Healing and the Mind: Emotions and the Immune System
Margaret Kemeny, PhD, UCLA psychologist and associate professor
This is a summary of a lecture presented on April 4, 2000.
Without a doubt, there is a connection between the mind and the body. A person walking down a dark alley in an unfamiliar part of town is likely to develop sweaty palms and a pounding heartbeat, especially if there are strange sounds. In the face of real or perceived danger, the body’s “fight or flee” response heightens. Clearly, as this example shows, the body reacts to emotions and feelings. Fear accelerates the heartbeat. But what about the far more complex relationship between emotions and disease? Can certain states of mind affect the growth of a tumor? Do people with positive attitudes have a better chance of not developing cancer? Is there such a thing as a “cancer personality?” These questions address the intricate and, as yet, not well understood issues surrounding the interaction of the body’s emotions and its immune system.
The field of psychoneuroimmunology (PNI) studies the ways in which the immune system and the nervous system communicate with each other and the impact that this interaction has on health. A great deal has been learned during the past decade, but what is not known still far exceeds what is known. Any source that claims to understand the relationship between the mind and the body should be viewed with skepticism, as should any book or article that states definitively that feelings or thoughts can cause or cure cancer. The scientific facts to date do not support such theories or suppositions. A growing body of research, however, is beginning to articulate some remarkable relationships between stress, positive emotions and feelings and immune function, disease, and mortality. The next decade is likely to shed much more light on these puzzling connections.
The human immune system
The human immune system is highly complex and understood only in part, although considerable advances in understanding have been made in recent years. The immune system allows the body to fight infection and disease in the following ways:
- Through the proliferative response, the immune system reacts to the presence of foreign agents in the body by rapidly producing an army of white blood cells that attack the foreign body. A well-functioning immune system responds quickly to the earliest indication that something is threatening the body.
- The immune system has “natural killer” cells that have the ability to recognize and kill viruses. When a virus enters the body, it multiplies rapidly until the host cell explodes, which releases more viruses into the body. The “natural killer” cells secrete a toxic substance that destroys the infecting viruses. These cells have been found to kill tumor cells in test tubes, leading some immunologists to believe that they represent an important defense against human tumors.
- The T-helper cells are another important component of the immune system. Scientists believe that the T-helper cells secrete substances into the blood system that tell other cells to begin fighting infection. In patients with AIDS, the HIV virus destroys T-helper cells, thus causing the complex breakdown of the immune system that results in death.
The impact of stress
Most of the psychoneuroimmunology research that has been conducted to date has studied the impact of stress. Scientists know that stress causes a chain reaction of biological responses. The hypothalamus, the pituitary glands and the adrenal glands play major roles in the release of substances often referred to as stress hormones (e.g. cortisol, adrenaline epinephrine, norepinephrine, B-endorphin, ACTH). Stress typically is categorized by its intensity including stresses that can be induced in a laboratory, as follows:
- Acute stress – major life events:
Death of a spouse
- Non-acute stress – minor life events:
- Chronic stress:
Taking care of a person with chronic illness
Living with natural disasters
- Acute stress in the laboratory:
Studies have found that people exposed to these various kinds of stresses have changes in their immune system. The research suggests that the immune system’s proliferative response decreases by about 15% and continues to decrease in chronically stressful situations. People exposed to chronic stress were found to have an increased likelihood of having colds, herpes outbreaks and decreased antibody build-up following vaccines. (When exposed to chronic stress, laboratory rats with cancer were found to have a greater likelihood to develop metastatic disease, but the presence of stress did not increase the likelihood of developing cancer among those rats that were cancer-free.) The scientists found that, within the different stress groups, people did not always have similar proliferative responses. Blood samples taken before and after a specific stressful event revealed that some people had increased responses, while others had decreased responses and others showed no change at all. These findings suggest that there may be differences in the make-up of individual immune systems so that the way in which a person responds to or deals with stress also may have an important protective role.
Researchers have learned that cells in the immune system release fluids called cytokines that act as messengers allowing cells to “talk” to one another, sending instructions to develop more cells to fight infection. Studies are beginning to reveal that stress hormones may inhibit the production of cytokines, thus thwarting the body’s ability to effectively fight infection.
Emotions and immune function
Studies of people with severe depression have found that they show a slightly decreased proliferative response. In people with normal “depressed” moods, there is some evidence of change in the immune system: when experiencing a depressed state, the response was at its lowest level. It was at its highest level when experiencing positive states. Studies that looked at short-term negative moods found that there was a slight drop in the proliferative response but that it returned to normal when the mood dissipated. These studies found that positive moods actually boosted the proliferative response and kept it elevated for a short time, and then it returned to its normal state.
Social relationships appear to play an important role in the functioning of the immune system and in general well-being. People who have support from those around them tend to do better in life. This is true even for people who do not have a great deal of support. Having at least one person to confide in seems to make a difference in life expectancy. New research indicates that the ways in which an individual responds to others may have an effect on his or her immune system. Several studies have looked at the role of hostility. The preliminary findings indicate that hostility may affect life expectancy – people who were hostile tended to have a greater likelihood of developing heart attacks, high blood pressure, other cardiovascular disease, stroke, and cancer. One study assigned a hostility measure to a group of physicians and then followed them for 30 years. The physicians who scored high on the hostility measure were five times more likely to have coronary heart disease than those who scored low on the hostility measure. Another study assessed the hostility levels of groups of medical and law students and followed them to age 50. In the low hostility groups, two percent of the doctors and four percent of the lawyers had died by age 50. In the high hostility group, 14% of the doctors and 20% of the lawyers had died by age 50.
It is important to understand that, as defined by these studies, hostility is more than just anger. Anger is a normal emotion and often serves a constructive purpose. Hostility differs from anger in that it involves overt aggression, frequent anger outbursts, and cynical mistrust. Frequent anger outbursts are the result of a great deal of underlying anger that is not dealt with effectively and thus builds up. Cynical mistrust is the assumption that one always is being taken advantage of and therefore must keep a vigilant watch over others. The research indicates that in general people who trust others live longer than those who chronically believe they are being cheated. Immunologic changes do appear to be associated with hostility, but there is no reliable clinical evidence that normal, healthy emotions including anger and fear have any negative effect on the immune system.
Optimism and immune function
A growing body of research, conducted mainly on HIV-positive men, indicates that positive and negative outlooks on life may have an impact on immune function. In these studies, men with AIDS who were optimistic lived longer than those who had pessimistic expectations of outcome and had lost someone close to AIDS. In another study of people who were HIV- positive but at the time had no symptoms, those who were optimistic tended to develop fewer symptoms than those who were pessimistic. These studies were conducted before combination therapy programs were available to treat HIV patients. Additional research studied the immune systems of HIV-infected men for five years. The immune systems of those who were highly pessimistic were more surpressed than those in men who were highly optimistic. It might be argued that the highly optimistic men were somewhat unrealistic. While they understood that they were likely to die from their disease, they still maintained optimism that a new discovery, a new course of treatment or some other factor might change their situation for the better. Their attitude illustrates the wisdom of Norman Cousins’ advice in, Health First: The Biology of Hope (1989): “Don’t deny the diagnosis; try to defy the verdict.”
Additional studies suggest that optimism is a predictor of better health in populations other than people with HIV. It is important to note that this does not mean that a cause-and-effect relationship exists between optimism and better health or between pessimism and disease. There is no evidence that any attitude can cause a disease or cure it. The state of hopefulness and the will to live, however, may produce positive biological changes that may help to influence a more positive outcome.
Studies also have indicated that self-blame and reproach may play a negative role in immune function. One study found that HIV- infected men who significantly blamed themselves had greater declines in immune function and decreased survival times than HIV men who were more self- accepting. Furthermore, gay men who were open about and accepting of their sexual orientation did better than those who were “in the closet.” The research indicated that the men’s sensitivity to rejection and their negative self-perceptions were more of a factor than any stress associated with being “in the closet.” These findings raise questions about the impact of shame on people’s well-being. One experimental study of college students found that students experiencing a higher degree of shame had higher levels of cytokines in their saliva. This finding and those of other studies suggest that how one views oneself may have an influence on one’s biological state.
While most of the research into emotions and the immune system has focused on negative emotions and conditions, a small number of studies indicate that when happiness is induced, the immune system functions better. There also is growing evidence that the relaxation response has positive effects. In a group of geriatric patients who were taught the relaxation response through progressive muscle relaxation, their immune systems showed an increase in the natural killer cells that are involved in destroying viruses and tumors. This improvement, however, was not permanent or long-term; the level of natural killer cells returned to baseline when the patients stopped using the relaxation response.
Deeper positive states and immune function
A few research studies are investigating the deeper positive states that many people develop as they confront a life-threatening illness such as cancer or AIDS. Many people find greater meaning to life and discover deeper levels of creativity and spirituality and other “silver linings.” There is some indication that these positive changes may lead to increased survival time. A recent study found that among a group of men who had lost a partner to AIDS, those who had dealt with the loss and had found new meaning to life in the process had higher immune function and lived longer than those who had not.
Other studies looked at college students dealing with trauma and patients with rheumatoid arthritis and found that those who worked through the difficulties in their lives showed improvement in immune function. Dr. David Spiegel conducted a study of women with metastatic breast cancer and found that those who participated in supportive expressive group therapy tended to live longer and had better quality of life than those who did not participate. Much work still needs to be done in this area, but the existing research does suggest that the process of working through one’s feelings and finding deeper meaning in life may have a beneficial impact on one’s health.
Cancer and emotions
What is the relationship between emotions and cancer? The following statements summarize what currently is known and not known:
- There is no good scientific evidence to support the theory that stress makes a person more vulnerable to the development of cancer. In animal models, there is no evidence that stress causes tumors.
- Scientists do not know if depression make a person more vulnerable to cancer: half say yes; half say no.
- There is no good evidence to support the theory that people who repress their emotions are more vulnerable to developing cancer.
- There is no good evidence to support the theory that there is a “cancer personality.”
A small amount of evidence suggests that some psychological states may influence the course of disease, but they do not create disease. A few studies indicate that once a person has a tumor, emotional states may influence its spread.
- Dr. David Spiegel’s study of women who had metastatic breast cancer looked at the impact of group experience on survival over a 10-year period, and concluded that support groups can have a positive effect. They allowed their members to confront their mortality in a safe and supportive environment, allowing them to feel and express normal reactions to the presence of metastatic disease including anger and fear. The group members then came to some new meaning related to breast cancer progression.
At UCLA, Dr. Fawzy Fawzy studied the effects of being in a problem-solving group among people with malignant melanoma. As they developed better coping skills, the participants’ negative moods improved, they coped more actively with stress, and during the follow-up period they experienced fewer relapses of melanoma.
What practical advice for women with cancer and their family members can be drawn from studies of the emotions and the immune system? The following suggestions are valid for anyone whether a cancer patient or not:
- It is important to recognize and acknowledge your feelings. Participation in a support group, such as those offered by the Resource Center, will allow you to confront stress and other negative feelings in a safe environment and may help you to move forward. Many techniques taught in groups, such as the relaxation response, meditation, and expressing feelings through writing and art may help you come to terms with your illness and may facilitate the development of deeper emotional states.
- Staying engaged and involved in life is important even though it often is painful and difficult to do. Staying engaged often leads to greater fulfillment and a better quality of life, which in turn may have a positive effect on outcome. Feelings of sadness and anger are normal and can coexist with hopefulness and being involved in life.
- Try to accept yourself, and try to develop and promote trusting relationships.
- Don’t believe everything you read or hear about positive attitudes and what causes cancer. Contrary to what many books and people will have you believe, there is no scientific data to support the notion that a negative attitude causes cancer or that a positive one prevents it. Be wary of people who tell you that you must have a positive attitude at all times. Cancer is a difficult disease – for the patient and for her family and loved ones. There will be many times when you just don’t feel like being positive. Don’t put yourself under additional stress by trying to maintain a cheerful face when you are feeling otherwise. At the same time, blaming and berating yourself on a continual basis can lock you into a negative state of mind, which also will not help. Try to recognize and accept whatever feelings you have, and try to work through them in a constructive way. Again, participation in a support group that is led by a trained professional often is an excellent way to come to terms with the range of emotions you may be feeling as you live with cancer.
(Editor’s Note: Please call the Resource Center if you want to pursue any of the suggestions mentioned above. We believe that each person has unique needs, so we offer a variety of ways to help women adapt to and manage the changes brought about by cancer and its treatments. The listing of our groups and classes begins on page 14. For people who do not want a group experience, our Insights Into Cancer lecture series offers another way to access information. You also may talk to one of our staff of licensed clinical social workers who can help you determine which resources best meet your needs. We are here to help. As Mr. Mann has said many times, “No one should have to face a cancer diagnosis alone.”
For reprint authorization, contact SimmsMannCenter@mednet.ucla.edu.