What’s the Link Between Mental Health and Autoimmune Disease?
Photo by Kelly Sikkema on Unsplash.
Autoimmune diseases are characterised by the immune system attacking the body's own tissues, causing a range of symptoms and affecting around 4% of the global population. In Western countries, the prevalence is even higher, at 8-10%. Traditional treatment often involves managing physical symptoms with medication, but research suggests that addressing mental wellbeing may also play a significant role in managing and potentially reversing autoimmune diseases.
Understanding Autoimmune Diseases
Autoimmune diseases result from inflammation, which is a normal part of the immune response. For example, when we sustain a cut, our immune system initiates what’s known as an innate immune system response to protect and heal the affected tissues. This happens at a local level and generally only involves the organs and tissues directly involved.
But when we have a bigger systemic issues, such as toxins in the bloodstream, a more coordinated response is mounted via the autonomic nervous system (ANS). There are two main branches of the ANS: the sympathetic nervous system and the parasympathetic nervous system (the enteric nervous system is also part of the ANS but I’ll talk about that in another post). The sympathetic nervous system (SNS) is the branch of the ANS responsible for activation. It's what makes your heat beat and gives you the action potential you need to move and do things. However, if left unchecked, it would have your heart beating at a rate of around 120 beats per minute so it needs to be reined in by the parasympathetic nervous system (PNS). One of its jobs is to put the brakes on SNS activity. It’s because of the PNS that a healthy person has a heart rate of around 60 beats per minute.
The SNS also plays an important role in modelling immune system function. When a system-wide threat within the body is detected, it becomes more dominant and the PNS withdraws. This allows the SNS to send signals to the adaptive immune system to produce inflammatory molecules to fight off and destroy the threat. Because the SNS is in contact with the entire body, an adaptive immune response is an entire body response - it’s not just local to the specific place where the threat was detected. This is advantageous under situations of acute stress or pathogen invasion because it means that the whole system is on high alert and can easily deal with a pathogen that breaks through the first line of defences.
Once the threat has been dealt with, the PNS receives signals that it needs to come back online. It steps in and balances out the activity of the SNS again, sending signals that dampen the immune response and actively blocking its activity.
The problem for people with chronic inflammatory health conditions, like autoimmune disease, is that that signal never gets sent. The immune system stays on high alert, eventually producing autoantibodies that mistakenly damage organs and tissues, disrupting bodily systems, and creating a whole host of problematic side effects.
Epigenetics and Autoimmune Disease
As you probably already know, genetics act as the blueprint for everything that happens in our body. Genetic predispositions play a significant role in autoimmune diseases. For instance, women are up to four times more likely than men to develop autoimmune diseases, possibly due to hormonal differences. Men with Klinefelter syndrome, a condition characterised by an extra X chromosome, also face a higher risk. Despite these genetic factors, not everyone with a genetic predisposition will develop an autoimmune disease, suggesting a strong epigenetic component. This indicates that environmental and lifestyle factors may play a role in triggering the expression of autoimmune genes.
This is the old nature vs. nurture debate. The truth is, it’s never just our biology or our environment that creates autoimmune conditions. It’s a combination of both.
You can have all of the genes associated with a specific autoimmune disease but if they never receive the signals to switch on, they don’t activate and you might live a perfectly healthy life. Diet, toxins, pathogens, and even too much exercise have all been investigated and reported on for their contribution to autoimmune disease. But less well-known and discussed is the role of emotional stress in the onset and exacerbation of autoimmune disease.
Stress and the Nervous System
Stress is a major cause of autoimmune disease. Why? The key is in what it does to the nervous system. Above, I explained how the SNS and PNS up regulate and dampen the immune system, respectively. Well, the SNS doesn’t just become active in response to infection. It coordinates what’s known as the “fight or flight” response. Our SNS can become more or less dominant throughout the day, depending on what’s happening. That’s completely normal. But if we are subject to chronic stress, for weeks, months, even years at a time, our SNS stays dominant, while the parasympathetic nervous system withdraws, creating an inflammatory cascade that, you guessed it, up regulates our adaptive immune system, keeps it working hard, and results in autoimmune disease.
This has been demonstrated in research looking at the link between post traumatic stress disorder (PTSD) and autoimmune disease. Researchers now know that acute, traumatic stress results in the production of cortisol in the brain. Concurrently, the SNS becomes more active, resulting in a brain-body inflammatory storm along with all the classic symptoms we know to be associated with PTSD - panic attacks, nightmares, and social anxiety are just a few of them.
But the relationship between inflammation and PTSD is bi-directional, with each condition potentially exacerbating the other. For instance, individuals with pre-existing inflammation may be more susceptible to PTSD in the event of trauma. Conversely, PTSD can lead to chronic inflammation, furthering the risk of developing autoimmune diseases. Inflammation in the brain can downregulate the production of dopamine and serotonin, essential neurotransmitters for motivation and reward, potentially leading to unhealthy habits and further inflammation.
If you’ve had some kind of an infection or illness, this can also make you more susceptible to psychological stress.
This bi-directional relationship is why it’s so important to take a holistic, functional approach to working with conditions like PTSD and autoimmune disease. There are multiple ways to alleviate symptoms and heal.
What Does This Mean For Me?
Interventions that directly modulate nervous system function may be one of the most powerful things you can do to reduce symptoms and improve wellbeing if you have an autoimmune disease. Researchers have been able to pinpoint specific neurons in the vagus nerve, the predominant branch of nerves in the PNS, that coordinate the inflammatory response. When these neurons are silenced, the vagus withdraws from the ANS, allowing the SNS to become dominant and up regulating the immune response. When these neurons are stimulated, the vagus nerve suppresses the inflammatory response. While the exact mechanisms underpinning how the vagus receives the signals that tell it whether to be silent or more active are yet to be understood, this finding has important implications for people with autoimmune disease. What it suggests is that if the vagus nerve receives the right signals, rather than being silent, it will be more active and reduce the immune response, alleviating symptoms and possibly reversing autoimmune disease.
Over the last few years, research on exactly how to do this has been accumulating.
Biofeedback training and guided meditation can help regulate the nervous system and reduce inflammation. For example, integrating a breathing technique into psychotherapy has been found to increase vagus nerve function, leading to improved emotion regulation and decreased immune system activity.
For people with a history of trauma, therapeutic approaches that improve trauma processing may also offer long-lasting benefits. Psychosocial interventions, such as Internal Family Systems (IFS), have shown promise in improving both mental and physical health in autoimmune disease patients. IFS lessens pain perception, improves physical function, and enhances mental health while decreasing sympathetic nervous system activity and increasing parasympathetic tone. This shift allows the body to move from a state of inflammation and agitation to one of rest and healing.
Spending time in nature, ice plunges, exercise, diet… these can all help too. The key is to do any or all of these things regularly, to ensure that the signal is sent consistently.
The Role of Awareness
Awareness of the link between emotional and physical wellbeing in autoimmune diseases is growing, but more integration is needed in medical and mental health education. Practicing deep breathing and other self-regulation techniques can help manage autoimmune diseases, and technologies for monitoring heart rate variability and respiratory rate over time can help you track your progress.
In conclusion, taking a holistic approach to treating autoimmune diseases, which includes improving emotional wellbeing, may lead to better outcomes for patients. By addressing both the physical and emotional aspects of these conditions, individuals may experience relief from symptoms and potentially even reverse the progression of their autoimmune disease. As research continues to explore the connections between emotional health and autoimmune conditions, patients and healthcare providers alike can benefit from incorporating these insights into treatment plans.