Stress, Energy, and Immunity: An Ecological View

ABSTRACT— A common perspective on stress-related changes in the human immune system is that such changes are potentially harmful, especially those occurring during chronic stress. In contrast, an ecological perspective views the immune system as an energetically costly system that may or may not have priority over other uses of that energy. From this perspective, the immune system may have energy made available for it via reduction of other activities, may change in energetically conservative ways when the protection it confers needs to be balanced with the energetic demands of other activities such as fight or flight, or may be suppressed when other activities are more important than immunity for total well-being. This last type of change can explain why aspects of psychosocial health such as optimism relate to worse immunity under some circumstances and suggests that both benefits and costs of immunosuppression during stress should be considered in research on human stress and immunity.     

Psychosocial risk factors, natural immunity, and cancer progression: Implications for intervention

One of the more important and emerging fields in which psychologists collaborate with other disciplines is psychoimmunology. Centuries of clinical anecdote and decades of psychosomatic hypotheses have gained credibility in the eyes of the medical establishment—and many patients—by the systematic investigation of mechanisms potentially explaining how events intrapsychic and interpersonal could affect physical disease processes. The central nervous system is connected with the immune system by both neuronal and endocrinological pathways. The immune system has been found to mediate the organism’s response to aberrations of its own normal functions, as well as to invading organisms from without. AIDS, arthritis, asthma, lupus, and herpes are some of the illnesses in which research is demonstrating important relationships among psychosocial and immunological factors and disease course. In this article, we first discuss the immunological apparatus in order to provide a base for subsequent discussions of the effects of stress on immune function. Then we discuss malignant diseases and current evidence that disease course is related to both psychosocial stressors and immune function. We next discuss a model of these interactions, and finally we talk about interventions incorporating psychosocial factors aimed at influencing immune status and, thus, disease course.     

Associations between stress, trait negative affect, acute immune reactivity, and antibody response to hepatitis B injection in healthy young adults.

Eighty-four healthy graduate participants were administered the standard course of 3 hepatitis B vaccinations. Five months after the first dose (shortly after the second injection), each participant completed psychosocial measures, and a blood sample was drawn for determination of hepatitis B surface antibody titer. After completion of the vaccination series, participants performed an acute stress protocol, consisting of a 30-min adaptation period and a 5-min evaluative speech task. Blood was drawn at the end of the resting and task periods for assessment of cellular immune measures. Lower antibody response, as assessed after the second hepatitis B injection, was predicted independently by (a) high trait negative affect and (b) diminished T-cell proliferation in response to PHA. These data provide evidence that trait negative affect and the magnitude of stress-induced suppression of immune function may have clinical significance.     

Stress and Disease: An examination of psychophysiological effects and alternative treatment approaches

This article examine the psychophysiological relationship between psychosocial stressors and physiological changes. Stress has been shown to cause changes in the human immune system, increasing susceptibility to disease. A selective review of the literature explores this relationship. Alternative treatment modes are being implemented to supplement traditional therapies for the preventative and post hoc care of diseases, particularly those associated with the immunologic system deficiencies which could be related to stress. Implications are explored for implementing biofeedback, guided imagery, and stress management techniques for supplemental treatment in cancer, coronary heart disease, and immunologic diseases such as the acquired immune deficiency syndrome.     

人格特质对个体心理性应激反应的调节作用

心理性应激是个体的内稳态受到社会心理威胁时候的状态。面对急性心理性应激源, 有机体的各大机能系统, 包括神经内分泌系统、免疫系统以及自主神经系统等, 会出现一系列生物功能的改变。已有研究表明人格特质(如自尊、特质焦虑和大五人格)会影响个体在心理性应激情境中的反应差异且影响方式尚不统一, 并且不同文化环境下人格特质影响心理性应激反应的方式是不一样的, 然而这种结果的差异有可能是生物标记物的不一致造成的, 也有可能是心理性应激任务的不一致造成的, 不能直接进行比较。未来研究应该在控制这些无关变量的基础上, 从跨文化的角度去考察人格特质对个体心理性应激反应差异的影响。     

The effects of stressful life events,coping, and cortisol on HIV infection

What is the role of stress and coping in changes in immunologic and clinical indicators of human immunodeficiency virus disease progression? There is substantial evidence that stressful life events and passive coping strategies, such as denial, may have a detrimental effect on HIV disease progression. Given the harmful effects of stress and passive coping, the author reviews the limited research testing the efficacy of interventions, such as cognitive-behavioral therapies for HIV-infected persons. Finally, in trying to understand psychoimmune relationships in HIV, the evidence is examined for the mediating and direct effects of cortisol, a hormone associated with stress, on HIV disease progression. Delineating the role of psychosocial factors and cortisol on HIV disease progression may aid in the development of new interventions for this devastating disease.     

Mid-life stress is associated with both up- and down-regulation of markers of humoral and cellular immunity

Perception of stress with consequent activation of a neuroendocrine cascade causes changes in immune function that may be bi-directional, with alterations in basal levels of biological parameters outside the optimal range. In this cross-sectional study of 302 healthy persons (males 56.3%, females 43.7%) aged 41-46 years, higher stress levels, as assessed by questionnaire measures of recurrent and recent perceived stress, were associated with a 4-fold greater risk of having a high compared to mid-range serum neopterin concentration, indicating activation of cellular immune mechanisms [adjusted odds ratio, OR; (95% confidence intervals, CI): Low stress=1.00 (reference group); Medium stress=4.13 (1.51, 11.29); High stress=4.63, (1.35, 15.83), p for trend=0.01]. Higher stress levels were associated with a 3-fold greater risk of having signs of humoral immune activation, as indicated by salivary IgA concentration [high compared to mid-range salivary IgA: Low stress=1.00 (reference group); Medium stress=1.06 (0.48, 2.34); High stress=3.62 (1.26, 10.39), p for trend=0.02], but also a 4-fold greater risk of humoral immune depression [low compared to mid-range IgA: Low stress=1.00 (reference group); Medium stress=1.72 (0.74, 3.99); High stress=4.38 (1.47, 13.00), p for trend=0.02]. In conclusion, in this cross-sectional study, higher stress levels were associated with higher serum neopterin and both elevated and depressed salivary IgA levels. These findings emphasise the importance of considering that stress may have bi-directional effects on immune mechanisms, and are consistent with an activational effect of chronic, perceived stress on cellular immunity, and a bi-directional effect on IgA levels, one aspect of humoral immunity.     

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     

儿童版特里尔社会应激测试对儿童唾液皮质醇、唾液α-淀粉酶和情绪的影响

研究以150名五、六年级的学生为被试,考察儿童版特里尔社会应激测试（TSST-C）对儿童客观生理反应（唾液皮质醇和唾液α-淀粉酶）和主观情绪反应的影响。结果发现,TSST-C引起了儿童显著的应激反应,包括皮质醇和唾液α-淀粉酶水平的升高,以及主观消极情绪（如焦虑和紧张）的增加,这表明TSST-C在中国儿童中的适用情况良好,能够有效诱发儿童的应激反应。同时,研究也发现,皮质醇反应和唾液α-淀粉酶反应不存在相关,生理反应和情绪反应之间也不存在相关。     

Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry

The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants. Acute stressors (lasting minutes) were associated with potentially adaptive upregulation of some parameters of natural immunity and downregulation of some functions of specific immunity. Brief naturalistic stressors (such as exams) tended to suppress cellular immunity while preserving humoral immunity. Chronic stressors were associated with suppression of both cellular and humoral measures. Effects of event sequences varied according to the kind of event (trauma vs. loss). Subjective reports of stress generally did not associate with immune change. In some cases, physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.     

Coping,psychological adjustment,and complementary and alternative medicine use in persons living with hiv and aids

Abstract

Many HIV-positive individuals dissatisfied with allopathic approaches to disease management have turned to complementary and alternative medicines (CAM). Although people use CAM for a variety of reasons (e.g., symptom management, holistic approach towards healthcare, improved immunity), the psychological benefits that these treatments may have are still not fully understood. The present study was designed to further previous research that demonstrated relationships between CAM use, stress appraisals, and coping behaviors. HIV-positive individuals (N= 127) completed measures assessing stress appraisals, coping, psychological adjustment, satisfaction with life, and immune functioning. After controlling for ethnicity and sexual orientation, stress appraisals and coping behaviors were found to be related to CAM use. Further, curvilinear relationships between CAM use and adjustment emerged, suggesting that some CAM use may be adaptive. Self-reported immune measures were unrelated to CAM use. In all, it appears that CAM use may be a complex form of coping that assists individuals in adjusting to a life-threatening illness. The implications of these findings with respect to adherence to highly active antiretroviral therapies (HAART) are also discussed.     

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.     

Psychosocial Factors and Disease Progression in Cancer

ABSTRACT— Psychosocial factors such as stress, personality, and social support relate to differences in disease progression in cancer patients. Neuroendocrine substances associated with psychosocial factors may regulate immune responses to cancer, as well as regulate the activity of oncogenic (cancer-causing) viruses, DNA-repair processes, and the expression in tumor cells of genes that may affect the tumor's growth and metastasis. Biobehavioral oncology research seeks to understand how these psychosocial factors, and interventions designed to modify them, become neurohormonal changes that alter cell signaling and tumor growth, viral oncogenesis, and immune responses. We review the empirical basis for psychosocial factors and biobehavioral processes in cancer progression and suggest future research.     

Psychoneuroimmunology

Psychoneuroimmunology is the study of the relationships among behavioral, neural and endocrine, and immune processes. Bidirectional pathways connect the brain and the immune system and provide the foundation for neural, endocrine, and behavioral effects on immunity. Examples of such effects are conditioned and stress-induced changes in immune function and in susceptibility to immunologically mediated diseases. These data indicate that researchers should no longer study the immune system as if it functioned independently of other systems in the body. Changes in immune function are hypothesized to mediate the effects of psychological factors on the development of some diseases, and research strategies for studying the clinical significance of behaviorally induced changes in immune function are suggested.     

Chronic stress, cognitive functioning and mental health

This review aims to discuss the evidence supporting the link between chronic stress, cognitive function and mental health. Over the years, the associations between these concepts have been investigated in different populations. This review summarizes the findings that have emerged from older populations as well as from populations suffering from pathological aging, namely Mild Cognitive Impairment and Alzheimer's Disease. Although older adults are an interesting population to study in terms of chronic stress, other stress-related diseases can occur throughout the lifespan. The second section covers some of these stress-related diseases that have recently received a great deal of attention, namely burnout, depression, and post-traumatic stress disorder. Given that chronic stress contributes to the development of certain pathologies by accelerating and/or exacerbating pre-existing vulnerabilities that vary from one individual to the other, the final section summarizes data obtained on potential variables contributing to the association between chronic stress and cognition.     

Are Large Physiological Reactions to Acute Psychological Stress Always Bad for Health?

How we react physiologically to stress has long been considered to have implications for our health. There is now persuasive evidence that individuals who show large cardiovascular reactions to stress are at increased risk of developing cardiovascular disease, particularly hypertension. By implication, low reactivity is protective or benign. However, there is recent evidence that low reactivity may predict elevated risk for a range of adverse health outcomes, such as depression, obesity, poor self-reported health and compromised immunity. In addition, low cortisol and cardiovascular reactivity may be a characteristic of individuals with addictions to tobacco and alcohol, as well as those at risk of addiction and those who relapse from abstinence. Our ideas about reactivity may have to be revised in the light of such findings.     

Depression and immunocompetence: a review of the literature.

Recent evidence suggests that there is a relationship between depression and immunity. On the basis of these studies, it has been argued that depressed mood may increase susceptibility to disease by means of aberrations occurring within the immune system. Empirical research investigating the relationship between depression and immunity is reviewed here. Studies examining both clinical and nonclinical manifestations of depression are discussed and evaluated. This review reveals that indexes of immunocompetence are lower among people exhibiting depressive symptomology and suggests that immune alterations may be more related to dysphoric mood than to specific situations or events. Alternative hypotheses accounting for links between depressed affect and altered immune states are provided, and suggestions for future research are offered.     

Chronic restraint stress impairs T-cell immunity and promotes tumor progression in mice

Long-term exposure to stressful situations can affect the immune system. The T-cell response is an important component of anti-tumoral immunity. Hence, impairment of the immune function induced by a chronic stressor has been postulated to alter the immunosurveillance of tumors, thus leading to a worse neoplastic prognosis. Here, we show that chronic restraint stress affects T-cell mediated immunity in mice. This was evidenced by a decrease of mitogen-induced T-cell proliferation, a reduction in CD4(+)T lymphocyte number and a decrease of tumor necrosis factor-alpha (TNF-alpha) and Interferon-gamma (IFN-gamma) production in stressed mice. Additionally, mice subjected to chronic restraint stress displayed an enhancement of tumor growth in a syngeneic lymphoma model, i.e. an increase of tumor proliferation and a reduction of animal survival. Finally, stressed mice had a reduced specific cytotoxic response against these tumor cells. These results suggest that chronic exposure to stress promotes cancer establishment and subsequent progression, probably by depressing T-cell mediated immunity. The T-cell immunity impairment as well as the tumor progression enhancement emphasize the importance of the therapeutic management of stress to improve the prognosis of cancer patients.     

Stress and Immunity: Age Enhances the Risks

A competent immune response is central to good health. There is good evidence that both aging and psychological stress can dysregulate immune function, resulting in changes in various aspects of the immune response that are large enough to have consequences for health. Older adults appear to show even greater immunological impairments associated with stress or depression than younger adults. Thus, the data suggest that aging interacts with stress and depression to enhance risks for morbidity and mortality among older adults.     

心理社会应激的免疫反应规律与机制

心理社会应激会引起免疫系统发生免疫防御、免疫自稳和免疫监视方面的功能变化, 并随着应激刺激的时间和强度的变化而发生着异常与正常之间的动态转变。其机制与遗传、神经内分泌、自由基代谢和肠道菌群变化等生物学因素相关, 且小胶质细胞可能在其中起着重要的中介作用。诸多的生物学因素与年龄、性别和经济地位等人口学因素共同决定着心理社会应激的免疫反应发生发展。在其干预中, 运动疗法中的体育锻炼是极为值得重视的一种手段。