rents admit that dillon is their most sensitive child, that he always got tense before big events such as holidays and the start of school. it wasn't necessarily bad stress. just certain-- before a holiday when little kids get all excited. his bihday is just around thanksgiving, too. starting then, he would start anticipating his birthday. he'd start having headaches. just before christmas, he'd get them. before school, he'd get excited. he'd start having headaches. how many headaches have you had since i saw you? dr. bernal took dillon's medical and personal history. then he did a psychophysiological profile. he wanted to measure certain physiological responses when dillon was placed under a variety of stressors. he was looking for signs that dillon was especially susceptible to stress. one of the signs of such stress is cold hands.

we look at what happens to the tension in the muscles of the forehead and neck, what happens to the temperature of the hands. a drop in temperature means that person is becoming tense. one question i ask is, "what about his hands? does he report having cold hands or feet?" that's a very common feature we've noticed with migraine headache sufferers. the answer was yes. dillon's hands became cold at moments of excitement. this indicated that his autonomic nervous system was aroused. when a person becomes aroused, there's an increase in heart rate. respiration rate changes. you may get a knot in the stomach. could the process be reversed? was there a way to reduce the stress and tension and arousal in dillon's life? obviously, getting rid of christmas, birthdays, and other exciting events wasn't realistic. what about training dillon to relax under stressful conditions? would that work?

enter biofeedback and relaxation exercises. they were the tools dr. bernal would give dillon to reduce his stress and, thereby, treatis migraines. biofeedback is simply a way of providing individuals with immediate information about ongoing physiological processes that they're usually not consciously aware of. for example, heart rate-- we don't know what our heart rate is unless we take our pulse or use a stethoscope to listen to it-- or blood pressure or muscular tension. in biofeedback, then, what we do is we're able to measure the activity going on in a person with headaches. dillon can monitor the tension in his forehead and neck muscles by watching his response line. the goal is to keep his response line at or below the standard line drawn across the screen. he knows when the temperature in his hands is rising

by changes in the sound of the tone. [beeping] relaxing diminishes the activity of the sympathetic nervous system, which leads to increased blood flow and a warming of the hands. one of the easiest ways to think about feeack is thinking about applying make-up or shaving. it is very hard to do a good job without information. if we don't have a mirror, we don't know how we're doing. the mirror is the simplest form of feedback. by looking in the mirror, i can see that i've left a part of my face unshaved. the idea is that the mirror serves as a feedback bit of information. it feels strange because i don't know how i'm doing it. i just think my hand's warm, and all of a sudden, it gets warm. dillon does his relaxation exercises at home twice a day.

[tape player] take a deep breath. then slowly exhale. i listen to the tape he gave me, and it relaxes me. but what proof is there that relaxation actually reduces the occurrence of migraines? in a recent analysis of numerous studies, dr. frank andrasik compared two treatments for migraine-- drug therapy and behavioral treatment, such as biofeedback and relaxation exercises. the response to this self-regulatory treatment was virtually identical to that of the most widely prescribed drug for migraine-- a beta blocker that decreases the activity of the sympathetic nervous system-- the same goal of biofeedback and relaxation exercises. you've only had one headache. yeah. christmas eve. how long did that headache last? about a couple of hours. couple of hours. since dillon began working with dr. bernal six months ago,

he has had only one migraine. even people at his school can see a difference in him. every teacher said he seemed more alive. he smiled, he did talk, which were things that he wasn't doing before. it seemed like he was a lot happier overall. he didn't fall asleep like he did when he was on the medicine. he's a more normal, average boy. it is estimated that 1 in 9 american women will get breast cancer some time in their life. when i first felt the pa in my breast, i thought i had pulled a pectoral muscle. i was doing exercises trying to trim down. kathleen morrell for ais 44 years old and works for columbia pictures. she lives with her daughter arianna in van nuys, california. i went to my gynecologist, who said, "you had a good mammogram six months ago.

wait until september. i think it's the muscle." a doctor told me i was all right, but i was still obsessing. i went home, and i was cranky. i apologized to arianna. i said, "i'm sorry i've been out of sorts lately, but this pain is bothering me." this 1o-year-old said, "get a mammogram." i said, "my insurance won't cover two in a year." "so pay for it. "you'll know tomorrow whether you're ok or not. if you're not, you'll take care of it." the next day, i made my appointment. i went in the following day. i credit her for saving my life. the diagnosiswas breast . and someone escorted me into a small room. it flashed, "i'm going to die of cancer." it was paralyzing. the major risk factors for breast cancer are...

it was paralyzing. kathleen's mother died of cancer. she understands that both biological factors and genetics played a role in her breast cancer, but she believes that psychological factors were also involved. i would say it probably started eight years ago with a traumatic event that happened in my life that devastated me. i didn't cope well with it. i didn't know how. it was major. i started to come back from that. my immune system kicked in and kept it in control, but it was stressful. just last year, i did get a divorce. my divorce was final in march. my cancer was scovered in may. while there's no evidence that emotional trauma can directly cause disease, there are many studies that associate stressful events in life

with higher levels of disease. let's suppose you have someone who has a high genetic predisposition to develop a certain kind of cancer. let's suppose that if the immune system is compromised in some way, this cancer might express itself, and let's suppose that psychological stress results in the suppression of the production of certain lymphocytes that are needed to prevent this cancer from expressing itself. one might have a confluence of factors that lead to the incidence of disease. no one would want toay the psychological stress caused the cancer, but i don't think we can so easily conclude that the psychological stress wasn't a partial contributor. a great deal of research is being done to determine what effect emotions have upon physical health. a new field of study is devoted to that investigation.

it's called psychoneuroimmunology, or pni. pni studies the interface between the brain, emotions, thinking, feeling, and the immune and endocrine systems, and how those interact and talk to each other. the immune system is our most basic sense of recognition. it functions to distinguish what is our self from what is not self. for instance, a virus or a bacteria coming in from outside would be recognized as not self. our immune defense system would launch its missiles. there are two kinds of basic missiles that the immune system launches called b- and t-cells. b-cells essentially are a type of lymphocyte that makes a humeral factor. that is a factor that goes into the bloodstream-- antibodies that we all know about-- and neutralizes viruses, bacteria, parasites, through the release of antibodies.

t-ces function in hand-to-hand combat. the cells actually zip in there and do battle with a cancer cell or with a bacteria. for years, we used to think that the immune system functioned in isolation. it's peculiar that anyone would thinthat because no system of the body functions in isolation. there was a lot of things that made me a candidate for cancer, but i think the emotional thing i went through recently is what triggere the final onset of it. the immune and nervous systems communicate with one another through neuropeptides. one of the most amazing linksbem and our thoughts and feelings have to do with neuropeptides. these are tiny little proteins, just a couple of amino acids long, that have been discovered over the last 1o years.

endorphins, for example, are neuropeptides, those painkillers that our own brain produces. now about 6o of these have been identified. the major site in the brain where they're produced is the limbic system. the limbic system is the seat of our emotions. we experience joy, anger, sorrow, confidence-- all of these feelings-- love, through the limbic system. it turns out that each one of these emotions has a different chemical fingerprint. we experience them, we release these various peptides down into the bloodstream, and they bind to various cells within our body, including the cells of our immune system. now that we know that the immune system is affected by neuropeptides and we understand that psychological stress can have direct effects on such phenomenon as the proliferation of lymphocytes,

um, it becomes... scientifically acceptable now to believe what all the grandmothers used to tell us, which is "relax, or you'll get sick." janice kiecolt-glaser and her husband ronald glaser are well-known researchers in the field of psychoneuroimmunology. she is a psychologist, and he is the chairman of the department of medical microbiology and immunology, and professor of internal medicine at ohio state university college of medicine. dr. glaser points out the direct link between stress, the immune system, and disease. i'll say that anything the immune response is important in controlling, theoretically, is modulated by psychological stress. there are three major groups of diseases for which the immune response plays a major role-- autoimmune diseases, infectious diseases like colds and virus infections,

and cancer. one could speculate that anything that's not good for the immune response wouldn't be good for those classes of diseases. doctors kiecolt-glaser and glaser began collaborating in the early 198os. jan convinced me that it would be worth designing a study to do between us. we designed a study to look at our medical students and the impact of academic stress on the immune system. blood samples were taken from the medical students a month before final examinations and at the beginning of their examinations. the results surprised the researchers. in summation, the studs have told us that the immune system, particularly the cellular immune system, can be modulated by academic stress, by psychological stress. it can be modulated at many different levels. what we're doing now is to explore these interactions

to learn how body systems interact witeach other to wind up with a depression in the immune response. studies have found suppression of the immune system in several populations experiencing various psychological stressors-- among them, people who were separated, divorced, or experiencing marital discord, bereaved spouses, and stents who reported being lonely. the med student studies told us even a really commonplace, real simple everyday stressor could alter immune functions. so we wondered, what if you had a very chronic, a very long-term stress, something that goes on for years at a time? um, what would happen, tually, to immune functions? the glasers are in a five-year study of the caregivers of alzheimer patients. with caregivers of alzheimer's victims, you have a really severe long-term chronic stress.

in some ways, it's analogous to bereavement work in that some caregivers call the process one of continual bereavement as they watch parts of someone they love dying. to study caregivers, we would look at not only caregivers, but then controls-- people who are the same age and sex but who don't have caregiving responsibilities-- so we'd know if it were the caregiving responsibilities versus the absence of them. over the course of several years of study, from the first to the second year in the study, immune function declined, particularly in spouses who are caregiving for a spouse, who tended to be older and tended to be providing more extensive care. what makes this study noteworthy is that the caregivers were ill more days than the control subjects. the researchers, with the subjects' permission, contacted their physicians to validate this data.

we find that there's really excellent correspondence, that when caregivers report certain symptoms, we have a good match with physician records for infectious illness. it gives us data that suggests that people under chronic stress, who show declines in immune function, have a greater health risk. research does show that stress may contribute to increased illness. yet experts advise caution when trying to draw cause-and-effect relationships between psychological factors and such diseases as cancer. i do get a little concerned about people who take what little scientific evidence is there, and then they take that an order of magnitude or two and propose that this has major implications for how patients should be managed, particularly cancer patients. i think they have to wait for the scientific evidence to be generated to answer that question.

weon kw yet what these immune changes actually mean for real health outcomes, especially for really serious illness. we have good preliminary evidence that there may be increased risk for infectious illness. when you talk about what this means for someone who has cancer, you need to tread cautiously. certainly, i think that... we know that the way you feel can affect your immune system, but that may not be such a large effect that will influence the outcome of an illness. recent books and articles have made dramatic claims about the causes of and cures for cancer. i get concerned about people who say you should be able to stop your cancer, and if you don't, you should feel guilty, because we know that having cancer is already a significant burden. you're not at fault if you have cancer. if you cannot stop it,

that has nothing to do with your being a good person. many of the less conventional therapists might suggest that that's the case. that's a real matter for concern. even cautious scientists agree that our minds and bodies influence each other. what they are only beginning to understand is how they do it. given what is known, however, kathleen morrell feels it makes sense to battle her cancer with her body and mind. she had a mastectomy, underwent a course of chemotherapy, and recently had breast reconstruction. bushe also engaged in some psychological therapy. i had confidence that my medical treatment was right, but i needed other stuff. i needed my mind taken care of because it's scary. dr. robert hoffman is a psychiatrist at the breast center where kathleen is a patient. their philosophy is to treat each patient as a whole person.

we try to help people to understand the basic ingredients that seem to correlate with better quality of life and even improved survival, and those seem to be emotional support, psychological suppor and taking care-- that's part of taking care of... the spiritual needs of a human being as well as the physical or biological needs. there's a variety of approaches that help people not only to manage stress, but to nurture their spirits. some people can get psychological support from participating in a group of cancer patients who share their experiences with each other. leonne schillo-coady, a registered nurse with a master's degree in psychiatric nursing runs the group kathleen is in. may 3oth will be my 1-year anniversary of finding the breast cancer at the breast center.

when i walk into e breast center on may 3oth, i'm going to have hair, it's going to be colored, and i'll have two breasts that match pretty well. i'll be looking good for '91. ha ha ha! maybe this idea of support isn't just making the patient feel better and dealing with their day-to-day operations better. maybe this is really impacting physiologically. at's what, what i believe, and that's what i've seen with my women. they're growing up now, and, um... there's this part of me still that has a hard time sharing cancer with them. i sort of want to protect them, but i feel now that they're getting a little bit older. they'r15 and 13 now. oh. they should-- yeah. they're ok. we talk a little bit more about it

and my fears of "am i going to be ok?" anand i still-- reoccurrences. feel things and immediately just panic. we've all been through that. when i do get depressed, i go in and i listen to my tapes. they've done wonders for me. i don't know what i would have been able to or how i'd have been able to handle the... the, uh... the fear of reoccurring cancer. i didn't feel very good. , when you don't feel gs your thoughts-- you think more. i don't know if it was flu or the chemo. usually i get chilled anyway, but it was so bad this time. i had sweats on. i had another ski cap that i wear at night. i was under the blankets and still freezing.

[leonne schillo-coady] we don't want to be making claims we can't support, but the mind-body connection is absolutely there. it's there every instant. when the mind thinks, the body listens. whatever goes through the mind, the body hears it. you can work with that. two recent studies suggest that psychological support may actually have biological consequences. sandra levy and her associates at t pittsburgh cancer institute have studied the effects of social support, fatigue, and depression on the immune system, especially natural killer cell activity, in women with breast cancer. natural killer cells play a surveillance role in curbing malignant cell spread. in general terms, levy found that women who felt they had lots of social support had greater levels of natural killer cell activity than those who did not. at stanford university, dr. david spiegel

studied a group of women with metastatic breast cancer. they were divided into two groups. one group received medical care plus a year of weekly supportive group therapy with self-hypnosis for pain. the control group received standard medical care only. the general finding was that patients who received group therapy survived an average of 36 1/2 months from the onset of intervention. the control group-- an average of almost 19 months. the treatment group lived twice as long. that's a remarkable finding. i'm delighted that--that-- that this finding is here. i'd like to see it replicated. i'd like to make sure that it's firm. if it is replicated, psychologists have an awful lot of work to do to discover what the critical ingredient is in the psychotherapeutic intervention that prevents the relapse. it may very well be

that the psychotherapeutic intervention is a sufficient stress reducer so that the immune system functions more effectively than it would under chronic stress. while experts agree that further research is necessary, kathleen morrell is convinced her mind can play an active role in her recovery. if stress can make you sick, your mind can convince your body to get well. in addition to her ongoing medical care, kathleen does relaxation exercises. she also practices guided imagery where she visualizes the cancer cells within her being destroyed by her immune system. though there is no evidence that this destroys cancer cells, it gives kathleen a sense of having some control over her disease. it is probably the case that if a patient like kathleen morrell believes that what she's doing will prevent her from relapsing, she should certainly continue doing it.

her peace of mind may be a very important tool in fighting a relapse or preventing a relapse. what i said before was if you have the genetic predisposition and if you're exposed to the toxic environment and if all the factors are correct and your immune system is compromised by stress, it may contributeto the dev. by the same token, if your immune system is not going to be compromised by stress because you're learning how to manage your stress and control your stress, it may give you a little advantage in preventing a relapse of the cancer. my biggest fear is recurrence or death, but if i'm living my life and not in the future worrying about that-- which gets easier each day. there's a lot less thought process about it now-- then i'm going to have a good life,

no matter when it ends. you can plan your funeral, or you can enjoy your life. for dillon vargas, frank pink, and kathleen morrell, people whose physical ailments are vastly different, there seem to be two common elements-- they believe stressful events of some kind played a role in the onset of their illnesses. they believe that stress reduction in the form of biofeedback or relaxation exercises can help them. for these three people, the result is an increased calmness, self-confidence, empowerment, and a lessening of symptoms. for the rest of us, it's an ongoing question. increasingly, researchers are trying to discover the exact dimensions of the role our emotions and other psychological factors play in our physical illness and physical well-being. captioning performed by the national captioning institute, inc.

captions copyright 1991 alvin h. perlmutter

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