***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Inflammation , part of the body 's innate immune response , can lead to " sickness behaviors , " as well as alterations in social and affective experiences . Elevated levels of pro-inflammatory cytokines have been associated with increased neural sensitivity to social rejection and social threat , but also decreased neural sensitivity to rewards . However , recent evidence suggests that inflammation may actually enhance sensitivity to certain social rewards , such as those that signal support and care . Despite a growing interest in how inflammation influences neural reactivity to positive and negative social experiences , no known studies have investigated these processes in the same participants , using a similar task . To examine this issue , 107 participants were r and omly assigned to receive either placebo or low-dose endotoxin  , which safely triggers an inflammatory response . When levels of pro-inflammatory cytokines were at their peak , participants were scanned using fMRI while they received positive , negative , and neutral feedback from an " evaluator " ( actually a confederate ) about how they came across in an audio-recorded interview . In response to negative feedback ( vs. neutral ) , participants in the endotoxin condition showed heightened neural activity in a number of threat-related neural regions ( i.e. , bilateral amygdala , dorsal anterior cingulate cortex ) and a key mentalizing-related region ( i.e. , dorsomedial PFC ) , compared to placebo participants . Interestingly , when receiving positive feedback ( vs. neutral ) , endotoxin ( vs. placebo ) led to greater neural activity in the ventral striatum and ventromedial PFC , regions often implicated in processing reward , as well as greater activity in dorsomedial PFC . Together , these results reveal that individuals exposed to an inflammatory challenge are more " neurally sensitive " to both negative and positive social feedback , suggesting that inflammation may lead to a greater vigilance for both social threats and social rewards OBJECTIVE Sub clinical depression is one of the most frequent mental comorbidities in patients with diabetes and is associated with a poorer long-term prognosis . Since there is a lack of specific intervention concepts for this patient group , a self-management – oriented group program ( DIAMOS [ Diabetes Motivation Strengthening ] ) was newly developed and evaluated in a r and omized trial . RESEARCH DESIGN AND METHODS DIAMOS is composed of cognitive behavioral interventions aim ing at the reduction of  diabetes distress . The active control group ( CG ) received diabetes education . The primary outcome was depressive symptoms . Secondary outcomes were diabetes distress , well-being , self-care behavior , diabetes acceptance , diabetes treatment satisfaction , HbA1c , and sub clinical inflammation . RESULTS Two hundred fourteen participants ( mean age 43.3 ± 13.3 years , female sex 56.5 % , type 2 diabetes 34.1 % , mean diabetes duration 14.2 ± 10.5 years , HbA1c 8.9 ± 1.8 % , BMI 28.7 ± 71 kg/m2 ) were r and omized . The 12-month follow-up revealed a significantly stronger reduction of depressive symptoms ( Center for Epidemiologic Studies Depression Scale score ) in the DIAMOS group compared with the CG ( Δ3.9 [ 95 % CI 0.6–7.3 ] , P = 0.021 ) . Of the secondary variables , the Patient Health Question naire-9 ( Δ1.7 [ 95 % CI 0.2–3.2 ] , P = 0.023 ) , Problem Areas in Diabetes scale ( Δ8.2 [ 95 % CI 3.1–13.3 ] , P = 0.002 ) , and Diabetes Distress Scale scores ( Δ0.3 [ 95 % CI 0.1–0.5 ] , P = 0.012 ) displayed significant treatment effects . Moreover , the risk of incident major depression in the DIAMOS group was significantly reduced ( odds ratio 0.63 [ 95 % CI 0.42–0.96 ] , P = 0.028 ) . Inflammatory variables were not substantially affected . CONCLUSIONS DIAMOS is more effective in lowering depressive symptoms and diabetes-related distress in diabetic patients with sub clinical depression . DIAMOS also has a preventive effect with respect to the incidence of major depression PURPOSE / OBJECTIVES To determine the dose effects of relaxation practice on immune responses and describe the types of relaxation techniques preferred and the extent of relaxation practice over 10 months . DESIGN Descriptive , prospect i ve , repeated measures . SETTING An interdisciplinary breast clinic at a university-affiliated comprehensive cancer center in the United States . SAMPLE 49 women with newly diagnosed breast cancer and undergoing adjuvant therapy who participated in a stress management intervention . METHODS Relaxation practice was assessed twice a month for 10 months with immune measurements ( e.g. , natural killer cell activity ; lymphocyte proliferation ; interferon [IFN]-γ ; interleukin [IL]-2 , -4 , -6 , and -10 ) at the beginning and end of 10-month practice . MAIN RESEARCH VARIABLES Relaxation practice ( representing the concepts of stress and adherence ) , relaxation technique , and immune response . FINDINGS After adjusting for covariates , the extent of relaxation practice significantly contributed to the variance of natural killer cell activity , lymphocyte proliferation , IL-4 , and IL-10 responses in a positive direction ; the higher the relaxation practice , the higher the immune responses . In comparison , IFN-γ , IL-2 , and IL-6 responses were not affected . The deep-breathing method was most preferred by participants , followed by progressive relaxation and imagination or visualization . The mean weekly frequency of relaxation practice  was 5.29 ( SD = 3.35 ) , and the mean duration of relaxation practice was 19.16 ( SD = 10.81 ) minutes per session . CONCLUSIONS Persistent relaxation practice may have positive effects on multiple immune responses in a dose-dependent manner . IMPLICATION S FOR NURSING Allowing the choice of preferred techniques and emphasizing the importance of long-term adherence , a relaxation program may need to be routinely offered to women under high stress UNLABELLED Neuropsychiatric disorders ( e.g. , autism , schizophrenia ) are partially characterized by social cognitive deficits , including impairments in the ability to perceive others ' emotional states , which is an aspect of social cognition known as theory of mind ( ToM ) . There is also evidence that inflammation may be implicated in the etiology of these disorders , but experimental data linking inflammation to deficits in social cognition is sparse . Thus , we examined whether exposure to an experimental inflammatory challenge led to changes in ToM. One hundred and fifteen ( n=115 ) healthy participants were r and omly assigned to receive either endotoxin , which is an inflammatory challenge , or placebo . Participants completed a social cognition task  , the Reading the Mind in the Eyes ( RME ) test , at baseline and at the peak of the inflammatory response for the endotoxin group . The RME test , a vali date d measure of ToM , evaluates how accurately participants can identify the emotional state of another person by looking only at their eyes . We found that endotoxin ( vs. placebo ) led to decreases in performance on the RME test from baseline to the peak of inflammatory response , indicating that acute inflammation can lead to decreases in the ability to accurately and reliably comprehend emotional information from others . Given that deficits in ToM are implicated in neuropsychiatric disorders , including those which may have an inflammatory basis , these results may have implication s for underst and ing the links between inflammation , social cognition , and neuropsychiatric disorders . CLINICAL TRIALS REGISTRATION Clinical Trials.gov NCT01671150 Although research has established links between feelings of social isolation and inflammation , the direction of these effects is unclear . Based on the role that proinflammatory cytokines play in initiating " sickness behavior , " which includes symptoms such as social withdrawal , it is possible that inflammatory processes heighten feelings of ' social disconnection . ' Here , we examined whether exposure to an inflammatory challenge increased self-reported feelings of social disconnection . In addition , because both inflammatory processes and feelings of social disconnection contribute to depressive symptoms , we also explored whether increases in feelings of social disconnection played a role in the link between inflammation and depressed mood . Participants were r and omly assigned to either receive endotoxin , an inflammatory challenge , or placebo . Proinflammatory cytokines ( IL-6 , TNF-alpha ) were collected at baseline and then hourly for 6h . Participants completed self-reports of sickness symptoms ( " fatigue " ) , social disconnection ( " I feel disconnected from others " ) , and depressed mood ( " unhappy " ) hourly . Results revealed that endotoxin led to significant increases ( from baseline ) in IL-6 and TNF-alpha levels as well as feelings of social disconnection and depressed mood . Moreover , controlling for increases in social disconnection eliminated the relationship between exposure to inflammatory challenge and depressed mood . This study demonstrates that inflammation can have social psychological consequences , which may play a role in cytokine-related depressive symptoms Major depressive disorder ( MDD ) is a debilitating disorder and its pathophysiology is associated with deregulation of the immune system . We investigated the changes in circulating levels of proinflammatory cytokines ( specifically IL-6 and TNF-α ) measured by the ELISA kit in two psychotherapeutic interventions for MDD : Narrative Cognitive Therapy ( NCT ) and Cognitive Behavioral Therapy ( CBT ) . This is a r and omized clinical trial including 97 individuals ( 18 to 29years-old ) with MDD .  In CBT there was a significant difference in serum levels of IL-6 and TNF-α , therefore indicating that CBT was more effective than NCT on serum levels proinflammatory cytokines BACKGROUND Chronic threat and anxiety are associated with pro-inflammatory transcriptional profiles in circulating leukocytes , but the causal direction of that relationship has not been established . This study tested whether a cognitive-behavioral stress management ( CBSM ) intervention targeting negative affect and cognition might counteract anxiety-related transcriptional alterations in people confronting a major medical threat . METHODS One hundred ninety-nine women undergoing primary treatment of stage 0-III breast cancer were r and omized to a 10-week CBSM protocol or an active control condition . Seventy-nine provided peripheral blood leukocyte sample s for genome-wide transcriptional profiling and bioinformatic analyses at baseline , 6-month , and 12-month follow-ups . RESULTS Baseline negative affect was associated with > 50 % differential expression of 201 leukocyte transcripts , including upregulated expression of pro-inflammatory and metastasis-related genes . CBSM  altered leukocyte expression of 91 genes by > 50 % at follow-up ( group × time interaction ) , including downregulation of pro-inflammatory and metastasis-related genes and upregulation of type I interferon response genes . Promoter-based bioinformatic analyses implicated decreased activity of NF-κB/Rel and GATA family transcription factors and increased activity of interferon response factors and the glucocorticoid receptor as potential mediators of CBSM-induced transcriptional alterations . CONCLUSIONS In early-stage breast cancer patients , a 10-week CBSM intervention can reverse anxiety-related upregulation of pro-inflammatory gene expression in circulating leukocytes . These findings clarify the molecular signaling pathways by which behavioral interventions can influence physical health and alter peripheral inflammatory processes that may reciprocally affect brain affective and cognitive processes Purpose There is ongoing controversy on the effectiveness of psychotherapy in inflammatory bowel disease ( IBD ) . In the few small studies , cognitive-behavioural therapy ( CBT ) has been shown to alleviate symptoms of anxiety or depression . However , there is little research on the impact of CBT on physical outcomes in IBD and no studies on long-term effectiveness of CBT . Methods The present two-arm pragmatic r and omised controlled trial aim ed to establish the impact of CBT on disease course after 24 months of observation . The study compared st and ard care plus CBT ( + CBT ) with st and ard care alone ( SC ) . CBT was delivered over 10 weeks , face-to-face ( F2F ) or online ( cCBT ) . The data were analysed using linear mixed-effects models . Results CBT did not significantly influence disease activity as measured by disease activity indices at 24 months ( Crohn ’s Disease Activity Index ( CDAI ) , p = 0.92 ; Simple Clinical Colitis Activity Index ( SCCAI ) , p = 0.88 ) or blood parameters ( C-reactive protein ( CRP ) , p < 0.62 ; haemoglobin ( Hb ) , p = 0.77 ; platelet , p = 0.64 ; white cell count ( WCC ) , p = 0.59 ) nor did CBT significantly affect mental health , coping or quality of life ( all p > 0.05 ) . Conclusions Therefore , we conclude that CBT does not influence the course of IBD over 24 months . Given the high rate of attrition , particularly in the CBT group , future trials should consider a personalised approach to psychotherapy , perhaps combining online and one-to-one therapist time OBJECTIVE To assess benefits of mindfulness meditation and cognitive behavioral therapy (CBT)-based intervention for opioid-treated chronic 
    Output:
    
Conclusion : Preliminary evidence suggests inflammation should be considered within the context of cognitive behaviour therapy , although robust studies examining the relationship are sparse , and heterogeneity between studies and population s examined was high .