Posts Tagged ‘Psychoneuroimmunology’

Psychological Reactions to Pandemics

April 21, 2020

This is the third post in a series of posts on a highly relevant book by Steven Taylor, Ph.D., The Psychology of Pandemics. The subtitle of this book is Preparing for the Next Global Outbreak of Infectious Disease. Stevens writes that contemporary methods for managing pandemics are largely behavioral or educational interventions, vaccination adherence programs, hygienic practices, social distancing, in which psychological factors play a vital role. “Excessive emotional distress associated with threatened or actual infection is a further issue of clinical and public health significance. Psychological factors are also relevant for understanding and addressing the socially disruptive behavioral patterns that can arise as a result of widespread, serious infection.”

During this pandemic many people are becoming fearful, some intensely so. The psychological “footprint” will likely be larger than the medical “footprint”. So it is likely that the psychological effects will be more pronounced, more widespread, and longer-lasting than the purely somatic effects of infection. In the 2014-2015 Ebola outbreak, the “epidemic of fear” was worse than the epidemic itself in terms of the number of people affected. Excessive public fear of Ebola arose in the United States even though there was little or no risk of contagion.

People differ in how they react to psychosocial stressors such as the fear of a pandemic. Reactions are diverse, ranging from fear to indifference to fatalism. At one end of the spectrum, some people disregard or deny risks, and fail to engage in recommended health behaviors such as hygiene and social distancing. At the other end of the spectrum, many people react with intense anxiety or fear. A moderate level of fear or anxiety can motivate people to cope with health threats, but severe distress can be debilitating.

Mental disorder can be triggered or exacerbated by pandemic-related stressors, including mood disorder, anxiety disorders, and posttraumatic stress disorder (PTSD). As a pandemic unfolds, some people adapt to the threat and become less anxious. But in some cases the psychological effects can be severe and long-lasting. Research on the SARS outbreak showed that the psychological effects are not always short-lived, and the emotional reactions can be severe and persistent. A longitudinal study found that 44% of SARS patients developed PTSD. In a survey of Beijing hospital workers during the SARs outbreak, about 10% developed PTSD symptoms. Respondents who had been quarantined, worked at high-risk sites such as SARS wards, or had friends to close relatives who contracted were 2-3 times more likely to have PTSD symptoms than people without these exposures.

For many SARS patients, psychological distress, including PTSD, persisted after the infection had been treated, in some cases for years after patients had recovered from the physical effects of the SARS virus. What made SARS especially distressing was that it was (1) a novel infection with an unknown course and treatment, (2) infection was managed with social isolation, and (3) there were fears of spreading this poorly understood infection to others. These results raise concerns about the long-term psychological consequences of the current coronavirus pandemic.

There are immunologically induced psychological reactions. These are psychological reactions that are the direct physiological consequence of infection. People infected by viral or bacterial agents may experience a syndrome called sickness behavior. Symptoms include nausea, fatigue, sleep disturbance, depression, irritability, and mild cognitive impairment. This sickness behavior is triggered by pro inflammatory cytokines such as tumor necrosis factor-alpha, interleukin-6, and interleukin-1beta. Immune reactions can involve neuroinflammation, which may lead to sickness behavior.

Research in the field of psychoneuroimmunology has shown that negative emotions and stressful events can lead to some degree of suppression of the immune system, thereby enhancing susceptibility to infection and dampening the beneficial effects of vaccines. A series of studies has shown that immune responses to viral and bacterial vaccines, including influenza vaccines, are delayed, substantially weakened, or shorter-loved in people who are distressed or exposed to stressors. These effects tend to be greater in people who are prone to experience frequent negative moods. Stressors and negative emotions have been found to influence the production of lymphocytes and pro inflammatory cytokines. Pandemic-related stressors may compromise the immune system, thereby making people more vulnerable to infections.

Even if pandemic-related stress and distress do significantly dampen the immune system, psychological interventions such as cognitive based therapy can reduce a person’s stress proneness and negative emotions, thereby offsetting any stress-related immunosuppression.

Meditation provides another technique for reducing a person’s stress proneness and negative emotions. There are many healthy memory posts on meditation. Just enter “meditation” in the search block at healthymemory.wordpress.com.

There are many posts on “The Emotional Life of Your Brain.” that can helpful. Just enter this title into the search block referenced above.

How to Talk to Your Immune System

April 7, 2020

This post is the fifth on an essential book by Jeffrey Rediger, M.D. titled Cured: The Life-Changing Science of Spontaneous Healing. Dr. Rediger writes, “Successes in immunotherapy today tell us that the power to overcome incurable illness may very well be locked inside each of us. Immunotherapy is a highly technical, precise way of targeting specific cells in the immune system and making them work against cancer. While you can’t practice immunotherapy yourself at home, you can communicate with your immune system, perhaps even—like so many of those who experience spontaneous healing—to the point of changing the way it functions, turning the tide against the disease.”

The key question is why do our natural killer cells sometimes target and remove mutating cancel cells and other times overlook them? When do they work for us, hunting down pathogens and viral invaders, and when do they turn against us, attacking our own tissues and biological systems?

The nervous system is an intricate network of nerve cells that winds and sparkles through the entire body. There are literally billions of nerve cells, or neurons, that allow us to do everything from lifting a finger to feeling an intense emotion. Nervous system cells are unceasingly sending messages through our body, whisking through the body as fast as electricity.

The immune system and the nervous system are intricately interwoven. They are not separate systems operating independently in different sectors of the body but overlapping networks that can swap information and “talk” to each other.

The nervous system connects directly to the thymus, one of the powerhouses of the immune system which nurtures and deploys natural killer cells and other types of white blood cells into the body on command. What is even more fascinating is the researchers now know that the cells of our immune systems actually have neuroreceptors on them. Neuroreceptors were believe to be limited to the brain and the nervous system until Candace Pert, often called “the mother of psychoneuroimmunology,” discovered the presence of neurotransmitter and neuropeptide receptors on the wall of cells in both the immune system and the brain. These neuroreceptors proved a way for the nervous system to communicate cell to cell. The cells of the immune system, roaming throughout our entire body at all times have that radio channel turned on. They are in direct communication with the nervous system, meaning whatever’s going on in your mind is being broadcast directly into the immune system. It is possible for our emotions to talk to our immune systems—sometimes with dramatic and unexpected results.

One recipient of a spontaneous remission attributed part of his healing to an ongoing, unshakable feeling of being loved by a special person who’d been important to him. Dr. Rediger writes, “Could this powerful feeling of being loved have been broadcast into his immune system, revivifying something deep within him? Whether it comes from a therapeutic session, a loving relationship, deep meditation or focused imagery, love touches and heals something that medications can’t touch.

Mind and Medicine

March 19, 2018

The title of this post is identical to the title of the title of a chapter in Daniel Goleman’s book “Emotional Intelligence.” There are two extreme views regarding the mind and medicine. One view, and it is unfortunate that there are physicians who hold this view, is that there is no relationship between the mind and medicine. The other extreme is that the mind controls all and medicine is unnecessary. Actually, this extreme view is the view adopted by some religions such as Christian Scientists, that prayer and meditation, not the mind, provides the basis for treating all illnesses. As the reader will see, the truth lies somewhere in between.

The truth is that there are links between the immune system and the central nervous system, and the field that studies this, psychoneuroimmunology (PNI) is a leading-edge medical science. It’s name acknowledges the links: psycho, or mind; neuro, for the neuroendocrine system (which subsumes the nervous system and hormone systems); and immunology, for the immune system.

Some surgeons will cancel scheduled surgeries for people who are panicked by the prospect of surgery. Every surgeon knows that people who are extremely scared do terribly in surgery. They bleed too much, they have more infections and complications, and they have a harder time recovering. Patients do much better if they are calm.

A study of anger in heart patients was done at Stanford University Medical School. All the patients in the study had suffered a first heart attack, and the question was whether anger might have a significant impact of some kind on their heart function. While the patients recounted incidents that made them mad, the pumping efficiency of their hearts dropped by 5 percentage points. Some patients showed a drop in pumping efficiency of 7% or greater. This is a range that cardiologists regard as a sign of myocardial ischemia, a dangerous drop in blood to the heart itself.

Another study by Dr. Redford Williams of Duke University found that those physicians who had had the highest scores on a test of hostility while still in medical school were seven times as likely to have died by the age of fifty as were those with low hostility scores. This is a stronger predictor of dying your than were other risk factors such as smoking, high blood pressure, and high cholesterol.

Anxiety, the distress evoked by life’s pressures, is perhaps the emotion with the greatest weight of scientific evidence connecting it to the onset of sickness and course of recovery. Yale psychologist Bruce McEwen noted a broad spectrum of effects: compromising immune functions to the point that it can speed the metastasis of cancer; increasing vulnerability to viral infections; exacerbating plaque formation leading to atherosclerosis and blood clotting leading to myocardial infarction; accelerating the onset of Type 1 diabetes and the course of Type II diabetes; and worsening or triggering an asthma attack. Stress can also lead to ulceration of the gastrointestinal tract, triggering symptoms in ulcerative colitis and in inflammatory bowel disease. The brain itself is susceptible to the long-term effects of sustained stress, including damage to the hippocampus, and so to memory.

There are also medical costs of depression. In patients with chronic kidney failures who were receiving dialysis, those who were diagnosed with major depression were most likely to die within the following two years; depression was a stronger predictor of death than any medical sign.

Heart disease is also exacerbated by depression. A study of 2832 middle-aged men and women tracked for twelve years, those who felt a sense of nagging despair and hopelessness had a heightened rate of death from heart disease. For the 3% who were most severely depressed, the death rate from heart disease compared to those with no feelings of depression was four times greater.

As there are medical costs to pessimism, there are medical advantages to optimism. For example, 122 men who had their first heart attack were evaluated on their degree of optimism or pessimism. Eight years later, of the 25 most pessimistic men, 21 had died; of the 25 most optimistic, just 6 had died.

There is medical value from relationships. Two decades of research involving more than 37,000 people show that social isolation, the sense that you have nobody with whom you can share your private feelings or have close contact—doubles the chance of sickness or death. A 1987 report in “Science” concluded that isolation is as significant to mortality rates as smoking, high blood pressure, high cholesterol, obesity, and and lack of physical exercise. Goleman takes care to note that solitude is not the same as isolation; many people who live on their own or see few friends are content and healthy. Rather, it is the subjective sense of being cut of from people and having no one to turn to that is a medical risk.

Goleman argues that for medicine to enlarge its vision to embrace the impact of emotions, two large implications of the scientific findings must be taken to heart:

HELPING PEOPLE BETTER MANAGE THEIR UPSETTING FEELINGS—ANGER, ANXIETY, DEPRESSION, PESSIMISM, AND LONELINESS IS A FORM OF DISEASE PREVENTION. The data show that the toxicity of these emotions, when chronic, is on a par with smoking cigarettes, helping people handle them better could potentially have a medical payoff as great as getting heavy smokers to quit. One way to do this that could have broad public-health effects would be to impart most basic emotional intelligence skills to children, so that they become lifelong habits. Another high-payoff preventive strategy would be to teach emotion management to people reaching retirement age, since emotional well-being is one factor that determines whether an older person declines rapidly or thrives. A third target group might be so-called at-risk populations—the very poor, single working mothers, residents of high-crime neighborhoods, and the like—who live under extraordinary pressure day in and day out, and so might do better medically with help in handing the emotional toll of these stresses.
MANY PATIENTS CAN BENEFIT MEASURABLY WHEN THEIR PSYCHOLOGICAL NEEDS ARE ATTENDED TO ALONG WITH THEIR PURELY MEDICAL ONES. While it is a step toward more humane care when a physician or nurse offers a distressed patient comfort and consolation, more can be done. But emotional care is an opportunity too often out of the way medicine is practiced today; it is a blind spot for medicine. Despite mounting data on the medical usefulness of attending to emotional needs, as well as supporting evidence for connecting between the brain’s emotional center and the immune system, many physicians remain skeptical that their patients’ emotions matter clinically, dismissing the evidence of this as trivial and anecdotal, as “fringe, or worse as the exaggerations of a self-promoting few.

Cure: A Journey Into the Science of Mind Over Body

February 23, 2016

The title of this blog post is identical to the title of an outstanding book by Jo Marchant.  The phrase, “it’s just a placebo effect,” has been one of my pet peeves for a long time as I find the placebo effect to be one of the most important facts of medicine.  Any medical trial needs to be run against a placebo treatment as the placebo treatment will result in a measurable effect, and the desire is to measure the effect of the treatment above and beyond the placebo effect.  However, what I find ironic is that this genuine effect is not routinely administered.  Absent some treatment, why not give the patient a placebo as there will be a benefit for at least some of the patients?  The reason that the physician would provide is that the placebo effect is not a real treatment so it would be dishonest to deceive the patient even though the patient might benefit from the deception.  Research has shown that patients still benefit from placebos even when they know that they are indeed placebos.  I find it ironic that physicians routinely treat viruses with antibiotics even though they know that the antibiotic is ineffective against viruses.  This practice has weakened the effectiveness of antibiotics,  Why not administer a placebo shot instead?  Any effect the antibiotic might have would be a placebo effect, so why not simply administer an injection of a placebo?

The truth is that too many physicians are infected with the bias that medicine is physical and that placebos are mental.  They refuse to appreciate the effect that the mind has over the body.  Marchant’s book goes a long way to documenting these effects.  The failure to correct this bias will result in unnecessary deaths, pain, and suffering.

At the outset, Marchant makes two important points about  the limitations of the placebo effect.  The first is that any effects caused by beliefs in a treatment are limited to the natural tools that the body has available  Note, however, that the body might not use some of the natural tools absent a placebo effect.

The second point is that effects mediated by expectations tend to be limited to symptoms—things that we are consciously aware of,such as pain, itching, rashes or diarrhea, as well as cognitive function, sleep and the effects of drugs such as caffeine and alcohol.  Placebo effects also seem to be particularly strong for psychiatric disorders such as depression, anxiety, and addiction.

However, these limitations are not as constricting as they might seem as placebo effects can affect the immune system, which is the disease fighting system of the body.  This is a new field of research, one that has been encouraged by the father of the Salk vaccine, Jonas Salk, called psychoneuroimmunology.  The potential of this new field of research is unknown.

So, who knows what placebos hold for the future, but today in many cases painkillers and antidepressants may not work much better than a placebo.  Moreover there are risks of addiction and side effects with these drugs.  The top ten grossing drugs in the United States help only between 1 in 25 and 1 in 4 of the people who take them,.  Statins might benefit as few as 1 in 50.

A study published in the British Medical Journal concluded that drugs are responsible for more than half a million deaths in the Western world each year with minimal benefit.

I would also call your attention to the healthy memory blog post, “Most Published Research Findings are False.”  So most physicians are working in the dark with research, most of which is wrong.

© Douglas Griffith and healthymemory.wordpress.com, 2016. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and healthymemory.wordpress.com with appropriate and specific direction to the original content.