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Stress vulnerability in adolescents with CFS: study investigating HRV and skin conductance responses

hixxy

Senior Member
Messages
1,229
Location
Australia
J Child Psychol Psychiatry. 2017 Mar 9. doi: 10.1111/jcpp.12711. [Epub ahead of print]

Stress vulnerability in adolescents with chronic fatigue syndrome: experimental study investigating heart rate variability and skin conductance responses.
Rimes KA, Lievesley K, Chalder T.

Abstract

BACKGROUND:
Stress vulnerability has been implicated in adolescent chronic fatigue syndrome (CFS), but has rarely been investigated directly. This study compared psychological and physiological responses to a laboratory social performance task in adolescents with CFS with chronic illness (asthma) and healthy control groups.

METHODS:
Adolescents with CFS (n = 60), adolescents with asthma (n = 31) and healthy adolescents (n = 78) completed questionnaires before and after a social performance task. Skin conductance responses (SCR; mean SCR and Max-Min) and heart rate variability (low frequency/high frequency; LF/HF and root mean square difference of successive RR intervals; RMSSD) was measured before, during and after the task.

RESULTS:
Baseline heart rate variability (HRV) (RMSSD) was significantly lower in the CFS and Asthma groups than the HC. During the speech, the CFS and Asthma groups had higher HRV (LF/HF) than the HC, adjusting for baseline LF/HF. Although the asthma group showed a subsequent reduction in HRV during recovery, the CFS group did not. Similarly, during recovery after the task, the CFS group showed a continued increase in skin conductance (Min-Max), unlike the Asthma and HC groups. Compared to control groups, adolescents with CFS expected to find the task more difficult, were more anxious beforehand and afterwards, rated it as more difficult, evaluated their performance more negatively and had lower observer ratings of performance. Parents of adolescents with CFS expected that their child would perform less well in the task than parents of control participants.

CONCLUSIONS:
Adolescents with CFS showed autonomic nervous system responses that are consistent with chronic stress vulnerability, difficulty coping with acute stress and slower recovery after acute stress. Self-report measures also indicated greater trait, pre- and posttask anxiety in the CFS group.

© 2017 Association for Child and Adolescent Mental Health.

KEYWORDS:
Chronic fatigue syndrome; adolescence; autonomic nervous system; fatigue; myalgic encephalomyelitis; stress

https://www.ncbi.nlm.nih.gov/pubmed/28276066
http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12711/abstract
 

MEMum

Senior Member
Messages
440
Is it surprising that adolescents with ME experience more "acute stress and slower recovery afterwards" in their dealings with psychologists? (In comparison to healthy controls or those with a "medically understood" disease)
Given the psychs view of ME and the repercussions of their stranglehold on UK treatment of ME, this is not unexpected.
 
Messages
87
??? This smacks of child abuse. Who would put their child knowingly in this position. Why do you need a study to find out a child with CFS would be acutely stressed and take longer to recover from this kind of experiment. If you could have tested them before they got ill then it might make sense. These more negative ratings don't result from personal traits but from knowledge and intimate experience of the illness. Grrr
 

Mohawk1995

Senior Member
Messages
287
These more negative ratings don't result from personal traits but from knowledge and intimate experience of the illness.

Yes ME/CFS is a "Beast of a task master" giving little forgiveness for "stepping out of line". It trains everyone well to avoid exertion, stressful situations or anything that drains more energy from the body. My description is of the physiologic behavior of the disease and not the psychological behavior of the person.

Out of ignorance we attempted to push our son in the early stages of his disease. He was diagnosed with "atypical migraines". ME/CFS was something I had heard of maybe once before. We quickly learned as did he, that every time you try to push it you are really just "poking the gorilla" and the results are not good. Maybe research was needed to verify this phenomenon, but there are far better ways to do it than this.

The same research on Juvenile RA, Juvenile Polymyositis, or any other debilitating childhood disease would give similar results. What it says to me, is that children with ME/CFS and their parents/caregivers should be supported and given permission to listen to the signs.

Adolescents with CFS showed autonomic nervous system responses that are consistent with chronic stress vulnerability, difficulty coping with acute stress and slower recovery after acute stress.

Perhaps on at least one note they got something right. That is to support that these changes are autonomic meaning they are not under the control of conscious thought. In other words the ability of adolescents (and adults) to cope well with ME/CFS is severely hampered by the dominant autonomic responses of the child's body. VERY VERY VERY Little control!
 

duncan

Senior Member
Messages
2,240
There are so many things wrong with this that I do not know where to start.

First and foremost - in my mind, at least - is that I do not believe the authors have demonstrated ANS involvement. I think they put sick kids in a stressful situation. That elicited the same kind of response (increased HRV and skin responses like sweating) it would in HCs, only it was more pronounced and lasted longer. Go figure.
 

TiredSam

The wise nematode hibernates
Messages
2,677
Location
Germany
Ms Chalder & co hooking kids up to an E-meter, who'd have thought it?

One of the great things about the recent OMF and Ron Davis threads is that now we have real research to focus on, so drivel like this becomes much easier to disregard because it's no longer the only narrative. Can't even be bothered ranting about it.
 

CFS_for_19_years

Hoarder of biscuits
Messages
2,396
Location
USA
Full article (haven't read yet):
http://sci-hub.cc/10.1111/jcpp.12711

Procedure
Written informed consent was provided by adolescents and one
of their parents prior to participation. Participants were sent
questionnaires to complete beforehand. They attended the
clinic with one parent who waited in a separate room. A
baseline physiological recording was taken with the participant
sitting in a quiet room for 5 min, before task instructions were
provided. Participants were asked to give a 3-min speech on a
topic of their choice to the experimenter, which was filmed,
using the procedure by Rapee and Lim (1992). They were told
that the experimenter would evaluate their performance and
that the film was being made to allow a performance evaluation
by independent raters later on. The task elicits a level of stress
that is manageable for adolescents (Rapee & Lim, 1992). Before
and after completing the experimental task, participants were
asked to complete ratings of their expectations, performance,
perceived difficulty and anxiety. At the end, participants were
debriefed and had the opportunity to talk about their feelings
about the task.
 

RogerBlack

Senior Member
Messages
902
I think they put sick kids in a stressful situation. That elicited the same kind of response (increased HRV and skin responses like sweating) it would in HCs, only it was more pronounced and lasted longer. Go figure.

This is important IMO.
While I question seriously the group in questions motive, this is stuff that should have been done in the 80s or earlier.
Positives in this study are the use of some objective measures.
Negatives are the presumable intent to use this paper to support the idea that it's 'simply' stress.

Understanding and providing useful cognitive and other benchmarks to measure PEM/fatigue is valuable.
Using it as an excuse to claim it's all stress therefore CBT to ignore the illness - not.
 

TiredSam

The wise nematode hibernates
Messages
2,677
Location
Germany
The task elicits a level of stress that is manageable for adolescents (Rapee & Lim, 1992).
When surveys are done about peoples' most common fears, public speaking usually comes top, ahead of death (I think spiders is no.3). Every semester I have two new classes of students in their twenties, my job is to prepare them for the presentation they have to give in their exam. After giving their first short presentation (less than 5 minutes) in front of the class, some of them sit down in tears. This level of stress is hardly manageable for many adults.

So here we have sick children being separated from their parents with no warning and having the life scared out of them, then their fear is measured using the same technology used in scientology's E-meters or bioresonance therapy (more on that quackery and their machines here:

https://en.wikipedia.org/wiki/Bioresonance_therapy)

and the "results" are considered worthy of publication by Ms. Chalder, who presumably is deluded enough to think that she has now contributed to the literature and "growing evidence base" of whatever. FFS.
 
Messages
15,786
Full text at http://sci-hub.cc/10.1111/jcpp.12711

Oxford criteria, so it's the usual irrelevant crap.

It's not clear if they were sitting or standing, but it did involve giving a speech, which is almost always done standing:
Participants were asked to give a 3-min speech on a topic of their choice to the experimenter, which was filmed, using the procedure by Rapee and Lim (1992). They were told that the experimenter would evaluate their performance and that the film was being made to allow a performance evaluation by independent raters later on.

They used a children's version of the Beck Depression Inventory, which equates physical disability with a mood disorder. The anxiety scale looks at autonomic nervous system arousal, so again, not assessing the actual feeling of anxiety, but symptoms which can have an entirely different cause. It's also a children's version, but not meant to be used with the older age group in the study.

This doesn't sound unreasonable:
The abnormally low HRV (measured by RMSSD) in the CFS group relative to healthy adolescents may indicate that the CFS participants have lower parasympathetic modulation of their heart rate. This could indicate a reduced ability to cope with stressors that tend to destabilise blood pressure.

But of course, as psychobabblers they must go on to conclude that even if depression isn't causing CFS, one factor is causing both CFS and depression. And the treatment is the one and only CBT, for both CFS and anxiety :rolleyes:

So, another idiotic paper produced by idiots. They apparently lack the intelligence to distinguish between disability and depression, or OI and anxiety. They should not be in academia or interacting with patients, until they can get a better grasp of the basics.
 
Last edited:

sarah darwins

Senior Member
Messages
2,508
Location
Cornwall, UK
Oxford criteria, so it's the usual irrelevant crap.

The bottom line, isn't it.

Sixty adolescents who fulfilled the Oxford criteria for CFS (Sharpe et al., 1991) were recruited from treatment waiting lists at King’s College Hospital or Great Ormond Street Hospital in London

Anything that starts from the Oxford criteria should just have a thick red line drawn through it. If we could figure out a way to put the Oxford criteria where they belong — in the trash can — most of the bogus research would vanish overnight.
 

Hutan

Senior Member
Messages
1,099
Location
New Zealand
Pre-illness, I liked public speaking. Now, there are times when chatting to a friend at my kitchen table is more than I can handle. My brain may not work fast enough to understand what is being said, my words might not come out right or I may not be able to think of the words I want. I might have a headache or just desperately want to lie down.

During the two years when I struggled on with work after becoming ill, preparing for a formal presentation, getting dressed right, getting to the place without getting lost and then the effort of appearing excited about my topic and dealing with questions was utterly exhausting. And knowing that my brain might take an unplanned rest break when I needed it to be working hard was confidence-sapping.

It's worse for the kids in this study. They probably haven't had much public speaking experience - not much call for it lying in bed. They may believe what they have been told about having poor coping skills and being generally inadequate people. Meanwhile the kids that they are compared to have been out in the world building their self-confidence.

These researchers clearly don't understand the illness. Their study makes as much sense as having people with broken legs jump up and down and then labelling them as 'anxious' when they are stressed before, during and after the jumping.

Can't even be bothered ranting about it.
Ha, yeah, I thought the same. And then ranted nonetheless.

another idiotic paper produced by idiots
Yep
 

Dolphin

Senior Member
Messages
17,567
Did the participants have to stand up to give the speech?
I don't think it says. I imagine there is a good chance they did in which case one has to consider what was measured was partly or wholly orthostatic stress.

The HF and LF/HF changes in the current study are consistent with Wyller et al.’s (2007) finding of a greater increase in the LF/HF ratio and greater decrease in HF power in the CFS group compared to healthy adolescents when undergoing a head-up tilt test.
 

Dolphin

Senior Member
Messages
17,567
Unexpectedly, the skin conductance response in the CFS group continued to increase during the recovery period, unlike the other two groups.

The abnormally low HRV (measured by RMSSD) in the CFS group relative to healthy adolescents may indicate that the CFS participants have lower parasympathetic modulation of their heart rate. This could indicate a reduced ability to cope with stressors that tend to destabilise blood pressure.

It has been argued that unusually low resting HRV reflects a transdiagnostic, general biomarker of reduced ability to adapt to stress (Beauchaine & Thayer, 2015).

The current pattern of findings may indicate that adolescents with CFS had lower vagal modulation of heart rate during the stressful task, with increased sympathetic heart rate control also possibly playing a role.

The findings may indicate that CFS adolescents had an impaired parasympathetic nervous system response during recovery from a challenging task, as well as possibly continued or increased sympathetic nervous system activity. Similarly, the CFS group showed a continued increase in Min–Max SCR (a marker of sympathetic nervous system activity) during the recovered period unlike the other two groups. Furthermore, the CFS group reported greater anxiety both before and after the task than the other two groups. These are consistent with suggestions that CFS is characterised by persistent stress arousal (Wyller et al., 2009).