UNIT II – STRESS AND THE IMMUNE SYSTEM

STRESS

What is stress?
Stress is a negative emotional experience accompanied by predictable biochemical,
physiological, cognitive, and behavioral changes that are directed either toward altering the
stressful event or accommodating to its effects.

What is a stressor?
The stressful events which cause the stress to a person are called stressors. Such events
include noise, crowding, a bad relationship, a round of job interviews, or the commute to
work.

A stressful experience may be stressful to some people but not to others. How a potential
stressor is perceived determines whether it will be experienced as stressful.
• If the ‘noise’ is the radio playing devotional songs, then it will be perceived stressful
to you and not to your mum.
• Whereas one person might find the loss of a job highly stressful, another might see it
as an opportunity to try a new field, as a challenge rather than a threat.

Person-environment fit
Lazarus defined stress as “a particular relationship between the person and environment that
is appraised by the person as taxing his resources and endangering his well being”.
Lazarus and Launier regarded stress as a transaction between people and the environment.
Stress is the consequence of a person’s appraisal processes; the assessment of whether
personal resources are sufficient to meet the demands of the environment.
• When a person’s resources are more than adequate to deal with a difficult situation, he
or she may feel little stress and experience a sense of challenge instead.
• When the individual perceives that his or her resources will probably be sufficient to
deal with the event but only at the cost of great effort, he or she may feel a moderate
amount of stress.
• When the individual perceives that his or her resources will probably not suffice to
meet an environmental stressor, he or she may experience a great deal of stress.

Stress, then, results from the process of appraising events (as harmful, threatening or
challenging), of assessing potential responses, and of responding to those events.

Theoretical contributions to the study of stress

Cannon’s fight or flight model of stress

One of the earliest contributions to stress research was Walter Cannon’s description of the
fight-or-flight response. Cannon proposed that, when an organism perceives a threat, the
body is rapidly aroused and motivated via the sympathetic nervous system and the endocrine
system. The responses include:
• Heart rate increase
• Blood pressure increase
• Blood sugar increase
• Respiration increase
• Decrease in the circulation of blood to the skin
• Increase in the circulation of blood to the muscles
This concentrated physiological response mobilizes the organism to attack the threat or flee,
hence it called the fight or flight response.

• At one time, fight or flight literally referred to fighting or fleeing in response to

stressful events such as an attack by a predator.
• Now more commonly fight refers to aggressive responses to stress, whereas flight
may be seen in social withdrawal or withdrawal through substance use such as alcohol
and drugs.
• On the one hand, the fight or flight response is adaptive because it enables the
organism to respond quickly to threat.
• On the other hand, it can be harmful because threat disrupts emotional and
physiological functioning, and when stress continues unabated, it lays the groundwork
for health problems.

❖ A research by Wolf and Wolf:

Due to some health issues, Tom was fitted with an opening in the stomach to drain out
hydrochloric acid. This also enabled him to observe the changes in the lining of his
stomach in accordance to his emotions and stressful incidents.
When Tom was in a balanced state, the lining of the stomach was pale – not much
blood rushing to that part. Also acid secretion was low.
However, when Tom was angry/ anxious, the lining of the stomach became red, along
with high acid secretion.
Therefore intense anger can lead to hemorrhages, which can lead to ulcers. Prolonged
stress causes wear and tear of the body and can cause specific illness depending on
which body organ is vulnerable. (For example, some people develop ulcers, others
have high blood pressure, yet others develop respiratory disorders).

Selye’s General Adaptation Syndrome

Hans Selye is called the father of modern stress research. He exposed rats to a variety of
stressors – such as extreme cold and fatigue – and observed the physiological responses.
• He found that all stressors, regardless of type, produced essentially the same pattern
of physiological responding.
• In particular they all lead to an enlarged adrenal cortex, shrinking of the thymus and
lymph glands, and ulceration of the stomach and duodenum.
According to him, when an organism is faced with prolonged stress there are a number of
physiological changes that take place, which he explained through his concept of General
Adaptation Syndrome.
It is general: as a variety of stressors have the same general effects on the body.
It is adaptive: because it starts off the defense process in the body to restore equilibrium.
It is a syndrome: because the various components of the response occur as a pattern.

The general adaptation system consists of three phases:

1. Alarm Reaction: Here the body prepares to tackle the stressor through the arousal of
the sympathetic nervous system and the endocrine system. Hormones are released by
the adrenal glands on the command of the nervous system. Glucose levels increase
giving much needed energy to the body. These changes help the person tackle the
stressor.
2. Stage of Resistance: This is the stage where the body tries to defend against or adapt
to the stressor with the help of the resources mobilized in the previous stage. The
adrenal glands continue to release hormones. The body is prepared to face the
stressful situation. The digestive system and the immune system have shut down, so
that the external threat can be met. In this stage outward signs of stress are rare.
However, the organism will be vulnerable to various health problems like ulcers, high
BP, asthma if this stage continues without time for recovery.
3. Exhaustion: If the stressor continues, it depletes the body’s energy resources and
weakens the immune system. The stage of exhaustion sets in. The body can no longer
cope with the stress. If the stressor continues unabated, it may result in various
diseases and even death (too much wear and tear of the system).

Impact of Selye’s model in the field of stress:

• It offers a general theory of reactions to a wide variety of stressors over time.
• It provides a way of thinking about the interplay of physiological and environmental
factors.
• It emphasizes the physiological mechanism in the stress-illness relationship.
Specifically, repeated or prolonged exhaustion (the third phase of the syndrome) is
responsible for the physiological damage that lays the groundwork for disease (such
as cardiovascular disease, arthritis, hypertension, immune-related deficiencies).

Criticism of the General Adaptation Syndrome:

1. Its assigns a very limited role to psychological factors, and researchers now believe
that the psychological appraisal of events is important in the determination of stress.
2. The theory assumes that responses to stress are uniform. However, there is evidence
that not all stressors produce the same endocrinological responses.
3. Moreover, how people respond to stress is substantially influenced by their
personalities, perceptions, and biological constitutions.
 4. The theory assesses stress as an outcome, such that stress is evident only when the
general adaptation syndrome has run its course. However, people experience many of
the debilitating effects of stress while a stressful event is going on and even in
anticipation of its occurrence.

The three phases of Selye’s General Adaptation Syndrome:

Normal level
Of resistance

A Alarm B Resistance C Exhaustion

• Phase A is the alarm response, in which the body first reacts to a stressor. At this time
resistance is diminished.
• Phase B, the stage of resistance, occurs with continued exposure to a stressor. The
bodily signs associated with an alarm reaction disappear and resistance rises above
normal.
• Phase C is the stage of exhaustion the results from long-term exposure to the same
stressor. At this point, resistance may fall again to below normal.

Tend and Be-friend Theory:

Taylor and her colleagues propose that rather than fighting or fleeing, women may respond to
stress by tending to themselves and their young and befriending others.
Although fight or flight may describe the primary psychological responses to stress for both
males and females, it is argued that females’ responses are characterized more by a pattern of
tend-and-befriend.
• They respond to stressful situations by protecting themselves and their young through
nurturing behaviors – the ‘tend’ part of the model.
• They also form connections with a large social group – the ‘befriend’ part of the
model.
The proponents of this model suggest that women may have developed a completely different
system of coping with stress, mainly because their responses evolved while being the primary
caregivers of their children.

Support for this theory comes from research into the neuroendocrine responses responsible
for fight or flight.
 • In terms of the fight response, while male aggression appears to be regulated by
androgen hormones, such as testosterone, and linked to sympathetic reactivity and
hostility, female aggression is not. It appears that female aggression appears to be
moderated by social circumstances, learning, culture and the situation.
• In terms of flight, fleeing too readily at any sign of danger would put a female’s
offspring at risk, a response that might reduce her reproductive success in
evolutionary terms.

Studies on rats show that there is a physiological response to stress in women (the release of
oxytocin) which enhances relaxation, reduces fearfulness and decreases the stress responses
typical to the fight-or-flight response.
Some studies have that found that mothers tend to be more nurturing and caring towards their
young when they are most stressed.
As for the idea of ‘befriending’ when stressed, it has been observed that women are much
more likely to seek out and use social support in all types of stressful situations, including
health-related concerns, relationship problems and work-related conflicts.

Psychological appraisal of stress

Both Cannon and Selye conceptualized stress as an automatic response to an external

stressor. Another approach to stress would be that which includes an individual who no
longer simple passively responds to stressors but actively interacts with them. This approach
to stress provides a role for an individual’s psychological state and is epitomized by
Lazarus’s transactional model of stress and his theory of appraisal. In humans, psychological
appraisals are an important determinant of whether an event is responded to as stressful.
Cognitive appraisal is a mental process by which people undergoing stress assess two factors:
Whether the stressor threaten their well-being (primary appraisal)
What are the resources available to tackle the stressor (secondary appraisal).

Primary Appraisal Processes

Lazarus maintains that, when individuals confront a new or challenging environment, they
engage in a process of primary appraisal to determine the meaning of the event.

Events may be perceived as the following in their consequences:

1. Positive
2. Neutral
3. Negative: Negative or potentially negative events are further appraised for their
possible harm, threat or challenge.
a) Harm: Harm is the assessment of the damage that has already been done by an event.
• Thus for example, a man who has just been fired from his job may perceive present
harm in terms of his own loss of self esteem and his embarrassment as his co workers
silently watch his pack up his desk.
 b) Threat: Threat is the assessment of possible future damage that may be brought about
by the event.
• Thus the man who has just lost his job may anticipate the problems that loss of
income will create for him and his family in the future.
• When we appraise events as high threats, it has an important effect on the
physiological response; such as increase in blood pressure.
c) Challenge: Finally negative events may be appraised in terms of their challenge, the
potential to overcome and even profit from the event.
• For example, the man who has lost his job may perceive that a certain amount of harm
and threat exists, but he may also see his unemployment as an opportunity to try
something new.
• Challenge appraisals are associated with more confident expectations of the ability to
cope with the stressful event, more favorable reactions to the event, and lower blood
pressure.

Study on the primary appraisal and its effect on the experience of stress:
The importance of primary appraisal in the experience of stress is illustrated in a classic study
of stress by Speisman, Lazarus, Mordkoff, and Davidson (1964).
College students viewed a gruesome film depicting unpleasant tribal initiation rites that
included genital surgery. Before viewing the film, they were exposed to one of four
experimental conditions:
Group 1: One group listened to an anthropological account about the meaning of the rites.
Group 2: Another group heard a lecture that gave an account of the excitement the initiates
underwent while undergoing the surgery. They did not emphasize the pain which the surgery
called for.
Group 3: A third group heard a description that emphasized the pain and trauma that the
initiates were undergoing.
Group 4: The fourth group was given no introductory information, and the film they viewed
had no sound track.
• Measures of autonomic arousal such as heart rate, blood pressure and self reports of
stress were taken.
• It was found that the first two groups experienced considerably less stress that did the
second two groups whose attention was focused on the trauma and pain.
• Thus this study illustrated that stress not only was intrinsic to the gruesome film itself,
but also depended on the viewer’s appraisal of it.

Secondary Appraisal Processes:

At the same time that primary appraisals of stressful circumstances are occurring, secondary
appraisal is initiated.
Secondary appraisal is the assessment of one’s coping abilities and resources and whether
they will sufficient to meet the harm, threat, and challenge of the event.
• When the demands of the stressor are high and the person feels his/ her resources are
low, substantial stress is felt.
 • If coping resources are high, less stress is experienced.
Ultimately, the subjective experience of stress is a balance between primary and secondary
appraisal.

The experience of stress

Primary appraisal:
Is the event positive, neutral, or negative in
its implications? If negative, to what extent
is it presently harmful, threatening for the Stress:
future, and potentially challenging? Physiological,
cognitive,
Potential stressor: emotional, and
(External event) behavioral
responses
Secondary appraisal:
Are coping abilities and resources sufficient
to overcome the harm, threat or challenge
posed by the event?

Responses to stress

When faced with a stressful situation there are physiological, cognitive, emotional, and
behavioral changes that take place. Some of these responses are involuntary reactions to
stress, whereas others are voluntarily initiated in a conscious effort to cope.

Physiological changes:
Physiological changes take place when confronted with a stressor because the body is looking
for energy to meet the threatening situation. The body believes that any stressful threat can be
confronted by running, fighting, scaring the “adversary” away, thus the body simply needs
energy for physical activity.
1. First, the sympathetic nervous system gets activated and the following changes occur:
• Heart rate increases
• Blood flows with greater pressure
• Muscles receive more blood supply
• Respiration rate increases to provide more oxygen to the body
• Pupils of the eye dilate
• More sugar is synthesized for energy
• Digestion decreases

2. The nervous system also activates the endocrine system.

 • Specifically, the hypothalamus stimulates the pituitary gland, to release
adrenocorticotropic hormone (ACTH) into the blood.
• ACTH stimulates the adrenal glands, which in turn release the catecholamines –
epinephrine and norepinephrine (also called adrenalin and noradrenalin).
• Adrenalin sustains the changes that were initiated by the sympathetic system.

3. The pituitary gland also releases peptides that activate the immune system in response
to stress.

4. After the emergency has passed, the body has to come back to a normal level of
functioning – homeostasis. This is done by the parasympathetic system which does
the following functions:
• Slows the heart rate
• Brings breathing back to normal
• Constricts the pupil
• Increases the activity of the digestive system
• Blood is circulated back from the muscles to the inner organs
Noradrenalin and a hormone called cortisol (also released by the adrenal glands) help
this process of restoring the body to equilibrium.

Cognitive responses:
• Cognitive responses to stress include beliefs about the harm or threat an event poses
and beliefs about its causes or controllability.
• Cognitive responses include involuntary responses to stress, such as distractibility,
lowered concentration, lowered attention and memory deficits.
• Thoughts which are usually repetitive and negative, such as, “these things happen
only to me”, “I am no good”, “nobody cares for me”, etc. are also part of the cognitive
response.
• Cognitive responses are also seen in the coping activities of stress. For example, the
way an individual plans out a strategy to cope with the situation (task oriented,
defense oriented).

Emotional responses:
Potential emotional reactions to stressful events range widely; they include fear, anxiety,
excitement, embarrassment, anger, depression, disgust, distress and even stoicism and denial.
Emotional responses can be quite insistent, prompting rumination over a stressful event,
which in turn may keep biological stress responses elevated. We shall look into three of these
emotional responses.
a. Fear: A very common reaction to stress, it has both physiological and psychological
consequences. Fear may include:
• Phobia: Intense and irrational fears associated with a specific event, e.g.,
claustrophobia – fear of being enclosed in small spaces.
 • Anxiety: Vague feelings of uneasiness, often very unspecific (the person suffering
from anxiety will be unsure regarding the cause of his suffering and the consequences
of the situation)

b. Depression: This is a feeling of sadness, which can be temporary or long-lasting. If it

is severe, frequent and long lasting, it is considered a psychological disorder,
symptoms of which may include:
• Being sad all the time
• Feeling of hopelessness
• Having low self esteem
• Persistence of guilt feelings
• Appear unenthusiastic
• Disruption of eating and sleeping habits

c. Anger: A reaction common to stressful and frustrating situations, it can lead to

aggressive behavior.

Behavioral responses:
Potential behavioral responses are virtually limitless, depending on the nature of the stressful
event, and the nature of the person undergoing stress. Two general categories of behavioral
responses include:
• Confrontative action against the stressor (fight)
• Withdrawal from the threatening event (flight)

THE IMMUNE SYSTEM

What is the immune system?

1) It is the surveillance system of the body
2) It guards against infections, allergies, cancer and autoimmune diseases.
3) It’s primary function is to recognize and distinguish between what is ‘self’ and what is
‘not self’ (foreign) and then to attack and get rid of the foreign invaders.

Parts of the immune system

The immune system consists of organs and structures that protect the body against harmful
substances like bacteria, viruses and fungi.
The organs of the immune system are called as lymphatic or lymphoid organs, of which the
important ones are:
• Bone marrow: soft tissue inside the bone
• Thymus: gland located in the chest
• Lymph nodes: bean shaped spongy tissue on the neck, armpits, abdomen, groin
• Spleen: upper left side of a person’s abdomen
• Tonsils
 • Appendix
• Peyer’s patches: in the intestine

When is the immune system activated?

The immune system is activated when an antigen enters the body.

What is an antigen?
An antigen is a foreign substance that is harmful and may cause disease. There are four types
of antigens:
1) Bacteria: Some bacteria grow rapidly and compete with our body cells for
nourishment. They also produce toxins to destroy our body cells, resulting in diseases
like TB, cholera etc
2) Fungi: Some fungi cause diseases like ringworm, athlete’s foot – through direct
contact.
3) Protozoa: They are one-celled animals living in water/ insects causing diseases like
amoebic dysentery or malaria.
4) Virus: These attach to cells and take over by assuming their own commands, causing
diseases like influenza, measles, polio etc.

Who are the soldiers of the immune system?

The WBC found in the bone marrow are the soldiers of the immune system?

What happens when an antigen attacks our body? How does the immune system react
to an antigen?
• The first line of defense is skin, saliva, stomach acid etc.
• If it gets past these – phagocytes and B cells (humoral level) attack the antigen by
producing antibodies before it reaches the cellular level.
• If it gets past these also, the cytotoxic T aided by the Helper T attack the antigens,
weaken it, and make it available for the phagocytes to ingest.
• The suppressor T commands the immune system to stop acting after the threat is over.

Assessing immunocompetence

There are many potential indicators of immune functioning. Some general approaches have
been used.

1. Measuring the number of different kinds of cells in the immune system by looking at
blood samples
• Here the number of T, B and NK cells are counted.
• The amount of circulating antibody levels in the body is assessed.

2. Assessing the functioning of immune cells

 This involves assessing the activation, proliferation, transformation and cytotoxicity
of cells.
Common assessments include:
• Ability of lymphocytes to kill invading cells (lymphocyte cytotoxicity)
• Ability of lymphocytes to reproduce when artificially stimulated by a chemical (B
cells reproduction into plasma cells and memory cells)
• Ability of certain WBC to ingest foreign particles (phagocytotic activity).

3. Assessing the degree to which an individual produces antibodies to a latent virus.

All of us carry around inactive viruses in our bodies. However if our body begins to
produce antibodies to the inactive viruses, this indicates that the immune system is not
working properly to control these latent viruses.

4. Producing antibodies to a vaccine

When people have received vaccination for a particular disorder, the degree to which
the body is able to produce antibodies to the vaccine is a sign of good functioning.
It has been observed that those who were exposed to high stress, subsequent to
vaccination showed inadequate antibody titre.

5. Examination of wound healing

Wound heal faster when the immune system is working vigorously. It has been noted
that psychological distress impairs the inflammatory response that initiates the wound
repair.

When indicators such as these (1-5) suggest that the immune system is working effectively, a
state of immunocompetence is said to exist.
When these indicators (1-5) suggest that immune functioning may have been disrupted or
reduced below a normal level, a state of immunocompromise is said to exist.

Psychoneuroimmunology

Definition: PNI refers to the interactions among behavioural, neuroendocrine, and

immunological processes of adaptation. PNI has lead to discoveries such as the existence of
an association between emotional state and the success of the immune system in fighting
disease.
This perspective provides a scientific basis for the ‘mind over matter’, ‘think yourself well’,
‘positive thinking, positive health’, approaches to life.

Stress and immune functioning.

Different kinds of stressors create different demands on the body, and different effects on the
Immune system.
 A. Short term stressors

Any short term stressor, for example a wound, or being called upon in class, produces a fight
or flight response. It elicits immune responses:
• that anticipate risk of injury
• Possible entry of infectious agents into the blood stream.

In a short term stress scenario:

• There is upregulation of non specific immunity
• There is downregulation of specific immunity (as this is slow to develop and not
useful in short term stressors).

B. Brief stressors of several days’ duration

Such stressors like preparing for an exam, or a wedding show different patterns in the
immune system.
• They do not alter number of cells in the blood.
• They mobilize immune functioning, particularly changes in cytokine production. Thus
there is a shift from humoral immunity toward cellular immunity.

Thus we see that short term challenges in real life, actually mobilize the immune system to
fight off invaders.

C. Chronically stressful events

Such events like living with a disability, being unemployed, having a highly stressful job, all
cause the downregulation of both cellular and humoral immunity.

Why does chronic stress have a negative impact on health?

Chronic stress affects health in two ways:

A. Directly by affecting the body’s physiology

1. Through the glandular system:
• When a person is under stress, the sympathetic nervous system kicks into action,
which in turn activates the glands. The release of catecholamines and cortisol by the
endocrine system is to prepare the body for an emergency situation. However, chronic
stress makes for high levels of these hormones to circulate in the blood, which causes
the heart beat to be erratic.
• These hormones circulating in the blood for long periods cause growth of plaques –
fatty patches—on the walls of arteries. This increases BP and the likelihood of stroke.
2. Stress also increases acid secretion in stomach causing ulcers
3. Increase in catecholamines causes kidney disorders.
4. Cortisol released in stress also affects the functioning of the immune system by:
 • Reducing the number of WBC
• Affecting the functioning of lymphocytes
• Reducing release of cytokines.
All this reduces the body’s ability to fight against antigens, leading to illness.

B. Indirectly by influencing a person’s behavior

People experiencing stress may indulge in behaviors, which increase the chances of falling
sick.
1. Smoking:
A number of studies show how with increase in stress, persons take to smoking for the
purpose of relief. However, smoking in turn causes deterioration in health
2. Alcohol:
There are theories which suggest that people drink alcohol for its tensions reducing
properties. Depresses and anxious people drink more, causing deterioration of health.
3. Eating:
Stress may cause over eating in some, and under eating in others. Either way causes
deterioration of our body’s health.

Coping Resources as Moderators of the Stress-Immune functioning Relationship

We have seen the connection between stress and illness. Can these adverse effects be reduced
or moderated by certain coping methods? Let us examine a few.

1. Protective effects of Social Support

Social support is generally used to refer to the perceived comfort, caring, esteem or help one
individual receives from others. There are different kinds of social support: esteem support,
information support, social companionship and instrumental support. Emerging evidence
suggests a potentially important role of social support in buffering people against adverse
immune changes in response to stress.

a. Levy et al (1990) studied breast cancer patients.

They observed that perceived social support buffered NK cell activity in response to stress.
The tendency to seek support and the perception that one had good emotional support from
one’s spouse, from an intimate other, or from physician were associated with high NK cell
activity.

b. Jemmott and Magloire (1998) studied students going through the stress of final
exams.
They observed that students who reported stronger social support had higher levels of
antibody response for warding off respiratory illness.

2. Optimism
Optimism is the general tendency to expect positive outcomes. Research suggests:
 • Optimists cope with stress in more adaptive ways than pessimists.
• They are more likely to engage in action oriented problem solving techniques, than
pessimists who use more of avoidant coping methods.
• Optimists are more likely to seek social support and are more positive in their
appraisal of stressful events.
• They are also less likely to give up when faced with a stressful situation.
Segerstrom and colleages (1998) studied 90 first year law students. They tested them at the
beginning of the school year and then halfway in the first semester. They were given
questionnaires regarding how they coped with stress of law school, and blood was also drawn
for an assessment of immune measures. Results were as follows:
• Pessimism, avoidance coping and mood disturbance lead to less NK cell cytotoxicity,
fewer number of T cells.

3. Hardiness
Hardiness is described as reflecting
i. Personal feelings of control
ii. A desire to accept challenges
iii. Commitment
Kobasa’s (1982) concept of hardiness influences an individual’s appraisal of potential
stressors and the resulting stress response. A hardy person avoids illness that a potential
stressor might cause by first transforming these into lesser stressful events and secondly by
using successful coping strategies to deal with the problem.

4. Self efficacy and control

Self efficacy refers to an individual’s feelings of confidence that they can perform a desired
action. For example, the belief that ‘I am confident that I can succeed in this exam’ may
result in physiological changes that reduce the stress response.
Such changes could come about in three ways: (Bandura, 1989)
✓ Perceived self-efficacy may reduce the experience of stress itself.
✓ It may reduce the tendency to develop depression in response to stressful events.
✓ It may create CNS modulation of immunological reactivity.

Zaura et al (1989) studied female rheumatoid arthritis patients and found that those who
perceived themselves as able to cope with stressors showed higher levels of B cells.

Sieber et al (1992) exposed male subjects to either controllable or uncontrollable noise. Those
who perceived they had control over the noise showed no reduction in NK cell activity.
Those who were in the uncontrollable noise group showed reduced NK cell activity.

5. Finding benefits in stressful events

If we believe that the stressful event is a learning experience, and that we will only gain
insights from these experiences, then potential damage of stress may be reduced. Prioritizing
goals, emphasizing relationships, personal growth and meaning in life has beneficial
biological effects on immune functioning.

6. Other coping styles

Exercise activates beta-endorphins, which may stimulate NK cell activity. Thus exercise may
be an important buffer against stress-related immune changes.
Active methods of coping work at high stress levels for maintaining immune function.
Avoidance coping may be more helpful at lower stressful levels.

Interventions to enhance immunocompetence

There are certain methods which can lessen the impact of stress on the immune system. We
shall look into a few stress management techniques such as catharsis and relaxation as well as
exercise and proper nutrition.

Catharsis
Catharsis is the process of giving vent to emotions associated with stressful events. This is
found to be beneficial in terms of improving health and mood.

Pennebaker et al (1988) asked 50 undergraduate students to either write for 20 minutes about
traumatic experiences they faced or about superficial topics. They did this for four
consecutive days.

• Though the students who were writing about their traumas felt initially upset, they
were found to be less likely to have health problems in the next 6 months.
• They also showed a stronger reaction to the mitogens that the control subjects.
This is because when people go through traumatic events about which they cannot or do not
communicate; these events fester inside them causing obsessive thoughts for a very long
time. This inhibition of thought and emotion may also increase physiological reactions like
increase in blood pressure, heart rate, hormonal imbalances.
Talking about these traumas reduce heart rate, blood pressure etc.

Relaxation
Relaxation methods aim to decrease anxiety and stress, and consequently improve immune
functioning.
Relaxation exercises follow a sequence of alternating tension and relaxation in different
muscle groups. Jacobson’s progressive muscle relaxation technique is one example.
Kiecolt-Glaser et al (1985) studied a group vulnerable in their immune systems, the elderly.
Subjects were assigned into one of three groups:
a) Relaxation training
b) Social contact
c) No intervention
Participants in the relaxation training group had higher levels of NK cell activity after the
intervention as compared to the other groups.
Kiecolt-Glaser et al (1986) studied medical students facing exams. They were put into two
groups, either a relaxation-group or a no-intervention group.
Frequent relaxation techniques were found to increase T cells considerably more than the
baseline.

Fawzy et al (1990) studied cancer patients.

• Patients undergoing relaxation training had higher NK cell activity, greater number of
NK cells as compared to control subjects (who did not receive this intervention).
• They were also less likely to have recurrences of cancer.

However there have been certain studies which indicate that there is no link between stress
management techniques and immune functioning. For example, AIDS patients assigned to a
comprehensive stress management program showed no impact on immune parameters. So
maybe, the benefits only influence certain groups of people.

Exercise
Exercise may be defined as ‘planned, structured and repetitive bodily movements done to
improve or maintain one or more components of physical fitness’. Exercise proves to be a
natural ‘high’ (Clingman and Hillard, 1987) and it may be a buffer against illness (Kobasa,
Maddi, Pucetti, 1982).
• Some of the physical benefits of exercise (aerobic exercise) are increased respiratory
capacity, improved cardiovascular activity, reduced risk of heart disease, improved
circulation, increased energy, and increased rate of metabolism. These benefits also
improve immune functioning.
• Some of the mental benefits of exercise are increased self confidence, improved self
esteem, emotional catharsis, or cleansing of tensions from interpersonal conflicts and
job stress, reduced levels of stress and relief from mild depression. And as stress is
linked to immune functioning, exercise (which reduces stress and depression) may
lead to improved immunocompetence.

Nutrition
Good health increases resistance to stress by increasing a person’s capacity for responding to
a demand (u may notice when we are unwell, simple issues look huge and insurmountable).
Conversely, poor health places a load on the psycho-physiological system, thus increasing
vulnerability to stress. Thus it is important for us have healthy eating habits, and eat
nutritious foods.
When we are healthy, the way we perceive a stressful situation is different from when we are
unhealthy and sick. A healthy individual perceives the stressful situation as something with
which he can cope, thus reducing the ill effects of stress on the immune system. Nutrition in
this way enhances immunocompetence.