Esther12
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Nothing important.
Was just reading this old paper, and thought that I'd pull out some quotes in case anyone is interested.
Was just reading this old paper, and thought that I'd pull out some quotes in case anyone is interested.
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. © 1997
Physical attribution
The finding that patients make predominantly physical illness attributions is in
keeping with results from previous hospital-based studies using quantitative methods
[4-10]. Why is this finding of interest? First, the attributions of patients are different
from those of many of their doctors, and this discrepancy is a potential cause
of discord in the doctor-patient relationship [19]. Second, it has been found to be
predictive of a poor outcome [5, 11-13]. The reasons for this association remain unclear.
It may be that patients are correct in placing a strong emphasis on the physiological
component of their illness, although the wide range of biochemical and immunological
measures assessed do not support this interpretation [13]. It is also
possible that a strong physical belief acts as a marker for psychological processes,
such as specific personality traits, but there is as yet no good evidence to support
this idea. Finally the attribution itself may perpetuate illness by encouraging certain
ways of thinking about and responding to symptoms. This possibility is elaborated
below.
Complex causation
Despite the predominantly physical attribution almost half of the sample studied
believed that psychosocial stressors had played a role in the etiology of their illness.
This finding supports previous observations from unstructured inquiries [10, 20] and
implies that a simple physical versus psychological dichotomy used in some previous
questionnaires [7] is an inadequate reflection of patients' illness beliefs. It also offers
potential common ground for discussions between doctor and patient.
Emphasising control and reversibility, in the absence of evidence of control and reversibility for a patient's condition, is a bit repulsive.The cognitive behavioral model of CFS
The findings of this study are broadly consistent with the cognitive behavioral
model of CFS [25]. This model hypothesizes that CFS is perpetuated by a belief in
physical disease and that this physical attribution inhibits recovery by encouraging
the patient to make certain predictions. First, the patient may only regard passive
physical illness-oriented coping strategies as relevant. Second, the patient may interpret
activity-induced increases in symptoms as heralding a worsening of the illness
[26]. Third, it may encourage the patient to predict that nothing they do will
make any difference [27]. The consequence is that symptoms persist, predictions are
confirmed, and a vicious cycle is completed. Further tests of this model are required,
but it has already led to a new approach to treatment [25, 28]. Cognitive behavior
therapy, which focuses on broadening the patient's illness model so as to emphasize
control and reversibility, is associated with clinical improvement [29].