The InterRelationship between Stress and the Human Immune, Psychology, College Term Papers.com


		Data Bases
		• Custom Term Papers • Free Term Papers • Free Research Papers • Free Essays • Free Book Reports • Plagiarism?

		Links
		• Top 100 Term Paper Sites • Top 25 Essay Sites • Top 50 Essay Sites • Search 97,000 Papers @ DirectEssays.com • Search 101,000 Papers @ ExampleEssays.com • Search 90,000 Papers @ MegaEssays.com

		Free Essays
		• Term Paper Sites • Chuck III's Free Essays • Free College Essays • TermPaperSites.com • My Term Papers • Get Free Essays • Essay World • Planet Papers

Search Lots of Essays

Back to Subjects - Psychology

The InterRelationship between Stress and the Human Immune

The InterRelationship between Stress and the Human Immune The Inter-Relationship between Stress and the Human Immune The impact of stress on human immune system functioning and health outcomes is an area of recent interest. This investigation as to how health outcomes are affected by this inter-relationship will firstly operationalise all of the variables (health, stress, immune system); and secondly, by describing the functions and reactions of the immune system to clinically induced stressors, establish that there is a correlation between stress and immune response. The final area of investigation will discuss how the human body, when exposed to a variety of stressors, causes major changes within the immune system (which can be scientifically measured), and thus affect health outcomes. How groups are affected throughout the life span continuum will be discussed, with particular reference to women diagnosed with breast cancer, HIV+ gay men, and the impact of personality types deemed to be at greatest risk. Stress, as defined by Selye (1960), is namely "the non-specific response of the body to any demand made upon it; a stereotypical, phylogenetically old adaptation pattern, primarily preparing the organism for physical activity" (cited Gunderson and Rahe, 1979, p. 9). The current scientific paradigm asserts that stress has three distinct characteristics. External stress refers to any or environmental stimulus that causes a person to feel tense or aroused. Internal stress refers to the subjective mental state of tension or arousal, and involves the interpretive, emotive, defensive and coping processes occurring inside that person. The third characteristic of stress involves the body's physical reaction to demand or demanding intrusions (Rice, 1999). Baum argues that the primary functions of these physical reactions are to support each individual's behavioural and psychological response in relation to stress (1990, cited Rice, 1999). There are two main categories of stress: acute and chronic. Acute (or external) stressors include films, work overload, unexpected or uncontrollable noise, prestige or status loss, electric shock, uncontrollable situations, physical illness, surgery, threats to self-esteem, and traumatic experiences. Examples of chronic stressors include sleep deprivation, role strain and social isolation (Elliott and Eisdorfer, 1982). Chronic stress within an individual is often associated with negativity, and the observable physical manifestations include exhaustion, disease and even death (Rice, 1999). Individual differences in responding to stress are influenced by genetics, developmental and environmental influences, as well as being linked with one's own life experiences (McEwen and Stellar, 1993). However, stress does cause some common changes. Emotionally, stress can lead to feelings of depression, anxiety and anger (McEwen et al, 1993). Accordingly, on the basis of the above criteria, it is clear that stress has a direct correlation on health outcomes. In order to assess the interaction between stress, the immune system and health outcomes it is necessary to operationalise the contextual meaning associated with health in this instance. Stedman's medical dictionary (1961) defines disease as "an interruption or perversion of function of any of the organs and/or tissues or an abnormal state of the body as a whole" (cited Newberry, Jaikins-Madden and Gerstenberger, 1991, p. 23). Weiner (1977, p. 11), using Stedman's criteria, suggests "illness" is a synonym of disease and "health" as the absence of disease (cited Newberry et als., 1991). By contrast Schwartz (1984) has distinguished between the current state of the organism and its potential to resist disease. In his terminology, "wellness" refers to the current state and "health" refers to the potential to be well. Thus people can be diseased (low wellness) yet be healthy if they are exhibiting resistance to the pathology and healing successfully. Conversely, a person can be well (not diseased) but still be unhealthy (cited Newberry et als., 1984). The importance of Weiner's construct between disease and illness in crucial to this argument, as it raises the issue of behaviour as an outcome variable in stress-disease studies (Newberry et als., 1984). The immune system constitutes a major defense against infectious organisms and possibly, to a lesser extent, against cancer. It is now beyond dispute that the immune system is affected by neuroendocrine factors and stress-related psychologic variables (Newberry et als, 1984). For this reason, and because of its role in host resistance to numerous disorders, the immune system has received a great deal of attention as a possible mediator of the stress-disease relationship (Newberry et als, 1984). It is the immune system which protects the body from disease organisms and other foreign bodies, known as antigens. The first line of defense are local barriers such as the skin, peritoneum, etc, and inflammation due to immunoglobulins, or antibodies. If these fail to block or destroy the antigens, the cell-mediated immune and humoral immune responses takes over (Gallagher, Gilder, Nossal and Salvatore, 1995). The cell-mediated responses use sensitised T cells (white blood cells derived in the thymus) to recognise, attach to, and render antigens inactive. Other types of T cells, called helper T cells, aid in production of antibodies by B (bone marrow) cells, and suppressor/cytotoxic T cells, (which inhibit that production), are also essential for proper immune system function. Helper T cells are known as CD4 cells, and suppressor T cells are known as CD8 cells (Kiecolt-Glaser, Cacioppo, Malarkey and Anderson, 1992). Immunocompetence is the degree to which the immune system is active and effective (Rice, 1999), and it is the ineffectiveness of the immune system which is used to measure, in this discussion, the inter-relation between stress and health outcomes. Up until the early 1980's, it was generally acknowledged by the then dominant scientific paradigm that the immune system was an auto-regulating one, working with minimal input from the central nervous system (CNS). Robert Ader (1983, p. 251) established that "the immune system is integrated with other physiological systems, and thus sensitive to regulation or modification by the brain" (cited Rice, 1999). Pinel (1993) elaborated on Ader's research showing that "as psychosocial stressors occur, neural cascade beings, a process which involves the hypothalamic-pituitary-adrenal (HPA) complex" (cited Rice, 1999). The corticotrophin-releasing factor (CRF) hormone is released by the hypothalamus, which in turn causes the anterior pituitary gland to release a hormone named adrenocorticotrophic (ACTH). This stimulates the adrenal cortex to secrete steroid hormones called glucocorticoids (Pinel, 1993, cited Rice, 1999; Kiecolt-Glaser et als., 1992). The primary purpose of this response is to contain (short term) the stress reaction, and in so doing avert damage to itself. However, in response to higher-level stressors, glucocorticoids negatively impact, resulting in suppression of the immune system (Rice, 1999; Brosschot, Benschop, Godaert, Olff, DeSmart, Hgeiinen and Ballieux, 1994). Thus the likelihood of resulting illness is increased, due to the immune system being weakened. Ader's findings also provided researchers with credible and convincing evidence in relation to the influence of conditioning on the immune function, and the relationship between psychosocial factors, (such as life stress) and immunocompetence. (Rice, 1999). Immunocompetence, as described by Rice, is the "degree to which the immune system is active and effective" (1999, p. 142). Studies by Manuck, Cohen, Rabin, Muldoon and Bachen (1991) showed that: Psychological stressors induced cell division among CD8 cells, thereby increasing the number of CD8 cells and suppressing immune function. Individuals fall into categories�..those who are "high reactors", and those who are "low reactors". High reactors are significantly affected by stress, as shown by a significant increase in heart rate, blood pressure, catecholamines, and CD8 cells. Low reactors show little or no change in those areas (p. 111). Catecholamines are chemicals produced by the body that work in nerve transmission. The three main catecholamines include dopamine, epinephrine and norepinephrine. Dopamine raises the heart rate and blood pressure, epinephrine raises heart rate and opens blood vessels (thereby lowering blood pressure); and norepinephrine closes blood vessels (thereby raising blood pressure) (Glaser, 1996). Epinephrine and norepinephrine are the catecholamines most commonly measured in stress experiments, and both increase under stress. Increases such as these can suppress aspects of immune function, including natural killer cells (cells that attack antigens without having recognised them first) activity. Increases in catacholemines may also rapidly alter cell numbers via redistribution. Changes in epinephrine levels are also thought to reflect lymphocyte migration from bone marrow, the extremities, and the thymus to other parts of the body (Gallagher et als., 1995; Naliboff, Benton, Solomon, Morley, Fahey, Bloom, Makinodan and Gilmore, 1991). All of the above supports the argument that there is an inter-relationship between stress and immune system functioning, and that this interaction can be measured. Or to word it another way, there is a clear causal relationship between the cognitive (stress in this case being the manipulated independent variable), and the physiological (the immune system which is being manipulated). Any variable which affects the normal immunocompetence of the immune system (wellness), thus impacts on health outcomes (illness/low wellness). Much anecdotal evidence is available in relation to psychoneuroimmunology (the interaction between psychological and immune variables). Wolf, Cole and Coyne (1996), undertook a statistical investigation to look at clustered psychological, health and immune variables using canonical correlation techniques. Canonical correlation is a multi-variant correlation technique for relating two separate domains where multiple measures exist within each domain. The results indicated that it was possible to identify specific indices of human stress response which correlate with specific and non-specific components of immune response. Wolf et als. (1996) concluded that in the case of the non-specific (inflammatory) immune component: "there was a statistically significant correlation between psychologic indices of stress and non-specific immune functions" (p. 9). Loneliness and helplessness represent a stressful condition that can be correlated with a non-specific immune response (Wolf et als, 1996). Younger, more obsessive-compulsive and more exercising individuals raise the possibility of increased tissue macrophage and mast cell activity. They were intrigued to note that: "suppressed hostility (obsessive-compulsive) is associated with enhanced cellular immunity while overt hostility is associated with enhanced humoral immunity" (Wolf et. als., 1996, p. 11). This study is impressive in its findings as the association between psychology, immune variables and health outcomes is deemed to be significant, and not the result of chance (p less than .038, to p less than .006) (Wolf et als., 1996). Strong relationships seem to exist between an individual's disease patterns and their personality type, and may negatively influence the health of that person. Eysenck suggests that various types of personalities are predisposed to particular illnesses. His is a biological based theory, which takes into consideration, and allows for, social influences (Wade and Tavris, 1993). As defined by Eysenck, the type one personality tends towards hopelessness, helplessness and suppression of emotion; and are prone to cancer (Hassed, 1998). Those categorised as type two experience anxiety, aggression, ambition and they express emotion inappropriately. These people are more prone towards heart disease. By contrast type three are sensitive and gregarious. They communicate better, tend to be optimistic, and are able to remain calm under stress. These individuals have significantly fewer illness, especially cancer and heart disease (Hassed, 1998). Hassed undertook two longitudinal studies aimed at testing Eysenck's hypotheses. The first showed that individual's with type three personality lived longer, and that cancer or heart disease being the cause of death was significantly decreased (Hassed, 1998). Of particular interest is Hassed's second longitudinal investigation, carried out over seven years, involving 490 cancer and heart disease prone individuals. The group that undertook a six months autonomy training program (therapy group), when followed up seven years later, had a death rate of only 20%. The group that received no therapy (control group), at the end of seven years, had a death rate of 76%. Especially in relation to cancer prone individuals, Hassed's findings clearly show that the effects of stress (exhibited through hopelessness, helplessness and suppression of emotion) upon the immune system (cancer) influence health outcomes (in this case positively). Animals exposed to uncontrollable (and acute) stress conditions showed depleted norepinephrine, dopamine and serotonin levels in some brain areas, resulting in learned helplessness behaviour (Wade and Tavris, 1993; Abramson, Seligman and Teasdale, 1978, cited Wade et al, 1993; Seligman and Gregory, 1996). Further studies confirmed this causal relationship between behavioural helplessness, the immune systems, suppression of lymphocyte function, and faster tumor growth (Anderson, 1997; Kiecolt-Glaser et als., 1992). Thus it was observed (Grabmeier, 1995, cited Henderson, 1998) that breast cancer patients who feel high levels of stress (including both acute and chronic stress) concerning their diagnosis and treatment show evidence of a weakened immune system, in particular lower levels of natural killer (NK) cells. Patients benefited from dealing with their feelings at an early stage. It was demonstrated that psychological and emotional support reduced stress, improved immune function, and possibly extended patient survival Anderson (Anderson and Grabmeier, 1997; Anderson, 1997). Rambo (1997) found that breast cancer patients who completed the in-care (hospital) six-week support program had an increase of 25% or more in natural killer cells. A similar study undertaken by Goldman (1989) observed that women who received medical treatment and emotional support lived twice as long as those who received only medical intervention. The effectiveness of emotional support, resulting in increased immune system function, according to Seligman and Buchanan (1996), is attributable to these women learning to dispute their negative thoughts, thus averting depression and learned helplessness. Craig Hassed's work showed the benefits of pro-active intervention in relation to the groups deemed to be at risk of developing cancer or heart disease, by providing autonomy training. The benefits of providing women with emotional support are also significant, as the research shows that a person already diseased with breast cancer (immune system depleted), when provided with emotional support (acknowledgement of the psychological stress), can result in a much improved health outcome. Research findings in relation to HIV+ gay men is of particular interest because of the cyclic nature of the stressors, and the fact that the virus is so specific to the immune system. A study of some 400 American gay men showed that the loss of a partner, or close friend, to an AIDS related illness resulted in a significant number experiencing acute stress, depression, anxiety and feelings of hopelessness (Judd, 1996). All of the participants were a-symptomatic in relation to the virus prior to the death-related events. After being exposed to the psychological stressors (grief and loss), a large number began to present with HIV/AIDS immune depleted illnesses. T-cell numbers dropped alarmingly in the majority of cases (some even depleting to zero). In a significant number of instances, upon re-connecting with their emotional support volunteer (a trained person who was able to assist in the working through of these issues pertaining to loss and grief), within three months their T-cell counts steadily rose. Most reported that their AIDS related illnesses had responded well to treatment, and many regained their a-symptomatic status. It was observed that this was a cyclic process, the pattern being repeated upon experiencing another loss (Martin, 1988; American Journal of Psychiatry, 1997). This cyclic process shows clearly how stress can weaken the immune system (especially in HIV/AIDS patients), resulting in physical illness, and how the reduction of stress improves immune system stability, and in so doing improves the physical health of the individual. There is now a great many scientifically documented studies alluding to the inter-relationship between stress, the immune system and health outcomes. What is of some interest is that they do not occur evenly throughout the whole life span continuum. Children with cancer currently receiving chemotherapy were remarkably similar to case controls on measures of emotional well being, and better on several dimensions of social functioning. These findings are not supportive of disability/stress models of childhood chronic cancer, psychosocial morbidity (Noll, Gartstein, Vannatta, Correll, Bikowski and Davies, 1999). However, in relation to childhood asthma, studies have shown that children with chronic asthma improve considerably when away from their parents, having severed the link with family related stressors (Elliott and Eisdorfer, 1982). At the other end of the life span continuum, Glaser's (1996) research around elderly partners caring for spouses with Alzheimer's disease showed that psychological stress inhibited different aspects of the cellular immune responses. A large percentage also showed a poor immune response to flu inoculation, and small skin biopsies took on average nine days longer to heal, again due to immune system suppression (Zakowski, Hall and Baum, 1992;Glaser, 1996). By way of summary, this paper has examined the multi-layer concept of stress, both acute and chronic, and has provided evidence as to how stress is integrally related to physiology, (involving the CNS, the brain, and major glands). Stress impacts upon the human immune system undermining its immunocompetence balance. The affect on health outcomes can be proactive (through autonomy training), or cause disease. Specific personality types have been shown to place individuals at a greater risk of acquiring, and drying from, depleted immune related illnesses such as cancer and heart disease. For women diagnosed with breast cancer, and gay men who are HIV+, early and continuing emotional and psychology support often results in the revitalisation of the immune system, positively affecting health outcomes. Children with cancer have been shown to not be aversely affected, and this is the exception. In all other age groups, including elderly caregivers of spouses with Alzheimers, stress does lower immune efficiency. In the case of HIV+ this immune deficiency is cyclic, due to on-going psychological stress. So, it has been clearly demonstrated that health 4outcomes, (short term and long term), whether using a proactive or reactive approach, are the result of the interaction of stressors which involve and impact upon the immune system. Bibliography: References Anderson, B. and Grabmeier, J. (1997). Study finds link between stress, immune system in cancer patients, URL: http://www.ohio-state.edu/units/research/archive/apastre1.htm, (1-2). Anderson, B. L. (1997). Stress-immune system links and breast cancer. Journal of the American Medical association v278:534, 1-5. Anderson, B. L. (1997). Study examines stress-immune system links in women with breast cancer. JAMA. The Journal of the American Medical Association, v278 n7 p534(1), URL: Expanded Academic ASAP Int'l: http://web3/searchbank.com/itw/session/614/156/12127909w5/49!fullart, (1-3). Brosschot, J. F., Benschop, R. J., Godaert, G. L. R., Olff, M., DeSmet, M., Heiinen, C. J., and Ballieux, R. E. (1994). Influence of life stress on Immunological reactivity to mild psychological stress. Psychosomatic Medicine. v56, (216-224). Can stress make you sick? (1998, April, v23 n6 pl (3). Harvard Health Letter, URL: Expanded Academic ASAP Int'l: http://web3/searchbank.com/itw/session/614/156/12127909w5/34!fullart, (1-4). Cancer tests can heighten anxiety - Women with breast cancer gene mutation suffer from stress. (1998, November 14). Science News, URL: Expanded Academic ASAP Int'l: http://web3/searchbank.com/itw/session/614/156/12127909w5/15!fullart, (1-2). Elliott, G. R. and Eisdorfer, C. (1982) Stress and Human Health. New York: Springer. Gallagher, R. B., Gilder, J., Nossall, G. J. V. & Salvatore, G. (1995). Immunology: The making of a modern science. London: Harcourt Brace. Glaser, R. The effects of stress on the immune system: Implications for health. (1996, December 17). Science Writers Briefing, p.1-2. Gunderson, E. K., Rahe, R. H. (1979). Life stress and illness. Springfield: Charles C. Thomas. Hassed, C. (1998). Mind-body medicine in health promotion: Science, practice and philosophy. Internet Journal of Health Promotions. URL: http://www.monash.edu.au/health/IJHP/1998/10 1-24, Henderson, W. H. (1998, Nov. 2). Stress lowers cancer-fighting ability among those who need it most. Cancer Weekly Plus, URL: Expanded Academic ASAP Int'l: http://web3/searchbank.com/itw/session/614/156/12127909w5/fullart, (1-3). Judd, B. (1996). Depression deepens as AIDS approaches. The American Journal of Psychiatry, URL: http://www.appi.org/nov96/issue.html, (1-4). Kiecolt-Glaser, J. K. Cacioppo, J. T., Malarkey, W. B. and Glaser, R. (1992). Acute psychological stressors and short-term immune changes, Psychosomatic Medicine, v54, 680-685, (From Advanced Biology Journal Article Summaries, URL: http://www.econ.uinc.edu/~hanko/Bio/stress.html,1995). Kiecolt-Glaser, J. K., Cacioppo, J. T., Malarkey, W. B. and Glaser, R. (1992). Acute psychological and short-term immune changes: What, why, for whom, and to what extent? Psychosomatic Medicine, v54, (680-685). Manuck, S. B. Cohen, S., Rabin, B. S., Muldoon, M. F. and Bachen, E. A. (1991). Individual differences in cellular immune response to stress. Psychological Science, 2, 111.114. (From Advanced Biology Journal Article Summaries, URL: http://www.econ.uinc.edu/~hanko/Bio/stress.html,1995). Martin, J. L. (1988). Psychological consequences of AIDS-related bereavement among gay men. Journal of Consulting and Clinical Psychology, v56, n6, 856-63. McEwen, B. S. and Stellar, E. (1993). Stress and the Individual: Mechanism Leading to Disease. URL: Expanded Academic ASAP Int'l: http://web3/searchbank.com/itw/session/614/156/12127909w5/fullart, (1-8). Naliboff, B. D. Benton, D., Solomon, G. F., Morley, J. E., Fahey, J. L., Bloom, E T., Makinodan, T. and Gilmore, S. L. (1991). Immunological changes in young and old adults during brief laboratory stress. Psychosomatic Medicine v53, 121-132, (From Advanced Biology Journal Article Summaries, URL: http://www.econ.uinc.edu/~hanko/Bio/stress.html,1995). Newberry, B. H., Jaikins-Madden, J. E., & Gerstenberger, T. J. (1991). A holistic conceptualization of stress and disease: Stress in modern society 7. New York: AMS Press. Noll, R. B., Gartstein, M. A., Vannatta, K., Correll, J., Bikowski, W. M. Davies, H. (1999). Social, emotional and behavioural functioning of children with cancer. Pediatrics, v103 i1, URL: Expanded Academic ASAP Int'l: http://web3/searchbank.com/itw/session/614/156/12127909w5/fullart, 71 (1-19). Rambo, T. (1997). Cancer patient support program, Bowman Gray School of Medicine Winston-Salem, URL: http://www. (http://www.newstimes.com/archieve/janl1896/lcgg.htm), 1-4. Rice, P. L. (1999). Stress and Help. Pacific Grove: Brooks/Cole. Seligman, M. and Buchanan, G. (1996), Learned optimism yields health benefits, American Psychology Association, URL: http://helping.apa.org/learned.html, (1). Wade, C. & Tavris, C. (1993). Psychology. New York: Harper Collins. Wolf, T., Cole, B. and Coyne. (1996). A canonical analysis of psychological and immune system interventions. Washburn University, URL: www://www.wuacc.edu/cas/biology/zzwolf.d/TIT.HTM, (1-24). Zakowski, S., Hall, M. H. and Baum, A. (1992). Stress, stress management, and the immune system. Applied and Preventative Psychology v1, 1-13, (From Advanced Biology Journal Article Summaries, URL: http://www.econ.uinc.edu/~hanko/Bio/stress.html,1995).

Word Count: 2900