How does compassionate caring make a difference to patient outcomes? New research shows that our life experiences, beliefs and internal stories dynamically change our gene expression, altering health outcomes. Now, for the first time, researchers have shown that helping patients to re-write their life stories and beliefs (through psychotherapy) results in epigenetic changes, correlated with clinical improvement.
Patients facing serious illness are especially vulnerable. Pessimistic patients recovering from heart attack have three times higher mortality rate compared to optimistic patients. Our patients’ experience of care can have a profound impact on the stories and beliefs they carry forward. While patients remember little about what was said or done to them but the emotional memories of care can last a lifetime.
We already know that lifestyle change including diet, exercise, relaxation and social support can radically alter gene regulation. A Dean Ornish study of men with prostate cancer showed that 150 cancer-promoting genes were down-regulated and 350 well-promoting genes were up-regulated and that cancer progression was halted. We also know that diabetic patients cared for by empathetic family doctors have 42% fewer hospital admissions for diabetic crisis. Something about being cared-for is changing the patient’s biology in a powerful way. Epigenetic change seems to be one of the mechanisms. Moreover, these positive or negative changes can be inherited by our patients’ children and grandchildren
This study published in Nature examined patients with borderline personality disorder, often associated with childhood abuse:
Down-regulation of brain-derived neurotrophic factor (BDNF) gene expression has been associated with stressful experiences in early life and may explain later adulthood psychopathology. We measured the percentage of methylation at BDNF CpG exons I and IV as well as plasma BDNF protein levels in 115 subjects with borderline personality disorder (BPD) and 52 controls.
Borderline Personality Disorder subjects then underwent a 4-week course of intensive dialectical behavior therapy [a form of group psychotherapy]. BDNF methylation status and protein levels were re-assessed at the end of treatment. Borderline Personality Disorder subjects had significantly higher methylation status in both CpG regions than controls. In addition, the higher the number of childhood trauma, the higher was the methylation status.
In Borderline Personality Disorder subjects, BDNF methylation significantly changed after psychotherapy. Patients who responded to treatment showed a decrease in methylation status over time, which were significantly associated with changes in depression scores, hopelessness scores and impulsivity.
These results support the idea that these epigenetic marks may be changed through psychotherapeutic approaches and that these changes underline changes in cognitive functions.