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The psychology of wound healing
Abstract
Research into the effects of psychological factors on wound healing represents an ideal research model for psychoneuroimmunology, as both the impact on clinically relevant health outcomes and the underlying biological mechanisms can be examined. Mounting interest in this topic from biological scientists, psychologists, and medical specialists has resulted in new findings that are discussed in this review.
Known psychological influences on wound healing include stress as well as coping styles, positive affect, environmental enrichment, and social support. Research has highlighted the roles of oxytocin, vasopressin, epinephrine, cortisol, and leukocyte redistribution in wound healing. Clinical significance has been demonstrated by a growing number of studies in patient populations. Furthermore, pragmatic interventions with clinical samples have demonstrated clear benefits of psychological interventions on wound healing.
Recent studies add to growing evidence that psychology impacts wound repair, and highlight in particular the positive role of social support on modulating the negative effects of stress. The first few studies to demonstrate that psychological interventions can improve healing in clinical populations are exciting developments. New knowledge of psychobiological mechanisms provides opportunities to develop further interventions to improve health outcomes.
... 17 In addition, positive affect (PA) has been shown to be associated with several desirable health outcomes, ranging from improved health behaviour and better cardiovascular health to better immune responses, quicker wound healing and reduced pain. [18][19][20] Apart from these beneficial outcomes, the well-being of patients is a valuable aim in itself. Thus, exploring well-being among affected patients utilizing diverse measures could greatly contribute to a better understanding and treatment of skin diseases. ...
... This finding is especially interesting, as PA has been shown to be associated with several desirable health outcomes, such as improved health behaviour, quicker wound healing, better cardiovascular health and better immune responses. [18][19][20] Thus, increasing PA in patients with skin diseases could not only improve well-being, but might even lead to a better prognosis. 38 There is large evidence on interventions to promote PA. 39,40 Interventions that have been found to be highly effective are, for example, a gratitude journal or interventions focusing on meaning or strength use in daily life. ...
Background:
According to the World Health Organization, mental health is a state of well-being and not merely the absence of disease. However, studies exploring subjective well-being in patients with skin diseases are very rare.
Objectives:
To assess subjective well-being, i.e., "happiness," in patients with different skin diseases and to compare them to other patient groups and healthy controls.
Methods:
A cross-sectional study was conducted from 12/2017 to 04/2019. Patients receiving in- or out-patient care for psoriasis, atopic eczema, nummular eczema, mastocytosis, skin cancer (malignant melanoma, keratinocyte carcinoma), HIV, or chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis) were recruited at two hospitals in Bavaria, Germany. Healthy individuals living in or near Munich served as a control group. All participants filled in a questionnaire assessing happiness, measured as positive affect, negative affect and satisfaction with life (together representing subjective well-being) and a heuristic evaluation of one's own happiness.
Results:
Data from 229 dermatologic patients (53.3±18.5 years, 48% women), 49 patients with inflammatory bowel diseases (48.9±18.7 years, 43% women), 49 patients with HIV (46±10.1 years, 10% women) and 106 healthy controls (38.4±13.4 years, 49% women) were analyzed. Compared to the controls, dermatologic patients reported lower heuristic happiness (p=.023) and positive affect (p=.001) but higher satisfaction with life (p=.043). Patients with psoriasis and atopic eczema reported the lowest happiness, as they reported significantly lower positive affect (p=.032 and p<.001) and heuristic happiness (p=.002 and p=.015) than the control group. Patients with skin cancer reported higher satisfaction with life than the control group (p=.003). Dermatologic patients reported lower happiness than patients with HIV but reported greater happiness than patients with IBD.
Conclusions:
Dermatologic patients experience lower levels of happiness, especially positive affect, compared to healthy controls. As positive affect is linked to desirable health outcomes, targeting positive affect could be a promising holistic approach for the treatment of skin diseases.
... 17 In addition, positive affect has been shown to be associated with several desirable health F o r P e e r R e v i e w 4 outcomes, ranging from improved health behavior and better cardiovascular health to better immune responses, quicker wound healing, and reduced pain. [18][19][20] Apart from these beneficial outcomes, the well-being of patients is a valuable aim in itself. Thus, exploring well-being among affected patients utilizing diverse measures could greatly contribute to a better understanding and treatment of skin diseases. ...
... This finding is especially interesting, as PA has been shown to be associated with several desirable health outcomes, such as improved health behavior, quicker wound healing, better cardiovascular health, and better immune responses. [18][19][20] Thus, increasing PA in patients with skin diseases could not only improve well-being, but might even lead to a better prognosis. 38 There is large evidence on interventions to promote positive affect. ...
... "Look to the nervous system as the key to maximum health. " Galen [1] Higher levels of psychological stress are associated with slower wound healing, including surgical wounds [2,3,4,5]. Much has been written about various factors -such as hypothalamic-pituitary-adrenal (HPA) axis dysfunction of the neuroendocrine stress system and the gut-microbiotabrain axis -contributing to the adverse health outcomes associated with chronic stress [6,7,8,9]. ...
... [23,24]. This might be why interventions that promote relaxation, reduce stress, and provide social support appear to aid wound healing [4,5,25]. Might activities departments play a role in this? ...
This past week (January 21 to 27, 2018) was National Activity Professional
week. Let us consider how activities departments in nursing homes are
part of the multidisciplinary team that facilitates healing after surgery.
... Stress-induced activation of the hypothalamic-pituitary-adrenocortical axis (HPA) and the sympathetic nervous system (SNS) with the release of cortisol and the catecholamines adrenaline and noradrenaline might affect clinical outcome in CABG (20). The evidence is accumulating that the increase in adrenaline released in reacting to stress leads to negative outcomes such as impaired wound healing (21)(22)(23) or even sudden cardiac death from the cardiotoxic effects from the oxidative by-products of high amounts of circulating catecholamines (24). An impressive example of how stress can negatively affect the heart is the increased incidence of stress cardiomyopathy and sudden cardiac death as a consequence of extreme psychological stress and elevated catecholamine levels(25-27). ...
... Elevated levels of adrenaline are associated with impaired heart functioning(24,26), suppressed immune system activity (34), impaired wound healing (21,22), stress cardiomyopathy(25,46) and may result in myocardial ischemia (47), while the use of betablockers to attenuate the effects of elevated catecholamines on the heart is associated with less cardiac events and lower postoperative mortality in high risk surgical patients (47,48). Thus, our findings of lower adrenaline levels after CABG surgery may have beneficial effects on patients" recovery process and future cardiovascular health. ...
Objective:
To examine whether preoperative psychological interventions targeting patients' expectations are capable of influencing the biological stress response after coronary artery bypass graft (CABG) surgery and could thus improve recovery after heart surgery.
Methods:
Randomized controlled trial with assessments 10 days before surgery, post-psychological intervention (day of hospital admission, but before surgery), postoperative (6-8 days later) and at follow-up (6 months after surgery). Eligible patients (N=124) scheduled for elective on-pump CABG or CABG with valve replacement surgery were approached before hospital admission. Standard medical care (SMC) was compared to two additional preoperative psychological interventions: a) an expectation manipulation intervention (EXPECT) to optimize patients' expectations about course and outcomes, or b) supportive therapy (SUPPORT), containing the same amount of therapeutic attention, but without specifically focusing on expectations. Postoperative plasma adrenaline, noradrenaline and cortisol levels were a secondary outcome of our study (primary outcome patients' disability 6 months after surgery and other secondary patient-reported or clinical outcomes were reported elsewhere).
Results:
EXPECT (3.68 ln pg/ml, 95% CI 3.38-3.98; p=.015) and SUPPORT (3.70 ln pg/ml, 95% CI 3.38-4.01; p=.026) led to significantly lower postoperative adrenaline levels compared to SMC (4.26 ln pg/ml, 95% CI 3.99-4.53) only. There were no treatment effects of the preoperative intervention for noradrenaline (p=.90) or cortisol (p=.30). Higher postoperative adrenaline levels predicted disability 6 months after surgery (r=.258, p=.018).
Conclusions:
In addition to standard medical care, preoperative psychological interventions seem to buffer psychobiological stress responses and could thus facilitate recovery from CABG surgery. Patients' postoperative stress responses could be an important factor for explaining trajectories of long-term outcomes.
Trial registration:
www.clinicaltrials.gov (NCT01407055).
... Osoby z wysokim przedoperacyjnym poziomem niepokoju odczuwają większy ból w okresie pooperacyjnym, a przedoperacyjny stres życiowy i cechy osobowości, takie jak niski poziom optymizmu i sumienności, powiązano z wolniejszym gojeniem się ran [5][6][7]. Niektórzy opisują też wpływ stresu na procesy gojenia się, tłumacząc to zjawisko mechanizmami psychoneuroimmunologicznymi [5,8,9]. ...
Treatment of patients with advanced heart failure (HF) with the use of left ventricular assist devices (LVADs) improves the quality of life and the length of survival. Despite the undeniable benefits associated with improved physical performance, as a result of the decrease of the underlying disease symptoms, it carries the risk of complications in the area of the patient's somatic and psychological status. Long-term circulatory failure can contribute to a weakening of the adaptative mechanism and consequently lead to a variety of emotional disruptions. Patients must face the fear of imminent physical, family, and social changes that LVAD requires. They may experience sleep disorders, mood disorders, anxiety disorders, and in the early postoperative period also disorders of consciousness with a pattern of delirium. For this reason, it is advisable to provide multidisciplinary medical care for the patient at all stages of treatment, including regular monitoring of general health and mental health. This article presents risk factors for psychiatric disorders in patients with LVADs and ways of pharmacological and non-pharmacological management when these factors are identified and disorders are diagnosed.
... Socialna izolacija je povezana z zmanjšanimi socialnimi interakcijami osebe, ker je socialne podpore osebi na razpolago manj, se lahko oseba z rano za ne ustveno zapirati vase. Raziskave kažejo, da so pozitivne socialne interakcije povezane s hitrejšim celjenjem ran (Detillion, 2004;Broadbent in Koschwanez, 2012). Socialna izolacija je lahko povezna tudi z zmanjšano energijo osebe zaradi motenj spanja, spanje pa ima zaradi povezanosti z imunskim sistemom pomembno vlogo pri celjenju ran (Upton in South, 2011). ...
... One such positive factor may be social support. Since social support is an important component for healing, alleviating negative effects of stress, and improving quality of life (Broadbent & Koschwanez, 2012;Helgeson, 2003), social support may be effective in reducing parents' stress during pandemics. Understanding the role of protective factors such as financial and social support for at-risk families will elucidate effective ways for resource allocation now and beyond COVID-19. ...
It is critically important to understand the environmental contexts and demographic factors that put families at greater risk of COVID-related parenting stress.
The current study examined a new scale measuring situational stress caused
by concern about family safety and stability during the COVID-19 pandemic.
We examined how this stress differed by socioeconomic status and children’s
schooling modality, and how this stress and parent social support affected parents’ severity of overall psychological distress. Parents of children in distance
learning experienced significantly less COVID-related family safety/stability
stress. COVID-related family safety/stability stress was a significant predictor for
severity of psychological distress, and this positive relationship was significantly moderated by perceived parent social support, controlling for all other predictors. Going forward, financial resources and perceived parent social support
should be incorporated in plans to assist parents during the pandemic, as these
serve as protective factors from COVID-related family safety/stability stress.
... Socialna izolacija je povezana z zmanjšanimi socialnimi interakcijami osebe, ker je socialne podpore osebi na razpolago manj, se lahko oseba z rano za ne ustveno zapirati vase. Raziskave kažejo, da so pozitivne socialne interakcije povezane s hitrejšim celjenjem ran (Detillion, 2004;Broadbent in Koschwanez, 2012). Socialna izolacija je lahko povezna tudi z zmanjšano energijo osebe zaradi motenj spanja, spanje pa ima zaradi povezanosti z imunskim sistemom pomembno vlogo pri celjenju ran (Upton in South, 2011). ...
... These studies should also seek to standardize the psychological interventions used to allow for more direct comparisons and better generalization of the results. 21 ...
This meta‐analysis investigates the impact of psychological interventions on the wound healing process at surgical sites in patients with psoriasis who have undergone various surgical procedures. Following the PRISMA guidelines, an extensive database search was conducted, initially identifying 679 articles, with 6 studies ultimately meeting our rigorous selection criteria. These studies, which included both Randomized Controlled Trials and observational designs, utilized a range of scales, such as the REEDA and Manchester Scar Scale (MSS), to measure the healing of surgical wounds. Statistical analyses were performed using Review Manager and SPSS, revealing that psychological interventions significantly expedited wound healing as early as 1 week post‐surgery ( I ² = 93%; Random: SMD = −3.01, 95% CI: [−4.35, −1.66], p < 0.01), according to the REEDA scale. At the one‐month follow‐up, a continued positive effect was observed on the MSS ( I ² = 69%; Random: SMD = 2.31, 95% CI: [1.54, 3.08], p < 0.01). The studies demonstrated a low risk of bias, and funnel plot analysis suggested no significant publication bias. These results highlight the beneficial role of psychological support in the postoperative recovery of psoriasis patients, suggesting a need for a more integrated approach to patient care that includes psychological well‐being as a component of comprehensive treatment strategies.
... Effective management of procedural distress is crucial, since fear causes the brain to be more perceptive to painful stimuli. This can create an upward spiral of distress [7]. Procedural distress early in life is associated with serious complications, such as needle phobia, anticipatory anxiety, and post-traumatic stress [8][9][10]. ...
Needle-related procedures can cause pain and fear in children and may lead to avoidance of future medical care. The aim of this study is to investigate whether virtual reality hypnosis (VRH) is non-inferior to medical hypnosis (MH) by a trained healthcare provider in reducing pain in children. This non-inferiority randomized trial was conducted at a teaching hospital in the Netherlands. Children aged 6 to 18 years were randomized to treatment with VRH or MH. The primary outcome was self-reported pain, using the Wong-Baker FACES Scale (WBFS) with the non-inferiority margin defined as a difference of 1.5 points. Secondary outcomes included observer-reported pain (Numeric Rating Scale), fear (scored by children and observers with the Children’s Fear Scale), blood pressure, heart rate, treatment satisfaction, and adverse effects. We randomized 138 children to VRH or MH treatment and included 114 children in the analyses (VRH n = 60, MH n = 54). We found non-inferiority for VRH compared to MH on patient-reported pain (mean difference = − 0.17, 95%CI − 1.01;0.66). Secondary outcomes were comparable between VRH and MH groups. Both treatments scored high on patient satisfaction (VRH median = 9.0, MH median = 10.0, p = 0.512).
Conclusion: VRH may be an effective and safe treatment option besides MH for reducing patient-reported pain in children during a needle-related procedure. VRH was non-inferior to MH in patient-reported fear and both treatments were comparable in terms of patient-reported fear, observer-reported pain and fear, physical distress, and patient satisfaction.
Trial registration: ICTRP https://trialsearch.who.int/, trial ID NL9385; date registered: 03/04/2021. What is Known:
• Medical hypnosis is effective in reducing procedural distress in children during needle-related procedures.
• Virtual reality (VR) is an audiovisual electronic device that guides users into an immersive three-dimensional environment.
What is New:
• This study shows that VR hypnosis is non-inferior to medical hypnosis in reducing pain and fear in children undergoing a needle-related procedure.
• Both VR hypnosis and medical hypnosis were appreciated highly by children to distract them during needle-related procedures.
... DFU extent significantly decreased in EG and ACG, but no significant differences were found in PCG, which may indicate that these sessions may positively influence the DFU area through the decrease in stress and emotional distress symptoms. 65,66 Also, DFU healing improved in all groups, although no significant differences between groups were found, probably due to the high scope of the DFU healing measure that may require an increased sample size, particularly a higher number of patients completing the four EG/ACG sessions, to detect a significant difference. ...
This Pilot Randomized Controlled Study (RCT) aimed to assess the feasibility and acceptability of progressive muscle relaxation with guided imagery intervention (experimental group-EG) compared to a neutral guided imagery placebo (active control group-ACG) and standard care to Diabetic Foot Ulcer (DFU) treatment (passive control group-PCG), to decide on the need for a definitive RCT. Diabetic Foot patients with one or two chronic DFU and significant levels of stress/anxiety/depression were recruited and assessed during a period of six months, at three moments. Primary outcomes: feasibility rates and satisfaction with relaxation sessions. Secondary outcomes: DFU healing score, DFU-related quality of life (DFUQoL), physical and mental QoL, stress and emotional distress, DFU representations, arterial blood pressure, and heart rate. A total of 146 completed the baseline (T0) assessment with 54 participants presenting significant distress being randomized into three groups. Patients were assessed two months post-intervention (T1) and four months after T1 (T2). Feasibility rates showed reduced values on eligibility, recruitment, and inclusion in the study, although with an acceptable rate of refusal lower than 10%. On average, participants reported being satisfied with relaxation sessions and recommended them to other patients. Differences between groups showed that, at T1, PCG participants reported higher levels of stress than those from EG and ACG. Within-group differences showed improvements in stress, distress, DFUQoL, and DFU extent over time only in EG and ACG. Only EG showed significant changes in DFU representations at T1. The results suggest that relaxation may be a promising coping strategy to deal with DFU distress and an important adjuvant therapy for DFU healing, supporting the performance of a definitive RCT. This article is protected by copyright. All rights reserved.
... 2,3 In recent years, some studies have believed that psychological intervention could also affect the effect of wound healing. 4 All factors mentioned above showed that wound healing would focus on surgery, skin management, and clinical treatment. It was also proved that wound healing needs various growth factors to be involved in the regulation. ...
Platelet‐rich plasma (PRP) has attracted attention because of its potential to accelerate the wound healing process. However, resources for evaluating research trends in the treatment of wounds with PRP were limited. In this study, we aimed to make a bibliometric analysis of the literature related to PRP in the treatment of wounds and explore the research status, hotspots and frontiers in this field in recent 20 years. Studies about PRP treatment for wounds from 2002 to 2021 were retrieved from the Science Citation Index Expanded (SCI‐E) of Web of Science (WOS) database. Visualisation softwares such as VOSviewer and SCImago Graphica, and CiteSpace were used to analyse the research trends and features. A total of 1748 studies were identified in the SCI‐Expanded from 2002 to 2021. The number of publications on PRP in the treatment of wounds has shown an increasing trend, from 6 (in 2002) to 228 (in 2021). The papers published in the United States have led in times cited (14637) and H‐index (63). Though Italy was slightly lower than China in the number of publications, the H‐index and average cited (47, 28.45) were higher than that of China (38, 27.01). The strongest keyword was “fibrin” (strength = 13.07), and the longest burst duration keyword was “thrombin” (began in 2002 and ended in 2014). The largest 10 co‐citation clusters are as follows: endothelial cell proliferation (#0), regenerative medicine‐associated treatment (#1), diabetic wound healing (#2), autologous derived (#3), platelet‐rich fibrin (#4), tissue engineering (#5), regenerative potential (#6), clinical randomised trial (#7), histologic observation (#8), and wound bacteria (#9). The United States has made the most outstanding contribution in this field. Chinese researchers need to enhance the quality of publications further. Wound Repair Regen. is the most noteworthy journal. The mechanism of growth factors of PRP, combination therapy, preparation of PRP, and related clinical trials may be topics that need attention.
... EXPECT as an additional psychological intervention might help improve patients' health status and quality of life and decrease disability and treatment costs due to less time spent in the hospital for cardiac surgery patients. EXPECT may further reduce costs by decreasing the time in the intensive care unit via biological and immunological mechanisms: Perceived stress can adversely impact psychoneuroimmunological processes which may delay wound healing (53,54) and increase stress and inflammatory biomarkers (i.e., adrenaline, IL-6) (55), which are predictors for poor cardiovascular outcomes (56). EXPECT might positively influence psychological and biological variables by increasing the patients' coping abilities and thus reducing stress and inflammatory biomarkers. ...
The PSY-HEART-I trial indicated that a brief expectation-focused intervention prior to heart surgery improves disability and quality of life 6 months after coronary artery bypass graft surgery (CABG). However, to investigate the clinical utility of such an intervention, a large multi-center trial is needed to generalize the results and their implications for the health care system. The PSY-HEART-II study aims to examine whether a preoperative psychological intervention targeting patients' expectations (EXPECT) can improve outcomes 6 months after CABG (with or without heart valve replacement). EXPECT will be compared to Standard of Care (SOC) and an intervention providing emotional support without targeting expectations (SUPPORT). In a 3-arm multi-center randomized, controlled, prospective trial (RCT), N=567 patients scheduled for CABG surgery will be randomized to either SOC alone or SOC and EXPECT or SOC and SUPPORT. Patients will be randomized with a fixed unbalanced ratio of 3:3:1 (EXPECT: SUPPORT: SOC) to compare EXPECT to SOC and EXPECT to SUPPORT. Both psychological interventions consist of 2 in-person sessions (à 50 min), two phone consultations (à 20 min) during the week prior to surgery, and one booster phone consultation post-surgery 6 weeks later. Assessment will occur at baseline approx. 3-10 days before surgery, preoperatively the day before surgery, 4-6 days later, and 6 months after surgery. The study's primary endpoint will be patients’ illness-related disability 6 months after surgery. Secondary outcomes will be patients’ expectations, subjective illness beliefs, quality of life, length of hospital stay and blood sample parameters (e.g., inflammatory parameters such as IL-6, IL-8, CRP). This large multi-center trial has the potential to corroborate and generalize the promising results of the PSY-HEART-I trial for routine care of cardiac surgery patients, and to stimulate revisions of treatment guidelines in heart surgery.
... 3,4 Much of the psychological literature on DFUs has focused on associations with mental health difficulties relating to personality disorders, depression, diabetes-related distress and dysfunctional beliefs about pathogenesis and treatment. However, there is some evidence that psychological supports that help to reduce stress and negative mood are associated with better wound healing 5,6 and that psychoeducational interventions may be of benefit for the prevention and management of DFUs. [7][8][9][10] Personality disorders have generally been associated with suboptimal health behaviours in diabetes, 11,12 but we identified only one paper that examined the relationship between personality and foot self-care. ...
The literature indicates the impact of psychological factors on the development and course of diabetes remains unclear. Aim To explore personality, depression, diabetes-related distress and illness beliefs in adults attending routine diabetes clinics and investigate whether the extent of these difficulties can predict foot self-care. Methods Participants were consecutive patients with diabetes attending diabetes outpatient and podiatry clinics in hospitals who completed self-administered questionnaires to access personality traits and evaluate them for personality disorders, depression, diabetes-related distress, beliefs about illness and foot self-care. Results Approximately 1 in 5 participants screened positive for Type D personality, personality disorders and diabetic related distress; 8% screened positive for major depression. A standard multiple regression model determined whether foot self-care was predicted by these variables. The results were non-significant, F (13, 106) = 1.63, p = .09. Having macrovascular complications was significantly positively related to foot self-care (r(118) = .20, p = .027). Participants with a current and/or past history of DFU had higher BMI, longer duration of diabetes, were more likely to be on insulin therapy and to have concomitant microvascular complications. Conclusion Personality and mood disorders are prevalent in people attending diabetes clinics, but the variables measured here do not predict foot self-care.
... The wound healing in skin is an all-around coordinated endurance instrument that can be impacted by different conditions prompting a superior or worse course of healing [1]. As of late, there is an equally mounting proof that mental impacts (for example stress, social help, positive effect, and environmental enhancement) may also connect with wound healing [2]. In any case, infection and sepsis can be caused by spoiling with a pathogenic microbial agent, which disturbs the repair continuum [3,4]. ...
The goal of the current study was to assess the effects of povidone iodine 10% in comparison with 5% of povidone iodine on full-thickness cutaneous wounds healing in rabbits. This was on twenty-four healthy male rabbits, weighing from (1.5–1.8 kg). Under the effect of intramuscular administration of a mixture of xylazine hydrochloride 5mg / kg, ketamine hydrochloride 35mg / kg and diazepam 1 mg / kg. On each animal, in the dorsal back area, one square (2 × 2) cm full-thickness skin wounds were made. The animals were divided into two groups, group (A) as the treatment group was treated with 10% povidone iodine daily for 1 time for day 7 post operation. While, at the same time in group (B), the rabbits were treated with 5% povidone iodine. For clinical evaluation, each group was divided into four subgroups (two wounds/subgroup) on 3 rd , 5 th , 7 th , 9 th , 14 th and 21 th days post-wound induction and treatment. Clinically, the result showed that 10 % of iodine was more effective than 5 % of iodine, and the wound healing rate in group (A) was faster than group (B). This was followed by statistical analysis results showing the wound healing process ((20%, 40%), (70%, 85%) contraction) and ((10%, 20%), (50%, 70%) re-epithelization). Respectively, there were significantly more (P≤0.05) than the iodine 5% during the study period. Conclusion; Povidone-iodine solution 10% is more efficient than iodine 5% so that lead to acceleration and enhancement of full-thickness cutaneous wounds healing.
... Kemeny та M. Schedlowski (2007) також вважали, що гострий і хронічний психологічний стрес може викликати виражені зміни вродженої й адаптивної імунної відповіді опосередковано через нейроендокринні медіатори гіпоталамо-гіпофізарно-надниркової та симпатико-надниркової систем. Дані систематичних оглядів та мета-аналізів наукової медичної літератури за окресленою проблемою вказують на те, що психологічний стрес має враховуватися в складних моделях передбачення прогнозів захворювань, таких як ГРВІ, реакції на вакцинацію, маніфестація герпесу, розповсюдження пухлинних метастазів і загоєння операційних ран, а також в епідеміологічних дослідженнях прогресування захворювання і смертності [14][15][16]. Отже, нейроендокринні та імунні взаємодії порушуються при багатьох патофізіологічних станах; стрес може сприяти цим порушенням, що може зіграти значну роль у прогресуванні патологічних процесів [17]. ...
The article is devoted to the assessment from the point of view of psychosomatic medicine of the place, role, and interaction of stress and nervous, immune, and endocrine systems in the pathogenesis of chronic mental and somatic non-communicable and infectious diseases. The concept of diffuse neuroimmunoendocrine system (DNIES) as a universal system of response, control, and protection of the organism is given. Attention is paid to the need for comprehensive management of patients with the involvement of psychotherapeutic and medical-psychological measures. Possible pharmacotherapeutic strategies for the treatment of anxiety disorders are considered. Keywords: neuroimmunoendocrinology, stress, depression, anxiety, immune system, psychotherapy, pharmacotherapy
... Emotions such as anger or sadness can increase pain sensations [33]. Perceived stress is associated with psychoneuroimmunological mechanisms which may delay wound healing and increase sickness behavior [34][35][36]. Psychological interventions which influence these psychological factors may thus improve postoperative outcomes [37]. In this article, we review recent developments in psychological preparation for patients undergoing cardiac surgery. ...
Purpose of Review
To review the current state of preoperative psychological preparation to improve outcomes after cardiac surgery.
Recent Findings
Preoperative psychosocial factors are associated with short- and long-term outcomes after cardiac surgery. There are several approaches to optimize patients’ preoperative psychological status with promising effects on postoperative outcomes (e.g., less complications, improved quality of life). Preoperative psychological preparation often aims to improve patients’ knowledge or social support and to modify and optimize expectations and illness beliefs.
Summary
Preoperative psychological preparation is gaining importance for cardiac surgery. However, patients’ psychological status still does not get as much attention as it deserves. Preoperative psychological preparation seems to have positive effects on postoperative outcomes. Since overall evidence is still weak, further studies are warranted to understand which intervention works best for whom and why.
... For example, Ostir and colleagues (2006) found that stroke patients with more positive emotions experienced recovery of greater functional status. In a general review, Broadbent & Koschwanez (2012) found that those with higher positive affect have faster wound healing following stress compared to those with lower positive affect. This link has also been supported via experimental studies. ...
Well-being has been strongly linked to many important life facets ranging from physical and mental health to social relationships to academic and work performance. Not only has it been associated with many beneficial outcomes across these realms, but it has also been demonstrated to predict positive changes in these key areas of functioning. In this article, we will review the benefits of high subjective well-being (high positive affect and life satisfaction and low negative affect) for health, resilience, work performance, and social relationships. Using multi-method assessments and approaches as well as cross-cultural findings, we review the evidence which vastly supports a strong link between well-being and crucial life domains. Gaps in our understanding of this connection and areas for future research to address the limits of our knowledge assessing the beneficial outcomes of well-being will be discussed. Implications of the link between well-being and important life outcomes for practical applications including interventions and preventative policy work are provided.
... Fear and aggression can directly impair animal welfare and pose a risk to human safety in the short-term (Jeyaretnam et al., 2000), and can also have long-term effects. For example, these negative responses can lead to inaccurate results for diagnostic tests (Bragg et al., 2015), prevent the completion of proper examinations (Glardon et al., 2010), negatively influence the health and recovery of sick and injured animals (Broadbent and Koschwanez, 2012), and discourage owners from seeking required care (Volk et al., 2011). ...
Veterinary visits result in behavioural and physiological signs of fear and stress for many companion dogs. There are a number of factors that likely contribute to this response, but little is known about possible effects of the acoustic environment. The aim of this study was to assess the effect of elevated levels of common veterinary background noises on fear-related responses in dogs during a routine physical examination in a veterinary setting. Testing took place in an examination room at a veterinary clinic and involved 33 owned companion dogs. All dogs received a standardized physical examination where each dog was either presented with no additional noise (n = 16, control), or a pre-recorded noise track that included the sounds of people talking, dogs barking, and metal doors clanging (n = 17). This noise track was played back with a peak sound level of 68.0 dB, which is comparable to levels previously recorded in clinic settings. The dogs’ behavioural responses (lip licking, yawning, reduced posture, avoidance, vocalizing, trembling) were scored from video by a blinded observer for each stage of the physical examination (i.e., head exam, lymph node palpation, body palpation, temperature assessment, heart rate assessment, and respiratory rate assessment). In addition, willingness to approach the examiner was assessed before and after the examination. For behavioural measures, generalized mixed models and Fisher's exact tests were used to assess the effects of noise, exam phase, sex, and age, with dog as a random effect. For temperature, a general linear model was used to assess the effects of noise, sex, and age, and the remaining physiological measures were assessed using t-tests. Only respiratory rate was increased with exposure to background noise (F 1,31 = 6.74, p = 0.0143); no other responses were affected. However, lip licking (F 5,65 = 4.04, p = 0.003), avoidance (F 5,158 = 6.36, p < 0.0001), and posture reductions (F 5,158 = 3.55, p = 0.0045) were increased during some exam phases. Background noise only affected a single, physiological measure during a routine exam, while exam phase seemed to have a larger influence, affecting various behavioural measures. These results suggest that ceiling effects did not prevent proper assessment of responses to noise. Thus, while noise should be minimized where possible, aspects of the examination itself should be a key focus of future research examining methods to reduce stress in dogs during veterinary examinations.
... Pain might be so severe that the use of compression therapy is contraindicated and, unfortunately, such patients become conditioned to pain, which then causes stress. Psychological stress impairs wound healing by up-regulating glucocorticoids and by reducing the levels of the pro-inflammatory cytokines at the wound site [3]. ...
... Over the past decades studies have repeatedly shown that psychological factors can influence the process of wound healing (e.g. Broadbent and Koschwanez 2012;House 2015). Most of these studies focused on the effects of psychosocial distress on wound healing and consistently reported impaired wound healing across different wound models and different stressors (Bosch et al. 2007;Cole-King and Harding 2001;Ebrecht et al. 2004;Garg et al. 2001;Kiecolt-Glaser et al. 2005;Maple et al. 2015). ...
Psychological factors have been shown to influence the process of wound healing. This study examined the effect of Mindfulness-Based Stress Reduction (MBSR) on the speed of wound healing. The local production of pro-inflammatory cytokines and growth factors was studied as potential underlying mechanism. Forty-nine adults were randomly allocated to a waiting-list control group (n = 26) or an 8-week MBSR group (n = 23). Pre- and post-intervention/waiting period assessment for both groups consisted of questionnaires. Standardized skin wounds were induced on the forearm using a suction blister method. Primary outcomes were skin permeability and reduction in wound size monitored once a day at day 3, 4, 5, 6, 7, and 10 after injury. Secondary outcomes were cytokines and growth factors and were measured in wound exudates obtained at 3, 6, and 22 h after wounding. Although there was no overall condition effect on skin permeability or wound size, post hoc analyses indicated that larger increases in mindfulness were related to greater reductions in skin permeability 3 and 4 days after wound induction. In addition, MBSR was associated with lower levels of interleukin (IL)-8 and placental growth factor in the wound fluid 22 h after wound induction. These outcomes suggest that increasing mindfulness by MBSR might have beneficial effects on early stages of wound healing.
Trial Registration NTR3652, http://www.trialregister.nl
... Psychological results were obtained by validated psychological scores and physiological data by measurement of oxytocin in children's saliva. Oxytocin is known for its physiological role in lactation and parturition, enhances wound healing [7], modulates stress [8] and indicates well-being [9]. However, its role in clown interventions for children has not been evaluated before. ...
Background Hospital stays and medical interventions are accompanied by worries and anxiety in children and parents. Recent studies show that hospital clowns may reduce anxiety and enhance well-being. However, so far studies are based solely on subjective measures and clowns are usually not integrated in medical routine. With this pilot study, we aim to provide both psychological and physiological evidence of positive effects of clowns’ interventions in hospitalized children.
Patients/Method In a consecutive randomized intervention-control group design with 31 children aged 4 to 13 years, 17 patients were accompanied by a clown prior to surgery or during ward round (intervention group) and 14 were not (control group). Saliva samples for oxytocin measurement were taken from all patients before hospitalization (T1) and prior to surgery or after ward round (T2). Self- and parents-reports were obtained at T1, T2 as well as at time of discharge from hospital (T3) regarding children’s anxiety (STAI), worries and well-being. Clowns evaluated their success in cheering up the child. Health professionals were asked for their acceptance of clowns in hospitals.
Results Children in the intervention group had lower anxiety ratings and a higher oxytocin concentration at T2 as compared with T1; the control group showed no changes. Parents rated the well-being of their children higher if their child had clown’s contact and were more willing to recommend the hospital. The staff judged the clowns as helpful for patients.
Discussion Consistent psychological and physiological results suggest the positive impact of a clown’s intervention in hospitalized children.
... Recently, there is also mounting evidence that psychological effects (i.e. stress, social support, positive affect, and environmental enrichment) might also interact with wound healing [3]. The hormone oxytocin (OXY) is best known for its role in lactation, parturition, and uterine contraction. ...
Objective
Oxytocin (OXY) has significant effects on mammalian behavior. Next to its role in lactation and social interactions, it is described to support better wound healing as well. However, direct OXY effects on wound healing and the regeneration of the microvascular network are still not clarified. We therefore examined the effects of OXY and an OXY receptor antagonist [atosiban (ATO)] on skin wound healing, focusing on epithelialization and neovascularization.
Methods
Skin wound healing has been assessed using intravital fluorescence microscopy in a model of full dermal thickness wounds in the dorsal skin fold chamber of hairless mice. Animals received repetitive low or high doses of OXY or ATO. Morphological and cellular characterization of skin tissue repair was performed by histology and
Results
The assessment of skin tissue repair using this therapy regimen showed that OXY and ATO had no major influence on epithelialization, neovascularization, wound cellularity, or inflammation. Moreover, OXY and ATO did neither stimulate nor deteriorate keratinocyte or fibroblast migration and proliferation.
Conclusion
In summary, this study is the first to demonstrate that OXY application does not impair skin wound healing or cell behavior. However, until now, the used transmitter system seems not to be clarified in detail, and it might be proposed that it is associated with the stress response of the organism to various stimuli.
... Besides direct effects on the immune system, anxiety lowers pain thresholds and facilitates overestimation of pain intensity which results in increased postoperative pain (Colloca & Benedetti, 2007). This weakens the immune function even more and may have consequences such as delayed wound healing (Broadbent & Koschwanez, 2012) and development and progression of cancer (Webster Marketon & Glaser, 2008). To reduce preoperative anxiety and stress, anxiolytics may be prescribed although preoperative use of this medication is an independent risk factor for major morbidity and mortality after surgery (Ward et al., 2015). ...
Medical procedures and tests become a challenge when anxiety and pain make it difficult for the patient to cooperate or remain still when needed. Fortunately, a short intervention with hypnoidal language at the onset of a procedure induces a positive and sustained change in the way pain and anxiety are processed. Although anesthesia may appear to be a simple solution to eliminate pain, the adverse effects of preanesthesia anxiety on postoperative behavior and recovery are often not fully appreciated. This article discusses options for self-hypnotic relaxation that are applicable to interactions with children. The high suggestibility of children makes it relatively easy to engage them in make-believe scenarios. Avoidance of negative suggestions is key in avoiding nocebo effects that may be difficult to overcome later. Once a child is immersed in his or her preferred scenario or hobby/activity of choice, environmental and procedural stimuli can be easily integrated in the imagery. Ego-strengthening metaphors that tie in features of strength, confidence, or resilience are particularly empowering. Even when children are fully under general anesthesia, they may still have recall of what is said in the room, and therefore, caution in word choice should be maintained.
... The hyperactivity of HPA axis in diabetes seems to have an important role in impairment of wound healing, once dexamethasone impaired collagen synthesis by fibroblasts and reduced proliferation, migration and contraction of these cells both in non-diabetic and diabetic animals [73]. Moreover, these animals over stress conditions present increased glucocorticoids levels which compromise the immune system and inflammatory response [74][75][76][77][78]. Furthermore, glucocorticoids can increase ROS production [79,80] and inhibit angiogenesis by reducing VEGF expression [81,82]. ...
Diabetes is a chronic metabolic disease whose incidence is increasing over the years in both developed and developing countries. Uncontrolled or poor controlled diabetic patients present several secondary complications induced by hyperglycemia, which are involved with the high morbidity and mortality of this disease. Moreover, the reduction of insulin production in diabetic patients induces increase of the activity of HPA axis that results in an increase of glucocorticoid production. This review gives an update of the state-of-the-art concerning the relationship of hyperactivity of HPA axis observed in type 1diabetic patients and the development of the disease complications.
... It is this process, and the utility of coping interventions in improving health outcomes, that will be the focus of this section. A recent review by Broadbent and Koschwanez (2012) highlights recent advances in wound healing and psychological interventions in clinical populations. ...
Stress has been consistently associated with negative health outcomes, including increased rates of heart disease, slower wound healing, and compromised immune function. Interventions designed to improve peoples' ability to cope with stress can improve health outcomes. Such interventions include relaxation training, emotional expression, benefit finding, and cognitive-behavioral stress management and mindfulness-based stress reduction programs. Coping interventions have the potential to improve health outcomes for patients undergoing a stressful illness experience.
... Exposure to everyday stressors [14] and/or chronic stressors tends to delay healing whereas social support has been shown to promote healing [15]. Crucially, as pointed out by Broadbent and Koschwanez [16], wound healing is itself a health outcome, and thus provides more direct and valid information than other biomarkers of health. As the immunological and endocrine mechanisms mediating wound healing have been clearly delineated [17], wound healing enables researchers to study both health outcomes and their mediating physiological mechanisms at the same time. ...
... Aktivita vagu přímo modifikuje metabolickou odpověď na jídlo a také zánětlivou aktivitu (23). PS stres tedy působí prozánětlivě, podporuje imunitní deregulaci, oslabuje protilátkovou odpověď na vakcinaci, zpomaluje hojení ran a potlačuje buněčnou imunitu (24,25). Navozené změny imunity ovlivňují vnímavost k infekčním chorobám a rychlost úzdravy (4). ...
Psychosocial factors significandy participate in the pathogenesis of complex diseases. Their effects correspond to the bio-psycho-social concept of health and disease on many levels. Brain functions, behaviour and immunity are closely linked and responsive to the environmental context. The effects of chronic psychosocial stress are described by the allostatic load model which high-lights dynamic adjustment of biological processes and the importance of the brain for feedback regulation in adapting to the environment. The personality of an individual, his cognitive and emotional characteristics, quality of social relationships and socioeconomic factors modify stress load and have a direct and indirect impact on health. Many of the effects of psychosocial factors are mediated epigenetically. In the early development epigenetic mechanisms form the vulnerability to stress-related pathologies. Psychological, genetic, behavioural and environmental factors continuously interact. The indirect effects of psychosocial factors are contained in the modification of behaviour and lifestyle. These effects are bidirectional, because lifestyle in turn has an impact on mental and physical health. Approaches aimed at promoting resilience to stress play an important role in prevention.
Hygiena, Tigis s.r.o., 2014, roč. 59, č. 2, s. 79-86. ISSN 1802-6281.
A wound is described as a break in a tissue's cellular and anatomic continuity. A wound is a cellular, anatomical, and functional disturbance of living tissue induced by physical, chemical, electrical, or microbiological threats to the tissue. Wound healing is a multi-step process involving injured tissue regeneration or restoration. The typical wound-healing response is a coordinated series of processes that starts with an injury. Wound healing is a series of interconnected cellular and biochemical activities that result in restoring structural and functional integrity and re-establishing strength in wounded tissues. This study includes a review of plants with wound-healing activities found via ethnobotanical and folklore medicinal surveys. This article discusses the wound-healing capabilities of plants, as well as their botanical names, common names, families, parts utilized, and references, all of which might assist researchers to design novel wound-healing formulations for human use.
Introduction
Entering an animal shelter is a stressful experience for dogs that can impair their welfare, adoptability, and shelter staff safety; thus, it is crucial to reduce the stress experienced during intake. This study investigated the current intake practices for dogs admitted in animal shelters in Texas, United States.
Methods
To gather data, an online survey was designed and distributed to shelter employees responsible for intake at animal shelters. The survey collected information about examination procedures, the type of information collected from owner-surrenders, as well as the housing environment for the dogs.
Results
Survey participants (n = 64) were shelter staff from municipal (59%, 38/64) and private shelters (23%, 15/64) in 47 counties. Handling techniques reported to be used during intake exams varied depending on the dog’s behavior, with participants reporting higher restraint for aggressive dogs and lower restraint for calm dogs. If the dog was displaying fear, participants reported offering food and attention (89%, 47/53), using towel restraint (64%, 34/53) and conducting the exam on someone’s lap (49%, 26/53). In cases of aggression, it was commonly reported to use muzzles (81%, 42/52) and catch poles (77%, 40/52), and shorten the exam (71%, 37/52). After the exam, most reported placing dogs on the adoption floor (45%, 27/60) or placing them wherever space was available (20%, 12/60).
Discussion
Results provide descriptive information on current intake procedures and routine handling techniques used in Texas shelters. Future research should explore shelter dog responses to routine handling techniques to support the development of evidence-based protocols during routine intake examinations and procedures.
Over the past half century, our best scientific understanding of the immune system has been transformed. The immune system has turned out to be extremely sophisticated, densely connected to the central nervous system and cognitive capacities, deeply involved in the production of behaviour, and responsive to different kinds of psychosocial event. Such results have rendered the immune system part of the subject-matter of psychology and cognitive science. I argue that such results, alongside the history of psychoneuroimmunology, give us good reason to be sceptical about the characterization of cognitive science and psychology as studying the mind and the mental.
The Current Research Aims to identify of the role played by psychological factor variables in the orientations of the client (patient) in the units of the special health department The Results Showed off There is a significant positive direct between the psychological factor of the patient related to the health service and the patient's attitudes, as well as a significant Negative direct of between the psychological factor of the patient related to the patient status and the patient's attitudes. The study also concluded with many Recommendations, Important: establishment of independent buildings for the units of private suites and the expansion of the number of beds and attention to its architectural functions and supplying them with modern and sophisticated devices at competitive prices and the creation of jobs to care for the psychological factor of the patient and jobs concerned with the dissemination of health education.
The Current Research Aims to identify of the role played by psychological factor variables in the orientations of the client (patient) in the units of the special health department The Results Showed off There is a significant positive direct between the psychological factor of the patient related to the health service and the patient's attitudes, as well as a significant Negative direct of between the psychological factor of the patient related to the patient status and the patient's attitudes. The study also concluded with many Recommendations, Important: establishment of independent buildings for the units of private suites and the expansion of the number of beds and attention to its architectural functions and supplying them with modern and sophisticated devices at competitive prices and the creation of jobs to care for the psychological factor of the patient and jobs concerned with the dissemination of health education.
Mental Health Disorders (MHD) are a growing concern nationwide. The significant impact MHD have on surgical outcomes has only recently started to be understood. This literature review investigated how mental health impacts the outcomes of general surgery patients and what can be done to make improvements. Patients with schizophrenia had the poorest surgical outcomes. Mental health disorders increased post-surgical pain, hospital length of stay, complications, readmissions, and mortality. Mental health disorders decreased wound healing and quality of care. Optimizing outcomes will be best accomplished through integrating more effective perioperative screening tools and interventions. Screenings tools can incorporate artificial intelligence, MHD data, resilience and its biomarkers, and patient mental health questionnaires. Interventions include cognitive behavioral therapy, virtual reality, spirituality, pharmacology, and resilience training.
The interest in the field of subjective well-being has dramatically increased in recent decades. There has been a burst of interest in what makes, keeps, and detracts us from being happy (see the comprehensive Nobascholar.com for further reading). However, the concept of subjective well-being extends being simple happiness and refers to how people evaluate their life. It captures how people feel (both positively and negatively) and judge their own life. In this chapter, we will first define the three primary components of our conceptualization of subjective well-being and review the measurements common in well-being research. Perhaps given the technological and scientific advances in the assessments available to measure well-being, we can move on to discuss the hallmark studies and recent trends in both the causes and outcomes associated with subjective well-being. We will describe the primary causes of well-being that researchers have focused on including income, relationships, biology, personality, and important positive behaviors. Subsequently, we will provide an overview of the critical outcomes associated with subjective well-being including the impact on our health, work success, income, relationships, and positive behaviors. Throughout we will pay close attention to discussing the cross-cultural relevancy of these findings and point out discrepancies in the experience and outcomes of well-being across cultures.
Background
Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus and a leading cause of lower limb amputation. Interventions to reduce psychological stress may have the potential to improve self-care and greatly reduce the morbidity and mortality associated with DFU. This review is focused on the consequences of psychological stress in wound healing and reflects on the effects of currently used psychological stress-reducing interventions in patients with DFU, proposing new applications for currently used stress-reduction interventions.
Results
Stress is a natural and fundamental survival mechanism that becomes harmful when chronic. DFU is associated with high levels of anxiety and chronic psychological stress. Chronic stress induced cortisol and adrenaline release impairs wound healing, independently of the stressor. Psychological stress-reducing interventions, such as relaxation with guided imagery, biofeedback-assisted relaxation, mindfulness-based strategies, and hypnosis can lead to a reduction in perceived stress and improve wound healing, by reducing wound inflammation and pain, while improving glycemic control. All stress reduction interventions also lead to pain relief and improved patient’s quality of life.
Social isolation and loneliness were already pressing concerns prior to the pandemic, but recent trends suggest a potential broadening of this public health crisis. Social connections have potent influences on health and longevity, and lacking social connection qualifies as a risk factor for premature mortality. However, social factors are often overlooked in medical and healthcare practice. There is also evidence documenting effects on biomarkers and health-relevant behaviors, as well as more proximal means social connection influences physical health. A recent National Academy of Science consensus committee report provides recommendations for how this evidence can inform medical and healthcare. Clinicians play an important role in assessing, preventing, and mitigating the adverse effects of social isolation and loneliness.
https://link.springer.com/chapter/10.1007/15695_2018_134 Wound healing is a complex process formed of various overlapping stages, namely, clot formation, inflammation, proliferation, and remodeling, which depend on the systemic health and a competent immune system. Negative cognitive processes such as pain and stress can induce the stress response, which delays wound healing by deteriorating health and modulating the immune function through the activation of the hypothalamus-pituitary-adrenal and sympathetic-adrenal-medullary axes. Hence, it seems that practices capable of mitigating stress or pain might accelerate wound healing. This chapter reviews the effects of relaxation and meditation, music therapy, expressive writing, hypnosis, and placebo on physiological health and wound recovery.
Clinical Nursing Skills provides students with a strong, industry-focused foundation in nursing across various clinical settings. It includes the essential theory as well as relevant practical examples, which illustrate the skills required to prepare students for the workplace and help them achieve clinical competence. Each chapter is written by academics who are leaders in their field. Topics are based on the national standards for practice and provide a connection to the profession by linking knowledge, understanding and practice.
Background:
Writing therapy to improve physical or mental health can take many forms. The most researched model of therapeutic writing (TW) is unfacilitated, individual expressive writing (written emotional disclosure). Facilitated writing activities are less widely researched.
Data sources:
Databases, including MEDLINE, EMBASE, PsycINFO, Linguistics and Language Behaviour Abstracts, Allied and Complementary Medicine Database and Cumulative Index to Nursing and Allied Health Literature, were searched from inception to March 2013 (updated January 2015).
Review methods:
Four TW practitioners provided expert advice. Study procedures were conducted by one reviewer and checked by a second. Randomised controlled trials (RCTs) and non-randomised comparative studies were included. Quality was appraised using the Cochrane risk-of-bias tool. Unfacilitated and facilitated TW studies were analysed separately under International Classification of Diseases, Tenth Revision chapter headings. Meta-analyses were performed where possible using RevMan version 5.2.6 (RevMan 2012, The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark). Costs were estimated from a UK NHS perspective and three cost-consequence case studies were prepared. Realist synthesis followed Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines.
Objectives:
To review the clinical effectiveness and cost-effectiveness of TW for people with long-term conditions (LTCs) compared with no writing, or other controls, reporting any relevant clinical outcomes. To conduct a realist synthesis to understand how TW might work, and for whom.
Results:
From 14,658 unique citations, 284 full-text papers were reviewed and 64 studies (59 RCTs) were included in the final effectiveness reviews. Five studies examined facilitated TW; these were extremely heterogeneous with unclear or high risk of bias but suggested that facilitated TW interventions may be beneficial in individual LTCs. Unfacilitated expressive writing was examined in 59 studies of variable or unreported quality. Overall, there was very little or no evidence of any benefit reported in the following conditions (number of studies): human immunodeficiency virus (six); breast cancer (eight); gynaecological and genitourinary cancers (five); mental health (five); asthma (four); psoriasis (three); and chronic pain (four). In inflammatory arthropathies (six) there was a reduction in disease severity [n = 191, standardised mean difference (SMD) -0.61, 95% confidence interval (CI) -0.96 to -0.26] in the short term on meta-analysis of four studies. For all other LTCs there were either no data, or sparse data with no or inconsistent, evidence of benefit. Meta-analyses conducted across all of the LTCs provided no evidence that unfacilitated emotional writing had any effect on depression at short- (n = 1563, SMD -0.06, 95% CI -0.29 to 0.17, substantial heterogeneity) or long-term (n = 778, SMD -0.04 95% CI -0.18 to 0.10, little heterogeneity) follow-up, or on anxiety, physiological or biomarker-based outcomes. One study reported costs, no studies reported cost-effectiveness and 12 studies reported resource use; and meta-analysis suggested reduced medication use but no impact on health centre visits. Estimated costs of intervention were low, but there was insufficient evidence to judge cost-effectiveness. Realist synthesis findings suggested that facilitated TW is a complex intervention and group interaction contributes to the perception of benefit. It was unclear from the available data who might benefit most from facilitated TW.
Limitation:
Difficulties with developing realist synthesis programme theory meant that mechanisms operating during TW remain obscure.
Conclusions:
Overall, there is little evidence to support the therapeutic effectiveness or cost-effectiveness of unfacilitated expressive writing interventions in people with LTCs. Further research focused on facilitated TW in people with LTCs could be informative.
Study registration:
This study is registered as PROSPERO CRD42012003343.
Funding:
The National Institute for Health Research Health Technology Assessment programme.
Background:
Patients with low fitness as assessed by cardiopulmonary exercise testing (CPET) have higher mortality and morbidity after surgery. Preoperative exercise intervention, or prehabilitation, has been suggested as a method to improve CPET values and outcomes. This trial sought to assess the capacity of a 4-week supervised exercise programme to improve fitness before liver resection for colorectal liver metastasis.
Methods:
This was a randomized clinical trial assessing the effect of a 4-week (12 sessions) high-intensity cycle, interval training programme in patients undergoing elective liver resection for colorectal liver metastases. The primary endpoint was oxygen uptake at the anaerobic threshold. Secondary endpoints included other CPET values and preoperative quality of life (QoL) assessed using the SF-36®.
Results:
Thirty-eight patients were randomized (20 to prehabilitation, 18 to standard care), and 35 (25 men and 10 women) completed both preoperative assessments and were analysed. The median age was 62 (i.q.r. 54-69) years, and there were no differences in baseline characteristics between the two groups. Prehabilitation led to improvements in preoperative oxygen uptake at anaerobic threshold (+1·5 (95 per cent c.i. 0·2 to 2·9) ml per kg per min) and peak exercise (+2·0 (0·0 to 4·0) ml per kg per min). The oxygen pulse (oxygen uptake per heart beat) at the anaerobic threshold improved (+0·9 (0·0 to 1·8) ml/beat), and a higher peak work rate (+13 (4 to 22) W) was achieved. This was associated with improved preoperative QoL, with the overall SF-36® score increasing by 11 (95 per cent c.i. 1 to 21) (P = 0·028) and the overall SF-36® mental health score by 11 (1 to 22) (P = 0·037).
Conclusion:
A 4-week prehabilitation programme can deliver improvements in CPET scores and QoL before liver resection. This may impact on perioperative outcome. Registration number: NCT01523353 (https://clinicaltrials.gov).
Interactions between the nervous system and immune system have been studied extensively. However, the mechanisms underlying the neural regulation of immune activity, particularly the neuroendocrine regulation of immunologic functions, remain elusive. In this review, we provide a comprehensive examination of current evidence on interactions between the immune system and hypothalamic oxytocin-secreting system. We highlight the fact that oxytocin may have significant effects in the body, beyond its classical functions in lactation and parturition. Similar to the hypothalamo-pituitary-adrenal axis, the oxytocin-secreting system closely interacts with classical immune system, integrating both neurochemical and immunologic signals in the central nervous system and in turn affects immunologic defense, homeostasis, and surveillance. Lastly, this review explores therapeutic potentials of oxytocin in treating immunologic disorders.
Objectives:
To determine the influence of patient depression (and anxiety) on postoperative outcome and surgeons' consideration of it.
Background:
Patients' mental state influences the course of nonpsychiatric diseases. Evidence in the surgical setting comes mainly from cardiac-surgery patients and no predictive-model of postoperative outcome considers this dimension.
Methods:
This prospective multicenter study included patients undergoing liver resections, a model of major abdominal surgery, between September 2013 and September 2014 in 8 centers. The primary outcome was postoperative morbidity or mortality (assessed by the Clavien-Dindo grade and the Comprehensive Complication Index) and the postoperative length of stay (LOS). Depression and anxiety were assessed preoperatively with the Hospital Anxiety and Depression Scale and a validated cutoff. Surgeons were preoperatively asked to predict outcome. Multivariable mixed-effects Cox models were fitted to evaluate the influence of depression on actual and surgeon-anticipated outcome and on the difference between actual and surgeon-anticipated LOS.
Results:
Hospital Anxiety and Depression Scale identified 142 of 591 patients (24.0%) as depressed and 40.3% as anxious. Neither condition was independently correlated with morbidity or mortality, but depression was an independent risk factor for prolonged LOS (adjusted hazard ratio 0.65, 95% confidence interval 0.50-0.83, P = 0.001). Depression was not correlated with anticipated LOS. Three variables explained the gap between anticipated and actual LOS: depression (P = 0.003), associated surgical procedures in addition to liver resection (P = 0.007), and postoperative morbidity (P < 0.001).
Conclusions:
Nearly 1 quarter of patients undergoing major abdominal surgery are depressed preoperatively. This depression is a strong independent predictor of prolonged LOS and partly explains surgeons' failure to predict outcome accurately.
This study extends stress and affiliation research by examining the effects of preoperative roommate assignments on the affiliation patterns, preoperative anxiety, and postoperative recovery of 84 male coronary-bypass patients. Patients were assigned preoperatively to a room alone or to a semiprivate room with a roommate who was either cardiac or noncardiac and either preoperative or postoperative. Patients assigned to a roommate who was postoperative rather than preoperative were less anxious, were more ambulatory postoperatively, and had shorter postoperative stays. Independently, patients were more ambulatory postoperatively and were discharged sooner if assigned to a roommate who was cardiac rather than noncardiac. No-roommate patients generally had the slowest recoveries. Affiliations reflecting cognitive clarity concerns, emotional comparison, and emotional support were examined. Theoretical implications for research involving social comparison and affiliation under threat are considered.
Unlabelled:
Objective. The aim of this study was to investigate coping strategies used by patients with chronic and/or complex wounds treated in an outpatient wound clinic.
Methods:
Coping strategies were assessed using the Utrecht Coping List (UCL). The Mini-Mental State Examination (MMSE) was used to assess the patient's cognitive functioning. Fifty patients were selected for this study. The wound etiologies studied were: diabetic foot ulcers, lower extremity ulcers, surgical wounds, trauma wounds, and pressure ulcers.
Results:
Scores on the coping measure for men and women differed significantly from the control groups. It was also found that each wound etiology showed a preference toward different coping strategies. Furthermore, 28% of the studied group had a lowered score on the MMSE, indicating possible cognitive impairments.
Conclusion:
There might be an association between wound etiology and the coping strategy that is preferred; this knowledge could be used to guide treatment strategies used by clinicians. Further research could focus on the effects of coping strategies on wound healing rates .
Numerous studies have examined the effect of psychological variables on surgical recovery, but no definite conclusion has been reached yet. We sought to examine whether psychological factors influence early surgical recovery.
We performed a systematic search in PubMed, Scopus and PsycINFO databases to identify studies examining the association of preoperative psychological variables or interventions with objectively measured, early surgical outcomes.
We identified 16 eligible studies, 15 of which reported a significant association between at least one psychological variable or intervention and an early postoperative outcome. However, most studies also reported psychological factors not influencing surgical recovery and there was significant heterogeneity across the studies. Overall, trait and state anxiety, state anger, active coping, subclinical depression, and intramarital hostility appeared to complicate recovery, while dispositional optimism, religiousness, anger control, low pain expectations, and external locus of control seemed to promote healing. Psychological interventions (guided relaxation, couple support visit, and psychiatric interview) also appeared to favor recovery. Psychological factors unrelated to surgical outcomes included loneliness, perceived social support, anger expression, and trait anger.
Although the heterogeneity of the available evidence precludes any safe conclusions, psychological variables appear to be associated with early surgical recovery; this association could bear important implications for clinical practice. Large clinical trials and further analyses are needed to precisely evaluate the contribution of psychology in surgical recovery.
Psychological stress (PS) exerts well-known negative consequences for permeability barrier function in humans and mice, and deterioration of barrier function appears to be attributable largely to excess production of endogenous glucocorticoids (GC). More recently, PS has been shown to compromise antimicrobial defense, also by GC-dependent mechanisms. We assessed here changes in a third antimicrobial peptide (AMP); i.e., the neuropeptide, catestatin (Cst), which also is expressed in the outer epidermis, and previously shown to be regulated by changes in permeability barrier status. In these studies, PS again provoked a decline in both mouse cathelicidin (CAMP) and mouse β-defensin 3 (mBD3) expression, in a GC-dependent fashion. In contrast, Cst immunostaining instead increased after short-term PS, but then began to decline with more sustained PS. In cultured keratinocytes, we showed further that GC downregulate Cst expression, but β-adrenergic blockade increased immunostaining for Cst in the face of long-term PS. Furthermore, β-adrenergic blockade also upregulated CAMP and mBD3 expression. Together, these results suggest that both endogenous GC and β-adrenergic signaling regulate AMP expression.
Stress-induced catecholamine impairs the formation of granulation tissue acting directly in fibroblast activity; however, the mechanism by which high levels of catecholamines alter the granulation tissue formation is still unclear. Thus, the aim of this study was to investigate how high levels of epinephrine compromise the activity of murine dermal fibroblasts. Dermal fibroblasts isolated from the skin of neonatal Swiss mice were preincubated with α- or β-adrenoceptor antagonists. Thereafter, cells were exposed to physiologically elevated levels of epinephrine or epinephrine plus α- or β-adrenoceptor antagonists, and fibroblast activity was evaluated. The blockade of β1- and β2-adrenoceptors reversed the increase in fibroblast proliferation, ERK 1/2 phosphorylation, myofibroblastic differentiation and the reduction of collagen deposition induced by epinephrine. In addition, the blockade of β3-adrenoceptors reversed the increase in fibroblast proliferation and nitric oxide synthesis as well as the reduction of fibroblast migration, AKT phosphorylation and active matrix metalloproteinase-2 expression induced by epinephrine. However, the blockade of α1- and α2-adrenoceptors did not alter the effects of epinephrine on the activity of murine dermal fibroblasts. In conclusion, high levels of epinephrine directly compromise the activity of neonatal mouse skin fibroblasts through the activation of β1-, β2- and β3-adrenoceptors, but not through α1- and α2-adrenoceptors.
Catecholamines are present in saliva, but their influence on oral epithelium is not understood. Because psychological stress increases salivary catecholamines and impairs oral mucosal wound healing, we sought to determine if epithelial adrenergic signaling could link these two findings. We found that cultured human oral keratinocytes (HOK) express the α(2B)- and β(2)-adrenergic receptors (ARs). Exposure of HOK to either epinephrine or the β-AR agonist, isoproterenol, reduced migratory speed and decreased in vitro scratch wound healing. Incubation with the β-AR antagonist timolol reversed the catecholamine-induced effects, indicating that the observed response is mediated by β-AR. Epinephrine treatment decreased phosphorylation of the mitogen-activated protein kinases (MAPK) ERK1/2 and p38; these decreases were also reversed with timolol. Cultured HOK express enzymes of the epinephrine synthetic pathway, and generate epinephrine. These findings demonstrate that stress-induced elevations of salivary catecholamines signal through MAPK pathways, and result in impaired oral keratinocyte migration required for healing.
Depression and anxiety are associated with increased risk of postoperative cardiac events and death in patients who have undergone coronary artery bypass graft surgery. These risks persist even several months after the procedure. Guided imagery has been used with cardiac surgery patients for some time and with numerous anecdotal reports of considerable benefit. In addition, this therapy is low-cost and easy to implement, and the literature holds ample evidence for its efficacy in symptom reduction in various patient populations. It was thus hypothesized that preoperative use of guided imagery would reduce postoperative distress in patients undergoing coronary artery bypass graft. Fifty-six patients scheduled to undergo coronary artery bypass graft at Columbia University Medical Center were randomized into 3 groups: guided imagery, music therapy, and standard care control. Patients in the imagery and music groups listened to audiotapes preoperatively and intraoperatively. All patients completed psychological, complementary medicine therapies use, and other assessments preoperatively and at 1 week and 6 months postoperatively. Only preoperative distress was predictive of postoperative distress at follow-up. Use of complementary medicine therapies was high in all groups and this fact, in addition to the small sample size, may have accounted for the lack of significant relationship between imagery and postoperative distress. Regardless, this complementary and alternative medicine therapy remains palatable to patients. Given its efficacy in other patient populations, it is worth exploring its potential utility for this population with a larger sample.
To examine the relationship between Intermittent Explosive Disorder (IED; a psychiatric diagnosis characterized by episodes of affective aggression) and adverse physical health outcomes.
A large epidemiological sample drawn from the Collaborative Psychiatric Epidemiological Surveys (N = 10,366), was used to compare participants with a lifetime diagnosis of IED (n = 929) to those without any history of IED (n = 9,437) on demographic variables (age, education, gender, race) common risk factors (smoking status, body mass index, substance use disorders, past accident or injury requiring treatment, major depression) and the presence of 12 adverse health outcomes.
History of heart attacks, coronary heart disease, hypertension, stroke, lung disease, diabetes, cancer, arthritis, back/neck pain, ulcer, headaches, and other chronic pain.
Logistic regression analysis controlling for demographic and other risk factors indicated that IED was associated with 9 of the 12 adverse physical health outcomes (coronary heart disease, hypertension, stroke, diabetes, arthritis, back/neck pain, ulcer, headaches, and other chronic pain). Only cancer, heart attacks, and lung disease were not significantly related to IED.
IED may be a risk factor for several significant adverse physical health outcomes.
Experimental evidence suggests that the healing of diabetic foot ulcers is affected by psychosocial factors such as distress. We examined this proposal in a prospective study, in which we considered the role of psychological distress and coping style in the healing of diabetic foot ulcers over a 24 week period. We also explored the role of salivary cortisol and matrix metalloproteinases (MMPs) as potential mechanisms.
For this prospective observational study we recruited 93 (68 men; mean age 60 years) patients with neuropathic or neuroischaemic diabetic foot ulcers from specialist podiatry clinics in secondary care. Clinical and demographic determinants of healing, psychological distress, coping, salivary cortisol and both MMP2 and MMP9 were assessed at baseline. Ulcers were assessed at baseline and at 6, 12 and 24 weeks post-baseline. The primary outcome was ulcer status at 24 weeks, i.e. healed vs not healed.
After controlling for clinical and demographic determinants of healing, ulcer healing at 24 weeks was predicted by confrontation coping, but not by depression or anxiety. Patients with unhealed ulcers exhibited greater confrontation coping (model including depression: OR 0.809, 95% CI 0.704-0.929, p = 0.003; model including anxiety: OR 0.810, 95% CI 0.704-0.930, p = 0.003). However, change in ulcer size over the observation period was associated with depression only (p = 0.04, d = 0.31). Healed ulcers by 24 weeks were also associated with lower evening cortisol, higher precursor MMP2 and a greater cortisol awakening response.
Confrontation coping and depression predict ulcer healing. Our preliminary enquiry into biological mechanisms suggests that cortisol and precursor MMP2 may underlie these relationships.
There is increasing evidence to support a relationship between psychological stress and delayed wound healing. Management should therefore include interventions that minimise patient distress, which will include social support and coping skills.
It is well-known that acute stress, presumably as a first defense against pathogens, enhances PBMC counts by mobilizing these beta2-adrenoceptor positive cells from the marginal pool. Yet, only select leukocyte subsets participate in this phenomenon of adrenergic leukocytosis and underlying mechanisms are obscure. In this study, we analyzed in human blood adhesion molecule and chemokine receptor profiles in 14 leukocyte subsets, and responsiveness of subsets to epinephrine in vivo and in vitro. Five subsets, namely, CCR7(-)CD45RA(+)CD8(+) effector T cells, CD4(-)CD8(-) gamma/delta T cells, CD3(+)CD56(+) NKT-like cells, CD16(+)CD56(dim) cytotoxic NK cells, and CD14(dim)CD16(+) proinflammatory monocytes showed a rapid and transient increase after infusion of epinephrine at physiological concentrations. These cells were characterized by a CD62L(-)CD11a(bright)CX3CR(bright) phenotype, whereby expression of both CD11a and CX3CR1 was strongly correlated with adrenergic leukocytosis in vivo (r = 0.86 and 0.78, p < 0.005). The same subsets showed highest adherence to activated endothelium in vitro, which (except for proinflammatory monocytes) was reversed by epinephrine. We conclude that these five cytotoxic effector leukocyte subsets comprise the marginal pool by a CD11a/CX3CR1-mediated attachment to the endothelium. Epinephrine rapidly attenuates this attachment to allow demargination and release of the cells into the circulation that, because of their cytotoxic effector function, provide immediate protection from invading pathogens.
While it has been suggested there is a link between stress and delayed wound healing, less is known about the role of pain as a contributor to stress. This paper reviews the evidence for this from studies of acute, surgical and chronic wounds.
This study examines the role of self-reported trait positive affect (PA) on skin barrier recovery after skin disruption, and whether the role of trait PA in wound healing is consistent with the direct effects model or the stress-buffering model of PA and health.
Sixty healthy participants (mean age 22.7 +/- 3.9 years) completed a self-report measure of trait positive and negative affect, underwent a "tape-stripping" procedure that disrupts normal skin barrier function, and were randomly assigned to a Stress (Trier Social Stress Test) or No Stress (reading task) condition.
Skin barrier recovery was assessed by measuring transepidermal water loss up to 2 hr after skin disruption.
Multilevel modeling indicated that greater trait PA was related to faster skin barrier recovery (p < .05). The effects of PA on skin barrier recovery were independent of levels of trait NA.
These findings suggest that trait PA may influence skin barrier recovery following a brief stressor. In addition, these results provide additional evidence that trait PA can positively impact objective health outcomes.
Environmental enrichment (EE) fosters attachment behavior through its effect on brain oxytocin levels in the hippocampus and other brain regions, which in turn modulate the hypothalamic-pituitary axis (HPA). Social isolation and other stressors negatively impact physical healing through their effect on the HPA. Therefore, we reasoned that: 1) provision of a rat EE (nest building with Nestlets) would improve wound healing in rats undergoing stress due to isolation rearing and 2) that oxytocin would have a similar beneficial effect on wound healing.
In the first two experiments, we provided isolation reared rats with either EE or oxytocin and compared their wound healing to group reared rats and isolation reared rats that did not receive Nestlets or oxytocin. In the third experiment, we examined the effect of Nestlets on open field locomotion and immediate early gene (IEG) expression. We found that isolation reared rats treated with Nestlets a) healed significantly better than without Nestlets, 2) healed at a similar rate to rats treated with oxytocin, 3) had decreased hyperactivity in the open field test, and 4) had normalized IEG expression in brain hippocampus.
This study shows that when an EE strategy or oxytocin is given to isolation reared rats, the peripheral stress response, as measured by burn injury healing, is decreased. The findings indicate an association between the effect of nest making on wound healing and administration of the pro-bonding hormone oxytocin. Further elucidation of this animal model should lead to improved understanding of how EE strategies can ameliorate poor wound healing and other symptoms that result from isolation stress.
Stress, both acute and chronic, can impair cutaneous wound repair, which has previously been mechanistically ascribed to stress-induced elevations of cortisol. Here we aimed to examine an alternate explanation that the stress-induced hormone epinephrine directly impairs keratinocyte motility and wound re-epithelialization. Burn wounds are examined as a prototype of a high-stress, high-epinephrine, wound environment. Because keratinocytes express the beta2-adrenergic receptor (beta2AR), another study objective was to determine whether beta2AR antagonists could block epinephrine effects on healing and improve wound repair.
Migratory rates of normal human keratinocytes exposed to physiologically relevant levels of epinephrine were measured. To determine the role of the receptor, keratinocytes derived from animals in which the beta2AR had been genetically deleted were similarly examined. The rate of healing of burn wounds generated in excised human skin in high and low epinephrine environments was measured. We utilized an in vivo burn wound model in animals with implanted pumps to deliver beta2AR active drugs to study how these alter healing in vivo. Immunocytochemistry and immunoblotting were used to examine the up-regulation of catecholamine synthetic enzymes in burned tissue, and immunoassay for epinephrine determined the levels of this catecholamine in affected tissue and in the circulation. When epinephrine levels in the culture medium are elevated to the range found in burn-stressed animals, the migratory rate of both cultured human and murine keratinocytes is impaired (reduced by 76%, 95% confidence interval [CI] 56%-95% in humans, p < 0.001, and by 36%, 95% CI 24%-49% in mice, p = 0.001), and wound re-epithelialization in explanted burned human skin is delayed (by 23%, 95% CI 10%-36%, p = 0.001), as compared to cells or tissues incubated in medium without added epinephrine. This impairment is reversed by beta2AR antagonists, is absent in murine keratinocytes that are genetically depleted of the beta2AR, and is reproduced by incubation of keratinocytes with other beta2AR-specific agonists. Activation of the beta2AR in cultured keratinocytes signals the down-regulation of the AKT pathway, accompanied by a stabilization of the actin cytoskeleton and an increase in focal adhesion formation, resulting in a nonmigratory phenotype. Burn wound injury in excised human skin also rapidly up-regulates the intra-epithelial expression of the epinephrine synthesizing enzyme phenylethanolamine-N-methyltransferase, and tissue levels of epinephrine rise dramatically (15-fold) in the burn wounded tissue (values of epinephrine expressed as pg/ug protein +/- standard error of the mean: unburned control, 0.6 +/- 0.36; immediately postburn, 9.6 +/- 1.58; 2 h postburn, 3.1 +/- 1.08; 24 h post-burn, 6.7 +/- 0.94). Finally, using an animal burn wound model (20% body surface in mice), we found that systemic treatment with betaAR antagonists results in a significant increase (44%, 95% CI 27%-61%, p < 0.00000001) in the rate of burn wound re-epithelialization.
This work demonstrates an alternate pathway by which stress can impair healing: by stress-induced elevation of epinephrine levels resulting in activation of the keratinocyte beta2AR and the impairment of cell motility and wound re-epithelialization. Furthermore, since the burn wound locally generates epinephrine in response to wounding, epinephrine levels are locally, as well as systemically, elevated, and wound healing is impacted by these dual mechanisms. Treatment with beta adrenergic antagonists significantly improves the rate of burn wound re-epithelialization. This work suggests that specific beta2AR antagonists may be apt, near-term translational therapeutic targets for enhancing burn wound healing, and may provide a novel, low-cost, safe approach to improving skin wound repair in the stressed individual.
The object of this animal study was to examine and further develop the expanded polytetrafluoroethylene wound healing model. The goal was to increase its potential for assessing wound healing by increasing yield, reducing variability, establishing the elements of a standard technique, and further testing its ability to detect variations of healing which have clinical significance. Expanded polytetrafluoroethylene implants of various dimensions and fabrications and several implantation and sterilization techniques were compared in rats. Hydroxyproline, DNA, and protein deposition into the expanded polytetrafluoroethylene implants as parameters for wound healing were assessed. Additionally, a 4 cm skin incision for tensile strength assessment was created. Wound healing was assessed under normal and corticosteroid-impaired healing conditions. The highest yield of collagen was found in the stiffer fabrication of expanded polytetrafluoroethylene with the larger pore size and after the more traumatic implantation technique of incisional placement. Variability was unaffected by fabrication, implantation technique, indexing by various geometric dimensions of the implant, sterilization, or sampling techniques. Variability was the same in the individual animals as in groups of animals. The expanded polytetrafluoroethylene method also detects the influence of antiinflammatory corticosteroids and reflects the tensile strength of incisional wounds made in other sites in the same animal.
It is widely believed that stress suppresses immune function and increases susceptibility to infections and cancer. Paradoxically, stress is also known to exacerbate allergic and autoimmune diseases that are proinflammatory and should theoretically be ameliorated by immunosuppression. These observations suggest that stress may have bidirectional effects on immune function, elucidation of which may have significant clinical consequences. It has recently been shown that in contrast to chronic stress that suppresses or dysregulates immune function, acute stress can be immunoenhancing. Studies have shown that acute stress experienced at the time of immune activation can affect dendritic cell, neutrophil, macrophage, and lymphocyte trafficking, maturation, and function, and augment innate as well as adaptive immune responses. Acute stress experienced prior to novel antigen exposure enhances innate immunity and memory T-cell formation and results in a significant and long-lasting immunoenhancement. Acute stress experienced during antigen re-exposure enhances secondary/adaptive immune responses. Therefore, depending on the conditions of immune activation and the nature of the immunizing antigen, acute stress may enhance the acquisition and expression of immunoprotection or immunopathology. In contrast, chronic stress dysregulates innate and adaptive immune responses by shifting the immunological balance from Type 1 to Type 2 cytokine-mediated immunity, and suppresses immunity by decreasing leukocyte numbers, trafficking, and function. Chronic stress also increases susceptibility to non-melanoma skin cancer by suppressing Type 1 cytokines and protective T cells while increasing suppressor T-cell function. We have suggested that the adaptive purpose of a physiological stress response may be to promote survival, with stress hormones and neurotransmitters serving as beacons that prepare the immune system for potential challenges (e.g., wounding or infection) perceived by the brain (e.g., detection of an attacker). However, this system may exacerbate immunopathology if the enhanced immune response is directed against innocuous or self-antigens, or dysregulated following prolonged activation during chronic stress. In view of the ubiquitous nature of stress and its significant effects on immunoprotection as well as immunopathology, it is important to further elucidate the mechanisms mediating stress–immune interactions and to meaningfully translate findings from bench to bedside.
Prior research has suggested that posttraumatic stress symptoms may occur in the context of medical events. Further, these symptoms are often comorbid with conditions associated with pain. Therefore, the current study examined the occurrence of distress following arthroplastic surgery and the relationship of these symptoms to postoperative recovery.
Patients (N =110) undergoing unilateral, total knee replacement (TKR) surgery were assessed at three time points proximal to their surgery: approximately 2 weeks prior to surgery (T1), 1 month following surgery (T2) and 3 months following surgery (T3). Patients completed survey assessments of recovery outcomes (Western Ontario and McMaster Universities Osteoarthritis Index) and distress (The Impact of Event Scale [IES]) following surgery (T2 and T3).
A significant percentage (20%) of patients undergoing TKR reported noteworthy levels of postsurgical stress 1 and 3 months following surgery. Further, this distress was associated with a more difficult recovery following TKR, characterized by more severe pain and greater functional limitations. After controlling for potential confounding variables, regression analyses suggested that postsurgical stress was cross-sectionally related to pain perception and longitudinally predicted subsequent functional limitations and global assessments of recovery.
To our knowledge, this is the first study to examine postoperative distress (using the IES) following TKR. The present study adds to the growing body of literature documenting the impact of psychological processes on postoperative recovery.
This review examined the effect of psychological interventions in patients with inflammatory bowel diseases (Crohn's disease and ulcerative colitis) on health related quality of life, emotional state and disease activity. Overall, 21 studies were included in the review, but not all provided sufficient data for the different study questions. All studies were of low methodological quality. Most studies examined combination therapies, often aimed at improving stress management. For example, a therapy might include patient information sessions, training in relaxation techniques and psychotherapy sessions, such as group therapy. Others were restricted to just providing information materials to patients. None of the included studies reported any side effects of psychological interventions. In adults, psychotherapy was not effective at 6 and 12 months for all outcomes (quality of life, emotional status/depression and relapse/disease activity), based on 3 studies. There was no difference by type of disease (Crohn's disease versus ulcerative colitis) or intensity of the therapy. In adolescents, there was a small positive effect for all outcomes (quality of life, coping, depression and anxiety), but only short term effects were reported in this group. Disease activity and relapse rates were not examined in adolescents. In adults, educational interventions were also not effective to improve quality of life and the course of the disease over 1 year, based on 5 studies. Generally, at this moment, it can not be recommended that all patients with IBD receive psychotherapy. We assume that adolescents, and patients with special needs (e.g. emotional problems) may benefit from psychological therapy. More research is needed to examine the effect of psychotherapy focusing on the individual psychological situation of IBD patients.
To assess whether stress management (SM) improved immune outcomes in men undergoing surgery for prostate cancer.
A total of 159 men were assigned randomly to a two-session presurgical SM intervention, a two-session supportive attention (SA) group, or a standard care (SC) group. Men in the SM group discussed their concerns about the upcoming surgery and were taught diaphragmatic breathing, guided imagery; they had an imaginal exposure to the day of surgery and learned adaptive coping skills. Men in the SA group discussed their concerns about the upcoming surgery and had a semistructured medical interview. Blood samples were collected at baseline (1 month before surgery) and 48 hours after surgery. Measures of mood (Profile of Mood States) were collected at baseline, 1 week pre surgery, and the morning of surgery.
Men in the SM group had significantly higher levels of natural killer cell cytotoxicity (p = .04) and higher levels of circulating proinflammatory cytokines (interleukin [IL]-12p70, p = .02; IL-1β, p = .02; tumor necrosis factor-α, p = .05) 48 hours post surgery than men in the SA group and higher levels of natural killer cell cytotoxicity (p = 0.02) and IL-1β (p = .05) than men in the SC group. Immune parameters increased for the SM group and decreased or stayed the same for the SA and SC groups. The SM group had significantly lower Profile of Mood States scores than the SC group (p = .006), with no other group differences between SA and SC groups. Changes in mood were not associated with immune outcomes.
The finding that SM leads to decreased presurgical mood-disturbance and increased immune parameters after surgery reveals the potential psychological and biological benefits of presurgical SM.
To provide a critical review of methods used to assess human wound healing in psychological research and related disciplines, in order to guide future research into psychological influences on wound healing.
Acute wound models (skin blister, tape stripping, skin biopsy, oral palate biopsy, expanded polytetrafluoroethylene tubing), surgical wound healing assessment methods (wound drains, wound scoring), and chronic wound assessment techniques (surface area, volumetric measurements, wound composition, and assessment tools/scoring systems) are summarized, including merits, limitations, and recommendations.
Several dermal and mucosal tissue acute wound models have been established to assess the effects of psychological stress on the inflammatory, proliferative, and repair phases of wound healing in humans, including material-based models developed to evaluate factors influencing post-surgical recovery. There is a paucity of research published on psychological factors influencing chronic wound healing. There are many assessment techniques available to study the progression of chronic wound healing but many difficulties inherent to long-term clinical studies.
Researchers need to consider several design-related issues when conducting studies into the effects of psychological stress on wound healing, including the study aims, type of wound, tissue type, setting, sample characteristics and accessibility, costs, timeframe, and facilities available. Researchers should consider combining multiple wound assessment methods to increase the reliability and validity of results and to further understand mechanisms that link stress and wound healing.
Neglected malignant ulcerating tumours often result from failure to seek medical attention, even when the advancing tumour is visible to the patient and their friends and families. Although the appropriate wound treatment procedures are the same as for non-neglected malignant wounds, clinicians must take such neglect into account when planning the patient's care. Over a 2-year period, 25 patients at the National Cancer Centre Wound Care Unit in Paris were identified as presenting with a neglected tumour; 18 of these agreed to participate in a structured interview with a psycho-oncologist for an evaluation of their neglect behaviour. Initial results demonstrate a frequent, but not systematic, presence of a wide range of psychopathological disorders.
To evaluate the effect of guided imagery as an intervention to reduce pain and anxiety in patients undergoing a total joint arthroplasty.
A total of 121 patients scheduled for elective total joint arthroplasty.
The design for this study was a 2-group quasi-experimental design. The intervention group listened to a guided imagery CD containing a message to develop a sense of relaxation and harmony. The intervention and control groups were compared on self-reported pain and anxiety levels postoperatively on Days 1, 2, and 3.
There was no significant difference in pain and anxiety levels between the groups. However, the intervention group had lower levels of anxiety and pain at all time points. Both groups followed a similar anxiety and pain pattern with the highest reported levels at Day 2.
Conduct further research of guided imagery as an intervention for reducing pain and anxiety utilizing randomized controlled trials with a diverse sample of patients.
Social interactions have long-term physiological, psychological, and behavioral consequences. Social isolation is a well-recognized but little understood risk factor and prognostic marker of disease; it can have profoundly detrimental effects on both mental and physical well-being, particularly during states of compromised health. In contrast, the health benefits associated with social support (both reduced risk and improved recovery) are evident in a variety of illnesses and injury states; however, the mechanisms by which social interactions influence disease pathogenesis remain largely unidentified. The substantial health impact of the psychosocial environment can occur independently of traditional disease risk factors and is not accounted for solely by peer-encouraged development of health behaviors. Instead, social interactions are capable of altering shared pathophysiological mechanisms of multiple disease states in distinct measurable ways. Converging evidence from animal models of injury and disease recapitulates the physiological benefits of affiliative social interactions and establishes several endogenous mechanisms (inflammatory signals, glucocorticoids, and oxytocin) by which social interactions influence health outcomes. Taken together, both clinical and animal research are undoubtedly necessary to develop a complete mechanistic understanding of social influences on health.
Converging and replicated evidence indicates that psychological stress can modulate wound-healing processes. This article reviews the methods and findings of experimental models of wound healing. Psychological stress can have a substantial and clinically relevant impact on wound repair. Physiologic stress responses can directly influence wound-healing processes. Furthermore, psychological stress can indirectly modulate the repair process by promoting the adoption of health-damaging behaviors. Translational work is needed to develop innovative treatments able to attenuate stress-induced delays in wound healing.
Bidirectional relationships between the immune system, nervous system, and psychological processes likely exist in inflammatory bowel disease (IBD) because stress can affect IBD, and IBD is associated with an increased risk of psychological difficulty. The field of psychoneuroimmunology (PNI) sheds light on specific mechanisms that are involved in these relationships, and this research can be applied specifically to IBD. The purpose of this article is to review research on PNI processes in IBD and provide recommendations for future research.
A literature search was conducted using the PubMed and PsychInfo computerized databases and bibliographies of relevant articles.
The hypothalamic-pituitary-adrenal axis, sympathetic-adrenomedullary system, proinflammatory cytokines, substance P, and mast cells play roles in inflammatory processes in IBD. These processes also respond to stress, and they have been implicated in psychological problems in otherwise healthy individuals. These overlapping processes in inflammation and psychological function have received limited attention in IBD, but preliminary evidence suggests that these mechanisms may play a role in the psychological difficulty experienced by those with IBD.
Several bidirectional PNI mechanisms overlap in IBD, suggesting ways that stress and psychological function can affect disease activity and, conversely, avenues by which the inflammation in IBD may contribute to psychological difficulty. More research on specific PNI processes is needed to fully understand these factors in IBD.
Patient stress and anxiety are common preoperatively and during dermatologic procedures and surgeries. Stress and anxiety can occasionally interfere with performance of procedures or surgery and can induce hemodynamic instability, such as elevated blood pressure or syncope, as well as producing considerable discomfort for some patients. Detection of excess stress and anxiety in patients can allow the opportunity for corrective or palliative measures. Slower breathing, biofeedback, progressive muscular relaxation, guided imagery, hypnosis, meditation and music can help calm and rebalance the patient's autonomic nervous system and immune functioning. Handheld miniaturized heart rate variability biofeedback devices are now available. The relaxation response can easily be taught. Guided imagery can be recorded or live. Live rapid induction hypnosis followed by deepening and then self-guided imagery requires no experience on the part of the patient but does require training and experience on the part of a provider. Recorded hypnosis inductions may also be used. Meditation generally requires more prior experience and training, but is useful when the patient already is skilled in it. Live, guided meditation or meditation recordings may be used. Relaxing recorded music from speakers or headphones or live performance music may also be employed to ease discomfort and improve the patient's attitude for dermatologic procedures and surgeries.
Please cite this paper as: Cutaneous wound healing of chronically stressed mice is improved through catecholamines blockade. Experimental Dermatology 2010; 19: 821–829.
Abstract: Stress impairs cutaneous wound healing; however, it is unclear how β-adrenoceptors participates in alterations induced by stress on skin wound repair. Therefore, the aim of this study was to investigate the effects of propranolol, a non-selective β-blocker, administration on cutaneous wound healing of chronically stressed mice. Male mice were spun at 115 rpm for 15 min every hour from three days before wounding until euthanasia. Control animals were not submitted to stress. Stressed and control animals were treated with propranolol dissolved in water; controls received only water. Propranolol administration began one day before wounding and was continued daily until euthanasia. A full-thickness excisional lesion was performed. Seven and fourteen days later, animals were killed, and lesions were formalin-fixed and paraffin-embedded. Sections were stained with hematoxylin-eosin and immunostained against F4/80 to quantify macrophages, α-smooth muscle actin to quantify the myofibroblast density and proliferating cell nuclear antigen to quantify the cell proliferation. Furthermore, matrix metalloproteinases (MMP)-2 and MMP-9 activity, nitrite and hydroxyproline levels and tumor necrosis factor-α (TNF-α) expression were measured in wound. Stress and control + propranolol groups presented a delay in wound contraction, re-epithelialization, F4/80-positive macrophages, neutrophils and mast cells infiltration, cellular proliferation, angiogenesis, myofibroblastic differentiation, MMP-2 and MMP-9 activation and TNF-α expression, whereas an increase in the nitrite levels. Stress + propranolol group presented results similar to control group. In conclusion, stress impairs cutaneous wound healing in mice through β1- adrenoceptors and β2-adrenoceptors activation.
Oxytocin (OT) has long been implicated in maternal bonding, sexual behavior and social affiliation behaviors. This paper reviews the wide effects of oxytocin and its key role in well-being.
Studies were identified through Medline, Pubmed, and PsychINFO search of the English-language literature from the past sixty years (1959 to 2009) using the key word "oxytocin" in human studies. Of the 287 articles identified, 102 were selected for review.
OT induces a general sense of well-being including calm, improved social interactions, increased trust, and reduced fear as well as endocrine and physiological changes. Some central effects of OT are temporary and its release is associated with induction of secondary biochemical actions which mediate long-term benefits including blood pressure reduction, calm and affiliative behavior. As OT release is augmented by touch and physiological support so the hormone is involved in both the cause and benefits of social interactions. Just as OT has widespread effects in factors encompassing well-being, its dysfunction is associated with morbidity and decreased quality of life as observed neuropsychiatric conditions such as autism, schizophrenia and social phobias.
Oxytocin (OT) is of potential use in enhancing interpersonal and individual well-being, and might have more applications in neuropsychiatric disorders especially those characterized by persistent fear, repetitive behavior, reduced trust and avoidance of social interactions.
Leg ulcer management focuses on healing, but if the wound does not respond to treatment, the patient may feel dejected and guilty. Centering the patient's life around treatment only makes matters worse. An alternative approach is needed.
Animal studies have implicated oxytocin and vasopressin in social bonding, physiological stress responses, and wound healing. In humans, endogenous oxytocin and vasopressin levels covary with perceptions of relationship quality, marital behaviors, and physiological stress responses. To investigate relationships among marital behavior, oxytocin, vasopressin, and wound healing, and to determine the characteristics of individuals with the highest neuropeptide levels, 37 couples were admitted for a 24-h visit in a hospital research unit. After small blister wounds were created on their forearm, couples participated in a structured social support interaction task. Blister sites were monitored daily following discharge to assess wound repair speed. Blood samples were collected for oxytocin, vasopressin, and cytokine analyses. Higher oxytocin levels were associated with more positive communication behaviors during the structured interaction task. Furthermore, individuals in the upper oxytocin quartile healed blister wounds faster than participants in lower oxytocin quartiles. Higher vasopressin levels were related to fewer negative communication behaviors and greater tumor necrosis factor-alpha production. Moreover, women in the upper vasopressin quartile healed the experimental wounds faster than the remainder of the sample. These data confirm and extend prior evidence implicating oxytocin and vasopressin in couples' positive and negative communication behaviors, and also provide further evidence of their role in an important health outcome, wound healing.
Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing. This article reviews the recent literature on the most significant factors that affect cutaneous wound healing and the potential cellular and/or molecular mechanisms involved. The factors discussed include oxygenation, infection, age and sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking, and nutrition. A better understanding of the influence of these factors on repair may lead to therapeutics that improve wound healing and resolve impaired wounds.
Gamma-delta (gammadelta) T lymphocytes are versatile cells that play key roles in bacterial clearance, wound repair, and delayed-type hypersensitivity reactions. Recently we showed that these cells are mobilized into the blood during acute psychological stress. gammadelta T lymphocytes are a heterogeneous population of cells, and the current study aimed to characterize the effects of stress on distinct gammadelta T cell populations. Twenty-nine healthy participants completed a 12min speech task. Blood samples were taken after a resting baseline, during the last two minutes of the task, and after a 15min recovery period. Flow cytometry was used to investigate the response of memory phenotypes (i.e. Naïve, Central memory, Effector Memory, and CD45RA(+) Effector Memory (EMRA)) within the delta1 and delta2 gammadelta T cell populations. Cells were further analysed on expression of adhesion molecules (CD11a, CD62L) and the NK-receptor CD94. Both the delta1 and delta2 subsets were mobilized during stress, and for both subsets, EMRA cells were mobilized to a much greater extent than the other memory phenotypes. Analysis of migration markers revealed that mobilized cells had a predominantly tissue migrating phenotype (CD11a(hi)CD62L(lo/neg)) and expressed high levels of the NK-receptor CD94. The current findings indicate that stress primarily mobilizes gammadelta memory cells that have high cytotoxic capability, tissue homing potential, and the capacity for rapid, innate-like target recognition. This selective mobilization possibly provides protection in contexts when tissue damage and antigen exposure are more likely to occur.
The experience of undergoing surgery is known to induce a short-term, fight-or-flight physiological stress response. As an optimum immune response at the site of surgery would enhance tissue repair, we examined surgical stress-induced immune cell redistribution profiles as predictors, and potential mediators, of short and long-term postoperative recovery. We tested the a priori hypothesis that predefined adaptive immune cell redistribution profiles observed during surgery will predict enhanced postoperative recovery.
This prospective longitudinal study involved fifty-seven patients undergoing meniscectomy. Knee function was assessed preoperatively and at one, three, eight, sixteen, twenty-four, and forty-eight weeks postoperatively with use of the clinically validated Lysholm scale, which assesses mechanical function, pain, mobility, and the ability to perform daily activities. Surgery-induced immune cell redistribution was measured in the blood at baseline, before surgery, and after surgery.
Mixed-model repeated-measures analyses revealed a main effect of immune cell redistribution: patients who showed the predefined "adaptive" lymphocyte and monocyte redistribution profiles during surgery showed enhanced recovery. Interesting differences were also observed between the sexes: women as a group showed less adaptive redistribution and correspondingly showed significantly delayed maximum recovery, requiring forty-eight weeks, compared with men, who required only sixteen weeks. Inter-individual differences in leukocyte redistribution predicted the rate of recovery across both sexes.
Immune cell redistribution that is induced by the stress of undergoing surgery can predict (and may partially mediate) postoperative healing and recovery. These findings may provide the basis for identifying patients (either prospectively or during surgery) who are likely to show good as opposed to poor recovery following surgery and for designing interventions that would maximize protective immune responses and enhance the rate and extent of recovery.
Stress impairs wound healing of cutaneous lesions; however, the mechanism is still unclear. The aim of this study was to evaluate the effects of rotational stress on cutaneous wound healing in mice and propose a mechanism. Male mice were spun at 45 rpm for 15 min every hour beginning 3 days before wounding until euthanasia. Control animals were not subjected to stress. To confirm that catecholamines participate in stress-induced delay of wound healing, mice were treated daily with propranolol. An excisional lesion was created and measured. Seven and 14 days later, animals were killed and lesions collected. Sections were stained with hematoxylin-eosin and immunostained for alpha-smooth muscle actin and proliferating cell nuclear antigen. Matrix metalloproteinase (MMP)-2 and -9 activity, nitrite levels, and tumor necrosis factor-alpha (TNF-alpha) expression were measured in the wounds. In addition, murine skin fibroblast cultures were treated with high levels of epinephrine and fibroblast activity was evaluated. Stressed mice exhibited reduced locomotor activity and increased normetanephrine plasma levels. Rotational stress was associated with decreased wound contraction, reduced re-epithelialization, reduced MMP-2 and MMP-9 activation, but with strongly increased nitrite levels. Furthermore, inflammatory cell infiltration, TNF-alpha expression, myofibroblastic differentiation, and angiogenesis were all delayed in the stress group. Propranolol administration reversed the deleterious effects of stress on wound contraction and re-epithelialization. High epinephrine concentrations increased murine skin fibroblast proliferation and nitric oxide synthesis, and strongly inhibited skin fibroblast migration and both pro- and active MMP-2. In conclusion, rotational stress impairs cutaneous wound healing due to epinephrine increased levels.