Therapy designed to address mental health issues may also tamp down chronic inflammation, a new review suggests.
In so doing, interventions like behavioral therapy may help to rein in not only anxiety, depression and stress, but also the risk of developing heart disease or cancer, researchers say.
The finding is based on a look at 56 studies that collectively involved more than 4,000 participants.
“Over the past several years, there has been a growing appreciation that inflammation is involved in many of the serious health problems that people experience,” said study author George Slavich.
“These conditions include mental health problems, such as anxiety disorders, post-traumatic stress disorder and depression, as well as physical health problems, such as asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders,” added Slavich. He’s an associate professor of psychiatry and biobehavioral sciences at the University of California, Los Angeles.
Inflammation can also cause molecular damage that accelerates biological aging. “It is a process that may be very important for understanding human health and longevity,” Slavich added.
Drugs that help control inflammation are effective, said Slavich, but they can be expensive, require long-term adherence and often entail side effects.
The review panel hoped to better understand how the body reacts to nondrug treatments for chronic inflammation. The researchers targeted the potential anti-inflammatory benefits of several individual and group therapy approaches, including cognitive behavior therapy (CBT), CBT combined with medication, grief counseling, bereavement support and psychotherapy.
Together, said Slavich, the studies revealed that patients who undergo some form of psychotherapeutic treatment can see a nearly 15% improvement in beneficial immune system function, and an 18% decrease in harmful immune system function.
Those benefits, he said, appear to last for at least six months after therapy concludes, regardless of a patient’s age or gender.
CBT was found to be the most beneficial, in this regard. According to the American Psychiatric Association (APA), CBT is designed to help patients change thinking patterns that contribute to unhelpful behavior.
The investigators also observed that psychotherapy — and CBT in particular — tended to control inflammation-causing immune system molecules called cytokines.
Such molecules can be helpful in battling disease and infections. But if cytokine levels stay high, even in the absence of a disease threat, they can themselves become the problem, triggering inflammation and related chronic illnesses.
But why would mental health therapy have these effects? Slavich said there are likely many factors at play.
“Several different processes have been previously shown to be associated with changes in immune system function, including life stress, threat sensitivity, negative emotions and social support,” he explained. “In addition, psychotherapy has the potential to change people’s physical activity levels, diet, sleep schedule and so forth.”
However, since the present study was not designed to test these different possibilities, future research is needed to shed light on this issue, Slavich said.
Yet the finding of a link between mental health treatment and reduced inflammation makes sense to Dr. Jon Levenson, an associate professor of psychiatry at Columbia University Medical Center, in New York City.
“It is not surprising that counseling or psychotherapy is associated with positive changes in immune function,” he said, given prior observations that chronic stress driven by anxiety or depression is associated with an uptick in inflammatory processes.
By cutting down on stress, anxiety and depression, it appears that psychotherapeutic treatment “can essentially re-regulate immune function, once the underlying psychiatric condition is treated,” said Levenson, who is also past chair of the APA’s Council on Consultation-Liaison Psychiatry.
But as to how and why there is an association, he agreed that more research will be needed as “we do not know the precise mechanism for this change yet.”
The study findings were published online June 3 in JAMA Psychiatry.
The American Psychiatric Association has more about psychotherapy.
SOURCES: George Slavich, PhD, associate professor, department of psychiatry and biobehavioral sciences, University of California, Los Angeles, and director, UCLA Laboratory for Stress Assessment and Research; Jon Levenson, MD, associate professor, psychiatry, Columbia University Medical Center, New York City, and past chair, American Psychiatric Association’s Council on Consultation-Liaison Psychiatry; JAMA Psychiatry, June 3, 2020, online
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