Elsevier

Brain, Behavior, and Immunity

Volume 36, February 2014, Pages 1-8
Brain, Behavior, and Immunity

Norman Cousins Lecture
“Anatomy of an Illness”: Control from a caregiver’s perspective

https://doi.org/10.1016/j.bbi.2013.08.012Get rights and content

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    Highlighting aspects of psychoneuroimmunology as seen by the author who began working in this field in animal models over 25 years ago to his translational approaches today.

Abstract

Caregivers of loved ones with chronic illnesses experience an uncontrollable challenge with potentially negative behavioral and medical consequences. Extensive research has demonstrated immune and endocrine regulation can be significantly disrupted by negative behavioral factors based on both animal models and human studies. However, fewer studies have focused on how psychosocial interventions might reverse the negative consequences of stressors such as caregiving. The distress of caring for individuals with cancer has only recently begun to receive attention. These interventions addressing caregiver distress are rare overall and caregivers of patients receiving hematopoietic stem cell transplants (HSCT) have received even less attention. HSCT caregivers report feelings of loss of control. Animal studies suggest that control over aversive events can mitigate the negative consequences of stressors. Caregivers of allogeneic HSCT patients for blood cancers must be available 24/7 for three months or longer following stem cell infusion to closely monitor the recipients’ health and well-being. Does establishing a greater sense of control have positive impacts on caregivers? A randomized control trial of a cognitive behavioral stress management intervention for allogeneic HSCT caregivers is briefly described. A model of caregiver mental health which may potentially impact the patient’s quality of life is proposed. These relationships exist in a complex system that includes genetic influences, sex, social environment, and prior experience. This system fits well within recent formulations of a “complexity science” approach to health and well-being.

Section snippets

The early years

At the time of the Tanque Verde Ranch meeting, the field of PNI was beginning an uphill battle with the medical community (Ader and Cohen, 1985). One paper in particular published in the influential New England Journal of Medicine challenged the field and threw the baby out with the bathwater after suggesting that psychosocial correlates of survival were non-significant contributors to outcome in cancer patients (Cassileth et al., 1985). Interestingly the same patients in that study had also

Animal models

Animal models permitted important insights into behavior and immune relationships in the development of the science of PNI, partly because of control over factors largely impractical for human studies (Fleshner and Laudenslager, 2004, Laudenslager and Fleshner, 1994). An adequate animal model includes a number of stipulations for supporting their relevancy: common etiology, phenomenology, pathophysiology, and efficacious interventions for the human condition they seek to model (Laudenslager et

Noninvasive assessment of the HPA

The question of a mechanism(s) for observed immune modulation by behavioral factors remained a challenge while the basic phenomenon of brain, behavior, and immune interactions were gaining credibility. Stressors clearly modulated immune regulation but how? Lymphocytes possessed a variety of receptors for recognizing not-self as well as regulatory molecules including cytokines and hormones. The hypothalamic pituitary adrenal (HPA) axis was a prime target for investigation due to the well-known

Controllability and caregivers

Translation of the diverse observations from animal models and human populations to clinical implications is an important goal for future studies in PNI. Caregiving of medically ill patients is a long recognized stressor with numerous behavioral and physiological consequences (Gouin et al., 2008, Vitaliano et al., 2003). The majority of early caregiving studies focused on dementia caregivers and only more recently on caregivers of cancer patients (Kim and Schulz, 2008, Lutgendorf and

Acknowledgments

The work reported herein was supported in part by Grants from the NIMH (R01MH37373), NCI (P30CA046934; R01CA126971), NIAAA (R01AA013973), and NIA (K07AG030337) and the Administration for Children and Families (ACF 90YR0058). Although colleagues are too numerous to name all, particular thanks and gratitude are directed to Martin Reite, MD, Steven Maier, PhD, and Monica Fleshner, PhD without whom much of the work described herein would not have been possible. I am particularly indebted to Teri

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