1 Role of Emotions in Mind-Body Health Vancouver, August 2017Dr. Angela Cooper Psychologist and Assistant Professor Dalhousie University, Halifax, Canada
2 Aims Medically Unexplained Symptoms (MUS) Assessing MUS Treating MUSWhat are MUS? How MUS develops Assessing MUS Framework to assess unconscious emotional processes and link to MUS Treating MUS Clinical examples of work with MUS patients Maximizing Your Effectiveness! Building your capacity to tolerate complexity and uncertainty not just knowledge. Deliberate practice
3 *Session Plan 09:30 – 10:45 – Introductions, Theory, Research FindingsBreak 11:00-12:30 – Clinical Assessment Anxiety Pathways, relational blocks and response to intervention Linking of processes to MUS presentations Building your assessment skills Lunch 1:15 – 2:30 – Treatment Vignettes Emotional processing and the impact on symptoms and functioning 2:45-4:00pm – Person of the Therapist Experiential exercises designed to tap into our own emotional processes Building our emotional capacities Reflections, Q&A ** statement of confidentiality**
4 Introductions Professions?
5 ‘Sorrow that finds no vent in tears may make other organs weep’Sir Henry Maudsley was a pioneering British psychiatrist,
6 MUS in a Nutshell Pain or other physical symptoms are caused or amplified by psychological/emotional processes and not primarily due to any disease or damage of the body's organs or structures “cannot be explained by traditional medical models” (Kenny and Egan, 2011). Common emotional processes linked to these symptoms include the long term physiological and psychological impact of adverse childhood experience, current life stresses, post-traumatic stress, depression and anxiety Common symptoms include: back pain, tension headaches, migraine, irritable bowel syndrome, chest pain, chronic pelvic pain, fatigue and fibromyalgia. These conditions can be helped effectively by accurate diagnosis and treatment of the underlying behavioural, psychological and emotional issues
7 Overview MUS is caused by persistent activation of our fight/flight/freeze/defensive responses (our reaction to danger) which can cause real physical symptoms in the body (head to toe – every system) Both physical and emotional pain trigger the ANS which helps us respond to threat – in fact studies have shown that emotional pain triggers exactly the same neural patterns in the brain and body as physical pain (Kross et al, 2011). These states get activated without awareness and therefore your body’s ANS drives the formation of symptoms outside of your awareness https://www.youtube.com/watch?v=XM5hdlEOSFM (6:33)
8 How do Emotions Affect Health?The centrality of emotions in MUS
9 Key Ideas about EmotionsEmotions are pre-conscious neurobiological events that serve to guide behavior from birth. Without access to our emotions we don’t know who we are or what we need. They are our compass for life If our emotions are blocked, punished or ignored regularly in early development (e.g ACE), our bodies begin to automatically produce anxiety and behaviors to keep the feelings locked down. This comprises our emotional/physical growth and functioning If our bodies chronically repress feelings/needs then overtime this leads to altered autonomic, endocrine and immune system activity related to the development of physical symptoms – it affects every bodily system! How this system gets developed is through attachment relationships, healthy responsive environments lead to affect tolerance, anxiety regulation and healthy relationships. Ambivalent, disorganized or abusive attachments lead to insecurity and anxiety. Anxiety becomes conditioned if these attachment relationships are repeated and so ucs anxiety is produced instead of core affects. This leads to a dysregulated system from the get go which leads to suppressed immune functioning, dysregulated endocrine and autonomic functioning – this over time leads to the symptoms you see in the GPs office. Then this anxiety gets activated whenever you try to connect with the person whether this is a consulting room or the wider environment because it triggers emotions and defences too.
10 Common Factor of Emotion DysregulationHeadache Confusion Irritable Bowel Dyspepsia Abdominal pain Emotion Dysregulation Bladder dysfunction Pelvic Pain Chemical Sensitivity Fibromyalgia Fatigue Hypertension Chest pain Each unexplained symptom may get a different diagnostic label or be seen by a different department e.g. gastroentreology (GI), cardiology for atypical chest pain, MSK for fibromyalgia for patients with unexplained symptoms, but the overlap between such syndromes is so great (Nimnuan et al. 2001b) that they are better seen as a single underlying disorder with emotional dysregulation as the common factor across all. Psoriasis Dermatitis Conversion Pseudoneurological Phenomena Depression Anxiety Panic
11 Emotions and WellbeingResearch evidence suggests that the free and unencumbered experience of emotion is vital for physical, as well as psychological, health (Pennebaker, 1990). https://www.youtube.com/watch?v=Qs6EKNklDds We are wired for emotion and wired for attachment. When we start blocking our emotions regularly, bad things start to happen in the body. https://www.youtube.com/watch?v=apzXGEbZht0 Patients who convert their feelings of pain, grief, and anger about life events into anxiety and depression double their risk of disease, including asthma, arthritis, headaches, ulcers, and heart disease (Fleshner et al., 1993; Friedman & Boothby-Kewley, 1987) Inhibition of the emotions evoked by upsetting life events leads to stress and impaired immune functioning, whereas free expression of these feelings leads to a decrease in physiological reactivity and improved immune functioning (Malan & Coughlin Della Selva, 2006). So why our emotions so important to our wellbeing?
12 Precipitating Events to MUS35% - Death or Illness of a loved one 30% - ‘Other’ Stressful event e.g moving/having children/work conflict 18% - Accident or Illness of self 12% - Relationship Breakdown Why we want to ask or know about what has happened before the symptoms occurred
13 As ACEs increases so does risk for: