Psychological Stress—Psychological Stress—Impact on the Impact on the

Cardiovascular SystemCardiovascular System

Dick Jennings Dick Jennings

OutlineOutlineSystems translating psychology into changes in our bodies

--somatic, autonomic, endocrine, immune

Focus on autonomic nervous system

--current anatomical/functional concepts

--stress only one factor altering autonomic nervous output

Behavioral Medicine and the cardiovascular system

--cardiovascular reactivity

--central origins of cardiovascular reactivity

Concept of mind-body and health/disease

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

Stress and its physiological sequelae Stress and its physiological sequelae have long been thought to influence have long been thought to influence the heartthe heart

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.

Controversial translation of stressful thoughts to physiology

Pathways to the HeartPathways to the Heart

Love?Love?

StomacStomach?h?

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

Stress?

Psychoneuroendoimmuno Psychoneuroendoimmuno anatomy and physiologyanatomy and physiology

Autonomic nervous system—sensing Autonomic nervous system—sensing and motor system for visceraand motor system for viscera

Links to endocrine system—SAM and Links to endocrine system—SAM and CORTCORT

Links to immune systemLinks to immune systemAnatomic concept of central Anatomic concept of central

influences on viscerainfluences on visceraOrganized and integrated response Organized and integrated response

supporting key behaviorssupporting key behaviors

From Lane et al. (submitted)

NIH artwork organized by Margaret Chesney

Sympathetic and ParasympatheticSympathetic and Parasympathetic SympatheticSympathetic Activating/energy mobilizingActivating/energy mobilizing Thoracic cord to paravertebral ganglia—processing for Thoracic cord to paravertebral ganglia—processing for

organ specificityorgan specificity 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 Cranial and sacral cord, Xth nerve—Vagus—synapse at end

organorgan Relates to immune system in development and possible Relates to immune system in development and possible

cytokine releasecytokine release Acetylcholine transmitter…muscarinic and nicotinic Acetylcholine transmitter…muscarinic and nicotinic

receptorsreceptors

From Lane et al. (submitted)

From Lane et al. (submitted)

Organized behavioral/autonomic actionOrganized behavioral/autonomic action

Functional Responsivity of the Functional Responsivity of the Nervous SystemNervous System

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

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

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

We now know that patterned responses, as We now know that patterned responses, as modulated by feedback, accomplish these functions. modulated by feedback, accomplish these functions. We question earlier ideas of en masse, autonomous We question earlier ideas of en masse, autonomous or emergency action with antagonistic sympathetic or emergency action with antagonistic sympathetic and parasympathetic responses.and parasympathetic responses.

What is normal/pathogenic/stressful?What is normal/pathogenic/stressful?

What is stress?What is stress?Some biopsychosocial views.Some biopsychosocial views.

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.

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.

The Stress ExperimentThe Stress Experiment

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. PSOM Med, 2005.

What we think we knowWhat we think we know

Blood pressure reactivity contributes to Blood pressure reactivity contributes to atherosclerosis and hypertensionatherosclerosis and hypertension

Negative affect/hostility creates risk for Negative affect/hostility creates risk for heart diseaseheart disease

BUT negative affect does not mediate BUT negative affect does not mediate reactivity/atherosclerosis relationshipreactivity/atherosclerosis relationship

Maintained heart rate variability, Maintained heart rate variability, particularly after an event, is protective particularly after an event, is protective (but we don’t know about recovery from (but we don’t know about recovery from stress yet)stress yet)

See references in your handout

What we think we know (cont.)What we think we know (cont.)

Daily stress is associated with Daily stress is associated with significant cardiovascular symptomssignificant cardiovascular symptoms—ischemia,endothelial dysfunction, —ischemia,endothelial dysfunction, arrhythmiaarrhythmia

Work demands and/or job control Work demands and/or job control associated with cardiovascular risk associated with cardiovascular risk

Social isolation/lack of social Social isolation/lack of social integration associated with integration associated with cardiovascular riskcardiovascular risk

See references in your handout

What we need to knowWhat we need to know

Influence of integrated patterns of endocrine, Influence of integrated patterns of endocrine, immune, and autonomic response and immune, and autonomic response and recovery on cardiovascular diseaserecovery on cardiovascular disease

Control of these integrated patterns by brain Control of these integrated patterns by brain systemssystems

More precise knowledge of how chronic and More precise knowledge of how chronic and acute stress reactions modulate each otheracute stress reactions modulate each other

Genetic/environmental sources of integrated Genetic/environmental sources of integrated response patternsresponse patterns

Mind=Body HypothesisMind=Body HypothesisBrain coordinates function of the whole organismBrain coordinates function of the whole organismBrain adjusts evolutionary mechanisms that, Brain adjusts evolutionary mechanisms that,

e.g., keeps the heart beating.e.g., keeps the heart beating.Brain organizes/initiatiates behavior attempting Brain organizes/initiatiates behavior attempting

to optimize reaching our biological and to optimize reaching our biological and psychological goalspsychological goals

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

Disruption of regulation encompasses control of Disruption of regulation encompasses control of both physiological activation and recovery both physiological activation and recovery processes.processes.

Idea/affect/motiv

Central Nervous System

Autonomic Nervous System

Bodily States

EnvironmentalEvents

Endocrine System

Immune System

Heart

Vasculature

Bodily State Feedback

Pathways