Illness beliefs & treatment outcome in Chronic Fatigue Syndrome (CFS)

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.

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