Hall, Daniel L, Lattie, Emily G, Antoni, Michael H et al. · Psychoneuroendocrinology · 2014 · DOI
This study looked at whether learning better stress management skills could help reduce post-exertional malaise (PEM)—the exhaustion that happens after physical or mental activity in ME/CFS. Researchers measured stress hormones called cortisol in saliva samples from 117 people with ME/CFS and found that those who reported better stress management skills had healthier cortisol patterns and less severe PEM symptoms.
This is the first study to directly examine the cortisol awakening response in ME/CFS patients, identifying a potential biological pathway linking stress management to PEM severity. If confirmed, it could support the development of stress management interventions as a therapeutic approach for reducing post-exertional malaise, one of the most disabling symptoms of ME/CFS.
This study cannot establish causation—only correlation. It does not prove that improving stress management skills will definitively reduce PEM, nor does it rule out that having less severe PEM makes stress management feel easier. The cross-sectional design means all measurements were taken at one time point, so the temporal sequence cannot be determined.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Hall, Daniel L, Lattie, Emily G, Antoni, Michael H, Fletcher, Mary Ann, Czaja, Sara, Perdomo, Dolores, et al. (2014). Stress management skills, cortisol awakening response, and post-exertional malaise in Chronic Fatigue Syndrome.. Psychoneuroendocrinology. https://doi.org/10.1016/j.psyneuen.2014.06.021
BibTeX
@article{mecfsatlas-hall-2014-stress-management,
author = {Hall, Daniel L and Lattie, Emily G and Antoni, Michael H and Fletcher, Mary Ann and Czaja, Sara and Perdomo, Dolores and Klimas, Nancy G},
title = {Stress management skills, cortisol awakening response, and post-exertional malaise in Chronic Fatigue Syndrome.},
journal = {Psychoneuroendocrinology},
year = {2014},
doi = {10.1016/j.psyneuen.2014.06.021},
note = {PubMed: 25049069},
url = {https://www.mecfsatlas.com/evidence/hall-2014-stress-management},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/hall-2014-stress-management
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