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Allied Health: Articles of Interest Psychoneuroimmunology: implications for asthma management Psychoneuroimmunology is a research field in which scientists attempt to understand how psychological variables such as stress affect the complex inter-relationship between the immune system, central nervous system and endocrine system. Historically, Hans Selye and Walter Cannon were among the first to describe how psychological stress affects health. Selye’s General Adaptation Syndrome described our response to stress as going through alarm, resistance and exhaustion stages. In the alarm stage, a stressor is presented and the body mounts a vigorous fight or flight response to the stimulus. This vigorous response includes the release of stress hormones such as cortisol and adrenaline and accelerated metabolism via the thyroid gland. If the stressor presents itself for a long period of time, the body goes into the resistance stage and finally the exhaustion phase. The exhaustion phase is a natural endpoint of secreting too much cortisol and thyroid hormones and is characterized by:
More recently, Ader and Cohen coined the term “psychoneuroimmunology.” In a landmark experiment, they demonstrated how the immune system can undergo classical conditioning. Rats were given a pairing of a neutral stimulus (saccarhin) followed by the unconditioned stimulus (cyclophosphamide) which was followed suppression of the immune system. After repeated pairing of the neutral stimulus and the unconditioned stimulus, when rats were subsequently given the saccharin alone they had an immunosuppressive response. Russell extended this finding to a learned histamine response in guinea pigs. In a simple experiment an immunologic challenge causing histamine release was paired with the presentation of an odor. Subsequently, the guinea pigs showed histamine release when presented with the odor alone. In asthma research, Smythe et al has demonstrated that writing about trauma statistically improves FEV for up to six months in adults with asthma. Kohen found that education on traditional asthma topics, and training on hypnosis, story-telling and relaxation led to fewer office visits, decreases in self-rated disease severity and increases in parent/child self-confidence. Castes combined traditional asthma pharmacotherapy with relaxation, guided imagery and self-esteem workshops and found significant improvements in pulmonary function. Lucas et al found that integrating a stress management component to a traditional asthma education program led to high patient satisfaction, and decreases in hospitalization and urgent care visits. Finally, when Onnis et al combined pharmacotherapy with family psychotherapy, they found fewer asthma attacks, fewer hospitalizations, less overprotectiveness and more conflict discussion and resolution than when asthma treatment consisted only of pharmacotherapy. In summary, research in psychoneuroimmunology PNI supports the idea that psychological variables can have a strong effect on the central nervous system, the immune system and the endocrine system These studies suggest that asthma management programs that include psychologically based interventions such as family therapy, journal writing, social support and/or stress management with traditional medical management may optimize patient outcomes 1. Busse WW, Kiecolt-Glaser JK, Coe C, Martin RJ, Weiss ST, Parker SR. NHLBI Workshop summary. Stress and asthma. Am J Respir Crit Care Med 1995 ;151:249-52. 2. Ader R, Cohen N. Behaviorally conditioned immunosuppression. Psychosom Med 1975 37:333-40. 3. Russell M, Dark KA, Cummins RW, Ellman G, Callaway E, Peeke HV. Learned histamine release. Science 1984 17;225:733-4 4. Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989 14;2:888-91. 5. Lucas DO, Zimmer LO, Paul JE, et al. Two-year results from the asthma self-management program: long term impact on health care services, costs, functional status and productivity. J Asthma 2001;38:289-297. 6. Kohen DP, Wynne E. Applying hypnosis in a preschool family asthma education program: use of storytelling, imagery, and relaxation. Amer J Clin Hypn 1997;39:169-81. 7. Castes M, Hagel I, Palenque M, Conelones P, Corao A, Lynch NR. Immunological changes associated with clinical improvement of asthmatic children subjected to psychosocial intervention. Brain Behav Immun 1999; 3:1-13. 8. Onnis L, Di Gennaro A, Cespa G, Dentale RC, et al. Prevention of chronicity in psychosomatic illness: A systemic research study into the treatment of childhood asthma. Fam Systems & Health 2001;19:237-50. |
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