Self-confidence as an immune-modifying psychotherapeutic intervention for COVID-19 patients and understanding of its connection to CNS-endocrine-immune axis

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) not only costs millions of human lives across the globe but also causes uncountable damage to mental health. As the incidence of COVID-19 continues to rise, so does the psychological burden. COVID-19 patients often encounter a variety of psychological stresses, including occupational damage, uncertain future of the family, and even fear of death which cause anxiety and distress, compromising the immune system, and influencing the severity of the disease. Beyond this, stressed individuals are more likely to practice unhealthy habits such as indifference to sleep and food that put them at greater risk. The CNS (central nervous system)-endocrine-immune axis is known to be crucially implicated in the stress-mediated dysregulation of the immune response [1]. Following CNS stimulation, stressors provoke the release of several hormones, including catecholamines (epinephrine and norepinephrine), adrenocorticotropin (ACTH), cortisol, growth hormone, and prolactin. Excess secretion of these stress hormones results in overactivation of immune cells and dysregulation of an immune response. Moreover, this interaction between the CNS and the immune system is bidirectional [1]. For example, cytokines (such as IL-1) produced by immune cells stimulate the hypothalamus to release corticotrophin-releasing hormones which further trigger secretion of stress hormones, resulting in immune malfunction.