Category: Psychiatry/Psychology

Chronic illness — a disruption in life: identity-transformation among women with chronic fatigue syndrome and fibromyalgia

Abstract:

BACKGROUND: People with chronic illnesses often suffer from identity-loss. Empirical research concerning patients with chronic fatigue syndrome (CFS) or fibromyalgia has not, however, adequately addressed the consequences of these illnesses for identity.

AIM: The aim of this article is to describe how women with CFS and fibromyalgia create new concepts of identity after the onset of illness, and how they come to terms with their newly arisen identities. I aim to illuminate the biographical work done by these individuals, which includes a re-evaluation of their former identity and life. This process is illustrated by the following themes: An earlier identity partly lost and Coming to terms with a new identity.

METHOD: The study is based on interviews with 25 women in Sweden, 12 with the diagnosis of CFS and 13 diagnosed with fibromyalgia. A grounded theory orientated approach was used when collecting and analysing the data.

FINDINGS: The main findings are that: (1) the illnesses can involve a radical disruption in the women’s biography that has profound consequences for their identity, particularly in relation to work and social life, (2) biographical disruptions are partial rather than total, calling for different degrees of identity transformation, (3) many of the women also experience illness gains in relation to the new identity.

CONCLUSIONS: Thus, the biographical disruption and illness experience comprised both losses and illness gains that had consequences for identity.

 

Source: Asbring P. Chronic illness — a disruption in life: identity-transformation among women with chronic fatigue syndrome and fibromyalgia. J Adv Nurs. 2001 May;34(3):312-9. http://www.ncbi.nlm.nih.gov/pubmed/11328436

 

Discriminating between chronic fatigue syndrome and depression: a cognitive analysis

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS) and depression share a number of common symptoms and the majority of CFS patients meet lifetime criteria for depression. While cognitive factors seem key to the maintenance of CFS and depression, little is known about how the cognitive characteristics differ in the two conditions.

METHODS: Fifty-three CFS patients were compared with 20 depressed patients and 38 healthy controls on perceptions of their health, illness attributions, self-esteem, cognitive distortions of general and somatic events, symptoms of distress and coping. A 6 month follow-up was also conducted to determine the stability of these factors and to investigate whether CFS-related cognitions predict ongoing disability and fatigue in this disorder.

RESULTS: Between-group analyses confirmed that the depressed group was distinguished by low self-esteem, the propensity to make cognitive distortions across all situations, and to attribute their illness to psychological factors. In contrast, the CFS patients were characterized by low ratings of their current health status, a strong illness identity, external attributions for their illness, and distortions in thinking that were specific to somatic experiences. They were also more likely than depressed patients to cope with their illness by limiting stress and activity levels. These CFS-related cognitions and behaviours were associated with disability and fatigue 6 months later.

CONCLUSIONS: CFS and depression can be distinguished by unique cognitive styles characteristic of each condition. The documented cognitive profile of the CFS patients provides support for the current cognitive behavioural models of the illness.

 

Source: Moss-Morris R, Petrie KJ. Discriminating between chronic fatigue syndrome and depression: a cognitive analysis. Psychol Med. 2001 Apr;31(3):469-79. http://www.ncbi.nlm.nih.gov/pubmed/11305855

 

Coping and illness cognitions: chronic fatigue syndrome

Abstract:

The chronic fatigue syndrome (CFS) is described, and research on coping with this illness reviewed and analysed. CFS is a severely disabling illness of unknown etiology, which has occurred in epidemic forms all over the world. However, the number of sufferers has dramatically increased over previous years. The heterogeneous symptomatology of CFS was reviewed, and diagnostic criteria were discussed. The difficulty in establishing causality was emphasized. An interaction of factors appears most likely to be associated with illness onset and maintenance. As the mediating factor could be sufferers’ coping behavior, the existing coping literature was reviewed. There might be an association between coping and physical and psychological well-being. Finally, recommendations are made for longitudinal research on coping and coping effectiveness, and for the development of therapeutic interventions.

 

Source: Ax S, Gregg VH, Jones D. Coping and illness cognitions: chronic fatigue syndrome. Clin Psychol Rev. 2001 Mar;21(2):161-82. http://www.ncbi.nlm.nih.gov/pubmed/11293364

 

Toward a new definition of chronic fatigue syndrome

To the editor,

I agree with Lane when he writes that the operative criteria for diagnosing chronic fatigue syndrome (CFS) are unsatisfactory. Some patients who have been assigned this label may be better described as having depression or somatization, and this mislabeling prejudices the understanding of CFS in cross-sectional studies.1 Lane is presumably referring to the definition of the Centers for Disease Control and Prevention, with its concentration on physical symptoms.2 This definition also is not all that helpful in assigning a label to individuals for the purposes of estimating prognosis or deciding on treatment because the physical symptoms cited are nonspecific.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071345/

 

Source: Robertson-Ritchie H. Toward a new definition of chronic fatigue syndrome. West J Med. 2001 Apr;174(4):241. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071345/ (Full article)

 

Illness perceptions and mood in chronic fatigue syndrome

Abstract:

BACKGROUND: Individual beliefs and cognitions may affect adjustment to chronic fatigue syndrome (CFS) and illness perceptions, in particular, have been reported to correlate with both disability and psychological adjustment to CFS in self-diagnosed cases.

OBJECTIVES: The aim of the present study was to examine these relationships in a clinic sample of CFS patients assessed by both a physician and psychiatrist.

METHOD: A sample of 173 patients referred to a multidisciplinary CFS clinic and fulfilling current operational criteria for CFS [Ann Intern Med 121 (1994) 953; J R Soc Med 84 (1991) 118.] were randomly selected from the clinic database and surveyed with the Hospital Anxiety and Depression scale, Fatigue Questionnaire and Illness Perceptions Questionnaire [J Psychosom Res 37 (1993) 147; Psychol Health 11 (1996) 431; Acta Psychiatr Scand 67 (1983) 361.].

RESULTS: A total of 126 patients responded (73% response rate). The illness perception components studied were consequences (of illness), illness identity, causes (of illness), the ability to control/cure the illness and (expected) timeline of the illness. These components accounted for 15%, 28% and 30% of the variance in levels of fatigue, depression and anxiety, respectively. Two of the illness perception components (consequences and illness identity) were stronger predictors of fatigue score than mood scores.

CONCLUSIONS: These findings confirmed in a clinical sample that illness perceptions are associated with variation in both disability and psychological adjustment in CFS. Illness perceptions may have an important and long-lasting effect on adaptation to CFS, and it is necessary to have a greater understanding of their role in order to tailor effective interventions for the condition.

 

Source: Edwards R, Suresh R, Lynch S, Clarkson P, Stanley P. Illness perceptions and mood in chronic fatigue syndrome. J Psychosom Res. 2001 Feb;50(2):65-8. http://www.ncbi.nlm.nih.gov/pubmed/11274662

 

Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial

Abstract:

BACKGROUND: Fatigue is a common symptom for which patients consult their doctors in primary care. With usual medical management the majority of patients report that their symptoms persist and become chronic. There is little evidence for the effectiveness of any fatigue management in primary care.

AIM: To compare the effectiveness of cognitive behaviour therapy (CBT) with counselling for patients with chronic fatigue and to describe satisfaction with care.

DESIGN OF STUDY: Randomised trial with parallel group design.

SETTING: Ten general practices located in London and the South Thames region of the United Kingdom recruited patients to the trial between 1996 and 1998. Patients came from a wide range of socioeconomic backgrounds and lived in urban, suburban, and rural areas.

METHOD: Data were collected before randomisation, after treatment, and six months later. Patients were offered six sessions of up to one hour each of either CBT or counselling. Outcomes include: self-report of fatigue symptoms six months later, anxiety and depression, symptom attributions, social adjustment and patients’ satisfaction with care.

RESULTS: One hundred and sixty patients with chronic fatigue entered the trial, 45 (28%) met research criteria for chronic fatigue syndrome; 129 completed follow-up. All patients met Chalder et al’s standard criteria for fatigue. Mean fatigue scores were 23 on entry (at baseline) and 15 at six months’ follow-up. Sixty-one (47%) patients no longer met standard criteria for fatigue after six months. There was no significant difference in effect between the two therapies on fatigue (1.04 [95% CI = -1.7 to 3.7]), anxiety and depression or social adjustment outcomes for all patients and for the subgroup with chronic fatigue syndrome. Use of antidepressants and consultations with the doctor decreased after therapy but there were no differences between groups.

CONCLUSION: Counselling and CBT were equivalent in effect for patients with chronic fatigue in primary care. The choice between therapies can therefore depend on other considerations, such as cost and accessibility.

Comment in:

Chronic fatigue in general practice. [Br J Gen Pract. 2001]

Cognitive behaviour therapy and chronic fatigue syndrome. [Br J Gen Pract. 2001]

 

Source: Ridsdale L, Godfrey E, Chalder T, Seed P, King M, Wallace P, Wessely S; Fatigue Trialists’ Group. Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial. Br J Gen Pract. 2001 Jan;51(462):19-24. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313894/ (Full article)

 

Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial

Abstract:

BACKGROUND: Cognitive behaviour therapy (CBT) seems a promising treatment for chronic fatigue syndrome (CFS), but the applicability of this treatment outside specialised settings has been questioned. We compared CBT with guided support groups and the natural course in a randomised trial at three centres.

METHODS: Of 476 patients diagnosed with CFS, 278 were eligible and willing to take part. 93 were randomly assigned CBT (administered by 13 therapists recently trained in this technique for CFS), 94 were assigned the support-group approach, and 91 the control natural course. Multidimensional assessments were done at baseline, 8 months, and 14 months. The primary outcome variables were fatigue severity (on the checklist individual strength) and functional impairment (on the sickness impact profile) at 8 and 14 months. Data were analysed by intention to treat.

FINDINGS: 241 patients had complete data (83 CBT, 80 support groups, 78 natural course) at 8 months. At 14 months CBT was significantly more effective than both control conditions for fatigue severity (CBT vs support groups 5.8 [2.2-9.4]; CBT vs natural course 5.6 [2.1-9.0]) and for functional impairment (CBT vs support groups 263 [38-488]; CBT vs natural course 222 [3-441]). Support groups were not more effective for CFS patients than the natural course. Among the CBT group, clinically significant improvement was seen in fatigue severity for 20 of 58 (35%), in Karnofsky performance status for 28 of 57 (49%), and self-rated improvement for 29 of 58 (50%). Prognostic factors for outcome after CBT were a higher sense of control predicting more improvement, and a passive activity pattern and focusing on bodily symptoms predicting less improvement.

INTERPRETATION: CBT was more effective than guided support groups and the natural course in a multicentre trial with many therapists. Our study showed a lower proportion of patients with improvement than CBT trials with a few highly skilled therapists.

Comment in:

Cognitive behaviour therapy for chronic fatigue syndrome. [Lancet. 2001]

Cognitive behaviour therapy for chronic fatigue syndrome. [Lancet. 2001]

Cognitive behaviour therapy for chronic fatigue syndrome. [Lancet. 2001]

Cognitive behaviour therapy for chronic fatigue syndrome. [Lancet. 2001]

ACP J Club. 2001 Sep-Oct;135(2):47.

Cognitive behaviour therapy for chronic fatigue syndrome. [Lancet. 2001]

Cognitive behaviour therapy for chronic fatigue syndrome. [Lancet. 2001]

 

Source: Prins JB, Bleijenberg G, Bazelmans E, Elving LD, de Boo TM, Severens JL, van der Wilt GJ, Spinhoven P, van der Meer JW. Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. Lancet. 2001 Mar 17;357(9259):841-7. http://www.ncbi.nlm.nih.gov/pubmed/11265953

 

Chronic fatigue syndrome: a woman’s dilemma

Abstract:

Chronic Fatigue Syndrome (CFS) is an illness characterized by fatigue with varying levels of disability. According to the Centers for Disease Control (CDC) there are 2 to 5 million people in the United States who suffer from CFS and a disproportionate number are women.

There are many theories of etiology of the condition and controversy has surrounded recommendations for diagnosis and treatment. CFS can mimic other diseases and women are doubly affected since many have comorbid conditions. While diagnoses and treatment are critical to the health of women, having the disease and coping with the symptoms may have a greater impact on their well-being and quality of life.

The authors report qualitative data describing the experience of having CFS (N = 22) and quantitative responses of 42 CFS sufferers reporting psychosocial factors. The psychosocial factors were measured by the Derogatis Stress Profile (DSP), Spielberger Trait-Anger Scale, Ways of Coping Survey, Profile of Moods States (POMS) Survey, and the Perceived Stress Scale. The findings indicate that CFS changes the lives of women who suffer with the disease and disrupts their relationships, careers, and perceptions of themselves.

 

Source: Tuck I, Wallace D. Chronic fatigue syndrome: a woman’s dilemma. Health Care Women Int. 2000 Jul-Aug;21(5):457-66. http://www.ncbi.nlm.nih.gov/pubmed/11261112

 

Chronic fatigue syndrome and fibromyalgia: clinical assessment and treatment

Abstract:

Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are closely related illnesses of uncertain etiology. This article reviews the research literature on these biobehavioral conditions, with an emphasis on explanatory models, clinical evaluation of comorbid psychiatric disorders, assessment of stress factors, pharmacologic and alternative therapies, and cognitive-behavioral treatment studies. Furthermore, clinical protocols suitable for professional practice are presented based on an integration of the authors’ clinical observations with published data. The article concludes with the recognition that mental health professionals can offer substantial help to these patients.

Copyright 2001 John Wiley & Sons, Inc.

 

Source: Friedberg F, Jason LA. Chronic fatigue syndrome and fibromyalgia: clinical assessment and treatment.  Clin Psychol. 2001 Apr;57(4):433-55. http://www.ncbi.nlm.nih.gov/pubmed/11255201

 

Short-term group therapy for patients with chronic fatigue syndrome

Abstract:

BACKGROUND: This study presents experiences of focused short-term group therapy for patients with chronic fatigue syndrome (CFS).

METHODS: Fourteen women diagnosed as CFS patients were randomly placed into two groups. The control group received group therapy 5 months after the first group. The project consisted of 10 group sessions of 1.5 h per week. Sense of coherence (SOC) was used for measuring coping resources, and self-rating scales of quality of life and of fatigue were compared before and after group therapy.

RESULTS: The most valuable aspect was the sharing of experiences. More than half of the patients also felt that the sessions had improved psychological well-being through adjustment of ambitions and improved coping with symptoms.

CONCLUSION: The study encourages further research. If group therapy is chosen as treatment for these patients, a longer period is recommended. A possible alternative is individualized short-term therapy adapted to each patient’s needs, problems and circumstances.

Copyright 2001 S. Karger AG, Basel

 

Source: Söderberg S, Evengård B. Short-term group therapy for patients with chronic fatigue syndrome. Psychother Psychosom. 2001 Mar-Apr;70(2):108-11. http://www.ncbi.nlm.nih.gov/pubmed/11244392