• Welcome to Phoenix Rising!

    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of and finding treatments for complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

    To become a member, simply click the Register button at the top right.

Stress Management Skills, Cortisol Awakening Response, and Post-Exertional Malaise in CFS

Dolphin

Senior Member
Messages
17,567
Free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165790/
Stress management skills, cortisol awakening response, and post-exertional malaise in Chronic Fatigue Syndrome.


Psychoneuroendocrinology. 2014 Nov;49:26-31. doi: 10.1016/j.psyneuen.2014.06.021. Epub 2014 Jul 6.

Hall DL1, Lattie EG2, Antoni MH2, Fletcher MA3, Czaja S4, Perdomo D4, Klimas NG3.
1
Department of Psychology, University of Miami, Coral Gables, FL, USA. Electronic address: dhall@psy.miami.edu.
2
Department of Psychology, University of Miami, Coral Gables, FL, USA.
3
Institute for Neuro Immune Medicine, Nova Southeastern University, Davie, FL, USA.
4
Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA


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.

Copyright © 2014 Elsevier Ltd. All rights reserved.

KEYWORDS:
Chronic Fatigue Syndrome; Cortisol; HPA axis; Stress management

PMID: 25049069
PMCID: PMC4165790

DOI: 10.1016/j.psyneuen.2014.06.021
[Indexed for MEDLINE]
Free PMC Article
 

Dolphin

Senior Member
Messages
17,567
The abstract doesn't make clear that there were 2 ways of measuring the cortisol awakening response and only one was related to PSMS or PEM severity:

Statistical analyses were performed using SPSS version 19.0. Awakening and 30 min post-awakening cortisol values from Day 1 to Day 2 were averaged. The resulting values were used to calculate participants’ cortisol awakening response (CAR). The CAR was operationalized using two area under the curve (AUC) computations, consistent with recommendations from Powell et al. (2013). The CAR derived from the area under the curve with respect to the ground (CARg) during the first 30 min after awakening, and from the area under the curve with respect to increase from baseline (CARi) were calculated using the formulas outlined by Pruessner et al. (2003). A commonly used parameter for modeling total cortisol secretion, CARg is less subject to measurement error associated with variability in the awakening measurement than other CAR measures (i.e., CARi), and has been positively related to chronic stress (Chida and Steptoe, 2009). However, CARi can also yield important information about morning output relative to one’s baseline (Powell et al., 2013). Both CARg and CARi had non-normal distributions, and were thus transformed using ln(x + 1) prior to analyses of direct and indirect effects.

The CARi was not significantly associated with PEM severity or PSMS, and no indirect effect of PSMS on PEM via the CARi was evident.

I think a lot of people would consider the CARi as the more specific measure of the cortisol awakening response. The CARg is more like the total cortisol rather than something specific to the cortisol awakening response.

They didn't use the other 2 cortisol measurements so one can't tell whether the same findings would hold up if one also used the other to cortisol measurements (i.e. later in the day).
 

Murph

:)
Messages
1,799
Makes sense to me. Very stressful times in my life saw my cfs deteriorate. I dealt with the stress (quit my job) and eventually got out of decline and back to a path where I've been able to improve.
 

Dolphin

Senior Member
Messages
17,567
1.2.1. Perceived Stress Management Skills (PSMS)

The Measure of Current Status (MOCS; Carver, 2006) was used to assess PSMS. Items on the MOCS are based on personal characteristics and behaviors that are associated with efficient stress management abilities, such as ‘‘I am able to use mental imagery to reduce any tension I experience’’ and ‘‘I can clearly express my needs to other people who are important to me.’’ Participants were asked to rate their perceived ability to appropriately respond to challenges and demands of daily life on a 5 point scale which ranged from ‘‘1 — I cannot do this at all’’ to ‘‘5 — I can do this extremely well.’’ The 17 items on the MOCS were summed to compose an overall stress management skill measure, with higher scores indicating greater PSMS (Penedo et al., 2006). In the present sample, the MOCS demonstrated a high degree of internal consistency (Cronbach’s ˛ = .85).

Carver, C.S., 2006. Measure of Current Status. http://www.psy.miami.edu/faculty/ccarver/sclMOCS.html

The questionnaire on the website has 23 questions. I'm not sure why there are more than 17 questions mentioned in the description but I haven't looked closely.

http://www.psy.miami.edu/faculty/ccarver/sclMOCS.html

The MOCS has two sections. Part A is items measuring participants' current self-perceived status on several skills that are targeted by the intervention: the ability to relax at will, recognize stress-inducing situations, restructure maladaptive thoughts, be assertive about needs, and choose appropriate coping responses as needed. Part B assesses potential "nonspecific effects" of the intervention: feelings of normalcy vs. alienation, sense of cohesiveness with other patients, perceptions of care from persons around them, and a sense of being better off than other cancer patients. All items were framed in such a way that they are sensible to participants in both conditions. Using these items, we have obtained evidence that the effects of the intervention are mediated by confidence about being able to relax at will (see article below by Antoni et al., 2006).

Here are the 2 parts of the measure, followed by scoring information.


MOCS Part A

People have different levels of various skills for responding to the challenges and demands of everyday life. The following items list several things that people are able to do--to a greater or lesser degree--to deal with daily stresses. For each item, indicate how well you currently can do what it describes. Please don't indicate what you think you should be able to do, or what you wish you could do. Be as accurate as you can in reporting your degree of confidence about being able to do each of these things. Choose from the following responses:

0 = I cannot do this at all
1 = I can do this just a little bit
2 = I can do this a medium amount
3 = I can do this pretty well
4 = I can do this extremely well

1. I am able to use muscle relaxation techniques to reduce any tension I experience
2. I become aware of any tightness in my body as soon as it develops
3. I can clearly express my needs to other people who are important to me
4. I can easily stop and re-examine my thoughts to gain a new perspective
5. It's easy for me to decide how to cope with whatever problems arise
6. I can easily recognize situations that make me feel stressed or upset
7. When problems arise I know how to cope with them
8. I notice right away whenever my body is becoming tense
9. It's easy for me to go to people in my life for help or support when I need it
10. I am able to use mental imagery to reduce any tension I experience
11. I am confident about being able to choose the best coping responses for hard situations
12. I can come up with emotionally balanced thoughts even during negative times
13. I can ask people in my life for support or assistance whenever I need it

Part B

People who are dealing with treatment for cancer have many different perceptions and reactions. The following items list several kinds of reactions that people sometimes have. For each item, indicate how much you currently agree or disagree with what the item says. Please don't tell us what you think your perceptions and reactions should be, or what you wish they were. Be as accurate as you can in reporting your degree of agreement or disagreement with each statement. Choose from the following responses:

0 = Strongly Disagree
1 = Mostly Disagree
2 = Neutral--neither agree nor disagree
3 = Mostly Agree
4 = Strongly Agree

1. Knowing that I've been diagnosed with cancer makes me feel like an outsider in life.
2. I'm receiving a lot of positive attention from the people around me
3. I feel strange knowing that I’ve been treated for cancer
4. I'm better off than most people who have cancer
5. People are making it known to me that they care about my situation and support me
6. I feel a bond to other breast cancer patients
7. The fact that I've been treated for cancer makes me feel different from other people.
8. I definitely feel as though people care about my well being
9. I feel a sense of connection to other people who have cancer
10. Most people who have cancer have life a lot harder than I do

Scales are computed as follows:

Part A

Relaxation: items 1, and 10
Awareness of tension: items 2, 6, and 8
Assertiveness: items 3, 9, and 13
Coping confidence: items 4, 5, 7, 11, and 12

Part B

Feeling cared for: items 2, 5, and 8
Normalization: items 1, 3, and 7 --all reverse coded
Downward comparison: items 4 and 10
Bonding: items 6 and 9
------------------------------------------------------------------------
 

A.B.

Senior Member
Messages
3,780
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.

If the CAR is related to the symptom "difficulties getting up in the morning", then I suspect this is just an indicator of being in PEM (or having messed up sleep cycles).

Thinking about it, I'm not sure if there have been studies that actually test the intervention "PEM education and activity reduction" in newly diagnosed patients.
 

Dolphin

Senior Member
Messages
17,567
The authors do briefly mention other ways the data can be looked at:
While cross-sectional in nature, our findings suggest that adults with CFS may similarly benefit from increases in CAR perhaps due to improvements in PSMS. However, alternative explanations may account for these associations. For instance, PEM could potentially influence CAR as a result of physical inactivity; alternatively, perceived stress, and consequently PSMS, could be influenced by CAR disturbance.
Illness severity might be an independent variable associated with both PEM and cortisol levels.
 

ash0787

Senior Member
Messages
308
These researchers are reaching a conclusion first and then looking for data to justify it ... im sick of people trying to insinuate that we are suffering from stress, anxiety etc