Mathersul Danielle C, Eising Carla M, DeSouza Danielle D, Spiegel David, Bayley Peter J
War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
Glob Adv Health Med. 2020 Apr 30;9:2164956120922812. doi: 10.1177/2164956120922812. eCollection 2020.
Gulf War Illness (GWI) is a poorly understood condition characterized by a constellation of mood, cognitive, and physical symptoms. A growing body of evidence demonstrates autonomic nervous system (ANS) dysfunction. Few published treatment studies exist for GWI.
We recently completed a randomized controlled trial comparing a 10-week group yoga intervention to 10-week group cognitive behavioral therapy (CBT) for veterans with GWI. Here, we present exploratory data on ANS biomarkers of treatment response from a small pilot exploratory neurophysiological add-on study (n = 13) within that larger study.
Findings suggest that veterans with GWI receiving either yoga or CBT for pain improved following treatment and that changes in biological ANS-especially for the yoga group-moved in the direction of healthy profiles: lower heart rate, higher square root of the mean squared differences between successive R-R intervals (RMSSD), greater parasympathetic activation/dominance (increased high-frequency heart rate variability [HF-HRV], decreased low-frequency/high-frequency [LF/HF] ratio), reduced right amygdala volume, and stronger amygdala-default mode/amygdala-salience network connectivity, both immediately posttreatment and at 6-month follow-up. Biological mechanisms of CBT appeared to underlie improvements in more psychologically loaded symptoms such as self-reported fatigue and energy. Higher tonic arousal and/or more sympathetic dominance (higher skin conductance, lower RMSSD, lower HF-HRV, higher LF/HF ratio) pretreatment predicted greater treatment-related improvements in self-reported ANS for both the yoga and CBT group.
These exploratory pilot data provide preliminary support for the suggestion that treatment (yoga, CBT) is associated with improvements in both biological and self-reported ANS dysfunctions in GWI. The major limitation for these findings is the small sample size. Larger and more controlled studies are needed to replicate these findings and directly compare biomarkers of yoga versus CBT.
海湾战争综合征（GWI）是一种尚不清楚的疾病，其特征为一系列情绪、认知和身体症状。越来越多的证据表明存在自主神经系统（ANS）功能障碍。关于GWI的已发表治疗研究很少。
我们最近完成了一项随机对照试验，比较了针对患有GWI的退伍军人进行为期10周的团体瑜伽干预与为期10周的团体认知行为疗法（CBT）。在此，我们展示了在该大型研究中一项小型探索性神经生理学附加研究（n = 13）中关于治疗反应的ANS生物标志物的探索性数据。
研究结果表明，接受瑜伽或CBT治疗疼痛的GWI退伍军人在治疗后有所改善，并且生物ANS的变化——尤其是瑜伽组——朝着健康状态发展：心率降低、连续R - R间期平方差的平方根（RMSSD）升高、副交感神经激活/优势增强（高频心率变异性[HF - HRV]增加、低频/高频[LF/HF]比值降低）、右杏仁核体积减小，以及在治疗后即刻和6个月随访时杏仁核 - 默认模式/杏仁核 - 突显网络连接更强。CBT的生物学机制似乎是自我报告的疲劳和精力等心理负担较重症状改善的基础。治疗前较高的静息觉醒和/或更多的交感神经优势（较高的皮肤电导率、较低的RMSSD、较低的HF - HRV、较高的LF/HF比值）预示着瑜伽组和CBT组在自我报告的ANS方面与治疗相关的更大改善。
这些探索性试验数据为治疗（瑜伽、CBT）与GWI中生物和自我报告的ANS功能障碍改善相关这一观点提供了初步支持。这些发现的主要局限性是样本量小。需要更大规模且更具对照性的研究来重复这些发现，并直接比较瑜伽与CBT的生物标志物。
