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CDC:Coping Styles in Chronic Fatigue Syndrome: Findings from a Population-Based Study

Dolphin

Senior Member
Messages
17,567
Afraid don't have any info on this but thought I'd start a thread. I'd imagine it uses the (so-called) empiric criteria (Reeves et al., 2005) so have little confidence its findings will be useful.

------
Vol. 81, No. 2, 2012

Article (PDF 85 KB)
Letter to the Editor

Coping Styles in Chronic Fatigue Syndrome: Findings from a Population-Based Study
Urs M. Natera, d, Elizabeth Maloneya, Jin-Mann S. Linb, Christine Heimc, William C. Reevesb

aChronic Viral Diseases Branch, Division of High-Consequence Pathogens and Pathology (proposed), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control & Prevention,
bMental Health Surveillance, Public Health Surveillance Program Office, Office of Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control & Prevention, and
cDepartment of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Ga., USA;
dClinical Biopsychology, Department of Psychology, University of Marburg, Marburg, Germany
Address of Corresponding Author

Psychother Psychosom 2012;81:127-129 (DOI: 10.1159/000329996)


Abstract

No abstract available

Author Contacts

William C. Reeves, MD, MSc
Public Health Surveillance Program Office, Mail Stop E-33
Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333 (USA)
Tel. +1 404 498 6521 , E-Mail wcr1@cdc.gov

Article Information

Received: October 25, 2010
Accepted after revision: June 10, 2011
Published online: February 2, 2012
Number of Print Pages : 3
 

Dolphin

Senior Member
Messages
17,567
Is there a direct link? A search reveals their original 2006 paper.

There have been a few studies on coping strategies over the years. With equivocal results. The following study for example only found a difference in the use of social support to predict clinical outcomes. http://onlinelibrary.wiley.com/doi/10.1002/smi.1185/abstract
http://content.karger.com/ProdukteD...e=256799&ProduktNr=223864&filename=329996.pdf

Journal page where listed: http://content.karger.com/ProdukteDB/produkte.asp?Aktion=Ausgabe&Ausgabe=256799&ProduktNr=223864
 

Dolphin

Senior Member
Messages
17,567
Tate Mitchell posted the following on Co-Cure https://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind1207b&L=co-cure&F=&S=&P=7462:


Tate's comment: Another landmark study which is sure to revolutionize ME/CFS research from the world-renowned CDC CFS research program, aka your tax dollars at work. Don't over exert yourself from enthusiasm.

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http://www.alphagalileo.org/ViewItem.aspx?ItemId=121978&CultureCode=en

Do patients with chronic fatigue syndrome have impairments in coping?
28 June 2012 Journal of Psychotherapy and Psychosomatics


A study published in the current issue of Psychotherapy and Psychosomatics examined the coping skills in a population of patients with chronic fatigue syndrome(CFS). CFS is a common and debilitating illness. As yet the pathophysiology of CFS remains inchoate, so pharmacologic management aims to alleviate symptoms and is not curative. Cognitive-behavioral therapy and graded exercise therapy appear to be the most effective treatments for CFS. In this current population based study, a group of investigators examined coping styles in CFS and how these are affected by depression and anxiety.

Study participants were identified during a survey of unwellness in metropolitan, urban, and rural populations of Georgia. To identify medical conditions considered exclusionary for CFS, participants completed past medical history questionnaires underwent a standardized physical examination, and provided blood and urine specimens for routine clinical laboratory screening. To identify exclusionary psychiatric conditions, participants completed the SCID, a standardized interview. Researchers diagnosed CFS as recommended by the International CFS Study Group. Well controls had no medical or psychiatric conditions considered exclusionary for CFS. 113 CFS suffers and 124 ‘well’ controls were included in the analyses. The Ways of Coping Questionnaire (WCQ) to measure coping styles was used .

Self-Rating Depression Scale was used to quantify depressive symptoms, based on 20 items. Anxiety was assessed using the State Anxiety Inventory that provides a continuous score based on 20 items.
Demographic features were similar among participants with CFS and well controls. The two groups differed significantly regarding depressive symptoms (p<0.001) and anxiety (p<0.001).

Coping strategies also differed significantly between the two groups.

A multivariate analysis indicated an overall difference (p<0.001).

Relative to the well group, those with CFS had statistically significantly higher mean scores in the escape-avoidance, confrontive, distancing, self-controlling, and accepting responsibility coping styles. All differences remained significant after controlling for age, sex, race, and education level. Effect sizes were of medium strength for those coping styles that differed significantly, with distancing being the exception. Several other studies have documented dysfunctional or maladaptive coping styles in CFS. In accordance with a previous study, escape-avoidance emerged as the most prominent coping style in CFS. People utilizing this coping style incorporated behavioral efforts to escape or avoid a specific problem. Further, confrontive coping, which was also used more often in CFS, is characterized by aggressive efforts to alter a stressful situation (‘I expressed anger to the person who caused the problem’). High scores in selfcontrolling coping indicate increased efforts to regulate an individual’s emotions (‘I tried to keep my feelings to myself’), and, finally, high scores in accepting responsibility indicate that someone acknowledges his or her own role in the problem (‘I criticized or lectured myself’). As these coping styles are not inherently negative, it can be assumed that they can turn maladaptive when predominantly used in solving everyday problems. Finally, the question arises of whether coping patterns found in CFS are similar to other chronic illnesses. Although some studies indicate that this might not be the case, future studies should ascertain whether coping styles found in this study are specific for CFS or not. Importantly, researchers found that discrepancies between the two groups could not be explained by the presence of depressive symptoms or anxiety, despite of high levels of psychopathology in individuals with CFS.

These findings have important consequences for treatment strategies in CFS. Interventions such as cognitive-behavioral therapy and graded exercise therapy aim at improving adaptive coping capabilities. These treatment approaches will most likely be successful without taking concomitant psychopathology into account. Future studies should now incorporate longitudinal designs in order to determine causal pathways between coping and illness.

Full bibliographic information
Urs M. Nater , Elizabeth Maloney , Jin-Mann S. Lin, Christine Heim, William C. Reeves. Coping Styles in Chronic Fatigue Syndrome: Findings from a Population-Based Study. Psychother Psychosom 2012;81:127–129
 

Dolphin

Senior Member
Messages
17,567
I'd imagine it uses the (so-called) empiric criteria (Reeves et al., 2005) so have little confidence its findings will be useful.
Given the figures (113) and the cohort, Georgia cohort, I'm 99.99% sure it uses the so-called "empiric" criteria, as those match figures for it in other studies on the Georgia cohort.

There is a petition against those criteria, with 2595 signatures currently, at: http://www.ipetitions.com/petition/empirical_defn_and_cfs_research/signatures/page/52
 

Dolphin

Senior Member
Messages
17,567
These findings have important consequences for treatment strategies in CFS. Interventions such as cognitive-behavioral therapy and graded exercise therapy aim at improving adaptive coping capabilities. These treatment approaches will most likely be successful without taking concomitant psychopathology into account.
I think this is stretching it/misleading. For example, GET in its pure form, has nothing to do with "improving adaptive coping capabilities". If people improve with it, what they have to cope with might be less, but that's the same for any therapy.
 
Messages
13,774
So it's another Nater study in Psychotherapy and Psychosomatics which got CFS patients to fill in questionnaires, but has no control group of people with a disabling non-psychiatric condition (like MS) to compare results with? And then the answers of CFS patients are taken as evidence of dysfunctional behaviour/cognitions? With a press release?

They must be so proud of themselves. Does he try and claim CBT and GET have been shown to be effective in double-blind RCTs again? That was good for a laugh.
 

biophile

Places I'd rather be.
Messages
8,977
Is this another one of those Reeves' legacy studies or was it initiated more recently? The (probable) use of the Reeves criteria is a red flag. The fact that Reeves' name in on the authors list is also indicative the criteria was used. Reminds me of Heim et al on childhood adversity: use dubious Reeves criteria, do not use adequate controls, then 'replicate' it.

Coping strategies also differed significantly between the two groups. A multivariate analysis indicated an overall difference (p<0.001). Relative to the well group, those with CFS had statistically significantly higher mean scores in the escape-avoidance, confrontive, distancing, self-controlling, and accepting responsibility coping styles. All differences remained significant after controlling for age, sex, race, and education level.

What a revelation, people suffering from globally disabling symptoms, which are dismissed and ridiculed, have different "coping strategies" than healthy people. As Esther12 already noted, no adequate illness control group, which must account for illness burden, suffering, and psychosocial environment. To be fair, this may be difficult, finding patients with a well-established/accepted disease with comparable global impairments but little or no treatment and placed in the same psychosocial environment as ME/CFS patients. Perhaps mainstream diseases found in remote areas of the world?

Alternatively if one was more cruel, you could take a bunch of CDC biopsychosocialists, induce a series of or maintain a state of chronic infection(s) with comparable symptoms and disability as ME/CFS, refuse treatment and any investigations except the most basic (but not anything which will detect said pathogens), let them hover at or below the poverty line without adequate assistance, "poison the well" by telling their friends and families the subjects are suffering from a functional psycho>somatic illness perpetuated predominately by cognitive and behavioural factors, express frequent disbelief and occasional ridicule everytime they claim something is wrong or attempt to describe their symptoms in a manner that contradicts the official party line, cut off their insurance if they refuse to make themselves better after CBT/GET, and, did I miss anything else to control for? Let us see how their coping is after 5 years of that, and label it maladaptive without evidence showing it is actually maladaptive.

Effect sizes were of medium strength for those coping styles that differed significantly, with distancing being the exception. Several other studies have documented dysfunctional or maladaptive coping styles in CFS. In accordance with a previous study, escape-avoidance emerged as the most prominent coping style in CFS. People utilizing this coping style incorporated behavioral efforts to escape or avoid a specific problem.

The "escape-avoidance" strategy (most prominent) may be a natural consequence of chronic pain/discomfort and attempts to reduce post-exertional symptoms.

Further, confrontive coping, which was also used more often in CFS, is characterized by aggressive efforts to alter a stressful situation (‘I expressed anger to the person who caused the problem’).

Sounds like irritability and frustration. Not really a surprise, given the combination of symptoms/impariments, and bullshit.

High scores in selfcontrolling coping indicate increased efforts to regulate an individual’s emotions (‘I tried to keep my feelings to myself’), and, finally, high scores in accepting responsibility indicate that someone acknowledges his or her own role in the problem (‘I criticized or lectured myself’).

Well, keeping one's emotions to oneself is wise if outbursts of emotions can exacerbate symptoms, and if such expressions of emotions are discouraged or even derided. Accepting responsibility is bad? Well, I guess it can be if overly perfectionist or guilt-ridden. But really, not surprising in a society which blames such symptoms on patients, and if they become more sensitive to pressure or less able to defend against criticism, they may start blaming themselves in general. When the 1st doctor I went to said nothing was wrong, people dismissed my rarely-expressed symptoms as "complaining", and the 2nd doctor said recovery was in my hands, what else was I supposed to think other than somehow I was responsible? As a teenager, it also prompted me to question myself more about other areas of life.

As these coping styles are not inherently negative, it can be assumed that they can turn maladaptive when predominantly used in solving everyday problems.

So it all boils down to who gets to decide when a coping mechanism is "negative" rather than the presence of these mechanisms? Of course, we all know that "negative" is when the patients' seasoned observations contradict the CBT/GET therapists' ideological assumptions about ME/CFS. I myself am about to be very naughty and have a "maladaptive" nap which "maladaptively" helps to restore some minor functions for later without really affecting sleep time. ME/CFS affects everyday activities, so no surprise the coping mechanisms spread out to them too.

Finally, the question arises of whether coping patterns found in CFS are similar to other chronic illnesses. Although some studies indicate that this might not be the case, future studies should ascertain whether coping styles found in this study are specific for CFS or not. Importantly, researchers found that discrepancies between the two groups could not be explained by the presence of depressive symptoms or anxiety, despite of high levels of psychopathology in individuals with CFS.

This question keeps arising, but authors of such studies do not seem very interested in exploring it. Didn't their last study even suggest it was not specific to CFS? I'm sure they are least asked this same question.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
One of the big symptoms of pseudoscience is that whatever the evidence it can be used to support the model. If evidence can only support the model, not refute it, there is a problem. They always interpret from within their specific view - they rarely question it. When it is questioned it tends to be questioned by a relatively small number of people - like Richard Sykes.

If they were serious they would take each of their general interpretions, develop the contrary and alternative view, and then design studies to put each of these views under rigorous testing.

If a model is only interpreted in light of itself it tends to run foul of either begging the question or its close problem circular reasoning.

Bye, Alex
 

Enid

Senior Member
Messages
3,309
Location
UK
Coping ? yes I did but not interested especially now medics/science have revealed pathologies from which it is possible to treat and move on - coping these revelations alone without the nitwits hell bent on behaviourism.
 

Sean

Senior Member
Messages
7,378
I myself am about to be very naughty and have a "maladaptive" nap which "maladaptively" helps to restore some minor functions for later...
He he he...

You do realise that behaviour will be classified as Defiant Napping Disorder (Type 2, NOS)?

And that was a damn fine rant about experimenting on CDC biopsychosocialists. Right on target.
 
Messages
13,774
To be fair, this may be difficult, finding patients with a well-established/accepted disease with comparable global impairments but little or no treatment and placed in the same psychosocial environment as ME/CFS patients. Perhaps mainstream diseases found in remote areas of the world?

While I like your idea of testing researchers responses to the conditions of CFS, and agree that no alternative condition is ideal, I think that MS is a pretty sensible comparison group, particularly if an effort is made to roughly match levels of incapacity.

A more complicated comparison group would be people wrongly diagnosed with CFS, and whose fatigue was later actually the result of a known disease. Didn't White do some study showing loads of patients sent to his CFS centre were wrongly diagnosed? Prior to sorting through them, all referred patients could be asked to do these sorts of questionnaires, and then differences in the results for those with 'CFS' and those later found to have other known diseases could be compared.

There are so many of these bullshit questionnaire studies for CFS. I think most of the questionnaires used are so poorly designed as to be virtually useless, but if researchers are so committed to doing them, why not try to do them properly? Why not think about what questions you want answered, and then spend twenty minutes trying to work out the best way of doing so? For most of these studies it reads like they just want to do something cheap to get their name in a journal and damn the patients, or they want something which will give them results to support what they already believe and will be utterly unconvincing to anyone with different starting assumptions.
 

biophile

Places I'd rather be.
Messages
8,977
Esther12.

Interesting suggestion about using controls who were seriously suspected of having CFS but were later excluded from that diagnosis. I think this is the White et al study you were referring to (http://shortreports.rsmjournals.com/content/3/1/4.full) where about half were excluded (from Oxford criteria); the most common medical exclusions were sleep disorders and pain disorders, while the most common psychiatric exclusions were depression and anxiety.

Newton et al (http://www.rcpe.ac.uk/journal/issue/journal_40_4/newton.pdf) also found (using Fukuda criteria): "Of the 40% of patients subsequently found not to have CFS the most common diagnosis was fatigue associated with a chronic disease (47% of all alternative diagnoses); 20% had primary sleep disorders, 15% psychological/psychiatric illnesses and 4% a cardiovascular disorder. Thirteen per cent remained unexplained (5.2% of the total referrals)."; the most common chronic diseases were neurological disorder, connective tissue disorder / autoimmune disease, and metabolic syndrome.

What I'm concerned about in CFS coping studies is adequately controlling for the effects of ME/CFS on the brain, not just physical disability and the negative psychosocial environment. As MS can indeed present with cognitive impairment and emotional symptoms, it may be a good comparison, but I do not know enough about MS to be sure.

Controlling for symptoms means all major symptoms, not just "fatigue". Pain in particular, as it can affect personality profiles and coping styles in ways which are resolved with successful pain medication. May be difficult to control for post-exertional states. I also wonder how many CFS patients attempt to cope by hyping themselves up in order to push through symptoms, or attempt to mask pain and flu-like malaise with novelty/pleasure seeking. CFS does not seem to cause much drug abuse in general, probably because increased sensitivity to the side-effects?

Sean. Hehe. Rant? I'm submitting my 'research proposal' to the NIH for funding! :p On a more serious note, I did notice in the earlier stages of illness that prolonged napping could increase sleep inertia and sometimes interfere with main sleep time so shorter naps were wiser. However, now I don't seem to have those problems and I need the longer duration and unconsciousness otherwise I do not get the same benefits.
 

Simon

Senior Member
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Location
Monmouth, UK
A more complicated comparison group would be people wrongly diagnosed with CFS, and whose fatigue was later actually the result of a known disease...
Prior to sorting through them, all referred patients could be asked to do these sorts of questionnaires, and then differences in the results for those with 'CFS' and those later found to have other known diseases could be compared.
I think that's a great idea. And I think the approach should be used in biological studies, particularly those of potential biomarkers, as well as studies lookinng at potential psychological factors. In both cases, the key question is 'how do we know these factors/markers are specific to ME/CFS, rather than some generic secondary consequence?'.
 
Messages
13,774
I think that's a great idea. And I think the approach should be used in biological studies, particularly those of potential biomarkers, as well as studies lookinng at potential psychological factors. In both cases, the key question is 'how do we know these factors/markers are specific to ME/CFS, rather than some generic secondary consequence?'.

Thanks Simon... it's a great idea relative to the way most CFS studies are done. In any other field I'm sure it would be seen as an obvious, mediocre and flawed (in some way I've not spotted) idea!

Yeah - a lot of the same issues do apply to biological studies. It seems that 'CFS' research is often dependent on the assumption that it makes sense to lump all these different patients together under a diagnosis of 'CFS', and I think that this inevitably leads to people focusing on the secondary factors of unexplained fatigue (both physical and psychological) that occur in patients regardless of the different causes of fatigue. This seems most transparently absurd with the psychosocial stuff: "OMG - People with 'CFS' are more concerned about fatigue than healthy controls... lets treat CFS as if it's the result of fear of normal fatigue!"... but I wouldn't be surprised if it also played a role in a lot of gene expression, neurological, hormonal and autonomic type findings too. I pay so little attention to physical findings in CFS that I can't really comment though.


What I'm concerned about in CFS coping studies is adequately controlling for the effects of ME/CFS on the brain, not just physical disability and the negative psychosocial environment. As MS can indeed present with cognitive impairment and emotional symptoms, it may be a good comparison, but I do not know enough about MS to be sure.

Controlling for symptoms means all major symptoms, not just "fatigue". Pain in particular, as it can affect personality profiles and coping styles in ways which are resolved with successful pain medication. May be difficult to control for post-exertional states. I also wonder how many CFS patients attempt to cope by hyping themselves up in order to push through symptoms, or attempt to mask pain and flu-like malaise with novelty/pleasure seeking. CFS does not seem to cause much drug abuse in general, probably because increased sensitivity to the side-effects?

The quackery that surrounds CFS is inevitably going to lead to some unusual responses from patients, and it's really difficult to control for that with other illnesses. MS does have a lot of the features that make CFS difficult, so even if an MS control group only shared some of the cognitive differences between CFS patients and healthy controls, it still points towards a possible explanation (living with a chronic illness is a bit of a shitter, and affects the way one fills in questionnaires about one's life).

re this Nater paper: It would be interesting to see the reviewers comments. This paper was left unpublished for a long time - it would be interesting to know if anyone spotted the problems with it but decided to just let it be published in the end anyway. With the Nater personality paper, it looked like they added in a control group with health problems (the weird 'insufficient fatigue' group) after collecting their initial results.
 

Sean

Senior Member
Messages
7,378
It seems that 'CFS' research is often dependent on the assumption that it makes sense to lump all these different patients together under a diagnosis of 'CFS', and I think that this inevitably leads to people focusing on the secondary factors of unexplained fatigue (both physical and psychological) that occur in patients regardless of the different causes of fatigue.
Agree. It is an approach that (surprise, surprise) has clearly failed to provide a primary explanation or therapy. And it is way past time the psych crowd conceded this, and got out of the way so the responsible adults can start dealing with the mess the psychs have left behind.
 
Messages
13,774
Just had a look at the full text. I've not taken the time to read up around this topic, but there was nothing here which made me think I should. I read a few bits on the Ways of Coping Questionnaire, but wasn't able to find a copy of it, which does rather limit my ability to understand some of their results (it can be really difficult to find copies of some of these questionnaires, and I didn't think it was worth the trouble here).

These are just my initial thoughts and notes, so don't expect much:

In another population-based study, we
found that about 60% of people with CFS suffered psychiatric comorbidity;
in particular affective and anxiety disorders [4] , and
displayed maladaptive personality styles [5] .

Surely it's worth mentioning that [5] found almost identical levels of "maladaptive personality styles" in their control group with ill health, and in [4] 45% of the ill health control group were classed as having a psychiatric comorbidity... and this group suffered from less serious health problems than those in the 'CFS' group.

Seeing as this new study has no control group with any sort of health problems, perhaps they thought that they could 'improve' the interpretation of results by missing this info out.

Our current study
circumvented the various methodological problems associated
with recruiting participants from primary or tertiary care, which
may increase the likelihood that our findings are generalizable to
the entire population of persons with CFS, not just those who have
obtained medical care.

Well, it was a population based study, but there are still the often mentioned problems with their selection CFS selection, but more importantly... their 'findings' are of no real value without a control group who are suffering from a comparable health problem.

Relative to the well
group, those with CFS had statistically significantly higher mean
scores in the escape-avoidance, confrontive, distancing, self-controlling,
and accepting responsibility coping styles.

So a clear and consistent pattern emerged...

In accordance with our previous study,
escape-avoidance emerged as the most prominent coping style in
CFS. People utilizing this coping style incorporated behavioral
efforts to escape or avoid a specific problem (item example from
the WCQ when asked about how the response to a recent stressful
event was: ‘I tried to make myself feel better by eating, drinking,
smoking, using drugs or medications, etc.’). Further, confrontive
coping, which was also used more often in CFS, is characterized
by aggressive efforts to alter a stressful situation (‘I expressed anger
to the person who caused the problem’). High scores in selfcontrolling
coping indicate increased efforts to regulate an individual’s
emotions (‘I tried to keep my feelings to myself’), and,
finally, high scores in accepting responsibility indicate that someone
acknowledges his or her own role in the problem (‘I criticized
or lectured myself’). As these coping styles are not inherently negative,
it can be assumed that they can turn maladaptive when predominantly
used in solving everyday problems. Also, in some instances
predominant use of some coping styles may even be an
adaptive reaction to the experience of a severe stressor.

re their example for escape-avoidance from the WCQ - this could indicate a problem with the selection of their CFS sample, as other research has shown that CFS patients tend to drink less than normal, and (I think... my memory's less good on this one) eat more healthily and smoke less than normal. I would have expected them to have looked in to whether there was independent evidence which showed CFS patients were more likely to have taken part in the sort of behaviour which they see as dysfunctional. I realise this is just one question, but the fact that they choose as an example one which refers to behaviours CFS patients are thought to engage in less than other groups, and this hasn't been commented upon, does seem a bit questionable.

It's probably worth again pointing out that people with health problems tend to have to cope with more than healthy controls, which would be likely to affect the way in which a questionnaire like this is answered anyway.

The list of coping methods more common in CFS seems to include a wide range of often contradictory responses. It's then assumed that all of these are maladaptive?! I'm not sure how sensible an assumption that is.

A further limitation is that no
statement can be made on whether the differences in coping styles
between CFS patients and well controls play a role in the causation
of CFS and/or might be a consequence of CFS.

or might be a consequence of illness.


Finally, the question arises of whether
coping patterns found in CFS are similar to other chronic illnesses.
Although some studies indicate that this might not be the case
[14] , future studies should ascertain whether coping styles found
in our study are specific for CFS or not.

Why would anyone do this study without a control group with a chronic illness?

What worthwhile question did the researchers want to answer here?

Our findings have important consequences for treatment strategies
in CFS. Interventions such as cognitive-behavioral therapy
and graded exercise therapy aim at improving adaptive coping capabilities.
These treatment approaches will most likely be successful
without taking concomitant psychopathology into account.
Future studies should now incorporate longitudinal designs in order
to determine causal pathways between coping and illness.

What an important consequence. Thank God for this vital paper.
 
Messages
13,774
One other thing...

These are the coping types assessed by that questionnaire, with the ones associated with 'CFS' in bold:

1. Confrontive coping (6 items) "Stood my ground and fought for what I wanted."
2. Distancing (6 items) "Went on as if nothing had happened."
3. Self-controlling (7 items) "I tried to keep my feelings to myself."
4. Seeking social support (6 items) "Talked to someone to find out more about the situation."
5. Accepting responsibility (4 items) "Criticized or lectured myself."
6. Escape-avoidance (8 items) "Hoped a miracle would happen."
7. Planful problem solving (6 items) "I made a plan of action and followed it."
8. Positive reappraisal (7 items) "Changed or grew as a person in a good way.

The coping types used seem very likely to depend more upon the situation than the individual. The quackery and prejudice that surrounds CFS makes seeking social support much less likely. The disability related to CFS means that it's usually impossible to go on as if nothing had happened. As the results from PACE make clear, there is normally no solution available for CFS, and it is not something which would change someone in a good way (unless you were really rubbish prior to falling ill).

Now this paper seems even more pointless. What a surprise that chronic health problems and a sustained reduction in capacity did not lead to individuals feeling that they had grown as a person in a good way.