Here is a copy of the presentation that I gave to MRC CBU at Cambridge University on the 5th July 2017, essentially a summary of a book chapter of mine to be published later this year. The focus of my presentation was on connections between #self, #other and our #connections with the environment.

1. Pathways to health & wellbeing:
A focus on the vagus nerve
Andrew Kemp, PhD
Associate Professor in Psychology
Swansea University
E: a.h.kemp@swansea.ac.uk; T: @andrewhkemp

2. Health in the 21st century & non-
communicable disease
 Epidemiological transition: increased burden from communicable
(red) to non-communicable disease burden (blue)
 Overall disease burden
 DALYs = YLL + YLD
https://vizhub.healthdata.org/gbd-compare/

3. Health in the 21st century & non-
communicable disease
 Epidemiological transition: increased burden from communicable
(red) to non-communicable disease burden (blue)
https://vizhub.healthdata.org/gbd-compare/

4. Overview
 Bigger picture & challenges
 What does it mean to be healthy?
 Bridging the gap from psychological science to epidemiology
 GENIAL model
 Bottom-lines from todays talk:
 Vagus nerve: plays an important regulatory role over multiple allostatic
systems
 Pathways to health & wellbeing include social ties & our relationship with
the environment

5. Bigger picture & inter-connected challenges
 “Britain has had enough of experts” – Michael Gove, June 2016
 Climate change
 Unsustainability
 International tensions
 Increasing global burden of chronic disease
 Loneliness, an epidemic of our age?

6. Loneliness, an epidemic of modern society?
 ‘Kodokushi’
 In U.K., more than 25% live alone
 60% teenagers report feeling lonely
 Loneliness  increases distress 
risk for morbidity, mortality
Kemp et al., in press. In book titled: Neuroscience and Social Science: The Missing Link

7. Health in the 21st century
 What does it mean to be healthy?
 The Oxford Dictionary defines “health” as “the state of
being free from illness or injury”
 World Health Organisation (WHO) definition: physical,
mental, and social wellbeing, not merely the absence of
disease and infirmity

8. Is it really possible to be healthy?
 Peter Skrabanek joked that
health is only achievable “at
the moment of mutual
orgasm”
http://blogs.bmj.com/bmj/2008/07/08/richard-smith-the-end-of-disease-and-the-beginning-
of-health/
 The WHO definition of health is often criticised for being
unachievable

9. Health… psychology…
 Others argue that cancer patients might be considered
healthy
 Optimism
 Sense of control
 Purpose and meaning
 Self-efficacy and capacity to overcome problems
 A supportive social network
 A nurturing family
See: http://blogs.bmj.com/bmj/2016/07/19/richard-smith-what-are-the-causes-of-health/
Health &
wellbeing
according to
salutogenic
theory & positive
psychology

10. On the importance of social ties
 Links bw positive social
ties & decreased
mortality
 Effects of social ties
rivals well-established
risk factors
Holt-Lunstad et al., 2010, PLOS Medicine
Epidemiological evidence for relative differences in the odds of
decreased mortality across several conditions

11. The ‘self’, social identity & wellbeing
 Links between social identity
and well-being
 Virtuous & vicious cycles to
wellbeing
Haslam et al., 2006

12. Groups 4 Health
 G4H pilot study
 Increased social
identity decreases
depression, anxiety,
stress, loneliness, &
life satisfaction
 But what might be
the mechanism here?
Haslam et al., 2016

13. Vagal function, positive emotions & social
ties
Kok et al (2013). Psych Sci

14. Porges (2011). The Polyvagal Theory
Myelinated vagus: originates
from nucleus ambiguus; social
communication; linked to HRV
Sympathetic nervous system:
supports mobilisation
behaviours, e.g. fight, fight, play
Unmyelinated vagus: most
phylogenetically primitive;
immobilisation behaviours, e.g.
extreme terror, bradycardia,
vasovagal syncope
Vagal function, polyvagal theory & social ties
… inhibits
… inhibits

15. Vagal function & heart rate variability (HRV)
 Vagal function is indexed by heart rate variability (HRV)

16. Vagal function & heart rate variability
(HRV)
Data from Sasha Saunders, Honours student, 20
Rest Stress: Task instructions followed by task
(serial 13’s task with social pressure)
 Under resting state: large beat to beat variability
 Stress condition: decreases HRV (& HR increase)

17. Vagal function, neurovisceral integration &
mammalian behaviour
 Vagal function is
indexed by heart rate
variability (HRV)
 HRV reflects the
output from
prefrontal-vagal
pathways
Reviewed in: Kemp et al., in press. In book titled: Neuroscience and Social Science: The Missing Link

18. Vagal function & unmedicated depression
 Sample: N=1,080
 Method: meta-analysis, 18 studies
 Finding: Unmedicated depressed
patients without CVD display
reduced HRV (relative to controls)
dy Hedges's g and 95% CI
p-Value
0.312
0.340
0.001
0.124
1.000
0.040
0.744
0.009
1.000
0.869
0.607
0.828
0.686
0.731
0.027
-2.00 -1.00 0.00 1.00 2.00
Reduced HRV Increased HRV
ency HRV
Reduced HRV
Kemp et al.., 2010, 2011, 2012. Biological
Psychiatry

19. Vagal function & anxiety disorders
 Sample: N=4,380
 Method: meta-analysis, 36
articles
 Findings: All anxiety
disorders – except OCD –
display reduced HRV (relative
to controls)
Chalmers, Kemp & colleagues, 2014. Frontiers in Psychiatry;
Kemp et al., 2014. Am J Psychiatry

20. Vagal function & GAD
 Sample: N=167
 Method: case – control
Kemp et al., 2012. PLOS ONE; Kemp et al., 2014. Am J Psychiatry
 Finding: HRV was reduced in MDD
relative to controls (d=0.48)
 MDD with comorbid GAD displayed
greatest reductions (d=0.84)

21. Impacts of a past hx of anxiety disorder
Pregnant women:
 Sample: Women with hx
of anxiety (n=22) versus
women w/out (n=34)
 Method: case – control
 Finding: Resting state
HRV is reduced in
mothers with hx of anxiety
disorder in first trimester
Braeken, Van Den Bergh, Kemp, PLOS ONE, 2013

22. Offspring:
 Sample: Offspring of women with
past anxiety (n=16) versus infants
of women w/out (n=28)
 Method: case – control
 Finding: History of maternal
psychopathology impacts on HRV
in mother and infant
RMSSD Child
H
ealthy
Lifetim
e
A
nxiety
0
1
2
3
4
Healthy
Lifetime Anxietyp=.048, Hg=.63
RMSSDChild
Past history even impacts on offspring
Braeken, Van Den Bergh, Kemp, PLOS ONE, 2013

23. Vagal function & multi-systemic regulation
 Vagal function is involved in the regulation of:
 Sympathetic nervous system (e.g. Porges, 2011)
 Hypothalamic-pituitary adrenal axis (e.g. Porges, 2011)
 Inflammatory processes (e.g. Tracey, 2002)
 Metabolism including glucose regulation (e.g. Tracey & Pavlov, 2012)
 Neurogenesis (?) (e.g. Follesa et al., 2007)
 Epigenetic modifications (?) (e.g. Stilling et al., 2013)
Reviewed in: Kemp et al., in press. In book titled: Neuroscience and Social Science: The Missing Link

24. Kevin Tracey & colleagues, 2002 – 2012; Wang et al. 2003. Nature; Thayer & Sternberg, 2010; McEwen & Wingfield, 2003
Vagal function & allostasis
 Vagus plays key role in
cholinergic anti-
inflammatory reflex
 Allostasis: the process
of achieving stability,
or homeostasis,
through physiological
or behavioral change

25. Vagal function & metabolic allostasis
 Impaired hepatic vagus nerve
signaling  insulin resistance (IR)
 IR is associated with a cluster of
cardiovascular risk factors
(metabolic syndrome)
Kevin Tracey & colleagues, 2002 – present; DeFronzo, 2010. Diabetologia; Bourdel-Marchasson et al., 2010. Diabetes &
Metabolism

26. Atherosclerosis & cognitive impairment
 To summarize:
 Vagal dysregulation  inflammation 
insulin resistance  atherosclerosis 
cognitive impairment
Santos et al., 2014, Atherosclerosis; Zhong et al., 2012, Athero
Mean CIMT 1.174 mm
Slide Source: www.lipidsonline.org
 IMT: ultrasound examination of carotid arteries to quantify early
atherosclerosis
 Larger IMT  Delay in completing Trail-Making Test-part B
 For every 0.1 mm IMT increase, executive function slowed by 2.3
s

27. Pathways to cognitive impairment
 Sample: N=15,105
 Method: Large cohort study, cross-
sectional
 Measures:
 10-min HRV at rest
 Trail Making Test (version B)
 Insulin resistance
(Glucose (mg/dl) * Insulin (mcUI/mL))/405
 IMT: measured in the outer wall of a
pre-defined carotid segment of 1 cm in
length from 1 cm below carotid
bifurcation, during three cardiac cycles
Kemp et al., 2016. Biological Psychology

28. Vagal function & time to complete TMT
Kemp et al., 2016. Biological Psychology
Difference bw High vs Low HF-HRV on Trail Making Test
(TMT)
 Reduced vagal activity
characterized by longer time
to complete the trails test
 Interpretation? Slowing
reflects impairment in PFC-
vagal pathways
 But, might this be mediated
by IR & IMT?

29. Pathways to cognitive impairment
 Relationship between HRV & TMT was partially mediated by IR and
IMT
 IR = insulin resistance; IMT = subclinical measure of atherosclerosis
 Finding was supported by 6 different sensitivity analyses
IR
Kemp et al., 2016. Biological Psychology

30. Vagal function & premature mortality
 Vagal impairment is associated with various risk factors:
 Age
 Smoking
 Excessive alcohol consumption
 Physical inactivity
 Abnormal cholesterol
 Hypertension
 Diabetes
 Obesity
Thayer et al., 2010; Kemp & Quintana, 2013

31. Vagal function & premature mortality
 N=344
 Longevity depends
on preservation of
vagal function
 BUT, this was a
cross sectional &
correlational study
Zulfiqar et al., AJC, 2010. Am J Cardiol.

32. Vagal function & premature mortality
 N=21,988 ppts w/out
known CVD
 An increase in HRV of
1% results in an 1%
lower risk of fatal or non-
fatal CVD over a 3-15yr
follow-up
Hillebrand et al., 2015. Europace.
IncreasedriskDecreasedrisk

33. Pathways to wellbeing?
 Prior work has highlighted:
 Positive emotion  health & wellbeing (Ernest Abel)
 Social ties  health & wellbeing (Alex Haslam)
 High levels of conscientiousness  health & wellbeing (Howard Friedman)
 High levels of vagal function  health & wellbeing (Barbara Fredrickson)
 Specific genomic profiles  health & wellbeing (Aysu Okbay)
 And these simplistic models have been criticised
accordingly…

34. Some recent examples…

35. Some recent examples…

36. Some recent examples…

37. Some recent examples…

38. Some recent examples…

39. Some recent examples…

40. Some recent examples…

41. Some recent examples…

42. The GENIAL model: Genomics - Environment -
vagus Nerve - social Interaction - Allostatic
regulation – Longevity
 Framework on
which future
research will be
based
 Links psychological
science to
epidemiology
Kemp et al., in press. In book titled: Neuroscience and Social Science: The Missing Link

43. Broad implications for health & wellbeing
 To summarise, vagal function has been associated with:
 Emotion (e.g. Fay Geisler & colleagues)
 Social connectedness (e.g. Bethany Kok & colleagues)
 Social engagement (e.g. Stephen Porges & colleagues)
 Emotion regulation (e.g. Julian Thayer & colleagues)
 Executive functioning (e.g. Anita Hanson & colleagues)
 Psychological flexibility (e.g. Todd Kashdan & Jon Rottenberg)
 Positive health behaviours (e.g. Anita Hanson & Julian Thayer)
 Future morbidity & mortality (e.g. Stefanie Hillebrand & colleagues)
Vagal function may
reflect an individual
resilience factor
Kemp et al., in press. In book titled: Neuroscience and Social Science: The Missing Link

44. Health is impacted on by other
factors including social,
environmental, political and
economic conditions
For example:
“climate change will weaken the
environmental and social conditions
that underpin our physical and
psychological health”
Ref: The Climate Institute, A Climate of Suffering: the real cost of living with inaction on climate
change (Melbourne & Sydney: The Climate Institute, 2011)
Health & sociostructural factors

45. An example: The Australian ‘Millennium
drought’
 Worst drought recorde
d since European
settlement
 15 % increased RR of
suicides in rural
Australian men, aged
30-49 years
(Alston, 2012, Social Science & Medicine;
Hanigan et al., 2012, PNAS)

46. Individual resilience  community resilience
 Vagal function 
resilience
 Individual  societal
resilience
 Resilience is needed
to help manage
societal challenges

47. Linking resilience to community action
 Recent scholarly work connects:
 Positive emotions & social ties
 To community action & societal
transformation
 Initiatives include:
 Happy cities
 Healthy cities
 Sustainable cities
 Transition network #amreading

48. Conclusions
 GENIAL framework:
 Emphasises an important regulatory role of vagal function
 Provides a systemic model of health & disease
 Links research on the ‘self’, ‘other’ & sociostructural factors
 Bridges the gap between psychological science & epidemiology
 Implications for the transition to a more caring &
understanding world (?)