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Psychosomatic Medicine: The Scientific Foundation of the Biopsychosocial Model

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Abstract

Objective

This article presents major concepts and research findings from the field of psychosomatic medicine that the authors believe should be taught to all medical students.

Method

The authors asked senior scholars involved in psychosomatic medicine to summarize key findings in their respective fields.

Results

The authors provide an overview of the field and summarize core research in basic psychophysiological mechanisms—central nervous system/autonomic nervous system, psychoneuroimmunology, and psychoendocrinology—in three major disease states—cardiovascular, gastrointestinal, and HIV virus infections.

Conclusions

Understanding the core scientific concepts and research findings of psychosomatic medicine should provide medical trainees with a scientific foundation for practicing medicine within a biopsychosocial model of care.

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References

  1. Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977; 196: 129–136

    CAS  PubMed  Google Scholar 

  2. Waldstein SR, Neumann SA, Drossman DA, et al: Teaching psychosomatic (biopsychosocial) medicine in United States medical schools: survey findings. Psychosom Med 2001; 63: 335–343

    CAS  PubMed  Google Scholar 

  3. Roter DL, Stewart M, Putnam SM, et al: Communication patterns of primary care physicians. JAMA 1997; 277: 350–356

    CAS  PubMed  Google Scholar 

  4. McClain T, O’Sullivan PS, Clardy JA: Biopsychosocial formulation: recognizing educational shortcomings. Acad Psychiatry 2004; 28: 88–94

    PubMed  Google Scholar 

  5. Anderson NB, Scott PA: Making the case for psychophysiology during an era of molecular biology. Psychophysiology 1999; 36: 1–13

    CAS  PubMed  Google Scholar 

  6. Vanselow N, Cuff P (eds): Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula. Washington, DC, National Academies Press, 2004

    Google Scholar 

  7. Gitlin DF, Levenson JL, Lyketsos CG: Psychosomaticmedicine: a new psychiatric subspecialty. Acad Psychiatry 2004; 28: 4–11

    PubMed  Google Scholar 

  8. Novack DH: Realizing Engel’s vision: psychosomatic medicine and the education of physician-healers. Psychosom Med 2003; 65: 925–930

    PubMed  Google Scholar 

  9. Singer BH, Ryff CD (eds): New horizons in health: an integrative approach. Washington, DC, National Academies Press, 2001

    Google Scholar 

  10. IOM: Health and Behavior: The Interplay of Biological, Behavioral and Societal Influences. Washington, DC, National Academy Press, 2001

    Google Scholar 

  11. House JS, Landis KR, Umberson D: Social relationships and health. Science 1988; 241: 540–545

    CAS  PubMed  Google Scholar 

  12. Marmot MG, Smith GD, Stansfeld S, et al: Health inequalities among British civil servants: the Whitehall II study. Lancet 1991; 337: 1387–1393

    CAS  PubMed  Google Scholar 

  13. Selye H: The Stress of Life. New York, McGraw-Hill, 1976

    Google Scholar 

  14. Dickerson SS, Kemeny ME: Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychol Bull 2004; 130: 355–391

    PubMed  Google Scholar 

  15. Epel ES, Blackburn EH, Lin J, et al: Accelerated telomere shortening in response to life stress. Proc Nat Acad Sci U S A 2004; 101: 17323–17324

    Google Scholar 

  16. Mcewen BS, Wingfield JC: The concept of allostasis in biology and biomedicine. Horm Behav 2003; 43: 2–15

    PubMed  Google Scholar 

  17. Saper conditioned stimulus: The central autonomic nervous system: conscious visceral perception and autonomic pattern generation. Ann Rev Neurosci 2002:433-469

  18. Craig AD: How do you feel? interoception: the sense of the physiological condition of the body. Nat Rev Neurosci 2002; 3: 655–666

    CAS  PubMed  Google Scholar 

  19. Loewy A, Spyer K: Central regulation of Autonomic Function. New York, Oxford University Press, 1990

    Google Scholar 

  20. Fava GA, Sonino N: Psychosomatic medicine: emerging trends and perspectives. Psychother Psychosom 2000; 69: 184–197

    CAS  PubMed  Google Scholar 

  21. Bechara A, Damasio H, Damasio AR: Emotion, decision making and the orbitofrontal cortex. Cereb Cortex 2000; 10: 295–307

    CAS  PubMed  Google Scholar 

  22. Servan-Schreiber D, Perlstein WM: Pharmacologic activation of limbic structures and neuroimaging studies of emotions. J Clin Psychiatry 1997; 58(suppl 16): 13–15

    PubMed  Google Scholar 

  23. Adolphs R: The human amygdala and emotion. Neuroscientist 1999:125-137

  24. Saper CB: Role of the Cerebral Cortex and Striatum in Emotional Motor Responses. Amsterdam, Elsevier, 1996

    Google Scholar 

  25. Adam G: Visceral Perception:Understanding Internal Cognition. New York, Plenum Press, 1998

    Google Scholar 

  26. Carroll D: Cardiac perception and cardiac control: a review. Biofeedback Self Regul 1977; 2: 349–369

    CAS  PubMed  Google Scholar 

  27. Cameron OG, Minoshima S: Regional brain activation due to pharmacologically induced adrenergic interoceptive stimulation in humans. Psychosom Med 2002; 64: 851–861

    PubMed  Google Scholar 

  28. Cameron OG: Interoception: the inside story—a model for psychosomatic processes. Psychosom Med 2001; 63: 697–710

    CAS  PubMed  Google Scholar 

  29. Gundel H, O’Connor MF, Littrell L, et al: Functional neuroanatomy of grief: an fMRI study. Am J Psychiatry 2003; 160: 1946–1953

    PubMed  Google Scholar 

  30. Phillips ML, Drevets WC, Rauch SL, et al: Neurobiology of emotion perception, I: the neural basis of normal emotion perception. Biol Psychiatry 2003; 54: 504–514

    PubMed  Google Scholar 

  31. Drossman DA, Ringel Y, Vogt BA, et al: Alterations of brain activity associated with resolution of emotional distress and pain in a case of severe irritable bowel syndrome. Gastroenterology 2003; 124: 754–761

    PubMed  Google Scholar 

  32. Ader R, Cohen N: Conditioning and Immunity, 3rd ed. New York, Academic Press, 2001

    Google Scholar 

  33. Ader R: A historical acount of conditioned immunobiologic responses, in Psychoneuroimmunology. Edited by Adler R. New York, Academic Press, 1981

    Google Scholar 

  34. Ader R: Psychoeuroimmunology, 3rd ed. New York, Academic Press, 2001

    Google Scholar 

  35. Ader R, Cohen N: Behaviorally conditioned immunosuppression and murine systemic lupus erythematosus. Science 1982; 214: 1534–1536

    Google Scholar 

  36. Klosterhalfen W, Klosterhalfen S: Pavlovian conditioning of immunosuppression modifies adjuvant arthritis in rats. Behav Neurosci 1983; 97: 663–666

    CAS  PubMed  Google Scholar 

  37. Klosterhalfen S, Klosterhalfen W: Conditioned cyclosporine effects but not conditioned taste aversion in immunized rats. Behav Neurosci 1990; 104: 716–724

    CAS  PubMed  Google Scholar 

  38. Lysle DT, Luecken LJ, Maslonek KA: Suppression of the development of adjuvant arthritis by a conditioned aversive stimulus. Brain Behav Immun 1992; 6: 64–73

    CAS  PubMed  Google Scholar 

  39. Gorczynski RM: Conditioned enhancement of skin allografts in mice. Brain Behav Immun 1990; 4: 85–92

    CAS  PubMed  Google Scholar 

  40. Grochowicz PM, Schedlowski M, Husband AJ, et al: Behavioral conditioning prolongs heart allograft survival in rats. Brain Behav Immun 1991; 5: 349–356

    CAS  PubMed  Google Scholar 

  41. Exton MS, von Horsten S, Schult M, et al: Behaviorally conditioned immunosuppression using cyclosporine A: CNS reduces IL-2 production via splenic innervation. J Neuroimmunol 1998; 88: 182–191

    CAS  PubMed  Google Scholar 

  42. Ben-Eliyahu S, Yirmiya R, Liebeskind JC, et al: Stress increases metastatic spread of a mammary tumor in rats: evidence for mediation by the immune system. Brain Behav Immun 1991; 5: 193–205

    CAS  PubMed  Google Scholar 

  43. Rasmussen AF, Jr, Marsh JT, Brill NQ: Increased susceptibility to herpes simplex in mice subjected to avoidance-learning stress or restraint. Proc Soc Exp Biol Med 1957:183-189

  44. Friedman SB, Ader R, Glasgow LA: Effects of psychological stress in adult mice inoculated with Coxsackie B viruses. Psychosom Med 1965; 27: 361–368

    CAS  PubMed  Google Scholar 

  45. Bonneau RH, Sheridan JF, Feng NG, et al: Stress-induced suppression of herpes simplex virus (HSV)-specific cytotoxic T lymphocyte and natural killer cell activity and enhancement of acute pathogenesis following local HSV infection. Brain Behav Immun 1991; 5: 170–192

    CAS  PubMed  Google Scholar 

  46. Ben-Nathan D, Lustig S, Feuerstein G: The influence of cold or isolation stress on neuroinvasiveness and virulence of an attenuated variant of West Nile virus. Arch Virol 1989; 109: 1–10

    CAS  PubMed  Google Scholar 

  47. Ben-Nathan D, Lustig S, Danenberg HD: Stress-induced neuroinvasiveness of a neurovirulent noninvasive Sindbis virus in cold or isolation subjected mice. Life Sci 1991; 48: 1493–1500

    CAS  PubMed  Google Scholar 

  48. Levine S, Strebel, R, Wenk EJ, et al: Suppression of experimental allergic encephalomyelitis by stress. Proc Soc Exp Biol Med 1962; 109: 294–298

    CAS  PubMed  Google Scholar 

  49. Friedman SB, Glasgow LA, Ader R: Psychosocial factors modifying host resistance to experimental infections. Ann N Y Acad Sci 1969; 164: 381–393

    CAS  PubMed  Google Scholar 

  50. Greenberg AH, Dyck DG, Sandler LS, et al: Neurohormonal modulation of natural resistance to a murine lymphoma. J Natl Cancer Inst 1984; 72: 653–659

    CAS  PubMed  Google Scholar 

  51. Ader R, Cohen N: Psychoneuroimmunology: conditioning and stress. Ann Rev Psychol 1993; 44: 53–85

    CAS  Google Scholar 

  52. Biondi M: Effects of Stress on Immune Functions: An Overview, 3rd ed. New York, Academic Press, 2001

    Google Scholar 

  53. Herbert TB, Cohen S: Depression and immunity: a meta-analytic review. Psychol Bull 1993; 113: 472–486

    CAS  PubMed  Google Scholar 

  54. Irwin M: Immune correlates of depression. Adv Exp Med Biol 1999; 461: 1–24

    CAS  PubMed  Google Scholar 

  55. Kiecolt-Glaser JK, McGuire L, Robles TF, et al: Psychoneuroimmunology: psychological influences on immune function and health. J Consult Clin Psychol 2002; 70: 537–547

    PubMed  Google Scholar 

  56. Glaser R, Sheridan J, Malarkey WB, et al: Chronic stress modulates the immune response to a pneumococcal pneumonia vaccine. Psychosom Med 2000; 62: 804–807

    CAS  PubMed  Google Scholar 

  57. Glaser R, Rice J, Sheridan J, et al: Stress-related immune suppression: health implications. Brain Behav Immun 1987; 1: 7–20

    CAS  PubMed  Google Scholar 

  58. Marucha PT, Sheridan JF, Padghett D: Stress and Wound Healing, 3rd ed. New York, Academic Press, 2001

    Google Scholar 

  59. Hall NRS, Andrerson JA, O’Grady MP: Stress and Immunity in Humans: Modifying Variables. New York, Academic Press, 1994

    Google Scholar 

  60. Sapolsky RM, Romero LM, Munck AU: How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocr Rev 2000; 21: 55–89

    CAS  PubMed  Google Scholar 

  61. Mcewen BS: Protective and damaging effects of stress mediators. N Engl J Med 1998; 338: 171–179

    CAS  PubMed  Google Scholar 

  62. Heim C, Ehlert U, Hellhammer DH: The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology 2000; 25: 1–35

    CAS  PubMed  Google Scholar 

  63. Surwit RS, Williams PG: Animal models provide insight into psychosomatic factors in diabetes. Psychosom Med 1996; 58: 582–589

    CAS  PubMed  Google Scholar 

  64. Rebuffe-Scrive M, Walsh UA, McEwen B, et al: Effect of chronic stress and exogenous glucocorticoids on regional fat distribution and metabolism. Physiol Behav 1992; 52: 583–590

    CAS  PubMed  Google Scholar 

  65. Manuck S, Marsland AL, Kaplan JR, et al: The pathogenicity of behavior and its neuroendorine mediation: an example from coronary artery disease. Psychosom Med 1995; 57: 275

    CAS  PubMed  Google Scholar 

  66. Peacock J, Bland J, Anderson HR: Preterm delivery: effects of socioeconomic factors, psychological stress, smoking, alcohol, and caffeine. Br Med J 1995; 311: 531–535

    CAS  Google Scholar 

  67. Bjorntorp P: Hypothalamic origin of prevalent human disease, in Hormones, Brain and Behavior. Edited by Pfaff AA, Etgen A, Fahrbach S, et al. San Diego, Academic Press, 2002

    Google Scholar 

  68. Epel E, McEwen B, Seeman T, et al: Stress and body shape: consistently greater stress-induced cortisol reactivity among women with abdominal fat. Psychosom Med 2000; 62: 623–632.

    CAS  PubMed  Google Scholar 

  69. Epel E, Lapidus R, McEwen B, et al: Stress may add bite to appetite in women: A laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology 2000; 26: 37–49

    Google Scholar 

  70. Surwit RS: Stress management improves long term glycemic control in type II diabetes. Diabetes Care 2002; 25: 30–34

    PubMed  Google Scholar 

  71. Sapolsky R, Krey L, McEwen BS, et al: Prolonged glucocorticoid exposure reduces hippocampal neuron number: implications for aging. J Neurosci 1985; 5: 1222–1227

    CAS  PubMed  Google Scholar 

  72. Sheline Y, Sanghavi M, Mintun MA, et al: Depression duration but not age predicts hippocampal volume loss in medically healthy women with recurrent major depression. J Neurosci 1999; 19: 5034–5043

    CAS  PubMed  Google Scholar 

  73. Bobinski M, de Leon M, Tarnawski M, et al. Neuronal and volume loss in CA1 of the hippocampal formation uniquely predicts duration and severity of Alzheimer disease. Brain Res 1998; 805: 267–269

    CAS  PubMed  Google Scholar 

  74. Bremner J, Vythilingam M, Vermetten E, et al: MRI and PET study of deficits in hippocampal structure and function in women with childhood sexual abuse and posttraumatic stress disorder. Am J Psychiatry 2003; 160: 924–932

    PubMed  Google Scholar 

  75. Starkman M, Sebarski S, Berent S, et al: Hippocampal volume, memory dysfunction, and cortisol levels in patients with Cushing’s syndrome. Biol Psychiatry 1992; 32: 756–765

    CAS  PubMed  Google Scholar 

  76. Gilbertson M, Shenton M, et al: Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma. Nat Neurosci 2002; 5: 1242–1247

    CAS  PubMed Central  PubMed  Google Scholar 

  77. Wolkowitz O, Epel E, et al: Antiglucocorticoid strategies in treating major depression and allostatic load, in The Physical Consequences of Depression. Edited by Jogin T. Philadelphia, Wrightson Biomedical Publishing, 2001, pp 181–213

    Google Scholar 

  78. Wolkowitz O, Epel E, Reus V: Stress hormone-related psychopathology: Pathophysiological and treatment implications. World J Biol Psychiatry 2001; 2: 113–141

    Google Scholar 

  79. Krantz DS, McCeney MK: Effects of psychological and social factors on organic disease: a critical assessment of research on coronary heart disease. Ann Rev Psychol 2002; 53: 341–369

    Google Scholar 

  80. Rozanski A, Blumenthal JA, Kaplan J: Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999; 99: 2192–2217

    CAS  PubMed  Google Scholar 

  81. von Kanel R, Mills PJ, Fainman C, et al: Effects of psychological stress and psychiatric disorders on blood coagulation and fibrinolysis: a biobehavioral pathway to coronary artery disease? Psychosom Med 2001; 63: 531–544

    Google Scholar 

  82. Kop WJ, Cohen N: Psychological risk factors and immune system involvement in cardiovascular disease, in Psychoneuroimmunology. Edited by Ader R, Felten DL, Cohen N. New York, Academic Press, 2001, pp 525–544

    Google Scholar 

  83. Kaplan JR, Manuck SB: Status, stress, and atherosclerosis: the role of environment and individual behavior. Ann N Y Acad Sci 1999; 896: 145–161

    CAS  PubMed  Google Scholar 

  84. Treiber F, Kamarck T, Schneiderman N, et al: Cardiovascular reactivity and development of preclinical and clinical disease states. Psychsom Med 2003; 65: 46–62

    Google Scholar 

  85. Carroll D, Davey Smith G, Willemsen G, et al: Blood pressure reactions to the cold pressor test and the prediction of ischemic heart disease: data from the Caerphilly Study. J Epidemiol Community Health 1998; 52: 528–529

    CAS  PubMed  Google Scholar 

  86. Everson S, Lynch J, Kaplan G, et al: Stress-induced blood pressure reactivity and incident stroke in middle-aged men. Stroke 2001; 32: 1263–1270

    CAS  PubMed  Google Scholar 

  87. Mittleman MA, Maclure M, Sherwood JB, et al: Triggering of acute myocardial infarction onset by episodes of anger: Determinants of Myocardial Infarction Onset Study Investigators. Circulation 1995; 92: 1720–175

    CAS  PubMed  Google Scholar 

  88. Gullette EC, Blumenthal JA, Babyak M, et al: Effects of mental stress on myocardial ischemia during daily life. JAMA 1997; 277: 1521–156

    CAS  PubMed  Google Scholar 

  89. Kamarck TW, Jennings JR: Biobehavioral factors in sudden death. Psychol Bull 1999; 109: 42–75

    Google Scholar 

  90. Connerney I, Shapiro P, McLaughlin J, et al: Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study. Lancet 2001; 358: 1766

    CAS  PubMed  Google Scholar 

  91. Lesperance F, Frasure-Smith N, Talajic M, et al: Five-year risk of cardiac mortality in relation to initial severity and 1-year changes in depression symptoms after myocardial infarction. Circulation 2002; 105: 1049–1053

    PubMed  Google Scholar 

  92. Linden W, Stossel C, Maurice J: Psychosocial interventions for patients with coronary artery disease: a meta-analysis. Arch Intern Med 1996; 156: 745–752

    CAS  PubMed  Google Scholar 

  93. Sheps DS, Freedland KE, Golden RN, et al: ENRICHD and SADHART: implications for future biobehavioral intervention efforts. Psychosom Med 2003; 65: 1–2

    PubMed  Google Scholar 

  94. Waldstein SR, Elias MF: Neuropsychological of Cardiovascular Disease. Mahwah, NJ, Lawrence Erlbaum, 2001

    Google Scholar 

  95. Dinan TG, O’Keane V, O’Boyle C, et al: A comparison of the mental status, personality profiles and life events of patients with irritable bowel syndrome and peptic ulcer disease. Acta Psychiatr Scand 1991; 84: 26–28

    CAS  PubMed  Google Scholar 

  96. Whitehead WE, Crowell MD, Robinson JC, et al: Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared with subjects without bowel dysfunction. Gut 1992; 33: 825–830

    CAS  PubMed  Google Scholar 

  97. Bernstein CN, Frankenstein UN, Rawsthorne P, et al: Cortical mapping of visceral pain in patients with GI disorders using functional MRI. Am J Gastroenterol 2002; 97: 319–327

    PubMed  Google Scholar 

  98. Karling P, Nyhlin H, Wiklund U, et al: Spectral analysis of heart rate variability in patients with irritable bowel syndrome. Scand J Gastroenterol 1998; 33: 572–576

    CAS  PubMed  Google Scholar 

  99. Drossman D, Toner B, Whitehead WE, et al: Cognitive behavior therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology 2003; 125: 19–31

    PubMed  Google Scholar 

  100. Creed F, Fernandes L GE, Palmer S, et al: The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology 2003; 124: 303–317

    PubMed  Google Scholar 

  101. Mayer EA, Gebhart GF: Basic and clinical aspects of visceral hyperalgesia. Gastroenterology 1994; 107: 271–293

    CAS  PubMed  Google Scholar 

  102. Nobaek S, Johansson ML, Molin G, et al: Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol 2000; 95: 1231–128

    CAS  PubMed  Google Scholar 

  103. Khan I, Collins SM: Is there an inflammatory basis for a subset of patients presenting with diarrhea in the irritable bowel syndrome? Gastroenterology 1994:A523

  104. Nanda R, James R, Smith H, et al: Food intolerance and the irritable bowel syndrome. Gut 1989; 30: 1099–1104

    CAS  PubMed  Google Scholar 

  105. Gwee KA, Leong YL, Graham C, et al: The role of psychological and biological factors in postinfective gut dysfunction. Gut 1999; 44: 400–406

    CAS  PubMed  Google Scholar 

  106. Bradley LA, Richter JE, Pulliam TJ, et al: The relationship between stress and symptoms of gastroesophageal reflux: the influence of psychological factors. Am J Gastroenterol 1993; 88: 11–19

    CAS  PubMed  Google Scholar 

  107. Lam SK, Hui WM, Shiu LP, et al: Society stress and peptic ulcer perforation. J Gastroenterol Hepatol 1995; 10: 570–576

    CAS  PubMed  Google Scholar 

  108. Anda RF, Williamson DF, Escobedo LG, et al: Self-perceived stress and the risk of peptic ulcer disease: a longitudinal study of US adults. Arch Intern Med 1992; 152: 829–833

    CAS  PubMed  Google Scholar 

  109. Bresnick WH, Rask-Madsen C, Hogan DL, et al: The effect of acute emotional stress on gastric acid secretion in normal subjects and duodenal ulcer patients. J Clin Gastroenterol 1993; 17: 117–122

    CAS  PubMed  Google Scholar 

  110. Levenstein S, Prantera C, Scribano ML, et al: Psychologic predictors of duodenal ulcer healing. J Clin Gastroenterol 1996; 22: 84–89

    CAS  PubMed  Google Scholar 

  111. Armstrong D, Arnold R, Classen M, et al: RUDER—a prospective, 2-year, multicenter study of risk factors for duodenal ulcer relapse during maintenance therapy with ranitidine. RUDER Study Group. Dig Dis Sci 1994; 39: 1425–1433

    CAS  PubMed  Google Scholar 

  112. Levenstein S, Prantera C, Varvo V, et al: Long-term symptom patterns in duodenal ulcer: psychosocial factors. J Psychosom Res 1996; 41: 465–472

    CAS  PubMed  Google Scholar 

  113. Saunders PR, Kosecka U, McKay DM, et al: Acute stressors stimulate ion secretion and increase epithelial permeability in rat intestine. Am J Physiol 1994; 267: G794–9

    CAS  PubMed  Google Scholar 

  114. Lyte M, Ernst S: Catecholamine-induced growth of gram negative bacteria. Life Sci 1992; 50: 203–212

    CAS  PubMed  Google Scholar 

  115. Collins SM, McHugh K, Jacobson K, et al: Previous inflammation alters the response of the rat colon to stress. Gastroenterology 1996; 111: 1509–1515

    CAS  PubMed  Google Scholar 

  116. Qiu BS, Vallance BA, Blennerhassett PA, et al: The role of CD4 + lymphocytes in the susceptibility of mice to stress-induced reactivation of experimental colitis. Nat Med 1999; 5: 1178–1182

    CAS  PubMed  Google Scholar 

  117. Levenstein S, Prantera C, Varvo V, et al: Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. Am J Gastroenterol 2000; 95: 1213–1220

    CAS  PubMed  Google Scholar 

  118. Farhadi A, Keshavarzian A, Van de Kar LD, et al: Heightened responses to stressors in patients with inflammatory bowel disease. Am J Gastroenterol 2005; 100: 1796–1804

    PubMed  Google Scholar 

  119. Mawdsley JE, Macey MG, Feakins RM, et al: The effect of acute psychologic stress on systemic and rectal mucosal measures of inflammation in ulcerative colitis. Gastroenterology 2006; 131: 410–419

    CAS  PubMed  Google Scholar 

  120. Mittermaier C, Dejaco C, Waldhoer T, et al: Impact of depressive mood on relapse in patients with inflammatory bowel disease: a prospective 18-month follow-up study. Psychosom Med 2004; 66: 79–84

    PubMed  Google Scholar 

  121. Persoons P, Vermeire S, Demyttenaere K, et al: The impact of major depressive disorder on the short- and long-term outcome of Crohn’s disease treatment with infliximab. Aliment Pharmacol Ther 2005; 22: 101–110

    CAS  PubMed  Google Scholar 

  122. Li J, Norgard B, Precht DH, et al: Psychological stress and inflammatory bowel disease: a follow-up study in parents who lost a child in Denmark. Am J Gastroenterol 2004; 99: 1129–1133

    PubMed  Google Scholar 

  123. Sainsbury A, Heatley RV: Review article: psychosocial factors in the quality of life of patients with inflammatory bowel disease. Aliment Pharmacol Ther 2005; 21: 499–508

    CAS  PubMed  Google Scholar 

  124. Mussell M, Bocker U, Nagel N, et al: Predictors of disease-related concerns and other aspects of health-related quality of life in outpatients with inflammatory bowel disease. Eur J Gastroenterol Hepatol 2004; 16: 1273–1280

    PubMed  Google Scholar 

  125. Maunder RG, Lancee WJ, Hunter JJ, et al: Attachment insecurity moderates the relationship between disease activity and depressive symptoms in ulcerative colitis. Inflamm Bowel Dis 2005; 11: 919–926

    PubMed  Google Scholar 

  126. Schwarz SP, Blanchard EB: Evaluation of a psychological treatment for inflammatory bowel disease. Behav Res Ther 1991; 29: 167–177

    CAS  PubMed  Google Scholar 

  127. Jantschek G, Zeitz M, Pritsch M, et al: Effect of psychotherapy on the course of Crohn’s disease: results of the German prospective multicenter psychotherapy treatment study on Crohn’s disease. German Study Group on Psychosocial Intervention in Crohn’s Disease. Scand J Gastroenterol 1998; 33: 1289–1296.

    CAS  PubMed  Google Scholar 

  128. Leserman J, Petitto JM, Golden RN, et al: Impact of stressful life events, depression, social support, coping, and cortisol on progression to AIDS. Am J Psychiatry 2000; 157: 1221–128

    CAS  PubMed  Google Scholar 

  129. Ironson G, Solomon GF, Balbin EG, et al: The Ironson-woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS. Ann Behav Med 2002; 24: 34–48

    PubMed  Google Scholar 

  130. Antoni MH: Stress management and psychoneuroimmunology in HIV infection. CNS Spectr 2003; 8: 40–51

    PubMed  Google Scholar 

  131. Ironson G, Balbin E, Solomon G, et al: Relative preservation of natural killer cell cytotoxicity and number in healthy AIDS patients with low CD4 cell counts. Aids 2001; 15: 2065–2073

    CAS  PubMed  Google Scholar 

  132. Rosenberg ZF, Fauci AS: Activaction of latent HIV infection. J Nat Instit Health Res 1991; 2: 41–45

    Google Scholar 

  133. Pereira DB, Antoni MH, Danielson A, et al: Life stress and cervical squamous intraepithelial lesions in women with human papilloma virus and HIV. Psychosom Med 2003; 65: 427–434

    PubMed  Google Scholar 

  134. Clerici M, Trabattoni D, Piconi S, et al: A possible role for the cortisol/anticortisols imbalance in the progression of HIV. Psychoneuroendocrinology 1997; 22(suppl 1): S27–31.

    CAS  PubMed  Google Scholar 

  135. Kumar M, Kumar A, Morgan R, et al: Abnormal pituitaryadrenocortical response in early HIV-1 infection. J AIDS 1993; 6: 61–65

    CAS  Google Scholar 

  136. Lortholary O, Christeff N, Casassus P, et al: Hypothalamicpituitary-adrenal function in human immunodeficiency virus-infected men. J Clin Endocrin Metabol 1996; 81: 791–796

    CAS  Google Scholar 

  137. Rondanelli M, Solerte S, Fioravanti M, et al: Circadian secretory pattern of growth hormone, insulin-like growth factor type I, cortisol, ACTH, thyroid-stimulating hormone, and prolactin during HIV infection. AIDS Res Hum Retrovir 1997; 13: 1243–1249

    CAS  PubMed  Google Scholar 

  138. Cole SW, Kemeny M: Psychosocial influences on the progression of HIV infection, in Psychoneuroimmunology, 3rd ed. Edited by Ader R, Cohen N, Felten DL. New York, Academic Press, 2001, pp 583–612

    Google Scholar 

  139. Cole SW, Kemeny M, Naliboff B, et al: ANS enhancement of HIV pathogenesis. Brain Behav Immun 2001; 15: 121

    Google Scholar 

  140. Chesney M, Folkman S, Chambers D: Coping effectiveness training for men living with HIV: preliminary findings. Int J STD AIDS 1996; 7(suppl 2): 75–82

    PubMed  Google Scholar 

  141. Kelly JA, Murphy DA, Bahr GR, et al: Outcome of cognitive behavior and support group brief therapies for depressed, HIV-infected persons. Am J Psychiatry 1993; 150: 1679–1686

    CAS  PubMed  Google Scholar 

  142. Antoni MH, Cruess S, Cruess DG, et al: Cognitive behavior stress management reduces distress and 24-hour urinary free cortisol output among symptomatic HIV-infected gay men. Ann Behav Med 2000; 22: 29–37

    CAS  PubMed  Google Scholar 

  143. Cruess S, Antoni M, Cruess D, et al: Reductions in herpes simplex virus type 2 antibody titers after cognitive behavior stress management and relationships with neuroendocrine function, relaxation skills, and social support in HIV-positive men. Psychosom Med 2000; 62: 828–837

    CAS  PubMed  Google Scholar 

  144. Antoni MH, Cruess DG, Klimas N, et al: Stress management and immune system reconstitution in symptomatic HIV-infected gay men over time: effects on transitional naive T cells (CD4(+)CD45RA(+)CD29(+)). Am J Psychiatry 2002; 159: 143–145

    PubMed  Google Scholar 

  145. Antoni MH, Carrico AW, Duran RE, et al: Randomized clinical trial of cognitive behavior stress management on HIV viral load in gay men treated with highly active antiretroviral therapy. Psychosom Med 2006; 68: 143–151

    PubMed  Google Scholar 

  146. Antoni MH, Cruess DG, Klimas N, et al: Increases in a marker of immune system reconstitution are predated by decreases in 24- hour urinary cortisol output and depressed mood during a 10-week stress management intervention in symptomatic HIV-infected men. J Psychosom Res 2005; 58: 3–13

    PubMed  Google Scholar 

  147. Oken D: Multiaxial diagnosis and the psychosomatic model of disease. Psychosom Med 2000; 62: 171–175

    CAS  PubMed  Google Scholar 

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Correspondence to Dennis H. Novack M.D..

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Novack, D.H., Cameron, O., Epel, E. et al. Psychosomatic Medicine: The Scientific Foundation of the Biopsychosocial Model. Acad Psychiatry 31, 388–401 (2007). https://doi.org/10.1176/appi.ap.31.5.388

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  • DOI: https://doi.org/10.1176/appi.ap.31.5.388

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