Stress management skills, neuroimmune processes and fatigue levels in persons w/ CFS (Lattie et al.)

[Tom Kindlon]

Stress management skills, neuroimmune processes and fatigue levels in persons with chronic fatigue syndrome.

Lattie EG, Antoni MH, Fletcher MA, Penedo F, Czaja S, Lopez C, Perdomo D, Sala A, Nair S, Fu SH, Klimas N.


Brain Behav Immun. 2012 Aug;26(6):849-58. doi: 10.1016/j.bbi.2012.02.008. Epub 2012 Mar 6.

Abstract*

OBJECTIVES:

Stressors and emotional distress responses impact chronic fatigue syndrome (CFS) symptoms, including fatigue.

Having better stress management skills might mitigate fatigue by decreasing emotional distress.
Because CFS patients comprise a heterogeneous population, we hypothesized that the role of stress management skills in decreasing fatigue may be most pronounced in the subgroup manifesting the greatest neuroimmune dysfunction.

METHODS:

In total, 117 individuals with CFS provided blood and saliva samples, and self-report measures of emotional distress, perceived stress management skills (PSMS), and fatigue.

Plasma interleukin-1-beta (IL-1β, IL-2, IL-6, IL-10, and tumor necrosis factor-alpha (TNF-α), and diurnal salivary cortisol were analyzed.

We examined relations among PSMS, emotional distress, and fatigue in CFS patients who did and did not evidence neuroimmune abnormalities.

RESULTS:

Having greater PSMS related to less fatigue (p=.019) and emotional distress (p<.001), greater diurnal cortisol slope (p=.023) and lower IL-2 levels (p=.043).

PSMS and emotional distress related to fatigue levels most strongly in CFS patients in the top tercile of IL-6, and emotional distress mediated the relationship between PSMS and fatigue most strongly in patients with the greatest circulating levels of IL-6 and a greater inflammatory (IL-6):anti-inflammatory (IL-10) cytokine ratio.

DISCUSSION:

CFS patients having greater PSMS show less emotional distress and fatigue, and the influence of stress management skills on distress and fatigue appear greatest among patients who have elevated IL-6 levels.

These findings support the need for research examining the impact of stress management interventions in subgroups of CFS patients showing neuroimmune dysfunction.

*Each sentence has its own paragraph

 

[Tom Kindlon]

This study has some immune data which is interesting enough on its own. The controls were matched for age and gender.

We found that the CFS patients revealed significantly greater levels of IL-1b (p < .03) and IL-6 (p < .05). Although TNF-a levels were also greater in CFS than controls, the difference was not statistically significant. There were no other differences in cytokines between CFS patients and healthy controls.

 

[Tom Kindlon]

Although the paper named in this thread isn't available open access, I believe, the following is available for free. Having a quick look at it, it looks very similar to the Lattie et al. paper. The difference is the symptoms looked at aren't fatigue. (Reading Lattie et al., I had thought it might be interesting to see whether any of these relationships exist for other symptoms.

Neuroimmune Function, Life Distress, Stress Management Skills and Physical Symptoms in Chronic Fatigue Syndrome

Emily Lattie, University of Miami

Publication Date 2012-05-17

Availability Open access

Embargo Period 2012-05-17

Degree Name Master of Science (MS)

Department Psychology (Arts and Sciences)

Date of Defense 2012-04-09

First Committee Member Michael H. Antoni

Second Committee Member Frank J. Penedo

Third Committee Member Mary Ann Fletcher

Fourth Committee Member Nancy Klimas

Abstract

Chronic Fatigue Syndrome (CFS) is a debilitating disorder with no clear etiology.

Many, but not all, patients with CFS evidence signs of neuroimmune dysfunction prompting the suggestion that there exist subgroups of CFS patients with significant neuroimmune dysfunction while other subgroups of diagnosed patients may suffer from CFS-like symptoms due to other causes.

Research has demonstrated that emotional distress responses impact CFS symptoms and that having adequate coping skills may predict less illness severity among individuals with CFS.

However, no study to date has examined the influence of a comprehensive set of stress management skills on CFS symptoms nor has prior work evaluated if a relationship between stress management skills and CFS symptoms is mediated by lowered levels of emotional distress.

Given the breadth of research literature linking neuroimmune dysfunction to emotional distress symptoms such as depression, and to physical symptoms such as fatigue, this study sought to examine a mediation model in which perceived stress management skills predict physical symptoms via lowered emotional distress.

Moreover this study also sought to examine whether this model is most salient in individuals with a higher degree of neuroimmune dysfunction.

In total, 117 individuals with CFS provided blood and saliva samples, as well as self-report measures of emotional distress, perceived stress management skills (PSMS), and CFS symptoms including fatigue.

Plasma interleukin-2 (IL-2), IL-5, IL-6, IL-12, and tumor necrosis factor-alpha (TNF-a) and diurnal salivary cortisol were analyzed.

This study examined relations among perceived stress management skills, emotional distress, and physical symptoms in CFS patients who did and did not evidence neuroimmune abnormalities.

Results indicated that higher levels of perceived stress management skills were related to lower levels of emotional distress, which related to lower levels of fatigue and a lower total symptom severity score.

Greater levels of PSMS were also associated with lower circulating levels of IL-2 and a more negative diurnal cortisol slope.

The indirect relationship between perceived stress management skills and fatigue via emotional distress was moderated by level of plasma IL-6, such that it was significant in participants with elevated levels of IL-6, but not significant in those participants with lower levels of IL-6.

No other neuroendocrine or cytokine indicator functioned as a moderator of this relationship.

In conclusion, the relationship between perceived stress management skills and fatigue via emotional distress was more pronounced in individuals with greater levels of the circulating pro-inflammatory cytokine IL-6.

These findings support the need for research examining the impact of stress management interventions in subgroups of CFS patients showing neuroimmune dysfunction.

Keywords Chronic Fatigue Syndrome, stress management, psychoneuroimmunology Recommended Citation Lattie, Emily, "Neuroimmune Function, Life Distress, Stress Management Skills and Physical Symptoms in Chronic Fatigue Syndrome" (2012). Open Access Theses. Paper 346.

http://scholarlyrepository.miami.edu/oa_theses/346

 

[SOC]

This is making my head hurt. So this research suggests that because my IL-6 value of 1.5 (~65%ile) is normal, my perceived stress management skills are unrelated to my fatigue, but that if I had higher IL-6 my stress management skills would affect my fatigue..?

This study has some immune data which is interesting enough on its own. The controls were matched for age and gender.

This table is interesting in that the mean of the CFS patients is within the range of of the controls, except for the IL-6. The means of the CFS patients are not hugely different from the controls. What seems significantly different is the ranges on IL-1beta, IL-6, and TNF-alpha.

I wonder if Drs Fletcher, Klimas, et al are finding any subsets based on immune data.

 

[Bob]

Stress management skills, neuroimmune processes and fatigue levels in persons with chronic fatigue syndrome.
Lattie EG, Antoni MH, Fletcher MA, Penedo F, Czaja S, Lopez C, Perdomo D, Sala A, Nair S, Fu SH, Klimas N.
Brain Behav Immun. 2012 Aug;26(6):849-58.
doi: 10.1016/j.bbi.2012.02.008.
Aug 2012

Thanks for posting, Tom.

Actually, the article has free access:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572196/
PDF:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572196/pdf/nihms363008.pdf

 

[Tom Kindlon]

Stress management skills, neuroimmune processes and fatigue levels in persons with chronic fatigue syndrome.
Lattie EG, Antoni MH, Fletcher MA, Penedo F, Czaja S, Lopez C, Perdomo D, Sala A, Nair S, Fu SH, Klimas N.
Brain Behav Immun. 2012 Aug;26(6):849-58.
doi: 10.1016/j.bbi.2012.02.008.
2012 Aug;26
Epub 2012 Mar 6.

Thanks for posting, Tom.

Actually, the article has free access:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572196/
PDF:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572196/pdf/nihms363008.pdf

Thanks. An example of Google Scholar not finding all free full texts.

 

[lastgasp]

Hey people, don't you get it, if you're sicker than someone else it's only because you're incompentently managing your emotional stress, nothing to do with severety, progression, pathology subgroup, medical a or social practical support. Whereas the people with a good outcome are reaping the just rewards of their own diligent responsibility as superior patients via the biopsychosocial HPA axis. We do live in a just world after all -- as long as you personally make it so for yourself!!1!!!!!!!!1!!!!

If only we could educate all these irresponsible, personal-psychology-neglectful, non-mindfulness people to manage their emotional reactions better, it wouldn't matter whatever it is that they're reacting to (and that would be much cheaper for everyone else). Rather than bother wasting money on chasing mysterious disease processes that would surely be a different thing than what we're fascinated by (fatigue and cytokines), we could efficiently target emotional-husbandry-CBT into tweaking the various functional cytokines into making them more worthy, less tired, tired people, while they're doing my good colleague's GET.

Therer's no such thing as an uncircumventable problem, patients must learn to rise above anything via their own bootstraps, disease pathology (too mysterious for us to find yet), neglect, misunderstanding and poverty are feeble excuses in order to choose to remain stressed and sick (or at least fatigued, it's all the same). Their minds should as necessary become disconnected from their bodies and circumstances only in the strress management model manner, so that they can remain impassive, serene in the face of our dismal research failures.

 

[Little Bluestem]

CFS patients having greater PSMS show less emotional distress and fatigue, and the influence of stress management skills on distress and fatigue appear greatest among patients who have elevated IL-6 levels.

Do they perhaps mean that patients experiencing less emotional distress and fatigue show greater PSMS and the influence of emotional distress and fatigue on stress management skills appears greatest among patients who have elevated IL-6 levels?

 

[Tom Kindlon]

Do they perhaps mean that patients experiencing less emotional distress and fatigue show greater PSMS and the influence of emotional distress and fatigue on stress management skills appears greatest among patients who have elevated IL-6 levels?

They mention at least once that all measures taken at one moment in time so it's not clear the direction like you say.

 

[SOC]

I don't think there's anything novel in the idea that people with better stress management skills have less emotional distress and/or depression. Nor is it novel to suggest that emotional distress/depression can exhibit as some form of fatigue. I wouldn't say it's the same kind of fatigue as the the crushing physical and mental exhaustion I've had with ME/CFS (and I've had both, so I think I can compare).

What's interesting (and unclear to me) is the correlation with IL-6. Is it that IL-6 somehow impairs a person's stress management skills? Or that people with poor stress management skills somehow generate more IL-6? Are they suggesting they can judge who would benefit from psychotherapy to improve stress management skills by measuring IL-6? My head still hurts.

 

[Tom Kindlon]

Are they suggesting they can judge who would benefit from psychotherapy to improve stress management skills by measuring IL-6? My head still hurts.

That's what they're suggesting as I recall.

These were baseline measurements for a trial so they should be able to test the hypothesis.

 

[SOC]

That's what they're suggesting as I recall.

These were baseline measurements for a trial so they should be able to test the hypothesis.

Well that's interesting and kinda cool -- an actual objective measure for the need for a specific type of psychotherapy (stress management and coping with chronic illness).

I'm really happy my IL-6 is as normal as normal can be.

 

[SickOfSickness]

I wonder if stress is the chicken or egg. I notice my stress tolerance getting better or worse for many reasons. Worse when I have poorer sleep or worse nutrition, don't take vit D3, when I have more fatigue because I am upset about doing even less that day, etc.