Causal Attributions,Perceived Control,and Psychological Adjustment: A Study of Chronic Fatigue Syndrome1

Causal attributions control, beliefs, and helpful and unhelpful support attempts were examined among people experiencing chronic fatigue syndrome (CFS) and their close others. Results revealed that 84% of respondents with CFS believed that their illness was due, at least in part, to physical or external causes, whereas 47% mentioned internal/psychological causes. Reports of internal causal attributions for CFS were positively correlated with indicators of poor psychological adjustment among those with CFS. Having an external locus of control (i.e., to powerful others) was also associated with poorer psychological adjustment among respondents with CFS. Close others' causal attributions to internal factors were related to frequency of self‐reported unhelpful support attempts and to reports of depression and anxiety those respondents with CFS.     

Health-related quality of life in chronic fatigue syndrome: predictors of physical functioning and psychological distress

This study investigated health-related quality of life (HRQoL; physical functioning and psychological distress) in an Australian chronic fatigue syndrome (CFS) population. The aims of the study were to compare HRQoL in those with CFS to the normal population, and to investigate the extent to which sociodemographic (age, gender, partner status, education), illness-related (illness duration, symptom frequency), and fatigue severity (physical, mental) variables predicted HRQoL. A total of 139 people meeting CFS criteria completed questionnaires. HRQoL was assessed using standardised measures of distress and physical functioning. Compared with norms, those with CFS obtained significantly lower scores on all physical functioning areas, whereas 63% of participants reported clinically significant psychological distress. Hierarchical regression analyses indicated that physical fatigue severity and symptom frequency were the strongest predictors of deficits in physical domain HRQoL. Physical HRQoL outcomes were also predicted by mental fatigue severity, older age, and female gender. All predictors were unrelated to psychological distress apart from weak positive associations with physical fatigue and symptom frequency. Results identify a potent set of predictors of HRQoL and show that CFS has a pervasive negative impact on quality of life, particularly physical and psychological functioning.     

Detecting Chronic Fatigue Syndrome: The Role of Counselors

Chronic fatigue syndrome (CFS) is a physical illness, the cause of which is unknown. Known also as chronic fatigue immune dysfunction syndrome and myalgic encepalomyelitis, the illness has a probable incidence of 2 to 3 per 1,000 among adults and adolescents and is seen also in children. Only a small minority of cases are diagnosed, and only 25% of those suffering from CFS suspect this as the diagnosis. For this reason, counselors often see persons with unsuspected cases and may play an important role in detecting and referring these clients appropriately. Case histories are used to illustrate how suspected cases of CFS can be distinguished from depression and other mental health conditions in counseling practice.     

Chronic Fatigue Syndrome: The Need for Subtypes

Chronic fatigue syndrome (CFS) is an important condition confronting patients, clinicians, and researchers. This article provides information concerning the need for appropriate diagnosis of CFS subtypes. We first review findings suggesting that CFS is best conceptualized as a separate diagnostic entity rather than as part of a unitary model of functional somatic distress. Next, research involving the case definitions of CFS is reviewed. Findings suggest that whether a broad or more conservative case definition is employed, and whether clinic or community samples are recruited, these decisions will have a major influence in the types of patients selected. Review of further findings suggests that subtyping individuals with CFS on sociodemographic, functional disability, viral, immune, neuroendocrine, neurology, autonomic, and genetic biomarkers can provide clarification for researchers and clinicians who encounter CFS characteristically confusing heterogeneous symptom profiles. Treatment studies that incorporate subtypes might be particularly helpful in better understanding the pathophysiology of CFS. This review suggests that there is a need for greater diagnostic clarity, and this might be accomplished by subgroups that integrate multiple variables including those in cognitive, emotional, and biological domains.     

Evaluating Attributions for an Illness Based Upon the Name: Chronic Fatigue Syndrome, Myalgic Encephalopathy and Florence Nightingale Disease

In recent years, considerable discussion has occurred about stigma surrounding the name given to an illness currently known as chronic fatigue syndrome (CFS). Although patients and medical personnel have expressed varying opinions on this issue, no studies have evaluated how beliefs about the illness change based upon the type of name used for diagnostic purposes. Proposals have been put forth to rename the illness with an eponym (a famous patient's or researcher's name) or with a less trivial sounding, more medically based type of name. In this study, attributions about CFS were measured in three groups of medical trainees. All groups read the same case study of a person with classic symptoms of chronic fatigue syndrome, with the only difference being in the type of name given. Trainees then were asked to provide attributions about certain aspects of the illness, including its cause, severity, and prognosis. Results suggested that, across name conditions, most trainees appeared to consider the symptom complex of CFS a serious illness resulting in poor quality of life. In addition, findings indicated that the name, chronic fatigue syndrome, may be regarded less seriously than the Myalgic Encephalopathy name with respect to some important aspects of the illness. In this study, specialty of medical trainee also played a role in how the illness was perceived.     

Cognitive Behavior Therapy for Relatively Active and for Passive Chronic Fatigue Syndrome Patients

In chronic fatigue syndrome (CFS), facilitating, initiating, and perpetuating factors are distinguished. Although somatic factors might have initiated symptoms in CFS, they do not explain the persistence of fatigue. Cognitive behavior therapy (CBT) for CFS focuses on factors that perpetuate and prolong symptoms. Recently it has been shown that, based on their level of activity, two groups of patients can be distinguished. For so-called “relatively active” CFS patients, the main perpetuating factors are nonaccepting and demanding cognitions leading to bursts of activity. For so-called “passive” CFS patients, their fear that activity might worsen their symptoms (which results in an avoidance of activity) is the most important perpetuating factor. These differences in perpetuating factors result in separate treatment manuals for relatively active and for passive CFS patients. Before describing the treatment manuals, we outline basic assumptions, considerations before starting CBT for CFS, and ways to determine the activity pattern.     

Telephone-based guided self-help for adolescents with chronic fatigue syndrome: A non-randomised cohort study

The aim of this study was to gain preliminary evidence about the efficacy of a new telephone-based guided self-help intervention, based on cognitive-behavioural principles, which aimed to reduce fatigue and improve school attendance in adolescents with chronic fatigue syndrome (CFS). A non-randomised cohort design was used, with a two-month baseline period. Sixty-three 11–18 year-old participants recruited from a specialist CFS unit received the intervention. Participants received six half-hour fortnightly telephone sessions and two follow-up sessions. Fatigue and school attendance were the main outcomes and the main time point for assessing outcome was 6 months post-treatment. Using multi-level modelling, a significant decrease in fatigue was found between pre-treatment and 6 month follow-up, treatment effect estimate = – 5.68 (?7.63, ?3.72), a large effect size (Cohen's d = 0.79). The decrease in fatigue between pre and post-treatment was significantly larger than between baseline and pre-treatment. A significant increase in school attendance was found between pre-treatment and 6 month follow-up, effect estimate = 1.38 (0.76, 2.00), a medium effect size (d = ?0.48). Univariate logistic regression found baseline perfectionism to be associated with poorer school attendance at six-month follow-up. In conclusion, telephone-based guided self-help is an acceptable minimal intervention which is efficacious in reducing fatigue in adolescents with CFS.     

Bedeutung von Stress bei chronischer Ersch?pfung

In this review article a novel approach to the explanation of chronic fatigue is presented. It has long been known that patients suffering from chronic fatigue syndrome (CFS) have reported increased occurrencesof traumatic experiences early in life compared to healthy individuals. Such experiences have been found to substantially impact on biological regulation processes later in life and thus alter sensitivity to stressful stimuli in adulthood. In CFS research has shown that patients display altered endocrine and immune stress regulation. A summary of current research in this area is given and the role of both childhood and adulthood stressors in biological regulation processes in CFS is discussed.     

Psychotherapie chronischer Erschöpfungszustände

Chronic fatigue is common. Since fatigue has little specificity, it can be the consequence of many different somatic diseases and psychiatric disorders. Therapy needs to be individually tailored with regard to the underlying or assumed causes. When objective and established causes cannot be identified or cannot adequately explain the symptoms experienced, the diagnosis of chronic fatigue syndrome (CFS) is possible. But what is CFS? Is it a valid diagnosis? How can the chronic fatigue patient be treated? Based on an integrative understanding, a psychobiological etiological and psychotherapeutical model of chronic fatigue will be developed and described.     

Emotion recognition and emotional theory of mind in chronic fatigue syndrome

Background: Difficulties with social function have been reported in chronic fatigue syndrome (CFS), but underpinning factors are unknown. Emotion recognition, theory of mind (inference of another's mental state) and ‘emotional’ theory of mind (eToM) (inference of another's emotional state) are important social abilities, facilitating understanding of others. This study examined emotion recognition and eToM in CFS patients and their relationship to self-reported social function.

Methods: CFS patients (n?=?45) and healthy controls (HCs; n?=?50) completed tasks assessing emotion recognition, basic or advanced eToM (for self and other) and a self-report measure of social function.

Results: CFS participants were poorer than HCs at recognising emotion states in the faces of others and at inferring their own emotions. Lower scores on these tasks were associated with poorer self-reported daily and social function. CFS patients demonstrated good eToM and performance on these tasks did not relate to the level of social function.

Conclusions: CFS patients do not have poor eToM, nor does eToM appear to be associated with social functioning in CFS. However, this group of patients experience difficulties in emotion recognition and inferring emotions in themselves and this may impact upon social function.     

Extended network learning error: A new way of conceptualising chronic fatigue syndrome

Abstract

The cause of chronic fatigue syndrome (CFS) is controversial: psychological, hypothalamic and immune mechanisms have been proposed as well as the possibility of some form of interaction between these mechanisms. Patients' own conceptual models vary and sometimes adversely affect self-management. This paper suggests an interactional way of conceptualising CFS using developments in complexity theory (networks, parallel processing or connectionism). I propose that the neurological, immune and endocrine systems are pan of a single, self-regulatory, extended brain-body network. Furthermore, that CFS is caused by self-organisational change in this extended network created by normally adaptive error-sensitive learning rules that malfunction when physiological and psychological challenges coincide. This psychoneuroimniunoendocrinological model shows how previously proposed mechanisms could interact to cause CFS. explains the heterogeneity of the presentation of the disease, and provides a conceptual model that may be acceptable to patients but is also consistent with effective self-management.     

The Effect of War Stressors and Life Events on Gulf War Veterans With Chronic Fatigue Syndrome Symptoms

This study examines the association of life stressors and the period when they occur, with the development of chronic fatigue syndrome (CFS) symptoms in Gulf War veterans. Of data collected from Gulf War Health Registry veterans, 113 met CFS criteria and 441were controls. After hierarchical multiple regression, several negative life stressors were associated with CFS group membership: being wounded, experiencing a traumatic war experience, frequent battle experiences, demotion, and unable to work within 2 years of returning from the Gulf. The positive life stressor of buying a house more than 2 years after returning protected against being in the CFS group. The findings are consistent with etiological hypotheses of CFS incorporating a psychosocial component and are useful in developing programs for veterans returning from war.     

Couples' Disease: The Experience of Living with a Partner with Chronic Depression

This study is concerned with the impact of chronic depression on partners. Thirteen male and female participants who lived with a partner with chronic depression were interviewed. Data were analyzed using thematic analysis. Findings highlighted a need for caregivers to be more centrally involved in their partner's care, given that they face stigma, shifts in role identity, and uncertainty, which all potentially threaten the level of support they can give their partner. In this sense, depression might be described as a “couples disease,” suggesting that couples therapy and group support for partners should be more widely available to help reduce the burden on partners and potentially prevent relationship breakdown.     

The Analyst and the Significant Other: Two's Company,Three's a Crowd: Commentary on Paper by Carla Leone

My response to Carla Leone's paper focuses on how psychoanalysts perceive the significant others of their patients is an attempt to both endorse raising this important question and to augment our thinking about it. Leone identifies the dynamic backdrop for the tendency of individual therapists to unquestionably accept their patient's representation of the significant other. From an interpersonal-relational and family systemic perspective, I raise other dynamic possibilities regarding transference and countertransference, the self as co-constructed with the significant other, introduce the importance of attachment theory, and suggest creative ways to keep a balanced view of the partner who is not known to the analyst except through the patient's representation.     

Patients with chronic fatigue syndrome do not score higher on the autism‐spectrum quotient than healthy controls: Comparison with autism spectrum disorder

Clinically, there is an overlap of several symptoms of chronic fatigue syndrome (CFS ) and autism spectrum disorder (ASD ), including fatigue; brain “fog”; cognitive impairments; increased sensitivity to sound, light, and odour; increased pain and tenderness; and impaired emotional contact. Adults with CFS (n = 59) or ASD (n = 50) and healthy controls (HC ; n = 53) were assessed with the Autism‐Spectrum Quotient (AQ ) in a cross‐sectional study. Non‐parametric analysis was used to compare AQ scores among the groups. Univariate analysis of variance (ANCOVA ) was used to identify if age, sex, or diagnostic group influenced the differences in scores. Patients with ASD scored significantly higher on the AQ than the CFS group and the HC group. No differences in AQ scores were found between the CFS and HC groups. AQ results were influenced by the diagnostic group but not by age or sex, according to ANCOVA . Despite clinical observations of symptom overlap between ASD and CFS , adult patients with CFS report few autistic traits in the self‐report instrument, the AQ . The choice of instrument to assess autistic traits may influence the results.     

Chronic fatigue syndrome/myalgicencephalomyelitis as a twentieth-century disease: analytic challenges

The challenges of chronic fatigue syndrome (often called myalgic encephalomyelitis, especially in the UK) (CFS/ME) to analytical and medical approaches are connected with our inability to understand its distressing somatic symptoms in terms of a single identifiable and understandable disease entity. The evidence for the roles of viral aetiologies remains inconclusive, as does our understanding of the involvement of the immune system. The history and social context of CFS/ME, and its relation to neurasthenia and psychasthenia are sketched. A symbolic attitude to the condition may need to be rooted in an awareness of psychoid levels of operation, and the expression and spread of CFS/ME may sometimes be aided by the ravages of projective identification. Psychic denial, sometimes violent, in sufferers (especially children and adolescents) and their families may be important in the aetiology of CFS/ME. We draw out common threads from psychodynamic work with five cases, four showing some symptomatic improvement, analytic discussions of three cases being presented elsewhere in this issue of JAP.     

Chronic Fatigue Syndrome Severity and Depression: The Role of Secondary Beliefs

Chronic fatigue syndrome (CFS) is a poorly understood illness that is characterized by profound and prolonged exhaustion and has no clear pathological marker. This study investigated the role of illness severity and secondary beliefs in depression among a CFS cohort, using the A–B–C framework of Rational Emotive Behavioral Therapy. Empirical research has consistently found that CFS patients tend to hold more negative cognitions about their illness, which could be associated with greater severity and emotional deficits. Specifically, secondary beliefs were explored as a mediating factor; as evidence suggests that secondary beliefs can result in dysfunctional emotions and/or behaviors, such as depression. Furthermore, it is estimated that up to 80% of CFS patients concurrently have depression. There were 156 participants with CFS who completed a questionnaire pack, which included the revised version of the Illness Perception Questionnaire, the Secondary Beliefs Scale (SBS), and the Cardiac Depression Scale. Hierarchical regression analysis revealed that secondary beliefs mediated the relationship between illness severity and depression. Specifically, the approval and comfort subscales of the SBS were significantly associated with depression. The current findings indicated that secondary beliefs could be an important focus in treatment of depression in chronic illness. As the mediating role of secondary beliefs is a new research finding, it is advised that further exploratory research is required.     

Is cognitive behaviour therapy for chronic fatigue syndrome also effective for pain symptoms?

Patients with chronic fatigue syndrome (CFS) frequently report chronic pain symptoms. Cognitive behavioural therapy (CBT) for CFS results in a reduction of fatigue, but is not aimed at pain symptoms. In this study, we tested the hypothesis that a successful treatment of CFS can also lead to a reduction of pain. The second objective was to explore possible mechanisms of changes in pain. The third objective was to assess the predictive value of pain for treatment outcome. Data from two previous CBT studies were used, one of adult CFS patients (n=96) and one of adolescent CFS patients (n=32). Pain severity was assessed with a daily self-observation list at baseline and post-treatment. The location of pain in adults was assessed with the McGill Pain Questionnaire (MPQ). Patients were divided into recovered and non-recovered groups. Recovery was defined as reaching a post-treatment level of fatigue within normal range. Recovered adult and adolescent CFS patients reported a significant reduction of pain severity compared to non-recovered patients. Recovered adult patients also had fewer pain locations following treatment. The decrease in fatigue predicted the change in pain severity. In adult patients, a higher pain severity at baseline was associated with a negative treatment outcome.     

Partner Enabling of Substance Use Disorders: Critical Review and Future Directions

Substance use disorders affect not only the identified client but significant others as well. Dyadic and family dysfunction is typically associated with a family member's alcohol or drug abuse. One area of research interest based on clinical conceptions of these families is that of partner support or coping in response to the addiction. Female partners of male alcoholics have received much of this clinical and research attention, and have alternatively been labeled as codependents, co-alcoholics, or enablers. Broadening the therapeutic emphasis beyond the impaired individual underscores the systemic notion that a loved one's addiction necessarily affects spouses and partners, and that partner responses may in turn affect drinking or drug behaviors. The present article contrasts the enabling and codependency constructs, reviews empirical studies of enabling, and offers a conceptualization of partner responses to addiction that could enhance future research efforts and clinical applications in this area.