Running head:  THE EFFECTS OF STRESS ON THE IMMUNE SYSTEM

The Effects of Stress on the Immune System in Young American Adults with Different Reactivity and Coping Mechanisms

By

Cheryl L. Mull

East Tennessee State University

ALHE 4060-904

Dr. Masini

ALHE4060 Research in Allied Health Portfolio Cover Sheet

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Comments about the course or the format:

I have completed the above activities as recommended in the syllabus and submit this summary for the total points of ______1528_____ and the final grade of   A_________.

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__Cheryl Mull______________________________________.

Abstract

            The study of the effects of stress on the immune system has ascertained that all people experience various forms of stress from time to time, of both genders and of all ages.  It has been found that even at the earliest stages of life and development it can have a lasting effect on the immune system.  Stress can negatively affect our health.   Different aspects can cause stress, such as: life event changes, home life, car trouble, divorce, balancing school and work etc. Studies performed in the past decades have educated people about the effects of stress on the immune system and people have developed various ways to cope with stressors.  We are not living in a stress-free environment and people will be faced with stress.  The best thing to do is to learn and develop effective ways of coping with stress.

INTRODUCTION

            In our everyday existence most people have, at one time or another, experienced a physical or mental tension, due to dealing with stress.  Life is uncertain, and changes can occur very rapidly.  These changes may occur within months, weeks, days and sometimes even hours.  Sudden changes in life can become stressful.  All individuals react differently to stressors, but it is critical that we note that stress is important to all living organisms.  “ ‘According to Dr. Chrousos, this stress response varies from person to person.  Presumably, it is partially influenced by heredity…however, other people may fail to have a strong enough response to a threat, while still others may over respond to even minor threats”’ (Chrousos 2002).  It is important for people to learn some tactics to cope with stress, for a healthier lifestyle. 

According to Lovallo, ‘ “Four levels in the central nervous system can determine differences among persons in stress reactivity’” (147).  They are the following, According to Lovallo, ‘“Individual Differences in Evaluative and Emotional Processes”’ (147).  The next one According to Lovallo, ‘“Neurophysiological Evidence on Prefrontal-Limbic Connections and Emotions’”…‘“Personality Dispositions, Emotions, and Responses to Stress’”…‘“Individual Differences in Autonomic and Endocrine Reactivity to Stressor Challenge’”(Lovallo 148-153).

 Sudden changes can make people feel their life has been turned upside down.  This could therefore cause a psychological disturbance.  A broad array of life events such as divorce, employment, education, loss of a loved one, and a serious illness are instances of possible stressors.  Stress can cause people to be more susceptible to illnesses.  According to Zarrow and Mc Veigh (1991), …‘“researchers are finding… that stress may work inside our arteries, unnoticed for years…that leads to heart disease.  It may also make our immune system less potent…for infectious diseases or even cancer”’ (par 3). 

Stress affects the immune system.  The sensory organs, the brain, the heart and blood vessels, and the lungs can perceive danger and react to it as well.  The human body can also detect emotional and mental stress such as fear, anxiety, rage, panic etc. While a person is under stress, hormones such as epinephrine, and norepinephrine, and adrenaline affect the immune response temporarily.  These hormones can slow down growth, reproduction and digestion.  It makes sense what researchers and people in general have noticed about stress.  It’s easy to agree with some of the conditions the authors have explained, because through personal communications and personal observations, it has been proven that a lot of their statements and the effects of stress on the immune system are obvious in people who are under stress. 

Although stress can be play a destructive role in the body, there have been proven and effective ways to cope with stress. Through education, old and young American adults can benefit by learning how to use techniques/strategies to cope with stress. 

 PROBLEM STATEMENT

What causes stress, and what resources or coping mechanisms are available in Washington County, Tennessee for those who want help in stress maintenance?

PROBLEM

            Stress is widespread in today’s culture.  Stress can cause the mind to be fatigued and prone to illness.  To obtain a better understanding, information must be given on the effects of stress on the immune system, and its consequences on the human body. As Lunney states, “Nursing interventions such as active listening and decision-making support are needed to help people reduce stress levels” (Lunney 2006). The extent of this subject matter is of extreme importance.  Long term stress creates: anxiety, depression, post traumatic stress, persistent fatigue, and burnout, heart problems, and overall numerous health problems.  According to Henner, “Often when a person can’t get past stress, she will turn to overeating, drinking or smoking, which can become a greater problem than the stress itself’” (Henner 2005).  Coping mechanisms are extremely important to help conquer of any kind of stress.  This research project will explore the basis of what causes stress, coping mechanisms, and resources available to Washington County Tennessee residents who want help in stress maintenance.

REVIEW OF LITERATURE

            Stressed spelled backwards is “desserts” (personal communication 2007), and being stressed is not a delightful treat.  Stress is a gigantic problem.  According to Lunney, “Stress overload, defined as excessive amounts and types of demands that require action, is a human response that is experienced as problems and contributes to the development of other problems” (Lunney 2006).  Stress can leave a person feeling ill.  As Lunney explains,

“The proposed defining characteristics perceives [are] situational stress as

excessive, expresses a feeling of tension or pressure, expresses difficulty in

functioning as usual, expresses problems with decision-making, demonstrates

increased feelings of anger and impatience, and reposts negative effects from

stress such as physical symptoms or psychological distress” (Lunney 2006).

 Stress has a propensity to be a principal basis of illnesses today.  Once again, According to Zarrow and Mc Veigh(1991), …‘“researchers are finding… that stress may work inside our arteries, unnoticed for years…that leads to heart disease.  It may also make our immune system less potent…for infectious diseases or even cancer”’ (par 3). 

In fact, research verifies that many people have and still yet should seek authorized help for stress disorders.  According to MacMillan, “Mysterious, complex chronic fatigue syndrome might just be triggered by stress” (MacMillan 2007). Stress can affect people in our local community, as well as world-wide.

According to MacMillan, “People who feel that their lives are spinning out of control are 65% more likely to develop CFS than those who cope well with anxiety, suggests a new 25-year, 20,000-person study from the Karolinska Institute, a Swedish medical university” (MacMillan 2007).

There’s also a type of stress that can cause a positive effect.  It is called Eustress which results from good events happening in people’s lives, such as buying a new car or home which can lift ones self-esteem.  Often people experience stress in obtaining their desired goals and the outcome can be rewarding.  This kind of stress has been known to be motivating. 

Stress can cause a person to feel exhausted, but sometimes it can be a good thing.  According to Ebbert, “Sure, you know stress can make you feel fatigued. But did you know that a lack of stress can contribute to fatigue?” (Ebbert, 1991). 

A person should strive to find the mean balance of stress.  As Ebbert explains, “If you’re stressed past the point of your optimal performance, your performance dips.  On the other hand, if you don’t have enough stress, you aren’t motivated to perform at all” (Ebbert). 

Basis for Certain Stress

The effects of stress can have a physical appearance and stress also has the influence to be harmful psychologically. The Journal of Behavioral Medicine mentions, “Even seemingly mild, fairly transient stress can result in immune dysregulation at all stages of life” (Kiecolt-Glaser 1991, p391). 

In certain situations, one person may be bothered more severely than the next person as earlier stated in this research paper and ‘“According to Dr. Chrousos, this stress response varies from person to person.  Presumably, it is partially influenced by heredity….however, other people may fail to have a strong enough response to a threat, while still others may over respond to even minor threats”’(Chrousos 2002 par14). It is important for people to learn some tactics to cope with stress, so they can live healthier lifestyles. 

In a stressful situation, the body’s sympathetic nervous systems take priority over the parasympathetic nervous system.  The flow of adrenaline, cortisol, and additional stress hormones travel through the body.  Response of this stimulus is carried to the brain and the reaction takes place.

  The mind becomes energized, causing physiological processes such as excitations, glycogenolysis, inhibitions, and thermogenesis to take place. The stressed hormones flood the brain, and the hippocampus and amygdale loose normal levels of neurotransmitters which help these parts; learning, the brain process emotions, memory and fears.  Long term effects of stress cause health problems which can cause brain cell damage, which hinders the brain to process the memory portion, emotions and learning can also be disrupted. Following stressful events, there is a possibility that emotional and mental disorders may exist.   It may cause some people to have distorted perception and concentration, so that can lead to negative feelings and distorted thoughts.  When people feel: stressed out, anxiety, depressed, or fearful they (usually) aren’t likely to correctly interpret thoughts to their best potential.

Recommended Coping Mechanisms

It is essential to minimize stress levels, to live life to the fullest and make life more enjoyable.  People, who come across ways to reduce stress, usually feel happier and healthier.  According to Henner, “Being in control of your life and having realistic expectations about your day-to-day challenges are the keys to stress management, which is perhaps the most important ingredient to living a happy, healthy and rewarding life” (Henner 2005). Coping tactics are ways to control stress rather than stress controlling the human being.  

 According to the staff at Mayo Clinic, (2006), “You can learn to identify what stresses you out, how to take control of some stress-inducing circumstances, and how to take care of yourself physically and emotionally when you face events you can’t control” (2006 par 26).   The purpose of the mechanisms of coping with stress is to return the body and mind to a state of homeostasis.  This will involve different mechanism(s) for different people.

One of the nicest ways to cope with stress is to assure oneself of adequate sleep because of the cortisols level are lowered in the body.  Nutrients are essential to the body, especially during periods of greater amounts of stress.  It is recommended at a time of stress to increase vitamins: B, C, E and copper, magnesium, zinc, selenium, and chromium.

Exercise is good for the body and mind.  Cortisol levels are reduced with moderate to light exercise.  There are all kinds of exercises that people can do without having to attend a gym regularly, such as walking, bike riding, swimming, yoga, Pilates, aerobics, etc.

Often time’s people will seek professional counseling to cope with their stress.  Psychiatrists, psychologists, and family physicians are aware of cognitive behavioral therapy.  A distorted thought can be converted to a positive one and the behavior, moods and physical reactions can be changed in certain situations with this kind of therapy.  The person learns to take the negative thoughts and focus on positive one(s) instead. 

Resources Available to Washington County Residents

          According to a randomly selected exercised individual, “Individuals who have put forth the effort to minimize stress have found various exercise programs to be highly effective in coping with their stress” (Personal communications 2007). There are multiple exercise and physical fitness programs located in the Washington County area.

Some of the professionals who council and help maintain stress and are the following Services in the Washington County area are indicated on the following table.

Resources

                                                                                                   Note: Listed ph no. (423) area code

METHOD

The participants involved lived in Washington County, and were selected from a Doctors Office in Jonesborough, Tennessee, due to the large amount of Washington County patients at this specific office.  The conducted study concentrated on adulthood ages twenty to seventy-nine years old and of an assorted ethnicity.

 The attending physician asked the patients, which were diagnosed of stress, whether or not they would like to partake in an experiment to control stress.  The participants were organized in one of three groups by random task of Texas Instruments calculator, the TI-83 Plus.  The group was constrained to three hundred (overall n =300) individuals for each grouping. 

Several of the partakers had previously been prescribed antidepressant psychotherapy from their physician.  Whichever individual who had been receiving antidepressant therapy was unwavering on that medication for six months and stayed on that prescription all the way through the study except if changes were made by their doctor.  There were no particular threats to validity, as capturing the data moreover than the truth.  Linkages and themes were sought out.  A triangulation process was used in gathering the data to observe the consistency.  In the replica study, no threats internal or external to reliability were found. 

          The subjects received an information packet, for this worthwhile study. The information that was included was a cover letter, a statement of the study, the reliability paper that this study was indeed safe to partake in, and an informed consent was also included. 

The cover letter stated the title of the assignment, listed contact names and telephone numbers, and included a map to the medical site.  The statement explained what was expected from the partaker, and their expectations were written out in bold print at 14 point font.  It explained the step-by-step (easy to read) comprehensive course of action for the study.  It furnished times and dates when pre-test of stress and post-test of stress were conducted.  Policy regulations of the study were also notorious.  According to the HIPPA guidelines, the partakers’ confidentiality was granted to be protected.

            The informed consent explained the study and described potential risks and/or discomforts.  This separate form which was included ensured the partakers’ confidentiality and types of treatment the subjects were/would be exposed to during this type of study.  Support from highly trained professionals was available throughout the study to assist with any type of problems and questions.  The subjects were given the opportunity to ask any questions they wanted to, at any given time to the professionals, but not other members being studied.  The benefits of serving in this study were greater than the risks. 

            Data collection for this study included a journal, pre/post-test for stress and questionnaire.  The participants kept a journal throughout the study.  The participants were required to compose two journal entries each week.  The record is to indicate how each participant felt about their stress level before and after all of the experiments.

 The control group prepared two entries per week also as an expression of how each one felt every week. After this instance, advice from a statistician was sought out to analyze the data.  The pre-test and post-test of stress included, measures, and records which were direct to the partaker individually by the psychiatrist.  The measured variables were personality factors, attitudes, and cognitive ability.  The questionnaire was given to each partaker previous to opening the study.  It rated the psychological stress level of each partaker.  It was planned with a numerous and interesting format for asking questions, so the partaker(s) would not lose concern in respond the questions.

Two experiment groups and a control group were randomly structured.  The control group consisted of ages 20 thru 39 year olds and was subjected to a program of intense exercise plan for four times a week for twenty minutes.  The second group consisted of ages 40 thru 59 and was subjected to cognitive conduct therapy once weekly for one hour.  The third group consisted of 60 thru 79 years of age and was not subjected to any type of coping means.  This cluster went on with “life as normal.” In the beginning and following each experiment the participants completed their journal entries.  The group being monitored as the control group, made journal entries twice per week.  After six months, the participants of the study completed a post-test.  If it become visible a participant suffered any type of injury, regardless of its severity, it was documented.

Participants’ questionnaires were collected and analyzed by the statistician and psychiatrist using the factor analysis. This conclusion discovered necessary proportions on how subjects appraised their agreement as regards to entering the study.  The participant’s turned in their journals they wrote in.  The statistician and psychiatrist ordered the reaction in each group and evaluated the journal record by structural equation modeling.  The outcome expressed the process of subject devotion to the study.  The post/pre tests for stress were compared by mean differences between experimental and control participants at baseline were compared by independent t tests and x(square) analysis.  Independent t tests were used to compare the pre-post intervention differences between experimental and control participants in the three different groups being studied.  

 The Chi-square analysis was also used to test the intervention program’s effect on some of the lifestyle measures.  A P value of .05 was chosen for significance and used for all statistical comparisons in the study.  This compared the mean scores of the three groups in the study, and had dealings with the multi-group inquiries, problems and questions. 

According to Miller & Segerstrom, “The results of meta-analysis of the hundreds of research reports generated by this hypothesis indicate that stressful events reliably associate with changes in the immune system and that characteristics of those events are important in determining the kind of change that occurs” (Miller-Segerstrom 2004).

 An approach used in various ways to study subjects can become quite interesting.  Triangulation can be used to help view things from another perspective.  According to Bailey, “The purpose of triangulation is to confirm information about a phenomenon and to obtain convergent validity—confidence that a finding is valid because it has been confirmed by more than one method” (Bailey 1997).   In comparison with the same amount of subjects studied, but using a different method it was found to both have a strong correlation in relationship to stressors and the effect on the immune system.  According to the American Psychological Association, “….This strategy was successful in most circumstances...

To compute Pearson’s r from descriptive statistics in between-subjects designs, we subtracted the control group mean from the stressed group mean and divided this value by the pooled sample standard deviation.  The value that emerged from this computation, known as Cohen’s d was then converted into a Pearon’s r by taking the square root of the quantity d2/ (d2 + 4)…These formulae had to be modified slightly for studies that used within-subjects designs because effect sizes are systematically overestimated when they are calculate from repeated measures test statistics (Dunlap, Cortina, Vaslow, & Burke, 1996).  “…Very similar findings emerged from these analyses, suggesting that the values we present below are reliable estimates of effect size.  If anything, they are probably conservative estimate, because the pre-post correlation between immune measures often is substantially lower than .60” (Miller-Segerstrom 2004).

In some tests conducted results may vary because of the statistics derived from small N (number) values.  Although, in such a situation it may be determined the amount of, direction, and an outcome a certain stressor has on the effect of the immune system. 

CONCLUSION

  The purpose of this study was in hope to accomplish whether or not stress affects the immune system.  It was determined to be valid, due to the confirmation by more than one method used (in the findings) that stress indeed does effects the immune system!  The local groundedness used throughout the study was helpful.  Also, in using a bit of my Phenomenology, I found that stress showed to be extremely widespread in today’s culture. Stress weakens the brain, leaving it open to disease.  The coping methods such as exercise and cognitive conduct therapy have confirmed to be regularly useful in returning the mind to a state of homeostasis.  The problem with stress is world-wide and all ages can be affected.  It is essential to become knowledgeable about the effects of stress on the immune system to help maintain healthy lifestyles.

REFERENCES

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