The effect of cognitive behaviour therapy for chronic fatigue syndrome on self-reported cognitive impairments and neuropsychological test performance

Department of Medical Psychology, Radboud University Nijmegen, Nymegen, Gelderland, Netherlands
Journal of neurology, neurosurgery, and psychiatry (Impact Factor: 6.81). 05/2007; 78(4):434-6. DOI: 10.1136/jnnp.2006.100974
Source: PubMed


Patients with chronic fatigue syndrome (CFS) often have concentration and memory problems. Neuropsychological test performance is impaired in at least a subgroup of patients with CFS. Cognitive behavioural therapy (CBT) for CFS leads to a reduction in fatigue and disabilities.
To test the hypothesis that CBT results in a reduction of self-reported cognitive impairment and in an improved neuropsychological test performance.
Data of two previous randomised controlled trials were used. One study compared CBT for adult patients with CFS, with two control conditions. The second study compared CBT for adolescent patients with a waiting list condition. Self-reported cognitive impairment was assessed with questionnaires. Information speed was measured with simple and choice reaction time tasks. Adults also completed the symbol digit-modalities task, a measure of complex attentional function.
In both studies, the level of self-reported cognitive impairment decreased significantly more after CBT than in the control conditions. Neuropsychological test performance did not improve.
CBT leads to a reduction in self-reported cognitive impairment, but not to improved neuropsychological test performance. The findings of this study support the idea that the distorted perception of cognitive processes is more central to CFS than actual cognitive performance.

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Available from: Hans Knoop
    • "First, people with CFS may overestimate their premorbid cognitive ability (the good-old-days phenomenon;Sullivan & Edmed, 2012) or the impact of CFS on it, leading them to underestimate their current cognitive ability and report more problems (Knoop, Prins, Moss-Morris, & Bleijenberg, 2010;Ray et al., 1993;Short et al., 2002;Wearden & Appleby, 1996). Some researchers believe that this indicates a problem with selfperception (e.g.,Knoop et al., 2007;Prins, van der Meer, & Bleijenberg, 2006). However, two studies that investigated selfassessments of cognitive performance found that CFS samples were either accurate in their evaluations (Wearden & Appleby, 1997) or underestimated their performance to the same extent as that of a healthy control group (Metzger & Denney, 2002), suggesting that people with CFS either do not have a problem with self-perception or that the problem is not specific to CFS. "
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    ABSTRACT: Objective: The purpose of this study was to examine the relationship between subjective and objective assessments of memory and attention in people with chronic fatigue syndrome (CFS), using tests that have previously detected deficits in CFS samples and measures of potential confounds. Method: Fifty people with CFS and 50 healthy controls were compared on subjective (memory and attention symptom severity, Cognitive Failures Questionnaire, Everyday Attention Questionnaires) and objective (California Verbal Learning Test, Rey-Osterreith Complex Figure Test, Paced Auditory Serial Addition Test, Stroop task) measures of memory and attention. Fatigue, sleep, depression, and anxiety were also assessed. Results: The CFS group reported experiencing more cognitive problems than the controls, but the two groups did not differ on the cognitive tests. Scores on the subjective and objective measures were not correlated in either group. Depression was positively correlated with increased severity of cognitive problems in both the CFS and control groups. Conclusions: There is little evidence for a relationship between subjective and objective measures of cognitive functioning for both people with CFS and healthy controls, which suggests that they may be capturing different constructs. Problems with memory and attention in everyday life are a significant part of CFS. Depression appears to be related to subjective problems but does not fully explain them.
    No preview · Article · Dec 2013 · Neuropsychology
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    • "Although several health problems were targeted in these Internet-based studies, there are gaps in the literature in terms of treatments for health problems which have been found to improve by means of CBT. For example, several studies have examined the effects of CBT for chronic fatigue syndrome (Knoop et al. 2007), fibromyalgia (Garcia et al. 2006), incontinence (Garley and Unwin 2006), or multiple sclerosis (Thomas et al. 2006), but these Table 2 Main outcomes of studies on Internet-based cognitive behavioral interventions for health problems "
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    ABSTRACT: Cognitive-behavioral interventions are the most extensively researched form of psychological treatment and are increasingly offered through the Internet. Internet-based interventions may save therapist time, reduce waiting-lists, cut traveling time, and reach populations with health problems who can not easily access other more traditional forms of treatments. We conducted a systematic review of twelve randomized controlled or comparative trials. Studies were identified through systematic searches in major bibliographical databases. Three studies focused on patients suffering from pain, three on headache, and six on other health problems. The effects found for Internet interventions targeting pain were comparable to the effects found for face-to-face treatments, and the same was true for interventions aimed at headache. The other interventions also showed some effects, although effects differed across target conditions. Internet-delivered cognitive-behavioral interventions are a promising addition and complement to existing treatments. The Internet will most likely assume a major role in the future delivery of cognitive-behavioral interventions to patients with health problems.
    Full-text · Article · Apr 2008 · Journal of Behavioral Medicine
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    ABSTRACT: Chronic fatigue syndrome (CFS) is considered to be one of the functional somatic syndromes (FSS). Cognitions and behavior are thought to perpetuate the symptoms of CFS. Behavioral interventions based on the existing models of perpetuating factors are quite successful in reducing fatigue and disabilities. The evidence is reviewed that cognitive processes, particularly those that determine the perception of fatigue and its effect on behavior, play a central role in the maintenance of symptoms. Narrative review. Findings from treatment studies suggest that cognitive factors mediate the positive effect of behavioral interventions on fatigue. Increased fitness or increased physical activity does not seem to mediate the treatment response. Additional evidence for the role of cognitive processes is found in studies comparing the subjective beliefs patients have of their functioning with their actual performance and in neurobiological research. Three different cognitive processes may play a role in the perpetuation of CFS symptoms. The first is a general cognitive representation in which fatigue is perceived as something negative and aversive and CFS is seen as an illness that is difficult to influence. The second process involved is the focusing on fatigue. The third element is formed by specific dysfunctional beliefs about activity and fatigue.
    No preview · Article · May 2010 · Journal of psychosomatic research
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