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The impact of self-hypnosis and Johrei on lymphocyte subpopulations at

exam time: A controlled study

Article  in  Brain Research Bulletin · January 2004

DOI: 10.1016/j.brainresbull.2003.09.014 · Source: PubMed

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 Brain Research Bulletin 62 (2003) 241–253

The impact of self-hypnosis and Johrei on lymphocyte

subpopulations at exam time: a controlled study
Akira Naito a,b,∗ , Tannis M. Laidlaw a , Don C. Henderson b ,
Linda Farahani a , Prabudha Dwivedi a , John H. Gruzelier a
a Department of Cognitive Neuroscience and Behaviour, Imperial College London, Charing Cross Campus, St Dunstan’s Road, London W6 8RF, UK
b Department of Immunology, Imperial College London, Chelsea and Westminster Campus, 369 Fulham Road, London SW10 9NH, UK

Received 9 June 2003; received in revised form 26 September 2003; accepted 26 September 2003

Abstract

In a prospective randomised controlled trial, 48 students were randomly assigned to stress reduction training before exams with self-hypnosis,
Johrei or a mock neurofeedback relaxation control. Peripheral blood lymphocyte subpopulations and self-reported stress (Perceived Stress
Scale) were measured before training and 1–2 months later as exams approached. Absolute number and percentages of CD3+ CD4+ and
CD3+ CD8+ T lymphocytes, CD3− CD56+ Natural Killer cells (NK cells) and NK cell cytotoxic activity was measured from venous blood.
Stressed participants showed small but significant declines in both CD3− CD56+ NK cell percentages and NK cell cytotoxic activity levels
while CD3+ CD4+ T cell percentages increased, changes supported by correlations with perceived stress. The effects of stress were moderated
in those who learned Johrei at exam time; 11/12 showed increases in CD3− CD56+ NK cell percentages with decreased percentages of
CD3+ CD4+ T cells, effects not seen in the relaxation control group. Stress was also buffered in those who learned and practised self-hypnosis
in whom CD3− CD56+ NK cell and CD3+ CD4+ T cell levels were maintained, and whose CD3+ CD8+ T cell percentages, shown previously
to decline with exams, increased. The results compliment beneficial effects on mood of self-hypnosis and Johrei. The results are in keeping
with beneficial influences of self-hypnosis and provide the first evidence of the suggestive value of the Japanese Johrei procedure for stress
reduction, which clearly warrants further investigation.
© 2003 Elsevier Inc. All rights reserved.

Keywords: Stress; Hypnosis; Visualisation; Healing; Lymphocytes; Natural Killer cell (NK cell)

1. Introduction
The question whether psychological interventions can
benefit health by influencing immune function [2,18,19,21]
is arguably best understood in the context of psychological
stress. Stress, according to the pioneering endocrinologist
Hans Selye, is “the non-specific response of the body to any
demand” [47]. His General Adaptation Syndrome (GAS)
specified three phases of stress: (1) an alarm reaction to mar-
shal resources; (2) a stage of resistance when resistance to
stress rises above normal; and (3) a stage of exhaustion when
adaptation energy has been consumed [45]. This roughly
equates to a two-stage model of stress classifying reactions
to stressors as acute in contrast to sustained or chronic.
Acute, momentary or short-lasting stress can be defined as
∗ Corresponding author. Tel.: +44-20-8846-7042;
fax: +44-20-8846-1670.
E-mail address: akira.naito@imperial.ac.uk (A. Naito).
the stress that falls in the period between alarm reaction and
resistance in Selye’s model. Sustained or chronic stress is
the period from resistance to exhaustion. The perception by
the subject of the significance of the “stressor” [46] is now
recognised as essential when the word ‘stress’ can mean
either the stressor or its perception [33]. Stress perception is
thought to be influenced by two capacities of appraisal [48],
which can be modified by psychological interventions. Pri-
mary appraisal is the perception of the threat or demand in
the situation, i.e. ranging from irrelevant or minor through
to stressful. Secondary appraisal is the evaluation of one’s
ability to cope with the threat or demand.
Stress has deleterious effects on health in many organ
systems including the immune system. The immune sys-
tem is closely aligned with the autonomic nervous system
(ANS) and recently has been shown to interact closely with
other systems as well, especially the central nervous and en-
docrinological systems [39]. Evidence shows that there are
bi-directional influences between the brain and the immune

0361-9230/$ – see front matter © 2003 Elsevier Inc. All rights reserved.
doi:10.1016/j.brainresbull.2003.09.014
242 A. Naito et al. / Brain Research Bulletin 62 (2003) 241–253
system with two major pathways—Sympathetic Adrenal
Modulation [12] and the Hypothalamus–Pituitary–Adrenal
axis [9]. These involve soluble mediators such as cytokines
and hormones [36,41,54]. Clearly effects on immune param-
eters will be complex because these pathways dynamically
interact with each other and with various homeostatic con-
trols through regulatory [13], buffering [37] and feedback
mechanisms [42]. Furthermore, effects may vary depending
on whether stress is acute or chronic.
Many aspects of the immune system are reported to be
altered by stress in healthy individuals, including T lympho-
cytes and Natural Killer cells (NK cells). In particular NK
cells have been shown to be reduced by sustained stress [24]
in both number and in functional activity, and these two mea-
sures have been found to be correlated [53]. As part of the
stress response, CD3+ CD8+ T cell counts can also decrease
in parallel with CD3− CD56+ NK cells [21], while reports
vary as to the effects of stress on CD3+ CD4+ T cell counts:
increased in chronic stress associated with burnout in nurses
[7] or little change with the stress of exams in students [21].
Acute stress has been mainly examined in experimental
settings in the laboratory using short-lasting anxiety reac-
tions coupled with tasks such as mental arithmetic [56,59]
and public speaking [23]. Sustained stress reactions have of-
ten been examined in healthy populations using academic
examinations as the stressor [8,16,18,20,21,27,28].
Among stress intervention techniques one approach has
involved the use of self-hypnosis, which overall has shown
considerable benefits in buffering the effects of stress that
were manifested in control groups [21,28]. Hypnosis has
been widely used in clinical studies involving health and im-
mune function parameters [26,28], and it is arguably one of
the more accepted therapies within complementary medicine
[3]. Self-hypnosis will be applied in the present study along
with a Japanese laying on of hands method known as Johrei,
or ‘purification’, where the participant acts as both the prac-
titioner, who concentrates on the transmission of subtle en-
ergies through the hand via the metaphor of light, and the
recipient, who in turn visualises images of light received.
Young and healthy students facing the stress of exams
were chosen to examine the effects of self-hypnosis and
Johrei. For comparison purposes, a relaxation technique in-
volving mock neurofeedback was chosen for the control
group, a procedure which has been shown to provide a valid
relaxation experience [11]. By controlling for expectations
when the outcome of one intervention is compared with an-
other, the placebo effect is effectively controlled. Similarly
as there is a relaxation component present in the mock neu-
rofeedback technique as well as in self-hypnosis and Johrei,
relaxation is also effectively controlled. These two aspects
of the control condition, expectation and relaxation, enable
a stringent test to be made for self-hypnosis and Johrei stress
reduction practices.
The effects of these psychological interventions on
mood have been published elsewhere [32]. In brief, both
self-hypnosis and Johrei were successful in countering some
of the emotional distress of examinations in contrast to the
control mock neurofeedback relaxation condition. These
advantages were unrelated to expectations about outcome
before or after training.
2. Methodology
2.1. Subjects
After approval from the Riverside Human Ethics Com-
mittee, 48 healthy young participants were recruited with
an age range 19–23 years with one participant of 37 years.
There were 22 males and 26 females of whom 39/48 were
medical students. Informed consent was obtained after they
were given detailed information sheets and then they were
randomly assigned to one of three interventions. Partici-
pants were given a simple breakfast after their blood had
been drawn and paid £30 at the end of the study. In a
1-month intervention period they attended weekly sessions
to be trained in and subsequently to practice at home either
self-hypnosis or Johrei, or, as the control measure, to par-
ticipate in eight ‘training’ sessions of ‘neurofeedback’. The
data collected comprised baseline assessments from 47 par-
ticipants: 16 each in hypnosis and Johrei, 15 in control (one
person’s blood collection missed due to non-attendance).
Post-training session I comprised 45 participants, 15 in
each group. Twenty-nine participants continued in the study
for approximately another month and were re-examined at
post-training session II (11 hypnosis, 10 Johrei, 8 control).
By this time preparation for examinations, which were held
at various times over a 2-month period, had been expe-
rienced by all participants. This variation in exam period
meant that bloods from the exam condition were from ei-
ther post-training sessions I or II. The distribution of the
participants according to intervention and exam period is
shown in Table 1. There were no demographic differences
between the groups, nor were there significant differences
for either hypnotisability (HGSHS:A, F = 0.64; P = ns)
or for absorption (the Jamieson version of the TAS, F =
1.61; P = ns) and further no post hoc differences using a
least significant differences analysis. No participants in the
Johrei group had experienced or indeed heard of Johrei.
Of those in the self-hypnosis group, many participants had
heard lectures on hypnosis and several had experienced the
HGSHS:A in a classroom setting. None had been taught or
practiced self-hypnosis before. All participants in the mock
biofeedback control condition were naı̈ve to biofeedback.
The proportion of participants in terms of exam versus
non-exam conditions, and between groups was almost equal.
Testing was done during the week prior to the participant’s
first exam to provide data from the exam preparation period.
2.2. Intervention groups
The self-hypnosis training, designed and run by an expe-
rienced clinical hypnotist, T.L., consisted of 4 weekly ses-
 A. Naito et al. / Brain Research Bulletin 62 (2003) 241–253 243

Table 1 group, PEI diaries were used to record their practice fre-
Numbers of participants in each intervention group with respect to con- quency and collect daily mood data.
dition of exams
The control participant group had eight mock neurofeed-
Condition Post-training I Post-training II n back sessions over 1 month. This condition appeared to
Exams 18 17 35 be extremely high-tech, with two computers and electrodes
Non-exams 27 12 39 fixed to earlobes and the centre of the scalp, and with au-
n 45 29 ditory feedback sounds (babbling brook and ocean waves)
Hypnosis
heard over headphones. The sounds were supposedly repre-
Exams 5 7 12 senting alpha and theta-wave feedback from the participant’s
Non-exams 10 4 14 brain, both waves associated with relaxation. Actually, the
n 15 11 sounds were recorded from another subject’s training ses-
sion. This procedure has been shown to generate a valid re-
Johrei
Exams 8 4 12
laxation response when used as a control condition [11].
Non-exams 7 6 13
2.3. Psychological measures
n 15 10
Relaxation control A series of mood measures was taken at the three assess-
Exams 5 6 11 ment points assessed by questionnaire.
Non-exams 10 2 12
n 15 8 2.3.1. Psychological testing
The Perceived Stress Scale (PSS [5]) was completed at the
time of the blood draws. The PSS is a well-used assessment
sions. The participants learnt firstly a Spiegel-type eye-roll scale designed to measure appraisals of stress with higher
for ‘instant’ relaxation, which could then be combined with scores meaning that the subject is experiencing more stress.
specific immune imagery. They were then taught a slower The PSS data at post-training session I were used to classify
relaxation-type induction, again to be combined with the all subjects into non-stressed or stressed groupings.
immune imagery, and all were provided with a standard
2.3.2. Personalised Emotional Index
tape-recording using a relaxation induction that included the
Personalised Emotional Index (diary [29]) was to be filled
imagery description. Further to the basic immune imagery,
out at the end of each day so that practice and mood data
all participants were taught two anxiety management tech-
could be collected. Data were collected for the first 4–6
niques: how to use breathing control for acute anxiety and
weeks of the project, after which diary completion was spo-
the Interrupt Distraction Procedure (IDP) for worries and
radic.
belief change to be used when appropriate [30]. It was re-
Two related tests to measure hypnotisability and absorp-
quested that each participant used self-hypnosis three-times
tion were used:
a day to learn the technique if possible for the first fortnight
and once a day after that. Diaries (Personalised Emotional Harvard Group Scale of Hypnotic Susceptibility (HGSHS:
Index: PEI) were used to record their practice frequency and A [49]): the most frequently used group assessment tool
to collect daily mood data [29]. for hypnotic susceptibility over several decades [31].
The training of the Johrei healing method was planned Tellegan’s Absorption Scale (TAS [52]): the Jamieson ver-
and run by a trained practitioner from Japan, A.N., who was sion [25].
also medically qualified, with materials and support from the
British Johrei Society. The four training sessions involved 2.4. Immunological measures
an introduction to Johrei philosophy which emphasises the
importance of awareness of spiritual well-being, harmony Venous blood samples were collected in Vacutainers (Bec-
and balance, aesthetics, and nature farming practices, and ton Dickinson, Oxford, UK). All samples were collected be-
the core principles needed to practise the Johrei techniques, tween 8.00 and 10.00 a.m. prior to breakfast to avoid diurnal
such as ‘healing oneself by healing others’. In essence, the effects [38].
practitioner imagines light entering his body being concen-
trated through their hands towards the recipient. The prac- 2.4.1. Lymphocyte profiles
titioner, without touching the recipient, slowly moves their The absolute lymphocyte count was derived from the
hands from head down to kidney area, front and back. The flow cytometric assessment of lymphocyte subsets using
procedure takes approximately 15 min and is mostly silent. two standard panels of fluorescently tagged antibodies, i.e.
The participants were requested to practise Johrei daily with CD45/CD3/CD4/CD8 and CD45/CD3/CD19/CD56 (Beck-
a partner, but at the end of training, self-Johrei was intro- man Coulter, Bedfordshire, UK). Ten microlitres of each
duced as a supplement so that participants could still prac- monoclonal antibody cocktail was added to 100 ␮l of whole
tice even if a partner was not available. As in the hypnosis blood according to the manufacturer’s instructions. Cell sur-
244 A. Naito et al. / Brain Research Bulletin 62 (2003) 241–253
Table 2
Methodological accountability when measuring lymphocyte profiles of CD4+, CD8+ (T) and CD56+ (NK) cells using a single volunteer (nine tubes
collected and averaged on three separate occasions)
CD4% (S.D.) CD8% (S.D.) CD56% (S.D.)
Time 1 48.1 (0.97) 29.6 (0.73) 9.7 (0.54)
Time 2 46.8 (0.89) 28.8 (0.33) 8.3 (1.31)
Time 3 44.4 (0.52) 28.2 (0.60) 14.3 (0.72)
Mean %C.V. 1.7 1.9 8.8
Mean percentages or counts of lymphocyte subpopulations, S.D., or mean of % coefficient of variation (%C.V.) are shown.
face marker expression was analysed on a Coulter Epics
Profile II Flow Cytometer.
In order to assess methodological variation in lym-
phocyte profiles, three preliminary blood samples from
one volunteer were assessed. Nine sample tubes of blood
were taken at each time point, and assessed for per-
centages of CD45+ CD3+ CD4+ (henceforth CD4+) and
CD45+ CD3+ CD8+ (CD8+) T cells and CD45+ CD3−
CD56+ (CD56+) NK cells. Means and ranges were within
normal limits and all standard deviations were less than 1%
with inter-assay coefficient variations (%C.V.) of 1.7, 1.9,
8.8%, respectively (Table 2).
2.4.2. Natural Killer cell cytotoxic activity
A flow cytometric method was used [17]. Effector cells
(Peripheral Blood Mononuclear Cells (PBMCs)): PBMCs
were separated by density gradient centrifugation using
Lymphoprep (Sigma, Dorset, UK). The effector cells were
maintained in Tissue Culture Medium (TCM: RPMI1640)
supplemented with l-glutamine, penicillin, streptomycin,
Hepes buffer, essential amino acids, and sodium pyruvate
(Sigma, Dorset, UK). Viability was assessed by dye exclu-
sion and the cell concentration adjusted to 5 × 106 cells/ml.
Ten microlitres of anti-human CD45 monoclonal antibody
(Becton Dickinson, Oxford, UK) directly conjugated with
fluorescein isothiocyanate (FITC) was added to each tube
containing 100 ␮l of effector cells.
Target cells (K562 cell line): K562 cells were maintained
in long-term culture at 2 × 105 cells/ml in TCM supple-
mented with 10% foetal calf serum (FCS). Viability was
assessed by dye exclusion and cell concentrations were ad-
justed to 1 × 105 cells/ml.
Assay procedure: Effector and target cells, a graded num-
ber of fresh PBMCs and K562 cells, were added in dupli-
cate in 12 mm × 75 mm round-bottom tubes (Beck Dickin-
son, Oxford, UK) to yield the Effector to Target (E:T) ratio
of 50:1, 25:1, 12.5:1. Control tubes including only target or
effector cells were assayed to determine spontaneous cell
death. Tubes were mixed by gently tapping, and incubated
at 37 ◦ C for 3 h. After incubation, tubes were placed on ice
until analysed. Twenty microlitres of Propidium Iodide (PI)
(Sigma) was added to each tube 15 min before acquisition
in order to stain dead K562 cells.
Flow cytometric acquisition: Flow cytometry was per-
formed with a FACS Calibur cytometer (Becton Dickinson).
CD4 count CD8 count CD56 count Total lymph
(S.D.) (S.D.) (S.D.) count (S.D.)
438.4 (12.71) 270.0 (11.27) 94.8 (9.27) 894.3 (31.97)
346.1 (10.69) 213.4 (9.79) 65.6 (12.57) 712.6 (36.17)
381.0 (36.36) 249.3 (11.59) 130.3 (8.69) 859.2 (33.60)
5.2 4.5 11.9 4.2
The instrument was set for two-colour analysis using FAC-
Scomp software in conjunction with Calibrite beads (Beck
Dickinson). Data were collected in list mode and analysis
was performed using CellQuest software (Beck Dickinson).
A region was set on a dot plot of SSC versus fluorescence 1
(fl 1) around the cluster of target cells identified in the con-
trol sample tubes and percentages of PI-stained cell number
in the region were counted. NK cell cytotoxic activity was
calculated by subtraction of target total from individual to-
tals. All samples were tested in duplicate. Due to technical
difficulties no NK cell activity data were available at base-
line. NK cell cytotoxic activity was examined by flow cy-
tometry using Godoy-Ramirez’s method [17]. However, it
should be noted that the NK cell activity numbers here ap-
pear to be relatively lower than noted in her paper.
2.5. Statistics
The results of the three groups were compared with
repeated-measures ANOVA followed by paired compar-
isons with non-parametric tests [50]. These were undertaken
from two viewpoints: First, the effects of the exam stressor
were compared with baseline by pooling subjects according
to their exam period from post-training sessions I and II. In
the ANOVA, the between-subject factor was Intervention
(Hypnosis, Johrei, Control) and the within-subject factor
was Session (Baseline, Exam). Secondly, the interventions
were compared for their effects at post-training I with sub-
jects subdivided as high or low on perceived stress accord-
ing to a median split on the PSS. Those perceiving more
stress (n = 20) had PSS scores at or above 22 and those
perceiving less stress (n = 21) with scores below 22. The
ANOVA included two between-subject factors, Intervention
(3) and perceived stress (2), and a within-subject factor
of Session (2). Intervention effects were not examined at
post-training session II due to the reduction in participant
numbers.
All analyses were performed with the Statistical Package
for Social Sciences, version 11.0 (SPSS 11.0® ) [14].
3. Results
Means and standard deviations for the three groups are
shown in Table 3 for the various immune variables at base-
 A. Naito et al. / Brain Research Bulletin 62 (2003) 241–253 245

Table 3
Mean total lymphocyte counts which is labelled as total counts, and mean percentages of CD4+ T cells, CD8+ T cells and CD56+ NK cells (S.D.)
Baseline Post-training I Post-training II Exams
All Total counts 1990.7 (549) 2055.7 (596) 2060.0 (536) 2062.1 (558.2)
CD4+% 46.0 (5.8) 46.1 (7.9) 45.3 (7.7) 45.2 (6.8)
CD8+% 26.1 (5.4) 26.8 (5.5) 27.3 (5.9) 27.5 (5.5)
CD56+% 9.7 (4.5) 9.6 (5.2) 8.8 (4.8) 8.9 (4.6)
n 47 45 29 33
Hypnosis Total counts 1959.2 (408) 1923.5 (545) 1958.4 (556) 2056.8 (500.6)
CD4+% 44.4 (5.9) 45.8 (8.2) 45.8 (8.3) 45.6 (8.4)
CD8+% 25.5 (6.6) 26.7 (5.8) 27.8 (7.0) 28.0 (6.4)
CD56+% 10.7 (4.4) 9.3 (5.7) 8.2 (4.2) 9.1 (4.9)
n 16 15 11 11
Johrei Total counts 2123.7 (788) 2213.7 (709) 2243.1 (631) 2195.5 (642.5)
CD4+% 47.0 (5.9) 44.6 (8.5) 44.8 (8.9) 43.1 (9.0)
CD8+% 25.7 (5.0) 26.5 (6.3) 26.2 (6.1) 27.6 (5.5)
CD56+% 8.9 (5.3) 11.7 (5.6) 10.0 (6.3) 10.8 (4.6)
n 15 15 10 11
Relaxation Total counts 1882.5 (334) 2029.9 (519.7) 1950.7 (347) 1934.5 (550.0)
CD4+% 46.4 (5.6) 48.0 (7.0) 45.2 (6.3) 46.9 (7.0)
CD8+% 27.0 (4.3) 27.3 (4.7) 28.2 (4.6) 26.9 (4.9)
CD56+% 9.4 (3.7) 7.7 (3.6) 7.9 (3.2) 6.7 (3.4)
n 15 15 8 11
Counts are expressed as cells per microlitre of blood.

line, post-training sessions I and II, with the post-training
sessions also subdivided according to exams.
All lymphocyte counts from these healthy students were
within normal ranges; see also Table 2. There were no sta-
tistical differences in mean lymphocyte counts (total lym-
phocytes, CD4+, CD8+, CD56+ cells) between the three
intervention groups at baseline. Nor were there statistical
changes in numbers of total lymphocyte counts from base-
line to post-training I or to the exam condition. Accordingly,
all the changes that occurred were proportional changes of
the various lymphocyte subpopulations within the total so
that the change of percentages also reflected the individual
lymphocyte subset absolute count change.
3.1. Intervention effects on exam stress: baseline versus
exams
3.1.1. Natural Killer cells
Change scores for all participants are shown in Fig. 1.
Johrei appeared to buffer the decline in CD56+ NK cells
where there were no consistent effects with the other inter-
ventions. This was confirmed by ANOVA where there was

14

12

10

8
Mean +- 1 SE

6 NKC% Baseline

4 NKC% Exams
N= 11 11 11 11 11 11
Hypnosis Johrei Relaxation control

GROUP

Fig. 1. Means (S.E.) of CD56+ Natural Killer cell percentages from baseline to exams.
246
20
NK cell percentages
10
0 0
NKC% Baseline NKC
Fig. 2. Effect of exam stress on peripheral blood CD56+ Natural Killer cell percentages in individual practising various stress reduction regimens with
respect to each intervention group.
no main effect of session but instead there was a significant
Intervention × Session effect (F(1, 33) = 5.86; P = 0.007).
This differential pattern of change was confirmed by paired
comparisons using Wilcoxon Signed Ranks tests. Only the
Johrei group showed an increase in CD56+ NK cell percent-
ages (mean change = 3.22; z(1, 11) = 2.94; P = 0.003),
whereas the hypnosis group maintained levels (mean =
−0.36; z(1, 11) = 0.22) and the control group showed a
non-significant decline (mean = −2.14; z(1, 11) = 1.42).
The advantages for Johrei were further demonstrated by
Mann–Whitney U tests comparing the extent of the changes
from baseline in the Johrei group over both the relaxation
group (z = 2.73; P = 0.005) and the hypnosis group (z =
2.37; P = 0.016). It is noteworthy that Johrei buffered the
decline in CD56+ NK cell percentages in all subjects bar
one, whereas there was no consistent direction of change in
the other groups, as illustrated in Fig. 2. 14/15 Johrei sub-
jects showed an increase in their NK cell percentages over
the course of the intervention (binomial test < 0.001), with
the one outlier 4.7 standard deviations below the mean, thus
influencing results. Accordingly, all statistics were computed
with this outlier changed to just below the other subjects
[50].
3.1.2. CD8+ T cells
The hypnosis group showed an increase (mean change =
2.26) with little change in the other groups (Table 3).
This was confirmed in an ANOVA using change scores.
A group effect approached significance (F(1, 33) = 3.02;
A. Naito et al. / Brain Research Bulletin 62 (2003) 241–253
20 20
10 10
0
NKC %1 NKC NKC% Baseline NKC
Johrei Hypnosis Relaxation Control
P = 0.063), while paired group comparisons showed that
the extent of change was greater in the hypnosis group than
in the relaxation group (z = 2.40; P = 0.016), but not
when the hypnosis group was compared to the Johrei group
(z = 1.60). Exploratory non-parametric tests within groups
also confirmed that the change in the hypnosis group was
significant (z(1, 11) = 2.13; P = 0.033).
3.1.3. CD4+ T cells
As can be seen in Fig. 3, there was no main effect of ses-
sion but there was a differential pattern of group changes
from baseline to exams. This was confirmed by a signifi-
cant Intervention×Session effect in an ANOVA (F(2, 32) =
4.71; P = 0.016) where the groups were ordered as fol-
lows: Control > Hypnosis > Johrei. The relaxation group
showed a non-significant increase in CD4+ T cell percent-
ages (mean = 1.63; z = 1.25), there was little change with
hypnosis (mean = 0.10; z = 0.13), whereas with Johrei
there was a marginal decline in CD4+ T cells (mean =
−3.44; z(1, 11) = 1.82, P = 0.068). Mann–Whitney U tests
comparing groups for the extent of change confirmed that
due to the increase in CD4+ T cell percentages, the control
group differed from the Johrei group (z = 2.07, P = 0.040)
although not from the hypnosis group (z = 0.77).
3.1.4. Perceived stress
A repeated measures ANOVA on the perceived stress
scores indicated that participants were significantly more
stressed (F(1, 44) = 4.55; P = 0.045) during the exam
 A. Naito et al. / Brain Research Bulletin 62 (2003) 241–253
50
48
46
44
42
Mean +- 1 SE
40
38
N= 11 11
Hypnosis
GROUP
Fig. 3. Mean (S.E.) percentages of CD4+ T cells at baseline and exams for each group.
preparation time (mean = 26.2) than a month before or after
(mean = 21.5).
3.2. The influence of perceived stress on intervention
effects: baseline versus post-training session I
The means and standard deviations are shown in Table 3.
Groups were compared with ANOVA with stress (2) in-
tervention (3) and session (2) as factors. We note that all
three-way interaction results with intervention groups sub-
divided by stress need to be interpreted with caution due to
small sample sizes.
3.2.1. Natural Killer cell percentages
In an ANOVA, there was a tendency towards an inter-
action between stress and session (F(1, 39) = 3.27; P =
0.079) whereby those who were more stressed (henceforth
the stressed group) showed decreased CD56+ NK cell per-
centages (n = 20, mean = −0.96, F = 1.62) and those who
were less stressed (the non-stressed group) showed an in-
crease (n = 20, mean = 1.32). There was also a significant
interaction between intervention and session (F = 5.76;
P = 0.007) and a tendency towards a further interaction
with intervention, session and stress (F = 2.70; P = 0.082).
As confirmed by Wilcoxon Signed Rank tests, the hypnosis
group showed a decline in CD56+ NK cell percentages in
the stressed group (n = 8, z = 2.52, P = 0.008) with no
significant change in the non-stressed group (n = 7, z =
0.85), implying no moderation of perceived stress in those
who were more highly stressed. With Johrei there were in-
creases in both stressed (n = 6, z = 2.02, P = 0.062), and
non-stressed (n = 7, z = 2.37, P = 0.014) groups, suggest-
247
CD4% Baseline
CD4% Exams
11 11 11 11
Johrei Relaxation control
ing a beneficial effect of Johrei independent of perceived
stress, while in the control group there were no significant
changes (stressed: n = 6, z = 0.67; non-stressed: n = 6,
z = 0.52).
3.2.2. Natural Killer cell cytotoxic activity
The measures were taken post-training due to techni-
cal difficulties with baseline assays. The pattern of results
post-training was similar to that of the CD56+ NK cell per-
centages. In an ANOVA with stress (2) and intervention (3)
as between-group factors, there was a significant stress ef-
fect (F(1, 40) = 5.29; P = 0.028); post-training the stressed
group had lower NK cell activity (mean = 5.75) compared
with the non-stressed group (mean = 11.96). There was no
interaction with intervention (F = 0.04). Exploratory com-
parisons within intervention groups with Wilcoxon Signed
Rank tests indicated a significant difference in the hypnosis
group with the non-stressed group (n = 6, mean = 14.5)
having significantly more NK cytotoxic activity than the
stressed group (n = 6, mean = 3.4) (t = 2.25, P = 0.025).
3.2.3. NK cell percentage to NK cytotoxic activity ratio
The actual cytotoxic activity per NK cell was calculated
using the ratio of NK cell activity to CD56+ NK cell per-
centages. As can be seen in Fig. 4, the stressed group had a
lower NK cell activity to NK cell percentage ratio (mean =
0.64, S.E. = 0.19) compared with the non-stressed group
(mean = 1.44, S.E. = 0.2), a significant difference (t =
2.38, P = 0.022).
There was a significantly positive correlation between the
percentage of CD56+ NK cells and NK cell activity (r =
0.52, P = 0.001, n = 44).
248 A. Naito et al. / Brain Research Bulletin 62 (2003) 241–253

1.8 are shown in Fig. 5. Paired comparisons disclosed that the

stressed group showed increased CD4+ T cell percentages
1.6 post-training (mean = 1.79, F(1, 19) = 4.14; P = 0.056),
Mean +- 1 SE NKC Activity / NKC% ratio

whereas the non-stressed group showed a non-significant de-

1.4 crease (F = 1.54). There was also a significant interaction
between intervention and session (F = 3.35; P = 0.047)
1.2 and a further interaction tendency between stress, interven-
tion and session (F = 2.78; P = 0.077). As confirmed by
1.0
Wilcoxon Signed Rank tests, the hypnosis group showed
little change in those who were less stressed (n = 7, z =
.8
1.36) although there was a tendency for a rise in CD4+ T
cell percentages in those who were more stressed (n = 8,
z = 1.89, P = 0.065). The opposite effects were found
.6
in the control group with a significant increase in the less
stressed group (n = 6, z = 2.20, P = 0.027) and no change
.4
in the more stressed group (n = 6, z = 0.63). With Johrei
.2 there was a fall in the less stressed group (n = 7, z = 1.86,
N= 20 21 P = 0.072) and no change in the stressed group (n = 7,
Non-stressed Stressed z = 1.36).
PSS midline split
Consistent with these findings Perceived Stress scores
were positively correlated with the increase in CD4+ T cell
Fig. 4. NK cell activity per cell (calculated as a ratio: NK cell activity/ percentages (n = 40, r = 0.443, P = 0.004), due primarily
CD56+ NK cell percentage). to the correlation found in the hypnosis group (r = 0.816,
P < 0.000).
3.2.4. CD8+ T cells
In the ANOVA, there were no significant main effects or 3.3. Hypnotisability and absorption
interactions with respect to stress, intervention and session.
There were no correlations for the group as a whole
3.2.5. CD4+ T cells between the change scores for the various immunological
In the ANOVA, there was a significant interaction be- variables and either the HGSHS:A or TAS Summary of
tween stress and session (F = 4.35; P = 0.044). Effects Sub-scales scores.

50

48

46

44
Mean +- 1 SE

42 CD4% Baseline

40 CD4% Post-training 1
N= 20 20 20 20
Non-stressed Stressed

PSS midline split

Fig. 5. Changes in CD4+ T cell percentages by stress grouping based upon PSS regardless of treatment group.
 A. Naito et al. / Brain Research Bulletin 62 (2003) 241–253
3.4. Beliefs about the efficacy of the interventions
After the intervention, subjects were asked how they rated
their belief in/attitude towards the efficacy of their interven-
tion before it started and again when they finished. These
beliefs did not vary significantly between the three groups
either before or after the intervention, although there was
some swing from belief to non-belief and vice versa in all
groups. No correlations could be found between belief rat-
ings before or after the intervention and results in any im-
munological or psychological outcome measure for any of
the three groups analysed separately. Interestingly, although
belief before their intervention was uncorrelated with any
other variables, belief in their intervention after experiencing
their training was positively correlated with hypnotisability
in the hypnosis group (r = 0.66; P = 0.008), and absorp-
tion in the Johrei (r = 0.61, P = 0.013) and the relaxation
control groups (r = 0.65, P = 0.015).
4. Discussion
At baseline, the lymphocyte subpopulation for all 48
healthy young volunteers were within the normal reference
ranges for counts and percentages. The degree of changes
in percentages following training and at exam time, were
small, but comparable with similar studies in the literature
using healthy students and examinations as a naturalistic
stressor [19,21,22,27,35,55]. Other stress studies finding
similar fluctuations used slightly different immunopheno-
typing: CD2 was used to gate T and NK cells instead of
-2
Mean
-4
Hypnosis Johrei
GROUP
Fig. 6. Profile of change scores for the hypnosis, Johrei and relaxation control groups from baseline to the time of exams showing unique profiles for
all three groups.
249
CD45 [35], and both CD16 and CD56 were included as NK
cells [7,55]. In keeping with random assignment to the inter-
vention groups no statistical differences existed at baseline.
Differences became apparent after training in all three inter-
vention methods—self-hypnosis, Johrei and the neurofeed-
back control, with each intervention having a characteristic
profile, as shown in Fig. 6. Further, those participants who
perceived themselves to be stressed displayed a different
profile from those who were comparatively unstressed.
4.1. Perceived stress
First, considering perceived stress, this was associated
with the following profile after a month or more of train-
ing/practice:
(a) a decline in the percentage of CD56+ Natural Killer
cells, lower NK cell cytotoxic activity and a lower ratio
between CD56+ NK percentages and cytotoxic activity
in the stressed group compared with the non-stressed
group,
(b) an increase in CD4+ T cell percentages together with
a positive correlation with percentage of CD4+ T cells,
and a higher mean percent in the stressed than the
non-stressed group (Fig. 5),
(c) few differences in the CD8+ T cell percentages.
The results with perceived stress and CD56+ NK cells
were in line with expectations, given there is substantive evi-
dence for more stressed participants having significantly less
CD3− CD16+ /CD3− CD56+ NK cells in their bloodstream
compared to those with less perceived sustained stress [7].
Exam: CD4 % change
Exam: CD8 % change
Exam: NKC % change
Relaxation Control
250 A. Naito et al. / Brain Research Bulletin 62 (2003) 241–253
Similarly, the NK cell cytotoxic activity and also cytotoxic
activity per NK cell, calculated as a NK cell percentage to
NK cell activity ratio, were found to be lower with per-
ceived stress. NK cell percentages and cytotoxic activity
are often together or separately used as stress benchmarks
[10,34,44,58].
Considering perceived stress and the T-lymphocyte mark-
ers CD4+ and CD8+, given the small changes discernible
in healthy people, there is no clear picture of what indicates
a ‘strong and effective’ immune system, other than in com-
parison to that of an ill person. The picture is further clouded
when stress is involved, as stress differentially affects the
numbers and percentages of the various lymphocytes. Our
CD4+ T cell results may illustrate this. Those participants
expressing a higher level of perceived stress had a signifi-
cantly higher CD4+ T cell percentage at the second blood
draw. This suggests that perceiving a situation as stressful
could be expressed immunologically by releasing CD4+ T
cells into the circulation, perhaps an alarm reaction or a stage
of resistance using Selye’s classifications. The increase in
CD4+ T cell percentages in stressed participants is consis-
tent with previous studies, and could suggest that the ampli-
fication is of activated CD4+ T cells, i.e. CD25+ CD4+ T
cells, as was found in nurses with chronic work stress [7].
In summary, the ecological validity of the examina-
tions acting as a stressor was supported by both the sig-
nificant increase in PSS scores when compared with the
pre-examination period baseline, and the profile of immune
results. A decrease in CD56+ NK cells and NK cytotoxic
activity was associated with an increase in perceived stress,
a result in keeping with the well-documented decline in NK
cells under conditions of exam stress. CD4+ T cell counts
on the other hand increased, and the increase correlated
positively with perceived stress.
4.2. Intervention profiles
4.2.1. Johrei
In terms of the intervention profiles, given the very clear
relation between stress and NK cells found here, one which
is well documented in the literature [7,8,16,21,22,27], per-
haps the most interesting result from this study was the in-
crease in the percentage of CD56+ NK cells in the Johrei
group at exam time. This result, summarised in Figs. 1 and
2, was apparent within the group over time, and it was also
evident when the Johrei percentages were compared to the
self-hypnosis and relaxation control groups. At the same
time, although statistically significant, caution should be ex-
pressed in that the changes are relatively small, and a test
sample of blood processed in separate batches will produce
some fluctuation of results, as shown in Table 2. Neverthe-
less, 14 of 15 Johrei participants showed raised percentages
of CD56+ NK cells in their peripheral blood. In concert with
the increase in CD56+ NK cells, the Johrei group showed
a decline in CD4+ T cell percentages, also congruent with
a possible stress reduction relationship.
4.2.2. Self-hypnosis
In the case of those practising self-hypnosis, the results
were perhaps less interesting than those with Johrei. In terms
of the perceived stress score, hypnosis did buffer the decline
in CD56+ NK cells in the non-stressed participants but not
in the stressed group. On average hypnosis buffered the de-
cline in CD56+ NK cells at exam time, in keeping with pre-
vious studies [20,21], though here without producing the in-
crease in CD56+ NK cell percentages that followed Johrei
training. On the other hand CD8+ T cell percentages were
not only maintained with hypnosis in replication of previous
results [15,20,21], but here there was a significant increase
in the paired t-test results. In previous reports, the benefi-
cial effects of hypnosis on levels of lymphocytes were se-
lective either to NK cells (labelled as CD3− CD56+ or/and
CD3− CD16+ ) only [4], or to both CD56+ NK cells and
CD8+ T cells [21].
However, one apparent discrepancy between the self-
hypnosis group results here and an earlier exam stress study
must be noted. Whereas the positive relation with CD4+ T
cell percentages and perceived stress was stronger in the
hypnosis group, in the earlier study an increase following
self-hypnosis training in CD4+ T cells at exam time cor-
related with the increase in calmness ratings in those with
self-hypnosis training. One implication was that hypnosis
may alter relations between stress and immune variables
[18,21] just as it may alter relations between cortical elec-
trophysiological responses to pain and ratings of distress
[6] presumably through effects on hormones. The reason
for the disparate results in the hypnosis group here is un-
clear, though the hypnosis training in the earlier studies
consisted of imagery training of the immune system and
ego strengthening without any mention of stress, whereas
here hypnotic stress reduction techniques were also taught
in a more eclectic approach. Subjects were given a tape
with identical wording to that used in previous studies,
but they could use non-tape self-hypnosis for stress if they
so wished. Thus, they could emphasise the stress reduc-
tion aspects and this may have been at the expense of the
immune-imagery training aspect of the intervention. The
latter is important because we have previously demonstrated
that relatively small changes in the wording of hypnosis
instructions result in quite different immune profiles; for
example, immune imagery appeared superior to relaxation
imagery in the series of exam stress studies [18].
4.2.3. Control
The relaxation control group in comparison to those
practising Johrei experienced higher levels of CD4+ T cell
percentages. Overall however, the relaxation control group
showed fewer significant results than either the Johrei or
self-hypnosis groups. This is all the more interesting because
of the complex nature of the control group. It was set up to
control for expectations and the placebo effect by the use
of an elaborate and pseudo-scientific apparatus to achieve
relaxation, yet using a procedure that has been shown to
 A. Naito et al. / Brain Research Bulletin 62 (2003) 241–253
actually produce a good relaxation response as measured by
Thayer activation and deactivation self-report ratings [11].
Interestingly, although the CD56+ NK cell percentages of
the relaxation control group were lower than the hypnosis
group, the decline in CD56+ NK cell percentages did not
reach significance, suggesting that relaxation could be con-
tributing to the maintenance of NK cell percentages during
exams as has been found in other studies [27].
4.3. Beliefs and hypnotisability/absorption
In the hypnosis group, belief in their intervention was
correlated with hypnotisability scores, possibly reflecting
the positive sensations experienced during hypnosis for
those with higher susceptibility. Absorption was correlated
with belief scores for Johrei and the relaxation control
group. Again, as those with higher absorption abilities par-
ticipated in their interventions, belief in their intervention
possibly reflects their conscious perception of becoming
absorbed.
There were a number of limitations to the study. Subject
numbers dropped off by the time of the second set of ex-
ams leaving a total of 35, who fortunately were distributed
evenly across the intervention groups. Although our student
subjects claimed to be practicing their interventions, it was
not possible to monitor this by post-training session II as
many had ceased completing their diaries. A further lim-
itation occurred with the assessment of NK cell activity.
Godoy-Ramirez’s assessment method [17] was chosen be-
cause it avoids having to use a radioactive substance in the
laboratory; the usual 51 Cr method is radioactive. Because
Godoy-Ramirez’s paper suggested there was no difference
between a 3 and 4-h incubation time we opted for 3-h incu-
bation. However, given that we obtained smaller values than
expected with the 3-h method, perhaps 4 h may be prefer-
able. It appears that more work needs to be done if this use-
ful non-radioactive methodology can be fully accepted as a
reliable measurement of NK cell activity that is comparable
to the radio-assay.
Finally, despite other life stressors that may beset student
life and which have sometimes compromised other attempts
to use examinations as a stressor (reviewed in [19]), in this
study there is clear evidence that examinations did act as a
real life stressor over and above other life vicissitudes [32].
One criticism of all studies that use exam stress as a natural-
istic stressor is that anxieties are considered to be synony-
mous with a negative experience, and patently this is untrue
for all students. Using perceived stress rather than relying
on a naturalistic stressor such as exams, though subjective
is arguably a useful supplement.
In sum, stressed participants decreased their CD56+ NK
cell percentages and their NK cell cytotoxic activity levels
and increased their CD4+ T cell percentages. At the time of
exams, participants who learned Johrei showed increases in
CD56+ NK cell percentages and decreases in their CD4+ T
cell percentages, the opposite pattern shown here to be in-
251
dices of stress. Those who learned self-hypnosis increased
their CD8+ T cell percentages; shown to decline with exam
stress in previous studies, and on average maintained their
CD56+ NK cell and CD4+ T cell percentages over exams
and all results are in line with other studies of students expe-
riencing the stress of exams. On comparison, the differences
between the groups were sufficient to suggest that Johrei
does not appear to be an elaborate form of hypnosis. Further,
there is more to both hypnosis and Johrei than relaxation.
The mock neurofeedback relaxation control condition pro-
vided a control against the placebo effect, so that any com-
parisons between results from Johrei or self-hypnosis to the
relaxation controls that are significant are in all probability
over and above placebo. Moreover, expectations about the
efficacy of the various interventions either before or after
training were unrelated to mood or lymphocyte subpopula-
tion outcomes.
These results coupled with the benefits for mood [32]
are suggestive that there is a possible role for Johrei and
self-hypnosis in moderating the effects of a stressor and,
in effect, acting as tools for stress management. Although
self-hypnosis has been studied in the past, this is the first
time that lymphocyte subpopulation results from a non-touch
healing method have been put to the test. Johrei may be
rightly considered as a positive agent for change. Other ap-
proaches similar to Johrei include distant healing [51], exter-
nal Qi Gong [40], Therapeutic Touch [43], Reiki [57], and
Spiritual healing [1]. However, Johrei may be unique in that
participants appear to benefit when acting either as practi-
tioner or receiver. More research on the efficacy of Johrei
and hypnosis in respect to immune and endocrine dynamics,
i.e. stress hormone and other cellular and humoral molecular
interactions, is needed to test this intriguing result further.
Acknowledgements
Appreciation to our student subjects and especially for all
the work contributed by the other B.Sc. student researchers
on this project: Catriona Lynch, Nick Enzor, Christine Brin-
cat, Tom French and Helena Marconell.
References
[1] N.C. Abbot, E.F. Harkness, C. Stevinson, F.P. Marshall, D.A. Conn,
E. Ernst, Spiritual healing as a therapy for chronic pain: a randomized,
clinical trial, Pain 91 (2001) 79–89.
[2] R. Ader, On the development of psychoneuroimmunology, Eur. J.
Pharmacol. 405 (2000) 167–176.
[3] N. Afari, D.M. Eisenberg, R. Herrell, J. Goldberg, E. Kleyman,
S. Ashton, D. Buchwald, Use of alternative treatments by chronic
fatigue syndrome discordant twins, Integr. Med. 2 (1999) 97–
103.
[4] A.C. Bakke, M.Z. Purtzer, P. Newton, The effect of hypnotic-guided
imagery on psychological well-being and immune function in pa-
tients with prior breast cancer, J. Psychosom. Res. 53 (2002) 1131–
1137.
252 A. Naito et al. / Brain Research Bulletin 62 (2003) 241–253
[5] S. Cohen, T. Kamarch, R. Mermelstein, A global measure of per-
ceived stress, J. Health Social Behav. 24 (1983) 385–396.
[6] R.J. Croft, J.D. Williams, C. Haenschel, J.H. Gruzelier, Pain per-
ception, hypnosis and 40 Hz oscillations, Int. J. Psychophysiol. 46
(2002) 101–108.
[7] V. De Gucht, B. Fischler, C. Demanet, Immune dysfunction associ-
ated with chronic professional stress in nurses, Psychiatry Res. 85
(1999) 105–111.
[8] R. Deinzer, N. Schuller, Dynamics of stress-related decrease of sali-
vary immunoglobulin A (sIgA): relationship to symptoms of the
common cold and studying behavior, Behav. Med. 23 (1998) 161–
169.
[9] F.S. Dhabhar, B.S. McEwen, Bidirectional effects of stress and glu-
cocorticoid hormones on immune function: possible explanations for
paradoxical observations, in: N. Cohen (Ed.), Psychoneuroimmunol-
ogy, 3rd ed., Academic Press, San Diego, USA, 2001, pp. 483–
497.
[10] J.M. Dopp, G.E. Miller, H.F. Myers, J.L. Fahey, Increased natural
killer-cell mobilization and cytotoxicity during marital conflict, Brain
Behav. Immun. 14 (2000) 10–26.
[11] T. Egner, E. Strawson, J.H. Gruzelier, EEG signature and phe-
nomenology of alpha/theta neurofeedback training versus mock
feedback, Appl. Psychophysiol. Biofeedback 27 (2002) 261–
270.
[12] I.J. Elenkov, R.L. Wilder, G.P. Chrousos, E.S. Vizi, The sympathetic
nerve—an integrative interface between two super systems: the brain
and the immune system, Pharmacol. Rev. 52 (2000) 595–638.
[13] P. Evans, F. Huckelebridge, A. Clow, Mind, Immunity and Health:
The Science of Psychoneuroimmunology, Free Association Books,
London, UK, 2000.
[14] A. Field, Discovering Statistics Using SPSS for Windows, Sage
Publications, London, UK, 2003.
[15] P.A. Fox, D.C. Henderson, S.E. Barton, A.J. Champion, M.S. Rollin,
J. Catalan, S.M. McCormack, J. Gruzelier, Immunological markers of
frequently recurrent genital herpes simplex virus and their response
to hypnotherapy: a pilot study, Int. J. STD AIDS 10 (1999) 730–734.
[16] R. Glaser, J.K. Kiecolt-Glaser, J.C. Stout, K.L. Tarr, C.E. Speicher,
J.E. Holliday, Stress-related impairments in cellular immunity, Psy-
chiatry Res. 16 (1985) 233–239.
[17] K. Godoy-Ramirez, K. Franck, H. Gainers, A novel method for the
simultaneous assessment of natural killer cell conjugate formation
and cytotoxicity at the single-cell level by multi-parameter flow
cytometry, J. Immunol. Methods 239 (2000) 35–44.
[18] J.H. Gruzelier, A review of the impact of hypnosis, relaxation, guided
imagery and individual differences on aspects of immunity and health,
Stress 5 (2002) 147–163.
[19] J.H. Gruzelier, The role of psychological intervention in modulating
aspects of immune function in relation to health and well-being, Int.
Rev. Neurobiol. 52 (2002) 383–417.
[20] J.H. Gruzelier, J. Levy, J. Williams, D. Henderson, Self-hypnosis
and exam stress: comparing immune and relaxation-related imagery
for influences on immunity, Contemp. Hypn. 18 (2001) 73–86.
[21] J. Gruzelier, F. Smith, A. Nagy, D. Henderson, Cellular and humoral
immunity, mood and exam stress: the influences of self-hypnosis and
personality predictors, Int. J. Psychophysiol. 42 (2001) 55–71.
[22] R. Halvorsen, O. Vassend, Effects of examination stress on some
cellular immunity functions, J. Psychosom. Res. 31 (1987) 693–701.
[23] J. Henning, P. Netter, K.H. Voigt, Cortisol mediates redistribution
of CD8+ but not of CD56+ cells after the psychological stress of
public speaking, Psychoneuroendocrinology 26 (2001) 673–687.
[24] C. Inoue-Sakurai, S. Maruyama, K. Morimoto, Posttraumatic stress
and lifestyles are associated with natural killer cell activity in victims
of the Hanshin-Awaji Earthquake in Japan, Prev. Med. 31 (2000)
467–473.
[25] G.A. Jamieson, The Structure and Meaning of Absorption, Unpub-
lished Master’s Dissertation, University of Queensland, 1987.
[26] J.K. Kiecolt-Glaser, R. Glaser, Psychoneuroimmunology: can psy-
chological interventions modulate immunity? J. Consult. Clin. Psy-
chol. 60 (1992) 569–575.
[27] J.K. Kiecolt-Glaser, R. Glaser, E.C. Strain, J.C. Stout, K.L. Tarr, J.E.
Holliday, C.E. Speicher, Modulation of cellular immunity in medical
students, J. Behav. Med. 9 (1986) 5–21.
[28] J.K. Kiecolt-Glaser, P.T. Marucha, C. Atkinson, R. Glaser, Hypnosis
as a modulator of cellular immune dysregulation during acute stress,
J. Consult. Clin. Psychol. 69 (2001) 674–682.
[29] T.M. Laidlaw, Designer testing: using subjects’ personal vocabulary
to produce individualised tests, Pers. Individual Differences 27 (1999)
1197–1207.
[30] T.M. Laidlaw, The interrupt distraction procedure: a brief hypnotic
intervention for belief change and diminishing distress, Am. J. Clin.
Hypn. 42 (1999) 22–34.
[31] T.M. Laidlaw, R.G. Large, The Harvard Group Scale of Hypnotic
Susceptibility and the Creative Imagination Scale: defining two sep-
arate but correlated abilities, Contemp. Hypn. 14 (1997) 26–37.
[32] T.M. Laidlaw, A. Naito, P. Dwivedi, N.A. Enzo, C.E. Brincat, J.H.
Gruzelier, Mood changes after self-hypnosis and the Johrei healing
method prior to exams, Contemp. Hypn. 20 (2003) 25–40.
[33] R.S. Lazarus, Psychological stress and coping in adaptation and
illness, Int. J. Psychiatry Med. 5 (1974) 321–333.
[34] S.M. Levy, R.B. Herberman, A. Simons, T. Whiteside, J. Lee, R.
McDonald, M. Beadle, Persistently low natural killer cell activity in
normal adults: immunological, hormonal and mood correlates, Nat.
Immun. Cell Growth Regul. 8 (1989) 173–186.
[35] M. Maes, D.R. Van Bockstaele, A. Gastel, C. Song, C. Schotte, H.
Neels, I. DeMeester, S. Scharpe, A. Janca, The effects of psycho-
logical stress on leukocyte subset distribution in humans: evidence
of immune activation, Neuropsychobiology 39 (1999) 1–9.
[36] S.F. Maier, L.R. Watkins, Cytokines for psychologists: implications
of bidirectional immune-to-brain communication for understanding
behaviour, mood, and cognition, Psychol. Rev. 105 (1998) 83–107.
[37] B.S. McEwen, C.A. Biron, K.W. Brunson, K. Bulloch, W.H. Cham-
bers, F.S. Dhabhar, R.H. Goldfarb, R.P. Kitson, A.H. Miller, R.L.
Spencer, J.M. Weiss, The role of adrenocorticoids as modulators
of immune function in health and disease: neural, endocrine and
immune interactions, Brain Res. Brain Res. Rev. 23 (1997) 79–
133.
[38] J.J. McGlone, E.A. Lumpkin, R.L. Norman, Adrenocorticotropin
stimulates natural killer cell activity, Endocrinology 129 (1991) 1653–
1658.
[39] J.A. Moynihan, S.Y. Stevens, Mechanisms of stress-induced mod-
ulation of immunity in animals, in: R. Ader, D.L. Felten, N. Co-
hen (Eds.), Psychoneuroimmunology, 3rd ed., Academic Press, San
Diego, USA, 2001, pp. 227–250.
[40] Y. Omura, Impression on observing psychic surgery and healing in
Brazil which appear to incorporate (+)qi gong energy & the use of
acupuncture points, Acupunct. Electrother. Res. 22 (1997) 17–33.
[41] S. Reichlin, Neuroendocrine–immune interactions, N. Engl. J. Med.
329 (1993) 1246–1253.
[42] C. Rivier, The hypothalamo–pituitary–adrenal axis response to im-
mune signals, in: R. Ader, D.L. Felten, N. Cohen (Eds.), Psychoneu-
roimmunology, 3rd ed., Academic Press, San Diego, USA, 2001, pp.
633–648.
[43] B. Scales, CAMPing in the PACU: using complementary and alter-
native medical practices in the PACU, J. Perianesth. Nurs. 16 (2001)
325–334.
[44] M. Schedlowski, R. Jacobs, G. Stratmann, S. Richter, A. Hadicke,
U. Tewes, T.O. Wagner, R.E. Schmidt, Changes of natural killer
cells during acute psychological stress, J. Clin. Immunol. 13 (1993)
119–126.
[45] H. Selye, A syndrome produced by diverse nocuous agents, Nature
138 (1936) 32.
[46] H. Selye, Confusion and controversy in the stress field, J. Human
Stress 1 (1975) 37–44.
 A. Naito et al. / Brain Research Bulletin 62 (2003) 241–253
[47] H. Selye, Implications of stress concept, N.Y. State J. Med. 75 (1975)
2139–2145.
[48] C.L. Sheridan, S.A. Ramacher, Stress and health, in: C.L. Sheridan,
S.A. Ramacher (Eds.), Health Psychology: Challenging the Biomed-
ical Model, Wiley, New York, USA, 1992, pp. 148–151.
[49] R.E. Shor, E.C. Orne, Harvard Group Scale of Hypnotic Suscep-
tibility, Form A, Consulting Psychologists Press, Palo Alto, CA,
1962.
[50] B.G. Tabachnick, L.S. Fidell, Using Multivariate Statistics, Harper
Collins College Publishers, New York, 1996.
[51] E. Targ, Research methodology for studies of prayer and distant
healing, Complement. Ther. Nurs. Midwifery 8 (2002) 29–41.
[52] A. Tellegen, G. Atkinson, Openness to absorbing and self-altering
experiences (“absorption”), a trait related to hypnotic susceptibility,
J. Abnorm. Psychol. 83 (1974) 268–277.
[53] H. Tryphonas, M. Fournier, F. Lacroix, P. McGuire, S. Hayward, F.
Bryce, D. Flipo, D.L. Arnold, Effects of great lakes fish consumption
on the immune system of Sprague–Dawley rats investigated during
a two-generation reproductive study. II. Quantitative and functional
aspects, Regul. Toxicol. Pharmacol. 27 (1998) S40–S54.
View publication stats
253
[54] A.V. Turnbull, C.L. Rivier, Regulation of the hypothalamic–pituitary–
adrenal axis by cytokines: actions and mechanisms of action, Physiol.
Rev. 79 (1999) 1–71.
[55] P.N. Uchakin, B. Tobin, M. Cubbage, G. Marshall Jr., C. Sams, Im-
mune responsiveness following academic stress in first-year medical
students, J. Interferon Cytokine Res. 21 (2001) 687–694.
[56] B.N. Uchino, J.T. Cacioppo, W. Malarkey, R. Glaser, Individual
differences in cardiac sympathetic control predict endocrine and
immune responses to acute psychological stress, J. Pers. Soc. Psychol.
69 (1995) 736–743.
[57] W.D. Wardell, J. Engebretson, Biological correlates of reiki touch
healing, J. Adv. Nurs. 33 (2001) 439–445.
[58] W.G. Whitehouse, D.F. Dinges, E.C. Orne, S.E. Keller, B.L. Bates,
N.K. Bauer, P. Morahan, B.A. Haupt, M.M. Carlin, P.B. Bloom, L.
Zaugg, M.T. Orne, Psychosocial and immune effects of self-hypnosis
training for stress management throughout the first semester of med-
ical school, Psychosom. Med. 58 (1996) 249–263.
[59] G. Willemsen, D. Carroll, C. Ring, M. Drayson, Cellular and mucosal
immune reactions to mental and cold stress: associations with gender
and cardiovascular reactivity, Psychophysiology 39 (2002) 222–228.