Imperial College The influence of psychological intervention upon stress related changes
London
2. In disease associated stress in HIV-infected patients
Akira NAITO*1,* 2, Tannis M. LAIDLAW*2,Bryan M. BENNETT*1, Simon BARTON*3, John H. GRUZELIER*2, Don C. HENDERSON*1
*1 Imperial College, Faculty of Medicine, Department of Immunology, Chelsea and Westminster Hospital, London
*2 Imperial College, Faculty of Medicine, Division of Neuroscience and Mental Health, Charing Cross Hospital, London
*3 Imperial College, Faculty of Medicine, Directorate of HIV/GUM, Chelsea and Westminster Hospital, London
BACKGROUND PROJECT SCOPE CONCLUSIONS
Premise: Stress affects both mental and physical well-being.
PROPOSAL: A psycho-neuro-endocrino-immune network • CD4 T-cell counts are used routinely to monitor disease
Hypothesis: - A change in one component has influences upon other parts of the network. - progression in HIV-infected patients, and in this study,
Psychological intervention can counteract the detrimental effects of stress. Mental factor: psychological intervention, particularly Johrei,
Study background: Stress is psychological input into the network alleviated the loss of CD4 T-cells in patients not
HIV infection may be considered as a life-long biological and Psychological intervention aims to reduce stress receiving medication.
psychological stressor, which leads to detrimental outcomes Training and practice for the purpose of
associated with disease progression. o Obtaining other perspectives • This in part supports the hypothesis that psychological
Stress reduction may have beneficial effects through the psycho- o Learning coping skills intervention may have beneficial effects on the immune
neuro-endocrino-immune network promoting health. o Applying relaxation techniques
system; acting through the psycho-neuro-endocrino-
Psychological interventions in the project Physical factor: neuro-endocrino-immune mediators
(HPA axis: Hypothalamus-Pituitary-Adrenal axis)
immune network.
(four weekly trainings sessions + three monthly follow-up sessions)
Brain (SAM: Sympathetic Adrenal-Medulla modulation)
(Amygdala &
1. Perspectives 2. Coping skills 3. Relaxation Hypothalamus)
Self-hypnosis Hypnotic Suggestions Imagery
Endocrine
(Adrenal glands)
Acknowledgement
„Trance‟ Thanks goes to all patients who took part in the project.
This work was supported by the British Johrei Society and the Johrei Association.
Johrei Philosophical ‘Healing oneself Imagery of the The research staff / clinical laboratory staff both at Division of Neuroscience and Mental Health and
background by healing others‟ healing „Light‟ Immunity
(Innate & Adaptive)
at Department of Immunology including Dr. Adrian Burgess, Dr. Prabudha Dwivedi, Dr. Martin
Goodier, Prof. Frances Gotch and Dr. Alan Steel
I. Randomized controlled trial (RCT) RESULTS II. Case controlled study (CCS) RESULTS
Five months intervention period analysis Total 24 months follow-up data analysis
• In HIV patients, there is a decline in CD4 T-cell FORMAT of Timing • There is a steady decline in CD4 counts of 7 ± 4
METHODS FORMAT of Timing METHODS cells/ml/month in HIV-infected individuals.
counts of 12 ± 17 cells/ml/month (Figure 1).
Subjects: HIV-infected subjects not receiving medication Baseline Post-intervention • Following Johrei training, this decline was Subjects: HIV-infected subjects not receiving Set-Point • Johrei (but not self-hypnosis) intervention
Pre 0.5 month Post 0.5 month
medication Pre 12 months Post 12 months
– Randomized to Post 3.5 month decreased in HIV patients (p = 0.047: Figure 1). significantly decreased this declining trend
• Following self-hypnosis training, there was no – Recruited over 14 months (p = 0.040: Figure 2).
– Recruited over 14 months Training Practice & Follow-ups
change in the rate of decline in CD4 T-cell – Randomized to • The NK cell counts and the viral load levels did
• Intervention free control (13 subjects) counts. • Self-hypnosis (27 subjects) not show any significant trends (data not shown).
1 month 3 months
• Self-hypnosis (15 subjects) • The NK cell counts and the viral load levels did • Johrei (19 subjects) Table 1
4 months
• Johrei (10 subjects) not show any consistent trends (not shown). GROUP Pre mean Post mean N
Example of CD4 T-cell counts in one Johrei group subject Controls: Case control individuals Example of CD4 T-cell counts in one Johrei group subject (95% C.I. range) (95% C.I. range)
Outcome measures 400 • Psychological intervention groups did not – Selected “blind” from the same database Hypnosis -7 -1 27
• Every other month for five month period significantly differ from controls in either stress – Over same time period
(-10 to -3) (- 4 to + 3)
– Immune parameters (CD4 T-cell, NK cell counts and viral
300
perceptions or stress associated hormone levels Johrei -9 +3 19
load levels) (data not shown). • Case-controls (49 subjects) Pre set-point Post set-point (- 14 to - 4) (- 2 to + 7)
CD4 T-cell count (cells/mcL)
200
• Baseline and Post-intervention Outcome measures Case control -5 -2 49
(- 8 to - 3) (- 5 to + 1)
Figure 1 - 10 cells/ml/month + 7 cells/ml/month
– Stress hormone levels (Cortisol and DHEA-S) 100
Every two-three months for 12 months both All together -7 96
– Stress perception (IES, PSS and LoC questionnaires) + 27 cells/ml/month p = 0.033 before and after the Set-Point for individual (- 11 to - 3)
50
0
-1 0 1 2 3 4 5 p = 0.047 subjects Set-Point
Months (Pre(-) and Post(+) from set-point) Figure 2
Statistical Analyses (SPSS®) Month – CD4 T-cell counts 30
– NK cell counts Regression lines show decline of 10 cells/ml/month in Pre set-point
• Linear Regression of CD4 T-cell counts Regression line shows an increase of 27 cells/ml/month over 5 months.
– Viral load levels
and increase of 7 cells/ml/month in Post set-point, over 12 months.
p = 0.040
Calculation of the rate of decline
CD4 gradient (95% C.I.) cells/month
Example of CD4 T-cell counts in one controlled subject Example of CD4 T-cell counts in one case-controlled subject
• Mann-Whitney U test for comparing the decline Statistical Analyses (SPSS®) Not significant
400 Not significant
• Linear Regression of CD4 T-cell counts
CD4 gradient (cells/mcl/month)
Independent and not normally distributed data 0
0
Between subjects comparisons
300
Calculation of the rate of decline
• Wilcoxon rank tests for the decline in CD4T-cells
CD4 T-cell count (cells/mcL)
Post set-point
• Self-hypnosis vs. control 200 Pre set-point
• Johrei vs. control Independent and not normally distributed paired data
100
- 6 cells/ml/month - 3 cells/ml/month Pre
• Analysis of Variance (ANOVA) repeated measures - 7 cells/ml/month Not significant Between subjects comparisons for pre set-point data
0
-1 0 1 2 3 4 5 -50 Set-Point Not significant
Independent and normally distributed paired data N= 15 10 13
Months (Pre(-) and Post(+) from set-point)
-30
N= 27 27 19 19 49 49
Post
Months
Regression lines show decline of 6 cells/ml/month in Pre set-
Between subjects comparisons: three groups Regression line shows a decline of 7 cells/ml/month over 5 months.
Hypnosis Johrei Control
point and 3 cells/ml/month in Post set-point, over 12 months.
Hypnosis Johrei Non-participants
Mann-Whitney U test Wilcoxon rank test