The breast cancer community is under tremendous stress as the COVID-19 crisis continues to rage across the country. Patients are navigating changes to treatments and heightened fears about contracting the virus. Many people are grieving the loss of loved ones to COVID-19 and dealing with feelings of isolation and loneliness. The holidays, too, are presenting their own particular challenges and stressors.
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We spoke with BCRF investigator Dr. Julienne Bower, associate professor of psychology and psychiatry at UCLA, who studies stress and how it impacts the immune system. She investigates mind-body interventions, such as mindfulness, and works with Diana Winston, director of mindfulness education at UCLA’s Mindful Awareness Research Center, who also joined in.
Here, they talk about how stress and immunity are linked, how mindfulness can improve everything from sleep to inflammation, and how to start meditating today.
Dr. Julienne Bower: My research looks broadly looks at the links between stress and the immune system and how that relates to women who are facing breast cancer or those that are survivors. Right now, we’re all thinking a lot about the importance of the immune system for fighting viruses, and we also know that the immune system plays a role in cancer progression. One area of my research examines how stress influences cells of the immune system, including those that promote tumor development and spread. We are also very interested in how we can develop a healthy immune system using psychological and mind-body interventions. Here, we are interested in reducing stress, but also cultivating positive emotions like happiness, joy, social connection, and a sense of meaning and purpose in life.
My work in this area began in graduate school, when I did a study with women who had lost their mothers to breast cancer. This kind of traumatic experience can sometimes lead us to re-evaluate our goals and priorities; indeed, I’m guessing that some of us are doing this during the current pandemic. We found that women who prioritized goals related to relationships, personal growth, and finding meaning in life showed evidence of a stronger immune system. I have continued to pursue that line of work throughout my career, which has led me to our current projects focusing on mindfulness meditation.
Diana Winston: The Mindfulness Awareness Research Center (MARC) has been at UCLA for about 14 years. We focus on education and research on mindfulness. Within UCLA, we’re located in the medical school, so we offer a lot within the UCLA health system, and then in wider ways throughout campus and globally to the general public. We also provide a program called MAPs (mindful awareness practices), a six-week introduction to mindfulness. And that’s been adapted in a number of different studies, including in Dr. Bower’s studies with breast cancer patients.
JB: We tend to take for granted this idea that stress affects the immune system today. The first rigorous research on stress and immunity in humans was conducted in the 1980s with students taking stressful medical exams, caregivers of dementia patients, and individuals experiencing the loss of a loved one. They all showed negative changes in the immune system. We now understand that the body’s stress response systems are intimately connected to the immune system and can influence what type of immune cells are made, where they go in the body, and how they function. We’ve been really interested in how this plays out in the context of breast cancer and stress’ role in inflammation and tumor progression.
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JB: Some of the most potent stressors from the perspective of the immune system are those that involve social threat, including social rejection, low social status, feeling socially isolated (an issue for many of us as we are confined at home during COVID-19). I should note that occasional feelings of loneliness are completely normal, and even adaptive, as they let us know that we are missing social contact. It is longer-term experiences of loneliness that may lead to decrements in the immune response.
JB: Mind-body interventions include mindfulness and other types of meditation, as well as yoga, Tai Chi, acupuncture, and relaxation techniques. Our group is also interested in other approaches to enhancing well-being, including “positive psychology” techniques like gratitude and acts of kindness interventions.
DW: The way I define mindfulness is paying attention to our present moment experiences with openness and curiosity and a willingness to be with that experience. It’s really about helping yourself come into the present moment. If you were to check in with your mind at any point in the day, it’s probably lost in the past or lost in the future, worrying about something that happened or that’s coming—especially now. Mindfulness is an invitation to come back into the present moment and connect with ourselves in a way where we can see that actually, I can be OK. I can take a breath, I can pause. This is a skill that can be trained.
JB: I’ll add that it’s good for us to be skeptical and look carefully at the evidence for some of these approaches. But there’s actually very strong and compelling evidence that mindfulness does reduce stress and depression. As Diana said, even these little five-minute practices can calm our minds and bodies. Mindfulness has a broader spectrum of effects, which is why we’re so excited about it as a technique. It can improve sleep, which is critical for our mental and our physical wellbeing. Sleep and the immune system are tightly connected.
In our studies with women with breast cancer, we found that mindfulness reduces stress and depression and that’s great, but it also increases positive feelings. It increases self-kindness and feelings of peace and meaning in life. It turns out that positive emotions are linked to beneficial changes in the immune system and may be even more important for immunity than negative emotions like stress and depression. One of my favorite practices is a loving kindness meditation (listen to one on UCLA’s website here), where you’re sending loving kindness out to someone in your life and having that come back on you. It’s very powerful. Relatively small things like doing acts of kindness for others, keeping a list of things we are grateful for, writing a gratitude letter, paying attention to and savoring positive experiences when they occur can also increase these positive feelings.
DW: There are lots of different meditation types and mind-body interventions. You’ve got to find the one that works for you or you’re not going to do it. A mindfulness practice is fairly straightforward and fairly easy to do. You don’t need a lot of props. You don’t need a lot of time to do it, at least to get started. I suggest people start out with just five minutes a day. Everybody has time for five minutes. Try to find a place where you can be quiet. Then just breathe. Feel your breathing and your body. When your attention wanders, bring it back, and just do that over and over.
If you need a little support, there are lots of ways to listen to guided meditations. Our app, UCLA Mindful, has five-, 10-, 20-minute meditations. I would also encourage people, if they’re practicing mindfulness, to know that sometimes we get discouraged because our minds are wandering. We think we’re supposed to have this perfectly quiet mind with nothing going on. But that’s not at all what happens. We sit down and we get to see what’s really going on—our worries and concerns and grief and so forth. It’s just a matter of noticing that’s happening, not making that a problem, and coming back to the present moment. It’s almost like developing a muscle at the gym. Over time, this gets easier.
JB: The idea of a weeks-long course may be daunting, but even a small “dose” of mindfulness—a five-minute guided meditation—is helpful.
Listen to a seven-minute stress-reducing mindfulness exercise that Diana Winston recorded exclusively for BCRF in the player below:
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