Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands,
Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands,
Psychother Psychosom. 2019;88(5):274-286. doi: 10.1159/000501645. Epub 2019 Aug 6.
There is consistent evidence showing an interplay between psychological processes and immune function in health and disease processes.
The present systematic review and meta-analysis aims to provide a concise overview of the effectiveness of stress-reducing psychological interventions on the activation of immune responses in both healthy subjects and patients.
Included are 3 types of challenges: in vivo, in vitro, and psychophysiological. Such challenges are designed to mimic naturally occurring immune-related threats.
A systematic literature search was conducted using PubMed, EMBASE, and PsychInfo, resulting in 75 eligible studies. The risk of bias was assessed with the Cochrane risk-of-bias tool. Across all studies, a small-to-medium effect size was found for the effects of psychological interventions on optimization of the immune function (g = 0.33; 95% CI 0.22-0.43). While the largest effects were found for in vivo immune-related challenges (g = 0.61; 95% CI 0.34-0.88; especially on studies that incorporated skin tests and wound healing), studies incorporating psychophysiological challenges and in vitro immune-related stimulations similarly suggest more optimal immune responses among those receiving stress-reducing interventions (g = 0.28; 95% CI 0.15-0.42).
These findings showed substantial heterogeneity depending on the type of challenge, the study populations, and the intervention types. These data demonstrate support for the effectiveness of stress-reducing psychological interventions in improving immunity in studies that tested immune function by means of incorporating an in vivo,in vitro, or psychophysiological challenge. Future research should more consistently incorporate challenges into the study design to gather more insights in the mechanisms underlying the optimized immune function following a psychological intervention. This is also relevant for clinical practice, as psychological interventions can possibly supplement, or at least partially replace, current drug treatments in various somatic conditions to reduce side effects.
有一致的证据表明，在健康和疾病过程中，心理过程和免疫功能之间存在相互作用。
本系统评价和荟萃分析旨在提供一个简洁的概述，即减轻压力的心理干预对健康受试者和患者的免疫反应激活的有效性。
包括 3 种类型的挑战：体内、体外和心理生理。这些挑战旨在模拟自然发生的与免疫相关的威胁。
使用 PubMed、EMBASE 和 PsychInfo 进行了系统文献检索，共纳入 75 项合格研究。使用 Cochrane 偏倚风险工具评估了偏倚风险。在所有研究中，发现心理干预对优化免疫功能的影响具有小到中等的效应大小（g = 0.33；95%CI 0.22-0.43）。虽然最大的影响是在体内免疫相关挑战中发现的（g = 0.61；95%CI 0.34-0.88；特别是在纳入皮肤测试和伤口愈合的研究中），但同样表明，接受减轻压力的干预措施的人具有更优化的免疫反应，纳入心理生理挑战和体外免疫相关刺激的研究（g = 0.28；95%CI 0.15-0.42）。
这些发现根据挑战类型、研究人群和干预类型显示出很大的异质性。这些数据表明，在通过纳入体内、体外或心理生理挑战来测试免疫功能的研究中，减轻压力的心理干预在改善免疫方面是有效的。未来的研究应更一致地将挑战纳入研究设计，以更深入地了解心理干预后优化免疫功能的机制。这对于临床实践也很重要，因为心理干预可能可以补充，或至少部分替代，各种躯体疾病中的当前药物治疗，以减少副作用。
