- A variety of interventions including mind-body practices, massage and exercise may reduce inflammation by optimizing genetic expression.
- Cognitive behavioral therapy (CBT) has been demonstrated to reduce inflammation in multiple studies.
- Since inflammation is one of the key drivers of chronic disease, CBT may create better health in our bodies as well as our minds.
A number of years ago, I attended a course on “The New Science of Resiliency and its Clinical Applications” at Harvard Medical School’s Benson-Henry Institute for Mind Body Medicine. I will never forget sitting in the Joseph B. Martin Conference Center, listening to Dr. Herbert Benson, M.D. and Dr. Manoj Bhasin, Ph.D. discuss the findings of a study their team had just published. I was so excited at the time, that I promptly wrote an article about what I’d learned. Very sadly, the world lost Dr. Benson last month. I'm so glad I got to listen to him lecture recently, one last time.
At that course on resiliency, not only was I learning that a variety of stress reduction practices like mindfulness could do things like reduce anxiety and even alter structures in the brain, but Benson and Bhasin reported that they had found notable alterations in the genetic expression of subjects who practiced relaxation-response inducing techniques. Pathways related to metabolism and mitochondrial health were enhanced (mitochondria are the energy powerhouses of our cells and our body), and pathways related to stress and inflammation were down-regulated.
A few months ago, I attended another Benson-Henry Institute course, this time virtually (this was when I got to sit and listen to Dr. Benson's wisdom, that final time). I sat at my desk, enthralled again by a new lecture from Dr. Bhasin. Bhasin, who is Director of Genomics, Proteomics, Bioinformatics and Systems Biology at Children’s Healthcare of Atlanta, listed off study after study that demonstrated the genomic impact of a variety of interventions. His list was broader this time, demonstrating that activities such as twice weekly exercise or a weekly 30-minute massage could also positively affect the expression of our genes and reduce inflammation in our bodies.
One piece of research hit me the hardest. Tears came to my eyes, as Bhasin described the results of a randomized controlled trial: "Cognitive Behavioral Therapy and Tai Chi Reverse Cellular and Genomic Markers of Inflammation in Late-Life Insomnia."
CRP, or C-Reactive Protein, is a key marker of inflammation in our bodies. We doctors often measure CRP levels in our patients to assess disease risk and to detect problematic levels of inflammation. Inflammation is very strongly tied to the development of most chronic diseases. Interventions that decrease inflammation (such as eating a Mediterranean-type diet, reducing stress, and sleeping more) can both decrease our risk of disease and facilitate healing.
I had never heard, though, that cognitive behavioral therapy (CBT) had been found to decrease inflammation. This implies that this type of supportive therapy helps to calm and heal our bodies, and may prevent disease. I have practiced a form of CBT for years, both with medical patients and coaching clients. This work was already so satisfying and obviously helpful to people, and now it might mean even more in terms of its impact and value.
The researchers that looked at the impact of CBT in insomnia, did so because of the known activation of both systemic and cellular inflammation in people experiencing sleep disturbances. The less you sleep, the more CRP increases (this is so unfortunate, but important to be aware of). They found that the control group that didn’t receive any intervention had persistently elevated inflammation (indicated by increased CRP levels), while the groups that received either CBT or Tai Chi demonstrated reduced CRP levels. The CBT was administered in a format known as CBT-I, or cognitive behavioral therapy for insomnia, which uses a multi-component approach to improving sleep.
Wanting to learn more about this phenomenon, I looked for other studies. Another paper looked at the impact of anxiety and threat on inflammation in patients undergoing breast cancer treatment, and whether a cognitive-behavioral stress management (CBSM) intervention might offset that negative effect. Indeed, they found that the 10-week CBSM intervention “can reverse anxiety-related upregulation of pro-inflammatory gene expression in circulating leukocytes” (white blood cells). They noted that this helped to clarify which behavioral interventions could influence physical health and alter peripheral inflammatory processes.
Finally, a more recent review paper, published in JAMA Psychiatry, performed a meta-analysis of trials that looked at "Psychosocial Interventions and Immune Function." They looked at 56 trials and reported that “psychosocial interventions were associated with positive changes in immunity over time, including improvements in beneficial immune system function and decreases in harmful immune function that persisted for at least six months following treatment for participants randomly assigned to a psychosocial intervention vs. a control group.” They also noted that one of the most reliable interventions, when it came to improvements in immune function, was cognitive behavioral therapy.
I’ve just touched on some of the research here, but I hope you find this as encouraging as I do. When we seek help with mental health challenges and receive evidence-based treatment such as cognitive behavioral interventions, it benefits our minds and our bodies.
Going through difficult times can be so hard, affecting our lives and our well-being in so many challenging and upsetting ways. What a comfort to know that by talking to a trained professional, we may experience healing on multiple levels.
© Copyright 2022 Dr. Susan Biali Haas M.D.
Bhasin, M. K., Dusek, J. A., Chang, B. H., Joseph, M. G., Denninger, J. W., Fricchione, G. L., Benson, H., & Libermann, T. A. (2013). Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretion and inflammatory pathways. PloS one, 8(5), e62817.
Irwin, M. R., Olmstead, R., Breen, E. C., Witarama, T., Carrillo, C., Sadeghi, N., Arevalo, J. M., Ma, J., Nicassio, P., Bootzin, R., & Cole, S. (2015). Cognitive behavioral therapy and tai chi reverse cellular and genomic markers of inflammation in late-life insomnia: a randomized controlled trial. Biological psychiatry, 78(10), 721–729. https://doi.org/10.1016/j.biopsych.2015.01.010
Antoni, M. H., Lutgendorf, S. K., Blomberg, B., Carver, C. S., Lechner, S., Diaz, A., Stagl, J., Arevalo, J. M., & Cole, S. W. (2012). Cognitive-behavioral stress management reverses anxiety-related leukocyte transcriptional dynamics. Biological psychiatry, 71(4), 366–372.
Shields, G. S., Spahr, C. M., & Slavich, G. M. (2020). Psychosocial Interventions and Immune System Function: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA psychiatry, 77(10), 1031–1043. https://doi.org/10.1001/jamapsychiatry.2020.0431