About Kelly Brogan

KELLY BROGAN, MD, is a holistic psychiatrist, author of the New York Times Bestselling book, A Mind of Your Own, Own Your Self, the children’s book, A Time For Rain, and co-editor of the landmark textbook Integrative Therapies for Depression.

The translation of emotions to physiology is becoming less and less “woo woo” and more and more scientifically validated. A landmark study1 of women with breast cancer was recently published that provides even more evidence of the power of emotions on disease outcomes.

In this study, researchers measured markers of inflammation called cytokines and correlated them with people’s emotional states. Cytokines are potent signaling proteins that direct cells to act in certain ways. This study focused on pro-inflammatory cytokines such as tumor necrosis factor (TNF)-alpha, IL-6, IL-8, IL-10, and IL-18.

These cytokines are elevated in cancer patients and can contribute to symptoms of “sickness behavior” like fatigue, chronic pain, and nausea.2 This sickness behavior not only diminishes a person’s quality of life, but also saps physical resources that are needed to heal. Interestingly, these cytokines are also elevated in people who suffer from social isolation or negative emotions.3

Sadly, the very process of being diagnosed with cancer creates a surge of pro-inflammatory cytokines4 and has been referred to as medical hexing. However, previous research has shown that using strategies for emotional acceptance leads to lowered distress,5 closer relationships, and increased survival following a breast cancer diagnosis.6 Emotional acceptance is the process by which a person allows emotions – both positive and negative – to emerge and dissipate without attempts to control, change, or reject these emotions.

Fortunately, in this study, researchers recognized this harmful side effect of cancer diagnoses and taught patients an emotional regulation technique to influence their feelings before, during, or after their diagnoses.7Ultimately, these researchers wanted to know if emotional acceptance caused measurable changes on the molecular level.

To answer this question, researchers analyzed data from 136 women who had been diagnosed with breast cancer (stage 0 to stage IIIB). Starting at diagnosis, researchers collected blood samples and questionnaire data every 3 months for 2 years, analyzing a variety of parameters.

Interestingly, women’s emotional acceptance scores were measured against their own average scores, not those of other people. This distinction is important because it accounts for a person’s baseline optimism level; if a woman was naturally pessimistic, her average emotional acceptance scores would be lower than that of an optimistic woman. In this study, the metrics of molecular changes are based on how a woman compares to herself, not to other women. The molecular results speak for themselves…

When a woman’s emotional acceptance scores were low, her sickness symptoms and inflammatory cytokines were high, particularly IL-8 and TNF-alpha. Conversely, as her emotional acceptance scores increased, her pro-inflammatory cytokines went down.

IL-8 is a particularly important cytokine to study in the context of breast cancer because IL-8 is produced by breast cancer cells themselves. This cytokine sets off further inflammatory cascades that can misdirect the immune system and enable breast cancer metastases.8 Therefore, anything that lowers pro-inflammatory cytokines like IL-8 has the potential to beat cancer at its own game. Overall, women with higher levels of emotional acceptance showed lower levels of IL-8 and lower sickness symptoms.

The data goes on to show that emotional acceptance disrupts the association between pro-inflammatory cytokines and sickness behavior; when a woman increased her emotional acceptance, her sickness symptoms became independent of her cytokines. That is, even if a woman exhibited high levels of IL-8, she didn’t necessarily feel sick due to high emotional acceptance. On average, high emotional acceptance predicted low sickness symptoms, regardless of cytokine levels.

Many other studies have shown that emotional acceptance decreases symptoms of depression9 and anxiety10 and can buffer the harmful effects of chronic stress.1 Overall, this study is significant because it provides a proposed mechanistic basis that helps explain how emotional acceptance creates more favorable experiences and outcomes in the context of disease diagnoses – and is yet another reason to consider symptoms not as sentences, but as invitations to explore underlying causes.

It is through accepting this invitation that we find personal meaning in our symptoms, our experience of being a patient, and our personal identification with illness. And suffering ends where meaning begins.


  • 1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917434/
  • 2 https://www.ncbi.nlm.nih.gov/pubmed/18281672/
  • 3 https://www.ncbi.nlm.nih.gov/pubmed/16165282/
  • 4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218259/
  • 5 https://www.ncbi.nlm.nih.gov/pubmed/16816961
  • 6 https://www.ncbi.nlm.nih.gov/pubmed/8991302
  • 7 http://www.elaborer.org/psy1045d/cours/Gross(1998).pdf
  • 8 https://www.ncbi.nlm.nih.gov/pubmed/23639322
  • 9 https://www.ncbi.nlm.nih.gov/pubmed/16321362/
  • 10 https://www.ncbi.nlm.nih.gov/pubmed/15262220/
  • 11 https://www.ncbi.nlm.nih.gov/pubmed/12643964/