For centuries, people have contemplated the connection between the mind and body; the interplay is deep-rooted and complex, calling into question whether different mental states can positively or negatively affect biological functioning. In recent years, research has suggested that emotions like stress and worry, when they persist long-term, may contribute to imbalance and disease in the body ranging from asthma to cancer to heart disease.1,2
The connections between stress and the immune system, in particular, have been the subject of rigorous inquiry. In 2004, a large meta-analysis of almost 300 independent studies over 30 years indicated that psychological stress was associated with suppression of the immune system3 and with a number of immune-related and autoimmune diseases such as inflammatory bowel disease, allergy, atopic dermatitis, and celiac disease.4 Both the rates of autoimmune diseases5 and stress levels across the globe6 have increased exponentially over the last decade. Theorists propose that stressful events may induce sympathetic nervous system and endocrine changes, among other biological responses, and that these changes can ultimately impair immune function.1 But whether stress or stress-related disorders play a direct role in the development of autoimmune disease remains an area of continuing research.
In the following video, IFM educator Robert Rountree, MD, describes how high levels of stress may change immune function and alter the progression of chronic illness.
In a groundbreaking study published in JAMA in 2018, scientists found evidence that stress-related disorders are significantly associated with subsequent autoimmune disease.7 Researchers evaluated over 100,000 people diagnosed with stress-related disorders and compared their tendency to develop autoimmune disease at least one year later with 126,000 of their siblings and with another million people who did not have stress-related disorders. What they found was that individuals diagnosed with a stress-related disorder were more likely to be diagnosed with an autoimmune disease and more likely to develop multiple autoimmune diseases. Interestingly, the study found that for those with post-traumatic stress disorder (PTSD) who were being treated with an SSRI, the increased rate of autoimmune disease was less significant.7
“The findings of this study are consistent with some biological evidence linking psychological stress and stressful events to varying impairments of immune function,” write the authors. “Under stress, the activated autonomic nervous system might induce the dysregulation of immune function and a disinhibition of inflammatory response via the inflammatory reflex.”7
In a 2014 study among children age five, researchers measured the association between high psychological stress in the family and immune response.4 Stress was assessed among four domains: serious life events, parenting stress, lack of social support, and parental worries. The results indicated that psychological stress may cause not only immune suppression, but also an imbalance that may possibly contribute to an autoimmune reaction against T cells. Moreover, in this study, children exposed to psychological stress (especially serious life events), induced an immune response against diabetes-related autoantigens. Researchers speculate whether this may indicate an autoimmune reaction against the insulin-producing ? cells, which, in some individuals, initiate progression toward type 1 diabetes.4
What stress-reducing interventions may positively affect the immune system and potentially prevent immune imbalance? Research suggests that people reporting stress may also engage in unhealthy behaviors more often than those who do not. For example, one study suggests that diet may be affected when people are under stress, with stressed people eating more “fast food,” higher calorie meals.8 Sleep may also be altered, as stressors such as job demands and lack of control at work correlate with insomnia, sleep deprivation, and daytime fatigue.9 Alcohol intake is likely to increase when individuals are under stress,10 as is cigarette use.11
In addition to modifying dietary and lifestyle trends for tense patients, various psychological interventions, including cognitive behavioral therapy, mindfulness, and relaxation, have been found to effectively reduce stress.2 Moreover, in a 2019 meta-analytic review of in-vitro and in-vivo models, researchers found that psychological interventions may improve immune function.2
One recent study evaluated the psycho-immune outcomes of an eight-week mindfulness-based stress reduction (MBSR) program for women newly diagnosed with breast cancer.12 Compared to the control group, women randomized to MBSR exhibited decreasing trajectories of perceived stress, fatigue, sleep disturbance, and depressive symptoms. They also exhibited trajectories demonstrating significantly more rapid restoration of natural killer cell activity, accompanied by lower circulating TNF-alpha levels, lower IL-6 production, and greater IFN-gamma production.12
Data from breast cancer patients also suggest that mind-body-based complementary therapies (e.g., mindfulness, meditation, yoga, Tai Chi, Qigong, guided imagery, and affirmations) may influence the immune profile of patients.13 Breast cancer survivors who undertook Iyengar yoga sessions for 8 and 12 weeks showed reduced morning and evening cortisol levels along with improved fatigue and emotional well-being.14 In another study, breast cancer patients who received Tai Chi Chuan training showed significant improvements in bone health, immune function, and quality of life.15
The National Institutes of Health estimates that 25 to 50 million Americans suffer from autoimmune diseases, and the prevalence is rising.5 While it is clear that environmental factors have important parts to play in the underlying etiology of these diseases, whether or not there is a causal link to stress is yet to be fully illuminated. However, as interest and research grows, more and more evidence suggests that when done in tandem, modifying unhealthy coping habits and integrating mind-body interventions into a patient’s daily life may help to alter the course of stress, and thus, immune dysfunction.
- Thornton LM, Andersen BL. Psychoneuroimmunology examined: the role of subjective stress. Cellscience. 2006;2(4):66-91.
- Schakel L, Veldhuijzen DS, Crompvoets PI, et al. Effectiveness of stress-reducing interventions on the response to challenges to the immune system: a meta-analytic review. Psychother Psychosom. 2019;88(5):274-286. doi:10.1159/000501645
- Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004;130(4):601-630. doi:10.1037/0033-2909.130.4.601
- Carlsson E, Frostell A, Ludvigsson J, Faresjö M. Psychological stress in children may alter the immune response. J Immunol. 2014;192(5):2071-2081. doi:10.4049/jimmunol.1301713
- National Institute of Environmental Health Sciences. Autoimmune disease fact sheet. National Institutes of Health. Published November 2012. Accessed October 1, 2019. https://www.niehs.nih.gov/health/materials/autoimmune_diseases_508.pdf
- Global Organization for Stress. Stress facts. Accessed October 1, 2019. http://www.gostress.com/stress-facts/
- Song H, Fang F, Tomasson G, et al. Association of stress-related disorders with subsequent autoimmune disease. JAMA. 2018;319(23):2388-2400. doi:10.1001/jama.2018.7028
- Kalimo R, Tenkanen L, Härmä M, Poppius E, Heinsalmi P. Job stress and sleep disorders: findings from the Helsinki Heart Study. Stress Med. 2000;16(2):65-75. doi:10.1002/(SICI)1099-1700(200003)16:2<65::AID-SMI834>3.0.CO;2-8
- Armeli S, Todd M, Mohr C. A daily process approach to individual differences in stress-related alcohol use. J Pers. 2005;73(6):1657-1686. doi:10.1111/j.0022-3506.2005.00362.x
- Kouvonen A, Kivimäki M, Virtanen M, Pentti J, Vahtera J. Work stress, smoking status, and smoking intensity: an observational study of 46,190 employees. J Epidemiol Community Health. 2005;59(1):63-69. doi:10.1136/jech.2004.019752
- Witek Janusek L, Tell D, Mathews HL. Mindfulness based stress reduction provides psychological benefit and restores immune function of women newly diagnosed with breast cancer: a randomized trial with active control. Brain Behav Immun. 2019;80:358-373. doi:10.1016/j.bbi.2019.04.012
- Abrahão CA, Bomfim E, Lopes-Júnior LC, Pereira-da-Silva G. Complementary therapies as a strategy to reduce stress and stimulate immunity of women with breast cancer. J Evid Based Integr Med. 2019;24: 2515690X19834169. doi:10.1177/2515690X19834169
- Banasik J, Williams H, Haberman M, Blank SE, Bendel R. Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. J Am Acad Nurse Pract. 2011;23:135-142. doi:10.1111/j.1745-7599.2010.00573.x
- Janelsins MC, Davis PG, Wideman L, et al. Effects of Tai Chi Chuan on insulin and cytokine levels in a randomized controlled pilot study on breast cancer survivors. Clin Breast Cancer. 2011;11(3):161-170. doi:10.1016/j.clbc.2011.03.013
Sleep can be an emotional topic for many patients. Balancing a life full of work and family dynamics with healthy eating, exercise, and self-care is challenging enough for many, without the added effort of good sleep hygiene. As a Functional Medicine clinician, how do you talk to your patients about sleep and give them tools to improve this important lifestyle factor?Read More