Chronic Fatigue Syndrome: Deary V

Deary V. · Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK. · Br J Health Psychol. · Pubmed #18267050 No free full text.

Abstract: The problem posed by chronic fatigue syndrome (CFS) to the affected individual can be conceptualized, using Leventhal's common sense model, as a health threat to be encoded and coped with accordingly. The current paper adopts an alternative use of self-regulation theory. It is hypothesized that in CFS the health threat is no longer the illness, but anything that threatens to disrupt a precarious accommodation to it. It is argued that attempts at threat regulation may become inadvertently self-defeating, promoting the threats they attempt to diminish. Evidence is presented for homeostatic mechanisms in physiological, neurocognitive and affective domains, and for their potential to become locked in vicious circles. It is further argued that illness attributions, rather than being independent cognitive processes, may be intimately linked with emotional and somatic processes. Damasio's somatic marker hypothesis is used to suggest ways in which the self-regulation of highly interconnected somatic, affective, and cognitive states may be substantially implicated in the maintenance of CFS. This perspective is used to reconsider effective treatment and to suggest new interventions. The self-regulation model is a potentially powerful explanatory framework for the consideration and treatment of CFS and medically unexplained symptoms in general.

Deary V, Chalder T, Sharpe M. · Institute of Health and Society, University of Newcastle, 21 Claremont Place, Newcastle Upon Tyne NE2 4AA, UK. · Clin Psychol Rev. · Pubmed #17822818 No free full text.

Abstract: The article is a narrative review of the theoretical standing and empirical evidence for the cognitive behavioural model of medically unexplained symptoms (MUS) in general and for chronic fatigue syndrome (CFS) and irritable bowel syndrome (IBS) in particular. A literature search of Medline and Psychinfo from 1966 to the present day was conducted using MUS and related terms as search terms. All relevant articles were reviewed. The search was then limited in stages, by cognitive behavioural therapy (CBT), condition, treatment and type of trial. Evidence was found for genetic, neurological, psychophysiological, immunological, personality, attentional, attributional, affective, behavioural, social and inter-personal factors in the onset and maintenance of MUS. The evidence for the contribution of individual factors, and their autopoietic interaction in MUS (as hypothesised by the cognitive behavioural model) is examined. The evidence from the treatment trials of cognitive behavioural therapy for MUS, CFS and IBS is reviewed as an experimental test of the cognitive behavioural models. We conclude that a broadly conceptualized cognitive behavioural model of MUS suggests a novel and plausible mechanism of symptom generation and has heuristic value. We offer suggestions for further research.

Deary V, Deary IJ, McKenna HP, McCance TV, Watson R, Hoogbruin AL. · Chronic Fatigue Syndrome Research and Treatment Unit, King's College Hospital, London, UK. · J Adv Nurs. · Pubmed #12074756 No free full text.

Abstract: BACKGROUND: Contemporary research into caring in nursing was criticized in the pages of this journal by John Paley. He charged that the study of caring has not been advanced by research which, he reckoned, merely generates endless lists of terms to describe caring. He also argued that research in the field was largely flawed by confusion over the difference between things said about caring and the act of caring itself. THE PRESENT PAPER: We have analysed Paley's criticism. Essentially, he is criticizing the whole field of survey research. The scientific process is underpinned by the implicit understanding that any field moves forward cautiously. In the social sciences multiple perspectives enrich understanding of phenomena and often confirm previous perceptions. The lack of any alternative approach from Paley is evident. Examples from psychology, where seemingly endless lists of descriptors have led through rigorous concept and statistical analysis to genuinely useful psychological and clinical data, are expounded. In contrast to Paley's assertions, the study of caring in nursing to date has also produced information which is useful within nurse education and practice. CONCLUSION: There is no confusion concerning the things said about and the things done in the name of caring in our minds. We acknowledge that studying the actual phenomena of caring is difficult. However, in the absence of definitive descriptions of caring and precise methods to study it, the search for perfection has not paralysed action. Much has been learned about caring and much remains to be learned.

Chalder T, Tong J, Deary V. · Academic Department of Psychological Medicine, Guy's, King's and St Thomas' School of Medicine, 103 Denmark Hill, London SE5 8AZ, UK. · Arch Dis Child. · Pubmed #11827901 links to  free full text

Abstract: AIM: To examine the efficacy of family focused cognitive behaviour therapy for 11-18 year olds with chronic fatigue syndrome. METHODS: Twenty three patients were offered family focused cognitive behaviour therapy. The main outcome was a fatigue score of less than 4 and attendance at school 75% of the time. RESULTS: Twenty patients completed treatment. Eighteen had completed all measures at six months follow up; 15 of these (83%) improved according to our predetermined criterion. Substantial improvements in social adjustment, depression, and fear were noted. CONCLUSIONS: Family focused cognitive behaviour therapy was effective in improving functioning and reducing fatigue in 11-18 year olds. Gains were maintained at six months follow up.