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Formica C, Bonanno L, Latella D, Ferrera MC, Maresca G, Logiudice AL, Sorbera C, Brigandì A, Di Lorenzo G, Marino S. The effect of Computer Assisted Rehabilitation Environment (CAREN) in cognitive impairment and coping strategies in Parkinson's disease: a preliminary study. Sci Rep 2023; 13:2214. [PMID: 36750642 PMCID: PMC9905468 DOI: 10.1038/s41598-023-29299-0] [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: 05/06/2022] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Parkinson's disease is a neurodegenerative disorder characterized by different motor, vegetative, behavioral, and cognitive impairments, with worsening quality of life. Virtual reality devices have given promising results in neurorehabilitation as they can provide multisensory stimulation in a realistic environment. This study aims to test the efficacy of virtual reality training by using Computer Assisted Rehabilitation Environment in cognitive impairment in a sample of PD. 31 patients affected by PD were enrolled. All PD patients underwent 24 sessions of Computer Assisted Rehabilitation Environment training. The participants were assessed at baseline (T0) and after two months (T1). Our results suggested that Computer Assisted Rehabilitation Environment training may be effective in the cognitive and emotional domains, particularly by improving executive function, anxiety, and depressive symptoms. These changes have helped to improve self-efficacy and coping strategies. These results indicate greater cognitive and physical effort to overcome stressors. Our results show that Computer Assisted Rehabilitation Environment training was beneficial in improving cognitive functions. Longer duration training may be especially beneficial for patients with mild cognitive impairment. Our findings open the door to tailored personalized treatments based on the patient's motor and cognitive profiles.
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Affiliation(s)
- Caterina Formica
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Lilla Bonanno
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Desiree Latella
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy.
| | - Maria Cristina Ferrera
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Giuseppa Maresca
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Anna Lisa Logiudice
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Chiara Sorbera
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Amelia Brigandì
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Giuseppe Di Lorenzo
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
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Adamowicz JL, Vélez-Bermúdez M, Thomas EB. Fatigue severity and avoidance among individuals with chronic disease: A meta-analysis. J Psychosom Res 2022; 159:110951. [PMID: 35665612 PMCID: PMC9629285 DOI: 10.1016/j.jpsychores.2022.110951] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fatigue is a common, debilitating symptom experienced by individuals with chronic disease. Avoidance, or the act of evading unwanted experiences, is associated with fatigue across chronic disease samples. The current study sought to determine the strength of association between fatigue severity and avoidance in individuals with chronic disease. METHODS PubMed, PsycINFO, CINAHL, and ProQuest Dissertations and Theses databases were searched. Eligible studies measured fatigue and avoidance in chronic disease samples. Sixty-six studies were included. Data analyses were conducted in Rstudio. A random effects model was employed, and a weighted mean effect size was computed for fatigue severity and avoidance. Mixed-effects meta-regression analyses were conducted to examine moderating variables, including patient, clinical, and measurement characteristics. Publication bias was examined using funnel plot, trim-and-fill, and p-curve. RESULTS The meta-analysis comprised of 71 unique patient samples from 66 studies. The total number of included participants was 13,024. A small, positive association was found between fatigue severity and avoidance, r(71) = 0.22, p < .001, 95% CI [0.18-0.27], SE = 0.02. There was also significant heterogeneity, Q(70) = 349.96, p < .001. Moderator analyses examining age, sex, illness duration, avoidance type, and disease sample were all non-significant. Regarding publication bias, trim-and-fill resulted in a modified weighted mean effect size (r(83) = 0.18, p < .001) and a p-curve analysis supported the evidential value of the current analysis. CONCLUSION Findings support that among individuals with chronic disease, fatigue severity and avoidance are positively associated, which has implications for behavioral interventions in this population.
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Affiliation(s)
| | - Miriam Vélez-Bermúdez
- University of Iowa, Department of Psychological and Brain Sciences, United States of America.
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Moncorps F, Jouet E, Bayen S, Fornasieri I, Renet S, Las‐Vergnas O, Messaadi N. Specifics of chronic fatigue syndrome coping strategies identified in a French flash survey during the COVID-19 containment. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1-10. [PMID: 33825299 PMCID: PMC8250744 DOI: 10.1111/hsc.13376] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/26/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has focused health systems on supporting patients affected by this virus. Meanwhile in the community, many other contained patients could only use self-care strategies, especially in countries that have set up a long and strict containment such as France. The study aimed to compare coping strategies deployed by patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS; a poorly recognised syndrome) to those with better known and referenced chronic conditions. An online flash survey was conducted during the containment period in partnership with French Patients Organizations including ME/CFS national association. Therefore, 'Brief COPE' version of Lazarus and Folkman's Ways of Coping Check List has been adapted to the specificity of the containment. The survey was e-distributed in France from 15 April to 11 May 2020. Differences of coping strategies were analyzed using Wilcoxon-Mann-Withney test. Amongst 637 responses, 192 were complete, presenting a wide variety of diseases, including 93 ME/CFS. The latter have significantly different coping strategies than recognised diagnosed diseases patients: similar uses of emotion focused coping but less uses of seek social support and problem-focused copings. In conclusion, coping strategies are different for those who deal with the daily experience of ME/CFS, highly disabling chronic condition with diagnostic ambiguity, low degree of medical and social recognition and without treatment. Better understanding of those strategies is needed to provide the means for health promotion researchers, managers and clinicians, to accompany those patients.
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Affiliation(s)
- Florence Moncorps
- Nursing Education InstituteChâteaubriant‐Nozay‐Pouancé Hospital GroupChâteaubriantFrance
- Education and Training Research Center (EA1589)University of Paris NanterreNanterreFrance
| | - Emmanuelle Jouet
- Research in Human, Social and Mental Health LaboratoryGHU Paris Psychiatrie and NeurosciencesParisFrance
- Education Ethics Health (EA7505)University of ToursToursFrance
- ASFCFrench ME/CFS AssociationNiceFrance
| | - Sabine Bayen
- Family Medicine DepartmentFaculty of MedicineUniversity of LilleLilleFrance
| | - Isabelle Fornasieri
- ASFCFrench ME/CFS AssociationNiceFrance
- Faculty of PsychologyUniversity of StrasbourgStrasbourgFrance
| | - Sophie Renet
- Education and Training Research Center (EA1589)University of Paris NanterreNanterreFrance
- Pharmacy DepartmentParis Saint‐Joseph Hospital GroupParisFrance
- Faculty of PharmacyParis‐Sud UniversityChatenay MalabryFrance
| | - Olivier Las‐Vergnas
- Education and Training Research Center (EA1589)University of Paris NanterreNanterreFrance
- Lille Research Center in Education (EA4354)University of LilleLilleFrance
| | - Nassir Messaadi
- Family Medicine DepartmentFaculty of MedicineUniversity of LilleLilleFrance
- Centre National de Ressources et de RésilienceLilleFrance
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Hughes AM, Campbell L, Graham H, Post F, Chalder T. A Biopsychosocial Approach to HIV Fatigue: A Cross-Sectional and Prospective Analysis to Identify Key Modifiable Factors. Behav Med 2021; 47:205-213. [PMID: 32078500 DOI: 10.1080/08964289.2020.1712582] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This study aimed to identify the prevalence and predictors of current fatigue and fatigue at 1-year follow-up, in people with HIV. Participants were recruited from HIV outpatient clinics in London, England. We explored a range of bio-psychosocial factors associated with current fatigue severity, identifying the most salient factors in a multifactorial model. A prospective study explored the predictive value of specific psychological and behavioral factors in predicting fatigue severity at one year. Sixty-four of 131 (49%) participants met the criteria for clinically significant fatigue at baseline. Psychological and behavioral variables, but not immune-virologic markers or antiretroviral treatment, were associated with current fatigue severity. In the multifactorial model, catastrophizing and distress independently predicted current fatigue severity. Higher levels of fatigue at 1 year was predicted by baseline catastrophizing, symptom focusing, distress and sleep quality, when controlling for baseline fatigue, clinical and demographic variables. These findings suggest psychological and behavioral factors are important in the maintenance of fatigue in people with HIV and identify potential opportunities for treatment. Future interventions for fatigue in HIV should not only address anxiety, depression and distress but could be optimized by targeting psychological processes such as catastrophic thinking styles and symptom focusing.
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Affiliation(s)
- Alicia M Hughes
- Department of Psychological Medicine, Institute of Psychiatry, King's College London
| | - Lucy Campbell
- Department of Psychological Medicine, Institute of Psychiatry, King's College London
| | - Hannah Graham
- Department of Psychological Medicine, Institute of Psychiatry, King's College London
| | - Frank Post
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, King's College London
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Kraaij V, Bik J, Garnefski N. Cognitive and behavioral coping in people with Chronic fatigue syndrome: An exploratory study searching for intervention targets for depressive symptoms. J Health Psychol 2019; 24:1878-1883. [PMID: 28810458 PMCID: PMC6745598 DOI: 10.1177/1359105317707259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to find relevant coping factors for the development of psychological interventions for people with chronic fatigue syndrome who suffer from depressive symptoms. A total of 30 adults with chronic fatigue syndrome filled in the Cognitive Emotion Regulation Questionnaire, the COPE and the Hospital Anxiety and Depression Scale. The findings suggested that cognitive coping strategies have a stronger influence than behavioral coping strategies on depressive symptoms. Especially, the cognitive coping strategies refocusing positive, positive reappraisal and catastrophizing were of importance. These findings suggest that these coping strategies should be part of psychological programs for people with chronic fatigue syndrome.
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Mitchell TL, Griffin K, Stewart SH, Loba P. ‘We Will Never Ever Forget...’: The Swissair Flight 111 Disaster and its Impact on Volunteers and Communities. J Health Psychol 2016; 9:245-62. [PMID: 15018726 DOI: 10.1177/1359105304040890] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In collaboration with a Community Advisory Group we examined the impact of the 1998 Swissair Flight 111 disaster on volunteer responders and surrounding communities. We conducted qualitative interviews and administered a set of structured questionnaires to 13 volunteer disaster workers and conducted a focus group with community leaders. Community silence and limited help-seeking behaviour were typical reactions to the SA 111 disaster. The nature and duration of the disaster response efforts contributed to a probable 46 per cent PTSD rate in the community volunteers. Community-based, culturally appropriate followup, as well as the development of volunteer protocols for future disaster response efforts, are necessary to minimize long-term health impacts and to promote resilience among community residents and volunteers exposed to a major disaster.
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Affiliation(s)
- Terry L Mitchell
- Department of Community Health & Epidemiology, Dalhousie University, Canada.
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Abstract
This article deconstructs accounts of coping with dizziness and causes of dizziness, using content analysis of interviews with 37 sufferers. Interviewees claimed that they were determined to cope, but were unable to master their illness. They reported attempting to conceal their problem and cope independently, but also admitted to relying on help from others. Most interviewees denied having any idea of what might cause dizziness, but nevertheless suggested several causes. These partly contradictory discourses arise in a context where people with chronic illness must simultaneously demonstrate that they are physically ill but socially responsible. Hence they are prompted to adopt the sanctioned role of a passive patient, rather than engaging actively in the interpretation and management of their symptoms.
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Roche R, Taylor RR. Coping and Occupational Participation in Chronic Fatigue Syndrome. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016. [DOI: 10.1177/153944920502500205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Existing studies have shown that individuals with chronic fatigue syndrome demonstrate functional impairment in several domains related to occupational participation. Researchers have not yet explored whether coping styles may be associated with occupational participation in individuals with this condition. The aim of this study was to examine the effects of coping styles on occupational participation among adults with chronic fatigue syndrome. The authors hypothesized that occupational participation would be associated with coping strategies oriented toward information seeking and maintaining activity, and that this relationship would endure despite individual differences in illness severity. The study used a cross-sectional design to describe the associations between coping and occupational participation for 47 individuals diagnosed as having chronic fatigue syndrome. Findings from linear regression analysis revealed that the coping style of maintaining activity was positively associated with occupational participation, whereas illness accommodation was negatively associated. Implications of the findings for continued research and clinical practice in occupational therapy are discussed.
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Aasvik JK, Woodhouse A, Jacobsen HB, Borchgrevink PC, Stiles TC, Landrø NI. Subjective memory complaints among patients on sick leave are associated with symptoms of fatigue and anxiety. Front Psychol 2015; 6:1338. [PMID: 26441716 PMCID: PMC4561749 DOI: 10.3389/fpsyg.2015.01338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022] Open
Abstract
Objective: The aim of this study was to identify symptoms associated with subjective memory complaints (SMCs) among subjects who are currently on sick leave due to symptoms of chronic pain, fatigue, depression, anxiety, and insomnia. Methods: This was a cross-sectional study, subjects (n = 167) who were currently on sick leave were asked to complete an extensive survey consisting of the following: items addressing their sociodemographics, one item from the SF-8 health survey measuring pain, Chalder Fatigue Questionnaire, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and Everyday Memory Questionnaire – Revised. General linear modeling was used to analyze variables associated with SMCs. Results: Symptoms of fatigue (p-value < 0.001) and anxiety (p-value = 0.001) were uniquely and significantly associated with perceived memory failures. The associations with symptoms of pain, depression, and insomnia were not statistically significant. Conclusions: Subjective memory complaints should be recognized as part of the complex symptomatology among patients who report multiple symptoms, especially in cases of fatigue and anxiety. Self-report questionnaires measuring perceived memory failures may be a quick and easy way to incorporate and extend this knowledge into clinical practice.
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Affiliation(s)
- Julie K Aasvik
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology Trondheim, Norway
| | - Astrid Woodhouse
- Hysnes Rehabilitation Center, St. Olav's University Hospital Trondheim, Norway ; National Competence Centre for Complex Disorders, St. Olav's University Hospital Trondheim, Norway ; Department of Public Health and General Practice, Norwegian University of Science of Technology Trondheim, Norway
| | - Henrik B Jacobsen
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology Trondheim, Norway ; Hysnes Rehabilitation Center, St. Olav's University Hospital Trondheim, Norway ; National Competence Centre for Complex Disorders, St. Olav's University Hospital Trondheim, Norway
| | - Petter C Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology Trondheim, Norway ; Hysnes Rehabilitation Center, St. Olav's University Hospital Trondheim, Norway ; National Competence Centre for Complex Disorders, St. Olav's University Hospital Trondheim, Norway
| | - Tore C Stiles
- Hysnes Rehabilitation Center, St. Olav's University Hospital Trondheim, Norway ; National Competence Centre for Complex Disorders, St. Olav's University Hospital Trondheim, Norway ; Department of Psychology, Norwegian University of Science and Technology Trondheim, Norway
| | - Nils I Landrø
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology Trondheim, Norway ; National Competence Centre for Complex Disorders, St. Olav's University Hospital Trondheim, Norway ; Clinical Neuroscience Group, Department of Psychology, University of Oslo Oslo, Norway
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Donovan KA, Gonzalez BD, Small BJ, Andrykowski MA, Jacobsen PB. Depressive symptom trajectories during and after adjuvant treatment for breast cancer. Ann Behav Med 2015; 47:292-302. [PMID: 24158626 DOI: 10.1007/s12160-013-9550-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The course of depressive symptoms during and after breast cancer treatment is not well understood. PURPOSE We identified patient subgroups based on distinct trajectories of depressive symptoms and determined whether subgroups could be distinguished by personal characteristics and coping strategies. METHODS Breast cancer patients completed the Center for Epidemiologic Studies-Depression Scale on clinically meaningful occasions and during the posttreatment period. The Illness Management Questionnaire was completed prior to treatment. RESULTS A three-class mixture model provided the best fit to the data. Subgroup membership was significantly (p < .05) associated with marital status, history of depression, and focusing on symptoms. In multivariate analysis, marital status and focusing on symptoms remained significant (p < .05) predictors of subgroup membership. CONCLUSIONS Distinct trajectories can be identified during and after adjuvant breast cancer therapy. Predictors of these trajectories have implications for addressing depressive symptoms in this clinical population and for future research.
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Affiliation(s)
- Kristine A Donovan
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, MRC-PSY, Tampa, FL, 33612, USA,
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van Leeuwen N, Bossema ER, Knoop H, Kruize AA, Bootsma H, Bijlsma JWJ, Geenen R. Psychological profiles in patients with Sjogren's syndrome related to fatigue: a cluster analysis. Rheumatology (Oxford) 2014; 54:776-83. [DOI: 10.1093/rheumatology/keu387] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Indexed: 11/13/2022] Open
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Krzeczkowska A, Karatzias T, Dickson A. Pain in people with chronic fatigue syndrome/myalgic encephalomyelitis: the role of traumatic stress and coping strategies. PSYCHOL HEALTH MED 2014; 20:210-6. [PMID: 25178481 DOI: 10.1080/13548506.2014.951370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pain is a significant problem for many people with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME). This exploratory study investigated the extent to which severity of pain was related to coping strategies and post-traumatic symptomatology in people with CFS/ME. Participants comprised 27 individuals with CFS/ME and 27 healthy controls. All participants completed the CFS/ME Symptom Questionnaire, the brief pain inventory, the impact of event scale-revised and the brief-COPE. It was found that CFS/ME participants present with significantly more post-traumatic stress symptoms and report significantly less emotion focused strategies and problem focused coping strategies compared with healthy controls. Severity of pain in the CFS/ME subgroup was not associated with traumatic symptomatology, although those with severe pain reported less use of self-distraction, positive re-framing and acceptance than those with mild pain. Our results suggest that the enhancement of certain coping strategies (facilitated by psychological interventions such as acceptance and commitment therapy) may be beneficial in alleviating pain in people with CFS/ME.
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Affiliation(s)
- Anna Krzeczkowska
- a School of Life, Sport and Social Sciences , Edinburgh Napier University , Edinburgh , UK
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Stahl D, Rimes KA, Chalder T. Mechanisms of change underlying the efficacy of cognitive behaviour therapy for chronic fatigue syndrome in a specialist clinic: a mediation analysis. Psychol Med 2014; 44:1331-1344. [PMID: 23931831 DOI: 10.1017/s0033291713002006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several randomized controlled trials (RCTs) have shown that cognitive behavioural psychotherapy (CBT) is an efficacious treatment for chronic fatigue syndrome (CFS). However, little is known about the mechanisms by which the treatment has its effect. The aim of this study was to investigate potential mechanisms of change underlying the efficacy of CBT for CFS. We applied path analysis and introduce novel model comparison approaches to assess a theoretical CBT model that suggests that fearful cognitions will mediate the relationship between avoidance behaviour and illness outcomes (fatigue and social adjustment). METHOD Data from 389 patients with CFS who received CBT in a specialist service in the UK were collected at baseline, at discharge from treatment, and at 3-, 6- and 12-month follow-ups. Path analyses were used to assess possible mediating effects. Model selection using information criteria was used to compare support for competing mediational models. RESULTS Path analyses were consistent with the hypothesized model in which fear avoidance beliefs at the 3-month follow-up partially mediate the relationship between avoidance behaviour at discharge and fatigue and social adjustment respectively at 6 months. CONCLUSIONS The results strengthen the validity of a theoretical model of CBT by confirming the role of cognitive and behavioural factors in CFS.
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Affiliation(s)
- D Stahl
- Department of Biostatistics, Institute of Psychiatry, King's College London, UK
| | - K A Rimes
- Department of Psychology, University of Bath, UK
| | - T Chalder
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
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Keijmel SP, Delsing CE, Sprong T, Bleijenberg G, van der Meer JWM, Knoop H, Bleeker-Rovers CP. The Qure study: Q fever fatigue syndrome--response to treatment; a randomized placebo-controlled trial. BMC Infect Dis 2013; 13:157. [PMID: 23536997 PMCID: PMC3620935 DOI: 10.1186/1471-2334-13-157] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/21/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Q fever is a zoonosis that is present in many countries. Q fever fatigue syndrome (QFS) is one of the most frequent sequelae after an acute Q fever infection. QFS is characterized by persistent fatigue following an acute Q fever infection, leading to substantial morbidity and a high socio-economic burden. The occurrence of QFS is well-documented, and has been described in many countries over the past decades. However, a treatment with proven efficacy is not available. Only a few uncontrolled studies have tested the efficacy of treatment with antibiotics on QFS. These studies suggest a positive effect of long-term treatment with a tetracycline on performance state; however, no randomized controlled trials have been performed. Cognitive behavioral therapy (CBT) has been proven to be an effective treatment modality for chronic fatigue in other diseases, but has not yet been tested in QFS. Therefore, we designed a trial to assess the efficacy of long-term treatment with the tetracycline doxycycline and CBT in patients with QFS. METHODS/DESIGN A randomized placebo-controlled trial will be conducted. One-hundred-eighty adult patients diagnosed with QFS will be recruited and randomized between one of three groups: CBT, long-term doxycycline or placebo. First, participants will be randomized between CBT and medication (ratio 1:2). A second double-blinded randomization between doxycycline and placebo (ratio 1:1) will be performed in the medication condition. Each group will be treated for six months. Outcome measures will be assessed at baseline and post intervention. The primary outcome measure is fatigue severity. Secondary outcome measures are functional impairment, level of psychological distress, and Coxiella burnetii PCR and serology. DISCUSSION The Qure study is the first randomized placebo-controlled trial, which evaluates the efficacy of long-term doxycycline and of cognitive behavioral therapy in patients with QFS. The results of this study will provide knowledge about evidence-based treatment options for adult patients with QFS. TRIAL REGISTRATION ClinicalTrials.gov: NCT01318356, and Netherlands Trial Register: NTR2797.
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Affiliation(s)
- Stephan P Keijmel
- Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Department of Internal Medicine and division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
| | - Corine E Delsing
- Department of Internal Medicine, Medical Spectrum Twente, P.O. Box 50000, 7500, Enschede, KA, the Netherlands
| | - Tom Sprong
- Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Department of Internal Medicine and division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Department of Internal Medicine and division of Infectious Diseases, Canisius Wilhelmina Hospital, P.O. Box 9015, 6500, Nijmegen, GS, the Netherlands
| | - Gijs Bleijenberg
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
| | - Jos WM van der Meer
- Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Department of Internal Medicine and division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
| | - Hans Knoop
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
| | - Chantal P Bleeker-Rovers
- Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Department of Internal Medicine and division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
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Role of psychological aspects in both chronic pain and in daily functioning in chronic fatigue syndrome: a prospective longitudinal study. Clin Rheumatol 2012; 31:921-9. [DOI: 10.1007/s10067-012-1946-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 11/16/2011] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
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Activity Limitations and Participation Restrictions in Patients with Chronic Fatigue Syndrom—Construction of a Disease Specific Questionnaire. ACTA ACUST UNITED AC 2011. [DOI: 10.1300/j092v10n03_02] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rimes KA, Wingrove J. Mindfulness-based cognitive therapy for people with chronic fatigue syndrome still experiencing excessive fatigue after cognitive behaviour therapy: a pilot randomized study. Clin Psychol Psychother 2011; 20:107-17. [PMID: 21983916 DOI: 10.1002/cpp.793] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 09/15/2011] [Accepted: 09/23/2011] [Indexed: 11/11/2022]
Abstract
UNLABELLED Cognitive behaviour therapy (CBT) is an effective treatment for chronic fatigue syndrome (CFS; sometimes known as myalgic encephalomyelitis). However, only a minority of patients fully recover after CBT; thus, methods for improving treatment outcomes are required. This pilot study concerned a mindfulness-based cognitive therapy (MBCT) intervention adapted for people with CFS who were still experiencing excessive fatigue after CBT. The study aimed to investigate the acceptability of this new intervention and the feasibility of conducting a larger-scale randomized trial in the future. Preliminary efficacy analyses were also undertaken. Participants were randomly allocated to MBCT or waiting list. Sixteen MBCT participants and 19 waiting-list participants completed the study, with the intervention being delivered in two separate groups. Acceptability, engagement and participant-rated helpfulness of the intervention were high. Analysis of covariance controlling for pre-treatment scores indicated that, at post-treatment, MBCT participants reported lower levels of fatigue (the primary clinical outcome) than the waiting-list group. Similarly, there were significant group differences in fatigue at 2-month follow-up, and when the MBCT group was followed up to 6 months post-treatment, these improvements were maintained. The MBCT group also had superior outcomes on measures of impairment, depressed mood, catastrophic thinking about fatigue, all-or-nothing behavioural responses, unhelpful beliefs about emotions, mindfulness and self-compassion. In conclusion, MBCT is a promising and acceptable additional intervention for people still experiencing excessive fatigue after CBT for CFS, which should be investigated in a larger randomized controlled trial. KEY PRACTITIONER MESSAGE Only about 30% of people with chronic fatigue syndrome (CFS) recover after cognitive behaviour therapy (CBT); thus, methods for improving treatment outcomes are needed. This is the first pilot randomized study to demonstrate that a mindfulness-based intervention was associated with reduced fatigue and other benefits for people with CFS who were still experiencing excessive fatigue after a course of CBT. Levels of acceptability, engagement in the intervention and rated helpfulness were high. A larger-scale randomized controlled trial is required.
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Affiliation(s)
- Katharine A Rimes
- University of Bath, Department of Psychology, Claverton Down, Bath, UK.
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Maher-Edwards L, Fernie BA, Murphy G, Nikcevic AV, Spada MM. Metacognitive factors in chronic fatigue syndrome. Clin Psychol Psychother 2011; 19:552-7. [PMID: 21567656 DOI: 10.1002/cpp.757] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
UNLABELLED Chronic fatigue syndrome (CFS), which is characterized by fatigue and flu-like symptoms that are not alleviated by rest, is a poorly understood condition and an often controversial diagnosis. Earlier research has indicated that general metacognitions are associated with the severity of symptoms in patients with CFS. In the current study, we aimed to determine whether specific metacognitive factors are implicated in CFS. Using the metacognitive profiling interview template we investigated the following: (1) whether patients held positive or negative metacognitions about conceptual processes; (2) what their goals with respect to engaging in these processes were; and (3) what indicated that it was appropriate to stop. We also examined attention focus when experiencing CFS symptoms, and its advantages and disadvantages. Results showed that patients endorsed positive and negative metacognitions pertaining to conceptual processes. The goals of engaging in these processes were to identify the cause of, and devise strategies to cope with, symptoms. Patients were either unable to identify a stop signal for conceptual processing or identified an improvement in fatigue-related symptoms as representing the stop signal. Finally, patients reported that their attention focus when experiencing symptoms included distraction and monitoring of symptoms. Advantages to these strategies included symptom management, whereas disadvantages included an escalation of negative affect. The present findings provide preliminary evidence that specific metacognitive factors may be involved in CFS. KEY PRACTITIONER MESSAGE Metacognitive profiling that may aid assessment and conceptualisation of psychological distress in CFS.
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Metacognitions and negative emotions as predictors of symptom severity in chronic fatigue syndrome. J Psychosom Res 2011; 70:311-7. [PMID: 21414450 DOI: 10.1016/j.jpsychores.2010.09.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 09/21/2010] [Accepted: 09/28/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Chronic fatigue syndrome (CFS) describes a condition that is primarily characterized by fatigue and flu-like symptoms that are not alleviated by rest. This study investigated the relationship among metacognitions, negative emotions, and symptom severity in CFS. METHODS A total of 96 patients who had received a diagnosis of CFS according to the Oxford Criteria completed a battery of self-report measures that consisted of the Depression Anxiety Stress Scales, the 30-Item Metacognitions Questionnaire, the Chalder Fatigue Questionnaire (CFQ), and the RAND 36-Item Short-Form Health Survey-Physical Functioning. RESULTS Correlation analyses showed that negative emotions and metacognitions were positively correlated with measures of symptom severity and that metacognitions were a better predictor of symptom severity than anxiety and depression. Hierarchical regression analyses indicated that (1) lack of cognitive confidence predicted both mental and physical factors of the CFQ and physical functioning independently of negative emotions and (2) beliefs about the need to control thoughts predicted the mental factor of the CFQ independently of negative emotions and lack of cognitive confidence. CONCLUSION The data support the potential application of the metacognitive model of psychological disorder to understanding CFS.
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Brown MM, Brown AA, Jason LA. Illness duration and coping style in chronic fatigue syndrome. Psychol Rep 2010; 106:383-93. [PMID: 20524538 DOI: 10.2466/pr0.106.2.383-393] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A sample of patients with chronic fatigue syndrome was recruited to assess coping strategies and illness duration. It was hypothesized that adaptive coping strategies would be higher among those with longer illness duration. Those in the longer illness duration group reported higher use of active coping, positive reframing, planning, and acceptance, and lower use of behavioral disengagement than those in the shorter illness duration group. No significant differences were found between the two illness duration groups for physical impairment or symptom severity, but the long duration group revealed a lower percentage of participants who were working than the short duration group. These findings suggest that individuals with longer or shorter duration of the illness have differences in coping styles but not differences in physical impairment or symptom severity.
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Affiliation(s)
- Molly M Brown
- Center for Community Research, DePaul University, Chicago, IL 60614, USA.
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22
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Song S, Jason LA. A population-based study of chronic fatigue syndrome (CFS) experienced in differing patient groups: An effort to replicate Vercoulen et al.'s model of CFS. J Ment Health 2009. [DOI: 10.1080/09638230500076165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Moss-Morris R. Symptom perceptions, illness beliefs and coping in chronic fatigue syndrome. J Ment Health 2009. [DOI: 10.1080/09638230500136548] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
A cognitive behavioural model for the development of chronic fatigue syndrome (CFS) is outlined. Six patients with CFS are described who were treated as in-patients using cognitive behaviour therapy. Treatment consisted of graded consistent exposure to activity and cognitive restructuring. Substantial improvements were made in all but one patient up to three months after discharge.
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Dorrian A, Dempster M, Adair P. Adjustment to inflammatory bowel disease: the relative influence of illness perceptions and coping. Inflamm Bowel Dis 2009; 15:47-55. [PMID: 18626980 DOI: 10.1002/ibd.20583] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The Common Sense Model (CSM) of illness representations was used in the current study to examine the relative contribution of illness perceptions and coping strategies in explaining adjustment to inflammatory bowel disease (IBD). METHODS Participants were 80 adults consecutively attending an outpatients' clinic with a diagnosis of either Crohn's disease or ulcerative colitis. Respondents completed and returned a questionnaire booklet that assessed illness perceptions, coping, and adjustment. Adjustment was measured from the perspectives of psychological distress, quality of life, and functional independence. RESULTS Illness perceptions (particularly perception of consequences of IBD) were uniformly the most consistent variables explaining adjustment to IBD. Coping did not significantly add to predicting adjustment once illness perceptions were controlled for and therefore did not mediate the relationship between illness perceptions and adjustment, as proposed in the CSM. CONCLUSIONS The results suggest the importance of addressing illness perceptions in developing appropriate psychological interventions for IBD.
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Njoku MGC, Jason LA, Torres-Harding SR. The relationships among coping styles and fatigue in an ethnically diverse sample. ETHNICITY & HEALTH 2005; 10:263-78. [PMID: 16191727 DOI: 10.1080/13557850500138613] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The present study focused on coping strategies among African Americans, Latinos, and European Americans with chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF). The coping strategies examined were measured by using the COPE Scales, which assess Seeking Emotional Social Support, Positive Reinterpretation and Growth, Acceptance, Denial, Turning to Religion, Behavioral Disengagement, and Focusing on and Venting Emotions. In addition, the four coping strategies specifically designed for people with CFS, including maintaining activity, accommodating to the illness, focusing on symptoms, and information-seeking, were used in this study. It was hypothesized that African Americans and Latinos in comparison to European Americans would be more likely to use religious coping, behavioral disengagement, and denial. As predicted, African Americans were significantly more likely to turn to religion than European Americans, and Latinos and African Americans used denial significantly more often than European Americans. An additional finding was that focusing on symptoms was associated with greater fatigue and more physical disability among African Americans. Within the Latino sample, acceptance was related to greater fatigue and less physical disability, and greater optimism predicted less mental disability. Among European American participants, maintaining activity was related to less mental disability, whereas accommodating to the illness predicted more physical disability. These results indicate that coping varies among various ethnic groups with CFS and ICF; however, denial is consistently related to less adaptive outcomes. Therefore, healthcare professionals should find ways to reduce patient use of denial and promote alternative strategies for managing life events.
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Affiliation(s)
- Mary Gloria C Njoku
- Center for Community Research, Chronic Fatigue Research Study, Chicago, IL 60614, USA.
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Ransom S, Jacobsen PB, Schmidt JE, Andrykowski MA. Relationship of problem-focused coping strategies to changes in quality of life following treatment for early stage breast cancer. J Pain Symptom Manage 2005; 30:243-53. [PMID: 16183008 DOI: 10.1016/j.jpainsymman.2005.03.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2005] [Indexed: 10/25/2022]
Abstract
This study examined whether problem-focused coping strategies used by early stage breast cancer patients at the end of treatment could predict changes in quality of life six months later. One hundred forty-six women completed measures of problem-focused coping and quality of life at the end of early stage breast cancer treatment. Quality of life was reassessed six months later. Women who focused more on their symptoms at treatment end experienced less physical and mental quality-of-life improvement six months later. Women more likely to seek out information about their illness experienced greater physical quality-of-life improvement. The relationship of focusing on symptoms with quality of life was broad-based; the relationship of information seeking with quality of life was limited to improvements in physical functioning. Results suggest that focusing on symptoms is a maladaptive approach to illness, but that information seeking may yield benefits to physical recovery.
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Affiliation(s)
- Sean Ransom
- Psychosocial Oncology and Palliative Care, H. Lee Moffitt Cancer Center, Tampa, Florida 33612, USA
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Moss-Morris R, Sharon C, Tobin R, Baldi JC. A randomized controlled graded exercise trial for chronic fatigue syndrome: outcomes and mechanisms of change. J Health Psychol 2005; 10:245-59. [PMID: 15723894 DOI: 10.1177/1359105305049774] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate the potential mechanisms underlying the efficacy of graded exercise therapy for chronic fatigue syndrome (CFS). Forty-nine CFS patients were randomized to a 12-week graded exercise programme or to standard medical care. At the end of treatment the exercise group rated themselves as significantly more improved and less fatigued than the control group. A decrease in symptom focusing rather than an increase in fitness mediated the treatment effect. Graded exercise appears to be an effective treatment for CFS and it operates in part by reducing the degree to which patients focus on their symptoms.
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Affiliation(s)
- Rona Moss-Morris
- Health Psychology, The Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92 019, Auckland, New Zealand.
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Abstract
OBJECTIVE To assess whether the fatigue commonly reported by patients following surgery is partly a result of somatization and/or cognitive-behavioral factors. METHODS One hundred eighty-three patients completed questionnaires before surgery and then 2 days, 3 weeks and 6 months afterward. Multiple regressions were used to assess which of the following factors were important in predicting self-reported postoperative fatigue, controlling for preoperative fatigue and for various demographic and surgical variables: negative mood, history of mood disorder, preoperative expectations of fatigue, preoperative worry or optimism about surgery, preoperative beliefs about the benefits of activity or rest, self-reported postoperative activity, self-reported cardiovascular deconditioning, and availability of social support. RESULTS Controlling for demographic and surgical variables and preoperative fatigue, postoperative fatigue showed significant associations with negative mood at each stage of follow-up (p < .001) and was significantly predicted by history of mood disorder at 2 days postoperatively (p = .02). Higher fatigue expectations were self-fulfilling at 3 weeks after surgery (p = .02), whereas preoperative belief in physical activity as being beneficial to recovery predicted reduced fatigue at 6 months (p < .001). Finally, self-reported breathlessness after exercise, an indicator of cardiovascular deconditioning, was also significantly associated with greater fatigue at 6 months (p = .02). CONCLUSION The results indicate that psychological processes may well be relevant in the etiology of postoperative fatigue. In particular, the results relating to mood and expectations suggest that somatization may be particularly important in the first few weeks following surgery, whereas cognitive-behavioral factors and cardiovascular deconditioning may be more important in determining later-stage recovery.
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Affiliation(s)
- G James Rubin
- Section of General Hospital Psychiatry, Division of Psychological Medicine, Institute of Psychiatry and Guy's, King's and St. Thomas' School of Medicine, King's College London, London, UK.
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Lewis IM, Read NW, McKendrick MW. Prospective study of factors influencing the persistence of symptoms in hospitalised patients with acute infection. J Psychosom Res 2003; 54:307-11. [PMID: 12670607 DOI: 10.1016/s0022-3999(02)00393-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sequential patients, aged 18-50, admitted to an Infectious Diseases Unit of a large teaching hospital with an acute infection, completed validated psychometric questionnaires on admission and were followed up at three monthly intervals for 12 months. 34% of patients available for follow-up remained symptomatic at 3 months, but by 6 months and for the rest of the study, only about 20% of patients available for follow-up remained symptomatic. Symptoms resembled those of the initial infection at 3 months, but for the remainder of the study, most patients complained of nonspecific symptoms of tiredness and lassitude. Patients symptomatic at 3 and 6 months (S+) had significantly higher depression scores on admission compared with nonsymptomatic group (S-) (P<.05). Stepwise logistic regression revealed that case level depression on admission was predictive of a 13-fold increase in the chance of remaining symptomatic at 6 months. These associations were lost by 12 months. In conclusion, this study has supported the hypothesis that psychopathology occurring at the time of an acute infection can lead to persistent symptoms that at least in the short term resemble those of the acute illness. This relationship breaks down after 6 months, when symptoms become less specific and may be conditioned by exhausting and distressing social situations other than acute illness.
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Affiliation(s)
- I M Lewis
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK
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Taillefer SS, Kirmayer LJ, Robbins JM, Lasry JC. Psychological correlates of functional status in chronic fatigue syndrome. J Psychosom Res 2002; 53:1097-106. [PMID: 12479992 DOI: 10.1016/s0022-3999(02)00566-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The present study was designed to test a cognitive model of impairment in chronic fatigue syndrome (CFS) in which disability is a function of severity of fatigue and depressive symptoms, generalized somatic symptom attributions and generalized illness worry. METHODS We compared 45 CFS and 40 multiple sclerosis (MS) outpatients on measures of functional ability, fatigue severity, depressive symptoms, somatic symptom attribution and illness worry. RESULTS The results confirmed previous findings of lower levels of functional status and greater fatigue among CFS patients compared to a group of patients with MS. Fatigue severity was found to be a significant predictor of physical functioning but not of psychosocial functioning in both groups. In CFS, when level of fatigue was controlled, making more somatic attributions was associated with worse physical functioning, and both illness worry and depressive symptoms were associated with worse psychosocial functioning. CONCLUSIONS Our findings support the role of depression and illness cognitions in disability in CFS sufferers. Different cognitive factors account for physical and psychosocial disability in CFS and MS. The SF-36 may be sensitive to symptom attributions, suggesting caution in its interpretation when used with patients with ill-defined medical conditions.
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Abstract
There is a paucity of research on the types of strategies that patients with psoriasis use to cope with the impact of their condition. By contrast there are a number of studies assessing coping by patients with nondermatological disease. The purpose of the present study was to examine strategies for coping in patients with psoriasis and investigate whether they differ as compared with normal controls and patients with other major medical diseases. Two hundred and fifty patients with a definite dermatologist-confirmed diagnosis of psoriasis participated in this cross-sectional study. Patients were assessed by psoriasis area severity index and all patients completed the COPE questionnaire and psoriasis disability index. Sixty healthy, control participants completed the COPE questionnaire for comparison purposes. Mean COPE scores from patients with psoriasis were also compared with published COPE scores from other medical diseases. The coping strategies most frequently used by patients with psoriasis were acceptance, planning, active coping and positive reinterpretation. The least frequently used were alcohol and nonprescription drugs, religion, and denial of their condition. Despite reporting greater disability, patients with severe psoriasis did not significantly differ from those with mild/moderate disease in their use of particular forms of coping strategies. Patients with psoriasis as a whole tended to use significantly less active coping strategies, planning, positive reinterpretation and humour when compared with normal controls. There was marked similarity in the frequency of use of particular coping strategies between patients with psoriasis and patients with other medical conditions. Similar types of coping strategies are utilized by patients regardless of whether their illness is visible (psoriasis) invisible (chronic fatigue syndrome, atrial fibrillation), has significant physical impairment (spinal cord injury), or is life-threatening (cancer, and myocardial infarction). It appears that illness brings with it a generic form of coping that may require shaping to fit the individual demands of diseases such as psoriasis.
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Affiliation(s)
- D G Fortune
- Dermatology Centre, University of Manchester School of Medicine, Hope Hospital, Salford, UK
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Petersen S, Heesacker M, Schwartz RC. Physical illness: social construction or biological imperative? J Community Health Nurs 2002; 18:213-22. [PMID: 11775555 DOI: 10.1207/s15327655jchn1804_02] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
All cultures have metaphors for mental illness that define how it is diagnosed, treated, and experienced by the patient. Cultural metaphors that define mental illness have been traced predominantly to biomedical and systems models. However, the research on factors such as progression of illness, survival rates, adherence to medical regimens, level of disability, and experience of pain in chronic and acute life-threatening illnesses suggests another metaphor. This article not only explores how a constructivist metaphor makes sense of this research, but also suggests an approach to consider in helping patients and their families deal with the difficult life circumstances that illness imposes. Implications for nurses are outlined.
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Affiliation(s)
- S Petersen
- Temple University Philadelphia, PA, USA.
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Cordingley L, Wearden A, Appleby L, Fisher L. The Family Response Questionnaire: a new scale to assess the responses of family members to people with chronic fatigue syndrome. J Psychosom Res 2001; 51:417-24. [PMID: 11516763 DOI: 10.1016/s0022-3999(01)00193-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Family responses to patients with chronic fatigue syndrome (CFS) may influence the course of the disorder and family members themselves are likely to be adversely affected. However, the beliefs and responses of relatives of CFS patients have been under-researched. The aim of this study was to produce an easy-to-administer questionnaire to assess the responses of family members to people with CFS. METHODS Seventy-eight people, all close relatives of (physician-diagnosed) CFS sufferers, completed the first version of the Family Response Questionnaire (FRQ). RESULTS Examination of the correlation matrix and a cluster analysis of the items support four scales rather than the original five. The four response scales were labelled: sympathetic-empathic, active engagement, rejecting-hostile, and concern with self. Measures of test-retest and internal reliability were high. Participants found the items both comprehensible and relevant to their experiences of living with people with CFS. CONCLUSION The new version of the FRQ will be useful in further examination of the responses of CFS on individuals and their families.
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Affiliation(s)
- L Cordingley
- School of Psychiatry and Behavioural Sciences, University of Manchester, Room 704, Stopford Building, Oxford Road, M13 9PT, Manchester, UK.
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35
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Abstract
The chronic fatigue syndrome (CFS) is described, and research on coping with this illness reviewed and analysed. CFS is a severely disabling illness of unknown etiology, which has occurred in epidemic forms all over the world. However, the number of sufferers has dramatically increased over previous years. The heterogeneous symptomatology of CFS was reviewed, and diagnostic criteria were discussed. The difficulty in establishing causality was emphasized. An interaction of factors appears most likely to be associated with illness onset and maintenance. As the mediating factor could be sufferers' coping behavior, the existing coping literature was reviewed. There might be an association between coping and physical and psychological well-being. Finally, recommendations are made for longitudinal research on coping and coping effectiveness, and for the development of therapeutic interventions.
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Affiliation(s)
- S Ax
- Liverpool John Moores University.
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37
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Afari N, Schmaling KB, Herrell R, Hartman S, Goldberg J, Buchwald DS. Coping strategies in twins with chronic fatigue and chronic fatigue syndrome. J Psychosom Res 2000; 48:547-54. [PMID: 11033373 DOI: 10.1016/s0022-3999(00)00093-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Individuals with chronic fatigue and chronic fatigue syndrome (CFS) face debilitating symptoms as well as stressful life situations that may result from their condition. The goal of this study was to examine the coping strategies used by fatigue-discordant twin pairs. METHODS We utilized a co-twin design to assess how twin pairs discordant for chronic fatigue and CFS cope with stress. All twin pairs were administered the Revised Ways of Coping Checklist. RESULTS Overall, the pattern of coping strategies was similar for fatigued and non-fatigued twins. However, twins with chronic fatigue or CFS utilized more avoidance strategies than their non-fatigued counterparts; those with chronic fatigue also used more avoidance relative to problem-focused coping than their co-twins. CONCLUSIONS These results suggest that while fatigue-discordant twins generally exhibit similar behavior patterns in order to cope with stress, there may be an association between fatigue and avoidance coping. Future research should focus on the role of avoidance and its relationship to fatiguing illnesses.
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Affiliation(s)
- N Afari
- Department of Medicine, University of Washington, Seattle, WA 98104, USA.
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Abstract
OBJECTIVE Our objective was to evaluate symptom patterns in patients with chronic fatigue syndrome (CFS) who were ill for 10 or more years. METHODS This cross-sectional self-report study compared patient groups with long-duration (median = 18 years; n = 258) and short-duration (median = 3 years; n = 28) CFS to a group of healthy significant others (n = 79) on symptomatic, neurocognitive, and psychological variables. Data were gathered from a 574-item postal questionnaire. RESULTS A principal-components analysis of CFS symptom data yielded a three-factor solution: cognitive problems; flu-like symptoms; and neurologic symptoms. Compared with the short-duration CFS group, the long-duration group had significantly higher CFS symptom severity scores (p < 0.04), largely attributable to increased cognitive difficulties. A subgroup comparison of subjects ill for < 3 years versus those ill 4-7 years suggested that denial coping strategies were more likely in those participants with the shorter illness duration. Significant differences between both CFS groups and healthy controls were found in a number of comorbid disorders. Participants with CFS most often endorsed immune/viral abnormalities and persistent stress as important perceived causes of their illness. CONCLUSION Participants with long-duration CFS reported a large number of specific cognitive difficulties that were greater in severity than those reported by participants with short-duration CFS. The pattern of comorbid disorders in the CFS groups was consistent with hypersensitivity and viral reactivation hypotheses.
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Affiliation(s)
- F Friedberg
- Department of Mathematics, Fitchburg State College, MA, USA
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Abstract
BACKGROUND A relatively high proportion of overseas development workers may develop chronic fatigue syndrome (CFS). A qualitative study was conducted in order to investigate how such people perceived their condition. METHODS Twelve people who had developed CFS while working overseas with development organizations, or shortly after visiting development projects, were interviewed about their experiences. Their responses were analyzed using a grounded theory approach. RESULTS Most of the participants considered themselves to have been extremely healthy before they developed CFS. The syndrome did not appear to have been caused by depression. The symptoms which were reported covered the range of symptoms typically found in studies of CFS. Respondents described difficulty in receiving, and accepting, a diagnosis. All of the participants attributed the CFS to multiple causes, the principal causes being overwork, stress and infections. Among the consequences of CFS reported to be the most difficult were having to leave the development project prematurely; pain; powerlessness; loss of independence, and the unpredictability of CFS. Factors which had helped respondents cope with these difficulties included religious beliefs; comparisons with people who were worse off than they were; thinking about positive consequences of the condition, and talking with supportive people. CONCLUSIONS Some theories have suggested that CFS symptoms arise as a result of depression or other emotional difficulties, which the individual is not able to acknowledge. The results indicated that such theories may not apply to this subgroup of people with CFS. Further research on the etiology of CFS is warranted. Respondents described high levels of work-related stress as common to the experience of development work. It might be beneficial to train development workers in stress management techniques. Development organizations should be encouraged to ensure that their workers take sufficient time to rest, and attempts should be made to reduce work pressures.
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Affiliation(s)
- D M Lovell
- Oxford University Psychiatry Department, Warneford Hospital, Oxford, England
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Heijmans M, de Ridder D. Assessing illness representations of chronic illness: explorations of their disease-specific nature. J Behav Med 1998; 21:485-503. [PMID: 9836133 DOI: 10.1023/a:1018788427100] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Elaborating on the five-dimensional structure of illness representation, as described in the self-regulation model of Leventhal (1980), the present study is aimed at identifying the relevance of this generic structure for two chronic illnesses: chronic fatigue syndrome (CFS) and Addison's disease (AD). Factor analyses showed the importance of the five dimensions identity, time-line, control/cure, cause, and consequences to differ according to the type of disease. That is, the items representing the five dimensions merged together for CFS patients and AD patients in a different manner and thereby produced different factor solutions for the two patient groups. In CFS patients, a four-factor solution was identified with manageability, seriousness, personal responsibility, and external cause as the factors. In AD patients a four-factor solution was also identified but with seriousness, cause, chronicity, and controllability as the factors. The value of these findings for our understanding of the disease-specific nature of illness representation is discussed.
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Affiliation(s)
- M Heijmans
- Department of Health Psychology, Utrecht University, The Netherlands
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Saltzstein BJ, Wyshak G, Hubbuch JT, Perry JC. A naturalistic study of the chronic fatigue syndrome among women in primary care. Gen Hosp Psychiatry 1998; 20:307-16. [PMID: 9788031 DOI: 10.1016/s0163-8343(98)00036-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chronic fatigue syndrome (CFS), a controversial illness without clear etiology, causes profound debilitation in its sufferers. This study explored subjects' perceptions of the variables that mediated the course of their illness and identified coping strategies in 15 women with CFS referred from the practice of a primary care physician. Exploratory semistructured interviews were adapted from Kleinman's Illness Narratives. Four instruments were used: the Beck Depression Inventory, the Sickness Impact Profile, a modified Karnofsky scale, and the Defense Mechanism Rating Scale. Of the 15 women, 60% reported improvement and/or recovery at the time of the interview. Improvement was associated with social support and lower levels of depressive symptoms. Health status was influenced by how subjects perceived their illness, their future, and the doctor's prognosis; and by the physician's early diagnosis, validation of the CFS, and intensive medical follow-up. Obsessional and healthy neurotic defense levels predominated, which differs from historical comparison groups with dysthymia and panic disorder. Psychological adaptation to CFS is similar to adaptive coping in other chronic illnesses: subjective perceptions of health status can predict functional status. Physician validation is particularly important given the controversial status of CFS. Maintaining relationships with others--doctor, work, family, and group/spiritual activities reflected healthy coping strategies that promoted hope and attitudinal shifts. The finding of a mixture of neurotic and healthy defenses and a low proportion of defenses associated with personality disorders has not been previously reported in the CFS literature and warrants further investigation.
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Abstract
In this study, the relations between illness representations, coping behavior, and adaptive outcomes in chronic fatigue syndrome (CFS) patients (N=98) were examined. Following Leventhal's self-regulation model, it was hypothesized that illness representations would be directly related to coping and, via coping, to adaptive outcome. The results showed patients who considered their illness to be a serious condition, who believed that they had no control over their illness, who saw little possibility for cure, and who believed their illness to have serious consequences to cope with their illness in a passive way, report higher levels of impairment in physical and social functioning and report greater problems in mental health and vitality. A series of regression analyses showed illness representations to be stronger predictors of adaptive outcome than coping scores. The implications of these findings for the treatment of CFS patients are discussed.
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Affiliation(s)
- M J Heijmans
- Department of Clinical and Health Psychology, Utrecht University, The Netherlands.
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Ray C, Jeffefues S, Weir W, Hayes K, Simon S, Akingbade F, Marriott P. Making sense of chronic fatigue syndrome: Patients' accounts of onset. Psychol Health 1998. [DOI: 10.1080/08870449808406134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- Trudie Chalder
- King's College School of Medicine and Dentistry and The Institute of Psychiatry, London SE5 8AZ
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Abstract
In this prospective study, 137 patients with chronic fatigue syndrome were followed-up at a 1-year interval to determine factors relating to outcomes. Nearly two thirds reported an improvement on direct ratings of change. In analyses with fatigue and functional impairment at follow-up as the criteria, and controlling for earlier status, poorer outcomes were predicted by illness duration, subjective cognitive difficulty, and somatic symptoms; there was no influence of anxiety, depression, or general emotional distress. Fatigue was also predicted by information-seeking, and impairment by behavioral disengagement and a low internal locus of control. The belief that one's actions can influence outcomes modified the relationship between illness accommodation and both fatigue and impairment; adverse outcomes were associated with accommodating to illness only in the context of lower levels of perceived control. Thus, it is suggested that interventions that either discourage avoidance of activity or enhance perceived control could benefit the course of the illness.
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Affiliation(s)
- C Ray
- Department of Human Sciences, Brunel University, Uxbridge, Middlesex, UK
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Clements A, Sharpe M, Simkin S, Borrill J, Hawton K. Chronic fatigue syndrome: a qualitative investigation of patients' beliefs about the illness. J Psychosom Res 1997; 42:615-24. [PMID: 9226609 DOI: 10.1016/s0022-3999(97)00087-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The chronic fatigue syndrome is a disabling chronic condition of uncertain cause. Previous studies have found that patients seen in hospital clinics with the syndrome often strongly believe that their illness is physical in nature and minimize the role of psychological and social factors. There is also evidence that patients cope by avoiding activity. However, almost all of these studies have assessed illness beliefs only by questionnaire. The aim of this study was to explore the nature and origin of illness beliefs in more detail using in-depth interviews and a qualitative analysis of patient responses. Sixty-six consecutive referrals meeting Oxford criteria for chronic fatigue syndrome were recruited. Analysis of responses indicated that, whereas the most commonly described explanation for the illness was a physical one, more than half the patients also believed "stress" had played a role. Patients believed that they could partially control the symptoms by reducing activity but felt helpless to influence the physical disease process and hence the course of the illness. Patients reported that they had arrived at these beliefs about the illness after prolonged reflection on their own experience combined with the reading of media reports, self help books, and patient group literature. The views of health professionals played a relatively small role. There is potentially a considerable opportunity to help patients arrive at a wider and more enabling explanation of their illness when they first present to primary care.
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Affiliation(s)
- A Clements
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK.
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Sharpe M, Chalder T, Palmer I, Wessely S. Chronic fatigue syndrome. A practical guide to assessment and management. Gen Hosp Psychiatry 1997; 19:185-99. [PMID: 9218987 DOI: 10.1016/s0163-8343(97)80315-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Chronic fatigue and chronic fatigue syndrome (CFS) have become increasingly recognized as a common clinical problem, yet one that physicians often find difficult to manage. In this review we suggest a practical, pragmatic, evidence-based approach to the assessment and initial management of the patient whose presentation suggests this diagnosis. The basic principles are simple and for each aspect of management we point out both potential pitfalls and strategies to overcome them. The first, and most important task is to develop mutual trust and collaboration. The second is to complete an adequate assessment, the aim of which is either to make a diagnosis of CFS or to identify an alternative cause for the patient's symptoms. The history is most important and should include a detailed account of the symptoms, the associated disability, the choice of coping strategies, and importantly, the patient's own understanding of his/her illness. The assessment of possible comorbid psychiatric disorders such as depression or anxiety is mandatory. When the physician is satisfied that no alternative physical or psychiatric disorder can be found to explain symptoms, we suggest that a firm and positive diagnosis of CFS be made. The treatment of CFS requires that the patient is given a positive explanation of the cause of his symptoms, emphasizing the distinction among factors that may have predisposed them to develop the illness (lifestyle, work stress, personality), triggered the illness (viral infection, life events) and perpetuated the illness (cerebral dysfunction, sleep disorder, depression, inconsistent activity, and misunderstanding of the illness and fear of making it worse). Interventions are then aimed to overcoming these illness-perpetuating factors. The role of antidepressants remains uncertain but may be tried on a pragmatic basis. Other medications should be avoided. The only treatment strategies of proven efficacy are cognitive behavioral ones. The most important starting point is to promote a consistent pattern of activity, rest, and sleep, followed by a gradual return to normal activity; ongoing review of any 'catastrophic' misinterpretation of symptoms and the problem solving of current life difficulties. We regard chronic fatigue syndrome as important not only because it represents potentially treatable disability and suffering but also because it provides an example for the positive management of medically unexplained illness in general.
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Abstract
In response to reports of negative cooperation between sufferers of chronic fatigue syndrome (CFS) and their doctors, semi-structured interviews were conducted with sufferers from two different patient samples. Satisfaction with support received and with medical professionals in general was low. Sufferers complained about insufficient informational as well as emotional support from their doctors, and as a consequence most opted for alternative or complementary forms of treatment. In addition, disagreements over illness aetiology and treatment precluded effective cooperation. If satisfaction and compliance are to improve, sufferers will need more information about CFS and more support.
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Affiliation(s)
- S Ax
- Birkback College, University of London, England
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