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Cognitions, behaviours and co-morbid psychiatric diagnoses in patients with chronic fatigue syndrome

Published online by Cambridge University Press:  09 May 2012

M. Cella ,
P. D. White ,
M. Sharpe  and
T. Chalder
M. Cella*
Affiliation:
Institute of Psychiatry, King's College London, UK
P. D. White
Affiliation:
Center for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University, London, UK
M. Sharpe
Affiliation:
Department of Psychiatry, University of Oxford, UK
T. Chalder
Affiliation:
Institute of Psychiatry, King's College London, UK
*
*Address for correspondence: M. Cella, Ph.D., Department of Psychology, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email: matteo.cella@kcl.ac.uk)
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Abstract

Background

Specific cognitions and behaviours are hypothesized to be important in maintaining chronic fatigue syndrome (CFS). Previous research has shown that a substantial proportion of CFS patients have co-morbid anxiety and/or depression. This study aims to measure the prevalence of specific cognitions and behaviours in patients with CFS and to determine their association with co-morbid anxiety or depression disorders.

Method

A total of 640 patients meeting Oxford criteria for CFS were recruited into a treatment trial (i.e. the PACE trial). Measures analysed were: the Cognitive Behavioural Response Questionnaire, the Chalder Fatigue Scale and the Work and Social Adjustment Scale. Anxiety and depression diagnoses were from the Structured Clinical Interview for DSM-IV. Multivariate analysis of variance was used to explore the associations between cognitive-behavioural factors in patients with and without co-morbid anxiety and/or depression.

Results

Of the total sample, 54% had a diagnosis of CFS and no depression or anxiety disorder, 14% had CFS and one anxiety disorder, 14% had CFS and depressive disorder and 18% had CFS and both depression and anxiety disorders. Cognitive and behavioural factors were associated with co-morbid diagnoses; however, some of the mean differences between groups were small. Beliefs about damage and symptom focussing were more frequent in patients with anxiety disorders while embarrassment and behavioural avoidance were more common in patients with depressive disorder.

Conclusions

Cognitions and behaviours hypothesized to perpetuate CFS differed in patients with concomitant depression and anxiety. Cognitive behavioural treatments should be tailored appropriately.

Keywords

Anxietychronic fatigue syndromecognitive behavioural therapyco-morbiditydepression
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 2 , February 2013 , pp. 375 - 380
Copyright
Copyright © Cambridge University Press 2012

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References

Castell, BD, Kazantzis, N, Moss-Morris, RE (2011). Cognitive behavioral therapy and graded exercise for chronic fatigue syndrome: a meta-analysis. Clinical Psychology: Science and Practice 18, 311–324.Google Scholar
Cella, M, Chalder, T (2010). Measuring fatigue in clinical and community settings. Journal of Psychosomatic Research 69, 17–22.CrossRefGoogle ScholarPubMed
Cella, M, Chalder, T, White, PD (2011 b). Does the heterogeneity of chronic fatigue syndrome moderate the response to cognitive behaviour therapy? Psychotherapy and Psychosomatics 80, 353–358.CrossRefGoogle ScholarPubMed
Cella, M, Sharpe, M, Chalder, T (2011 a). Measuring disability in patients with chronic fatigue syndrome: reliability and validity of the Work and Social Adjustment Scale. Journal of Psychosomatic Research 71, 124–128.CrossRefGoogle ScholarPubMed
Chalder, T, Berelowitz, G, Pawlikowska, T, Watts, L, Wessely, S, Wright, D, Wallace, EP (1993). Development of a fatigue scale. Journal of Psychosomatic Research 37, 147–153.CrossRefGoogle ScholarPubMed
Chalder, T, Power, M, Wessely, S (1996). Chronic fatigue in the community: a question of attribution. Psychological Medicine 26, 791–800.CrossRefGoogle ScholarPubMed
Deary, V, Chalder, T, Sharpe, M (2007). The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clinical Psychology Review 27, 781–797.CrossRefGoogle ScholarPubMed
Edmonds, M, McGuire, H, Price, JR (2004). Exercise therapy for chronic fatigue syndrome. Cochrane Database Systematic Review 2004, Issue 3. Art. No.: CD003200. doi:10.1002/14651858.CD003200.pub2CrossRefGoogle Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition with Psychotic Screen (SCID-I/P W/ PSY SCREEN). Biometrics Research, New York State Psychiatric Institute: New York.Google Scholar
Gilbert, P (2000). The relationship of shame, social anxiety and depression: the role of the evaluation of social rank. Clinical Psychology and Psychotherapy 7, 174–189.3.0.CO;2-U>CrossRefGoogle Scholar
Knoop, H, Prins, JB, Moss-Morris, R, Bleijenberg, G (2010). The central role of cognitive processes in the perpetuation of chronic fatigue syndrome. Journal of Psychosomatic Research 68, 489–494.CrossRefGoogle ScholarPubMed
Knudsen, AK, Henderson, M, Harvey, SB, Chalder, T (2011). Long term sickness absence among patients with chronic fatigue syndrome. British Journal of Psychiatry 199, 430–431.CrossRefGoogle ScholarPubMed
Moss-Morris, R, Petrie, KJ (1997). Cognitive distortions of somatic experiences: revision and validation of a measure. Journal of Psychosomatic 43, 293–306.CrossRefGoogle ScholarPubMed
Mundt, JC, Marks, IM, Shear, MK, Greist, JH (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry 180, 461–464.CrossRefGoogle Scholar
Price, JR, Mitchell, E, Tidy, E, Hunot, V (2008). Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database of Systematic Reviews 2008, Issue 3, Art. No.: CD001027. doi:10.1002/14651858.CD001027.pub2CrossRefGoogle Scholar
Prins, J, Bleijenberg, G, Rouweler, EK, van der Meer, J (2005). Effect of psychiatric disorders on outcome of cognitive-behavioural therapy for chronic fatigue syndrome. British Journal of Psychiatry 187, 184–185.CrossRefGoogle ScholarPubMed
Rapee, RM, Heimberg, RG (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy 35, 741–756.CrossRefGoogle ScholarPubMed
Reeves, WC, Lloyd, A, Vernon, SD, Klimas, N, Jason, LA, Bleijenberg, G, Evengard, B, White, PD, Nisenbaum, R, Unger, ER (2003). International Chronic Fatigue Syndrome Study Group. Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution. BMC Health Service Research 3, 25.CrossRefGoogle Scholar
Sharpe, MC, Archard, LC, Banatvala, JE, Borysiewicz, LK, Clare, AW, David, A, et al. (1991). A report – chronic fatigue syndrome: guidelines for research. Journal of the Royal Society of Medicine 84, 118–121.CrossRefGoogle ScholarPubMed
Skapinakis, P, Lewis, G, Mavreas, V (2003). Unexplained fatigue syndromes in a multinational primary care sample: specificity of definition and prevalence and distinctiveness from depression and generalized anxiety. American Journal of Psychiatry 160, 785–787.CrossRefGoogle Scholar
Skerrett, TN, Moss-Morris, R (2006). Fatigue and social impairment in multiple sclerosis: the role of patients' cognitive and behavioral responses to their symptoms. Journal of Psychosomatic Research 61, 587–593.CrossRefGoogle ScholarPubMed
Ware, JE (1992). The MOS 36-item short form health survey (SF-36). Medical Care 30, 473–483.CrossRefGoogle ScholarPubMed
Wessely, S, White, PD (2004). There is only one functional somatic syndrome. British Journal of Psychiatry 185, 95–96.CrossRefGoogle ScholarPubMed
White, PD, Goldsmith, KA, Johnson, AL, Potts, L, Walwyn, R, DeCesare, JC, Baber, HL, Burgess, M, Clark, LV, Cox, DL, Bavinton, J, Angus, BJ, Murphy, G, Murphy, M, O'Dowd, H, Wilks, D, McCrone, P, Chalder, T, Sharpe, M; PACE trial management group (2011). Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 377, 823–836.CrossRefGoogle Scholar
Young, JE, Weinberger, AD, Beck, AT (2001). Cognitive therapy for depression. In Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual (ed. Barlow, D. D.), pp. 264–308. Guilford: New York.Google Scholar