Stress Management Skills, Cortisol Awakening Response and Post-Exertional Malaise in Chronic Fatigue Syndrome, 2014, Hall, Klimas et al

[Hutan]

2014 paper
https://pmc.ncbi.nlm.nih.gov/articles/PMC4165790/
open access

Daniel L Hall, Emily G Lattie, Michael H Antoni, Mary Ann Fletcher, Sara Czaja, Dolores Perdomo, Nancy Klimas

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.

 

[Hutan]

Version of what I posted on another thread, having only seen the abstract:

It looks as though they are suggesting that a higher cortisol awakening response is associated with better self reported stress management skills and reduced pEM symptomology.

But, there is an obvious explanation. People who have no need to be energetic in the morning, getting the children fed and off to school, getting ready for work, rushing off to the bus or driving to work, don't need a pronounced cortisol awakening response. So, all of these things are consequences of ME/CFS severity.

If your ME/CFS severity is bad and you don't work, then you don't need to and won't be rushing about in the morning. You have probably been told that you aren't managing stress well, and you may have internalised that. And increased ME/CFS severity means a lower threshold for PEM, more severe symptoms.

I haven't read the study. It would be interesting to see the detail e.g. how were 'stress management skills' defined. I suspect that that definition would make this study even shakier.

It looks as though the authors (disappointingly including Klimas) have mixed up correlation with causation.

 

[Hutan]

jnmaciuch replying to @dundrum on another thread, with a link to the Perceived Stress Management Skills measure:

The perceived stress scale used in the second study is full of questions that assume two people taking the test will have a similar functional capacity to accomplish tasks and will only meaningfully differ in perceived ability to tackle those tasks.

you’d be utterly unable to distinguish between someone who feels unable to handle all their tasks because they are emotionally overwhelmed or [edit:] because running errands is extraordinarily draining and painful.

So all this study tells us is that people who have a higher severity of PEM have less capacity to accomplish tasks, and this severity may also be weakly correlated with CAR.

perhaps you were not able to look at the measurement scale used in the study before you linked it. You can view it here.

Added: @Hutan I just saw your earlier post, I suspect you will find the scale used in the study as laughable as I did

 

[Utsikt]

Crossposting mine as well even though it doesn’t add much.

I’m slightly running out of patience with these studies, because they all suffer from the same problems. Vague and insufficient subjective measurements and in this case a vague biomarker. And it’s cross sectional so it can’t really tell us anything, certainly not about the causal directions.

 

[Hutan]

Thanks @jnmaciuch. Yes, that scale is laughable.
e.g.
2. In the last month, how often have you felt that you were unable to control the important things in your life?

Of course the score will be associated with ME/CFS severity levels.

 

[jnmaciuch]

3. In the last month, how often have you felt nervous and stressed?

Gosh, well normally I'd have no problem but there's this pesky issue of my body not really working properly.

5. In the last month, how often have you felt that things were going your way?

Gosh, well normally I'd have no problem but there's this pesky issue of my body not really working properly.

6. In the last month, how often have you found that you could not cope with all the things that you had to do?

Gosh, well normally I'd have no problem but there's this pesky issue--

 

[Yann04]

It’s absolutely ridiculous how inadequate every single one of these mental health questionnaires are for pwME.

 

[Utsikt]

It’s absolutely ridiculous how inadequate every single one of these mental health questionnaires are for pwME.

I fixed your typo