A review of the impact of hypnosis,relaxation, guided imagery and individual differences on aspects of immunity and health

This review considers psychological interventions involving relaxation and guided imagery targeting immune functions. The review provides evidence of immune control accompanied by reports of enhanced mood and well-being. Three recent investigations of the author and his colleagues with self-hypnosis training incorporating imagery of the immune system are outlined. In two studies, hypnosis buffered the effects of stress on immune functions in medical students at exam time, and the comparison of self-hypnosis with and without immune imagery confirmed advantages to targeted imagery for both immune function and mood, and importantly, fewer winter viral infections. The implications for health were investigated in a third study in patients with virulent and chronic herpes simplex virus-2 HSV-2). Six weeks of training almost halved recurrence, improved mood and reduced levels of clinical depression and anxiety. Immune functions were up-regulated, notably functional natural killer cell activity to HSV-1. Individual differences in hypnotic susceptibility and absorption have typically been found to predict efficacy. New replicable evidence is reviewed of the importance of cognitive activation, a personality difference whose neurophysiological underpinning is consistent with left hemispheric preferential influences over the immune system. Now that the validation of psychological interventions includes advantages for health, this field of enquiry, which has been characterised by modest, small scale, largely preliminary studies, warrants a greater investment in research.     

Ways to independence

Much research attests to the beneficial effects of equine interventions on physical development and ability. However, less is known about the possible psychological benefits of horse activities, such as therapeutic riding or interactions with horses. Although there is public consensus that horses can have psychological benefits, it is an under-researched area and conclusions are largely based on anecdotal data. The little empirical evidence that is available about the efficacy of equine-assisted interventions on psychological outcomes tends to be mixed and is often difficult to interpret due to the lack of rigorous research designs. The purpose of this review was to examine the current state of the literature regarding the psychological effects of equine-assisted interventions, and to make recommendations for future research. Findings from this review suggest that equine-assisted interventions hold much promise, particularly in terms of child/adolescent social and behavioural issues, and perhaps adult affective disorders. However, the current state of the literature does not allow us to definitively conclude that equine-assisted interventions are efficacious. Well-designed randomised controlled trials are greatly needed in this area, as it is an appreciation of the need to standardise and document equine-assisted interventions and outcomes in future research.     

The value of stress-management interventions in life-threatening medical conditions

Emotional stress has been associated with the development and progression of several chronic medical conditions. Recently, researchers have assessed the impact of stress-management interventions on patients' psychological functioning, quality of life, and various disease outcomes, including survival. This review summarizes the value of stress-management techniques in the treatment of two important, life-threatening conditions: coronary heart disease and cancer. Results from randomized clinical trials indicate that psychological interventions can improve patients' psychological functioning and quality of life. However, there is limited evidence to suggest that these interventions significantly reduce morbidity and mortality.     

Counselling in primary care: a systematic review of the research evidence

Counselling in primary care in the UK is expanding rapidly, and its evidence base needs to be established. We present the rationale for conducting controlled trials of counselling in primary care, and suggest that a systematic review of controlled trials of counselling in primary care is timely. We describe the process of conducting the review in accordance with Cochrane Collaboration guidelines. The review aimed to assess the effectiveness and cost-effectiveness of counselling in primary care, by systematically reviewing cost and outcome data from randomised controlled trials and controlled patient preference trials of counselling interventions, for patients with psychological and psychosocial problems considered suitable for counselling. The search strategy, inclusion and exclusion criteria, data collection and data analysis are described. The results of the review are presented. The review included only controlled trials of counselling in which counsellors accredited by the British Association for Counselling (or equivalent) provided non-directive counselling in primary care. Four trials met the inclusion criteria. Results indicated that patients who receive counselling show a modest but significant improvement in symptom levels compared with those who receive GP care. Levels of satisfaction with counselling are high. There is very tentative evidence to suggest that counselled patients are more likely to be considered recovered than usual GP care patients. There is limited information about the cost-effectiveness of counselling. We conclude by reflecting upon the results of the review and their implications for counselling research.     

Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue.

CONTEXT: Fatigue is among the most common and distressing symptoms experienced by cancer patients. OBJECTIVE: This systematic review and meta-analysis evaluates the efficacy of psychological and activity-based interventions against cancer-related fatigue in cancer patients. DATA SOURCES: MEDLINE, PsycINFO, and CINAHL. STUDY SELECTION: Randomized controlled trials of psychological and activity-based interventions involving adult cancer patients in which fatigue was an outcome were reviewed. EXTRACTION: Forty-one trials were reviewed and 30 were included in a meta-analysis. DATA SYNTHESIS: Fifty percent of psychological trials and 44% of activity-based trials rated fair or better in quality yielded significant findings favoring the intervention condition. Meta-analysis yielded an overall effect size of 0.09 (95% CI = .02- .16) favoring nonpharmacological conditions. Further analysis indicated that effect sizes were significant for psychological interventions (d-sub(w) = .10, 95% CI = .02-.18) but not activity-based interventions (d-sub(w) = .05, 95% CI = -.08 - .19). CONCLUSIONS: Findings provide limited support for use of nonpharmacological interventions to manage cancer-related fatigue. The lack of research with heightened fatigue as an eligibility criterion is a notable weakness of the existing evidence base.     

Meta-analysis of cognitive-behavioral interventions on HIV-positive persons' mental health and immune functioning.

OBJECTIVE: To evaluate the efficacy of cognitive-behavioral interventions (CBIs) for improving the mental health and immune functioning of people living with HIV (PLWH). DESIGN: Comprehensive searches of electronic databases from 1988 to 2005, hand searches of journals, reference lists of articles, and contacts with researchers. Meta-analytic approaches were used in synthesizing findings. MAIN OUTCOME MEASURES: Intervention effects on symptoms of depression, anxiety, and anger, stress, and CD4 cell counts were assessed. RESULTS: Data from 15 controlled trials were analyzed. Significant intervention effects were observed for improving symptoms of depression (d = 0.33), anxiety (d = 0.30), anger (d = 1.00), and stress (d = 0.43). There is limited evidence suggesting intervention effects on CD4 cell counts (d = 0.08). The aggregated effect size estimates for depression and anxiety were statistically significant in trials that provided stress management skills training and had more than 10 intervention sessions. CONCLUSION: CBIs are efficacious in improving various psychological states of PLWH. Future research should examine the relationship among interventions, psychological states, medication adherence, and immune functions, and identify other relevant factors associated with intervention effects.     

Optimizing the effects of stress management interventions in HIV

Scott-Sheldon, Kalichman, Carey, and Fiedler (2008) present a thoughtful, important, and timely meta-analysis of randomized controlled trials of stress management interventions in HIV. They differentiate controlled effect sizes across classes of acute outcomes including psychological distress, psychosocial processes, biological processes (immune status, viral, and hormonal) and fatigue. The authors join Scott-Sheldon et al., in considering future directions for this type of clinical psychosocial intervention research in HIV. Recommendations for addressing the high prevalence of psychosocial problems including diagnosable mental health disorders comorbid with HIV are presented. Suggestions for addressing medication adherence and accommodating interventions with concomitant substance use treatment are also considered. These recommendations are presented with an emphasis on expanding both the efficacy and effectiveness of psychosocial interventions in HIV. These recommendations are presented as realistic strategies for improving the modest treatment effect sizes for psychosocial outcomes and identifying meaningful effects on distal physiological outcomes associated with traditional stress management interventions in HIV.     

Effective obesity treatments

To curb the epidemic of obesity in the United States, revised Medicare policy allows support for efficacious obesity treatments. This review summarizes the evidence from rigorous randomized trials (9 lifestyle trials, 5 drug trials, and 2 surgical trials) on the efficacy and risk- benefit profile of lifestyle, drug, and surgical interventions aimed at promoting sustained (= 2 years) reductions in weight. Both lifestyle and drug interventions consistently produced an approximate 7-lb (3.2-kg) weight loss that was sustained for 2 years and was associated with improvements in diabetes, blood pressure, and/or cardiovascular risk factors. Surgical interventions have a less solid empirical base but offer promise for the promotion of significant and sustained weight reduction posttreatment in the morbidly obese but with possible significant short-term side effects. In summary, there is strong and consistent support from rigorous randomized trials that lifestyle or drug interventions result in modest weight loss with minimal risks but disproportionate clinical benefit. Combinations of lifestyle, drug, and, where appropriate, surgical interventions may be the most efficacious approach to achieving sustained weight loss for the widest diversity of patients.     

A meta-analysis of psychological and pharmacological treatments for Body Dysmorphic Disorder

Although psychological and pharmacological treatment approaches for Body Dysmorphic Disorder have been evaluated, the relative effectiveness of these two types of interventions has not been examined. We conducted a meta-analysis of randomized clinical trials and case series studies involving psychological (i.e., behavioural, cognitive-behavioural, cognitive) or medication therapies. Our findings support the effectiveness of both types of therapy, but suggest that cognitive-behavioural treatment may be the most useful. These findings require cross-validation through large-scale clinical trials.     

Psychological interventions for arthritis pain management in adults: a meta-analysis.

CONTEXT: The psychosocial impact of arthritis can be profound. There is growing interest in psychosocial interventions for managing pain and disability in arthritis patients. OBJECTIVE: This meta-analysis reports on the efficacy of psychosocial interventions for arthritis pain and disability. DATA SOURCES: Articles evaluating psychosocial interventions for arthritis were identified through Cochrane Controlled Trials, EMBASE, Ovid MEDLINE, and Ovid PsycINFO data sources. STUDY SELECTION: Randomized controlled trials testing the efficacy of psychosocial interventions in arthritis pain management were reviewed. DATA EXTRACTION: Twenty-seven randomized controlled trials were analyzed. Pain intensity was the primary outcome. Secondary outcomes included psychological, physical, and biological functioning. DATA SYNTHESIS: An overall effect size of 0.177 (95% CI=0.256-0.094) indicated that patients receiving psychosocial interventions reported significantly lower pain than patients in control conditions (combined p=.01). Meta-analyses also supported the efficacy of psychosocial interventions for the secondary outcomes. CONCLUSIONS: These findings indicate that psychosocial interventions may have significant effects on pain and other outcomes in arthritis patients. Ample evidence for the additional benefit of such interventions over and above that of standard medical care was found.     

Counselling in primary care: a review of the practice evidence

This paper describes the level of mental health problems that are encountered in primary health care. The limitations of using randomised control trials (RCTs) in evaluating effectiveness of psychological therapies in primary health care are described. Although the RCT may be useful in evaluating interventions in highly controlled situations, its use in evaluating clinically representative service delivery research is limited. A three-stage model of psychological therapies research is described to show that distinct stages require different methodologies in order to evaluate them, and this model is used to structure the review. The literature on research carried out in more naturalistic circumstances is then reviewed. Evaluating psychological interventions in this way shows there is considerable evidence that psychological therapies are effective in a number of ways in a primary care setting. The naturalistic studies that are more typical of clinical practice support the use of psychological interventions. The theme of the grey literature is almost entirely positive from the point-of-view of patients and GPs alike. However, there is considerable diversity in the sophistication of the methodology of the latter studies. Some were comprehensive evaluations, while others were more akin to audit. A major shortcoming is that few described their qualitative methodology. This said, the themes arising from the reports are very consistent and, had they been supported by a more robust qualitative methodology, would have added even more support, financially and clinically, for the arguments for counselling provision in primary health care. The level of referred clients' distress, measured by a variety of measures, was shown to be moderate to severe and similar to the level of patients referred to Community Mental Health Teams (CMHTs). When they were measured, there was a considerable reduction in subsequent psychiatric symptoms.     

Stress, emotion, and human immune function

This article provides a review of empirical evidence linking emotional processes to immune function in humans. Acute stressors have produced mixed effects on immunity, presumably through differential activation of physiological stress systems. Chronic stress has been associated with suppression of immune function, and there is evidence that the immune system may not adapt over time. Effects of stress accompanying social disruption and psychological depression, when demonstrated, have been consistently adverse. Certain personality styles may enhance or degrade immune response. Relationships between psychosocial factors and immunity have been identified for several diseases, including cancer, acquired immune deficiency syndrome, and autoimmune diseases; psychosocial interventions have been tested with variable results. Theoretical and methodological considerations are summarized and directions for future research suggested.     

Effects of psychological interventions for patients with osteoarthritis: a systematic review and meta-analysis

The aim of this study was to determine the effects of psychological interventions (e.g. cognitive restructuring, relaxation) on physiological and psychological health in osteoarthritis patients. A systematic literature search was done using PubMed, Embase, PsycINFO, Web of Science, China National Knowledge Infrastructure, and Wanfang Database through November 2016. Studies were included if they used a randomized controlled trial designed to explore the effects of psychological interventions in osteoarthritis patients. Two independent authors assessed the methodological quality of the trials using criteria outlined by Jadad et al. Meta-analysis was done with the Revman5.0. Twelve randomized controlled trials, including 1307 osteoarthritis patients, met the study inclusion criteria. Meta-analysis showed that psychological interventions could reduce the levels of pain [standard mean difference (SMD) ?0.28, 95% CI ?0.48, ?0.08, P-value 0.005)] and fatigue (SMD ?0.18, 95% CI ?0.34, ?0.01, P-value 0.04). In addition, psychological interventions significantly improved osteoarthritis patients’ self-efficacy (SMD 0.58, 95% CI 0.40, 0.75, P-value 0.00) and pain coping (MD 1.64, 95% CI 0.03, 3.25, P-value 0.05). Although the effects on physical function, anxiety, depression, psychological disability were in the expected direction, they were not statistically significant. In conclusion, the role of psychological interventions in the management of osteoarthritis remains equivocal. Some encouraging results were seen with regard to pain, pain coping, self-efficacy, and fatigue. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.     

心理神经免疫学研究

心理神经免疫学（Psychoneuroimmunology）是一门探索人类心身健康奥秘的新型边缘学科。它研究神经系统如何将心理因素转换为可以影响健康的生理状态的机制,特别是脑和行为如何影响免疫系统,又如何受到免疫系统的影响的。免疫系统和神经系统之间是否真正存在联系一直有争论,我们实验室围绕高级神经活动对免疫系统的作用开展了研究。工作包括：条件反射性免疫抑制和增强、情绪应激与免疫、心理行为干预与癌症等。这些工作不仅证实了心理调控,比如信号刺激、情绪和意念想象等,确实可以影响免疫系统的功能,而且对有关机制进行了探讨     

Patients who come back: Clinical characteristics and service outcome for patients re‐referred to an IAPT service

Aims: Patients who are referred more than once to a Primary Care Mental Health Improving Access to Psychological Therapies (IAPT) Service raise questions about those patients' clinical characteristics, the appropriateness of the interventions offered and their capacity to make use of them. IAPT treatments are based on National Institute for Health and Clinical Excellence (NICE) guidelines for the treatment of common mental health problems. NICE recommendations are based on evidence gained from clinical trials, in particular Randomised Controlled Trials (RCTs), which tend to exclude the sort of patient with complex and co‐morbid conditions who often present in practice. Method: Using data routinely collected from the IAPTus clinical database, re‐referral patterns and level of complexity of 50 patients who were referred on more than one occasion to a Primary Care Mental Health (Improving Access to Psychological Therapies) Team from 2009–2010, were analysed. Results: The evidence presented in this study indicates patients who re‐refer exhibit complex environmental, historical and psychological problems. Implications for practice: Although further research is required to compare the characteristics of this patient group with those who are referred only once, this study provides limited evidence that such patients may be more likely to engage and complete treatments that offer regular, structured and one‐to‐one interventions.     

Neuropharmacological treatment of mental dysfunction in Parkinson's disease

Many patients with Parkinson's Disease (PD) experience significant cognitive and mood impairment -even early in the course of the disease. These mental impairments are only partially responsive to levodopa treatment and are often as disabling as the motor impairment, particularly in mid and late stages of the disease. Investigators have recently begun a search for new agents that can effectively treat mental dysfunction of PD. Although there have been only a handful of properly controlled clinical trials of interventions targeted at amelioration of mental dysfunction in PD, progress has been made. Based on the available evidence, targeting catecholaminergic and cholinergic function may be an effective strategy for amelioration of cognitve, mood and psychiatric disturbances in PD.     

A systematic review and meta‐analysis of tertiary interventions in clinical burnout

Clinical burnout is one of the leading causes of work absenteeism in high‐ and middle‐income countries. There is hence a great need for the identification of effective intervention strategies to increase return‐to‐work (RTW) in this population. This review aimed to assess the effectiveness of tertiary interventions for individuals with clinically significant burnout on RTW and psychological symptoms of exhaustion, depression and anxiety. Four electronic databases (Ovid MEDLINE, PsychINFO, PubMed and CINAHL Plus) were searched in April 2016 for randomized and non‐randomized controlled trials of tertiary interventions in clinical burnout. Article screening and data extraction were conducted independently by two reviewers. Pooled odds ratios (ORs) and hazard ratios (HRs) were estimated with random‐effects meta‐analyses. Eight articles met the inclusion criteria. There was some evidence of publication bias. Included trials were of variable methodological quality. A significant effect of tertiary interventions compared with treatment as usual or wait‐list controls on time until RTW was found, HR = 4.5, 95% confidence interval (CI) = 2.15–9.45; however, considerable heterogeneity was detected. The effect of tertiary interventions on full RTW was not significant, OR = 1.33, 95% CI = 0.59–2.98. No significant effects on psychological symptoms of exhaustion, depression or anxiety were observed. In conclusion, tertiary interventions for individuals with clinically significant burnout may be effective in facilitating RTW. Successful interventions incorporated advice from labor experts and enabled patients to initiate a workplace dialogue with their employers.     

The modification of attentional bias to emotional information: A review of the techniques,mechanisms, and relevance to emotional disorders

A negative bias in the deployment of attention to emotional stimuli is commonly found in both anxiety and depression. Recent work has highlighted that such biases are causally related to emotional vulnerability, suggesting that interventions that ameliorate them may be therapeutic. Here, we review the evidence that attentional bias can be modified using both pharmacological and psychological interventions. We highlight the behavioral and neuroimaging studies that suggest that these interventions impact upon attention via alteration of distinct neural mechanisms. Specifically, pharmacological interventions appear to influence the initial deployment of attention via an effect on the amygdala-based stimulus appraisal system, whereas psychological interventions influence attention at later time points and may alter activity in the lateral prefrontal cortex. Finally, we suggest a conceptual framework that embraces both pharmacological and psychological approaches and consider the possible implications of this work for future research and treatment development.     

Psychological treatments

Psychology has recently identified itself as a health care profession and codified this change in the bylaws of the American Psychological Association. Although psychologists make a number of contributions to the nation's health--and mental health--the most identifiable activity focuses on treating physical or psychological pathology with psychological interventions. Recently, health care policymakers have established that evidence supporting the efficacy of these interventions is more than sufficient for their inclusion in health care systems around the world. To promote faster and more widespread dissemination of these interventions specifically targeting problems severe enough to be included in health care systems and to solidify the identification of psychology as a health care profession, perhaps it is time for a change in terminology. It is proposed that psychologists label these procedures psychological treatments so as to differentiate them from more generic psychotherapy, which is often used outside of the scope of health care systems.     

A systematic review of interventions for adults who stutter

PurposeTo examine the effectiveness of (i) face to face interventions (ii) models of service delivery and (iii) psychological treatments combined with speech-focused interventions for adults who stutter.MethodsFive electronic databases and three clinical trial registries were searched. Systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with adults who stutter were included. Pharmaceutical interventions were excluded. Primary outcomes included a measure of stuttering severity. Risk of bias assessment was conducted on included studies and overall quality of the evidence was graded.ResultsFive RCTS, four registered trials and three systematic reviews met inclusion criteria. Intervention approaches included speech restructuring programs (e.g. Camperdown Program) and transcranial direct current stimulation (tDCS). One study investigated cognitive behaviour therapy (CBT) alongside speech restructuring. Overall, studies were classified low risk of bias and good quality. Speech restructuring was included in all but one study (tDCS study) and had the most evidence i.e. supported by the greatest number of RCTs. On average, stuttering frequency was reduced by 50–57 % using speech restructuring approaches. No study reduced stuttering to the same level as community controls who don’t stutter. The study on tDCS reduced stuttering frequency by 22–27 %. Speech restructuring delivered via telehealth was non-inferior to face-to-face intervention. One study reported CBT was an effective adjunct to speech restructuring interventions.ConclusionSpeech restructuring interventions were found to reduce stuttering in adults, however degree and maintenance of fluency varied. The body of evidence surrounding tDCS and psychological interventions is limited. Replication studies should be considered.