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Nijmegen again

Discussion in 'Latest ME/CFS Research' started by lansbergen, Mar 29, 2010.

  1. lansbergen

    lansbergen Senior Member


    The central role of cognitive processes in the perpetuation of chronic fatigue syndrome☆

    Hans Knoop a, Judith B. Prins b, Rona Moss-Morris c, Gijs Bleijenberg d

    Received 8 November 2009; received in revised form 26 January 2010; accepted 26 January 2010. published online 17 March 2010. Corrected Proof Abstract Objective

    Chronic fatigue syndrome (CFS) is considered to be one of the functional somatic syndromes (FSS). Cognitions and behavior are thought to perpetuate the symptoms of CFS. Behavioral interventions based on the existing models of perpetuating factors are quite successful in reducing fatigue and disabilities. The evidence is reviewed that cognitive processes, particularly those that determine the perception of fatigue and its effect on behavior, play a central role in the maintenance of symptoms.

    Narrative review.

    Findings from treatment studies suggest that cognitive factors mediate the positive effect of behavioral interventions on fatigue. Increased fitness or increased physical activity does not seem to mediate the treatment response. Additional evidence for the role of cognitive processes is found in studies comparing the subjective beliefs patients have of their functioning with their actual performance and in neurobiological research.

    Three different cognitive processes may play a role in the perpetuation of CFS symptoms. The first is a general cognitive representation in which fatigue is perceived as something negative and aversive and CFS is seen as an illness that is difficult to influence. The second process involved is the focusing on fatigue. The third element is formed by specific dysfunctional beliefs about activity and fatigue.
    Keywords: Chronic fatigue syndrome, Functional somatic syndromes, Perpetuating factors, Treatment studies, Cognitive processes, Perception

    a Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    b Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    c School of Psychology, University of Southampton, Southampton, United Kingdom

    d Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Corresponding Author InformationCorresponding author. Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Postbox 9011 , 6500 HB Nijmegen, The Netherlands. Tel.: +31 24 3610042; fax: +31 24 3610041.

    ☆ This article was written while the first author was a visiting staff member of the School of Psychology at the University of Southampton. The working visit was made possible by a grant of the Dutch MSresearch fund (Stichting MSresearch).
  2. lansbergen

    lansbergen Senior Member


    Long-term efficacy of cognitivebehavioral therapy by general
    practitioners for fatigue: A 4-year follow-up study

    Stephanie S. Leone a, Marcus J.H. Huibers b, IJmert Kant a, Ludovic G.P.M. van Amelsvoort a, Constant P. van Schayckc , Gijs Bleijenbergd, J. Andre Knottnerus c

    a Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
    b Department of Medical, Clinical, and Experimental Psychology, Maastricht University, Maastricht, The Netherlands
    c Department of General Practice, Maastricht University, Maastricht, The Netherlands
    d Radboud University Nijmegen Medical Centre, Expert Centre Chronic Fatigue, Nijmegen, The Netherlands

    Received 16 November 2005; received in revised form 11 April 2006; accepted 25 April 2006

    Objective: In an earlier study, we found that cognitive behavioral therapy (CBT) delivered by general practitioners (GPs) for fatigue among employees on sick leave was not effective after 12 months. In this study we aim to assess the long-term efficacy of CBT by GPs for fatigue. It was hypothesized that the intervention could prevent deterioration as well as relapse of fatigue complaints and relapse into absenteeism in the long term. Methods: Patients who participated in the original randomized controlled trial were followed up 4 years later. Fatigue and absenteeism were the main outcomes. Results: Fatigue and absenteeism were high in the intervention and control groups at the 4-year follow-up. There was no significant difference between the intervention group and the control group on fatigue and absenteeism. The intervention group however tended toward less-favorable outcomes as compared with the control group. Conclusions: Like that of chronic fatigue syndrome, the prognosis of less-advanced fatigue is rather poor. CBT delivered by GPs is not effective in the long term.

    D 2006 Elsevier Inc. All rights reserved.
  3. Dr. Yes

    Dr. Yes Shame on You

    From the first study:

    By whom? A group of rogue psychiatrists?

    It is not classified as such by the WHO nor, for that matter, in the DSM. So basically they decided to redefine a (physical) medical illness that already has its own classification the way THEY decided to, based on no scientific evidence, or even reasoning, whatsoever. And then based their study and conclusions on that made-up premise.

    That pretty much sums up the state of psych lobby "science".
  4. dancer

    dancer Senior Member

    Midwest, USA
    ARGH!!!! This is so maddening.
    I was a ballet teacher/choreographer/dancer for twenty years. I LOVED the feeling of healthy fatigue... I didn't fear it or "perceive it to be negative." I loved exertion. Now I'm sick, and exertion (sometimes very little) makes me SICKER.

    It does not make me "anxious" or "worried" about "feeling tired."

    Dr. Yes, I also noticed that phrase "considered to be one of the functional somatic syndromes" and thought the same thing. Considered by whom? GRRR!
  5. Dolphin

    Dolphin Senior Member

    They ignore the fact that their own studies showed they didn't increase activity levels. They might decrease self-reported fatigue but the reduced disabilities they refer to again is self-reported so is disputable. CBT programmes often involve a lot of rest periods so the bit of benefit patients get from them might be from the rest periods, better pacing of activities (even though this isn't necessarily the explicit aim) rather than the other means generally claimed.
  6. biophile

    biophile Places I'd rather be.

    Not only do they ignore the possible implications of their own research regarding activity levels, but they twist it to support the alleged role of "cognitive processes"/distortions. All they have done is influence subjective reports of fatigue by convincing patients they aren't really fatigued, and it does not seem to bother them that their patients are just as disabled as before (unless their cohort are "high functioning" patients who did not start out with much disability in the first place?). The irony of course is, remaining significantly disabled while believing you've recovered, sounds like a cognitive distortion in its own right, a disconnect from reality.
  7. biophile

    biophile Places I'd rather be.

    Maarten, I also noticed how just like the phrases "multi-disciplined" and "integrative approach", the word "multifactorial" is used differently by biomedical proponents and biopsychosocialists. The former group list several biological aspects and sometimes a psychological component. The latter group usually just list a bunch of different psychosocial, cognitive and behavioural attributes along with their "biological" consequences (eg deconditioning).

    Nijmegen (Knoop et al) state "fatigue is perceived as something negative", "CFS is seen as an illness that is difficult to influence" and (dysfunctional) "beliefs about activity and fatigue" as if these are all unreasonable conclusions by patients. No mention whatsoever of any biological factors/components in the abstract. They do not appear to acknowledge or understand the existence of post-exertional symptom exacerbation either. I have little faith in the perspective of anyone who claims exertional symptoms are a "dysfunctional belief" or a merely consequence of misinterpreting ordinary signs of deconditioning. Even the questionable "chronic stress" model of CFS is more respectable than that.

    Although Wessely is often seen as the pinnacle of the biopsychosocial approach, he may not necessary be the most hardcore proponent and there are plenty of others who would be willing to pick up the slack even if the entire UK school retired from CFS. We may be witnessing a split of biopsychosocial schools where some will become even more extremist about patient delusions while others will incorporate more biological factors.

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