Research 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 minutes 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.

Stress Management Skills, Cortisol Awakening Response and Post-Exertional Malaise in Chronic Fatigue Syndrome by Daniel L Hall et al in Psychoneuroendocrinology July 5 2014 [published online]

Cort Johnson discusses this research study on his blog and concludes:

It’s important to understand what this study did not suggest. It did not suggest that better stress management skills can cure ME/CFS  or remove post-exertional malaise (PEM). All the patients, whether or not they had high PSMS skills, still had ME/CFS.  The study simply suggested that more stress management skills are associated with improved cortisol and reduced (but obviously still present) levels of PEM in ME/CFS.

(A Lenny Jason study, on the other hand, suggested that while many ME/CFS patients can benefit from stress management skills and pacing, a subset of the more severely ill may not.)

The level of Perceived Stress Management Skills in patients with ME/CFS does not appear to be different from patients suffering from other chronic illnesses.