Developing Research on PsychoNeuroImmunology (PNI)
Written & Published By Megan “Megz” Roberts
December 9th, 2018
Psychoneuroimmunology (PNI) Informed By Emotional Processes.
The purpose of this literature is to illustrate current research on the interdisciplinary term known as psychoneuroimmunology (PNI) with the effects of health and disease induced by human emotional processes. PNI is the, “bidirectional pathways connecting the influences of brain, neuroendocrine, and immune system” (Tanyi, Arechiga, Berk, & Boyd, 2011, p. 151). Though PNI is unquestionably scientific, the idea for this literature review stemmed from a spiritual assumption and explanation of how deep forces within one’s self can heal any disease or illness present in the body. However, the challenge was knowing, “our systems of health generally do not speak in terms of spiritual forces” (Gaztambide, 2008, p. 14). So, how do I articulate spiritual healing knowledge in a concrete and scientific demonstration? With a positivistic paradigm, I was able to do just that when I connected current scientific evidence of bodily and emotional processes in a way that interprets my spiritual knowledge into scientific evidence. I call it mental regulation, and is a framework to expand upon in the future.
Daniel Siegel in his book called, “The Developing Mind” (2012, 2nd ed.), proposes emotional regulation as a framework to invite resiliency and adaptive capacity into the human experience by regulating the, “intensity, sensitivity, specificity, windows of tolerance, recovery processes, access to consciousness, and external expression” of our emotions (p. 272). Informed by my work with patients diagnosed with posttraumatic stress disorder (PTSD), I believe that my idea of mental regulation involves emotional regulation, as well as addressing cognitive distortions that precede emotional distress and plays an important role in the, “etiology and maintenance of [PTSD]” (Daniels et al, 2011). Emotional distress has many inhibiting factors on the body’s immune system making humans more susceptible to the development of disease and illness (Gaztambide, 2008). William Walker Atkinson (2014) points out, “It is true that the majority of the race are slaves of their emotions and feelings, and are governed by them to a great degree” (section Law of Mental Control, location 765). I understand we can self heal by averting the causation of emotional stress through mental regulation and addressing cognitive distortions. Mental regulation is consciously focusing our attention to internal processes in order to produce desired functioning in the body. In this literature review, I chose to focus on PNI processes in the body and how it is affected by emotional unfolding.
Psychoneuroimmunology
Early History
PNI is the “scientific enquiry into the bi-directional relationship between the psychological and biological processes; and the implications of these relationships for health” (HFS-Halsoframjande Sjukvard, 2013). Kavita Vedhara explains that these findings help to validate the connection from the mind to the body and the body to the mind (HFS-Halsoframjande Sjukvard, 2013). The term psychoneuroimmunology had not been established until 1981 after multiple studies validated that emotions have a direct effect on the immune system (Zachariae, 2009). Before this, researchers believed that the immune system was autonomous and functioned alone (Zachariae, 2009). One of the first studies showed mice became more susceptible to herpes when their immune system shut down after being induced with stress by researchers (Rasmussen, Brill & Marsh, 1957). Another study done on rats in 1975 used Pavlov’s work in classical conditioning to show how illness could be induced through taste by pairing a sweet liquid called saccharin with an immune suppression agent called cyclophosphamide (Ader & Cohen, 1975). What they found was that even though the immune suppression agent was no longer present in the sweet liquid, the rats’ perception of the liquid caused some of them to die instantly when given to them by the researchers (Ader & Cohen, 1975). Perceptions will be explored later in this literature review when we address emotional processes, but it’s worth noting that these studies led researchers to inquire more deeply about the mind and body connection, specifically the connection to the immune system.
PNI Processes
Robert Zachariae (2009) explained that both the brain and the immune system are able to learn and memorize, “through interactions with the environment”, and he further considers the immune system to be the sixth sense of the body (p. 646). Researchers began by first identifying neural connections between the brain and the immune system that allowed this communication to take place (Zachariae, 2009). In their investigation, they discovered a “common biochemical language” between the nervous system and the immune system through neuroendocrine hormones such as neurotransmitters and cytokines (Zachariae, 2009, p. 646). Neurotransmitters are chemical responses that pass on neuronal impulses received from electrical information in the body during internal and external interactions (Siegel, 2012), and cytokines happen to directly affect inflammation, motor responses, and other hormones in the body associated with the autonomic nervous system (ANS) (Miller, Felger, Haroon & Raison, 2013). Scientist discovered that previous knowledge about the immune system functioning in isolation was indeed false, but in reality, it received information from important natural processes in the human body such as the brain and hormones, and is also able to send information back.
The ANS, known as the fight or flight response, is a system that mediates arousal and alertness states in the body, and is located in the lower region of the brain that include the thalamus, for sensory information, the hypothalamus and pituitary, that activate hormonal release for equilibrium in the body, and the adrenal cortex, which responds to stress and controls blood pressure (Siegel, 2012). Three neuronal clusters of the ANS, the hypothalamus, pituitary, and adrenal cortex, is also known as the hypothalamic-pituitary-adrenocortical (HPA) axis, and is “adversely affected by trauma” (Siegel, 2012, p. 17). It can as well negatively impact the ways which one responds to stressors, such as motor activity and emotional states (Siegel, 2012). Above the ANS structure of the brain in the central region, is the hippocampus and amygdala that coordinate activity in the rest of the brain such as emotions, motivation, memory and appraisal of meaning (Siegel, 2012). Remembering that both the immune system and the brain are capable of learning, here, scientist are beginning to understand that the natural processes involved in the communication from the brain to the immune system incorporates learned responses from individualized perception of stress and trauma. This means the immune system reacts to internal and external stressors inclusive of touch, sound, taste, smell, sight, and memory.
Immune System and Stress. “Interactions between the immune and nervous system play an important role in modulating host susceptibility and resistance to inflammatory disease” (Sternberg, 2001). The HPA axis serves as a physiological feedback loop between the immune system and ANS (Sternberg, 2006). The ANS is made up of two other systems: the sympathetic nervous system (SNS), which is responsible for stimulating stress responses such as increasing the heart rate to circulate more blood and oxygen throughout the body, and the parasympathetic nervous system (PNS), which activates a relaxation response in the body, like decreasing the heart rate (Sternberg, 2006). When the SNS becomes stimulated by emotional responses from the central region of the brain, being the hippocampus and amygdala, (Mandal, 2018), the hypothalamus is then activated to release corticotrophin releasing hormones (CRH) that then releases adrenocorticotropin hormones (ACTH) from the pituitary glands (Sternberg, 2001). ACTH next activates the secretion of glucocorticoids, cortisol for example, and catecholamines, such as adrenaline and dopamine, from the adrenal cortex (Tanyi et al., 2011). High levels of these stress hormones are shown to increase inflammation and suppress the immune system (Zachariae, 2009) in order to preserve energy for this stress response in the SNS (Gaztambide, 2008). What is being made clear here is how the immune system begins to shut down during perceived stressful events.
The immune system is made up of white blood cells (WBC) and antibodies that defend against intruders, such as bacteria or infections, in the body (Trakhtenberg, 2008). In his research, Ephraim Trakhtenberg (2008) finds that psychological and physical stressors on and in the body shuts down the functioning of the immune system and also reduces the amount of these WBC and antibodies circulating in the blood. This means that, not only is inflammation occurring, but the body is also at an increased risk for infection and disease during stressful situations in part of a suppressed immune system. However, this response by the ANS and immune system does create increased reactivity and conditionability to fight against future intrusions or stressors making the immune system stronger, a concept called allostasis, or, “the processes involved in the adaptive responses to stressful situations” (Zachariae, 2009, p. 647). After a stress response, the PNS system kicks in to relax the body and the immune system rapidly releases an increased amount of WBCs to reduce inflammation and fight against intruders in the body, working to alleviate symptoms of pain and fatigue in the bidirectional communication to the brain (Khanfer, 2011).
In contrast, constant and prolonged activation of stress induced hyperarousal states is associated with nervous system malfunctioning and an autoimmune response where the body begins to attack itself, interpreting its own tissues as the intruders (Zachariae, 2009). Moreover, stress, for one, automatically reduces neural signaling in the prefrontal cortex (PFC) of the brain, which is our rational thinking section and most evolved region of the brain (Arnsten, 2009). Not only is stress impacting our ability to think rationally, but chronic and uncontrollable acute stressors, “cause rapid and dramatic loss of”, cognitive abilities and, “architectural changes in prefrontal dendrites” (Arnsten, 2009, para. 1). “Taken together, these studies indicate that a fine balance of [stress response hormones] is required for maintenance of immune homeostasis, and to avoid excessive immunosuppression and death from overwhelming infection” (Sternberg, 2006, para. 18). A balance is also necessary to keep disease and illness out of the body (Sternberg, 2006). It also shows that healing takes place when the PNS is activated during relaxed states but inhibited during stressful times.
Stress responses involve emotional processing; the next section intends to break down what exactly emotions are, how we discern them from feelings, and how our learned emotional processes produce stress responses, leaving our bodies vulnerable to adverse health outcomes.
Emotional Processing
Emotions vs. Feelings. As presented above, Daniel Gaztambide (2008) states, “the brain and the body are connected by the feedback mechanism underlying emotions and feelings” (p. 6). The limbic region, or the central portion of the brain where the hippocampus and amygdala live, “is specialized to carry out the appraisal of meaning or value of stimuli” and translates them into emotions that lead to feelings (Siegel, 2012, p. 147). Siegel (2012) further suggests that emotions are ubiquitous as emotional processing happens during cognitive processes, and intra and inter-personal relationships. Emotional processing is the process of physiological assessments in the body through neurotransmitters and hormones, that evaluate stimuli, and produce chemical and physical effects mapped into certain areas of the brain called emotional states (Gaztambide, 2008). As these bodily reactions occur, our perceptions of them are what we call feelings (Gaztambide, 2008). Feelings are mental ideas of what we feel physiologically, constituted by beliefs, memories, thoughts and personal experiences, and they can also exist without conscious awareness (Siegel, 2012). Daniel Gaztambide (2008) illustrates this process in his article:
[W]hen we perceive an object that irritates us—that makes us angry—there is a delicate feedback process between the external object and our internal world. Anger begins with the actual physiological changes that take place during the emotion: the tension of the muscles, an increase in blood pressure and heart rate, and increases in cortisol [. . .]. This state of the body is then mapped in the brain via a variety of neural patterns that come together to constitute an image of what the body looks like during the emotion anger [. . .]. The emotion anger leads to the feeling of anger: we thus become aware that we are angry. (p. 5)
The evaluation of our feelings comes from our learned experiences of what stress and trauma feel and look like (Siegel, 2012). Our process of evaluation can either be within our conscious awareness, and other times outside of our awareness. The initial physiological assessment, as researchers and scientist are beginning to discover in the field of PNI, is a significant key to controlling stress responses.
Learned Stress Response
“Stress, a psychophysiological state that occurs as a result of the body responding to real or imagined threats, is considered a risk factor for [contributing] to physiologic consequences such as hyperarousal or fatigue, centrally mediated increases in pain and compromised immune function” (Menzies, Elswick, Gray, Lyon, McCain, 2012, p. 71). “Events become traumatic [or threatening] because they are consciously or unconsciously perceived as being horrendous, ontologically destabilizing, and so on” (Breslau &Young, 2015, p. 137). Breslau and Young (2015) explains stress requires a subjective contribution and interpretation of an experience or event. Subjective contribution stems from memory stored in our body. Memory is a collection of encoded past events and internal and external sensory experiences seen in the body as web-like neural networks that create our reality (Siegel, 2012). When the neural networks fire, or when neurotransmitters send impulses through synaptic connections between neurons, a process called “retrieval” or “remembering” happens and informs how we behave and respond to intrapersonal and interpersonal stimuli; this informs our current or future behavioral patterns (Siegel, 2012). Research is showing how stress responses are learned and patterned behaviors that are a result of remembering past experiences, sparked by memories inhabiting the body consciously or unconsciously. This means our subjective reality, or our perception of our experiences, initiates internal processes that affect our immune system’s ability to function.
Research Results
Researchers have taken the above information to see how subjective experiences can impact the immune functioning and other bodily processes. For example, a quantitative study done on adult women with fibromyalgia showed a significant decrease in depression levels and bodily pain after they had participants listen to guided imagery tracks for 10 weeks (Menzies et al., 2012). The guided imagery tracks took them through a journey in their immune system and they were paired with relaxation techniques (Menzies et al., 2012). They found that by altering perceived stress and consciously directing awareness to the immune system, the women were able to experience less pain, fatigue and depressive symptoms (Menzies et al., 2012).
Another quantitative study done on medical students at exam time showed up-regulated immune functioning, improved mood, and decreased levels of depression and anxiety when they provided self-hypnosis training to the students and had them imagine mental images of the immune system in a relaxed state (Gruzelier, 2001). They also encouraged biofeedback activity, meaning actively controlling bodily functions (Gruzelier, 2001). This discovery informed PNI researchers that not only can healing be induced with relaxation and imagery, but that healing processes can also be controlled and directed by the mind.
In 2017, researchers decided to explore this idea of directing bodily processes when they studied a group of hotel maids who considered themselves to have no regular physical activity and told the participants that their work was high in activity and exercise (Crum & Langer, 2017). Four weeks later, researchers found that the maids had a decrease in body fat, lowered their blood pressure and lowered their body mass index (BMI) (Crum & Langer 2017). By altering the maids’ mental perceptions of exercise, they produced exercise related results without changing their daily routines.
There are many studies around PNI that researchers have explored with guided imagery, hypnosis, the Bonnie-Method (Heiderscheit, 2017), and vaccination coherence (HFS-Halsoframjande Sjukvard, 2013), that are not fully covered in this literature review. Although, it’s worth noting that similar results were found and showed how the PNI process indeed has an affect on the health outcomes people through emotional processes.
Conclusion
PNI is the bidirectional feedback loop between the brain, endocrine and immune system. A stimuli is introduced to the body sending impulses and information to the hippocampus and amygdala sections of the central brain region. The physiological assessment causes chemical and physical reactions to take place in the body called emotions, and they can happen consciously or unconsciously. These emotional states become interpreted as feelings relative to the person’s past experiences and current perceptions. If the feeling is perceived to be in response to stress, the brain sends signals to the HPA axis of the SNS. From there, stress response hormones are activated to prepare the body for fight, flight or other stress responses patterned in the body, and the immune system is momentarily suppressed. At this moment, the body becomes susceptible to disease, sickness and illness, as the body is unable to defend against intruders or fight against inflammation. Shortly after the stress response has returned to a relaxed state via the PNS, the immune system rapidly releases WBCs and antibodies into circulation to eventually return the body to homeostasis. Occasional stress responses help condition the immune system for future stressors or traumatic events. However, chronic stress and trauma can result in a malfunctioning immune system and can also lead to disease, illness or death.
The motivation for this literature originated from a spiritual perspective of healing disease and illness rather than managing it. Information gathered on PNI helped to concretely present my spiritual knowledge into scientific demonstrations. Healing through PNI is not restricted to any one type of person, regardless of skin, ability or class, and that’s what makes it so potentially powerful. With mental regulation, I believe that by addressing cognitive distortions and thoughts that proceed emotional processing, we can control PNI processes in order to heal. However, there is more research to be done and more information to gather.
I end this literature with guiding questions for future research. PNI processes deal a lot with the body and the mind, so how can this be introduced and practiced within the dance/movement therapy field? How can guided imagery be incorporated into dance/movement therapy groups? What are the limits or the risk of using guided imagery will ill adults, such as those diagnosed with dementia or schizophrenia? What trainings or certifications are necessary to train participants with self-hypnosis or guided imagery techniques? Research demonstrates these techniques can reduce negative symptoms, but can it actually heal, or rid, the body of a disease, illness, or sickness?
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References
Arnsten, A. F. T. (2009). Stress signaling pathways that impair prefrontal cortex structure and function. Nat Rev Neuroscience, 10(6), 410-422. doi: 10.1038/nrn2648
Atkinson, W.W. (2014). Law of mental control, Thought vibration: Or the law of attraction in the thought world. (1st Ed.). Floyd, VA: Sublime Books.
Breslau, N., Young, A. (2015). What is PTSD? The heterogeneity thesis. Culture and PTSD: Trauma in Global and Historical Perspective, 135-154.
Crum, A. J., Langer, E. J. (2007). Mind-set matters: Exercise and the placebo effect. Psychology Science, 18(2), 165-171. doi: 10.1111/j.1467-9280.2007.01867.x
Daniels, J. K., Coupland, B. H., Hegadoren, K., Lanius, R. A., Neufeld, R. W. J., Rowe, B. H. (2011). Cognitive distortions in acutely traumatized sample: an investigation of predictive power and neural correlates. Psychological Medicine, 41, 2149-2157. doi: 10.1017/S0033291711000237
Gaztambide, D. J. (2008). Psychoneuroimmunology and jesus healing miracles. In J Harold Ellens (Ed.), Miracles: God, Science, and Psychology in the Paranormal. (Vol. 2, 94-113). Westport, CT: Praeger.
Gruzelier, J. H. (2001). A review of the impact of hypnosis, relaxation, guided imagery, and individual differences on aspects of immunity and health. Stres, 5(2), 147-163. doi:10.1080/10253890290027877
Heiderscheit, A. (2017). The effects of the Bonnie Method of guided imagery and music on interpersonal problems, sense of coherence, and salivary immunoglobin a of adults in chemical dependency treatment. Music & Medicine, 9(1), 24-36
HFS-Halsoframjande Sjukvard (2013). Prof Kavita Vedhara PNI-psychoneuroimmunology. Retrieved from https://www.youtube.com/watch?v=wwpZUG8BDgeQ&t=20s
Khanfer, R. S. (2011). Psychological stress and neutrophil function. (Published dissertation). The University of Birmingham, United Kingdom.
Mandal, A. (2018). What is the hypothalamus?. Retrieved from https://www.news-medical.net/health/What-is-the-Hypothalamus.aspx
Menzies, V., Elswick, R. K., Gray, D. P., Lyon D. E., McCain, N. L. (2012). Effects of guided imagery on biobehvaioral factors in women with fibromyalgia. J Behav Med, 37, 70-8. doi: 10.1007/s10865-012-9464-7
Miller, A. H., Felger, J. C., Haroon, E., Raison, C. L. (2013). Cytokine targets in the brain: Impact on neurotransmitters and neurocircuits. Department of Psychiatry and Behavioral Sciences, 30(4), 297-306. doi: 10.1002/da.22084
Rasmussen, A. F., Brill, N. Q., Marsh, J. T. (1957). Increased susceptibility to herpes simplex in mice subjected to avoidance-learning stress or restraint. National Institute of Mental Health, 96(1), 183-189 https://doi.org/10.3181/00379727-96-23426
Siegel, D. (2012). The developing mind: How relationships and the brain interact to shape who we are (2nd ed.). New York, NY: The Guilford Press.
Sternberg, E. M. (2001). Neuroendocrine regulation of autoimmune disease. Journal of Endocrinology, 169, 429-435. doi: 10.1677/joe.0.1690429
Sternberg, E. M. (2006). Neural regulation of innate coordinated immunity: A nonspecific host response to pathogens. Nat RevI Immunology, 6(4), 318-328. doi: 10.1038/nri1810
Tanyi, R., Arechiga, A., Berk, L. S., & Boyd, K. (2011). The effects of a psychoneuroimmunology (PNI) based lifestyle intervention in modifying the progression of depression in clinically depressed adults. Int’l J. Psychiatry in Medicine, 42(2), 151-166. doi: 10.2190/PM.42.2.d
Trakhtenberg, E. C. (2008). The effects of guided imagery on the immune system: A critical review. International Journal of Neuroscience, 118, 839-855. doi: 10.1080/002074507001792705
Zachariae, R. (2009). Psychoneuroimmunology: A bio-psycho-social approach to health and disease. Scandinavian Journal of Psychology, 50, 645-651. doi: 10.1111/j.1467-9450.2009.00779.x
