent of race, age, gender and body mass

20. Link to Disease Chronic stress → chronic HPA & SAM activation: Chronic stress → chronic HPA & SAM activation: May increase other risk factors (abdominal obesity, immune functioning, insulin resistance)May increase other risk factors (abdominal obesity, immune functioning, insulin resistance) May disrupt normal homeostatic processes resulting in abnormal physiological functioningMay disrupt normal homeostatic processes resulting in abnormal physiological functioning May have long-term effects on the immune and cardiovascular systems, increasing risk of disease and leading to more rapid progression once established (Adler, N. & Ostrove, J, 1999)May have long-term effects on the immune and cardiovascular systems, increasing risk of disease and leading to more rapid progression once established (Adler, N. & Ostrove, J, 1999)