Anxiety Self Help

Stress and Wound Healing

Individual differences in wound healing have long been recognized. Clinical observation has suggested that negative mood or stress is associated with slow wound healing. Basic mind-body research is now confirming this observation. Matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs), whose expression can be controlled by cytokines, play a role in wound healing.¹⁶ Using a blister chamber wound model on human forearm skin exposed to ultraviolet light, researchers have demonstrated that stress or a change in mood is sufficient to modulate MMP and TIMP expression and, presumably, wound healing.¹⁷ Activation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal medullary (SAM) systems can modulate levels of MMPs, providing a physiological link among mood, stress, hormones, and wound healing. This line of basic research suggests that activation of the HPA and SAM axes, even in individuals within the normal range of depressive symptoms, could alter MMP levels and change the course of wound healing in blister wounds.

Surgical Preparation

Mind-body interventions are being tested to determine whether they can help prepare patients for the stress associated with surgery. Initial randomized controlled trials--in which some patients received audiotapes with mind-body techniques (guided imagery, music, and instructions for improved outcomes) and some patients received control tapes--found that subjects receiving the mind-body intervention recovered more quickly and spent fewer days in the hospital.¹⁸

Behavioral interventions have been shown to be an efficient means of reducing discomfort and adverse effects during percutaneous vascular and renal procedures. Pain increased linearly with procedure time in a control group and in a group practicing structured attention, but remained flat in a group practicing a self-hypnosis technique. The self-administration of analgesic drugs was significantly higher in the control group than in the attention and hypnosis groups. Hypnosis also improved hemodynamic stability.¹⁹

Conclusion

Evidence from randomized controlled trials and, in many cases, systematic reviews of the literature, suggests that:

Mechanisms may exist by which the brain and central nervous system influence immune, endocrine, and autonomic functioning, which is known to have an impact on health.

Multicomponent mind-body interventions that include some combination of stress management, coping skills training, cognitive-behavioral interventions, and relaxation therapy may be appropriate adjunctive treatments for coronary artery disease and certain pain-related disorders, such as arthritis.

Multimodal mind-body approaches, such as cognitive-behavioral therapy, particularly when combined with an educational/informational component, can be effective adjuncts in the management of a variety of chronic conditions.

An array of mind-body therapies (e.g., imagery, hypnosis, relaxation), when employed presurgically, may improve recovery time and reduce pain following surgical procedures.

Neurochemical and anatomical bases may exist for some of the effects of mind-body approaches.

Mind-body approaches have potential benefits and advantages. In particular, the physical and emotional risks of using these interventions are minimal. Moreover, once tested and standardized, most mind-body interventions can be taught easily. Finally, future research focusing on basic mind-body mechanisms and individual differences in responses is likely to yield new insights that may enhance the effectiveness and individual tailoring of mind-body interventions. In the meantime, there is considerable evidence that mind-body interventions, even as they are being studied today, have positive effects on psychological functioning and quality of life, and may be particularly helpful for patients coping with chronic illness and in need of palliative care.