Tema 4.pdf

Estils de vida i salut cerebral Tema 4: Cervell i Salutogènesi Dr. Kilian Abellaneda Pérez [email protected] Unitat de Psicologia Mèdica, Departament de Medicina Facultat de Medicina i Ciències de la Salut Universitat de Barcelona PART 1 THEORETICAL FOUNDATIONS Llibre recomanat Brief...

Estils de vida i salut cerebral Tema 4: Cervell i Salutogènesi Dr. Kilian Abellaneda Pérez [email protected] Unitat de Psicologia Mèdica, Departament de Medicina Facultat de Medicina i Ciències de la Salut Universitat de Barcelona PART 1 THEORETICAL FOUNDATIONS Llibre recomanat Brief history on today’s lecture Søren Kierkegaard 5 May 1813 – 11 November 1855 Viktor Frankl 26 March 1905 – 2 September 1997 Jean-Paul Sartre 21 June 1905 – 15 April 1980 Martin Heidegger 26 September 1889 – 26 May 1976 Aaron Antonovsky 19 December 1923 – 7 July 1994 Marc contextual • Modern conceptions of PiL stem from the philosophical writings of existential philosophy, which has its formal beginning on the dissertations published in the 1840s by Sören Kierkegaard. • It is relevant to consider that: 1) philosophers have debated whether meaning exists and what its contingencies might be. 2) psychologists and neuroscientists have primarily focused on the importance of experiencing meaning and purpose in one’s life, exploring how this links with human health. Factors principals de l’estudi BBHI Activitat cognitiva Activitat física Pla vital Nutrició Son Socialització Salut general Factors principals de l’estudi BBHI Eudaimonic or Psychological Wellbeing • The concept of well-being—a sense of purpose and meaningful, positive engagement with life (Ryff, 1989)—has been of interest to philosophers since at least Aristotle. • Aristotle termed this type of wellbeing eudaimonia and differentiated it from hedonic positive affect (PA), defined as the momentary experience of pleasure (see also Diener & Lucas, 1999). • Aristotle was fundamentally interested in how people may increase their own degree of eudaimonic wellbeing, and at one point called eudaimonia the “highest of all goods achievable by human action” (Aristotle, 350 B.C./1925, p. 5). Meaning in life (MiL) Recent literature defends that MiL entails three components [it includes a cognitive component (coherence), a motivational component (goal/purpose), and an affective component (feelings of satisfaction and fulfillment, and that one’s life matters): a) Sense of coherence (SoC) - Cognitive b) Purpose in life (PiL) - Motivational c) Engagement with life (EwL) - Affective Bartrés-Faz et al., 2018. Alzheimer’s Research & Therapy. Meaning in life components a) SoC refers to the ability to ‘make sense, understand one’s life, the external world and how one fits within it’ Antonovsky b) PiL encapsulates ‘long-term life aspirations that motivate behavior’ – Viktor Frankl c) EwL, the affective component, is closely connected to the idea of ‘having significance and life satisfaction and fulfillment’. Bartrés-Faz et al., 2018. Alzheimer’s Research & Therapy. Ryff et al., 2014. Psychother Psychosom Istigkeit — wasn't that the word Meister Eckhart liked to use? "Is-ness." The Being of Platonic philosophy — except that Plato seems to have made the enormous, the grotesque mistake of separating Being from becoming and identifying it with the mathematical abstraction of the Idea. He could never, poor fellow, have seen a bunch of flowers shining with their own inner light and all but quivering under the pressure of the significance with which they were charged; could never have perceived that what rose and iris and carnation so intensely signified was nothing more, and nothing less, than what they were — a transience that was yet eternal life, a perpetual perishing that was at the same time pure Being, a bundle of minute, unique particulars in which, by some unspeakable and yet self-evident paradox, was to be seen the divine source of all existence. Aldous Huxley (Godalming, 1894 – Los Angeles, 1963) The Doors of Perception The Salutogenesis Model The Salutogenesis Model From pathogenesis to salutogenesis • Having worked as a stress and coping researcher with foci on multiple sclerosis, cancer and cardiovascular diseases, Antonovsky came to realise that his real interest did not have its starting point in any particular disease. Pathogenesis • Antonovsky came then to the question ‘what makes people healthy?’ and the need to coin the term salutogenesis. Salutogenesis The Meanings of Salutogenesis In its most general meaning, salutogenesis refers to a scholarly orientation focusing attention on the study of the origins of health vs. the origins of disease and risk factors The Meanings of Salutogenesis Locus control intern vs. extern In its narrower meaning, salutogenesis is often equated with one part of the model, the sense of coherence, defined as: ... a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments are predictable and that there is a high probability that things will work out as well as can reasonably be expected (Antonovsky). The Handbook of Salutogenesis Editors: Maurice B. Mittelmark, Shifra Sagy, Monica Eriksson, Georg F. Bauer, Jürgen M. Pelikan, Bengt Lindström, and Geir Arild Espnes. Springer; 2017. The Meanings of Salutogenesis • Salutogenesis refers to a model described in detail in Antonovsky’s 1979 Health, Stress and Coping, which posits that life experiences help shape one’s sense of coherence. • Through this mechanism, the sense of coherence helps determine one’s movement on the health Ease/Dis-ease continuum. Life experiences Sense of Coherence Ease/Dis-ease continuum The Salutogenesis Model Antonovsky’s illustration of the salutogenic model of health The Salutogenesis Model RESISTANCE RESOURCES STRESSORS Salutogenesis in Context • The salutogenic model originated as a stress and coping model. • Antonovsky referred to Selye’s (1956) and Lazarus and Cohen’s (1977) work as particularly inspirational. Physiological evidence • Hans Selye’s General Adaptation Syndrome (1956) • Alarm/defense reaction stage: Preparation to face the threat /danger (the stressor) Autonomic hyperreactivity (sympathetic-adrenomedular): increased adrenaline, increased blood pressure,…. • Resistance stage: The stressor does not resume but the organism resists. Hypothalamus-Hypophysis-Adrenal axe: glucocorticoids Redistribution of resources: decrease sexual and gastric activity • Exhaustion stage: Stressor is intense and continuous Depletion of the organism resistance resources ‘Adaptability diseases’ emerge: ulcer, cardiovascular diseases, nervous manifestations,.... Stress & disease Each organ has a different vulnerability to stress Stress may precipitate or aggravate medical conditions. Cardiovascular Hypertension Coronary artery disease Congestive heart failure Sudden cardiac death Immune Common cold Some forms of cancer Rheumatoid arthritis Systemic lupus erythematosus Musculoeskeletal Fibromyalgia Gastrointestinal Ulcer Alterations of gastric motility Neurologic Brain atrophy Reduce neurogenesis Headache Dizziness, vertigo Depression Psychosis Dementia Pulmonary Asthma Chronic obstruct. pulmonary disease Dermatologic Vasodilatation Pruritus Psychological perspective Not only physical stressors (i.e. wounds from war) but also a long list of experiences can induce similar responses in the organisms Hassles & chronic or cumulative stressors Insufficient income Difficulties in finding a job Problems in school Difficulty finding housing Girlfriend or boyfriend problems Which degree of readjustment would this imply to you? Social Readjustment Rating Scale Holmes & Rae (1967) The Salutogenesis Model – Stress inoculation The term “stress inoculation” was first described by Levine (Science, 1962) who showed that infant rats exposed to intermittent foot shocks subsequently respond more effectively when confronted with novel situations compared to their non stressed counterparts Incrementa el rang d’estrès tolerable The Salutogenesis Model – Stress inoculation • Previous work has examined in detail the long–term effects of brief intermittent mother–offspring separations in squirrel monkeys. • In a common experimental design, socially housed monkeys are randomized to either brief intermittent separations or a non–separated control condition at 17 weeks of age. • Over 10 separation sessions, a monkey is removed from the group for one hour per week. • At nine months of age, behavioral and hormonal parameters are measured in separated and non– separated monkeys in a novel environment stress test. Compared to non–separated monkeys, previously separated monkeys showed fewer signs of anxiety and increased exploration of the environment coupled with diminished plasma levels of cortisol and ACTH. The Salutogenesis Model: Summary Antonovsky summarizes the essence of the salutogenic orientation in contrast to the pathogenic orientation (Antonovsky, 1996): 1. In contrast to the dichotomous classification of pathogenesis into healthy or not, salutogenesis conceptualizes a healthy/dis-ease contínuum 2. In contrast to pathogenesis’ risk factors, salutogenesis illuminates salutary factors that actively promote Health 3. In contrast to focusing on a “particular pathology, disability or characteristic” of a person, salutogenesis might work with a community of persons and “must relate to all aspects of the person” The Measurement of the Sense of Coherence The Measurement of Sense of Coherence The Measurement of the Purpose in Life The Measurement of Engagement with Life Part 2 BIOMEDICAL RESEARCH Meaning in life dimensions (EWB) Believing that one’s life has meaning is associated with: a) greater levels of satisfaction in life (Chamberlain and Zika 1988) b) greater levels of enjoyment of work (Bonebright et al. 2000) c) greater levels of happiness (Debats et al. 1993 ) d) greater levels of positive affect (Hicks and King 2007), and hope (Mascaro and Rosen 2005). e) better physical health and general well-being (Reker et al. 1987 ; Ryff 1989; Ryff and Singer 1998 ; Wong and Fry 1998 ; Zika and Chamberlain 1992) f) lower levels of stress (Mascaro and Rosen 2006) g) lower levels of psychopathology (Crumbaugh and Maholick 1964) h) lower incidence of depression (Mascaro and Rosen 2005) i) self-perceived cognitive and affective profile (Bartrés-Faz et al., 2018) Purpose in life Higher purpose in life is associated with: a) higher scores for memory, executive functioning, and overall cognition (Lewis et al., 2017) b) reduced risk for mild cognitive impairment and Alzheimer’s disease (Boyle et al., 2010) c) reduced rates of mortality (Boyle et al., 2009). d) reduced cardiovascular events and all-cause mortality (Cohen et al., 2016). e) reduced brain pathology associated with vascular factors, such as stroke (Kim et al., 2013; Yu et al., 2015). f) lower odds of subsequent hospitalizations for ambulatory care-sensitive conditions (Wilson et al., 2017) Associations between MIL (EWB) constructs and health • Participants: 1238 older persons without dementia from two longitudinal cohort studies (Rush Memory and Aging Project and Minority Aging Research Study). • Conclusion: Greater purpose in life is associated with a reduced risk of all-cause mortality among community-dwelling older persons. Boyle et al. 2009. Psychosom Med Associations between MIL (EWB) constructs and health Participants: 6985 individuals from The Health and Retirement Study (HRS), a national cohort study of US adults older than 50 years. Conclusions: Stronger purpose in life was associated with decreased mortality. Alimujiang et al., 2019. JAMA Netw Open. Associations between MIL (EWB) constructs and health • Participants: 805 older persons residents in the Chicago metropolitan area. • Conclusions: In older adults, higher sense of purpose in life was associated with lower odds of subsequent hospitalization. • The log odds of hospitalization for a person with a high level of purpose in life was -0.25 (an odds ratio of 0.778); this represents a reduction of 22.2% in odds compared to a person with a median level of purpose in life. Wilson et al. 2018. Am J Geriatr Psychiatry. Associations between MIL (EWB) constructs and health 1 SD below Mean An sample of 143 college undergraduates was used to test the hypothesis that meaning in life is a buffer against the effects of stress on depression. 1 SD above Associations between MIL (EWB) constructs and health Associations of sense of coherence with psychological distress and quality of life in inflammatory bowel disease. Freitas et al. 2015., World J Gastroenterol Associations between MIL (EWB) constructs and health Participants: More than 900 community-dwelling older persons without dementia from the Rush Memory and Aging Project. Boyle et al., 2010. Arch Gen Psychiatry. A person with a high score on the purpose in life measure was approximately 2.4 times more likely to remain free of AD than was a person with a low score A person with a high score on the purpose in life measure was approximately 1.5 times more likely to remain free of MCI than was a person with a low score. Boyle et al., 2010. Arch Gen Psychiatry. Persons with greater purpose started at a higher level of cognition than did those with low purpose and declined less rapidly than did those with low purpose. Boyle et al., 2010. Arch Gen Psychiatry. Conclusions Higher purpose in life is associated with a reduced risk of AD and MCI in community-dwelling older persons. Boyle et al., 2010. Arch Gen Psychiatry. Associations between MIL (EWB) constructs and health High levels of purposeful life engagement have been associated with significantly lower levels of cortisol Lindfors & Lundberg. 2002. Stress and Health Associations between MIL (EWB) constructs and health Positive relations with others and purpose in life have been linked with lower levels of inflammatory markers. • Participants: 135 women ages 61–91 years (74.5 years) participated in this study. • Enzyme-linked immunosorbent assays were used to determine interleukin-6 (IL-6) and soluble IL-6 receptor (sIL-6R) concentrations in plasma. • Results: Regression analyses showed that plasma IL-6 levels were lower in women scoring higher on positive relationships, whereas sIL-6R levels were lower in women scoring higher on purpose in life. Friedman et al. 2007. Health Psychology Friedman et al. 2007. Health Psychology • Participants: 453 participants were included in the analyses from the Rush Memory and Aging Project. Associations between MIL (EWB) constructs and health • Results: Greater purpose in life was associated with a lower odds of having one or more macroscopic infarcts. • These results persisted after adjusting for vascular risk factors of body mass index, history of smoking, diabetes, and blood pressure, as well as measures of negative affect or physical activity. RESISTANCE • The association with macroscopic infarcts was driven by lacunar infarcts Lacunar infarcts are small infarcts (2–20 mm in diameter) in the deep cerebral white matter, basal ganglia, or pons, presumed to result from the occlusion of a single small perforating artery supplying the subcortical areas of the brain. Yu et al., 2015. Stroke. Each Panel shows the boxplot of purpose in life by burdens of a specific type of cerebral infarcts (0=no infarct; 1=1 infarct; 2=multiple infarcts). Associations between MIL (EWB) constructs and health RESERVE AND RESILIENCE Higher levels of purpose in life reduce the deleterious effects of AD pathologic changes on cognition in advanced age. A bit of fMRI Meaning in life and brain network connectivity A greater sense of life meaning was associated with increased, and more modular, connectivity between default and limbic networks. SoC and brain network connectivity • Significant associations for SoC emerged for those RSNs linked to higher-order cognitive processing, such as the default-mode, the salience and the left and right executive-control networks. • On the contrary, associations with sensorimotor systems did not emerge as being significant. Abellaneda-Perez et al., 2021, AAIC PIL, WMHL, cognition, and brain networks • Age, neuropsychological status and WMLs burden did not differ between PiL groups. • A significant group interaction (HP vs. LP) in the association between EFc and WMLs emerged. • More specifically, only in the LP group, greater WMLs entailed a negative impact on executive functions. 4 Executive Functions COGNITIVE RESILIENCE WMLs and Executive Functions HP LP 2 0 Resilience refers to a general term refecting the capacity of the brain to maintain cognition and function with advancing age and disease. -2 -4 -2 0 WMLs 2 4 Abellaneda-Pérez et al., 2023. Alzheimer’s Research & Therapy PIL, WMHL, cognition, and brain networks • Regarding rs-FC differences, subjects in the HP group showed lower SyS on the dorsal DMN (dDMN). BRAIN RESERVE • Precisely, HP individuals had greater inter-network connectivity between specific dDMN nodes, including the frontal cortex, the hippocampal formation, and the midcingulate region, and the rest of the brain. Abellaneda-Pérez et al., 2023. Alzheimer’s Research & Therapy PIL, WMHL, cognition, and brain networks Greater functional connectivity in some of these nodes positively correlated with cognitive performance. 3 2 1 0 -1 -2 -3 -3 -2 -1 0 1 Executive Functions 2 3 B) EFc and dDMN: midCC - PREC: midCC dDMN: midCC - PREC: midCC dDMN: midCC - PS: L thal BRAIN RESERVE A) EFc and dDMN: midCC - PS: L thal 3 2 1 0 -1 -2 -3 -3 -2 -1 0 1 2 3 Executive Functions Abellaneda-Pérez et al., 2023. Alzheimer’s Research & Therapy EWB and brain's reward circuitry • Participants view positive, neutral, and negative images while fMRI data were collected. • Individuals with sustained activity in the striatum and dorsolateral prefrontal cortex to positive stimuli over the course of the scan session reported greater well-being and had lower cortisol output. EWB and brain's reward circuitry This suggests that sustained engagement of reward circuitry in response to positive events underlies well-being and adaptive regulation of the hypothalamic-pituitary-adrenal axis. Is this philosophy? Or biomedical research?