In this blog post, we will discuss the mind-body connection as it pertains to two frequently encountered diseases we see in the primary care clinic: hypertension and depression. First, we will review research suggesting that the increased frequency of hypertension seen among African Americans in the United States may be due to racism and stresses associated with race-based discrimination. Next, we will consider how fostering self-compassion can improve mental and physical health in our patients.
According to the Centers for Disease Control (CDC), people who self-identify as African American are almost twice as likely as people who self-identify as European American to develop hypertension, leading to increased morbidity and mortality associated with cardiovascular disease. Multiple studies have shown that African Americans in the United States are more likely to develop hypertension, develop more severe hypertension, and do so at earlier ages than European Americans. When this difference was first noticed, a tremendous amount of research attempted to delineate whether this increase in hypertension rates has genetic underpinnings; however, scientists have not been able to pinpoint any specific genetic cause. Furthermore, the increased prevalence of hypertension seen in African Americans is not found in people living in Africa or in other parts of the African Diaspora. Possible differences in access to healthcare, socioeconomic status, dietary intake, family history, and emotional stress, have not adequately accounted for the discrepancy seen in frequency of hypertension. However, several papers, including a paper by Dolezsar, et al., have shown that perceived racial discrimination has a small, significant association with increased hypertension. These researchers conclude that differences in hypertension rates may be due to the cardiovascular reactivity hypothesis, which posits that psychosocial stress can alter cardiovascular physiology.
In contrast, activities such as mindfulness meditation have been shown to improve mental and physical health. Researchers have recently been looking at the impact of self-compassion on health. Self-compassion involves mindful awareness of negative emotions, while also feeling kindness towards one’s self and feeling interconnected with the human experience. The literature on self-compassion suggests that people who exhibit self-compassion are less likely to be anxious, depressed, or stressed. Studies have shown that, among people with depression, those with greater self-compassion had fewer depressive symptoms. In addition, people with greater self-compassion had better immune function and metabolic control, as seen in a study where self-compassion buffered the influence of distress on HbA1c among patients with diabetes.
The notion that self-compassion can be a positive attribute has been met with some resistance. For example, how can people learn if they are not self-critical? It seems that, while people with high levels of self-compassion may not be as interested in shoring up their self-worth through external evaluation, they are much more interested in mastering self-administered goals. They also experience less disappointment and are more likely to try again when faced with failure, suggesting that resilience is enhanced when self-compassion is present.
Dolezsar CM, Mcgrath JJ, Herzig AJ, Miller SB. Perceived racial discrimination and hypertension: a comprehensive systematic review. Health Psychol. 2014;33(1):20-34.
Neff KD and MC Knox. Self-Compassion. In Zeigler-Hill E, Shackelford TK, eds. Encyclopedia of Personality and Individual Differences. 2017:1-8.
Dr. V. Silverstein
Published on 2/6/19