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Compassion - Shifting the Balance From Bad to Good Stress

Firdaus Dhabhar Department of Psychiatry & Behavioral Sciences Institute for Immunity, Transplantation, & Infection Stanford University

Outline: good stress bad stress compassion

Mother Nature did not give us the stress response to kill us. She gave us the stress response to help us survive!

Stress is a constellation of events that begins with a stimulus (stressor), that precipitates a reaction in the brain (stress perception), that subsequently results in the activation of fight / flight systems in the body (stress response). Acute / Short-term stress = minutes to hours Chronic / Long-term stress = months to years

(Dhabhar & McEwen, Brain Behavior & Immunity, 1997, 11: 286.)

Central Hypothesis: Just as the stress response prepares the cardiovascular, musculoskeletal, and neuroendocrine systems for fight or flight, it may also prepare the immune system for challenges (wounding or infection) that may be imposed by a stressor (Brain, Behavior, & Immunity, 1994) Short-term stressors will ENHANCE immune function in compartments (e.g. skin) that are likely to be compromised by the actions of a stressor (e.g. predator, surgery, etc.)

Most research is understandably focused on long-term / chronic stress.

Long-term stress (months-years)

We believe that it is also important to investigate, and harness the protective effects of short-term / acute stress.

Short-term stress (minutes-hours)

Q: How does the immune system react during short-term stress?

What does this acute stress induced UP-DOWN change in immune cell numbers signify?

Immune Effects of Short-term Stress

BARRACKS (e.g. spleen) BOULEVARDS (blood vessels) BATTLEFIELDS (e.g. skin)

cell number

# defenders firepower
early late

duration of stress

Short-term stress activates the bodys defenses even before there is wounding or infection!

Q: Does a short-term stress response experienced during surgery, vaccination, or cancer progression, enhance immune function?


(Rosenberger et al., JBJS, 2009)


(Dhabhar et al., BBI, 2010)

(Dhabhar et al., AJP, 2005, Viswanathan, et al., 2005)

A clinical example of the beneficial effects of short-term stress

Knee Surgery Study: Time Line

adaptive redistribution maladaptive response

surgery stress
-- ?

++ ?

7-10 days baseline presurgery postsurgery

48 weeks monitor recovery (Lysholm Scale)

Rosenberger et al., J. Bone & Joint Surgery, Vol 91.

High Leukocyte Redistribution = Recovery Over 1 Year

higher MAX recovery

during surgery

earlier recovery

during surgery

Rosenberger et al., J. Bone & Joint Surgery, Vol 91.

One of our goals is to maximally harness the protective biology of short-term stress during surgery, vaccination, and cancer therapy.

What about BAD stress?

Q: How do we reconcile immuno-enhancement findings with the well-known stress-induced suppression / dysregulation of immune function Q: How does an adaptive system become maladaptive? Transition from acute to chronic stress

Chronic stress is BAD protective immunity chronic inflammation biological aging mental & physical health susceptibility to: infection cancer cardiovascular disease depression

GOOD stress LOW stress (resting zone) BAD stress

Sleep, nutrition, exercise, meditation, yoga, dance, What you want exercise, art, music, fishing, for good health is: neurosurgery COMPASSION?

PRACTICING COMPASSION stress factors (Pace et al., 2009)

RECEIVING COMPASSION recovery from common cold (Rakel et al., 2009)

SELF-COMPASSION stress, anxiety, depression Dont be too hard on yourself but dont go too easy either MAKE TIME: for stress-reducing activities TAKE ACTION: meditation, yoga, hiking, dancing, exercise, painting, music, friends, neurosurgery different strokes for different folks does not HAVE to be meditation, levitation

(Dhabhar, Science of Compassion, Telluride, 2012)


chronic stress

resting equilibrium

fight-or-flight protection

health & wellbeing

(Dhabhar, Science of Compassion, Telluride, 2012)

Our Goals
Maximally harness the biology of GOOD stress. Reduce/eliminate BAD stress, and maximize the zone of health and healing.

Link to article

Thank You!
Dhabhar Lab
Nicole Bricker* Jean Tillie* Kavitha Viswanathan* Alison Saul* Christine Daugherty* Allison Litzinger Tuong Phan Tanaz Chhor Jayce Pangilinan Nora Nguyen

Yale Stanford
David Spiegel* et al. James Gross et al. Ruth OHara Joachim Hallmayer Shelli Kesler Donna Bouley* Tyson Holmes* David Lyons et al. Jamie Zeitzer Jeannette Ickovics* Patty Rosenberger* Peter Jokl, et al.*

Elissa Epel* Owen Wolkowitz* Elizabeth Blackburn*

UC Davis
Cliff Saron

Rockefeller University
Bruce McEwen* Ralph Steinman*

Ohio State
Tatiana Oberyszyn* William Malarkey* Stanley Lemeshow* Randy Nelson

Marty Altemus

M. D. Anderson
Donna Kusewitt*

NIH: AI48995, AR46299, CA107498 Univ. Louisville Sandie Sephton Dana Foundation MacArthur Foundation