Publication Date



Open access

Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Psychology (Arts and Sciences)

Date of Defense


First Committee Member

Michael H. Antoni

Second Committee Member

Gail Ironson

Third Committee Member

Brian Doss

Fourth Committee Member

Nancy Klimas

Fifth Committee Member

Mary Ann Fletcher


Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multi-systemic and unpredictable medical illness for which effective treatments are lacking. A number of studies have documented immune dysregulation in this patient population, and past research has demonstrated the benefits of stress management training on immune functioning. Due to unpredictable and often severe symptoms, patients with ME/CFS have reported difficulties in attending appointments outside of the home. In consideration of these difficulties, this patient population may particularly benefit from therapeutic services available from one’s own home. This study aimed to examine the impact of telephone-delivered CBSM on inflammation and symptoms in individuals with ME/CFS. In order to determine the relationships between cytokine network coexpression patterns and CFS symptoms, the first study examined the presence of cytokine network coexpression patterns and symptom patterns in 215 women diagnosed with ME/CFS. Principal component analyses of 16 cytokines demonstrated a two-component solution in which the first component was characterized primarily by the presence of pro-inflammatory and Th1 cytokines, while the second component was primarily characterized by absence of pro-inflammatory and Th1 cytokines and presence of anti-inflammatory IL-13. Examination of 20 common ME/CFS symptoms revealed three distinct clusters of ME/CFS symptoms: Fatigue/Sleep Impairments, Pain/Neurological Impairments and Immune/Gastrointestinal Impairments. Attempts to model cytokine components and symptom clusters together revealed that while cytokines shared a substantial amount of variability with one another and the variables within each symptom cluster were highly correlated with one another, there were few direct pathways, or “links” between the cytokines and symptoms. Direct relationships were observed between IL-1α and the symptoms chills and sinus or nasal symptoms, IL-6 and the symptom of severe headaches, IL-17 and the symptom problems getting to sleep or problems waking up early in the morning, and IFN-γ and the symptom eyes extremely sensitive to light. In a second study, longitudinal differences in cytokines and symptoms were examined between participants who received telephone-delivered CBSM (N = 53) and participants who received a telephone-delivered health promotion program (N = 40) as part of a randomized controlled trial. No group by time effects were detected in changes in cytokines or symptoms over a 9-month follow-up, which may have been due to both the use of a stronger control condition and a weaker intervention, as group CBSM participants may have had difficulty engaging with the intervention material over the telephone. However, there were significant changes across time in both groups in the cytokine components (the first described the presence of pro-inflammatory and Th1 cytokines, while the second component was primarily characterized by absence of pro-inflammatory and Th1 cytokines and presence of anti-inflammatory IL-13) and in the Fatigue/Sleep Impairments symptom cluster. Mechanisms for change over this period may include increased self-efficacy to solve one’s problems, resulting in reduced stress and enhanced self-care. Given the barriers to treatment faced by many individuals with ME/CFS, future therapeutic interventions for this population should examine the effects of alternate modes of intervention delivery such as home-based video-conferencing or module-based websites.


Chronic Fatigue Syndrome; Immunology; Network Analysis; Stress Management; Cognitive Behavioral Therapy