A thorough knowledge and understanding of the theory and practical

applications of psychoneuroimmunology proves invaluable in the promotion

of physical well-being.

The western world has only recently come to realise that mind and body may not be
separate entities as we have always believed, but that mind and body interact with
each other and that the one may affect the other's functioning. This realisation has
led to a more holistic approach to health and well-being, where the optimal
functioning of both biological and psychological aspects of the human being is
regarded as important in preventing illness and disease.
Psychoneuroimmunology (PNI) is one of the fields that have developed as a result of
this more holistic approach to illness and it involves the integration of behavioural,
neuronal, endocrine and immune functions (Song & Leonard, 2004) in determining
physical well-being.
There are some pertinent issues that stand out in the field of PNI, for instance the
likelihood that mental processes like stress and behaviour can have an influence on
biological functions and health.

Pertinent issues in the field generate research

questions, which guide research. For instance research in the field of PNI may
involve finding the answer to questions like do psychosocial factors have an impact
on the outcome of advanced cancer in patients and does stress influence infection
and clinical presentation of colds after direct contact with rhinovirus".
Research in the field of PNI involves some unique methodological issues. Firstly
research needs to be non-invasive. It would not be appropriate to administer
antigens in vivo to people, therefore non-invasive immunological techniques are
used involving a restriction to in vitro studies and peripheral blood and skin. There is
a lack of research exploring the complete Stress-Immunity-Health (S-I-H) link. In
other words research, showing that stress (which leads to distress) causes changes
in immune function (through an underlying physiological mechanism) which has an
impact on a person's health needs to be conducted in order to infer causality. A third
methodological issue in research in the field of PNI involves the issue of control.
Nuisance variables may jeopardise a study if not taken into account, but these
1

variables are not easily controlled in research on human subjects. For instance
alcohol, drugs, chronic or acute medical conditions, sleep disturbances, smoking and
caffeine intake can influence immune function directly or indirectly. In order to try and
counteract the negative impact that these nuisance variables may have on the
reliability of results, control groups need to be assessed on all psychosocial
measures which are relevant for the experimental group. A final methodological issue
applicable to research in this field involves that effect sizes of behavioural or
psychosocial factors have to be considered carefully in order to be sufficient to
reveal related changes in immune function. (Keller, Shiflett, Schleifer and Bartlett,
2004).
The immune systems function is to protect the organism from invading pathogens
and cancer which threatens its survival. The immune system consists of innate (or
non-specific immunity) and acquired (or specific immunity) which work together in
protecting the body from invading pathogenic microorganisms.
Innate or non-specific immunity is present from early development and is always
available to the organism. It involves amongst others anatomic barriers consisting of
the skin and surface of mucous membranes which prevent pathogens from entering
the body. Physiological barriers include body temperature which inhibits pathogen
growth, gastric acidity which creates an environment in which pathogens would find it
difficult to survive and soluble proteins which render pathogens harmless. Endocytic
and phagocytic barriers created by the inflammatory response destroy antigen.
(Kuby, 2004).
Acquired immunity is more specific and develops later than innate immunity. It
consists of immune organs like the Thymus gland, bone marrow, spleen and lymph
nodes. Immune organs are responsible for the production, proliferation and
differentiation of immune cells. B lymphocytes (B cells) produce antibodies mainly
consisting of immunoglobulin which destroy pathogens and are mostly involved in
humoral immunity. T lymphocytes (T cells) are involved in cell mediated responses
and consist of amongst others T helper (T H) cells which are responsible for
phagocytosis and killing of micro-organisms in the bodys host defence against
intracellular bacteria. T cytotoxic (T C) cells which produce cytotoxic T lymphocyte
(CTL) are responsible for the killing of altered self-cells like virus-infected cells and
2

tumour cells. Other immune cells include Natural Killer (NK) cells which are
responsible for antibody-dependant cell-mediated cytotoxicity, monocytes or
macrophages involved in phagocytosis and antigen presentation and granulocytes or
neutrophils which are also responsible for phagocytosis. (Kuby, 2004).
The immune system and central nervous system are (CNS) closely interconnected.
The CNS controls and regulates immune system responses through afferent signals
and the immune system constantly provides the CNS with necessary information.
Brain lesions (particularly if located in the hypothalamus) can affect immune
functioning by causing alterations of autonomic or endocrine functioning. The brain
modulates the immune system through direct innervation from the CNS to the
immune system and indirectly through various neurotransmitters, neuropeptides and
endocrine hormones.

Nervous innervation of the immune system is mediated

through the autonomic nervous system which serves as a major link between the
brain and immune system. Neurotransmitters differ in their effects on immune
functions. In general, Noradrenalin (NA), Adrenaline (A), Dopamine (DA) and opioids
are mostly immunosuppressive, while acetylcholine (Ach) is an immunostimulant.
Immune responses also result in changes in neurotransmitters, due to one of the
responses to immunisation simulating the CNS's stress response. (Song & Leonard,
2004).
Stress is a state of disharmony which occurs when homeostasis in the body is
threatened and a stress response is initiated in a person when he or she perceives a
situation as stressful or difficult. The stress system in the CNS comprises mainly of
the corticotrophin-releasing hormone (CRH)/ paraventricular nucleus of the
hypothalamus (PVN),

and

locus cereleus-norepinephrine

(LC/NE)-autonomic

systems and their peripheral effectors, the pituitary-adrenal axis, and the limbs of the
autonomic system. These determine the stress response.
High levels of CRH in the CNS activate the sympathetic nervous system (SNS) and
pituitary-adrenal axis, which cause increases in heart rate, blood pressure and
serum glucose and stimulates arousal. Higher CRH levels lead to the secretion of
ATCH, which stimulates the secretion of glucocorticoid hormones by the adrenal
cortex. The LC-NE/ sympathetic system is located in the brainstem and activation

hereof leads to the release of NE, which results in enhanced arousal and anxiety in
the individual.
Immune responses can take the form of humoral or cell-mediated responses.
Humoral responses involve the interaction of B lymphocytes with antigen which
leads to their proliferation and differentiation into antibody-secreting plasma cells.
The antibody binds to antigen and neutralises it or leads to its elimination. The cellmediated responses involve T lymphocytes which are generated in response to
antigen. TH cells respond with the production of lymphokines, which can activate
phagocytic cells, enabling them to phagocytose and kill antigen. Cytotoxic T
lymphocytes mediated the killing of altered self-sells. Activation of immune cells
leads to regulation by cytokines (produced by lymphocytes, macrophages,
granulocytes and other cells) which serve as communication signals between
leucocytes. These cytokines have different biological effects which change the
behaviour and function of leucocytes.
Stress, whether inflammatory, traumatic or psychological, leads to the activation of
the stress response. Cytokines and humoral inflammation mediators activate the
central stress response. All three inflammatory cytokines, tumour necrosis factor
(TNF ), interleukin-1 (IL-1 ), and interleukin-6 (IL-6) can cause stimulation of the
hypothalamic-pituitary-adrenal (HPA) axis. Activation of the HPA-axis has inhibitory
effects on inflammatory/immune response. Almost all components of the immune
response seem to be inhibited by the cortisol produced by the stress response.
Glucocorticoids result in changes in leukocyte activity, decreases in cytokine
production, and inhibition of inflammation mediators' effects on target tissues. Stress
causes a significant decrease in NK cell activity, decreases in T-lymphocytes and T H
cells and the production of interferon (IF) by stimulated lymphocytes. Increased
serum cortisol is associated with decreased lymphocyte response to mitogen, and
decreased ability of lymphocytes to destroy foreign cells.
(Haddy & Clover, 2001; Tsigos & Chrousos, 2002).
Not only are the immune system and CNS closely interconnected, but both of these
systems are also interconnected with the endocrine system. Due to all these
interconnections it is possible for psychological factors influencing the function of the
CNS to have an impact on functioning of the immune system. The hypothalamic4

pituitary-adrenocortical (HPAC) pathway, the sympathetic adrenal-medullary (SAM)

systems, and other endocrine systems, are some of the major pathways contributing
to the interconnectedness of the CNS, immune system and endocrine system. The
brain influences organs in the body through the HPA-axis and SAM-system in the
face of stress. The SAM-system is reciprocally connected with the CRH-system of
the HPA-axis, and receives and transmits humoral and nervous immune signals from
the periphery through the innervation of lymphoid organs and by reaching
inflammation sites via sympathetic neurons. Sex hormones released by the
endocrine system may also have immunosuppressive or immuno-enhancing effects
on the immune system. (Tsigos & Chrousos, 2002).
If it is true that psychosocial factors can influence the immune system and health, it
would explain why not all people exposed to the same pathogen would become ill,
display the same severity of symptoms, or stay ill for the same period. This would
mean that disease is not only caused by biological processes but that psychological
factors like affect and coping styles also influence health. Research results suggest
that psychosocial factors do seem to have an effect on variations in immune
function.
For instance the effects of acute stressors, which last for five to twenty minutes, on
the immune system can be seen as soon as five minutes after the onset of the
stressor (Kiecolt-Glaser et al. cited in Cohen & Herbert, 1996). Effects include
increases in NK and suppressor/cytotoxic T cell numbers and decreased proliferation
in response to mitogens. Manuck, Cohen, Muldoon and Bachen (cited in Cohen &
Herbert, 1996) found that individuals experiencing high SNS activation following
acute stressors, as indicated by large increases in blood pressure, heart rate and
epinephrine and norepinephrine, showed the most notable immune changes. An
example of acute short-term stress is exam stress which students experience before
or during exams. Glaser, Kiecolt-Glaser, Bonneay, Malarkey, Kennedy and Hughes
(cited in Kiecolt-Glaser et al., 2002) found that students who could produce an
antibody response (seroconvert) after the first hepatitis B (Hep B) vaccination in a
series of three, were less stressed and anxious than students who only
seroconverted after the second vaccination. This is an indication that the experience
of stress influences immune responses to vaccines - and therefore to pathogens.
According to Cohen and Herbert (1996) the differences in antibody level may
5

however not necessarily be great enough to influence the amount of protection

against infection.
Daily stressors may also influence the immune system and the effect thereof on the
immune system seems to depend on whether the event that produces the stress is
perceived as positive or negative. Stone, Neale, Cox, Napoli, Valdimarsdottir and
Kennedy-Moore (cited in Cohen & Herbert, 1996) found that more desirable events
were related to the production of greater amounts of secretory immunoglobulin A
(sIgA) antibodies in response to an antigen, while negative events was related to a
decrease in sIgA antibodies.
Chronic stress may have more sustained effects on the immune system and health
than acute stress. According to Kiecolt-Glaser et al (2002) individuals caring for a
loved one with Alzheimer's disease regularly experience high levels of stress which
is associated with prolonged endocrine and immune dysregulation, and health
changes which include slow wound healing and variations in their responses to
vaccines. Kiecolt-Glaser and Glaser (cited in Cohen & Herbert, 1996) found that
these individuals also show elevated levels of herpes virus antibodies. Studies by
Esterling, Kiecolt-Glaser, Bodnar and Glaser (cited in Cohen & Herbert, 1996) found
that both current and former caregivers had poorer NK-cell responses to stimulatory
chemicals than a control group, which suggests that the negative effect on immune
function may persist after the cessation of the stressful event.
The impact of psychosocial factors on the immune system may be influenced by
coping styles that the individual possesses. People with repressive coping styles will
generally not admit that they are experiencing stress and will report low anxiety and
high defensiveness. It was found that when these individuals are subjected to
anxiety-provoking stimuli, they show increases in physiological activation that equal
or surpass those of subjects who report high anxiety (Anderson, Hall, Spielberger &
Olivier cited in Hall et al. 2004). Repressors may not be motivated to gain control
over stressful events if they do not experience the emotional discomfort which is
associated with anxiety and pain. Animal studies by Laudenslager, Ryan, Drugan,
Hyson and Maier (cited in Hall et al., 2004) show that, perceived control over a
stressor affects the responses of lymphocytes to phytohemagglutinin (PHA) and
concanavalin A (ConA), and Sklar and Anisman (cited in Hall et al., 2004) found that
6

the lack of control over stressors is associated with more rapid growth of tumours.
Because repressors are prone to denying their feelings, they are not likely to turn to
self-disclosure. Esterling, Antoni, Kumar and Schneiderman (cited in Hall et al.,
2004) found that low disclosure and repression is related to impaired control of
latent Epstein-Barr Virus (EBV) and with suppression of cellular immune function as
indicated by higher numbers of antibodies to herpes viruses. (Hall et al., 2004).
Coping style may be determined by a person's personality and dispositional style. In
a study by Cole, Kemeny, Weitzman, Schoen and Anton (cited in Kiecolt-Glaser et
al., 2002), it was demonstrated that social inhibition may be associated with
physiological hyper-responsiveness as socially inhibited subjects showed an
increased delayed-type hypersensitivity (DTH) response after being subjected to a
high social engagement condition. Optimists seem to have better immune function.
Situational optimism about their health outcome in HIV-infected men is shown to be
associated with slower immune decline later onset of symptoms and longer survival
time (Kemeny cited in Kiecolt-Glaser et al., 2002).
Mood and affect has also been associated with immune functioning and health. It
seems that negative affect generally has negative consequences for immune
functioning, while positive moods may improve immune functioning. According to
Herbert and Cohen (cited in Cohen & Herbert, 1996) depressed mood is related to
decreased proliferative responses to mitogens and also in NK activity. Anxious mood
is also related to a decrease in NK activity and in proliferative responses to PHA and
Con A (Linn, Linn & Jensen and Locke, Kraus, Leserman, Hurst, Heisel & Williams
cited in Cohen & Herbert, 1996).
Interpersonal relationships can have diverse influences on immune function. For
instance loneliness may affect the immune system negatively as shown in a study
where students who reported more loneliness had lower NK activity and higher
numbers of herpes virus antibodies (Kiecolt-Glaser et al. cited in Cohen & Herbert,
1996). Persons who perceive that they have social supportive relationships show
more proliferation in response to PHA than persons without people to confide in
(Thomas, Goodwin & Goodwin cited in Cohen & Herbert, 1996). Negative
relationships also seem have negative consequences for the immune system and
health. It has been found that women who are separated and divorced tend to have
7

higher levels of herpes antibody, lower numbers of NK cells, and they show lower
lymphocyte proliferation in response to PHA and Con A than a control group (KiecoltGlaser, Fisher, Ogrocki, Stout, Speicher and Glaser cited in Cohen & Herbert, 1996).
Disclosure seems to be one of the factors that mediate the relationship between
support and immune function. Pennebaker and Beall (cited in Cohen & Herbert,
1996) found that college students who disclosed emotions and facts about a
traumatic event in writing had visited the health centre less often subsequently than
students who only wrote about emotions and facts. Behavioural factors may also
contribute to the association between relationships and immune functioning as
people in happy relationships are more likely to engage in health promoting
behaviours than people who are miserable in their relationships.
Psychosocial factors indeed seem to affect the function of the immune system and
health, and therefore the development of diseases is not completely out of our hands
or as predetermined as linear theories would suggest. According to Weiner (cited in
Hall et al. 2004, p118) biological .factors and psychosocial factors both contribute to
psychological and physiological responses, and the interaction between these
responses

determine

the

balance

between

health

and

illness. Therefore

interventions that target psychological factors which may be detrimental to immune

function may decrease illness. Preliminary research has shown that hypnosis,
disclosure, relaxation training and stress-management intervention have the
potential to influence immune responses (Miller & Cohen, 2001).
Stress-management interventions attempt to alleviate stress and its resulting
detrimental effects on the immune system. These interventions generally comprise of
illness education, cognitive restructuring, coping skills training, and provision of
psychological support. They modify the way in which individuals appraise stressful
circumstances by making them seem more benign and less threatening, which in
turn lessens the negative impact on immune functioning. (Miller & Cohen, 2001).
Relaxation interventions may include relaxation response, progressive muscle
relaxation and biofeedback-assisted relaxation (Benson; Lehrer & Woolfolk cited in
Miller & Cohen, 2001). This type intervention may reduce negative emotions
associated with stress and dampen activity in hormonal systems and descending

sympathetic fibres which may innervate lymphoid organs and consequently disrupt
immune function.
During disclosure interventions persons are asked to write essays about a stressful
experience that they have not often shared. Some people cope with stressful
experiences through inhibition and do not express thoughts, feelings and behaviour
associated with the experience and this may negatively affect the immune system.
By encouraging them to write about the experience they become cognitively involved
and learn to perceive the experience as more benign, resulting in a sense of
personal control. This may decrease negative emotions associated with the
experience and therefore dampen hormonal and sympathetic activity which cause
immune dysregulation. (Miller & Cohen, 2001).
Hypnosis with immune suggestion (HWIS) involves the induction of person into a
hypnotic state and explicit suggestions are made that immune responses to an
antigen be enhanced. According to research people are able to follow hypnotic
suggestions and alter autonomous processes like heart rate, blood pressure and
skin temperature (Lehrer & Woolfolk cited in Miller & Cohen, 2001). It is therefore
possible, that people will also be able to respond to hypnotic suggestions aimed at
enhancing immune functioning. HWIS will be most beneficial to persons who are
highly susceptible to hypnotic suggestion.
Human conditioning interventions are generally based on the principles of classical
conditioning where an initially neutral stimulus (conditional stimulus or CS) is paired
with an immune-modulating stimulus (unconditional stimulus or UCS). After repeated
presentation the CS would be able to elicit the same response as the UCS. (Miller &
Cohen, 2001). Studies by Lieberman (cited in Miller & Cohen, 2001) have shown that
hormone secretion and sympathetically mediated biological processes can be
conditioned with success. Successful interventions will rely on the pairing of
sufficiently salient CS with a UCS for an adequate number of times.
Meta-analysis showed more success for disclosure interventions in that they were
associated with a reduction in antibody titers to Epstein-Barr virus (EBV), and
therefore may result in enhanced control of the body over latent Herpes Simplex
Virus (HSV) (Miller & Cohen, 2001). HISW seems to be effective in that participants
in research were able to modulate immune responses and show increases in sIgA
9

concentration and neutrophil adherence, as well as success in suppressing

immediate-type hypersensitivity (ITH) response (Miller & Cohen, 2001). Metaanalysis has also demonstrated that conditioning interventions can enhance natural
killer cell cytotoxicity (NKCC) (Miller & Cohen, 2001). It seems as if disclosure
interventions, HISW and conditioning interventions are most effective in reducing
negative effects that psychological factors have on immune functioning.
The discussion thus far mostly revolved around effects of psychosocial factors on
immune functioning. Research linking psychosocial factors to health outcomes has
had mixed results. Studies trying to link psychosocial factors to cancer have not
been very effective, and as a whole this type of study does not make the whole
endeavour to try and find links between the two factors seem a very lucrative one.
For instance in one of the most influential studies researchers found no effect of
psychosocial factors on non-operable cancers and limited effects on operable cancer
remission rates (Cassileth, Lusk, Miller, Brown & Miller cited in Keller, Shifflett,
Schleifer & Bartlett, 2004). It may be that the influence of psychosocial factors on the
disease that is already in an advanced state may be very small compared to the
influence of biological factors that it may be overlooked. In order to establish a link
between psychosocial factors and cancer progression, behavioural and psychosocial
factors need to have such a notable influence the immune system that it stands out
from immune dysregulation already found in the course of biological disease and
treatment thereof.
It seems that one has to look further than trying to find a simple linear relationship
between psychosocial factors and cancer development. In a follow up study by
Cassileth et al. (cited in Keller et al., 2004) results indicated a curvilinear relationship
between psychosocial factors and prognosis. The researchers found that patients
with high and low psychosocial functioning seemed to have better remission rates
than patients whose psychosocial functioning was on intermediate level. Greer,
Morris and Pettingale (cited in Keller et al., 2004) found evidence for a similar
relationship when their research indicated that cancer patients who approached the
disease with either denial on the one hand, or a fighting spirit on the other, had better
clinical outcomes than patients who had an attitude of resigned acceptance.

10

Although links between depression and markers of disease progression and shorter
survival time has been found in cancer patients, research trying to link depression to
cancer has not produced consistent results (Cohen & Herbert, 1996). Persky,
Kempthorne-Rawson and Shekelle (cited in Cohen & Herbert, 1996) found that
persons who scored higher in tests measuring depression, had a much higher risk of
dying of cancer 17 to 20 years later, regardless of the site and type of cancer.
Grossarh-Maticek, Kanzir, Schmidt and Vetter (cited in Cohen & Herbert, 1996) also
found that persons suffering from chronic hopelessness and depression were
more likely than controls to develop cancer-within 10 years. Other studies failed to
find an association between clinical depression and cancer incidence and
mortality (Hahn & Pettiti cited in Cohen & Herbert, 1996).
Evidence linking social support to the progression of cancer seems to be more
consistent. Persons with greater access to social support are more likely to have
better prognosis and to survive longer (Levy, Herberman, Maluish, Schliew &
Lippman cited in Cohen & Herbert, 1996). It seems that psychosocial effects on
the outcome and progression of cancer may differ according to among others
gender and age of the patient. According to Funch & Marshall (cited in Cohen &
Herbert, 1996), social support were more related to survival in younger than older
women, and also more related to disease onset and mortality in women than in
men (Reynolds & Kaplan cited in Cohen & Herbert, 1996).
Psychosocial factors seem to have different influences on different kinds of
cancers. This is understandable in light of the fact that different cancers have
many different etiologies and not all of them are influence by the immune system.
Fawzy, Cousins, Fawzy, Kemeny, Elashoff & Morton (cited in Keller et al., 2004)
did a study on patients diagnosed with malignant melanoma where the
patients were subjected to psychiatric intervention aimed at altering emotional
reactions to cancer and to develop coping behaviours. The researchers found that
the intervention did alter emotional reaction and coping behaviours, and that
emotional reaction was associated with immune functioning. The group receiving
intervention had longer intervals before recurrence and increased survival rates.
The researchers also found that patients with higher baseline distress that coped

11

actively with their illness had better chances of surviving and better recurrence rates
than those patients using denial.
In patients with breast cancer, psychosocial factors such as perceived family
support and mood states, were predictors for the interval before recurrence after
surgery (Levy, Herberman, Whiteside, Lee, Ward & Massoudi cited in Keller et
al., 2004). Stone, Mezzacappa, Donatone & Gonder (cited in Kiecolt-Glaser,
Mcguire, Robles & Glaser, 2002) found a relationship between stress and higher
levels of prostate-specific antigen in the blood which is a marker for the
development of prostate cancer.
Although some studies reported some promising results regarding psychological
interventions in treating cancer, a meta-analysis of by Miller and Cohen (2001)
does not report much promising results. For instance they mention that there
was no indication that stress-management or relaxation caused any reliable
changes in immune functioning in cancer patients.
More convincing evidence has been found linking psychosocial factors to the
onset and progression of upper respiratory infections (URI) and other less serious
infectious diseases than to cancer and AIDS. For instance Meyer and Haggerty
(cited in Cohen & Herbert, 1996) already found an association between
stressful daily events and chronic family stress and a likeliness to contract a URI
in 1962. Graham, Douglas and Ryan (cited in Cohen & Herbert, 1996) found
similar results in a later study where subjects experiencing high stress suffered
from more incidences of illness and had more days of experiencing symptoms
of upper respiratory illness. Cohen, Tyrell and Smith (cited in Keller, Shiflett,
Schleifer and Bartlett, 2004) showed that stress increases infection and the
likelihood of developing common colds after healthy subjects has been inoculated
with rhinovirus.
Family stress in particular seems to be especially influential in the
susceptibility of persons to URI like influenza. In a study where families who
were rigid and chaotic were classified as "stressed" and balanced families as
"non-stressed", the stressed families experienced more episodes of disease
12

than the non-stressed families (Clover, Abell, Becker, Crawford & Ramsey
cited in Cohen & Herbert, 1996). In a study by Levy, Fernstrom, Herberman,
Whiteside, Lee, Ward and Massoudi (cited in Keller et al., 2004) a relationship
between perceived stress and URI morbidity has been found. In a study by
Cohen and Herbert (cited in Cohen & Herbert, 1996) it has also been found
that stressful life events, perceived stress and negative effect were predictive
of the likelihood that subjects would develop a cold. Greater stress seems to
have a linear relationship with greater probability of developing a cold. Affect
and mood also seem to be predictors of the development of URI. Healthy
adolescents suffering from depressed mood or clinical depression and
aggression against the self were more likely to develop URI 6 to 9 months
later in a study by Keller, Schleifer, Bartlett and Eckhold (Keller et al., 2004).
It seems that the duration of stressors is an indication of whether or not it will
influence onset and progression of a URI. Cohen, Doyle, Skoner, Rabin and
Gwaltney (cited in Kiecolt-Glaser, Mcguire, Robles and Glaser, 2002) found
that subjects experiencing chronic stressors were more likely to develop a
cold after inoculation with different strains of cold viruses. These researchers
also found evidence that social support as a psychosocial factor may have a
role in URI onset and progression. They found that individuals are more
susceptible to respiratory viruses if they have few social ties (Cohen et al.
cited in Kiecolt-Glaser, Mcguire, Robles and Glaser, 2002). Negative
relationships also seem to influence health according to Morag, Morag,
Reichenberg, Lerer and Yirmina (cited in Kiecolt-Glaser, Mcguire, Robles and
Glaser, 2002) who reported that subjects who received inoculation with a
rhinovirus were more likely to develop a cold when experiencing long-term
difficulties in interpersonal relationships.
According to Keller et al., 2004 one explanation of the role of psychosocial
factors in URI may be that distress influences susceptibility and stressors are
associated with the actual progression or severity of the infection.
Herpes is one of the less serious infectious diseases and there seem to be
some evidence implicating psychosocial factors in the activation of the latent
13

herpes virus and recurrent outbreaks of cold sores and genital lesions,
infectious mononucleosis, mononucleosis syndrome and deafness in neonates
(Kiecolt-Glaser & Glaser cited in Cohen & Herbert, 1996). According to Cohen
and Williamson (cited in Keller et al., 2004) stress is associated with
reactivation of latent herpes virus. It is possible that the experience of stress
impairs immune function, which makes the person with the latent herpes virus
vulnerable and causes the virus to become active. It has been suggested that
stress causes the body to be vulnerable to general illnesses excluding herpes,
but that this general vulnerability for many kinds of illnesses may open the
door for the recurrence of herpes (Hoon, Hoon, Rand, Johnson, Hall and
Edwards cited in Cohen & Herbert, 1996).
Already in the 1970's a study has been conducted involving student nurses
(Friedmann, Katcher and Brightman cited in Cohen & Herbert, 1996). Those
nurses experiencing negative moods at the beginning of the school year were
more likely to suffer from oral herpes. It seems as if mood may be a better
predictor of recurrence of herpes virus outbreaks than stress. In a study by
Kemeny, Cohen, Zegans and Conant (cited in Keller et al., 2004) association
between overall stress and distress, and cold sore occurrences were weak,
however a positive correlation has been found between depressed mood and
recurrence.
In a meta-analysis by Miller and Cohen (2001) of different psychosocial
interventions aimed at improving health it has been found that disclosure
interventions may cause a reduction in antibody titers to Epstein-Barr Virus
(EBV), which is seen as indirect evidence that this intervention can be
beneficial to the body's control over latent Herpes Simplex Virus (HSV)
production.
At first glance it may seem as if a thorough knowledge and understanding of
the theory and practical applications of psychoneuroimmunology proves
invaluable in the promotion of physical well-being, but most of the ideas
associated with this notion are speculation at this stage. Research trying to
link psychosocial factors, immune functioning and the development and
14

outcome of disease has not been conclusive. Psychological interventions also

do not seem to be as effective as it is often proclaimed to be. It does seem
that stress and psychosocial factors affects immune functioning, and it makes
sense that changes in immune functioning will affect health, but research is
lacking to link the complete model. In conclusion more research is probably
needed in order to gain more thorough knowledge and a better understanding
of psychoneuroimmunology before we can determine the effectiveness of this
endeavour.

15

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