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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: [email protected])
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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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