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Linnea Cooper, RN Julia Delcour, RN Karin Pearson, RN Susie

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Title: Linnea Cooper, RN Julia Delcour, RN Karin Pearson, RN Susie


1
Psychoneuroimmunology
  • Linnea Cooper, RN
  • Julia Delcour, RN
  • Karin Pearson, RN
  • Susie Clabots, RN
  • Chris Peredney, RN, M.S.

2
Background
3
What is Psychoneuroimmunology (PNI)?
  • In summary PNI is a theory that investigates the
    implications for clinical disease manifestation,
    progression, and inhibition, as a result of the
    bidirectional relationships between the mind,
    brain, and immune system.

4
Phenomena of Concern in PNI
  • Personality, psychology, emotional states, the
    physical response (behaviors) to these states and
    the following action on the immune system.
  • The result of these interactions, in terms of
    disease acquisition or exacerbation on the
    individual person.


5
Historical Context
  • 460-370 BC Hippocrates
  • 2nd century Galen
  • 17th century Rene Descartes
  • (Cartesian split- reductionism)
  • Late 19th century Robert Koch- theorized that
    every disease had a simple, specific, cause
    germs.
  • 1900s Anatomists first discovery of nerve
    fibers in immune tissue.
  • 1920s Dr. Walter Cannon- Coined the term
    homeostasis
  • His experiments gave physical proof that glands
    in body respond to stress
  • 1930s Hans Seyle- flight or fight response to
    stress (GAS)

6
PNI Founders
  • A few big players in PNI history and development
    are
  • George F. Solomon, MD and Rudolf H. Moos, PhD
  • (Emotions, Immunity, and Disease, 1964)
  • Dr. Robert Ader
  • Professor at University of Rochester, NY
  • Coined the term Psychoneuroimmunology
  • Created interdepartmental Center for PNI Research
  • Founding member of PNI Research Society (1993)
  • Experimental study with rats (Ader Cohen, 1975)

7
Is PNI Inductive or Deductive ?
  • Theory is considered both inductive and deductive
    in nature.
  • Beginning- many different experiments were
    finding particular phenomena in certain
    situations, leading to the idea of illness as
    being affected not only by the pathogen, but also
    by the person factors (personality, stress
    response).
  • Currently- After establishing PNI inductively, it
    is now being substantiated and further refined
    deductively, using scientific research frameworks
    as the guide.

8
Structure and Philosophical Orientation
9
Assumptions
  • There are many significant factors that affect
    health and well-being (Solomon Moos, 1964).
  • Emotions play an important role in the
    development of physical disease (Langley,
    Fonseca, Iphofen, 2006).
  • Different stressors produce different reactions
    in the body (Ader, 2001). These reactions alter
    the state of homeostasis (Langley et al, 2006).
  • There is a bi-directional interaction between
    neuroendocrine and immune systems (Zeller et al,
    1996).

10
Assumptions Continued
  • Methods used to mitigate the effects of stress
    can actually help boost immunity (Fawzy et al,
    1993, as cited in Langley et al, 2006).
  • Responses to stressful life experiences involve a
    complex relationship between behaviour, nervous
    system, endocrine system and immune system
    (Rabin, 1999, as cited in Ader, 2001).
  • Peoples' perception of stress is ever-changing
    and depends on circumstances they find themselves
    in and the resources they have at their disposal
    (Sternberg, 2000).

11
World View
  • Psychological scientific
  • Why??
  • Focuses on causality
  • Began in a psychology realm based on their own
    concepts
  • Moved to a scientific realm where they were able
    to perform experiments

12
PNI Paradigm
  • Theory began over 40 years ago as part of the
    biopsychological paradigm
  • In McCain, Gray, Walter, Robins (2005), PNI is
    defined as a paradigm itself
  • PNI is an integrative paradigm for advancing
    both theoretical and empirical knowledge of
    physiological patters that contribute to the
    dynamics of health (McCain et al, 2005)

13
Nursing Metaparadigm
  • Person complex relationship
  • Environment environmental factors
  • Health Adaptational outcomes (McCain, Gray,
    Walter, Robins, 2005).
  • Nursing comfort and teaching (Sternberg, 2000).

14
Concept
  • Psychoneuroimmunology
  • Psycho
  • Neuro
  • Immunology

15
Definitions
  • Solomon and Moos, 1964 theoretical integration
    of the relation of stress, emotions,
    immunological dysfunction and disease, both
    physical and mental
  • Ader, 2001 the means by which behavior and
    emotion influence immune function, and the means
    by which the immune system affects the nervous
    and psychological response.

16
Related Concepts
  • Interplay between the psychological states, the
    physiologic response, and the immune system
  • Introduction of other concepts
  • Bidirectional relationships
  • Stress

17
Propositions
  • The individual is not seen as a collection of
    systems but as a whole without division between
    the mind and body. There are networks of
    communication that exists between the brain and
    the neurological, endocrine, and immune systems
    (Halldorsdottir, 2007 Langely, 2006).
  • Immune function is capable of modification by
    non-immune stimuli (Langely, 2006).

18
Propositions
  • Communication systems include
  •  HPA
  • Sympathetic nervous system (SNS)
  •  Noradrenergic innervate immune system
  • Cytokines induce symptoms of illness
  •  

19
(Thorton Andersen, 2006)
20
Propositions
  • Cofactors are those components that have the
    potential to predispose an individual to certain
    stress, coping and health patterns.
  • Personal characteristics
  • Health related feature
  • Individual transactional processes (McCain,
    2005).

21
Psychosocial FunctioningQuality of
LifePhysical Health

HEALTH
Psychosocial Moderators
Potential Co-Factors
Neuro- Endocrine Mediators
Person Factors
Immunological Mediators
Coping Patterns
Perceived Stress
Pre tx Critical Factors
22
Concept and Proposition Critique
  • 1. Underlying mechanism for the weakened immune
    system is unclear.
  • 2. If stressors were gone we would always expect
    to see a health gain.
  • 3. Healing is intangible.

23
Application of PNI Theory
24
Clarity
  • Definitions
  • Concepts are not operationally defined
  • Developed over time with multiple authors
  • Definitions were not always exactly the same
  • Author assumed the known definition from their
    respective fields

25
Examples of the definition of the PNI concept
throughout research
  • Kemeny bidirectional relationships between
    mind, brain, and immune system and its
    relationship to clinical disease.
  • McCain and associates put the emphasis of PNI on
    developing an understanding of how the immune
    system is influenced by both sociobehavioral and
    physiological interactions.
  • Langley and associates treat PNI as an
    interdisciplinary field of study of the
    interactions between psychological processes and
    neurological, endocrine, and immune function and
    their influence on health.
  • Halldorsdottir states it to be the study of
    interaction of the psycho, neuro (CNS), and
    immune within the body and the body communicates
    with a multidirectional flow of information,
    holistically.

26
Clarity Continued
  • Diagrams
  • Very clear and straightforward
  • Offer insight into how the theory is structured
  • Different versions of the theory showed similar
    diagrams
  • Intersubjectivity
  • - (shared agreement within the relationships
    between the concept)
  • Not consistent across the different theorists
  • Relationship has been substantiated but the
    mechanisms still remain unclear.

27
Congruence
  • Values of PNI Theory
  • Inductive and Deductive Reasoning
  • Personal Observations
  • Evidence
  • Collaboration
  • Congruence with professional values
  • Deductive Reasoning
  • Personal Observations
  • Evidence

28
Congruence with social values
  • The Social Setting of Nursing
  • Is the role of the nurse within the model
    congruent with the role of the nurse as perceived
    by society?
  • Are actions and outcomes congruent with societal
    expectations of nursing?
  • (Meleis, 2007)

29
Level
  • Micro-Macro
  • The interplay between the micro functions of the
    body systems and the outward behavior of the
    individual.
  • Micro
  • Biological, neurological, and immune functions
    interacting is all within the person.

30
Level
  • Solomon and Moos (1964) introduced the theory in
    order to describe and explain phenomena between
    systems.
  • As the theory developed the application of the
    theory is used to control and manipulate the
    outcomes.

31
And then.
32
And then..?
  • What does this mean to my practice?
  • NP
  • CNS
  • Midwife
  • Psychiatric Nurse
  • Administrator
  • Manager

33
Nursing Use
  • Nursing interventions to reduce psychological
    stress have direct positive effects on prevention
    of, or recovery from, physiological insult.

34
Inflammation
  • Relaxation on Inflammatory cytokines (Koh, et al,
    2008)
  • Tissue Necrosis Factor (TNF) Interleukins (WBC
    signaling)
  • Self esteem on cardiovascular in inflammatory
    response (O Donnell et al, 2008)
  • TNF Interleukins
  • Anger on wound healing (Gouin et al, 2008)
  • Cortisol

35
Outbreaks and Manifestation of Viral Diseases
  • Laughter and natural killer cell (Bennett et al,
    1998)
  • Psychological stress and vaginal HSV-1 infection
    and outbreaks (Ashcraft and Bonneau, 2008)
  • CD8 T-cells
  • Tai Chi and HIV (Robins et al, 2006)
  • Reduction of HIV related psychological distress

36
Third party stress
  • Family psychological stress and frequency of
    illness in children. (Caserta, et al, 2008)
  • Significant relationship between parental mental
    illness and physiological illness in children

37
Working Backward
  • Reduction of PTSD by boosting the immune system
    (Lewitus et al, 2008)
  • T-cells are important factors in psychological
    stress response
  • Immunization with a myelin-related peptide to
    alleviate chronic consequence of PTSD

38
How does this relate to your practice
  • NP
  • CNS
  • Midwife
  • Psychiatric Nurse
  • Administrator
  • Manager

39
Testability
  • The theory is supported by a large and growing
    peer reviewed research base
  • Several nursing schools have programs in
    developing, assessing, implementing and
    evaluating the applicability and efficacy of PNI
    based interventions
  • UCSF-Nursing
  • San Jose State-Nursing
  • USF-Nursing
  • Virginia Commonwealth Nursing School

40
Who is testing?
  • UCLA - Semel InstituteCousins Center for
    Psychoneuroimmunology
  • The Psychoneuroimmunology (PNI) Research Program
    in the Institute for Behavioral Medicine Research
    at The Ohio State University Medical Center
  • USF College of Nursing hosted a National
    conference for the Center for Psychoneuroimmunolog
    y, entitled Frontiers in Psychoneuroimmunology
    The Emotional Interface, September 18-21, 2008
  • The list goes on..

41
Future
  • The field is very active
  • The future is in developing and implementing
    evidence based nursing interventions based on PNI
    physiological and psychological research that
    elicit the desired effect
  • Incorporation into nursing education and practice
  • Working through physiological interventions to
    psychological disease

42
REFERENCES
  • Ader, R. (2001). Psychoneuroimmunology. Current
    Directions in Psychological Science 10(3), 94-98.
  • Ader, R., and Cohen, N. (1975).
    Behaviorally-conditioned Immunosuppression.
    Psychosomatic Medicine, 37 (4) 333-40.
  • Ashcraft,K. and Bonneau, R. (2008).
    Psychological stress exacerbates primary vaginal
    herpes simplex virus type 1 (HSV-1) infection by
    impairing both innate and adaptive immune
    responses. Brain, Behavior, and Immunity 22
    (2008), 12311240.
  • Azar, B. (1999). Father of PNI reflects on the
    field's growth. American Psychological
    Association Monitor Online 30(6).
  • Bennett, M., Zeller, J., Rosenberg, L., McCain,
    J., and Short, S. (1998). The effect of mirthful
    laughter on stress and natural killer cell
    cytotoxicity. In Proceeding of the Midwest
    Nursing Research Society Meeting, April 1998
  • Caserta, M., OConnor, T., Wyman, P., Wang H.,
    Moynihan, J., Cross, W., Xin, T., and Xia, J.
    (2008) The associations between psychosocial
    stress and the frequency of illness, and innate
    and adaptive immune function in children. Brain,
    Behavior, and Immunity 22(2008), 933940.
  • Gouin , JP., Kiecolt-Glaser, J., Malarkey, R.,
    and Glaser, R. (2008) The influence of anger
    expression on wound healing. Brain, Behavior,
    and Immunity 22(2008), 699708.
  • Halldorsdottir, S. (2007). A psychneuroimmunologic
    al view of the healing potential of professional
    caring in the face of human suffering.
    International Journal of Human Caring. 11(2).
  • Koh K., Lee,Y., Beyn, K., Chu, S., and Kim, D.
    (2008) Counter-stress effects of relaxation on
    proinflammatory and anti-inflammatory Cytokines.
    Brain, Behavior, and Immunity 22(2008),
    11301137.
  • Langley, P., Fonseca, J. Iphofen, R. (2006).
    Psychoneuroimmunology and health from a nursing
    perspective. British Journal of Nursing 15(20),
    1126-29.

43
REFERENCES
  • Lewitus, G., Cohen, H., Schwartz, M. (2008)
    Reducing post-traumatic anxiety by immunization.
    Brain, Behavior, and Immunity 22(2008),
    11081114.
  • McCain, N., Gray, D., Walter, J., Robins, J.
    (2005). Implementing a comprehensive approach to
    the study of health dynamics using the
    psychoneuroimmunology paradigm. Advances in
    Nursing Science 28(4), 320-32.
  • Nassau, J., Tien, K., Fritz, G. (2007). Review
    of the literature Integrating psychoneuroimmunolo
    gy into pediatric chronic illness interventions.
    Journal of Pediatric Psychology. 1-13.
  •  ODonnell, K., Brydon, L., Wright, C., and
    Steptoe, A. (2008) Self-esteem levels and
    cardiovascular and inflammatory responses to
    acute stress. Brain, Behavior, and Immunity 22.
    12411247.
  •  Robins, J., McCain, N., Gray, D., Elswick R.,
    Jr, Walter, J, and McDade, E. (2006) Research on
    psychoneuroimmunology tai chi as a stress
    management approach for individuals with HIV
    disease. Applied Nursing Research 19, 2 9.
  • Solomon, G., and Moos, R. (1964) Emotions
    immunity, and disease. Archives of General
    Psychiatry. 11(12), 657-674.
  • Sternberg, E. (2000). The balance within The
    science connecting health and emotions. New York,
    NY W.H. Freeman and Company.
  • Thorton, B. Andersen, L. (2006)
    Psychoneuroimmunology examined The role of
    subjective stress. Cellscience. 2(4).
  • Zeller, J., McCain, N., Swanson, B. (1996).
    Psychoneuroimmunology an emerging framework for
    nursing research. Journal of Advanced Nursing.
    23, 657-664.
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