Category: Psychiatry/Psychology

Illness duration and coping style in chronic fatigue syndrome

Abstract:

A sample of patients with chronic fatigue syndrome was recruited to assess coping strategies and illness duration. It was hypothesized that adaptive coping strategies would be higher among those with longer illness duration.

Those in the longer illness duration group reported higher use of active coping, positive reframing, planning, and acceptance, and lower use of behavioral disengagement than those in the shorter illness duration group. No significant differences were found between the two illness duration groups for physical impairment or symptom severity, but the long duration group revealed a lower percentage of participants who were working than the short duration group.

These findings suggest that individuals with longer or shorter duration of the illness have differences in coping styles but not differences in physical impairment or symptom severity.

 

Source: Brown MM, Brown AA, Jason LA. Illness duration and coping style in chronic fatigue syndrome. Psychol Rep. 2010 Apr;106(2):383-93. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036543/ (Full article)

 

Possible detrimental effects of cognitive behaviour therapy for chronic fatigue syndrome

Abstract:

BACKGROUND: Cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) can decrease the level of fatigue and disabilities, but it has been suggested that during therapy some patients experience a deterioration of their symptoms rather than an improvement. The aim of this study is to examine the frequency and severity of symptom deterioration during CBT for CFS.

METHODS: Data from 3 randomised controlled trials on CBT for CFS were pooled and reanalysed. Symptom deterioration during the trial was rated by patients and measured as deterioration in fatigue, pain, functional impairment and psychological distress. Both the frequency and severity of deterioration in these domains were compared between the patients receiving CBT and those in the control group. Predictors of symptom deterioration were identified by comparing their means in patients with and without an increase in fatigue. Statistically significant predictors were then combined in a logistic regression model.

RESULTS: The frequency of symptom deterioration varied from 2 to 12% in patients receiving CBT and from 7 to 17% in the control group. None of the measures showed a significantly higher frequency of symptom deterioration in the CBT group. The severity of deterioration was also comparable in the CBT and in the control group. No predictors of symptom deterioration specific to CBT were found.

CONCLUSION: Patients receiving CBT do not experience more frequent or more severe symptom deterioration than untreated patients. The reported deterioration during CBT seems to reflect the natural variation in symptoms. Thus, CBT is not only a helpful, but also a safe treatment for CFS.

Copyright 2009 S. Karger AG, Basel.

Comment in: Harms of cognitive behaviour therapy designed to increase activity levels in chronic fatigue syndrome: questions remain.[Psychother Psychosom. 2011]

 

Source: Heins MJ, Knoop H, Prins JB, Stulemeijer M, van der Meer JW, Bleijenberg G. Possible detrimental effects of cognitive behaviour therapy for chronic fatigue syndrome. Psychother Psychosom. 2010 Jun;79(4):249-56. doi: 10.1159/000315130. Epub 2010 May 25. https://www.ncbi.nlm.nih.gov/pubmed/20502065

 

The central role of cognitive processes in the perpetuation of chronic fatigue syndrome

Abstract:

OBJECTIVE: Chronic fatigue syndrome (CFS) is considered to be one of the functional somatic syndromes (FSS). Cognitions and behavior are thought to perpetuate the symptoms of CFS. Behavioral interventions based on the existing models of perpetuating factors are quite successful in reducing fatigue and disabilities. The evidence is reviewed that cognitive processes, particularly those that determine the perception of fatigue and its effect on behavior, play a central role in the maintenance of symptoms.

METHOD: Narrative review.

RESULTS: Findings from treatment studies suggest that cognitive factors mediate the positive effect of behavioral interventions on fatigue. Increased fitness or increased physical activity does not seem to mediate the treatment response. Additional evidence for the role of cognitive processes is found in studies comparing the subjective beliefs patients have of their functioning with their actual performance and in neurobiological research.

CONCLUSION: Three different cognitive processes may play a role in the perpetuation of CFS symptoms. The first is a general cognitive representation in which fatigue is perceived as something negative and aversive and CFS is seen as an illness that is difficult to influence. The second process involved is the focusing on fatigue. The third element is formed by specific dysfunctional beliefs about activity and fatigue.

Copyright 2010 Elsevier Inc. All rights reserved.

 

Source: Knoop H, Prins JB, Moss-Morris R, Bleijenberg G. The central role of cognitive processes in the perpetuation of chronic fatigue syndrome. J Psychosom Res. 2010 May;68(5):489-94. doi: 10.1016/j.jpsychores.2010.01.022. Epub 2010 Mar 16. https://www.ncbi.nlm.nih.gov/pubmed/20403509

 

Chronic fatigue syndrome: Is it one discrete syndrome or many? Implications for the “one vs. many” functional somatic syndromes debate

Abstract:

There is a current debate as to whether “functional somatic syndromes” (FSSs) are more similar to or different from each other. While at the same time, there is evidence of heterogeneity within single syndromes. So, it could be that these syndromes are all part of one big process/illness, are discrete in their own right, or that they are heterogeneous collections of different illnesses lumped together by common symptoms but separated by uncommon pathophysiologies. The example of chronic fatigue syndrome (CFS) is instructive. There is evidence to support all three models of understanding. Three recent large studies have suggested that FSSs are both similar and dissimilar at the same time. The solution to the debate is that we need to both “lump” and “split.” We need to study both the similarities between syndromes and their dissimilarities to better understand what we currently call the FSSs.

Copyright 2010 Elsevier Inc. All rights reserved.

 

Source: White PD. Chronic fatigue syndrome: Is it one discrete syndrome or many? Implications for the “one vs. many” functional somatic syndromes debate. J Psychosom Res. 2010 May;68(5):455-9. doi: 10.1016/j.jpsychores.2010.01.008. Epub 2010 Mar 17. https://www.ncbi.nlm.nih.gov/pubmed/20403504

 

One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders

Abstract:

BACKGROUND: In order to clarify the classification of physical complaints not attributable to verifiable, conventionally defined diseases, a new diagnosis of bodily distress syndrome was introduced. The aim of this study was to test if patients diagnosed with one of six different functional somatic syndromes or a DSM-IV somatoform disorder characterized by physical symptoms were captured by the new diagnosis.

METHOD: A stratified sample of 978 consecutive patients from neurological (n=120) and medical (n=157) departments and from primary care (n=701) was examined applying post-hoc diagnoses based on the Schedules for Clinical Assessment in Neuropsychiatry diagnostic instrument. Diagnoses were assigned only to clinically relevant cases, i.e., patients with impairing illness.

RESULTS: Bodily distress syndrome included all patients with fibromyalgia (n=58); chronic fatigue syndrome (n=54) and hyperventilation syndrome (n=49); 98% of those with irritable bowel syndrome (n=43); and at least 90% of patients with noncardiac chest pain (n=129), pain syndrome (n=130), or any somatoform disorder (n=178). The overall agreement of bodily distress syndrome with any of these diagnostic categories was 95% (95% CI 93.1-96.0; kappa 0.86, P<.0001). Symptom profiles of bodily distress syndrome organ subtypes were similar to those of the corresponding functional somatic syndromes with diagnostic agreement ranging from 90% to 95%.

CONCLUSION: Bodily distress syndrome seem to cover most of the relevant “somatoform” or “functional” syndromes presenting with physical symptoms, not explained by well-recognized medical illness, thereby offering a common ground for the understanding of functional somatic symptoms. This may help unifying research efforts across medical disciplines and facilitate delivery of evidence-based care.

Copyright 2010 Elsevier Inc. All rights reserved.

 

Source: Fink P, Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res. 2010 May;68(5):415-26. doi: 10.1016/j.jpsychores.2010.02.004. https://www.ncbi.nlm.nih.gov/pubmed/20403500

 

An investigation of victimization and the clinical course of chronic fatigue syndrome

Abstract:

Medically unexplained syndromes, including chronic fatigue syndrome (CFS), have been associated with victimization in childhood and adulthood. The purpose of this study was to examine the associations of victimization experiences in childhood and adulthood with functional status and illness severity in a sample of patients with CFS using longitudinal data. In the sample of 93 patients with CFS, childhood abuse and neglect had greater impact than adulthood victimization. Overall, victimization experiences in childhood demonstrated modest associations with clinical outcomes in CFS, although several victimization experiences were in the opposite direction of expectations. Victimization predicted worse outcomes, but not worsening outcomes over time.

 

Source: Johnson SK, Schmaling KB, Dmochowski J, Bernstein D. An investigation of victimization and the clinical course of chronic fatigue syndrome. J Health Psychol. 2010 Apr;15(3):351-61. Doi: 10.1177/1359105309349453. https://www.ncbi.nlm.nih.gov/pubmed/20348356

 

Chronic fatigue syndrome, fibromyalgia, and related illnesses: a clinical model of assessment and intervention

Abstract:

A clinically informative behavioral literature on chronic fatigue syndrome (CFS) and fibromyalgia (FM) has emerged over the past decade. The purpose of this article is to (a) define these conditions and their less severe counterparts, i.e., unexplained chronic fatigue (UCF) and chronic widespread pain; (b) briefly review the behavioral theory and intervention literature on CFS and FM; and (c) describe a user-friendly clinical model of assessment and intervention for these illnesses. The assessments described will facilitate understanding of the somewhat unusual and puzzling somatic presentations that characterize these patients. Using an individualized cognitive-behavioral approach the mental health clinician can offer significant help to these often stigmatized and medically underserved patients.

(c) 2010 Wiley Periodicals, Inc.

 

Source: Friedberg F. Chronic fatigue syndrome, fibromyalgia, and related illnesses: a clinical model of assessment and intervention. J Clin Psychol. 2010 Jun;66(6):641-65. doi: 10.1002/jclp.20676. https://www.ncbi.nlm.nih.gov/pubmed/20186721

 

Mood volatility with rumination but neither attentional nor interpretation biases in chronic fatigue syndrome

Abstract:

OBJECTIVES: This study tested whether (1) chronic fatigue syndrome (CFS) individuals have a bias in the initial orientation of attention to illness-related information, which is enhanced by rumination. (2) CFS individuals have an illness interpretation bias (IB) in their early automatic processing of ambiguous information. (3) CFS individuals experience a greater degree of mood fluctuation following rumination and distraction inductions.

DESIGN: Thirty-three CFS participants who had received a medical practitioner’s diagnosis of CFS were compared to 33 healthy matched controls on an exogenous cueing task and a lexical decision task.

METHOD: All participants underwent either a rumination or distraction induction. They then completed an exogenous cueing task to assess bias to illness and social threat compared with neutral stimuli, as well as a lexical decision task to assess their interpretation of ambiguous words having illness, social threat, or neutral interpretations.

RESULTS: Reaction time data revealed that CFS individuals did not have an attentional bias (AB) in the initial orientation of attention to illness-related material. Nor was there an IB towards illness in CFS individual’s automatic response to ambiguous information. However, as hypothesized, CFS individuals showed a greater degree of mood fluctuation following the rumination/distraction induction.

CONCLUSION: Rumination and distraction lead to greater mood volatility in CFS individuals than in controls, but not to attentional nor interpretation biases in the early automatic stages of information processing in CFS individuals.

 

Source: Martin M, Alexeeva I. Mood volatility with rumination but neither attentional nor interpretation biases in chronic fatigue syndrome. Br J Health Psychol. 2010 Nov;15(Pt 4):779-96. doi: 10.1348/135910709X480346. Epub 2010 Jan 22. https://www.ncbi.nlm.nih.gov/pubmed/20100398

 

How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity

Abstract:

BACKGROUND: Cognitive behaviour therapy (CBT) is known to reduce fatigue severity in chronic fatigue syndrome (CFS). How this change in symptomatology is accomplished is not yet understood. The purpose of the present study was to determine whether the effect of CBT on fatigue is mediated by an increase in physical activity.

METHOD: Three randomized controlled trials were reanalysed, previously conducted to evaluate the efficacy of CBT for CFS. In all samples, actigraphy was used to assess the level of physical activity prior and subsequent to treatment or a control group period. The mediation hypothesis was analysed according to guidelines of Baron & Kenny [Journal of Personality and Social Psychology (1986)51, 1173-1182]. A non-parametric bootstrap approach was used to test statistical significance of the mediation effect.

RESULTS: Although CBT effectively reduced fatigue, it did not change the level of physical activity. Furthermore, changes in physical activity were not related to changes in fatigue. Across the samples, the mean mediation effect of physical activity averaged about 1% of the total treatment effect. This effect did not yield significance in any of the samples.

CONCLUSIONS: The effect of CBT on fatigue in CFS is not mediated by a persistent increase in physical activity.

 

Source: Wiborg JF, Knoop H, Stulemeijer M, Prins JB, Bleijenberg G. How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity. Psychol Med. 2010 Aug;40(8):1281-7. doi: 10.1017/S0033291709992212. Epub 2010 Jan 5. https://www.ncbi.nlm.nih.gov/pubmed/20047707

 

Unexplained chronic fatigue and interpersonal problems: a study in a primary care population

Abstract:

OBJECTIVE: Unexplained fatigue syndromes are multidimensional phenomena that involve a constellation of symptoms. This article explores whether typical interpersonal problems are associated with self-reported and clinically-rated fatigue symptoms in chronically fatigued patients. We hypothesize that the severity of fatigue symptoms will be associated with a pattern of withdrawal from social interaction.

METHOD: Interpersonal problems were assessed by means of a self-report questionnaire. Chronic fatigue was assessed with a self-report questionnaire (both self-rated and clinically-rated) in a primary care Chronic Fatigue Syndrome (CFS) group (N = 52) and compared with two other clinical populations (minor medical condition: N = 51; chronic organic disease: N = 52).

RESULTS: Compared to patients with a minor medical condition, CFS patients are substantially more fatigued and more socially withdrawn. Compared to patients with a chronic organic disease, somewhat more fatigue-related disability was observed in CFS patients, but no distinct interpersonal problems came to the fore. CFS patients and physicians proved to differ in their opinion on the patient’s motivation. In line with the hypothesis, self-rated and clinically-scored fatigue problems proved to be related to a pattern of withdrawal from social interaction.

CONCLUSION: Differences between physicians’ and patients in how symptoms are interpreted might be related to patients feeling misunderstood and result in social withdrawal.

 

Source: Vandenbergen J, Vanheule S, Desmet M, Verhaeghe P. Unexplained chronic fatigue and interpersonal problems: a study in a primary care population. Int J Psychiatry Med. 2009;39(3):325-40. https://www.ncbi.nlm.nih.gov/pubmed/19967903