IACFS/ME • 12TH BIENNIAL CONFERENCE • OCTOBER 2016 p34
A reexamination of the cognitive behavioral theory of CFS
Madison Sunnquist & Leonard A. Jason
DePaul University, Center for Community Research
Background: Cognitive behavioral theories of chronic fatigue syndrome (CFS) suggest that cognitions and
behaviors perpetuate the fatigue and impairment that individuals with CFS experience. The first empirical study of
this theory resulted in a model that was supportive of the cognitive behavioral framework (Vercoulen et al., 1998).
However, an attempt to replicate this model resulted in inadequate fit statistics for a well-characterized group of
individuals with CFS, though the model fit well for individuals with chronic fatigue from primary psychiatric
disorders (Song & Jason, 2005). These studies differed in the case definitions applied and the examination of
psychiatric disorders, indicating that these factors may have contributed to the discrepant findings.
Objectives: The current study sought to reexamine the behavioral pathway of the cognitive behavioral model of
CFS: activity level as a mediator between individuals’ causal attribution for their illness (i.e., belief in a physical or
psychological cause) and their degree of impairment. Moderators were examined to investigate reasons for
previous studies’ discrepant results.
Methods: Second-stage conditional process modeling (i.e., moderated mediation) was conducted on a sample of
990 individuals with CFS to reevaluate the model’s behavioral pathway. Additionally, participants were classified by
case definition [Oxford (Sharpe et al., 1998; Canadian ME/CFS (Carruthers et al., 2003); ME Ramsay (as
operationalized by Jason et al., 2012)], and case definition fulfillment was entered as a moderator of the relation
between activity level and impairment.
Results: Results were inconsistent with the cognitive behavioral theory of CFS. Activity level did not significantly
mediate the relation between causal attribution and impairment (R2 = 0.002, p = 0.175). An interaction between
case definition fulfillment and activity predicted impairment (β = 0.588, p < 0.001); when individuals met less
stringent case definitions, the relation between activity level and impairment was stronger.
Conclusion: These findings suggest that individuals do not reduce activity level due to illness beliefs, as proposed
by the cognitive behavioral theory of CFS. Additionally, as the relation between activity level and impairment
attenuated with increased case definition specificity, exercise-based interventions lack empirical justification and
may not be appropriate.
1. Presenting Author Information:
Madison Sunnquist, B.S.
Graduate Research Assistant, DePaul University, Center for Community Research
990 W. Fullerton Ave. Suite 3100
Chicago, IL 60614, USA
Email:
msunnqui@depaul.edu
