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Campbell MJ, Cregan SC, Joyce JM, Kowal M, Toth AJ. Comparing the cognitive performance of action video game players and age-matched controls following a cognitively fatiguing task: A stage 2 registered report. Br J Psychol 2024; 115:363-385. [PMID: 38140897 DOI: 10.1111/bjop.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Recent work demonstrates that those who regularly play action video games (AVGs) consistently outperform non-gamer (NG) controls on tests of various cognitive abilities. AVGs place high demands on several cognitive functions and are often engaged with for long periods of time (e.g., over 2 h), predisposing players to experiencing cognitive fatigue. The detrimental effects of cognitive fatigue have been widely studied in various contexts where accurate performance is crucial, including aviation, military, and sport. Even though AVG players may be prone to experiencing cognitive fatigue, this topic has received little research attention to date. In this study, we compared the effect of a cognitively fatiguing task on the subsequent cognitive performance of action video game players and NG control participants. Our results indicated AVGs showed superior spatial working memory and complex attention abilities while showing no difference from NGs on simple attention performance. Additionally, we found that our cognitive fatigue and control interventions did not differentially affect the cognitive performance of AVGs and NGs in this study. This pre-registered study provides evidence that AVGs show superior cognitive abilities in comparison to a non-gaming population, but do not appear more resilient to cognitive fatigue.
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Affiliation(s)
- Mark J Campbell
- Lero, the Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Sarah C Cregan
- Lero, the Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - John M Joyce
- Lero, the Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Magdalena Kowal
- Lero, the Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Adam J Toth
- Lero, the Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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2
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Nadinda PG, van Laarhoven AIM, Van den Bergh O, Vlaeyen JWS, Peters ML, Evers AWM. Expectancies and avoidance: Towards an integrated model of chronic somatic symptoms. Neurosci Biobehav Rev 2024; 164:105808. [PMID: 38986893 DOI: 10.1016/j.neubiorev.2024.105808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/23/2024] [Accepted: 07/07/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Putu Gita Nadinda
- Leiden University, the Netherlands; Maastricht University, the Netherlands.
| | | | | | - Johan W S Vlaeyen
- Maastricht University, the Netherlands; Katholieke Universiteit Leuven, Belgium
| | | | - Andrea W M Evers
- Leiden University, the Netherlands; Medical Delta, Leiden University, Technical University Delft, and Erasmus University Rotterdam, the Netherlands
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3
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Radmanesh D, Powell E, Trinh H. Too tired to think: Relationship between post-COVID-19 fatigue and cognition in a veteran sample. Neuropsychol Rehabil 2024; 34:823-844. [PMID: 37584412 DOI: 10.1080/09602011.2023.2244159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/26/2023] [Indexed: 08/17/2023]
Abstract
COVID-19 survivors often endorse persistent physical and neuropsychiatric problems following disease recovery, a phenomenon described as "long COVID." Research exploring long-COVID continues to evolve in large-scale studies but remains limited among smaller populations (e.g., veterans). We explored the relationship between persistent post-COVID-19 fatigue and cognition among a sample of 246 veterans who voluntarily enrolled in a COVID-19 Convalescence Programme and completed a mental health evaluation of post-illness mood (depression, anxiety, PTSD), cognition (subjective complaints, Modified Telephone Interview for Cognitive Status [TICS-M] performance), fatigue, pain, and sleep. In concert with our hypotheses, subjective cognitive complaints are not significantly correlated with TICS-M performance, but rather are strongly correlated with long-COVID fatigue. Although cognitive changes are common post-COVID complaints, these are likely better predicted by other factors, (e.g., fatigue, mood, pain, and sleep disruption). Furthermore, comorbid mood, sleep, and pain complaints appeared to mediate the relationship between subjective cognitive complaints and fatigue. Limitations to this study included use of retrospective chart review data, limited access to pre-disease data for comparison, and lack of healthy controls. Clinicians should consider the impact of modifiable conditions associated with cognitive and functional decline, as these conditions may be targets for interdisciplinary treatment in a long-COVID veteran population.
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Affiliation(s)
| | - Eric Powell
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Hanh Trinh
- South Texas Veterans Health Care System, San Antonio, TX, USA
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4
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Wormgoor MEA, Rodenburg SC. Focus on post-exertional malaise when approaching ME/CFS in specialist healthcare improves satisfaction and reduces deterioration. Front Neurol 2023; 14:1247698. [PMID: 38107643 PMCID: PMC10722442 DOI: 10.3389/fneur.2023.1247698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/31/2023] [Indexed: 12/19/2023] Open
Abstract
Background Post-exertional malaise (PEM) is considered a hallmark characteristic of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This may also apply to subgroups of patients with long COVID-induced ME/CFS. However, it is uncertain to what extent PEM is acknowledged in routine specialist healthcare for ME/CFS patients, and how this affects patient outcomes. Objective This study aims to evaluate to what extent ME/CFS patients experienced focus on PEM in specialist healthcare practice and its significance for outcome and care quality. Methods Data from two online cross-sectional surveys covering specialist healthcare services for ME/CFS patients at rehabilitation institutes in Norway and two regional hospitals, respectively, were analyzed. Evaluations of 788 rehabilitation stays, 86 hospital consultations, and 89 hospital interventions were included. Logistic regression models and Mann-Whitney U-tests were used to quantify the impact of addressing PEM on health and functioning, care satisfaction, or benefit. Spearman's rank correlation and Cronbach's alpha of focus on PEM with the respondents' perception of healthcare providers' knowledge, symptom acknowledgment, and suitability of intervention were assessed as measures for care quality and their internal consistency, respectively. Results PEM was addressed in 48% of the rehabilitation stays, 43% of the consultations, and 65% of the hospital interventions. Failure to address PEM roughly doubled the risk of health deterioration, following rehabilitation (OR = 0.39, 95% CI 0.29-0.52; 40.1% vs. 63.2% P = <0.001) and hospital intervention (OR = 0.34, 95% CI 0.13-0.89; 22.4% vs. 45.2%, p = 0.026). The focus on PEM (PEM-focus) during the clinical contact was associated with significantly higher scores on patients' rated care satisfaction and benefit of both consultation and intervention. Furthermore, addressing PEM was (inter)related to positive views about healthcare providers' level of knowledge of ME/CFS, their acknowledgment of symptoms, obtained knowledge, and the perceived suitability of intervention (Cronbach's alpha ≥0.80). Discussion PEM is still frequently not acknowledged in specialist healthcare practice for ME/CFS patients in Norway. Not addressing PEM substantially increased the probability of a decline in health and functioning following the intervention and was strongly associated with reduced perceived care quality, satisfaction, and benefit. These findings may be related to the applied explanatory models for ME/CFS and are most likely of relevance to long COVID.
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Affiliation(s)
| | - Sanne C. Rodenburg
- Neuroscience and Cognition, Graduate School of Life Sciences, Faculty of Medicine, Utrecht University, Utrecht, Netherlands
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5
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Vroegindeweij A, Levelt L, Houtveen J, Van de Putte EM, Wulffraat NM, Swart JF, Nijhof SL. Dynamic modeling of experience sampling methodology data reveals large heterogeneity in biopsychosocial factors associated with persistent fatigue in young people living with a chronic condition. J Psychosom Res 2023; 167:111195. [PMID: 36801659 DOI: 10.1016/j.jpsychores.2023.111195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To evaluate associations between self-reported biopsychosocial factors and persistent fatigue with dynamic single-case networks. METHODS 31 persistently fatigued adolescents and young adults with various chronic conditions (aged 12 to 29 years) completed 28 days of Experience Sampling Methodology (ESM) with five prompts per day. ESM surveys consisted of eight generic and up to seven personalized biopsychosocial factors. Residual Dynamic Structural Equation Modeling (RDSEM) was used to analyze the data and derive dynamic single-case networks, controlling for circadian cycle effects, weekend effects, and low-frequency trends. Networks included contemporaneous and cross-lagged associations between biopsychosocial factors and fatigue. Network associations were selected for evaluation if both significant (α < 0.025) and relevant (β ≥ 0.20). RESULTS Participants chose 42 different biopsychosocial factors as personalized ESM items. In total, 154 fatigue associations with biopsychosocial factors were found. Most associations were contemporaneous (67.5%). Between chronic condition groups, no significant differences were observed in the associations. There were large inter-individual differences in which biopsychosocial factors were associated with fatigue. Contemporaneous and cross-lagged associations with fatigue varied widely in direction and strength. CONCLUSIONS The heterogeneity found in biopsychosocial factors associated with fatigue underlines that persistent fatigue stems from a complex interplay between biopsychosocial factors. The present findings support the need for personalized treatment of persistent fatigue. Discussing the dynamic networks with the participant can be a promising step towards tailored treatment. TRIAL REGISTRATION No. NL8789 (http://www.trialregister.nl).
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Affiliation(s)
- Anouk Vroegindeweij
- Department of Paediatric Rheumatology/Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Lisa Levelt
- Department of Experimental Psychology, Utrecht University, Utrecht, the Netherlands.
| | - Jan Houtveen
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elise M Van de Putte
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Nico M Wulffraat
- Department of Paediatric Rheumatology/Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Joost F Swart
- Department of Paediatric Rheumatology/Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Sanne L Nijhof
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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6
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Petersen MW, Carstensen TBW, Frostholm L, Wellnitz KB, Ørnbøl E, Jørgensen T, Eplov LF, Dantoft TM, Fink P. High Perceived Stress and Low Self-Efficacy are Associated with Functional Somatic Disorders: The DanFunD Study. Clin Epidemiol 2023; 15:407-419. [PMID: 37008745 PMCID: PMC10065012 DOI: 10.2147/clep.s399914] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Objective Several psychological factors have been proposed to be associated with functional somatic disorders (FSD) including functional somatic syndromes, such as irritable bowel, chronic widespread pain, and chronic fatigue. However, large randomly selected population-based studies of this association are sparse. This study aimed to investigate the association between FSD and perceived stress and self-efficacy, respectively, and to investigate if FSD differed from severe physical diseases on these aspects. Methods This cross-sectional study included a random sample of the adult Danish population (n = 9656). FSD were established using self-reported questionnaires and diagnostic interviews. Perceived stress was measured with Cohen's Perceived Stress Scale and self-efficacy with the General Self-Efficacy Scale. Data were analysed with generalized linear models and linear regression models. Results FSD were associated with higher perceived stress and lower self-efficacy, especially for the multi-organ and the general symptoms/fatigue FSD types and for chronic fatigue. However, controlling for the personality trait neuroticism altered the associations with self-efficacy so it became insignificant. The analysis did not support an important interaction between perceived stress and self-efficacy on the likelihood of having FSD. Individuals with FSD presented levels of perceived stress that were not equal, ie higher, to those in individuals with severe physical diseases. Conclusion FSD were positively associated with perceived stress and negatively associated with self-efficacy. Our study may point to stress being part of the symptomatology of FSD. This underlines the severity of having FSD and stresses the relevance of the resilience theory in the understanding of the condition.
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Affiliation(s)
- Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
- Correspondence: Marie Weinreich Petersen, Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, Aarhus, 8200, Denmark, Tel +45 7846 4310, Email
| | - Tina Birgitte Wisbech Carstensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Kaare Bro Wellnitz
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg/Frederiksberg Hospital, Frederiksberg, Capital Region, Denmark
- Department of Public Health, Faculty of Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Center for Mental Health – CORE, Mental Health Centre Copenhagen, Copenhagen, Capital Region, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg/Frederiksberg Hospital, Frederiksberg, Capital Region, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
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7
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Gotaas ME, Landmark T, Helvik AS, Fors EA. Characteristics associated with physical functioning and fatigue in patients with chronic fatigue syndrome (CFS): secondary analyses of a randomized controlled trial. FATIGUE: BIOMEDICINE, HEALTH & BEHAVIOR 2023. [DOI: 10.1080/21641846.2023.2175521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Merethe Eide Gotaas
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- National Competence Centre for Complex Symptom Disorders, St. Olav’s University Hospital, Trondheim, Norway
| | - Tormod Landmark
- National Competence Centre for Complex Symptom Disorders, St. Olav’s University Hospital, Trondheim, Norway
| | - Anne S. Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Egil A. Fors
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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8
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Performance Validity and Outcome of Cognitive Behavior Therapy in Patients with Chronic Fatigue Syndrome. J Int Neuropsychol Soc 2022; 28:473-482. [PMID: 34130768 DOI: 10.1017/s1355617721000643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is limited research examining the impact of the validity of cognitive test performance on treatment outcome. All known studies to date have operationalized performance validity dichotomously, leading to the loss of predictive information. Using the range of scores on a performance validity test (PVT), we hypothesized that lower performance at baseline was related to a worse treatment outcome following cognitive behavioral therapy (CBT) in patients with Chronic Fatigue Syndrome (CFS) and to lower adherence to treatment. METHOD Archival data of 1081 outpatients treated with CBT for CFS were used in this study. At baseline, all patients were assessed with a PVT, the Amsterdam Short-Term Memory test (ASTM). Questionnaires assessing fatigue, physical disabilities, psychological distress, and level of functional impairment were administered before and after CBT. RESULTS Our main hypothesis was not confirmed: the total ASTM score was not significantly associated with outcomes at follow-up. However, patients with a missing follow-up assessment had a lower ASTM performance at baseline, reported higher levels of physical limitations, and completed fewer therapy sessions. CONCLUSIONS CFS patients who scored low on the ASTM during baseline assessment are more likely to complete fewer therapy sessions and not to complete follow-up assessment, indicative of limited adherence to treatment. However, if these patients were retained in the intervention, their response to CBT for CFS was comparable with subjects who score high on the ASTM. This finding calls for more research to better understand the impact of performance validity on engagement with treatment and outcomes.
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9
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Albers E, Nijhof LN, Berkelbach van der Sprenkel EE, van de Putte EM, Nijhof SL, Knoop H. Effectiveness of Internet-Based Cognitive Behavior Therapy (Fatigue in Teenagers on the Internet) for Adolescents With Chronic Fatigue Syndrome in Routine Clinical Care: Observational Study. J Med Internet Res 2021; 23:e24839. [PMID: 34397389 PMCID: PMC8398746 DOI: 10.2196/24839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/23/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background Internet-based cognitive behavior therapy (I-CBT) for adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has been shown to be effective in a randomized controlled trial (RCT; Fatigue in Teenagers on the Internet [FITNET]). FITNET can cause a significant reduction in fatigue and disability. Objective We aimed to investigate whether FITNET treatment implemented in routine clinical care (IMP-FITNET) was as effective, using the outcomes of the FITNET RCT as the benchmark. Methods Outcomes of CFS/ME adolescents who started IMP-FITNET between October 2012 and March 2018 as part of routine clinical care were compared to the outcomes in the FITNET RCT. The primary outcome was fatigue severity assessed posttreatment. The secondary outcomes were self-reported physical functioning, school attendance, and recovery rates. Clinically relevant deterioration was assessed posttreatment, and for this outcome, a face-to-face CBT trial was used as the benchmark. The attitude of therapists toward the usability of IMP-FITNET was assessed through semistructured interviews. The number of face-to-face consultations during IMP-FITNET was registered. Results Of the 384 referred adolescents with CFS/ME, 244 (63.5%) started IMP-FITNET, 84 (21.9%) started face-to-face CBT, and 56 (14.6%) were not eligible for CBT. Posttreatment scores for fatigue severity (mean 26.0, SD 13.8), physical functioning (mean 88.2, SD 15.0), and full school attendance (mean 84.3, SD 26.5) fell within the 95% CIs of the FITNET RCT. Deterioration of fatigue and physical functioning after IMP-FITNET was observed at rates of 1.2% (n=3) and 4.1% (n=10), respectively, which is comparable to a waiting list condition (fatigue: 1.2% vs 5.7%, χ21=3.5, P=.06; physical functioning: 4.1% vs 11.4%, χ21=3.3, P=.07). Moreover, 41 (16.8%) IMP-FITNET patients made use of face-to-face consultations. Conclusions IMP-FITNET is an effective and safe treatment for adolescents with CFS/ME in routine clinical care.
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Affiliation(s)
- Eline Albers
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Linde N Nijhof
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Elise M van de Putte
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sanne L Nijhof
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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10
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Kallesøe KH, Rimvall MK, Schröder A, Jensen JS, Wicksell RK, Rask CU. Adolescents with functional somatic syndromes: Symptom profiles, illness perception, illness worry and attachment orientation. J Psychosom Res 2021; 145:110430. [PMID: 33810861 DOI: 10.1016/j.jpsychores.2021.110430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Karen Hansen Kallesøe
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Martin K Rimvall
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark; Department of Child and Adolescent Psychiatry, Psychiatry Region Zealand, Roskilde, Denmark
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Jens Søndergaard Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Ulrikka Rask
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
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11
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Hyland KA, Nelson AM, Eisel SL, Hoogland AI, Ibarz-Pinilla J, Sweet K, Jacobsen PB, Knoop H, Jim HSL. Fatigue Perpetuating Factors as Mediators of Change in a Cognitive Behavioral Intervention for Targeted Therapy-Related Fatigue in Chronic Myeloid Leukemia: A Pilot Study. Ann Behav Med 2021; 56:137-145. [PMID: 33991085 DOI: 10.1093/abm/kaab035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy for targeted-therapy related fatigue (CBT-TTF) has demonstrated preliminary efficacy in reducing fatigue in patients treated with tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML). PURPOSE The aim of the current analyses was to explore whether fatigue perpetuating factors (disturbed sleep/wake cycle, dysregulated activity patterns, maladaptive cognitions about fatigue and cancer, insufficient processing of cancer and treatment, inadequate social support and interactions, heightened fear of cancer progression) changed over time in patients receiving CBT-TTF, and whether the effect of CBT-TTF on fatigue was mediated by these factors. METHODS Secondary data analyses were conducted from a pilot randomized controlled trial. Patients with CML treated with a TKI who reported moderate to severe fatigue were randomized 2:1 to CBT-TTF delivered via FaceTime for iPad or a waitlist control condition (WLC). Self-report measures of fatigue and fatigue perpetuating factors were obtained before randomization and post-intervention (i.e., approximately 18 weeks later). Mixed model and mediation analyses using bootstrap methods were used. RESULTS A total of 36 participants (CBT-TTF n = 22, WLC n = 14) who had baseline and 18-week follow-up data and attended >5 sessions for CBT-TTF were included. Participants randomized to CBT-TTF reported improvements in activity (mental, physical, social, p's ≤ .023) and cognitions (helplessness, catastrophizing, focusing on symptoms, self-efficacy, p's ≤ .003) compared to WLC. Mental activity, social activity, self-efficacy, helplessness, and focusing on symptoms, as well as sleep and insufficient processing (avoidance) mediated the relationship between treatment group and fatigue. CONCLUSIONS CBT-TTF appears to improve TKI-related fatigue in CML patients through changes in behavior (sleep, activity patterns) and cognitions about fatigue and cancer. A larger randomized controlled trial is warranted to confirm these findings.
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Affiliation(s)
- Kelly A Hyland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Ashley M Nelson
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Sarah L Eisel
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Kendra Sweet
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
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12
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Müller F, Wijayanto F, Abrahams H, Gielissen M, Prinsen H, Braamse A, van Laarhoven HWM, Groot P, Heskes T, Knoop H. Potential mechanisms of the fatigue-reducing effect of cognitive-behavioral therapy in cancer survivors: Three randomized controlled trials. Psychooncology 2021; 30:1476-1484. [PMID: 33899978 PMCID: PMC8518952 DOI: 10.1002/pon.5710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Fatigue is a common symptom among cancer survivors that can be successfully treated with cognitive-behavioral therapy (CBT). Insights into the working mechanisms of CBT are currently limited. The aim of this study was to investigate whether improvements in targeted cognitive-behavioral variables and reduced depressive symptoms mediate the fatigue-reducing effect of CBT. METHODS We pooled data from three randomized controlled trials that tested the efficacy of CBT to reduce severe fatigue. In all three trials, fatigue severity (checklist individual strength) decreased significantly following CBT. Assessments were conducted pre-treatment and 6 months later. Classical mediation analysis testing a pre-specified model was conducted and its results compared to those of causal discovery, an explorative data-driven approach testing all possible causal associations and retaining the most likely model. RESULTS Data from 250 cancer survivors (n = 129 CBT, n = 121 waitlist) were analyzed. Classical mediation analysis suggests that increased self-efficacy and decreased fatigue catastrophizing, focusing on symptoms, perceived problems with activity and depressive symptoms mediate the reduction of fatigue brought by CBT. Conversely, causal discovery and post-hoc analyses indicate that fatigue acts as mediator, not outcome, of changes in cognitions, sleep disturbance and depressive symptoms. CONCLUSIONS Cognitions, sleep disturbance and depressive symptoms improve during CBT. When assessed pre- and post-treatment, fatigue acts as a mediator, not outcome, of these improvements. It seems likely that the working mechanism of CBT is not a one-way causal effect but a dynamic reciprocal process. Trials integrating intermittent assessments are needed to shed light on these mechanisms and inform optimization of CBT.
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Affiliation(s)
- Fabiola Müller
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Faculty of Science, School of Psychology, The University of Sydney, Sydney, Australia
| | - Feri Wijayanto
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands.,Department of Informatics, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - Harriët Abrahams
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marieke Gielissen
- Academy Het Dorp, Arnhem, The Netherlands.,Siza (disability service) Arnhem, Arnhem, The Netherlands
| | - Hetty Prinsen
- Department of Medical Oncology, Radboud University, Nijmegen, The Netherlands
| | - Annemarie Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Perry Groot
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam University Medical Centers, Expert Center for Chronic Fatigue, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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13
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Worm-Smeitink M, Monden R, Groen RN, van Gils A, Bekhuis E, Rosmalen J, Knoop H. Towards personalized assessment of fatigue perpetuating factors in patients with chronic fatigue syndrome using ecological momentary assessment: A pilot study. J Psychosom Res 2021; 140:110296. [PMID: 33264751 DOI: 10.1016/j.jpsychores.2020.110296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to explore the associations between cognitions, behaviours and affects and fatigue in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and their relation to reduction of fatigue after cognitive behaviour therapy (CBT). METHODS In CFS/ME patients, 22 behaviours, cognitions and affects, potentially perpetuating fatigue were registered 5 times a day using ecological momentary assessment (EMA) and an actigraphy. Simultaneous Components Analysis (SCA) was used to identify components of perpetuation, that were tested for their associations with fatigue in multilevel vector autoregressive (VAR) modelling. Fatigue severity was measured pre- and posttreatment with the Checklist Individual Strength. The relationship between perpetuation (the strength and direction of the possible associations between fatigue and the components) and therapy outcome was investigated. RESULTS 58 patients met inclusion criteria (m age = 36.5; 65.5% female) and data of 50 patients were analysed in the multilevel analysis. Two perpetuating components were found: "psychological discomfort" and "activity". For the total group, both perpetuating components did not predict fatigue on a following time-point. For individual patients the strength and direction of the associations varied. None of the associations between perpetuating components and fatigue significantly predicted treatment outcome. CONCLUSION Results suggest that there is heterogeneity in perpetuation of fatigue in CFS/ME. Investigating fatigue and perpetuators on an individual rather than group level could lead to new insights.
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Affiliation(s)
- Margreet Worm-Smeitink
- Expert Center for Chronic Fatigue, Department of Medical Psychology, University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Rei Monden
- University of Groningen, University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Netherlands
| | - Robin Nikita Groen
- University of Groningen, University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Netherlands
| | - Anne van Gils
- University of Groningen, University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Netherlands
| | - Ella Bekhuis
- University of Groningen, University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Netherlands
| | - Judith Rosmalen
- University of Groningen, University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Netherlands
| | - Hans Knoop
- Expert Center for Chronic Fatigue, Department of Medical Psychology, University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands.
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14
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Braamse A, Voss H, Nikolaus S, Wearden A, Knoop H. The role of partners' fatigue and the patient-partner relationship in the outcome of cognitive behavioural therapy for chronic fatigue syndrome. J Psychosom Res 2020; 135:110133. [PMID: 32450339 DOI: 10.1016/j.jpsychores.2020.110133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND In chronic fatigue syndrome (CFS) little is known about how partner-related factors influence patients' fatigue symptoms and treatment outcome. We examined partners' fatigue severity, and determined the role of partner-related factors for patients' symptoms and the outcome of cognitive behavioural therapy (CBT). METHODS 1356 CFS patients and their partners completed baseline measures of fatigue severity (Checklist Individual Strength), causal attributions of symptoms, partner responses to patient symptoms, and relationship satisfaction. Fatigue in partners of patients with CFS was compared with fatigue in age- and gender-matched controls from the Dutch population. Associations between partners' fatigue severity and other partner-related factors were determined. In a subgroup of 760 CFS patients who completed CBT, logistic regression analyses were used to identify partner-related baseline predictors for treatment outcome (fatigue severity, functional impairment). RESULTS Partners' fatigue (M = 21.66, SD 11.60) was significantly lower than in controls (M = 24.58, SD = 11.02) (p < .001) and not related to patients' fatigue (r = -0.02, p = .58). Partners' fatigue was correlated with patients' functional impairment (p = .001), partners' and patients' relationship dissatisfaction, negative partner responses, and partners' and patients' psychological attributions of patient symptoms at baseline (all p < .001). After controlling for patients' baseline fatigue severity and functional impairment, only relationship dissatisfaction as reported by (female) patients significantly predicted worse treatment outcome. For male patients with female partners, higher partners' fatigue severity predicted higher fatigue severity after CBT. CONCLUSIONS Female partners' fatigue and relationship dissatisfaction as reported by the female patient should be addressed in CBT for CFS, as these factors affect treatment outcome.
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Affiliation(s)
- Annemarie Braamse
- Amsterdam UMC, University of Amsterdam, department of Medical Psychology, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, Netherlands.
| | - Hille Voss
- Expert Center for Chronic Fatigue, Amsterdam UMC, VU University Amsterdam, department of Medical Psychology, De Boelelaan 1117, Amsterdam, Netherlands.
| | - Stephanie Nikolaus
- Expert Center for Chronic Fatigue, Amsterdam UMC, VU University Amsterdam, department of Medical Psychology, De Boelelaan 1117, Amsterdam, Netherlands.
| | - Alison Wearden
- School of Health Sciences, University of Manchester, Manchester, United Kingdom.
| | - Hans Knoop
- Amsterdam UMC, University of Amsterdam, department of Medical Psychology, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, Netherlands; Expert Center for Chronic Fatigue, Amsterdam UMC, VU University Amsterdam, department of Medical Psychology, De Boelelaan 1117, Amsterdam, Netherlands.
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15
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Geraghty K. The negative impact of the psychiatric model of chronic fatigue syndrome on doctors’ understanding and management of the illness. FATIGUE: BIOMEDICINE, HEALTH & BEHAVIOR 2020. [DOI: 10.1080/21641846.2020.1834295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Keith Geraghty
- Centre for Primary Care, The University of Manchester, Manchester, UK
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16
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Sullivan N, Phillips LA, Pigeon WR, Quigley KS, Graff F, Litke DR, Helmer DA, Rath JF, McAndrew LM. Coping with Medically Unexplained Physical Symptoms: the Role of Illness Beliefs and Behaviors. Int J Behav Med 2020; 26:665-672. [PMID: 31701389 DOI: 10.1007/s12529-019-09817-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Medically unexplained syndromes (MUS) are both prevalent and disabling. While illness beliefs and behaviors are thought to maintain MUS-related disability, little is known about which specific behavioral responses to MUS are related to disability or the way in which beliefs and behaviors interact to impact functioning. The purpose of the present study was to examine the relationship between illness beliefs and disability among patients with MUS, and assess the extent to which behaviors mediate this relationship. METHODS The study examined data from the baseline assessment of a multi-site randomized controlled trial (RCT). Participants were 248 veterans with MUS. Illness beliefs, behavioral responses to illness, and disability were assessed through self-report questionnaire. Data were analyzed using mediation analysis. RESULTS Threat-related beliefs predicted greater disability through decreased activity and increased practical support seeking. Protective beliefs predicted less disability through reductions in all-or-nothing behavior and limiting behavior. CONCLUSIONS These outcomes suggest that all-or-nothing behavior, limiting behavior, and practical support seeking are important in the perpetuation of disability among those with MUS. This has implications for improving MUS treatment by highlighting potential treatment targets. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02161133.
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Affiliation(s)
- Nicole Sullivan
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA.
| | | | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA
| | - Karen S Quigley
- Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, 01730, USA.,Department of Psychology, Northeastern University, Boston, MA, 02115, USA
| | - Fiona Graff
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - David R Litke
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA.,Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Drew A Helmer
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA.,Department of Medicine, Rutgers University- New Jersey Medical School, Newark, NJ, USA
| | - Joseph F Rath
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA.,Rusk Institute of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA.,Department of Educational and Counseling Psychology, University at Albany, 1400 Washington Ave Ext, Albany, NY, 12222, USA
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17
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Wolf J, Sattel H, Limburg K, Lahmann C. From illness perceptions to illness reality? Perceived consequences and emotional representations relate to handicap in patients with vertigo and dizziness. J Psychosom Res 2020; 130:109934. [PMID: 31972479 DOI: 10.1016/j.jpsychores.2020.109934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/11/2020] [Accepted: 01/11/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Vertigo and dizziness (VD) are frequent symptoms that can occur due to various structural pathologies or due to functional impairment. Independent of their aetiology, the symptoms are often associated with physical and psychological burden which manifests in severe handicap in more than half of the patients. It is suggested that illness perceptions, the patients' cognitive and emotional concept of their disease, most likely impact the degree of handicap. For patients with VD, however, this relation of illness perceptions and handicap is so far not well understood. This study aimed to investigate the relation of illness perceptions and handicap for patients with VD. METHODS In a cross-sectional study design, n = 419 patients with VD were examined (53.7% female, age 53.5 ± 15.5 years). Participants underwent neurological and psychiatric examinations as well as a comprehensive assessment using self-report questionnaires. RESULTS Illness perceptions, specifically perceived consequences and emotional representations showed a moderate correlation with VD related handicap (r(419) = 0.62, p < .001). Our regression model including symptom severity, psychiatric comorbidity, and aspects of cognitive and emotional illness perceptions accounted for 52% of the variance in VD related handicap. In a moderation analysis, this relation did not differ significantly in patients with functional VD symptoms. CONCLUSION Findings of the present study provide evidence for the relevance of illness perceptions to handicap in patients with VD symptoms.
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Affiliation(s)
- Johannes Wolf
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-Universität Freiburg, Hauptstraße 8, 79104 Freiburg, Germany.
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karina Limburg
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-Universität Freiburg, Hauptstraße 8, 79104 Freiburg, Germany
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18
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Geraghty K, Scott MJ. Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified. BMC Psychol 2020; 8:13. [PMID: 32020880 PMCID: PMC7001321 DOI: 10.1186/s40359-020-0380-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 01/24/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Improving Access to Psychological Therapies is a UK Government funded initiative to widen access to psychological treatment for a range of common mental health complaints, such as depression and anxiety. More recently, the service has begun to treat patients with medically unexplained symptoms. This paper reports on a review of treatment protocols and early treatment data for medically unexplained symptoms, specifically the illness myalgic encephalomyelitis/chronic fatigue syndrome. MAIN TEXT A series of seven core problems and failings are identified, including an unproven treatment rationale, a weak and contested evidence-base, biases in treatment promotion, exaggeration of recovery claims, under-reporting of drop-out rates, and a significant risk of misdiagnosis and inappropriate treatment. CONCLUSIONS There is a pressing need for independent oversight of this service, specifically evaluation of service performance and methods used to collect and report treatment outcomes. This service offers uniform psycho-behavioural therapy that may not meet the needs of many patients with medically unexplained health complaints. Psychotherapy should not become a default when patients' physical symptoms remain unexplained, and patients should be fully informed of the rationale behind psychotherapy, before agreeing to take part. Patients who reject psychotherapy or do not meet selection criteria should be offered appropriate medical and psychological support.
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Affiliation(s)
- Keith Geraghty
- Centre for Primary Care, Division of Health Sciences and Population Health, University of Manchester, Manchester, UK
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19
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Breukers EMC, Raijmakers RPH, Nieuwkerk PT, Bleijenberg G, van der Meer JWM, Bleeker-Rovers CP, Keijmel SP, Knoop H. Mediation analysis shows that a decline in self-efficacy mediates the increase in fatigue severity following an initial positive response to cognitive behavioural therapy in Q fever fatigue syndrome. J Psychosom Res 2019; 127:109841. [PMID: 31734556 DOI: 10.1016/j.jpsychores.2019.109841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/21/2019] [Accepted: 09/25/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Q fever fatigue syndrome (QFS) is characterized by chronic fatigue following acute Q fever. Previously, it was shown that cognitive behavioural therapy (CBT), and not doxycycline, was significantly more effective than placebo in reducing fatigue severity in QFS patients. However, this effect was not maintained after one year. The aim of this study is to elucidate the cognitive and behavioural variables which mediate the positive effect of CBT on fatigue during the treatment and the relapse of fatigue after completion of CBT, by using multiple mediation analysis. METHODS Additional analyses were performed on data of a randomized controlled trial that investigated the efficacy of CBT and antibiotics compared to placebo for QFS [1]. Only those patients in the CBT group who completed the allocated CBT treatment, and those patients in the medication group who did not follow additional CBT during follow-up, were included in this study. Two mediation models were tested, using respectively assessments at baseline and end-of-treatment (EOT), and EOT and follow-up, comparing the CBT group (n = 43) with the medication group (n = 89). RESULTS During treatment, the decrease in fatigue brought on by CBT was completely mediated by an increase in self-efficacy with respect to fatigue. A reduction in self-efficacy partly mediated the increase in fatigue at follow-up in the CBT group. CONCLUSIONS Given the decline in self efficacy, booster sessions focussing on restoration and maintenance of self-efficacy with respect to fatigue, may lead to elongation of the initial positive effects of CBT for QFS.
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Affiliation(s)
- Evi M C Breukers
- Radboud Expert Centre for Q Fever, Radboud university medical center Nijmegen, the Netherlands.
| | - Ruud P H Raijmakers
- Radboud Expert Centre for Q Fever, Radboud university medical center Nijmegen, the Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center Nijmegen, the Netherlands.
| | - P T Nieuwkerk
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, the Netherlands.
| | - Gijs Bleijenberg
- Radboud Expert Centre for Q Fever, Radboud university medical center Nijmegen, the Netherlands.
| | - Jos W M van der Meer
- Radboud Expert Centre for Q Fever, Radboud university medical center Nijmegen, the Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center Nijmegen, the Netherlands.
| | - Chantal P Bleeker-Rovers
- Radboud Expert Centre for Q Fever, Radboud university medical center Nijmegen, the Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center Nijmegen, the Netherlands.
| | - Stephan P Keijmel
- Radboud Expert Centre for Q Fever, Radboud university medical center Nijmegen, the Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center Nijmegen, the Netherlands.
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, the Netherlands; Expert Centre for Chronic Fatigue, Department of Medical Psychology, Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands.
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20
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Řiháček T, Čevelíček M. Common therapeutic strategies in psychological treatments for medically unexplained somatic symptoms. Psychother Res 2019; 30:532-545. [PMID: 31345126 DOI: 10.1080/10503307.2019.1645370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: Medically unexplained somatic symptoms (MUSS) represent a frequent complaint in health care services. While psychological treatments have demonstrated some effect in patients with MUSS, further progress may be achieved by a synthesis of clinical strategies used in diverse treatment models. The aim of this study was to identify clinical strategies shared across multiple psychological treatments intended for the treatment of adult patients with MUSS. Method: Descriptions of psychological treatments for patients with MUSS were searched in the PsycINFO, PsycARTICLES, and Medline databases and manually. N = 135 resources met inclusion criteria and were subjected to qualitative analysis. Results: Similarities across treatments were captured in 8 broad categories and 18 subcategories that covered aspects of the therapeutic relationship, specific skills (bodily, emotional, and relational) for patients to develop, search for the meaning of symptoms, and the orientation on life beyond symptoms. Conclusions: Despite the differences in technique, it was possible to identify common therapeutic strategies in psychological treatments for patients with MUSS. These overarching treatment strategies, many of which have already obtained empirical support, may inspire further research and the development of comprehensive treatments with enhanced efficacy. Limitations of the present study include the lack of focus on specific syndromes.
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Affiliation(s)
- Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Michal Čevelíček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
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21
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Psychometric properties of the Cognitive and Behavioural Responses Questionnaire (CBRQ) in adolescents with chronic fatigue syndrome. Behav Cogn Psychother 2019; 48:160-171. [PMID: 31113527 DOI: 10.1017/s1352465819000390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To better understand the maintenance of chronic fatigue syndrome (CFS), a valid and reliable measure of cognitive and behavioural responses to symptoms is required. Such a measure could also assess beliefs and coping behaviours in the context of fatigue in other somatic conditions. AIMS We aimed to establish the psychometric properties of both the Cognitive and Behavioural Responses Questionnaire (CBRQ) and its shortened version (CBRQ-S) in adolescents with CFS. METHOD The full questionnaire was completed by a clinical cohort of adolescents (n = 121) presenting to specialist CFS units in the UK. RESULTS Both the CBRQ and CBRQ-S had good internal consistency. The CBRQ scores were strongly associated with depression, anxiety, school and social functioning, but weakly associated with fatigue and physical functioning, providing evidence of validity. CONCLUSION Both the 40-item and the 18-item versions of the CBRQ were found to be reliable and valid in adolescents with CFS. To minimize unnecessary burden, the 18-item version is favoured. Using this assessment tool in future studies, including intervention studies, may help to better target interventions during clinical practice and improve outcomes.
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22
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Geraghty K, Jason L, Sunnquist M, Tuller D, Blease C, Adeniji C. The 'cognitive behavioural model' of chronic fatigue syndrome: Critique of a flawed model. Health Psychol Open 2019; 6:2055102919838907. [PMID: 31041108 PMCID: PMC6482658 DOI: 10.1177/2055102919838907] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Chronic fatigue syndrome/myalgic encephalomyelitis is a debilitating illness that greatly impacts the lives of sufferers. A cognitive behavioural model attempts to explain illness onset and continuance with a hypothesis that the illness is perpetuated by patients' irrational beliefs and avoidance behaviours. This theory underpins the promotion of cognitive behavioural therapy, a treatment that aims to change beliefs and behaviours. This article reports on a detailed review of the cognitive behavioural model. Our review finds that the model lacks high-quality evidential support, conflicts with accounts given by most patients and fails to account for accumulating biological evidence of pathological and physiological abnormalities found in patients. There is little scientific credibility in the claim that psycho-behavioural therapies are a primary treatment for this illness.
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23
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van der Schaaf ME, Roelofs K, de Lange FP, Geurts DEM, van der Meer JWM, Knoop H, Toni I. Fatigue Is Associated With Altered Monitoring and Preparation of Physical Effort in Patients With Chronic Fatigue Syndrome. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:392-404. [PMID: 29628071 DOI: 10.1016/j.bpsc.2018.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is characterized by disabling fatigue, which is suggested to be maintained by dysfunctional beliefs. Fatigue and its maintenance are recently conceptualized as arising from abnormally precise expectations about bodily inputs and from beliefs of diminished control over bodily states, respectively. This study used functional neuroimaging to identify the neural correlates of fatigue and its maintenance by beliefs during a physical effort task. METHODS We isolated behavioral adjustments and cerebral activity during feedback processing and motor preparation, in the context of a task in which patients with CFS (n = 85) and healthy control subjects (n = 29) produced 30%, 50%, and 70% of their right-hand maximal voluntary contraction, and received directional feedback on performance (e.g., too little force). RESULTS Patients with CSF showed an effort-dependent behavioral bias toward less effort investment in response to directional feedback for the highest effort level as compared with healthy control subjects. This bias was associated with reduced feedback-related activity in the dorsolateral prefrontal cortex. These effects were proportional to state-related fatigue and prior beliefs about CFS patients' ability to perform the task. Patients with CFS also showed higher activity in the supplementary motor area, proportional to their state-related fatigue, and reduced connectivity between the supplementary motor area and sensorimotor cortex during motor preparation as compared with control subjects. CONCLUSIONS These findings link fatigue symptoms to alterations in behavioral choices on effort investment, prefrontal functioning, and supplementary motor area connectivity, with the dorsolateral prefrontal cortex being associated with prior beliefs about physical abilities.
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Affiliation(s)
- Marieke E van der Schaaf
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, the Netherlands.
| | - Karin Roelofs
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Floris P de Lange
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Dirk E M Geurts
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jos W M van der Meer
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Hans Knoop
- Department of Medical Psychology and Expert Center for Chronic Fatigue, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Ivan Toni
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, the Netherlands
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24
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Lenaert B, Jansen R, van Heugten CM. You make me tired: An experimental test of the role of interpersonal operant conditioning in fatigue. Behav Res Ther 2018; 103:12-17. [DOI: 10.1016/j.brat.2018.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/29/2017] [Accepted: 01/17/2018] [Indexed: 11/26/2022]
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25
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Prevalence of severe fatigue among adults with cystic fibrosis: A single center study. J Cyst Fibros 2018; 17:368-374. [PMID: 29606526 DOI: 10.1016/j.jcf.2018.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/13/2018] [Accepted: 03/05/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND With life expectancy increasing among patients with cystic fibrosis (CF), the prevalence of complications such as fatigue is also expected to increase. Our aim was to investigate the prevalence of severe fatigue among adults with CF and to identify factors associated with fatigue. METHODS Adult patients with CF receiving treatment at a single center were invited to complete three questionnaires. We then studied the associations between fatigue and clinically measured parameters and between fatigue and patient-reported outcomes. RESULTS A total of 77 patients (age 19-54years; 56% males; mean FEV1: 63%) completed the questionnaires (43% response rate). The prevalence of severe fatigue among these patients was 26%. The variance in fatigue was explained partially by clinically measured parameters. However, patient-reported outcomes were stronger independently associated with fatigue and included the patients' reported respiratory symptoms, emotional functioning, and social functioning. CONCLUSIONS Fatigue is a clinically important and highly prevalent issue among adults with CF and is associated with a significant reduction in health-related quality of life and participation in society. In addition, fatigue is associated more strongly with the patient's perception of symptoms and well-being than with clinically measured parameters.
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26
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Lenaert B, Boddez Y, Vlaeyen JW, van Heugten CM. Learning to feel tired: A learning trajectory towards chronic fatigue. Behav Res Ther 2018; 100:54-66. [DOI: 10.1016/j.brat.2017.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
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27
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Geraghty K, Hann M, Kurtev S. Myalgic encephalomyelitis/chronic fatigue syndrome patients' reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys. J Health Psychol 2017; 24:1318-1333. [PMID: 28847166 DOI: 10.1177/1359105317726152] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cognitive behavioural therapy and graded exercise therapy are promoted as evidence-based treatments for myalgic encephalomyelitis/chronic fatigue syndrome. This article explores patients' symptom responses following these treatments versus pacing therapy, an approach favoured by many sufferers. We analyse data from a large cross-sectional patient survey (n = 1428) and compare our findings with those from comparable patient surveys (n = 16,665), using a mix of descriptive statistics and regression analysis modelling. Findings from analysis of primary and secondary surveys suggest that cognitive behavioural therapy is of benefit to a small percentage of patients (8%-35%), graded exercise therapy brings about large negative responses in patients (54%-74%), while pacing is the most favoured treatment with the lowest negative response rate and the highest reported benefit (44%-82%).
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Esser P, Kuba K, Götze H, Mehnert A. Long-term effects and psychological adjustment: study protocol of a large register-based study on quality of life among survivors of hematological malignancies. BMC Cancer 2017; 17:482. [PMID: 28701154 PMCID: PMC5508694 DOI: 10.1186/s12885-017-3454-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/26/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Both incidence and survival rates of hematological cancers are increasing, leading to a growing number of survivors with specific late and long-term effects. However, relevant research in physical, psychological and social aspects of quality of life is scarce. Existing literature shows that a considerable number of cancer survivors report a relatively high quality of life despite a variety of adverse and persistent symptoms. To date, the reasons for this phenomenon as well as moderating and mediating factors are widely unknown. Given these research gaps, we aim to investigate the different domains of quality of life among long-term survivors of hematological cancers and to identify factors predicting high quality of life. METHODS/DESIGN This is a large cross-sectional study among hematological cancer survivors at a minimum of 3 years after diagnosis. We will collect 1000 survivors completing a set of self-report-questionnaires encompassing physical, psychological and social domains of quality of life. Participants are clustered in groups according to time since diagnosis and compared with each other. Furthermore, survivors will be compared with the general population. Factors predicting high quality of life will be identified via multiple regression analyses and structure equation modeling. DISCUSSION Our study will help to inform health care providers about the specific long-term burden among survivors with hematological malignancies. Identification of factors predicting high quality of life will help to develop adequate intervention strategies to enhance well-being in hematological cancer survivors. Our methodological advantages including the large sample as well as the assessment of different domains of quality of life will ensure novel and robust results. A limitation of the study is the cross-sectional design.
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Affiliation(s)
- Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.
| | - Katharina Kuba
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Heide Götze
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
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De Gucht V, Garcia FK, den Engelsman M, Maes S. Do changes in illness perceptions, physical activity, and behavioural regulation influence fatigue severity and health-related outcomes in CFS patients? J Psychosom Res 2017; 95:55-61. [PMID: 28314549 DOI: 10.1016/j.jpsychores.2017.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Examine to what extent changes in cognitions and changes in physical activity and behavioural regulation patterns influence fatigue severity, physical symptoms, and physical and psychological functioning of patients suffering from Chronic Fatigue Syndrome (CFS) at follow-up. METHODS The present study is an observational longitudinal study with a 12-month follow-up. A total of 144 CFS patients participated both at baseline and at follow-up. Four separate hierarchical regression analyses were conducted with fatigue, physical symptoms, physical functioning and psychological functioning at follow-up as the dependent variables, and (changes in) illness perceptions and behavioural regulation patterns (all-or-nothing and limiting behaviour) as the independent variables. Data were collected making use of self-report questionnaires. RESULTS Increased Consequence and Identity beliefs over time, as well as increases in all-or-nothing behaviour predicted higher fatigue severity at follow-up. Both number and severity of physical symptoms and psychological functioning at follow-up were only determined by changes in illness perceptions, with increased Consequence beliefs influencing both outcomes, and increased Timeline beliefs only determining physical symptoms. Physical functioning at follow-up was predicted by changes in illness perceptions as well as increased levels of both all-or-nothing and limiting behaviour. CONCLUSION The findings point at a differential pattern of associations between changes in illness perceptions and behaviour regulation patterns on the one hand, and patient outcomes on the other hand. Whereas illness perceptions significantly contribute to each of the outcomes, behaviour regulation patterns contribute only to fatigue severity and physical functioning.
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Affiliation(s)
- V De Gucht
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, The Netherlands.
| | - F K Garcia
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, The Netherlands
| | - M den Engelsman
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, The Netherlands
| | - S Maes
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, The Netherlands
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Hughes AM, Chalder T, Hirsch CR, Moss-Morris R. An attention and interpretation bias for illness-specific information in chronic fatigue syndrome. Psychol Med 2017; 47:853-865. [PMID: 27894380 DOI: 10.1017/s0033291716002890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies have shown that specific cognitions and behaviours play a role in maintaining chronic fatigue syndrome (CFS). However, little research has investigated illness-specific cognitive processing in CFS. This study investigated whether CFS participants had an attentional bias for CFS-related stimuli and a tendency to interpret ambiguous information in a somatic way. It also determined whether cognitive processing biases were associated with co-morbidity, attentional control or self-reported unhelpful cognitions and behaviours. METHOD A total of 52 CFS and 51 healthy participants completed self-report measures of symptoms, disability, mood, cognitions and behaviours. Participants also completed three experimental tasks, two designed specifically to tap into CFS salient cognitions: (i) visual-probe task measuring attentional bias to illness (somatic symptoms and disability) v. neutral words; (ii) interpretive bias task measuring positive v. somatic interpretations of ambiguous information; and (iii) the Attention Network Test measuring general attentional control. RESULTS Compared with controls, CFS participants showed a significant attentional bias for fatigue-related words and were significantly more likely to interpret ambiguous information in a somatic way, controlling for depression and anxiety. CFS participants had significantly poorer attentional control than healthy individuals. Attention and interpretation biases were associated with fear/avoidance beliefs. Somatic interpretations were also associated with all-or-nothing behaviour and catastrophizing. CONCLUSIONS People with CFS have illness-specific biases which may play a part in maintaining symptoms by reinforcing unhelpful illness beliefs and behaviours. Enhancing adaptive processing, such as positive interpretation biases and more flexible attention allocation, may provide beneficial intervention targets.
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Affiliation(s)
- A M Hughes
- Psychology Department,King's College London,Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - T Chalder
- Department of Psychological Medicine,King's College London,London,UK
| | - C R Hirsch
- Psychology Department,King's College London,Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - R Moss-Morris
- Psychology Department,King's College London,Institute of Psychiatry, Psychology and Neuroscience,London,UK
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Hughes AM, Gordon R, Chalder T, Hirsch CR, Moss-Morris R. Maximizing potential impact of experimental research into cognitive processes in health psychology: A systematic approach to material development. Br J Health Psychol 2017; 21:764-780. [PMID: 27659260 DOI: 10.1111/bjhp.12214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/19/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is an abundance of research into cognitive processing biases in clinical psychology including the potential for applying cognitive bias modification techniques to assess the causal role of biases in maintaining anxiety and depression. Within the health psychology field, there is burgeoning interest in applying these experimental methods to assess potential cognitive biases in relation to physical health conditions and health-related behaviours. Experimental research in these areas could inform theoretical development by enabling measurement of implicit cognitive processes that may underlie unhelpful illness beliefs and help drive health-related behaviours. However, to date, there has been no systematic approach to adapting existing experimental paradigms for use within physical health research. Many studies fail to report how materials were developed for the population of interest or have used untested materials developed ad hoc. The lack of protocol for developing stimuli specificity has contributed to large heterogeneity in methodologies and findings. PURPOSE In this article, we emphasize the need for standardized methods for stimuli development and replication in experimental work, particularly as it extends beyond its original anxiety and depression scope to other physical conditions. METHOD We briefly describe the paradigms commonly used to assess cognitive biases in attention and interpretation and then describe the steps involved in comprehensive/robust stimuli development for attention and interpretation paradigms using illustrative examples from two conditions: chronic fatigue syndrome and breast cancer. CONCLUSIONS This article highlights the value of preforming rigorous stimuli development and provides tools to aid researchers engage in this process. We believe this work is worthwhile to establish a body of high-quality and replicable experimental research within the health psychology literature. Statement of contribution What is already known on this subject? Cognitive biases (e.g., tendencies to attend to negative information and/or interpret ambiguous information in negative ways) have a causal role in maintaining anxiety and depression. There is mixed evidence of cognitive biases in physical health conditions and chronic illness; one reason for this may be the heterogeneous stimuli used to assess attention and interpretation biases in these conditions. What does this study add? Steps for comprehensive/robust stimuli development for attention and interpretation paradigms are presented. Illustrative examples are provided from two conditions: chronic fatigue syndrome and breast cancer. We provide tools to help researchers develop condition-specific materials for experimental studies.
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Affiliation(s)
- Alicia M Hughes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rola Gordon
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Colette R Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rona Moss-Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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Band R, Barrowclough C, Caldwell K, Emsley R, Wearden A. Activity patterns in response to symptoms in patients being treated for chronic fatigue syndrome: An experience sampling methodology study. Health Psychol 2017; 36:264-269. [PMID: 27819461 PMCID: PMC5327891 DOI: 10.1037/hea0000422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive-behavioral models of chronic fatigue syndrome (CFS) propose that patients respond to symptoms with 2 predominant activity patterns-activity limitation and all-or-nothing behaviors-both of which may contribute to illness persistence. The current study investigated whether activity patterns occurred at the same time as, or followed on from, patient symptom experience and affect. METHOD Twenty-three adults with CFS were recruited from U.K. CFS services. Experience sampling methodology (ESM) was used to assess fluctuations in patient symptom experience, affect, and activity management patterns over 10 assessments per day for a total of 6 days. Assessments were conducted within patients' daily life and were delivered through an app on touchscreen Android mobile phones. Multilevel model analyses were conducted to examine the role of self-reported patient fatigue, pain, and affect as predictors of change in activity patterns at the same and subsequent assessment. RESULTS Current experience of fatigue-related symptoms and pain predicted higher patient activity limitation at the current and subsequent assessments whereas subjective wellness predicted higher all-or-nothing behavior at both times. Current pain predicted less all-or-nothing behavior at the subsequent assessment. In contrast to hypotheses, current positive affect was predictive of current activity limitation whereas current negative affect was predictive of current all-or-nothing behavior. Both activity patterns varied at the momentary level. CONCLUSIONS Patient symptom experiences appear to be driving patient activity management patterns in line with the cognitive-behavioral model of CFS. ESM offers a useful method for examining multiple interacting variables within the context of patients' daily life. (PsycINFO Database Record
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Affiliation(s)
- Rebecca Band
- School of Psychological Sciences and Manchester Centre for Health Psychology, University of Manchester
| | - Christine Barrowclough
- School of Psychological Sciences and Manchester Centre for Health Psychology, University of Manchester
| | - Kim Caldwell
- School of Psychological Sciences and Manchester Centre for Health Psychology, University of Manchester
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, University of Manchester
| | - Alison Wearden
- School of Psychological Sciences and Manchester Centre for Health Psychology, University of Manchester
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Marques MM, de Gucht V, Leal I, Maes S. Efficacy of a randomized controlled self-regulation based physical activity intervention for chronic fatigue: Mediation effects of physical activity progress and self-regulation skills. J Psychosom Res 2017; 94:24-31. [PMID: 28183399 DOI: 10.1016/j.jpsychores.2016.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Examine the medium-term effects of a brief physical activity (PA) self-regulation (SR) based intervention (4-STEPS program) for chronic fatigue, and explore the mediating effects of PA related variables and SR skills. METHODS A two-arm randomized controlled trial (Usual Care vs 4-STEPS) was carried out. The 4-STEPS program consisted of Motivational Interviewing and SR-skills training. Fatigue severity (primary outcome) and impact, PA, health-related quality of life (HrQoL), and somatic and psychological distress were assessed at baseline, post-treatment (12weeks) and 12months follow-up. RESULTS Ninety-one patients (45 intervention and 46 controls) were included. At follow-up, there were significant treatment effects on fatigue severity (g=0.72) and fatigue impact, leisure-time PA, and physical and psychological HrQoL. No significant effects were found for number of daily steps and somatic and psychological distress. Fatigue severity at follow-up was partially mediated by post-treatment progress on a personal PA goal (effect ratio=18%). CONCLUSION Results suggest that a brief intervention, focusing on the formulation and pursuit of personal PA goals and the use of SR skills, produces sustained benefits for fatigue severity. Despite these promising results, dropout was high and the intervention was not beneficial for all secondary outcomes.
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Affiliation(s)
- M M Marques
- Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Portugal; Leiden University, Department of Health, Medical and Neuropsychology, PO Box 9555, 2300 RB Leiden, The Netherlands.
| | - V de Gucht
- Leiden University, Department of Health, Medical and Neuropsychology, PO Box 9555, 2300 RB Leiden, The Netherlands
| | - I Leal
- ISPA- University Institute, Rua Jardim do Tabaco, 34, 1149-041 Lisboa, Portugal
| | - S Maes
- Leiden University, Department of Health, Medical and Neuropsychology, PO Box 9555, 2300 RB Leiden, The Netherlands
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Windthorst P, Mazurak N, Kuske M, Hipp A, Giel KE, Enck P, Nieß A, Zipfel S, Teufel M. Heart rate variability biofeedback therapy and graded exercise training in management of chronic fatigue syndrome: An exploratory pilot study. J Psychosom Res 2017; 93:6-13. [PMID: 28107894 DOI: 10.1016/j.jpsychores.2016.11.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 11/27/2016] [Accepted: 11/29/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Chronic fatigue syndrome (CFS) is characterised by persistent fatigue, exhaustion, and several physical complaints. Research has shown cognitive behavioural therapy (CBT) and graded exercise training (GET) to be the most effective treatments. In a first step we aimed to assess the efficacy of heart rate variability biofeedback therapy (HRV-BF) as a treatment method comprising cognitive and behavioural strategies and GET in the pilot trial. In a second step we aimed to compare both interventions with regard to specific parameters. METHODS The study was conducted in an outpatient treatment setting. A total of 28 women with CFS (50.3±9.3years) were randomly assigned to receive either eight sessions of HRV-BF or GET. The primary outcome was fatigue severity. Secondary outcomes were mental and physical quality of life and depression. Data were collected before and after the intervention as well as at a 5-month follow-up. RESULTS General fatigue improved significantly after both HRV-BF and GET. Specific cognitive components of fatigue, mental quality of life, and depression improved significantly after HRV-BF only. Physical quality of life improved significantly after GET. There were significant differences between groups regarding mental quality of life and depression favouring HRV-BF. CONCLUSION Both interventions reduce fatigue. HRV-BF seems to have additional effects on components of mental health, including depression, whereas GET seems to emphasise components of physical health. These data offer implications for further research on combining HRV-BF and GET in patients with CFS. TRIAL REGISTRATION The described trial has been registered at the International Clinical Trials Registry Platform following the number DRKS00005445.
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Affiliation(s)
- Petra Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany.
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany.
| | - Marvin Kuske
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany.
| | - Arno Hipp
- Department of Sports Medicine, University Hospital, University of Tuebingen, Germany.
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany.
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany.
| | - Andreas Nieß
- Department of Sports Medicine, University Hospital, University of Tuebingen, Germany.
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany.
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany.
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Janssens KAM, Houtveen JH, Tak LM, Bonvanie IJ, Scholtalbers A, van Gils A, Geenen R, Rosmalen JGM. A concept mapping study on perpetuating factors of functional somatic symptoms from clinicians' perspective. Gen Hosp Psychiatry 2017; 44:51-60. [PMID: 28041577 DOI: 10.1016/j.genhosppsych.2016.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/15/2016] [Accepted: 10/24/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this concept mapping study was to identify the structure and alleged importance of perpetuating factors of functional somatic symptoms (FSS) from the perspective of professionals. Further, we examined to which extent these factors have been addressed in scientific literature. METHODS Ninety-nine perpetuating factors were sorted with respect to content using a card-sorting task by 61 experienced clinicians (62.3% psychologists, 75.4% female, mean age: 45.7 [SD: 10.6] years, mean duration of experience in treating FSS patients: 10.5 [SD: 7.6] years). These factors had been derived from in-depth interviews with 12 clinicians, with extensive experience in treating FSS. Thirty-eight clinicians rated the importance of the 99 factors on a scale ranging from 1 ('not important at all') to 10 ('extremely important'). RESULTS Hierarchical cluster analysis revealed three overarching domains of perpetuating factors: 'Hypochondria', 'Social and relational problems' and 'Symptom-related emotions and habits'. These domains comprised 16 clusters, which were rated on importance between 6.1, 'Adverse physical factors and counterproductive lifestyle', and 7.8, 'Frustration and despair regarding the symptoms'. All clusters have been addressed in scientific literature. CONCLUSIONS This study revealed an encompassing hierarchical structure of somatic, emotional, cognitive, behavioral, and social factors of importance in the perpetuation of FSS based on expert opinions. This structure will guide the development of personalized treatment of FSS.
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Affiliation(s)
- Karin A M Janssens
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
| | - Jan H Houtveen
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Lineke M Tak
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands; Dimence, Institute for Mental Health Care, Deventer, The Netherlands
| | - Irma J Bonvanie
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Anna Scholtalbers
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Anne van Gils
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Rinie Geenen
- Utrecht University, Department of Clinical and Health Psychology, Utrecht, The Netherlands; Altrecht Psychosomatic Medicine, Zeist, the Netherlands
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
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Ali S, Matcham F, Irving K, Chalder T. Fatigue and psychosocial variables in autoimmune rheumatic disease and chronic fatigue syndrome: A cross-sectional comparison. J Psychosom Res 2017; 92:1-8. [PMID: 27998507 DOI: 10.1016/j.jpsychores.2016.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/01/2016] [Accepted: 11/10/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Fatigue is common in autoimmune rheumatic diseases (ARD). This study compared symptom-related cognitions, beliefs, behaviours, quality of sleep, lack of acceptance and distress in participants with ARD such as rheumatoid arthritis (RA), seronegative spondyloarthropathy (SpA), and connective tissue disease (CTD), and participants with chronic fatigue syndrome (CFS). METHODS 303 participants with RA, SpA, CTD and CFS completed questionnaire measures of fatigue, social adjustment, cognitive-behavioural responses, lack of acceptance, distress and quality of sleep. The RA, SpA and CTD groups were first compared with each other. They were then combined into one group and compared with the CFS group. RESULTS There were no statistically significant differences between the RA, SpA or CTD groups for any of the measures. The CFS group was more fatigued, reported more distress and sleep disturbance and had worse social adjustment than the ARD group after adjustment for age and illness duration. After adjustment for fatigue, age, and illness duration, the CFS group scored more highly on lack of acceptance and avoidance/resting behaviour while the ARD group showed significantly higher levels of catastrophizing, damage beliefs, and symptom focusing than the CFS group. CONCLUSION Fatigue in rheumatic diseases may be perpetuated by similar underlying transdiagnostic processes. The ARD and CFS groups showed similarities but also key differences in their responses to symptoms. Specific aspects of treatment may need to be tailored towards each group. For example, lack of acceptance and avoidance behaviour may be particularly important in perpetuating fatigue in CFS.
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Affiliation(s)
- Sheila Ali
- Chronic Fatigue Research and Treatment Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Faith Matcham
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London
| | - Katherine Irving
- Rheumatology, Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London.
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Hughes A, Hirsch C, Chalder T, Moss-Morris R. Attentional and interpretive bias towards illness-related information in chronic fatigue syndrome: A systematic review. Br J Health Psychol 2016; 21:741-763. [DOI: 10.1111/bjhp.12207] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/14/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Alicia Hughes
- Psychology Department; Institute of Psychiatry; Psychology and Neuroscience; King's College London; UK
| | - Colette Hirsch
- Psychology Department; Institute of Psychiatry; Psychology and Neuroscience; King's College London; UK
| | - Trudie Chalder
- Department of Psychological Medicine; Weston Education Centre; King's College London; UK
| | - Rona Moss-Morris
- Psychology Department; Institute of Psychiatry; Psychology and Neuroscience; King's College London; UK
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Geraghty KJ, Blease C. Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent. J Health Psychol 2016; 23:127-138. [DOI: 10.1177/1359105316667798] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Cognitive behavioural therapy is increasingly promoted as a treatment for chronic fatigue syndrome. There is limited research on informed consent using cognitive behavioural therapy in chronic fatigue syndrome. We undertook a narrative review to explore efficacy and to identify the salient information that should be disclosed to patients. We found a complex theoretical model underlying the rationale for psychotherapy in chronic fatigue syndrome. Cognitive behavioural therapy may bring about changes in self-reported fatigue for some patients in the short term, however there is a lack of evidence for long-term benefit or for improving physical function and cognitive behavioural therapy may cause distress if inappropriately prescribed. Therapist effects and placebo effects are important outcome factors.
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Cognitive behaviour therapy for chronic fatigue syndrome: Differences in treatment outcome between a tertiary treatment centre in the United Kingdom and the Netherlands. J Psychosom Res 2016; 87:43-9. [PMID: 27411751 DOI: 10.1016/j.jpsychores.2016.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Cognitive behaviour therapy (CBT) reduces fatigue and disability in chronic fatigue syndrome (CFS). However, outcomes vary between studies, possibly because of differences in patient characteristics, treatment protocols, diagnostic criteria and outcome measures. The objective was to compare outcomes after CBT in tertiary treatment centres in the Netherlands (NL) and the United Kingdom (UK), using different treatment protocols but identical outcome measures, while controlling for differences in patient characteristics and diagnostic criteria. METHODS Consecutively referred CFS patients who received CBT were included (NL: n=293, UK: n=163). Uncontrolled effect sizes for improvement in fatigue (Chalder Fatigue Questionnaire), physical functioning (SF-36 physical functioning subscale) and social functioning (Work and Social Adjustment Scale) were compared. Multiple regression analysis was used to examine whether patient differences explained outcome differences between centres. RESULTS Effect sizes differed between centres for fatigue (Cohen's D NL=1.74, 95% CI=1.52-1.95; UK=0.99, CI=0.73-1.25), physical functioning (NL=0.99, CI=0.81-1.18; UK=0.33, CI=0.08-0.58) and social functioning (NL=1.47, CI=1.26-1.69; UK=0.61, CI=0.35-0.86). Patients in the UK had worse physical functioning at baseline and there were minor demographic differences. These could not explain differences in centre outcome. CONCLUSION Effectiveness of CBT differed between treatment centres. Differences in treatment protocols may explain this and should be investigated to help further improve outcomes.
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The Process of Change in Pain During Cognitive-Behavior Therapy for Chronic Fatigue Syndrome. Clin J Pain 2016; 31:914-21. [PMID: 25503595 DOI: 10.1097/ajp.0000000000000191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive-behavior therapy (CBT) leads to a reduction of fatigue and pain in chronic fatigue syndrome. The processes underlying the reduction in pain have not been investigated. Recently, it was shown that increased self-efficacy, decreased focusing on symptoms, increased physical functioning, and a change in beliefs about activity contribute to the decrease in fatigue. OBJECTIVES The present study has 2 objectives: (1) to determine the relationship between the reduction of fatigue and pain during CBT; (2) test to what extent the model for change in fatigue is applicable to the reduction in pain. MATERIALS AND METHODS One hundred forty-two patients meeting United States centers for Disease Control and Prevention criteria for chronic fatigue syndrome, currently reporting pain, and starting CBT were included. A cross-lagged analysis was performed to study the causal direction of change between pain and fatigue. Pain and process variables were assessed before therapy, 3 times during CBT, and after therapy. Actual physical activity was also assessed. The model was tested with multiple regression analyses. RESULTS The direction of change between pain and fatigue could not be determined. An increase in physical functioning and decrease in focusing on symptoms explained 4% to 14% of the change in pain. CONCLUSIONS Pain and fatigue most probably decrease simultaneously during CBT. Pain reduction can partly be explained by a reduction of symptom focusing and increased physical functioning. Additional, yet unknown cognitive-behavioral factors also play a role in the reduction of pain.
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Kim BH, Namkoong K, Kim JJ, Lee S, Yoon KJ, Choi M, Jung YC. Altered resting-state functional connectivity in women with chronic fatigue syndrome. Psychiatry Res 2015; 234:292-7. [PMID: 26602611 DOI: 10.1016/j.pscychresns.2015.10.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 10/05/2015] [Accepted: 10/14/2015] [Indexed: 12/15/2022]
Abstract
The biological underpinnings of the psychological factors characterizing chronic fatigue syndrome (CFS) have not been extensively studied. Our aim was to evaluate alterations of resting-state functional connectivity in CFS patients. Participants comprised 18 women with CFS and 18 age-matched female healthy controls who were recruited from the local community. Structural and functional magnetic resonance images were acquired during a 6-min passive-viewing block scan. Posterior cingulate cortex seeded resting-state functional connectivity was evaluated, and correlation analyses of connectivity strength were performed. Graph theory analysis of 90 nodes of the brain was conducted to compare the global and local efficiency of connectivity networks in CFS patients with that in healthy controls. The posterior cingulate cortex in CFS patients showed increased resting-state functional connectivity with the dorsal and rostral anterior cingulate cortex. Connectivity strength of the posterior cingulate cortex to the dorsal anterior cingulate cortex significantly correlated with the Chalder Fatigue Scale score, while the Beck Depression Inventory (BDI) score was controlled. Connectivity strength to the rostral anterior cingulate cortex significantly correlated with the Chalder Fatigue Scale score. Global efficiency of the posterior cingulate cortex was significantly lower in CFS patients, while local efficiency showed no difference from findings in healthy controls. The findings suggest that CFS patients show inefficient increments in resting-state functional connectivity that are linked to the psychological factors observed in the syndrome.
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Affiliation(s)
- Byung-Hoon Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul 120-752, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea
| | - Kee Namkoong
- Department of Psychiatry, Yonsei University College of Medicine, Seoul 120-752, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea
| | - Jae-Jin Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul 120-752, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea
| | - Seojung Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea
| | - Kang Joon Yoon
- Gangnam St. Peter's Hospital, Seoul 135-270, South Korea
| | - Moonjong Choi
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea
| | - Young-Chul Jung
- Department of Psychiatry, Yonsei University College of Medicine, Seoul 120-752, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea.
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Verspaandonk J, Coenders M, Bleijenberg G, Lobbestael J, Knoop H. The role of the partner and relationship satisfaction on treatment outcome in patients with chronic fatigue syndrome. Psychol Med 2015; 45:2345-2352. [PMID: 25732090 DOI: 10.1017/s0033291715000288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) leads to a significant decrease in CFS-related symptoms and disability. The primary objective of this study was to explore whether partners' solicitous responses and patients' and partners' perceived relationship satisfaction had an effect on treatment outcome. METHOD The treatment outcome of a cohort of 204 consecutively referred patients treated with CBT was analysed. At baseline, CFS patients completed the Maudsley Marital Questionnaire. The Checklist Individual Strength subscale Fatigue and the Sickness Impact Profile total scores completed by CFS patients post-treatment were used as measures of clinically significant improvement. Partners completed the Family Response Questionnaire, the Maudsley Marital Questionnaire, the Brief Illness Perception Questionnaire, and the Causal Attribution List. Logistic regression analyses were performed with clinically significant improvement in fatigue and disability as dependent variables and scores on questionnaires at baseline as predictors. RESULTS Solicitous responses of the partner were associated with less clinically significant improvement in fatigue and disability. Partners more often reported solicitous responses when they perceived CFS as a severe condition. Patients' relationship dissatisfaction was negatively associated with clinically significant improvement in fatigue. CONCLUSIONS Partners' solicitous responses and illness perceptions at the start of the therapy can negatively affect the outcome of CBT for CFS. We emphasize the importance of addressing this in therapy.
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Affiliation(s)
- J Verspaandonk
- Expert Centre for Chronic Fatigue, Radboud University Medical Centre,Nijmegen,The Netherlands
| | - M Coenders
- Faculty of Social and Behavioural Sciences,Utrecht University,The Netherlands
| | - G Bleijenberg
- Expert Centre for Chronic Fatigue, Radboud University Medical Centre,Nijmegen,The Netherlands
| | - J Lobbestael
- Faculty of Clinical Psychological Science,Maastricht University,The Netherlands and RINO Zuid,Postdoctoral Education Institute,Eindhoven,The Netherlands
| | - H Knoop
- Expert Centre for Chronic Fatigue, Radboud University Medical Centre,Nijmegen,The Netherlands
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Marques M, De Gucht V, Gouveia M, Leal I, Maes S. Differential effects of behavioral interventions with a graded physical activity component in patients suffering from Chronic Fatigue (Syndrome): An updated systematic review and meta-analysis. Clin Psychol Rev 2015; 40:123-37. [DOI: 10.1016/j.cpr.2015.05.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 01/21/2015] [Accepted: 05/13/2015] [Indexed: 01/17/2023]
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van Der Schaaf ME, Schmits IC, Roerink M, Geurts DEM, Toni I, Roelofs K, De Lange FP, Nater UM, van der Meer JWM, Knoop H. Investigating neural mechanisms of change of cognitive behavioural therapy for chronic fatigue syndrome: a randomized controlled trial. BMC Psychiatry 2015; 15:144. [PMID: 26138726 PMCID: PMC4489043 DOI: 10.1186/s12888-015-0515-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is characterized by profound and disabling fatigue with no known somatic explanation. Cognitive behavioral therapy (CBT) has proven to be a successful intervention leading to a reduction in fatigue and disability. Based on previous neuroimaging findings, it has been suggested that central neural mechanisms may underlie CFS symptoms and play a role in the change brought on by CBT. In this randomized controlled trial we aim to further investigate the neural mechanisms that underlie fatigue in CFS and their change by CBT. METHODS/DESIGN We will conduct a randomized controlled trial in which we collect anatomical and functional magnetic resonance imaging (MRI) measures from female CFS patients before and after CBT (N = 60) or waiting list (N = 30) and compare these with measures from age and education matched healthy controls (N = 30). By including a large treatment group we will also be able to compare patients that benefit from CBT with those that do not. In addition, to further investigate the role of endocrine and immune biomarkers in CFS, we will determine cortisol and cytokine concentrations in blood, hair and/or saliva. DISCUSSION This project creates an unique opportunity to enhance our understanding of CFS symptoms and its change by CBT in terms of neuroanatomical, neurofunctional, endocrinological and immunological mechanisms and can help to further improve future treatments strategies. TRIAL REGISTRATION Dutch Trial Register #15852. Registered 9 December 2013 ( http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4311 ).
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Affiliation(s)
- Marieke E van Der Schaaf
- Radboud University Medical Center, Expert Centre for Chronic Fatigue, Nijmegen, The Netherlands. .,Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands. .,Donders Institute, Centre for neuroimaging, Kapittelweg 29, P.O. Box 9101, NL-6500 HB, Nijmegen, The Netherlands.
| | - Iris C Schmits
- Radboud University Medical Center, Expert Centre for Chronic Fatigue, Nijmegen, The Netherlands.
| | - Megan Roerink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Dirk EM Geurts
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ivan Toni
- Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Karin Roelofs
- Behavioral Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Floris P De Lange
- Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Urs M Nater
- Department of Psychology, University of Marburg, Marburg, Germany.
| | - Jos WM van der Meer
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Knoop
- Radboud University Medical Center, Expert Centre for Chronic Fatigue, Nijmegen, The Netherlands.
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Hall DL, Antoni MH, Lattie EG, Jutagir DR, Czaja SJ, Perdomo D, Lechner SC, Stagl JM, Bouchard LC, Gudenkauf LM, Traeger L, Fletcher M, Klimas NG. Perceived Fatigue Interference and Depressed Mood: Comparison of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis Patients with Fatigued Breast Cancer Survivors. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2015; 3:142-155. [PMID: 26180660 DOI: 10.1080/21641846.2015.1039289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Persistent fatigue and depressive symptoms are both highly prevalent among patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) as well as breast cancer survivors. This study aimed to assess and directly compare perceptions of fatigue as highly interfering in one's daily functioning in both patient populations to better understand their relationships with depressed mood. METHODS Participants were 95 female CFS/ME patients and 67 females who were approximately 5 years post-treatment for stage 0-III breast cancer presenting with clinically elevated fatigue severity. Self-report measures were obtained on participants' fatigue-related interference in daily functioning and fatigue severity as well as depressed mood. Hierarchical regression was used to test effects controlling for relevant demographic, psychosocial, and medical covariates. RESULTS CFS/ME patients endorsed greater depressed mood and fatigue interference than did fatigued breast cancer survivors, p's<.001. These factors were significantly positively correlated among CFS/ME patients (β=.36, p<.001), but not the fatigued breast cancer survivors (β=.18, p=.19). CONCLUSIONS CFS/ME patients reported elevated fatigue symptoms and depression relative to fatigued breast cancer survivors. In the former group, greater depressed mood was highly and significantly associated with greater fatigue-related inference in daily activities. Potential targets for cognitive behavioral interventions are discussed.
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Affiliation(s)
| | - Michael H Antoni
- Department of Psychology, University of Miami ; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine ; Department of Psychiatry and Behavioral Sciences, University of Miami
| | | | | | - Sara J Czaja
- Department of Psychiatry and Behavioral Sciences, University of Miami
| | - Dolores Perdomo
- Department of Psychiatry and Behavioral Sciences, University of Miami
| | - Suzanne C Lechner
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
| | - Jamie M Stagl
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School
| | | | | | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School
| | - MaryAnn Fletcher
- Institute for Neuro Immune Medicine, Nova Southeastern University
| | - Nancy G Klimas
- Institute for Neuro Immune Medicine, Nova Southeastern University
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Treatment Outcome and Metacognitive Change in CBT and GET for Chronic Fatigue Syndrome. Behav Cogn Psychother 2015; 44:397-409. [PMID: 25895437 DOI: 10.1017/s135246581500017x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Studies have reported that Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) are effective treatments for Chronic Fatigue Syndrome (CFS). METHOD One hundred and seventy-one patients undertook a course of either CBT (n = 116) or GET (n = 55) and were assessed on a variety of self-report measures at pre- and posttreatment and follow-up. AIMS In this paper we present analyses on treatment outcomes for CBT and GET in routine clinical practice and evaluate whether changes on subscales of the Metacognitions Questionnaire-30 (MCQ-30) predict fatigue severity independently of changes in other covariates, and across the two treatment modalities. RESULTS Both CBT and GET were equally effective at decreasing fatigue, anxiety, and depression, and at increasing physical functioning. Changes on the subscales of the MCQ-30 were also found to have a significant effect on fatigue severity independently of changes in other covariates and across treatment modalities. CONCLUSION The findings from the current study suggest that CFS treatment protocols for CBT and GET, based on those from the PACE trial, achieve similar to poorer outcomes in routine clinical practice as in a RCT.
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Christensen SS, Frostholm L, Ørnbøl E, Schröder A. Changes in illness perceptions mediated the effect of cognitive behavioural therapy in severe functional somatic syndromes. J Psychosom Res 2015; 78:363-70. [PMID: 25541119 DOI: 10.1016/j.jpsychores.2014.12.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 11/18/2014] [Accepted: 12/07/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although there is substantial evidence that cognitive behavioural therapy alleviates symptoms in functional somatic syndromes, the mechanisms of change are less investigated. This study examined whether changes in illness perceptions mediated the effect of cognitive behavioural therapy. METHODS We analysed additional data from a randomised controlled trial comparing completers of cognitive behavioural group therapy (46 patients) to an enhanced usual care group (66 patients). Proposed mediators (illness perceptions) and primary (physical health) and secondary (somatic symptoms and illness worry) outcomes were assessed by means of questionnaires at referral, baseline, end of treatment, and 10 and 16 months after randomisation. Multiple mediation analysis determined whether (1) changes in specific illness perceptions during treatment mediated the effect of cognitive behavioural therapy (primary analysis), and (2) whether changes in illness perceptions during the whole trial period were associated with improved outcome (secondary analysis). RESULTS Improvements in illness perceptions during treatment partially mediated the effect of cognitive behavioural therapy on physical health one year after treatment (sum of indirect effects 1.556, BCa 95% CI (0.006; 3.620)). Improving perceived control was particularly important. Changes in illness perceptions from baseline to 16 months after randomisation were associated with clinically meaningful improvements in physical health, somatic symptoms and illness worry during the same period. CONCLUSION Our results suggest that changing patients' illness perceptions is an important process in cognitive behavioural therapy for functional somatic syndromes. Challenging patients' own understanding of their illness may hence be a key element of successful treatment.
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Affiliation(s)
- Sara Sletten Christensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Aarhus C, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Aarhus C, Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Aarhus C, Denmark
| | - Andreas Schröder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Aarhus C, Denmark.
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Zalai D, Sherman M, McShane K, Shapiro CM, Carney CE. The importance of fatigue cognitions in chronic hepatitis C infection. J Psychosom Res 2015; 78:193-8. [PMID: 25433976 DOI: 10.1016/j.jpsychores.2014.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/09/2014] [Accepted: 11/12/2014] [Indexed: 12/17/2022]
Abstract
UNLABELLED Chronic Hepatitis C virus (HCV) infection is a source of significant public health burden worldwide. Fatigue is a cardinal patient reported consequence of the disease. HCV infection associated fatigue leads to significant impairment in the quality of life and day-to-day functioning. Despite its clinical significance, the factors that contribute to adverse impact of fatigue in HCV infection are largely unknown. OBJECTIVES This study evaluated the contributions of insomnia, depression symptoms, and fatigue-specific cognitions to fatigue-related functional impairment. METHODS Fatigue, insomnia, depression symptoms, as well as fatigue cognitions were assessed in participants (36% females; age>18 years, N=115) with chronic HCV infection at a tertiary hepatitis clinic. RESULTS Sixty percent of participants reported clinically significant fatigue (Fatigue Severity Index FSS ≥ 4). Comorbidities and fatigue perceptions accounted for 61% of the variation of fatigue. Fatigue perceptions were the main predictors of adverse fatigue outcomes (B=.114, 95% CI=.054-.154). Patients with clinically significant fatigue were four-times more likely than less fatigued patients to believe that the main cause of their fatigue was the infection. CONCLUSION Patients' beliefs about their fatigue were the main predictors of adverse fatigue outcomes. These results suggest that fatigue associated with chronic hepatitis C infection can be conceptualized using a cognitive behavioral approach. This was the first study to evaluate the role of both comorbid mood/sleep and cognitive predictors of fatigue in a single model. Integrating the findings into existing treatment strategies could improve patient reported outcomes in chronic hepatitis C infection.
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Affiliation(s)
- Dora Zalai
- Dept. of Psychology, Ryerson University, Toronto, Canada.
| | - Morris Sherman
- Dept. of Gastroenterology, University Health Network, University of Toronto, Toronto, Canada
| | - Kelly McShane
- Dept. of Psychology, Ryerson University, Toronto, Canada
| | - Colin M Shapiro
- Dept. of Psychiatry, University Health Network, University of Toronto, Toronto, Canada; Dept. of Ophthalmology, University Health Network, University of Toronto, Toronto, Canada
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Rongen-van Dartel SAA, Repping-Wuts H, van Hoogmoed D, Knoop H, Bleijenberg G, van Riel PLCM, Fransen J. Relationship between objectively assessed physical activity and fatigue in patients with rheumatoid arthritis: inverse correlation of activity and fatigue. Arthritis Care Res (Hoboken) 2014; 66:852-60. [PMID: 24339437 DOI: 10.1002/acr.22251] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 11/26/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Fatigue is generally associated with low physical activity in patients with various chronic medical conditions. However, such an association has not been reported among patients with rheumatoid arthritis (RA). The objectives of this study were to investigate whether daily activity level is associated with fatigue in patients with RA, and whether pain, disability, coping, and/or cognition are associated with the level of daily activity. METHODS Patients with RA who visited our outpatient clinic were recruited consecutively. Fatigue severity was measured using the Checklist Individual Strength (CIS20). Physical activity was measured for 14 consecutive days using an ankle-worn actometer. The daily activity level of each patient was calculated, and each patient was classified as having a low or high activity level with respect to the group average. Data were analyzed by linear regression. RESULTS A total of 167 patients were included in the analysis; 25% had a low activity level and 75% had a high activity level. A regression analysis revealed that higher activity levels were associated with reduced fatigue (P = 0.008). The mean ± SD CIS fatigue score was 30.9 ± 12.3 among the patients with a high activity level and 35.7 ± 12.8 among the patients with a low activity level (P = 0.03). Pain, disability, coping, and cognition were not associated significantly with daily activity level. CONCLUSION Among patients with RA, a higher level of daily physical activity was associated with reduced levels of fatigue. This relationship was not explained by differences in sex, age, disease duration, pain, disability, or other fatigue-related factors.
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Brurberg KG, Fønhus MS, Larun L, Flottorp S, Malterud K. Case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review. BMJ Open 2014; 4:e003973. [PMID: 24508851 PMCID: PMC3918975 DOI: 10.1136/bmjopen-2013-003973] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To identify case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and explore how the validity of case definitions can be evaluated in the absence of a reference standard. DESIGN Systematic review. SETTING International. PARTICIPANTS A literature search, updated as of November 2013, led to the identification of 20 case definitions and inclusion of 38 validation studies. PRIMARY AND SECONDARY OUTCOME MEASURE Validation studies were assessed for risk of bias and categorised according to three validation models: (1) independent application of several case definitions on the same population, (2) sequential application of different case definitions on patients diagnosed with CFS/ME with one set of diagnostic criteria or (3) comparison of prevalence estimates from different case definitions applied on different populations. RESULTS A total of 38 studies contributed data of sufficient quality and consistency for evaluation of validity, with CDC-1994/Fukuda as the most frequently applied case definition. No study rigorously assessed the reproducibility or feasibility of case definitions. Validation studies were small with methodological weaknesses and inconsistent results. No empirical data indicated that any case definition specifically identified patients with a neuroimmunological condition. CONCLUSIONS Classification of patients according to severity and symptom patterns, aiming to predict prognosis or effectiveness of therapy, seems useful. Development of further case definitions of CFS/ME should be given a low priority. Consistency in research can be achieved by applying diagnostic criteria that have been subjected to systematic evaluation.
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Affiliation(s)
| | | | - Lillebeth Larun
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Signe Flottorp
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kirsti Malterud
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Research Unit for General Practice, Uni Health, Uni Research, Bergen, Norway
- Research Unit for General Practice in Copenhagen, Copenhagen K, Denmark
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