Cognitive Behavioral Stress Management for Chronic Fatigue Syndrome

描述（由申请人提供）：这是一项为期4年的研究，使用为期10周的基于电话的认知行为压力管理干预（T-CBSM）来阐明压力和压力管理对慢性疲劳综合征（CFS）个体的身体健康状况和免疫调节的影响的神经免疫机制，相对于接受健康促进电话（T-HP）干预的参与者。慢性疲劳综合症的特点是身体症状，使生活方式行为和职业活动受到严重限制。相关症状包括衰弱性疲劳、低烧、淋巴结疼痛和压痛、认知困难和情绪变化。越来越多的证据表明，CFS患者也可能表现出HPA轴功能和免疫功能的一些指标的异常。慢性压力还与皮质醇的昼夜分泌模式变平有关。无法维持HPA轴的调节可能通过减少对促炎细胞因子的控制以及与慢性免疫激活和炎症相关的相关身体症状，促进CFS的病理生理。鉴于慢性疲劳综合症的衰弱性，我们建议通过电信系统（即Telecare）提供T-CBSM干预，旨在为难以进入传统心理治疗环境的人群提供正式和非正式护理。在我们之前对CFS患者的研究中，我们已经表明，与对照组相比，接受结构化CBSM干预的个体在生活质量、感知压力、疲劳、记忆、肌肉疼痛和运动后不适方面都有显著改善。远程医疗系统成功地为老年痴呆症患者护理人员提供了一种支持性干预。这项研究的新颖之处在于，它将我们之前的工作扩展到患有慢性疲劳综合症的个体，这些个体报告说，由于身体负担，他们难以参与有组织的团体。研究设计为2 × 3随机实验设计，以组（T-CBSM, n=60 vs. T-HP, n=60）为组间因素，时间（干预前、干预后和6个月随访）为组内因素。我们的主要目的是评估旨在建立焦虑减轻、痛苦耐受、压力源评估和适应性应对策略的T-CBSM干预在多大程度上可以通过调节神经免疫相互作用来改善CFS的身体健康状况和免疫调节。

DESCRIPTION (provided by applicant): This is a 4-year study that uses a 10-week telephone based cognitive behavioral stress management intervention (T-CBSM) to illuminate neuroimmune mechanisms underlying the effects of stress and stress management on physical health status and immune regulation in individuals with chronic fatigue syndrome (CFS) relative to participants receiving a health promotion telephone (T-HP) intervention. CFS is characterized by physical symptoms which bring about severe limitations in lifestyle behaviors and vocational activities. Associated symptoms include debilitating fatigue, low grade fever, lymph node pain and tenderness, cognitive difficulties, and mood changes. There is growing evidence that CFS patients may also show abnormalities in HPA axis functioning and on several indices of immune functioning. Chronic stress is also associated with a flattened diurnal secretion pattern for cortisol. An inability to maintain regulation in the HPA axis may contribute to the pathophysiology of CFS via diminished control of pro-inflammatory cytokines and associated physical symptoms related to chronic immune activation and inflammation. Given the debilitating nature of CFS, we propose to deliver the T-CBSM intervention through a telecommunications system (i.e. Telecare) designed to enhance access to formal and informal care for a population that may have difficulty accessing traditional psychotherapeutic settings. In our prior work with individuals with CFS, we have shown that individuals in a structured group CBSM intervention report significantly improved quality of life, perceived stress, fatigue, memory, muscle pain, and post-exertional malaise compared to individuals in the control condition. The Telecare system has been successful in delivering a supportive intervention for older caregivers of dementia patients. This study is novel in expanding our prior work to individuals with CFS who have reported difficulty participating in structured groups due to physical burden. The study design is a 2 X 3 randomized experimental design with group (T-CBSM, n=60 vs. T-HP, n=60) as the between-group factor, and time (Pre-intervention, Post-intervention and 6 month follow-up) as the within-group factor. Our primary objective is to evaluate the extent to which a T-CBSM intervention Aimed at building skills in anxiety reduction, distress tolerance, stressor appraisals, and adaptive coping strategies may improve physical health status and immune regulation in CFS by modulating neuroimmune interactions.