Psychosocial interventions, especially cognitive-behavioral therapy (CBT), are associated with strengthening immune system function, new research suggests.
With the results of a systematic review and meta-analysis involving 56 randomized controlled trials and more than 4000 participants, psychosocial interventions enhanced beneficial immune system function over time while at the same time compared to control status. And appeared to reduce harmful immune system function.
“These relationships were most reliable for studies evaluating cognitive-behavioral therapy and multiple or combined interventions, as well as inflammatory cytokines or markers that are key indicators of inflammation in the body,” research investigator George said. · Dr. M. Slavic said. Medscape Medical News..
“This analysis helps address the question of what type of psychosocial intervention is most consistently associated with changes in immune system function and under what circumstances.” Knowledge can be used to inform the following research activities and public policies: Improving immune-related health outcomes using psychosocial interventions,” said the Institute for Stress Assessment at the University of California, Los Angeles. Mr Slavic, the director, added.
Research Published online June 3 JAMA Psychiatry..
Links to serious physical and mental illness
There is Substantial evidence The role of the immune system in various mental and physical health problems. Such problems include Anxiety disorder, depression, suicide, schizophrenia, Cardiovascular, autoimmune, and neurodegenerative diseases. Recently, more than half of all deaths worldwide have been suggested to be due to inflammation-related conditions.
Although pharmacological interventions can play a role in combating inflammation, they are not without drawbacks, especially cost and adverse side effects.
The World Health Organization, National Academy of Medicine, National Institutes of Health, and other groups Address the burden of global illness Through psychosocial interventions when possible.
Such recommendations are supported by scientific evidence. Previous studies have shown that immune system processes are affected by a variety of social, neurocognitive, and behavioral factors.
Based on these findings, researchers investigated the effects of interventions that reduce stress on immune system function and strengthen psychological resources.
However, such studies have had conflicting results. Some research While psychosocial interventions clearly show enhanced immunity, Nothing else..
In addition, questions remain as to what kind of intervention will surely improve immune system function and under what conditions and for whom.
“Research shows that psychological factors such as life stress, negative emotions, and social support are associated with altered immune system function,” Slavic said.
“In addition, the immune system processes involved in inflammation may contribute to the risk of people with some major mental and physical health problems, including anxiety disorders, depression, heart disease, autoimmune disorders, and neurodegenerative disorders.” There is a growing awareness that there is a potential.”
First research of that kind
To clarify these potential links, researchers believe they are the first systematic review and meta-analysis of randomized clinical trials on the impact of psychosocial interventions on immune system outcomes Was carried out.
As part of the review, Slavic and colleagues estimated associations with eight psychosocial interventions and seven markers of immune system function.
The eight psychosocial interventions were behavioral therapy, cognitive therapy, CBT, CBT plus supplemental or delivery modalities, bereavement or supportive care, multiple or combination therapy, other psychotherapy, and psychoeducation.
Seven immune consequences that could be affected by these interventions include inflammatory cytokines and markers, anti-inflammatory cytokines, antibodies, immune cell numbers, natural killer cell activity, viral load, and other immune consequences. It will be.
The researchers also examined nine potential factors that could mitigate the link between psychosocial interventions and immune system function.
They searched various databases for all relevant randomized controlled trials published by December 31, 2018. Studies were included if they included psychosocial interventions and immune outcomes, and pre- and post-interventional immunological assessments.
The researchers identified 4621 studies. Of these studies, 62 were eligible. 56 people were included in the final meta-analysis, including 4060 patients.
The results showed that psychosocial interventions were associated with enhanced immune system function (P <.001). Interestingly, the magnitudes of these effects have relatively low heterogeneity between studies and relatively consistent associations across studies and conditions, the investigators say.
A meta-analysis showed that individuals assigned to psychosocial intervention conditions showed a 14.7% improvement (95% confidence interval) [CI], 5.7% to 23.8%) are in beneficial immune system function compared to the corresponding immune system function assigned to control conditions.
Similarly, participants who received psychosocial interventions showed a 18.0% reduction in adverse immune system function (95% CI, 7.2%–28.8%) over time.
Outstanding
For the impact of the type of intervention on the association, see CBT (31 studies; P <.001) and multiple or combined interventions (7 studies; P = .01) was significantly associated with altered outcomes of the immune system.
The analysis also found that interventions with group components were more consistently associated with enhanced immune function than interventions without group components. Nevertheless, this difference did not reach statistical significance (P = .06).
Contrary to the researchers’ expectations, the analysis also revealed that the length of the intervention did not alleviate the link between psychosocial intervention and immune system function (P = .93).
Regarding the types of immune markers studied, a meta-analysis found that psychosocial interventions had significantly different associations with the various immune markers studied. Of the seven immune outcomes investigated, only levels of inflammatory cytokines or markers (33 studies; P <.001) and immune cell counts (27 studies; P <.001) was significantly associated with the psychosocial interventions investigated.
The association between psychosocial interventions and immune system function persisted for at least 6 months after treatment and was strong over age, gender, and duration of intervention.
These results suggest that psychosocial interventions, especially CBT and multiple or combined psychotherapy modalities, may play important roles in improving immune-related health outcomes.
In addition to being effective, such interventions may prove to be an affordable alternative to current treatment options. The average duration of CBT interventions in meta-analysis was 10.4 weeks, which the researchers equated to a total cost of $1560 per patient.
“Comparing, the cost of use Infliximab To reduce inflammation in people with autoimmune disease is about $25,000 Per patient per year, “They write.
“The results suggest that in certain situations, psychotherapy may help reduce inflammation and improve immune-related health,” Slavich concluded. “But the studies we looked at differed in quality, and the current study did not look at health outcomes.
“Therefore, more research needs to be done to determine how current findings translate into treatment options and public policy.”
The road to better health
so Accompanying editorialDr. Veronica Engart, Dr. Joshua A. Grant, and Dr. Bernhard Strauss said that infectious diseases were once the leading cause of death in society, but were replaced by other complex and chronic illnesses. be careful. A simple causal relationship.
“These diseases can come from a complex environment of biological, psychological, and social factors that can also affect disease progression and prognosis. Against this backdrop, Shields and colleagues Meta-analysis by is an important confirmation of the biopsychological social model.”
The editors explain that recent psychophysiological, neurobiological, and epigenetic studies provide a glimpse into the relationship between psychological and social factors in etiology. Nevertheless, the authors note the lack of a comprehensive study of the potential effects of psychosocial interventions on immune parameters of various physical health conditions.
“The evidence provided by Shields and colleagues is exactly what is needed to shift treatment more completely from a disease-centered approach to a patient-centered approach,” they write. “For that reason, this meta-analysis may serve as a guide for policy makers looking to improve immune-related health.”
This work was supported by the Society of Science-Branco Weiss Fellowship, Brain and Behavior Research, and the National Institutes of Health. Slavich, Engert, Grant, and Strauss do not disclose related financial relationships.
JAMA Psychiatry.. Published June 3, 2020 Online. Overview, editorial
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