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IMMUNE DYSREGULATION AND TRAUMATIC STRESS 1

Immune Dysregulation Following Chronic Traumatic Stress

Introduction Comment by Cheney, Alan B (Community Care and Counseling): APA-7 no longer uses this heading

Chronic traumatic stress affects more than emotion and cognition because prolonged threat can alter biological systems that regulate health. This is where immune dysregulation comes into play, as it brings together stress physiology, vulnerability to physical illness, and functioning in everyday life, and is a useful way to think about trauma counseling. There is increasing evidence in the modern literature that PTSD is correlated with inflammatory activity. However, there is no consensus in the literature on a single immune pattern found in all survivors. This is important because counselors must have sufficient knowledge of the biological system to recognize potential burdens, rather than rely on laboratory tests as a substitute for clinical judgment. The new analysis thus combines a physiological, psychological, contextual, and spiritual approach to trauma, rather than focusing on one mechanism. There is an interplay between neuroendocrine and inflammatory pathways that can disrupt immune regulation. So far, there is no common profile of markers to look for, so trauma counselors must understand immune results in relation to the whole person, the whole family, and spiritually responsive care.

Comparison of Trauma Resources

There is a consensus that chronic traumatic stress can disrupt immune regulation and increase immune marker inflammation. According to Sapolsky (2004), acute stress may increase immune activity, but chronic sympathetic activation and glucocorticoid signaling may lead to altered regulation. Peruzzolo et al. (2022) combined the results of 54 studies with 8,394 participants and reported significantly higher levels of C-reactive protein, interleukin 6, and tumor necrosis factor alpha in those with posttraumatic stress disorder compared to healthy controls. Lauten et al. (2024) also discussed the innate and adaptive immune effects of PTSD and noted that systemic inflammation, changes in neuroimmune signaling, and increased susceptibility to inflammatory comorbidities are possible. The results are in support of the initial argument that traumatic stress can be experienced as subjectively distressing as well as being biologically embedded. Yang et al. (2026) found that there was moderately higher peripheral blood interleukin 6 in persons with posttraumatic stress disorder than in healthy controls, but there was still important variation across subgroups. This result can be added to the current evidence for the inflammatory pattern reported by Peruzzolo et al. (2022), along with the finding that individual differences are not negated by group-level effects. These results explain why trauma counselors need to pay attention to abiding complaints of fatigue, sleep disturbance, pain, cardiovascular issues, and other physical concerns, within the scope of their practice.

Peer feedback provides another layer of support by introducing newer, clinically available inflammatory markers and maintaining a cautionary note about interpreting them. “Do not assume that changes in the biological system are the same across all trauma survivors,” said Gina Terry, another classmate. She highlighted that the neutrophil to lymphocyte ratios, platelet to lymphocyte ratios, and systemic immune inflammation index values were significantly higher among the posttraumatic stress disorder group than the control group, when 80 patients with posttraumatic stress disorder were compared with 80 control patients (Yontar & Aktan Mutlu, 2024). While not the same cytokines that Peruzzolo et al. (2022) highlighted, both studies lead to the conclusion that low-grade systemic inflammation is one possible outcome of chronic traumatic stress. Levers (2023) also views trauma as multidimensional, rooted in biological, psychological, relational, cultural, and systemic processes. These sources extend the comparison beyond a single laboratory marker and demonstrate convergence across stress physiology, cytokine research, blood cell-based indices, and trauma counseling theory. This more comprehensive synthesis enhances clinical vigilance without turning inflammatory markers into diagnostic tools. Comment by Cheney, Alan B (Community Care and Counseling): The idea is to use the (personal communication, September 2026) designation

Contrast of Trauma Resources

When researchers compare the direction and magnitude of immune changes across studies, as well as their consistency, the literature becomes more complicated. Elevated inflammatory markers were reported by Peruzzolo et al. (2022) but not by Petakh et al. (2024), who conducted a meta-analysis of the inflammatory markers they included. The disagreement does not imply that one study negates the other, since the reviews used different evidence sets, biomarkers, eligibility criteria, and analytic choices. Although systemic inflammation is mentioned frequently in the literature, its mechanisms in the context of posttraumatic stress disorder are not well understood (Lauten et al., 2024). The contrast thus changes the clinical question from one of presence to one involving timing, population, and circumstances of the detection of immune changes. Factors such as type of trauma, duration of exposure, time since trauma, medication use, smoking, body composition, sleep, medical illness, age, etc., may affect inflammatory measurements. The conflicting results highlight the need for counselors to avoid the easy biological conclusion and view immune information as one component of a much broader trauma response.

This need for control is reinforced by peer feedback, as variability is clinically meaningful and not just an inconvenience. In Petakh et al. (2024), the authors specifically emphasized that the lack of consistent differences in biomarkers supports the need to be wary of inflammatory markers as broad markers of posttraumatic stress disorder. Yontar and Aktan Mutlu 2024 also recognized relevant drawbacks of their single-center, cross-sectional study, such as the limit of generalizability and sample size. Briere and Scott (2025) highlight the need for individualized trauma assessment that takes into account the symptoms, history, safety, coping, and contextual factors of each survivor, and not presume a single response pattern for all. The following perspectives indicate that when medical records contain immune data, these can be used to aid in case conceptualization; however, counselors should not order, interpret, or share these markers as evidence of trauma unless they have the authority to do so as part of their professional role. Rather, physical symptoms may lead to a productive interaction with medical services, and counseling will focus on coping, emotional management, safety, relationships, and recovery. This method can transform conflicting evidence into further incentive for interdisciplinary and individual practice.

Biblical Integration

Compassionate presence is the proper response to suffering, and God is present to people who are deeply emotionally hurt ( New International Version Bible, 2011, Ps. 34:18). This perspective is complementary, not alternative to empirical assessment, as trauma can impact meaning, hope, relationships, body, and spirituality all simultaneously. Terry amplified this by stressing the importance of Christian meaning-making in recovery and the text of Psalm 147. In a Christian context, Shannonhouse et al. (2024) found that Christian refugees drew on their faith in God, prayer, social support, spiritual surrender, and making sense of their situation, while also experiencing spiritual challenges, including feelings of distance and doubt. Their results indicate that spiritual life can serve as a coping mechanism and as a distressing experience following trauma. Therefore, in assessing spiritual coping, the counselor is as humble and individualized as in assessing psychological and biological responses. Thus, the counselor is as humble and individualized as in assessing psychological and biological responses to strengthen spiritual coping. Comment by Cheney, Alan B (Community Care and Counseling): Good!

Additional qualities, such as clinical competence, consent, and tolerance of religious differences, are also essential to an ethically integrated spirituality. Captari et al. (2022) reviewed evidence-based research on spiritually integrated psychotherapy and highlighted culturally contextual, spiritually responsive practice over the imposition of the therapist's beliefs. This rule applies to biological and spiritual evidence: the interpretation of spiritual evidence should not be more restrictive than the person's lived experience. A multidimensional trauma counseling approach, such as that described by Levers (2023), which takes into account context and the whole person, empowers counselors to take a look at spiritual issues along with emotional, relational, and physical functioning. If Christian clients want to be integrated with their faith, Scripture provides support for themes of presence, lament, hope, community, and meaning; or if evidence-informed treatment is needed for trauma symptoms, a medical referral is needed for physical concerns. If clients do not want religious integration, counselors should respect that and offer the same quality of trauma care without making assumptions about religion.

Conclusion

In conclusion, immune dysregulation offers an important but incomplete lens to view chronic traumatic stress. Existing studies provide compelling evidence for inflammatory and immune changes after trauma, but opposing results indicate that there is no uniform "biomarker" signature of trauma exposure. The best clinical conclusion is reached by combining them rather than selecting one or the other. Counselors can identify potential physical effects of trauma, be alert to symptoms that indicate the need for medical intervention, and conduct individual psychological evaluations without exceeding the scope of the counseling profession. This is reinforced by peer feedback, highlighting the quantitative nature of inflammation and the significant inter-individual differences. Biblical integration provides another layer when spiritual resources are sought; it offers the opportunity for compassionate presence and client-centered meaning. Therefore, the whole-person approach is the most responsible, since it does not exclude trauma from any aspect of the person.

References

Briere, J., & Scott, C. (2025). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (3rd ed.). SAGE

Captari, L. E., Sandage, S. J., & Vandiver, R. A. (2022). Spiritually integrated psychotherapies in real-world clinical practice: Synthesizing the literature to identify best practices and future research directions. Psychotherapy, 59(3), 307. https://psycnet.apa.org/doi/10.1037/pst0000407

Lauten, T. H., Natour, T., & Case, A. J. (2024). Innate and adaptive immune system consequences of post-traumatic stress disorder. Autonomic Neuroscience, 252, 103159. https://doi.org/10.1016/j.autneu.2024.103159

Levers, L. L. (Ed.). (2023). Trauma counseling: Theories and interventions for managing trauma, stress, crisis, and disaster (2nd ed.). Springer Publishing Company. Comment by Cheney, Alan B (Community Care and Counseling): Omit this

New International Version Bible. (2011). Zondervan. (Original work published 1978). Comment by Cheney, Alan B (Community Care and Counseling): Perfect

Peruzzolo, T. L., Pinto, J. V., Roza, T. H., Shintani, A. O., Anzolin, A. P., Gnielka, V., ... & Passos, I. C. (2022). Inflammatory and oxidative stress markers in post-traumatic stress disorder: a systematic review and meta-analysis. Molecular Psychiatry, 27(8), 3150–3163. https://doi.org/10.1038/s41380-022-01564-0

Petakh, P., Oksenych, V., Kamyshna, I., Boisak, I., Lyubomirskaya, K., & Kamyshnyi, O. (2024). Exploring the interplay between posttraumatic stress disorder, gut microbiota, and inflammatory biomarkers: a comprehensive meta-analysis. Frontiers in immunology, 15, 1349883. https://doi.org/10.3389/fimmu.2024.1349883 Comment by Cheney, Alan B (Community Care and Counseling): Be sure to proofread carefully

Sapolsky, R. M. (2004). Why zebras do not get ulcers: The acclaimed guide to stress, stress-related diseases, and coping (3rd ed.). St. Martin’s Griffin.

Shannonhouse, L., Dosal‐Terminel, D., Kwag, D., Hall, M. E. L., Park, C. L., McMartin, J., ... & Kapic, K. (2024). “God was with me”: A qualitative study of Christian meaning‐making among refugees. Journal of Traumatic Stress, 37(1), 166–177. https://doi.org/10.1002/jts.22997

Yang, L., Meng, M., Tian, M., Zhang, C., Zou, J., Cai, L., ... & Liu, M. (2025). Aberrations in peripheral blood interleukin-6 levels in post-traumatic stress disorder: A systematic review and meta-analysis. Behavioural Brain Research, 115881. https://doi.org/10.1016/j.bbr.2025.115881

Yontar, G., & Mutlu, E. A. (2024). Neutrophil-to-lymphocyte, platelet-to-lymphocyte ratios and systemic immune-inflammation index in patients with post-traumatic stress disorder. BMC psychiatry, 24(1), 966. https://doi.org/10.1186/s12888-024-06439-y Comment by Cheney, Alan B (Community Care and Counseling): Ditto!