Stress und Covid-19: Ein Narrativer Review über
                    neuroendokrin-immune Mechanismen, die eine Abwehr von SARS-CoV-2 verbessern
                    könnten

Eva Milena Johanne Peters; Manfred Schedlowski; Carsten Watzl; Ulrike Gimsa

doi:10.1055/a-1322-3205

PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie, Table of Contents

Psychother Psychosom Med Psychol 2021; 71(02): 61-71
DOI: 10.1055/a-1322-3205

Übersicht

Stress und Covid-19: Ein Narrativer Review über neuroendokrin-immune Mechanismen, die eine Abwehr von SARS-CoV-2 verbessern könnten

Can Stress Interact with SARS-CoV-2? A Narrative Review with a Focus on Stress-Reducing Interventions that may Improve Defence against COVID-19

Eva Milena Johanne Peters

¹Klinik für Psychosomatik und Psychotherapie, Psychoneuroimmunologie Labor, Justus-Liebig Universität Gießen, Deutschland

²Medizinische Klinik mit Schwerpunkt Psychosomatik und Psychotherapie, CharitéCentrum 12 (CC12) für Innere Medizin und Dermatologie, Berlin, Deutschland

,

Manfred Schedlowski

³Institut für Medizinische Psychologie und Verhaltensimmunbiologie, Universitätsklinik Essen, Deutschland

⁴Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden

,

Carsten Watzl

⁵Fachbereich Immunologie, Leibniz-Institut für Arbeitsforschung an der TU Dortmund, Deutschland

,

Ulrike Gimsa

⁶Institut für Verhaltensphysiologie, Leibniz-Institut für Nutztierbiologie, Dummerstorf, Deutschland

› Author Affiliations

Abstract

Zusammenfassung

Ziel des Reviews Die COVID-19 Pandemie ist auf dem Vormarsch, die Sorgen und Ängste in der Bevölkerung wachsen, ebenso wie im medizinischen System. Aus der Perspektive der Stressforschung steht jetzt auf der einen Seite die Frage, wie diese psychosozialen Belastungen bewältigt werden können. Auf der anderen Seite entsteht die Frage, ob bestimmte Formen von Stress zu einer Häufung von Infektionen und kritischen Krankheitsverläufen beitragen können.

Methodik In einem narrativen Review wird vor dem Hintergrund des aktuellen Forschungsstandes zu Stressbelastungen und Immunantwort dargelegt, wie Stress die Immunabwehr von Viruserkrankungen beeinflussen kann.

Ergebnisse Übermäßiger Stress kann die Funktion der Barriere von Atemwegen kompromittieren und über eine Fehlanpassung der neuroendokrinen Stressreaktionssysteme zu einer Virus-permissiven Immunantwort beitragen.

Diskussion Da bestimmte Formen von Stress für eine erfolgreiche Immunabwehr von viral bedingten Atemwegserkrankungen eine Rolle spielen können, ist es wichtig Menschen mit hoher psychosozialer Belastung frühzeitig zu identifizieren und mit geeigneten Stress-reduzierenden Interventionen zu versorgen.

Schlussfolgerung Von Verhaltensänderungen und psychosozialen Maßnahmen, die zu einem verbesserten Umgang mit Stress beitragen, kann eine positive Wirkung auf die Immunantwort bei viralen Atemwegsinfekten erwartet werden.

Abstract

Objective The COVID-19 pandemic is on the rise and causes many concerns and fears in the population as well as among medical care givers. This raises the question as to how psychosocial stress associated with the pandemic can be managed, and also if certain forms of stress can contribute to an increase in infections and critical illnesses.

Methods Against the background of the current state of research on stress and the immune response, we provide a narrative review of studies addressing the question as to how stress can influence the immune defence against viral diseases.

Results Excessive stress can compromise the barrier function of the airways and alter neuroendocrine control of immune function, which can create a virus-permissive immune response.

Discussion Because certain forms of stress can play a role in the successful immune defence against viral respiratory disease, it is important to identify people with high psychosocial stress and to help them manage their stress. Conclusion Psychosocial measures that contribute to improved stress management may have a positive effect on the immune response against viral respiratory infections.

Schlüsselwörter

Stress - Psychoneuroimmunologie - Virus-Infektion

Key words

stress - psychoneuroimmunology - viral infection

Full Text

References

Literatur
1 Peters EM, Liezmann C, Klapp BF. et al. The neuroimmune connection interferes with tissue regeneration and chronic inflammatory disease in the skin. Ann N Y Acad Sci 2012; 1262: 118-126
2 Ali Abdelhamid Y, Kar P, Finnis ME. et al. Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta-analysis. Crit Care 2016; 20: 301
3 Olvera Alvarez HA, Kubzansky LD, Campen MJ. et al. Early life stress, air pollution, inflammation, and disease: An integrative review and immunologic model of social-environmental adversity and lifespan health. Neurosci Biobehav Rev 2018; 92: 226-242
4 Ippoliti F, Canitano N, Businaro R. Stress and obesity as risk factors in cardiovascular diseases: a neuroimmune perspective. J Neuroimmune Pharmacol 2013; 8: 212-226
5 Guan WJ, Liang WH, Zhao Y. et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: A nationwide analysis. Eur Respir J. 2020
6 Augsburger M, Maercker A. [Mental disorders specifically associated with stress in the upcoming ICD-11: An overview]. Fortschr Neurol Psychiatr 2018; 86: 156-162
7 Grossi G, Perski A, Osika W. et al. Stress-related exhaustion disorder – clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout. Scand J Psychol 2015; 56: 626-636
8 Atroszko PA, Demetrovics Z, Griffiths MD. Work addiction, obsessive-compulsive personality disorder, burn-out, and global burden of disease: implications from the ICD-11. Int J Environ Res Public Health 2020; 17
9 Solomon GF, Moss RH. Emotions, immunity, and disease; a speculative theoretical integration. Arch Gen Psychiatry 1964; 11: 657-674
10 Solomon GF. Emotions, stress, the central nervous system, and immunity. Ann N Y Acad Sci 1969; 164: 335-343
11 McEwen BS. Allostasis and the Epigenetics of Brain and Body Health Over the Life Course: The Brain on Stress. JAMA Psychiatry 2017; 74: 551-552
12 Fava GA, McEwen BS, Guidi J. et al. Clinical characterization of allostatic overload. Psychoneuroendocrinology 2019; 108: 94-101
13 Selye H. Stress and the general adaptation syndrome. Br Med J 1950; 1: 1383-1392
14 Mason JW, Giller EL, Kosten TR. et al. Elevation of urinary norepinephrine/cortisol ratio in posttraumatic stress disorder. J Nerv Ment Dis 1988; 176: 498-502
15 Lazarus RS, Folkman S. Stress, appraisal and coping. New York: Springer; 1984
16 Dhabhar FS. Effects of stress on immune function: the good, the bad, and the beautiful. Immunol Res 2014; 58: 193-210
17 Jensen MM, Rasmussen AF. Stress and susceptibility to viral infection. I. Response of adrenals, liver, thymus, spleen and peripheral leukocyte counts to sound stress. J Immunol 1963; 90: 17-20
18 Totman R, Reed SE, Craig JW. Cognitive dissonance, stress and virus-induced common colds. J Psychosom Res 1977; 21: 55-63
19 Cohen S, Frank E, Doyle WJ. et al. Types of stressors that increase susceptibility to the common cold in healthy adults. Health Psychol 1998; 17: 214-223
20 Basler K, Brandner JM. Tight junctions in skin inflammation. Pflugers Arch 2017; 469: 3-14
21 LeMessurier KS, Tiwary M, Morin NP. et al. Respiratory barrier as a safeguard and regulator of defense against influenza A virus and streptococcus pneumoniae. Front Immunol 2020; 11: 3
22 Rahn E, Thier K, Petermann P. et al. Epithelial barriers in murine skin during herpes simplex virus 1 infection: the role of tight junction formation. J Invest Dermatol 2017; 137: 884-893
23 Garg A, Chren MM, Sands LP. et al. Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol 2001; 137: 53-59
24 Maarouf M, Maarouf CL, Yosipovitch G. et al. The impact of stress on epidermal barrier function – an evidence-based review. Br J Dermatol 2019; 181: 1129-1137
25 Guo X, Han Y, Liu ZJ. et al. Expert recommendations for prevention, treatment and care of oral ulcers and other mucosal diseases during the coronavirus outbreak. Chin J Dent Res 2020; 23: 95-98
26 Altemus M, Rao B, Dhabhar FS. et al. Stress-induced changes in skin barrier function in healthy women. J Invest Dermatol 2001; 117: 309-317
27 Smith TJ, Wilson MA, Young AJ. et al. A suction blister model reliably assesses skin barrier restoration and immune response. J Immunol Methods 2015; 417: 124-130
28 Martin JV, Liberati DM, Diebel LN. Disparate effects of catecholamines under stress conditions on endothelial glycocalyx injury: An in vitro model. Am J Surg 2017; 214: 1166-1172
29 Choe SJ, Kim D, Kim EJ. et al. Psychological stress deteriorates skin barrier function by activating 11beta-hydroxysteroid dehydrogenase 1 and the HPA axis. Sci Rep 2018; 8: 6334
30 Buske-Kirschbaum A, Geiben A, Wermke C. et al. Preliminary evidence for Herpes labialis recurrence following experimentally induced disgust. Psychother Psychosom 2001; 70: 86-91 doi:56231 [pii]
31 Huda MN, Ahmad SM, Alam MJ. et al. Infant cortisol stress-response is associated with thymic function and vaccine response. Stress. 2019: 36-43
32 Curtis BJ, Plichta JK, Blatt H. et al. Nicotinic acetylcholine receptor stimulation impairs epidermal permeability barrier function and recovery and modulates cornified envelope proteins. Life Sci 2012; 91: 1070-1076
33 Peters EM, Kuhlmei A, Tobin DJ. et al. Stress exposure modulates peptidergic innervation and degranulates mast cells in murine skin. Brain Behav Immun 2005; 19: 252-262
34 Kumari S, Pasparakis M. Epithelial cell death and inflammation in skin. Curr Top Microbiol Immunol 2017; 403: 77-93 doi:10.1007/82_2015_466
35 Geng S, Yang L, Cheng F. et al. Gut microbiota are associated with psychological stress-induced defections in intestinal and blood-brain barriers. Front Microbiol 2019; 10: 3067
36 Groeger SE, Meyle J. Epithelial barrier and oral bacterial infection. Periodontol 2000 2015; 69: 46-67
37 Le Messurier KS, Tiwary M, Morin NP. et al. Respiratory barrier as a safeguard and regulator of defense against influenza a virus and streptococcus pneumoniae. Front Immunol 2020; 11: 3
38 Verdecchia P, Cavallini C, Spanevello A. et al. The pivotal link between ACE2 deficiency and SARS-CoV-2 infection. Eur J Intern Med 2020; 76: 14-20
39 Varga Z, Flammer AJ, Steiger P. et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020
40 Fang Y, Gao F, Liu Z. Angiotensin-converting enzyme 2 attenuates inflammatory response and oxidative stress in hyperoxic lung injury by regulating NF-kappaB and Nrf2 pathways. QJM 2019; 112: 914-924
41 Sharma N, Anders HJ, Gaikwad AB. Fiend and friend in the renin angiotensin system: An insight on acute kidney injury. Biomed Pharmacother 2019; 110: 764-774 doi:10.1016/j.biopha.2018.12.018
42 Calvillo L, Gironacci MM, Crotti L. et al. Neuroimmune crosstalk in the pathophysiology of hypertension. Nat Rev Cardiol 2019; 16: 476-490 doi:10.1038/s41569-019-0178-1
43 Zhu D, Tong Q, Liu W. et al. Angiotensin (1-7) protects against stress-induced gastric lesions in rats. Biochem Pharmacol 2014; 87: 467-476 doi:10.1016/j.bcp.2013.10.026
44 Yisireyili M, Uchida Y, Yamamoto K. et al. Angiotensin receptor blocker irbesartan reduces stress-induced intestinal inflammation via AT1a signaling and ACE2-dependent mechanism in mice. Brain Behav Immun 2018; 69: 167-179 doi:10.1016/j.bbi.2017.11.010
45 Fontes MA, Martins Lima A, Santos RA. Brain angiotensin-(1-7)/Mas axis: A new target to reduce the cardiovascular risk to emotional stress. Neuropeptides 2016; 56: 9-17 doi:10.1016/j.npep.2015.10.003
46 McInnis CM, Thoma MV, Gianferante D. et al. Measures of adiposity predict interleukin-6 responses to repeated psychosocial stress. Brain Behav Immun 2014; 42: 33-40 doi:10.1016/j.bbi.2014.07.018
47 Janicki-Deverts D, Cohen S, Turner RB. et al. Basal salivary cortisol secretion and susceptibility to upper respiratory infection. Brain Behav Immun 2016; 53: 255-261 doi:10.1016/j.bbi.2016.01.013
48 Jiang W, Li Y, Wei W. et al. Spleen contributes to restraint stress induced hepatocellular carcinoma progression. Int Immunopharmacol 2020; 83: 106420 doi:10.1016/j.intimp.2020.106420
49 Miller GE, Cohen S, Pressman S. et al. Psychological stress and antibody response to influenza vaccination: when is the critical period for stress, and how does it get inside the body?. Psychosom Med 2004; 66: 215-223 doi:10.1097/01.psy.0000116718.54414.9e
50 Zhang Z, Yao W, Wang Y. et al. Wuhan and Hubei COVID-19 mortality analysis reveals the critical role of timely supply of medical resources. J Infect. 2020 doi:10.1016/j.jinf.2020.03.018
51 Emeny R, Lacruz ME, Baumert J. et al. Job strain associated CRP is mediated by leisure time physical activity: results from the MONICA/KORA study. Brain Behav Immun 2012; 26: 1077-1084 doi:10.1016/j.bbi.2012.07.004S0889-1591(12)00187-0 [pii]
52 Kong AP, Xu G, Brown N. et al. Diabetes and its comorbidities - where East meets West. Nat Rev Endocrinol 2013; 9: 537-547 doi:10.1038/nrendo.2013.102
53 Huth C, Thorand B, Baumert J. et al. Job-strain-a risk factor for the onset of type 2 diabetes mellitus: findings from the MONICA/KORA Augsburg cohort study. Psychosom Med. 2014 in print: under review
54 Fitzmaurice C, Allen C, Barber RM. et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: A systematic analysis for the global burden of disease study. JAMA Oncol. 2016 doi:10.1001/jamaoncol.2016.5688
55 Bandelow B, Baldwin D, Abelli M. et al. Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition. World J Biol Psychiatry 2017; 18: 162-214
56 Sandoval D, Nazzal C, Romero T. Clinical, socioeconomic, and psychosocial factors associated with blood pressure control and adherence: Results from a multidisciplinary cardiovascular national program providing universal coverage in a developing country. Int J Hypertens 2018; 2018: 5634352
57 Iddir M, Brito A, Dingeo G. et al. Strengthening the immune system and reducing inflammation and oxidative stress through diet and nutrition: Considerations during the COVID-19 crisis. Nutrients 2020; 12 doi:10.3390/nu12061562
58 Zannas AS, Jia M, Hafner K. et al. Epigenetic upregulation of FKBP5 by aging and stress contributes to NF-kappaB-driven inflammation and cardiovascular risk. Proc Natl Acad Sci U S A 2019; 116: 11370-11379 doi:10.1073/pnas.1816847116
59 Domnich A, Manini I, Calabro GE. et al. Mapping host-related correlates of influenza vaccine-induced immune response: an umbrella review of the available systematic reviews and meta-analyses. Vaccines (Basel) 2019; 7 doi:10.3390/vaccines7040215
60 Lago-Penas S, Rivera B, Cantarero D. et al. The impact of socioeconomic position on non-communicable diseases: what do we know about?. Perspect Public Health. 2020
61 Maroko AR, Nash D, Pavilonis BT. COVID-19 and inequity: a comparative spatial analysis of New York city and Chicago hot spots. J Urban Health. 2020 doi:10.1007/s11524-020-00468-0
62 Patel AP, Paranjpe MD, Kathiresan NP. et al. Race, socioeconomic deprivation, and hospitalization for COVID-19 in English participants of a national biobank. Int J Equity Health 2020; 19: 114 doi:10.1186/s12939-020-01227-y
63 Cohen S, Janicki-Deverts D, Doyle WJ. Self-rated health in healthy adults and susceptibility to the common cold. Psychosom Med 2015; 77: 959-968 doi:10.1097/PSY.0000000000000232
64 Chan KW, Wong VT, Tang SCW. COVID-19: An update on the epidemiological, clinical, preventive and therapeutic evidence and guidelines of integrative chinese-western medicine for the management of 2019 novel coronavirus disease. Am J Chin Med. 2020 48: 737-762
65 Barrett B, Hayney MS, Muller D. et al. Meditation or exercise for preventing acute respiratory infection (MEPARI-2): A randomized controlled trial. PLoS One 2018; 13: e0197778 doi:10.1371/journal.pone.0197778
66 Lucille Sanzero Eller RN. Effects of two cognitive-behavioral interventions on immunity and symptoms in persons with HIV. Ann Behav Med 1995; 17: 339-348 doi:10.1007/BF02888599
67 Liu K, Chen Y, Wu D. et al. Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complement Ther Clin Pract 2020; 39: 101132 doi:10.1016/j.ctcp.2020.101132
68 Janicki Deverts D, Cohen S, Doyle WJ. Dispositional affect moderates the stress-buffering effect of social support on risk for developing the common cold. J Pers 2017; 85: 675-686
69 Hossain MM, Sultana A, Purohit N. Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence. Epidemiol Health 2020; 42: e2020038 doi:10.4178/epih.e2020038
70 Xiao H, Zhang Y, Kong D. et al. The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in january and february 2020 in China. Med Sci Monit 2020; 26: e923549 doi:10.12659/MSM.923549
71 Brooks SK, Webster RK, Smith LE. et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020; 395: 912-920 doi:10.1016/S0140-6736(20)30460-8
72 Bo HX, Li W, Yang Y. et al. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychol Med. 2020: 1-2 doi:10.1017/S0033291720000999
73 Rohr S, Muller F, Jung F. et al. [Psychosocial Impact of Quarantine Measures During Serious Coronavirus Outbreaks: A Rapid Review]. Psychiatr Prax 2020; 47: 179-189 doi:10.1055/a-1159-5562
74 Besedovsky L, Lange T, Haack M. The sleep-immune crosstalk in health and disease. Physiol Rev 2019; 99: 1325-1380 doi:10.1152/physrev.00010.2018
75 Prather AA, Leung CW. Association of insufficient sleep with respiratory infection among adults in the United States. JAMA Intern Med 2016; 176: 850-852 doi:10.1001/jamainternmed.2016.0787
76 Finnell JE, Wood SK. Putative inflammatory sensitive mechanisms underlying risk or resilience to social stress. Front Behav Neurosci 2018; 12: 240 doi:10.3389/fnbeh.2018.00240
77 Davidson RJ, Kabat-Zinn J, Schumacher J. et al. Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med 2003; 65: 564-570 doi:10.1097/01.psy.0000077505.67574.e3
78 Kabat-Zinn J. Foreword: Seeds of a necessary global renaissance in the making: the refining of psychology's understanding of the nature of mind, self, and embodiment through the lens of mindfulness and its origins at a key inflection point for the species. Curr Opin Psychol 2019; 28: xi-xvii doi:10.1016/j.copsyc.2019.02.005
79 Barrett B, Hayney MS, Muller D. et al. Meditation or exercise for preventing acute respiratory infection: a randomized controlled trial. Ann Fam Med 2012; 10: 337-346 doi:10.1370/afm.1376
80 Creswell JD, Myers HF, Cole SW. et al. Mindfulness meditation training effects on CD4+T lymphocytes in HIV-1 infected adults: a small randomized controlled trial. Brain Behav Immun 2009; 23: 184-188 doi:10.1016/j.bbi.2008.07.004
81 Hayney MS, Coe CL, Muller D. et al. Age and psychological influences on immune responses to trivalent inactivated influenza vaccine in the meditation or exercise for preventing acute respiratory infection (MEPARI) trial. Hum Vaccin Immunother 2014; 10: 83-91 doi:10.4161/hv.26661
82 Shields GS, Spahr CM, Slavich GM. Psychosocial interventions and immune system function: A systematic review and meta-analysis of randomized clinical trials. JAMA Psychiatry. 2020 77. 1031-1043 doi:10.1001/jamapsychiatry.2020.0431
83 Moraes LJ, Miranda MB, Loures LF. et al. A systematic review of psychoneuroimmunology-based interventions. Psychol Health Med. 2018 23: 635-652
84 Vallejo AN, Hamel DL, Mueller RG. et al. NK-like T cells and plasma cytokines, but not anti-viral serology, define immune fingerprints of resilience and mild disability in exceptional aging. PLoS One 2011; 6: e26558 doi:10.1371/journal.pone.0026558
85 Tegeler CL, Gerdes L, Shaltout HA. et al. Successful use of closed-loop allostatic neurotechnology for post-traumatic stress symptoms in military personnel: self-reported and autonomic improvements. Mil Med Res 2017; 4: 38 doi:10.1186/s40779-017-0147-0
86 Mello MF, Faria AA, Mello AF. et al. [Childhood maltreatment and adult psychopathology: pathways to hypothalamic-pituitary-adrenal axis dysfunction]. Braz J Psychiatry 2009; 31: S41-S48 doi:10.1590/s1516-44462009000600002
87 Jaremka LM, Glaser R, Loving TJ. et al. Attachment anxiety is linked to alterations in cortisol production and cellular immunity. Psychol Sci 2013; 24: 272-279 doi:10.1177/0956797612452571
88 Miller CWT. Epigenetic and Neural Circuitry Landscape of Psychotherapeutic Interventions. Psychiatry J 2017; 2017: 5491812 doi:10.1155/2017/5491812
89 Ridout KK, Khan M, Ridout SJ. Adverse Childhood Experiences Run Deep: Toxic Early Life Stress, Telomeres, and Mitochondrial DNA Copy Number, the Biological Markers of Cumulative Stress. Bioessays 2018; 40: e1800077 doi:10.1002/bies.201800077
90 Jimenez JP, Botto A, Herrera L. et al. Psychotherapy and Genetic Neuroscience: An Emerging Dialog. Front Genet 2018; 9: 257 doi:10.3389/fgene.2018.00257
91 Het S, Vocks S, Wolf JM. et al. Treatment-Resistant Blunted HPA Activity, but Reversible Cardiovascular Stress Reactivity in Young Women With Eating Disorders. Front Psychiatry 2020; 11: 726 doi:10.3389/fpsyt.2020.00726
92 Bauer ME, Wieck A, Lopes RP. et al. Interplay between neuroimmunoendocrine systems during post-traumatic stress disorder: a minireview. Neuroimmunomodulation 2010; 17: 192-195 doi:10.1159/000258721
93 Ewin DM. Treatment of HPV with hypnosis--psychodynamic considerations of psychoneuroimmunology: a brief communication. Int J Clin Exp Hypn 2011; 59: 392-398 doi:10.1080/00207144.2011.594664
94 Jobst A, Brakemeier EL, Buchheim A. et al. European psychiatric association guidance on psychotherapy in chronic depression across Europe. Eur Psychiatry 2016; 33: 18-36 doi:10.1016/j.eurpsy.2015.12.003
95 von Sydow K, Beher S, Schweitzer J. et al. The efficacy of systemic therapy with adult patients: a meta-content analysis of 38 randomized controlled trials. Fam Process 2010; 49: 457-485 doi:10.1111/j.1545-5300.2010.01334.x
96 Peters EM, Michenko A, Kupfer J. et al. Mental stress in atopic dermatitis--neuronal plasticity and the cholinergic system are affected in atopic dermatitis and in response to acute experimental mental stress in a randomized controlled pilot study. PLoS One 2014; 9: e113552 doi:10.1371/journal.pone.0113552
97 Kikkert M. Innate immune evasion by human respiratory RNA viruses. J Innate Immun 2020; 12: 4-20 doi:10.1159/000503030
98 Taylor SJ, Mann TS, Henry PJ. Influence of influenza A infection on capsaicin-induced responses in murine airways. J Pharmacol Exp Ther 2012; 340: 377-385 doi:10.1124/jpet.111.187872
99 Dhabhar FS. The short-term stress response - Mother nature's mechanism for enhancing protection and performance under conditions of threat, challenge, and opportunity. Front Neuroendocrinol 2018; 49: 175-192 doi:10.1016/j.yfrne.2018.03.004
100 Sandifer PA, Walker AH. Enhancing disaster resilience by reducing stress-associated health impacts. Front Public Health 2018; 6: 373 doi:10.3389/fpubh.2018.00373
101 Sijbrandij M, Kleiboer A, Bisson JI. et al. Pharmacological prevention of post-traumatic stress disorder and acute stress disorder: a systematic review and meta-analysis. Lancet Psychiatry 2015; 2: 413-421 doi:10.1016/S2215-0366(14)00121-7
102 Chevance A, Gourion D, Hoertel N. et al. Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review. Encephale 2020; 46: 193-201 doi:10.1016/j.encep.2020.04.005
103 Reive C. The Biological Measurements of Mindfulness-based Stress Reduction: A Systematic Review. Explore (NY) 2019; 15: 295-307 doi:10.1016/j.explore.2019.01.001
104 Schumacher S, Niemeyer H, Engel S. et al. Psychotherapeutic treatment and HPA axis regulation in posttraumatic stress disorder: A systematic review and meta-analysis. Psychoneuroendocrinology 2018; 98: 186-201 doi:10.1016/j.psyneuen.2018.08.006
105 Ludlow AT, Ludlow LW, Roth SM. Do telomeres adapt to physiological stress? Exploring the effect of exercise on telomere length and telomere-related proteins. Biomed Res Int 2013; 2013: 601368 doi:10.1155/2013/601368
106 Bennett JM, Rohleder N, Sturmberg JP. Biopsychosocial approach to understanding resilience: Stress habituation and where to intervene. J Eval Clin Pract 2018; 24: 1339-1346 doi:10.1111/jep.13052
107 Beserra AHN, Kameda P, Deslandes AC. et al. Can physical exercise modulate cortisol level in subjects with depression? A systematic review and meta-analysis. Trends Psychiatry Psychother 2018; 40: 360-368 doi:10.1590/2237-6089-2017-0155
108 Wan S, Xiang Y, Fang W. et al. Clinical features and treatment of COVID-19 patients in northeast chongqing. J Med Virol 2020; 92: 797-806 doi:10.1002/jmv.25783
109 Khan S, Siddique R, Shereen MA. et al. Emergence of a novel coronavirus, severe acute respiratory syndrome coronavirus 2: Biology and therapeutic options. J Clin Microbiol. 2020 58. e00187-20 doi:10.1128/JCM.00187-20
110 Dhabhar FS. Psychological stress and immunoprotection versus immunopathology in the skin. Clin Dermatol 2013; 31: 18-30 doi:10.1016/j.clindermatol.2011.11.003
111 McInnis CM, Wang D, Gianferante D. et al. Response and habituation of pro- and anti-inflammatory gene expression to repeated acute stress. Brain Behav Immun 2015; 46: 237-248 doi:10.1016/j.bbi.2015.02.006
112 Weyh C, Kruger K, Strasser B. Physical activity and diet shape the immune system during aging. Nutrients 2020; 12 doi:10.3390/nu12030622
113 Barra NG, Fan IY, Gillen JB. et al. High intensity interval training increases natural killer cell number and function in obese breast cancer-challenged mice and obese women. J Cancer Prev 2017; 22: 260-266 doi:10.15430/JCP.2017.22.4.260
114 Frantz EDC, Prodel E, Braz ID. et al. Modulation of the renin-angiotensin system in white adipose tissue and skeletal muscle: focus on exercise training. Clin Sci (Lond) 2018; 132: 1487-1507 doi:10.1042/CS20180276
115 Martin SA, Pence BD, Woods JA. Exercise and respiratory tract viral infections. Exerc Sport Sci Rev 2009; 37: 157-164 doi:10.1097/JES.0b013e3181b7b57b
116 Berk LS, Tan SA, Fry WF. et al. Neuroendocrine and stress hormone changes during mirthful laughter. Am J Med Sci 1989; 298: 390-396 doi:10.1097/00000441-198912000-00006
117 Bennett MP, Zeller JM, Rosenberg L. et al. The effect of mirthful laughter on stress and natural killer cell activity. Altern Ther Health Med 2003; 9: 38-45
118 Tanaka A, Tokuda N, Ichihara K. Psychological and physiological effects of laughter yoga sessions in Japan: A pilot study. Nurs Health Sci 2018; 20: 304-312 doi:10.1111/nhs.12562
119 Nasr SJ. No laughing matter: Laughter is good psychiatric medicine. Current Psychiatry 2013; 12: 20-25
120 Grebosz-Haring K, Thun-Hohenstein L. Effects of group singing versus group music listening on hospitalized children and adolescents with mental disorders: A pilot study. Heliyon 2018; 4: e01014 doi:10.1016/j.heliyon.2018.e01014
121 Schladt TM, Nordmann GC, Emilius R. et al. Choir versus solo singing: Effects on mood, and salivary oxytocin and cortisol concentrations. Front Hum Neurosci 2017; 11: 430 doi:10.3389/fnhum.2017.00430
122 Kreutz G. Does singing facilitate social bonding?. Music & Medicine 2014; 6: 51-60
123 Li T, Wang P, Wang SC. et al. Approaches mediating oxytocin regulation of the immune system. Front Immunol 2016; 7: 693 doi:10.3389/fimmu.2016.00693
124 Kang J, Scholp A, Jiang JJ. A review of the physiological effects and mechanisms of singing. J Voice 2018; 32: 390-395 doi:10.1016/j.jvoice.2017.07.008