Motivation and emotion/Book/2014/Healing and emotion
How do emotions affect medical treatment effectiveness?
Sandra is a 54 year old female, married with 5 children who lives in a remote country town. She recently was diagnosed with cancer of the breast that has metastasis to her lungs and bones. Her initial reaction was shock, despair and sadness. Always so vigilant with her health and exercise, she thought it was highly unlikely that it would ever happen to her. In the weeks that followed with surgery, checks and therapy, she decided that for a better quality of life she had to change her belief systems and how she thought about herself and her place in the world. She believed that this would help her relieve some of the anxiety and stress that, she thought, had plagued her for so long and brought on ill health. Sandra’s awareness had brought her a new lease on life. She was not cured, but with a good social support systems and a focus on Mind-Body awareness she was able to use her emotions to guide her treatment and alleviate some of the cancer symptoms and live the rest of her time in peace.
Emotions play an important role in the effectiveness of overcoming illness. In our case study Sandra become aware that health was not only about healthy eating and exercising but also healthy emotions, positive and negative, all play a part in her overall health. Illness is a time when disease or sickness affects the body and the mind. This chapter will focus on some of the emotions that affect us during illness and how they can affect our health and treatment effectiveness.
What are emotions?
Emotions are multidimensional, subjective, purposive, social and biological phenomena (Reeve, 2009) that help us to navigate our way through life by allowing individuals to determine the value of stimuli. They allow us to determine the approach or avoidance level of environmental stimuli which give us the ability to fight or flee in the face of danger. Like the hunter running for his life from a tiger, when we become sick and our health is threatened, our need for survival kicks in and our emotions guide us through this process. When we experience the initial onset of an illness, our brain gathers and assesses the information and determines the emotional response perceived necessary for the individual to survive. Difficult life threatening illness such as cancer can elicit emotional responses such as fear, anger and despair. These emotions are often seen as negative emotions but they are actually very important, relevant and almost positive emotions to encounter when ones life is threatened (Bonanno, 2004). These emotions allow us to become motivated and goal directed to survive, which is a good thing.
Theories of emotions: Connecting the dots
Biological, and Cognitive Perspectives of emotions
According to the biological perspective of emotions, emotions happen before we are even aware of their onset. They evolved over time as way to help us determine the importance of events and for adaptation (Reeve, 2009). Emotions have also been seen as being genetically endowed thus we are born with the capacity to feel emotions and not learn them from social situation. (Reeve, 2009). Under this theory we can see how the flight or fight mode may come about as a result of a threat to our system. However, cognitive theorists suggest that cognition is a prerequisite to emotions (Reeve, 2009). When we come across an emotionally stimulating event, our appraisal of that event determines the outcome of our emotion. During illness, we might feel anger, sadness or joy, depending on how we evaluated the situation and that personal relevance elicited and emotion state that helps us cope with it. (Reeve, 2009). Though Ellis’ Rational Emotive Theory, understanding the process of negative thinking and emotions can give patients with illness tools to help them cope and/or change their belief of the illness. Using Ellis’ A-B-C process of therapy, patients can assess the Activating (A) experience and the emotional Consequence (C). With the intervention of a changed Belief (B) system, negative emotions and irrational belief of the illness can be channelled to more positive emotions that can help during illness (Cocker, Rell, & Kidman, (1994); Burger, 2014)
Emotions during illness
|Stress||There’s a sabre tooth tiger chasing after you or you have a life threatening illness. Your emotional response to the stimuli (tiger, illness) has readied you for survival-mode. When we become stressed we respond by activating the nervous system and releasing hormones such as adrenaline and cortisol. In this instance, the release of the hormones adrenaline and cortisol cause the physiological changes to happen in the body. Blood to the extremities allows the individual to be ready to move quickly and a decrease in digestive functioning allows the body to use precious energy where it’s needed (Reeve, 2009; Sapolsky, 2000). This is all well and good in the face of immediate physical danger, but stress, if not turned off has serious implication for health and illness recovery. Stress, emotions as well asbehaviour have been linked to coronary artery disease (Davidson et al, 2010). Emotions that preceed and generate stress can generate physiological responses such as hypertension and cardiac arrest (Tobo-Medina & Canaval-Erazo, 2010)..|
|Fear||Is a basic emotion which is the product of perceived psychological or physical danger from a situation (Reeve, 2009). When we become ill, our survival is threatened and fear becomes an important emotional response. Fear like anger and stress are normal emotional responses to illness because they elicit the reactive mode of flight or flight (Qiu, 2006). Fear can also lead to learning of new coping strategies as the individual is faced with a new conundrum of being ill. It also enables us to take stock, reassess and identify the situation that may be making us ill, thus giving us insight into what is needed to take positive steps during treatment and overall health (Sapolsky, 2000)..|
|Anger||Illness derails our plans, halts us in our tracks and forces us to realise the magnitude of the dependency we have on our bodies and its health (Biro, 2012). Anger can infiltrate our emotional state through many different angles presenting us with an energised state that can motivate us to act in ways that were once though inconceivable. When we experience anger from the diagnoses of an illness or in the event that a treatment was ineffective, it can motivate us to be aggressive and inconsolable (Reeve, 2009). However anger can have a positive emotional response in that it can energise us, make us stoic in the face of the injustice of the illness driving us to seek out alternatives in treatments or personal perspectives, enabling the person to achieve a sense of equilibrium (Staicu & Cutov, 2010).|
|Sadness||Illness’ relationship with sadness encompasses loss and despair. Such an aversive state directs the motivation towards doing whatever is possible to correct the imbalance (Reeve, 2009). But when you are ill, your capacity to quickly change the circumstances is not always achievable. Sadness is the most aversive, negative emotion and its relationship with illness is strong (Biro, 2012). The loss of freedom, health, and the capacity to do whatever pleases during sickness all contribute to the confounding affects of the emotion. The loss that we feel with sadness can also direct us to seeking companionship, channelling that loss and alienation into seeking meaningful relationships with loved ones and necessary support networks. This seeking of companionship is a positive affect of feeling sad and social networks can have a positive affect on acceptance of the illness and if possible, recovery (Biro, 2012).|
|Joy||Is it possible, in the face of adversity, to find hope, joy and interest in the most aversive life affecting afflictions? Does channelling hope, joy and interest change how we deal with the journey and the outcome? Joy, according to Garrard and Wrigley (2009), “with its inbuilt orientation towards the future, is a centrally important part of a persons life”. If we take away hope we takethe persons belief that existence is worthwhile and relevant. So, in the face of illness channeling positive emotions such as joy, interest initiates that will to survive and gives hope for the future (Reeve, 2009). Joy is the consequence of achieved desirable outcomes (Reeve, 2009) and has positive affects on mood and emotional stability. Positive outcomes as the result of goal pursuits and accomplishment facilitate joy and help to counteract feeling of sadness. It is therefore easy to see the benefits of feeling joyful in moment of adversity. The problem with these positive emotions during illness is that they are elusive and often hard to conjure . But if knowing that your emotional state can have positive implications for the way you understand, accept and live with the illness can lead people to seek ways to nurture positive emotions . According to Jim, Richardson, Golden-Kreutz, & Andersen, (2006), humans are motivated to find meaning in their lives no time some more when adversity hits . In the article by Heather et al, (2006) meaning of life for women in cancer, positive coping led to less stress and more inner peace and acceptance of the situation.|
Illness and emotions: How they can effect treatments and healing
Self determination theory
Autonomy, relatedness and competence aid psychological needs and development. During illness, these factors can be thwarted and lead to less than optimal well-being. Trying to stay motivated in the face of adversity is difficult but nevertheless is integral to the recovery and health of patients undergoing treatment (Ryan & Deci, 2000). Fostering autonomy within the patient by engaging with doctors in determining treatment plans can help maintain integrated regulation, an important extrinsic motivation that is associated with positive psychological outcomes (Reeve, 2009; Charles, Gafni, & Whelan, 1999)
Emotions are short lived experiences that arise from significant life experiences (Reeve, 2009). Moods are the after effect of the emotions and exist as positive affect and negative affect state. Positive affect had been associated to better immune functioning, improved sleeping quality as well as lower levels of the stress hormones, epinephrine, norepinephrine, and cortisol (Cohen & Pressman, 2006). When it comes to the argument that PA might have a direct influence helping people get better from an illness, the jury is still out. However an experiment by Sepah & Bower, (2009) found that patients with higher levels of positive affect before the treatment exhibited higher levels of an inflammatory cytokines (cell) response during radiation therapy, which, in the context of the radiation therapy, is a good thing. This article did not directly link PA as the cause of the increase in cytokines that facilitate positive tissue repair processes but that there may be a link, some relevance which aligns PA, cancer and treatment. .
In a study by Davidson, Mostofsky, & Whang, (2010), increased positive affect was associated with a reduced risk of Coronary Heart Disease. Positive affect has been shown to lower the risk of hypertension improve and immune functioning (Davidson et al, 2010). Even during times of acute stress and sadness, positive emotions like joy and happiness have the capacity to put peoples bodies at ease (Fredrickon, Tugade, Waugh, & Larkin, 2003). In the article by Fredrickon et al., (2003) positive emotions after an aversive situation, facilitated personal coping strategies, quell lingering cardiovascular effects of stress, increase dopamine circulation and help build higher levels of resilience which see long term coping strategies exhibited that lead to personal empowerment and overall improved health. According to the Broaden and Build Theory by Barbara Fredrickson , broadening of positive emotional states build increased active coping mechanisms that allows the individual to equip draw from during aversive times.
Perception effect, belief effect or the placebo effect all could be said harness the same effect. The placebo effect refers to positive consequences of unspecific factors that are associated with a treatment (Rief, Hofmann, & Nestoriuc, 2008). Over the last decade research has directed itself to start looking at the placebo effect and its relationship with positive treatment outcomes. One notable example of how the placebo effect is for the treatment of hypertension. Materson, Reda and Williams (2000), (as cited in Rief et al., (2008) found that a drug used to treat hypertension and control group had similar treatment outcomes indicating that hypertension, which is a medical condition can be improved with the effects of a placebo intervention.
Sham surgery has also included some interesting and though provking instances of recovery and health benefits. The results were that both the sham and the real surgeries both had improved health outcome with no significant difference between the two groups. The invasive surgery was no better than the sham. Also, the follow up long term effect was the same, with both the sham and real surgery patients maintaining optimal improvements (Mosley et al., (2002) as cited in Rief et al., (2008). Expectancy Theory and Classical Conditioning have been used to try and understand what goes on behind the placebo effect. According to the Expectancy Theory, a placebo produces an effect because the recipient expects it to (Stewart-Williams & Podd, 2004) and, according to Classical Conditioning, a placebo effect is the result of a conditioned response. Simply put, taking pain killers to suppress pain might not just be the effect of the pain suppressing ingredient as much as it is responding to the context and cues which are linked to taking the pill and the consequences that follow. Our belief systems and emotions can have a significant affect on treatment outcomes especially if we believe in the efficacy of the treatment being given (Rief, Hofmann, & Nestoriuc, 2008).
Imagine sitting down opposite a doctor who looks at some files with a stone cold face and the air of indifference knowing that what he/she says next will determine the rest of your life. How do think this would effect you? Or even, can it? The relationship between health practitioners and patients has been the area of focus during the last decade. When it comes to patient doctor care, the research is suggesting that yes, a good, honest, open communication that incorporates, listening, trust, understanding and better management and acknowlege of emotional care can increase intermediate health outcomes like abherence to medication, self care and well-being (Street, Makoul, Arora, & Epstein, 2009). Communication as a means of facilitating treatments for illness can come from communication as a therapeutic process. This open dialogue can help the patient improve psychological well-being and facilitate more optimistic emotion, less negative emotions by generating self worth and optimism (Street et al., (2009). Health care professionals can utilise emotional care as another tool for recovery by using it to lower emotions like fear, anxiety and stress, all which can have physiological and harmful impact on the patient. By addressing these negative emotions the patient and the doctor can use this form of care to enhance the effectiveness of therapy or physical care (Blasi, Harkness, Ernst, Georgiou, & Kleijnen, 2001).
We use the word “mind’ so often in day to day language but trying to figure out what the mind actually constitutes is quite difficult. According to Darwin (1999) the Mind-Body medicine (MBM) takes the stance that the cells are not passively following orders from higher control centres, rather MBM metaphorically recasts the body as a cellular democracy. All the cells act cohesively together, through a shared intelligence, constantly in communication with each other. (Darwin, 1999). Darwin’s paper posits that due to the scientific grounding of MBM this gives rise to the legitimacy of the patient as having primary agency and control over their health and wellbeing. Also according to Darwin (1999), this then gives the patient the capacity to be the controller of their own self healing, controlled by ones own thought and feelings. (Darwin, 1999). Candace Pert, an internationally recognised pharmacologist was a significant contributor to the emergence of the MBM as a legitimate field through her scientific research. During her research she came to confirm the mind-body connectedness and how the emotions, expressed though neuropeptides, can be seen as the key to explaining disease.
"Emotions. The neuropeptides and the receptors, the biochemical’s of emotion, are, as I have said, the messengers carrying information to link the major systems of the body into one unit that we can call the body-mind. We can no longer think of the emotions as having less validity than physical, material substance, but instead must see them as cellular signals that are involved in the process of translating information into physical reality, literally transforming mind into matter. Emotions are at the nexus between matter and mind, going back and forth between the two and influencing both(…)Every one of the zones, or systems, of the network- the neural, the hormonal, the gastrointestinal and the immune- is set up to communicate with one another, via peptides and messenger- specific peptide receptors(…) Mind doesn’t dominate body, it becomes body-body and mind are one." (Pert C.B., 1999, P. 189) Candace Pert Youtube video
According to Pert, the body communicates with itself in two major ways, through neuropeptides and the receptors they fit. The neuropeptides talk and the receptors listen for information that can change the cell to do what it needs to do. (Pert C. B., 1988). Pert has also proved that the brain, nervous system, and immune system all work together, all communicate together figuring out what is best for you. So if they all function together then what happens when we fall ill? We know that emotions such as anger, sadness and stress all have aversive affects on the body (although all emotions are good in some amounts and at some times) such as raised cortisol and epinephrine from stress can increase the chance of Coronary Heart Disease (Chandola, et al., 2008). So if the emotions have the capacity to “talk” to the immune system, can we consciously tell them what so say? Emotional baggage that can be toxic to our physical and psychological health could be helped using Personal Construct Theory (Kelly, 2003). George Kelly, used this approach to change peoples personal constructs - the lense in which we see the world and how we let it affect us. By understanding how we perceive the world and the emotions that ensue from our reaction to stimuli we can redirect negative emotions to positive emotions through a shift in our personal contructs. Pert (1988) suggest that the emotions are stored in the Body Mind, which can be triggered through meditations, breathing, spiritual practice and other diverse psychosomatic modalities. What we feel especially negative feelings can be stored in our body- not just in the brain. Painful memories can be slipped away, smouldering, festering not just in our brain memory banks but also in the organs, glands, tissue and cells.
"A feeling sparked in our mind-or body-will translate as a peptide being released somewhere. [Organs, tissues, skin, muscle and endocrine glands], they all have peptide receptors on them and can access and store emotional information. This means the emotional memory is stored in many places in the body, not just or even primarily, in the brain. You can access emotional memory anywhere in the peptide/receptor network, in any number of ways. I think unexpressed emotions are literally lodged in the body. The real true emotions that need to be expressed are in the body, trying to move up and be expressed and thereby integrated, made whole, and healed" (Pert C. B., 1999,P. 220).
Research looking at the efficacy of MBM is slowly growing. Most research focus is on using MBM in an integrative manner with biomedicine or by itself as a moderator of after treatment care. During cancer illness, many patients suffer from pain, fatigue, depression and anxiety. According to Paul et al., (2013) Integrative oncology uses complementary medicine like MBM and alternative medicine to facilitate the cancer treatment. Clinics that have been specially designed to intergraded MBM have proven to be effective in improving psychological as well at the physical and health and quality of life of the patient (Paul, Cramer, Lauche, Altner, Langhorst, & Dobos, 2013). It may be a little tooearly to make the big connection that cancers caused by ill emotions since this a complex task that needs to take in all aspect of a person life, environment and behaviours. However, just because we cannot measure it yet, does not mean it does not exist.
There are many fascinating branches of research that are focusing on a collection of bodily systems and their interaction with each other. Neuroimmunology the study of the nervous system and immune system furthers the development of the MBM ideas. Also, another exiting field is Psychoneuroimmunology, the study of the interaction between the psychological process’s, the nervous and immune systems. These are fascinating branches of research that gravitate towards a better understanding of the Mind-Body Medicine concept and how emotions can affect medical treatment effectiveness.
Emotions can play a major part in our health and illness. The direct links between emotions and health are slowly coming to fruition, which leads to interesting and positive times ahead for our health and how we could use our emotions to heal ourselves. Further research will help define the individual roles of our emotions and enable us to understand the extent to which we can foster them for our health. This chapter highlights some emotions and their influences during ill health and how they can affect us especially during treatments. This chapter is not intended to be an alternative for seeking treatments for illness, rather a guide to show that there is supporting evidence that suggest we may one day be able to heal ourselves through out emotions.
Blasi, Z. D., Harkness, E., Ernst, E., Georgiou, A., & Kleijnen, J. (2001). Influence of context effects on health outcomes: a systematic review.The Lancet , 357, 757-762.
Bonanno, G. A. (2004). Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events? American Psychologist , 59, 20-28.
Burger, J. M. (2014). Personality (Vol. 9). Stamford: Cengage Learning.
Chandola, T., Britton, A., Brunner, E., Hemingway, H., Malik, M., Kumari, M., et al. (2008). Work stress and coronary heart disease: what are the mechanisms? European Heart Journal , 29, 640-648.
Charles, C., Gafni, A., & Whelan, T. (1999). Dceision maling in the physician patient encounter: revisiting the shared treatment decision making model. Social Science & medicine , 49, 651-661.
Cocker, K. I., Rell, D. R., & Kidman, A. D. (1994). Cognitive behaviour therapy with advanced breast cancer patients: a brief report of a pilot study. Psycho-Oncology , 3, 233-237.
Cohen, S., & Pressman, S. D. (2006). Positive Affect and Health. Current Directions in Psychological Science , 15, 122-125.
Darwin, T. J. (1999). Intelligent cellsand the body as conversation: The democratic rhetoric of mind body medicine. 36, 35-49.
Davidson, K. W., Mostofsky, E., & Whang, W. (2010). Don't worry, be happy: positive affect and reduced 10 year incident coronary heart disease: The Canadian Nova Scotia health survey. European Heart Journal , 31, 1065-1070.
Fredrickon, B. L., Tugade, M. M., Waugh, C. E., & Larkin, G. R. (2003). What good are positive emotions in crises? A prospective study of resilience and emotions following the terroist attacks on the united states on september 11th, 2001. Personality Processes and Individual Differences , 84, 365-376.
Jim, H. S., Richardson, S. A., Golden-Kreutz, D. M., & Andersen, B. L. (2006). Strategies Used in Coping With a Cancer Diagnosis Predict Meaning in Life for Survivors. Health Psychology , 25, 753-763.
Kelly, G. (2003). A brief introduction to personal construct psychology. John Wiley & Sons, Ltd.
Paul, A., Cramer, H., Lauche, R., Altner, N., Langhorst, J., & Dobos, G. J. (2013). An oncology mind- body medicine day care clinic: concept and case presentation. Intergrative Cancer Therapies , 6, 503-507.
Pert, C. B. (1999). The Molecules of Emotion. Washington DC: Simon & Schuster.
Pert, C. B. (1988). The Wisdom of the receptors: Neuropeptides, the emotions, and bodymind. Institue for Advances of Health , 3, 8-16.
Pert, C. B., Dreher, H., & Ruff, M. (1998). The psychosomatic network: foundations of mind-body medicine. Alternative Therapies in Health and Medicine , 4, 30-41.
Qiu, J. (2006). Fear not. Neuroscience , 7, 1.
Reeve, J. (2009). Understanding Motivation and Emotion. Iowa: Wiley.
Rief, W., Hofmann, S. G., & Nestoriuc, Y. (2008). The power of expectation - Understanding the placebo and nocebo effect. Social and Personality Psychology Compass , 2, 1624-1637.
Ryan, R. M., & Deci, E. L. (2000). Self determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist , 55, 66-78.
Sapolsky, R. M. (2000). Stress Hormones: good and bad. Neurobiology of Disease , 7, 540-542.
Sepah, S. C., & Bower, J. E. (2009). Positive affect and inflammation during radiation treatment for breat and prostate cancer. Brain, Behaviour, and Immunity , 23.
Staicu, M., & Cutov, M. (2010). Anger and health risk behaviours. Journal of Medicine and Life , 3, 372-375.
Stewart-Williams, S., & Podd, J. (2004). The Placebo Effect: Dissolving the Expectancy Versus Conditioning Debate. Psychological Bulletin , 130 (2), 324-340.
Street, R. L., Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education and Counseling , 74, 295-301.
Tobo-Medina, N., & Canaval-Erazo, G. E. (2010). Emotions and Stress in Persons with Coronary Disease. Aquichan , 10, 19-33.