title: Stress management skills, cortisol awakening response, and post-exertional malaise in Chronic Fatigue Syndrome.
abstract: Chronic Fatigue Syndrome (CFS) is characterized in part by debilitating fatigue typically exacerbated by cognitive and/or physical exertion, referred to as post-exertional malaise (PEM). In a variety of populations, the cortisol awakening response (CAR) has stood out as a marker of endocrine dysregulation relevant to the experience of fatigue, and may therefore be particularly relevant in CFS. This is the first study to examine PEM and the CAR in a sample of individuals with CFS. The CAR has also been established as a stress-sensitive measure of HPA axis functioning. It follows that better management of stress could modulate the CAR, and in turn PEM. In this cross-sectional study, we hypothesized that greater Perceived Stress Management Skills (PSMS) would relate to lower reports of PEM, via the impact of PSMS on the CAR. A total of 117 adults (72% female) with a CFS diagnosis completed self-report measures of PSMS and PEM symptomatology and a two-day protocol of saliva collection. Cortisol values from awakening and 30 min post-awakening were used to compute the CAR. Regression analyses revealed that greater PSMS related to greater CAR and greater CAR related to less PEM severity. Bootstrapped analyses revealed an indirect effect of PSMS on PEM via the CAR, such that greater PSMS related to less PEM, via a greater CAR. Future research should examine these trends longitudinally and whether interventions directed at improving stress management skills are accompanied by improved cortisol regulation and less PEM in individuals with CFS.
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, FL, USA. Electronic address: dhall@psy.miami.edu.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Hall
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, FL, USA.
authors.forename: Emily G
authors.initials: EG
authors.lastname: Lattie
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, FL, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Antoni
authors.affiliation: Institute for Neuro Immune Medicine, Nova Southeastern University, Davie, FL, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Fletcher
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Czaja
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA.
authors.forename: Dolores
authors.initials: D
authors.lastname: Perdomo
authors.affiliation: Institute for Neuro Immune Medicine, Nova Southeastern University, Davie, FL, USA.
authors.forename: Nancy G
authors.initials: NG
authors.lastname: Klimas
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D003430:Cross-Sectional Studies; D015673:Fatigue Syndrome, Chronic / Q000378:metabolism* / Q000523:psychology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D010912:Pituitary-Adrenal Function Tests; D012463:Saliva / Q000378:metabolism; D014851:Wakefulness; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone
keywords: Chronic Fatigue Syndrome; Cortisol; HPA axis; Stress management