سبک های مقابله با استرس دفاعی در سندرم خستگی مزمن

Objective: The cognitive–behavioral model of chronic fatigue syndrome (CFS) proposes that rigidly held beliefs act to defend individuals against low self-esteem. This study is the first to investigate the prevalence of a potential mechanism, the Defensive High Anxious coping style, among individuals with CFS. Methods: The study comprised 68 participants (24 CFS; 24 healthy volunteers; 20 chronic illness volunteers). Participants completed the Bendig short form of the Taylor Manifest Anxiety Scale (B-MAS) and the Marlowe–Crowne Social Desirability Scale (MC) in order to ascertain the distribution of participants in each group within the four coping styles defined by Weinberger et al. [J. Abnorm. Psychol. 88 (1979) 369]. Results: A greater number of participants in the CFS group (46%) were classified as Defensive High Anxious compared to the two comparison groups [χ2(2)=8.84, P=.012]. Conclusion: This study provides support for the existence of defensive coping mechanisms as described by the cognitive–behavioral model of CFS. Furthermore, it has been suggested that this particular coping style may impinge directly on physical well being through similar mechanisms as identified in CFS, and further research linking these areas of research is warranted.

Chronic fatigue syndrome (CFS) is a disorder characterized by a principal complaint of fatigue accompanied by substantial functional impairment [2]. Sharpe [3], following Surawy et al. [4], described a cognitive–behavioral model of CFS that implies that people with CFS have low underlying levels of self-esteem which are protected by rigid defence mechanisms. This has not, however, been addressed in the literature to date. Similarities are apparent between the cognitive model of CFS and characteristics of defensive coping styles. Weinberger et al. [1] proposed a fourfold classification of individuals based on their coping styles including Repressors (low anxiety–high defensiveness) and Defensive High Anxious (high anxiety–high defensiveness). Some similarities are apparent between repressive coping and the cognitive model of CFS. For example, in both cases, it is hypothesized that beliefs are formed which value low levels of negative affect and these beliefs lead to a lifestyle characterized by not asking for help and putting on a brave face [1] and [3]. Unlike Repressive Copers, however, people with CFS report high levels of anxiety [5] and [6]. It is hypothesized here that the similarities described above may reflect high levels of defensiveness in the context of high anxiety among people with CFS, that is, Defensive High Anxious coping. This coping style is generally of low prevalence and hence has received little direct investigation. A number of studies have suggested that a Defensive High Anxious style may impinge on physical health [7] and [17]. A hypothesized mechanism is via the hypothalamic–pituitary–adrenal axis, which has also been implicated in CFS [8], [9] and [10]. The present study investigates the prevalence of the Defensive High Anxious coping style among participants with CFS. A comparison of a group of people with a different chronic illness, insulin-treated diabetes mellitus, is included in the present study to evaluate the extent to which this coping style is a response to chronic illness. Like CFS, diabetes is a “hidden” condition that is not readily apparent to other people and requires significant regulation of behavior and imposes restrictions on lifestyle. The present study addresses the following hypothesis: participants with CFS will display a greater tendency to hold a Defensive High Anxious coping style, characterized by high levels of reported trait anxiety and high levels of defensiveness compared to a healthy control group and comparison chronic illness group.