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Which cognitions and behaviours mediate the positive effect of cognitive behavioural therapy on fatigue in patients with multiple sclerosis?

Published online by Cambridge University Press:  15 June 2011

H. Knoop ,
K. van Kessel  and
R. Moss-Morris
H. Knoop
Affiliation:
Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
K. van Kessel
Affiliation:
Department of Psychology, University of Auckland, Auckland, New Zealand
R. Moss-Morris*
Affiliation:
School of Psychology, University of Southampton, Highfield, Southampton, UK
*
*Address for correspondence: R. Moss-Morris, Ph.D., School of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, UK. (Email: remm@soton.ac.uk)
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Abstract

Background

Chronic fatigue is a common symptom of multiple sclerosis (MS). A randomized controlled trial (RCT) showed that cognitive behavioural therapy (CBT) was more effective in reducing MS fatigue than relaxation training (RT). The aim of the current study was to analyse additional data from this trial to determine whether (1) CBT compared to RT leads to significantly greater changes in cognitions and behaviours hypothesized to perpetuate MS fatigue; (2) changes in these variables mediate the effect of CBT on MS fatigue; and (3) these mediation effects are independent of changes in mood.

Method

Seventy patients (CBT, n=35; RT, n=35) completed the Cognitive and Behavioural Responses to Symptoms Questionnaire (CBSQ), the Brief Illness Perception Questionnaire (B-IPQ) modified to measure negative representations of fatigue, the Hospital Anxiety and Depression Scale (HADS), and the Chalder Fatigue Questionnaire (CFQ), pre- and post-therapy. Multiple mediation analysis was used to determine which variables mediated the change in fatigue.

Results

Avoidance behaviour and three cognitive variables (symptom focusing, believing symptoms are a sign of damage and a negative representation of fatigue) improved significantly more in the CBT than the RT group. Mediation analysis showed that changing negative representations of fatigue mediated the decrease in severity of fatigue. Change in anxiety covaried with reduction in fatigue but the mediation effect for negative representations of fatigue remained when controlling for improvements in mood.

Conclusions

Change in beliefs about fatigue play a crucial role in CBT for MS fatigue. These beliefs and the role of anxiety deserve more attention in the further development of this intervention.

Keywords

Cognitive behaviour therapyfatigueillness perceptionsmultiple sclerosismediation analysis
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 1 , January 2012 , pp. 205 - 213
Copyright
Copyright © Cambridge University Press 2011

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References

Bol, Y, Duits, AA, Hupperts, RM, Vlaeyen, JW, Verhey, FR (2009). The psychology of fatigue in patients with multiple sclerosis: a review. Journal of Psychosomatic Research 66, 3–11.CrossRefGoogle ScholarPubMed
Broadbent, E, Petrie, KJ, Main, J, Weinman, J (2006). The Brief Illness Perception Questionnaire. Journal of Psychosomatic Research 60, 631–637.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
Feinstein, A (2007). Neuropsychiatric syndromes associated with multiple sclerosis. Journal of Neurology 254 (Suppl. 2), 1173–1176.CrossRefGoogle ScholarPubMed
Frazier, PA, Tix, AP, Barron, KE (2004). Testing moderator and mediator effects in counseling psychology research. Journal of Counseling Psychology 51, 115–134.CrossRefGoogle Scholar
Gielissen, MF, Verhagen, S, Witjes, F, Bleijenberg, G (2006). Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial. Journal of Clinical Oncology 24, 4882–4887.CrossRefGoogle ScholarPubMed
Jenkins, CD, Stanton, BA, Niemcryk, SJ, Rose, RM (1988). A scale for the estimation of sleep problems in clinical research. Journal of Clinical Epidemiology 41, 313–321.CrossRefGoogle ScholarPubMed
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
Mohr, DC, Hart, SL, Goldberg, A (2003). Effects of treatment for depression on fatigue in multiple sclerosis. Psychosomatic Medicine 65, 542–547.CrossRefGoogle ScholarPubMed
Moss-Morris, R, Petrie, K (2001). Discriminating between chronic fatigue syndrome and depression: a cognitive analysis. Psychological Medicine 31, 469–479.CrossRefGoogle ScholarPubMed
Moss-Morris, R, Sharon, C, Tobin, R, Baldi, JC (2005). A randomized controlled graded exercise trial for chronic fatigue syndrome: outcomes and mechanisms of change. Journal of Health Psychology 10, 245–259.CrossRefGoogle ScholarPubMed
Preacher, KJ, Hayes, AF (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods 40, 879–891.CrossRefGoogle ScholarPubMed
Price, JR, Mitchell, E, Tidy, E, Hunot, V (2008). Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database of Systematic Reviews. Issue 3, Art. No. CD001027.Google ScholarPubMed
Siegert, RJ, Abernethy, DA (2005). Depression in multiple sclerosis: a review. Journal of Neurology, Neurosurgery and Psychiatry 76, 469–475.CrossRefGoogle ScholarPubMed
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
Strober, LB, Arnett, PA (2005). An examination of four models predicting fatigue in multiple sclerosis. Archives of Clinical Neuropsychology 20, 631–646.CrossRefGoogle ScholarPubMed
Van Breukelen, GJP (2006). ANCOVA versus change from baseline: more power in randomized studies, more bias in nonrandomized studies. Journal of Clinical Epidemiology 59, 920–925.CrossRefGoogle ScholarPubMed
Van der Werf, SP, Evers, AJongen, PJ, Bleijenberg, G (2003). The role of helplessness as mediator between neurological disability, emotional instability, experienced fatigue and depression in patients with multiple sclerosis. Multiple Sclerosis 9, 89–94.CrossRefGoogle ScholarPubMed
van Kessel, K, Moss-Morris, R (2006). Understanding multiple sclerosis fatigue: a synthesis of biological and psychological factors. Journal of Psychosomatic Research 61, 583–585.CrossRefGoogle ScholarPubMed
van Kessel, K, Moss-Morris, R, Willoughby, E, Chalder, T, Johnson, MH, Robinson, E (2008). A randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue. Psychosomatic Medicine 70, 205–213.CrossRefGoogle ScholarPubMed
Vercoulen, JH, Swanink, CM, Galama, JM, Fennis, JF, Jongen, PJ, Hommes, OR, van der Meer, JW, Bleijenberg, G (1998). The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: development of a model. Journal of Psychosomatic Research 45, 507–517.CrossRefGoogle ScholarPubMed
Wiborg, J, Knoop, H, Prins, J, Bleijenberg, G (2011). Does a decrease in avoidance behavior and focusing on fatigue mediate the effect of cognitive behaviour therapy for chronic fatigue syndrome? Journal of Psychosomatic Research 70, 306–310.CrossRefGoogle ScholarPubMed
Wiborg, J, Knoop, H, Stulemeijer, M, Prins, J, Bleijenberg, G (2010). How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity. Psychological Medicine 40, 1281–1287.CrossRefGoogle ScholarPubMed
Zigmond, AS, Snaith, RP (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361–370.CrossRefGoogle ScholarPubMed