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

Emily G. Lattie, Michael H. Antoni*, Mary Ann Fletcher, Frank Penedo, Sara Czaja, Corina Lopez, Dolores Perdomo, Andreina Sala, Sankaran Nair, Shih Hua Fu, Nancy Klimas

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

38 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)849-858
Number of pages10
JournalBrain, Behavior, and Immunity
Issue number6
StatePublished - Aug 2012


  • Chronic fatigue syndrome
  • Immune dysfunction
  • Stress management

ASJC Scopus subject areas

  • Endocrine and Autonomic Systems
  • Behavioral Neuroscience
  • Immunology


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