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There is evidence linking psychosocially mediated immunological alterations with cancer, infectious illness, and HIV progression. The data reviewed suggest that immune modulation by psychosocial stressors and/or interventions may importantly influence health status. The research literature also suggests that the impact of chronic stressors and psychosocial factors on sympathetic nervous system and endocrine function influences the immune system, thereby providing shared mechanisms that may impact on disease susceptibility and progression across a broad spectrum of disorders. A better understanding of individual vulnerability, such as occurs with aging, may help to pinpoint those at greatest risk.

There is ample evidence from human and animal studies demonstrating the downward modulation of immune function concomitant with a variety of stressors. As a consequence, the possible enhancement of immune function by behavioral strategies has generated considerable interest. Researchers have used a number of diverse strategies to modulate immune function, including relaxation, hypnosis, exercise, classical conditioning, self-disclosure, exposure to a phobic stressor to enhance perceived coping self-efficacy, and cognitive-behavioral interventions, and these interventions have generally produced positive changes. Although it is not yet clear to what extent these positive immunological changes translate into any concrete improvements in relevant aspects of health, that is, alterations in the incidence, severity, or duration of infectious or malignant disease, the preliminary evidence is promising.

Psychoimmunology--a neologism--is a short term for the growing evidence that there are multiple interactions between central nervous system, vegetative nervous system, endocrinological system and immunological system. In the history of research the psychobiological stress concept of Hans Selye has been the most powerful basis for the ongoing empirical work in investigating aspects of systemic processes of psychoimmunology. Nowadays there is no doubt that the immunological system must not be seen as an independently functioning organic system. Simple causal links (like stressor-strain-relations) are not useful in explaining the complex interactions that we observe when biological phenomena simultaneously are taken into consideration. Especially with psychological stressors--the most frequent kind of troubles in our contemporary way of life--we have to stress the importance of the individual's evaluation of potentially stressful situations. In a wide variety a stressor becomes the potential of provoking strain because of my own appraisal. This multiple-step-process of appraisal is dependent on my coping abilities and coping strategies regarding an objectively or subjectively dangerous situation. Although there are common genetic and predispositional factors influencing the stress reaction we have to focus more on psychological phenomena, especially the possibility of conditioning stress reactions. As we know by empirical data some reactions of the immunological system are also influenced by learning processes like classical conditioning procedures. This knowledge may be used for a better understanding of a lot of chemical findings.

In critically reviewing the sources of evidence connecting psyche and brain with the immune system, the authors include a brief review of current knowledge of the immune system, its interactions with the neuroendocrine system, and other factors influencing its regulation. These include developmental stages, aging, rhythmicity, and a variety of exogenous influences. The need for developing further information about normal base lines is emphasized. Against that background, many sources of data demonstrating connections between the central nervous system and the immune system are presented: indirect evidence from clinical and experimental illnesses involving the immune system, and direct changes in either humoral or cellular immunity after natural or experimental stress, conditioning, hypnosis, and direct brain stimulation. Possible mechanisms are discussed, as well as some important methodological issues for further research.