Recent evidence from animal models of stress suggests that stress can impair immunologic competence, rendering the host more vulnerable to infection and neoplasm. The present article reviews studies on the relationship between psychosocial factors and human immunologic functioning. It draws on two literatures: studies bearing on the relationship of psychosocial factors to altered susceptibility to infectious diseases and those bearing on the relationship of such factors to specific aspects of the human immune response. The review reveals that a variety of psychosocial variables, disease states, and aspects of both humoral and cell-mediated immune responses have been investigated and that, although many studies have methodological weaknesses, the bulk of evidence favors the view that psychosocial variables may play a role in modulating the human immune response. It is suggested that more research is needed before it can be definitively concluded that the relationship between stress and human susceptibility to infectious diseases is a psychoimmunologic nexus. Relationships between the endocrine and immune systems are discussed and suggestions for future research on human psychoimmunology are offered.The authors would like to thank John Darley and Peggy Thoits for their helpful comments on an earlier version of this manuscript. John B.
After controlling for demographic and clinical variables, more recent stressful events were associated with earlier time to relapse. These findings, which support a biopsychosocial model of disease, might help clinicians identify patients who might benefit from more intensive maintenance medical therapy and behavioral medicine interventions to reduce stress and improve coping.
Computers can be used to deliver self-guided interventions and to provide access to live therapists at remote locations. These treatment modalities could help overcome barriers to treatment, including cost, availability of therapists, logistics of scheduling and traveling to appointments, stigma, and lack of therapist training in evidence-based treatments (EBTs). EBTs could be delivered at any time in any place to individuals who might otherwise not have access to them, improving public mental health across the United States. In order to fully exploit the opportunities to use computers for mental health care delivery, however, advances need to be made in four domains: (1) research, (2) training, (3) policy, and (4) industry. This article discusses specific challenges (and some possible solutions) to implementing computer-based distance therapy and self-guided treatments in the United States. It lays out both a roadmap and, in each of the four domains, the milestones that need to be met to reach the goal of making EBTs for behavioral health problems available to all Americans.
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