Social Support Improves Health

Dean Ornish, M.D., Founder of Preventive Medicine Research Institute and Professor atUCSF

Most behavioral medicine studies involving heart patients focus on the efficacy of lifestyle changes to reduce atherosclerosis and reverse ischemic heart disease. World-renowned cardiologist Dean Ornish’s behavioral medicine program includes weekly psychoeducational group participation, which was initially instigated as a way to promote the healthy lifestyle changes he advocates, especially adherence to a very strict low-fat diet. Doctor Ornish reported that although the researchers in his studies had not previously controlled for the effect of the group support aspect of the program, it was his personal belief that the social support aspect of those weekly groups may be the single most powerful intervention of the entire program. Research psychologist Ute Schultz and his team studied the efficacy of the Ornish program and found the social support aspect to be one of the ingredients that have made the Ornish program a lifesaver for cardiology patients who had failed previous behavioral medicine interventions.

We have all experienced heart-warming feelings when we are with close friends. These feelings have been traced to relaxation of the smooth muscle in the cardiac arteries, which then trigger other healthy physiological responses. The relaxed smooth muscle results in vasodilation. The vasodilation allows arteries that may have atherosclerotic plaques to open and permit increased cardiac oxygenation and perfusion. The increased oxygenation and perfusion then results in fewer and milder cardiac events. The “heart-warming” feeling itself is the result of increased blood flow to the center of the chest.

Psychoneuroimmunology researchers have consistently found a positive correlation between social support and the immune system. In a study by research psychologist Bert Uchino, thirty-eight residents of a retirement community received visits by volunteers three times a week for a month. Immune function tests were performed on all of them at the start of the month, during, and at the end of the month. At month’s end, immunoglobulin (antibody) levels as well as natural killer (NK) cell activity were increased. NK cells attack and destroy cancer cells and virus-infected cells.

Psychoneuroimmunology researcher Janice Kiecolt-Glaser and her team proved that social support improves immune function and that the damaging physiological effects of emotional distress can be reversed through social support. She found that leukocyte cell counts and immune function are both improved by social support. College students are under enormous emotional distress during exam periods. At Ohio State University, students were interviewed prior to a period of final exams to determine their base-line emotional distress levels as well as their level of social support. Saliva samples were collected before, during, and after the exam period. Salivary immunoglobulin A (s-IgA) is often used by researchers because it is one of the few lab measures that can be collected non-invasively.

Researcher Susan Kennedy, working in the lab of Dr. Kiecolt-Glaser, found that s-IgA was significantly diminished in the emotionally distressed students who lacked good social support, making them more vulnerable to both bacterial and viral respiratory diseases. The students with good social support were found to have far less diminution of their s-IgA. The researchers also discovered that the students with strong social support had higher levels of s-IgA during all three collections. In other studies by these Ohio State researchers, NK cells were measured during stressful periods. Reductions in NK cells correlated with lower levels of social support. The significance of this finding is that people without social support are more likely to develop cancer because it is the NK cells that attack and destroy cancer cells after the cancer cells are flagged by CD-4 (T-Helper) cells.

Dr. Kiecolt-Glaser’s husband is Dr. Ronald Glaser. In one of his studies, forty-eight medical students at Ohio State Medical School were inoculated with the standard series of three injections of hepatitis B vaccine. The inoculations were administered on specific dates to coincide with a very stressful exam period. The students who had reported having the most social support were the same ones who produced the most antibodies in response to the vaccine. These same students also manifested the most robust T-cell responses to the hepatitis B surface antigen. Antigens are the substances that initially provoke the immune response. Antibodies are the proteins that are secreted as a result of the antigen-provoked triggered immune response.

In another study by Kiecolt-Glaser and her team, volunteers visited thirty elderly retirement home residents three times a week for one month. These thirty residents agreed to allow the researchers to draw blood multiple times throughout the study. The researchers found a very significant increase in NK cells. The way the researchers decided on three times a week was because they had previously noticed that those residents who had visitors three times a week or more had significantly stronger immune systems than the residents who had fewer visitors. One of the surprises of this study was that despite the fact that the visits were by strangers, and the residents of the retirement home knew the visitors were only visiting them as part of an experiment, the subjects still received a boost in their immune systems as a result of the visits. Under the circumstances, these visits could barely qualify as social support, yet there was still a positive effect. Obviously, the affect of being visited by people close to them would have produced an even greater effect.