Skip to main content Accessibility help
×
×
Home

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

  • M. Cella (a1), P. D. White (a2), M. Sharpe (a3) and T. Chalder (a1)

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.

Copyright

Corresponding author

*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)

References

Hide All
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, 311324.
Cella, M, Chalder, T (2010). Measuring fatigue in clinical and community settings. Journal of Psychosomatic Research 69, 1722.
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, 353358.
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, 124128.
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, 147153.
Chalder, T, Power, M, Wessely, S (1996). Chronic fatigue in the community: a question of attribution. Psychological Medicine 26, 791800.
Deary, V, Chalder, T, Sharpe, M (2007). The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clinical Psychology Review 27, 781797.
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.pub2
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.
Gilbert, P (2000). The relationship of shame, social anxiety and depression: the role of the evaluation of social rank. Clinical Psychology and Psychotherapy 7, 174189.
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, 489494.
Knudsen, AK, Henderson, M, Harvey, SB, Chalder, T (2011). Long term sickness absence among patients with chronic fatigue syndrome. British Journal of Psychiatry 199, 430431.
Moss-Morris, R, Petrie, KJ (1997). Cognitive distortions of somatic experiences: revision and validation of a measure. Journal of Psychosomatic 43, 293306.
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, 461464.
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.pub2
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, 184185.
Rapee, RM, Heimberg, RG (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy 35, 741756.
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.
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, 118121.
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, 785787.
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, 587593.
Ware, JE (1992). The MOS 36-item short form health survey (SF-36). Medical Care 30, 473483.
Wessely, S, White, PD (2004). There is only one functional somatic syndrome. British Journal of Psychiatry 185, 9596.
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, 823836.
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. 264308. Guilford: New York.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed