Original articleThe central role of cognitive processes in the perpetuation of chronic fatigue syndrome☆
Section snippets
Background
Chronic fatigue syndrome (CFS) is characterized by severe fatigue lasting longer than 6 months and leading to disability. A somatic explanation for the fatigue is lacking [1]. CFS is often considered to be one of the functional somatic syndromes (FSS) where patients report persistent symptoms while there is no known somatic substrate. All CFS patients have, aside from fatigue, additional symptoms. According to the US Centers for Disease Control criteria for CFS [2], a patient must report four
Models of perpetuating factors in CFS
One of the first models of CFS was developed by Wessely et al. [5]. Somatic attributions, depressive symptoms, and physical inactivity interacted and perpetuated symptoms. The vicious cycle of avoidance of activity in response to the fatigue, and the resulting physical deconditioning, was considered to be an important maintaining factor. It followed from this that patients had to become more physically active to reduce symptoms and disabilities. This became an important element of the
Findings from treatment studies aimed at changing the perpetuating factors
On the basis of the models of perpetuating factors behavioral interventions have been developed. Cognitive behavior therapy (CBT) and graded exercise therapy (GET) are most often used. In GET it is postulated that the graded exercise will improve the physical condition of patients which ameliorates symptoms and will enable patients to become more physically active. CBT is not only aimed at the gradual increase of activity levels but also at changing cognitions [11].
Systematic reviews report
Discrepancies between patients' subjective beliefs about their functioning and their objective performance
Other studies have looked at the role of cognitive processes in CFS by testing the discrepancy between the actual performance or functioning of patients and their own evaluation of this performance. If negative beliefs about symptoms and the ability to be active are indeed central to the perpetuation of CFS, one would expect to see such a discrepancy [7].
Most CFS patients report neuropsychological symptoms including difficulty concentrating and forgetfulness. However, only a small minority of
Neurobiological correlates of CFS and its relationship with perpetuating factors
Although until now no consistent somatic impairment has been found in CFS, a recent and promising line of research has looked at possible neurobiological abnormalities associated with CFS. The findings support the idea of the important role of cognitive processes in CFS. De Lange et al. [35] compared brain activity patterns in patients with CFS and those in healthy controls when they were performing the same tasks. They found that areas in the brain that play a role in evaluating the emotional
Discussion
There is evidence of a disorder in cognitive processes in CFS. We hypothesize that three different cognitive processes play a crucial role in the perpetuation of CFS. The first is a general cognitive representation or schema of the illness that gets activated in a wide range of situations. In this representation fatigue is continuously perceived as something negative and aversive [17]. CFS is seen as an illness with a substantial impact on life that is difficult to influence [37]. This last
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2019, Journal of Psychosomatic ResearchCitation Excerpt :In this study we investigated the mediators of the initial positive effect of CBT on fatigue severity in QFS and the mediators of the relapse in fatigue at follow-up. Based on the aforementioned studies and the variables addressed in our CBT program for ME/CFS, we included the following cognitive-behavioural variables as possible mediators [29–33,36–38]: catastrophizing beliefs in response to fatigue, focusing on bodily symptoms, self-efficacy with respect to fatigue and to performing activities, damaging beliefs, fear avoidance beliefs, resting/avoidance, all-or-nothing behaviour, problems with sleeping/resting, and the objective physical activity level. This study assesses whether cognitive-behavioural variables mediate the initial treatment response to CBT in QFS patients and the relapse of fatigue after completion of treatment.
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This article was written while the first author was a visiting staff member of the School of Psychology at the University of Southampton. The working visit was made possible by a grant of the Dutch MSresearch fund (Stichting MSresearch).