# Motivation and emotion/Book/2013/Emotion and health
## Overview

* Emotions play an important, sometimes critical, role in the outcomes of health, good and poor, physiologial and mental. Emotions are pivotal to any human interaction and have strong links to self-esteem and overall well-being. Emotions also have very powerful motivational qualities (Butler & Sbarra, 2013).
* The big challenge for tapping into a deeper understanding of the links between emotions and health is managing and navigating the complex, multi-mechanistic, reactionary and subjective individual that presents as your everyday, run-of-the-mill person on the street.
* It could be said that human relationships are as varied as there are things on earth (or things we can see from earth, for that matter)and research (Butler & Sbarra, 2013; Ekman, 1992) examining the links between physiological arousal, health and emotions is ongoing, with psychologists continuing to define emotion into particular classes of subjective feeling.
* Emotions drive us or de-motivate us, direct us and can make us well, or unwell. Defining ever subjective emotions and understanding how and why they can become overwhelming, how the connection between the cognitive brain and the emotional brain works, and the important role emotions play in the oucome of good or poor physical and mental health will be the subject of intensive study and research for decades to come.

## What are Emotions

Definitions of emotions can be very subjective. They are functional responses to inputs into one's life, leading to adaptive responses caused by hormonal balance/level and physiological changes. Based on experiences one can predict emotional responses, however it has been shown in some studies that people generally inaccurately predict their emotions, in particular in regards to negative emotions (Kermer, 2006). This may indicate that emotions are so subjective, influenced by ever changing environments, homeostatic states and mood states, that even when presented with similar situations that have been experienced many times before that we may still react in a different way than we expected.
Emotions can be motivating or debilitating.

### Basics of Emotions

As the limbic system interacts with the pre-frontal lobes, there is a direct relationship with our feelings (mediated by the emotional brain) and our thoughts (mediated by the cognitive brain). Result: we react emotionally to things we consciously understand to be occurring, and we become acutely aware of the emotions in our lives (Marieb & Hoehn, 2009). This communication may go a long way towards explaining why emotions sometimes overpower logic.

### The Purpose of Emotions

Ekman & Friesen (1982) suggest a set of 6 basic emotions comprised of fear, anger, disgust, surprise, happiness, and of course, sadness
As emotions are strongly linked to changes within the body, psychologists have pondered if such changes contribute to or are essential for emotions (Gray, 2002). It mat be likely that emotions are there as an educational and motivational tool for the mind and the body to learn from, a defensive tool and an offensive tool. Attempts to arrange emotions along a two-dimensional plane has proved frustrating and somewhat futile for psychologists as the degree to which the emotion is felt, whether it be experienced as positive or negative,and the level of bodily arousal involved is highly subjective, no such classification is likely to be agreed upon by all parties (Kissin, 1986).
* In short, the arousal response can be either helpful or harmful and the pattern varies from person to person, but the Fight of Flight response is a well versed, yet good example, and commonly includes the following.
* 1. STIMULUS
* 2. Skeletal muscles tense, blood is diverted from other body parts to the muscles that may be required to carry us away
* 3. Heart rate, respirations per minute increase and energy stores are released into the blood
* 4.Changes in blood occur enabling it to clot more easily and pain relieving hormones are dumped into the system
* 5. Mechanisms in the brain are alerted and strongly activated, cognitive processes are narrowed, focused on the stimulus or thought
* (Marieb & Hoehn, 2007)
Sounds exhausting!
A point of interest to touch lightly on is emotions and memory recall.
Let's presume that emotions and any assosciated responses are indeed a learning mechanism for us, humans, to build up a database with a view to someday having the 'appropriate' response to any given situation or stimulus. To this point consider the following regarding memory and learning;
It is an individual’s experience and interpretation of information, or an event (stimulus) that underlies their encoding of information, its storage and also its retrieval (Roediger, Jacoby & McDermott, 1996). Taking into account memory and learning fundamentals and definitions, it may be a calm mood state, a relaxed mind, repetition of events, excellent viewing conditions and no interference make for optimal situations for improved accuracy of memory encoding and retrieval (Roediger, Jacoby & McDermott, 1996).
An encoding of information may be influenced by mood state, prior experience, retro or proactive interference, or personal expectations (Deffenbacher, 1994; Jacoby, Wahlheim, Rhodes, Daniels & Rogers, 2010; Emery, Hess, Elliot, 2012). Personal expectations may include issues such as prior experience of a stimulus. Some researchers of the effects of irrelevant stimuli, anxiety arousing, or overstimulating conditions have often assumed that, in relation to memory, negative emotional states equate to memory inhibition (Deffenbacher 1994; Belli, Lindsay & Gales, 1994). Researchers have proposed that increases in emotional state will be associated with increased memory performance until an optimal level is attained. Further arousal then leads to a diminished memory performance (Deffenbacher, 1994). An individual may be so overwhelmed and stressed by an incident that information processing may become limited by other emotions (Emery, Hess, Elliot, 2012; Deffenbacher, 1994). Encoding may not get past the first stage of Atkinson and Schiffin’s (1968) processing model, sensory memory, where information is deemed to be somewhat fleeting.
This suggests that learning from experience may not always be the easiest thing to do even when not highly aroused. How we can easily identify what we are feeling, learn from those emotions and apply them to future potential stimuli appears to be a massive task.

### Theory
##### Three Theories of Emotion

There are many theories of emotion, but we will have a brief look at three of them.
William James (1890) all those years ago argued that it was the body's arousal that caused emotion, stating that it was the body that changed (responded) directly following an exciting fact (stimulus), and that emotions are one's sense of arousal (as cited in Gray, 2002). Much of James' theory came from introspection, looking inward on his own emotions and that what he was feeling really came from his bodily changes. He believed that if he could not fel the bodily changes then he could not feel or have experienced the emotion (Gray, 2002) In essence James' theory states it is the initial assessment and subsequent response happen quickly and without awareness. The feeling comes later and is based on what is felt around the body with physiological responses. This would become known as James' Theory
The Common Sense Theory (also labelled by James) suggests the order of James' Theory be slighlty re-arranged;
* James' Theory
* 1. Stimulus (Spider) 2. Perception/Interpretation 3. Bodily Arousal (Increased heart rate) 4. Emotion (Fear)
* Common Sense Theory
* 1. Stimulus (Spider) 2. Perception/Interpretation 3. Emotion (Fear) 4. Bodily Arousal Increased heart rate
The third theory is Schacter's Theory; it holds that the feedback loop of emotion does not just depend on sensory information relative to the body's responses, but also on the perceptions and thoughts relative to the environment (Gray, 2002) and the event/stimulus. He porposed that thoughts and individual perception if the stimulus diectly influence the emotion felt. That is, if you see a big hairy spider on your shoe and you perceive it to be dangerous, that will determine your emotion and the degree of physilogical arousal. Your perception of how highly you are aroused by the stimulus then determines how much fear you will have (Gray, 2002).

## What is Health
### Homeostasis

Homeostasis; a term from the early 20th century that has a literal translation of 'unchanging'. In fact in physiology it it used to indicate a state of balance or equilibrium. This balance is always within narrow limits with constantly changing internal bodily conditions. The body is in homeostasis when it's needs are adequately met and it is functioning well.
The balance of homeostasis is somewhat trickier than one might think. Nearly every vital organ plays a critical role in regulating and maintaining a nearly impossible constancy of the body's internal environment (Marieb & Hoehn, 2007). Things such as body temperature, blood pressure, body waste management, to name but a few, must all be accurately controlled. Additionally, a range of chemical, hormonal and neural factors compound to produce a 'dance' that pushes and pulls the body's internal state as it goes about its routine, day and night, in an effort to keep things steady and balanced. Regardless of the factor being monitored and regulated the pathway for feedback remains the same (Marieb & Hoehn, 2007). A receptor senses the environment, or change, a control centre determines the threshold and analyses input from the receptor and the effector provides a response, ether suppressing (negative feedback) or enhancing it (positive feedback) (Marieb & Hoehn, 2007).

### Homeostatic control mechanisms

Communication, or feedback, about the body's internal state is handled mainly by the nervous and endocrine systems, using electrical impulses and hormones. Negative feedback systems form the bulk homeostatic control mechanisms (Marieb & Hoehn, 2007 and work by going in the opposite direction of the stimulus). A common example of this mechanism is body temperature control. Much like a thermostat on a heater, the body senses changes in temperature and reacts accordingly. The body's ability to regulate its internal environment is fundamental, with all mechanisms striving to achieve the same objective; preventing abrupt and extreme changes within the body. Positive feedback mechanisms enhance the original stimulus so that change is in the same direction (Marieb & Hoehn, 2007). Positive feedback mechanisms are likely to speed out of control and are not often used in the body. The two familiar uses are blood clotting and enhancement of labour contractions in child birth (Marieb & Hoehn, 2007).

### Homeostatic Imbalance and Overstimulus

Our internal conditions can be unstable at the best of times and this only becomes more difficult for our feedback mechanisms to control and regulate as we get older (Marieb & Hoehn, 2007). This can increase our chance of illness as our boy systems become less efficient. A particular homeostatic imbalance of concern is when the usual negative feedback systems are overwhelmed and begin to fail allowing the more destructive positive feedback mechanisms to take over (Marieb & Hoehn, 2007). Heart failure is a common example given to reflect this.

## Positive Emotions; Feeling good about yourself and physiological health
### Self-efficacy

There is evidence that the psychological attribute of perceived self-efficacy plays a role in mediating health outcomes. An instrument to measure perceived self-efficacy was developed through consultation with patients and physicians and through study of 4 groups of patients (Lee, 1990).
The General Self-Efficacy Scale (GSE) perceived self-efficacy facilitates goal-setting, effort investment, persistence in face of barriers and recovery from setbacks. It can be regarded as a positive resistance resource factor. Ten items are designed to tap this construct. Each item refers to successful coping and implies an internal-stable attribution of success (Lorig, Chastain, Ung, Shoor & Holman, 1989).
A German version was developed in 1979 by Matthias Jerusalem and Ralf Schwarzer, and later revised and adapted to 26 other languages by various co-authors (Aston & Webb, 1996). The scale was created to assess a general sense of perceived self-efficacy with the aim in mind to predict coping with daily hassles, health, as well as adaptation after experiencing all kinds of stressful life events. The scale is usually self-administered, as part of a more comprehensive questionnaire (Lee, 1990).
| General Self-Efficacy Scale | (GSE) |
| 1 | I can always manage to solve difficult problems if I try hard enough |
| 2 | If someone opposes me, I can find the means and ways to get what I want |
| 3 | It is easy for me to stick to my aims and accomplish my goals |
| 4 | I am confident that I could deal efficiently with unexpected events |
| 5 | Thanks to my resourcefulness, I know how to handle unforeseen situations |
| 6 | I can solve most problems if I invest the necessary effort |
| 7 | I can remain calm when facing difficulties because I can rely on my coping abilities |
| 8 | When I am confronted with a problem, I can usually find several solutions |
| 9 | If I am in trouble, I can usually think of a solution |
| 10 | I can usually handle whatever comes my way |
| Response Format | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
In studies with cardiac patients, their recovery over a half-year time period could be predicted by pre-surgery self-efficacy.
Strengths - The measure has been used internationally with success for two decades. It is suitable for a broad range of applications. It can be taken to predict adaptation after life changes, but it is also suitable as an indicator of quality of life at any point in time (Lorig, et al., 1989).
Weaknesses - As a general measure, it does not tap specific behaviour change. Therefore, in most applications it is necessary to add a few items to cover the particular content of the survey or intervention (such as smoking cessation self-efficacy, or physical exercise self-efficacy). How to write such items is described in Schwarzer and Fuchs (1996).

### Helping Behaviour

The desire to help appears to be an essential aspect of human nature. One particular type of helping behaviour is volunteerism. Every year, millions of people engage in volunteerism, whether it is providing health care in free clinics, or tutoring for the illiterate. Not everyone can reach the state of empathy and compassion that leads to action and subsequently the role of volunteering. This is to say that a set of emotional, cognitive and physiological states that lead to helping behaviour (Oman, 2007).
Research on helping behaviour has shown that such behaviour (volunteering) can buffer the effects of stress on health (Oman, 2007; Poulin, 2013). The health benefits of volunteering do appear to be most beneficial for those who have a positive view of others. (Consider brief statement regarding the effects of stress on health) research has also shown that providing help or support to others benefits the helper, to the point where it can predict life longevity (Poulin, 2013).
Of course in this sense not everyone will get a health benefit from volunteering, or helping behaviour, which may open up a further research question; how can we adjust 'attitudes' to get an ongoing health benefit from volunteering? It is noted that the mechanisms involved with volunteering and why people volunteer are very diverse. Topics of interest for researchers have been; increased community access, social participation, having a valued role in the society, distraction from one’s troubles and learning new skills…all of which may promote better health (Oman, 2007).
However, some studies show that to get the health benefits from volunteering the volunteer may need additional social contact(Oman, 2007; Poulin, 2013)). This may require someone outside of the volunteering circle that can validate, wonder about and perhaps praise the amazing feats of the volunteer, that sets off a chain reaction of beneficial 'feel-good' hormones coursing through the body. But why volunteering is beneficial, and promotes better health, to those that engage in helping type behaviour is currently unknown. But empirically there appears to be that buffer provided to stress from helping behaviour. But it seems emotionally feeling good about yourself is healthy, and can lead to better health.

## Management of Health and Emotions
#### The connection of mind and body

Different parts of out body are affected in different ways depending on the type of emotion we are experiencing. Homeostatic balances are challenged as systems fire into action.
The limbic system is our emotional brain. The connections from the limbic system to the upper and lower brain regions provide the integration necessary for us to respond to the variety of environmental stimuli that we experience constantly, with most of the limbic system output relayed through the hypothalamus.
The Hypothalamus lies at the 'centre' of the limbic system. It is involved with emotions like; perception of pleasure, rage and fear. It has links to biological rhythms and drives/motivations, and also physical expressions of of emotion, for example raised heart rate, sweating, raised blood pressure and the dry mouth of someone who is experiencing fear. Few tissues are spared its influence and it plays a lead role in many homeostatic dramas (Marieb & Hoehn, 2009).
The hypothalamus also steers parts of the endocrine system by releasing hormones that control the pituitary gland releasing its hormones, and parts of the hypothalamus' nuclei produce the hormones oxytocin (the 'bonding' hormone) and ADH (Anti-diuretic hormone) (Marieb & Hoehn, 2009).

##### Just a few examples of how emotions and health are linked

* Gastrin-secreting enteroenocrine cells, called G-Cells, prompt the dump of acid into the stomach and create an overly high acidic state in the stomach. Highly acidic gastric contents inhibit digestion. G-Cells can be activated by emotion as part of the fight-or-flight response, ceasing digestion and gastric secretions as the sympathetic system over-rides the parasympathetic (Marieb & Hoehn, 2009).
* Respiritory alkolosis (hyperventilation)has as possible triggers; stress, fear, pain, anxiety, and panic attack (Marieb & Hoehn, 2009). Carbon Dioxide is eliminated from the body faster than it is produced causing the blood to become more alkaline.
* As part of the important role the hypothalamus plays in the limbic system it gets lumbered with being the pathway for both the autonomic (visceral) functions and emotional responses. It makes sense that some individuals under acute, or chronic, emotional pressures and stress experience major organ related illnesses such as high blood pressure. A term for some of these type of illnesses is is psychosomatic illness.

## Conclusion

* Conclusion
* Emotions are critical partners in the outcomes of health. They may not always be obvious, and we may not always learn from from them...or even work out the true purpose and intention of the emotion. It is safe to say though that emotions definitely have the power to motivate and direct. Embarrassment has always been a stickler for me! The purpose that emotion serves me really is elusive.
* This point leads into the subjectivity of emotions and how what is experienced, felt, by one can be completely different for another. Ongoing research in this field will be just that, ongoing. The range of emotions, how individuals interpret stimuli, our geographical position, who we are with and previous and current mood state are all factors to drop into the mix when trying to decipher the "emotion/health" equation.
* However, it does appear that feeling good about yourself and the world can be healthy, and feeling bad not. It can be difficult to assess one's emotion, tag and label it and then store that information for future reference, in particular when highly aroused and focused at time of stimulus. Yet for the most part our bodies are very good at regulating our internal states and keeping that homeostatic balance needed for good health. But ut doesn't take much to tip the scales.
* Is that a hairy spider on your shoe?