باورهای بیماری و نتایج درمان در سندرم خستگی مزمن

Longitudinal studies have shown that physical illness attributions are associated with poor prognosis in chronic fatigue syndrome (CFS). Speculation exists over whether such attributions influence treatment outcome. This study reports the effect of illness beliefs on outcome in a randomized controlled trial of cognitive-behavior therapy versus relaxation. Causal attributions and beliefs about exercise, activity, and rest were recorded before and after treatment in 60 CFS patients recruited to the trial. Physical illness attributions were widespread, did not change with treatment, and were not associated with poor outcome in either the cognitive-behavior therapy group or the control group. Beliefs about avoidance of exercise and activity changed in the cognitive behavior therapy group, but not in the control group. This change was associated with improved outcome. These findings suggest that physical illness attributions are less important in determining outcome (at least in treatment studies) than has been previously thought. In this study, good outcome is associated with change in avoidance behavior, and related beliefs, rather than causal attributions.

Chronic fatigue syndrome (CFS) is a disabling condition of unknown origin. Despite medical uncertainty over cause, most CFS sufferers seen in specialist clinics believe themselves to have a physical illness caused by a virus 1, 2, 3, 4, 5, 6, 7, 8 and 9. Such attributions are of interest because they have been associated with poor prognosis in several longitudinal and naturalistic studies of CFS 7, 8, 9 and 10. If physical illness attributions are associated with worse outcome, there may be a case for altering physical illness attributions through treatments such as cognitive-behavioral therapy [9]. A randomized, controlled trial, which found brief graded activity to be ineffective for CFS [11] has been criticized for failing to challenge physical illness attributions [12]. In contrast, another randomized, controlled trial found CBT (cognitive restructuring with graded activity) to be superior to standard medical care [13]. The efficacy of treatment in this study was ascribed to its emphasis on reevaluating illness beliefs. Others have questioned this interpretation, arguing that the attributions of patients in the study did not actually change substantially, and the essential therapeutic ingredient was altering avoidance behavior [14]. This study reports the role of physical illness attributions and beliefs about avoidance of exertion in outcome for CFS patients enrolled in a randomized, controlled trial of CBT versus relaxation [15]. The hypotheses were that: (a) physical illness attributions would not change with treatment, and would not affect outcome; (b) beliefs about avoidance would change more in the CBT group than in the control group, and such changes would be associated with good outcome.