Schakel L., Veldhuijzen D.S., Crompvoets P.I., Bosch J.A., Cohen S.d • van Middendorp H.,
Joosten S.A., Ottenhoff T.H.M. Visser L.G., Evers A.W.M.

Psychother Psychosom 2019;88:274–286


Background: There is consistent evidence showing an interplay between psychological processes and immune function in health and disease processes.

Objectives: The present systematic review and meta-analysis aims to provide a concise overview of the effectiveness of stress-reducing psychological interventions on the activation of immune responses in both healthy subjects and patients.

Methods: Included are 3 types of challenges: in vivo, in vitro, and psychophysiological. Such challenges are designed to mimic naturally occurring immune-related threats.

Results: A systematic literature search was conducted using PubMed, EMBASE, and PsychInfo, resulting in 75 eligible studies. The risk of bias was assessed with the Cochrane risk-of-bias tool. Across all studies, a small-to-medium effect size was found for the effects of psychological interventions on optimization of the immune function (g = 0.33; 95% CI 0.22–0.43).

While the largest effects were found for in vivo immune-related challenges (g = 0.61; 95% CI 0.34–0.88; especially on studies that incorporated skin tests and wound healing), studies incorporating psychophysiological challenges and in vitro immune-related stimulations similarly suggest more optimal immune responses among those receiving stress-reducing interventions (g = 0.28; 95% CI 0.15–0.42).

Conclusion: These findings showed substantial heterogeneity depending on the type of challenge, the study populations, and the intervention types. These data