Abstract
A substantial subgroup of patients with chronic fatigue syndrome (CFS) profits from behavioural interventions. 1 Knoop H Bleijenberg G Gielissen MFM Van der Meer JWM White PD Is a full recovery possible after cognitive behavioural therapy for chronic fatigue syndrome?. Psychother Psychosom. 2007; 76: 171-176 Crossref PubMed Scopus (118) Google Scholar , 2 White PD Goldsmith K Johnson AL Chalder T Sharpe M Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychol Med. 2013; 43: 2227-2235 Crossref PubMed Scopus (86) Google Scholar , 3 White PD Goldsmith KA Johnson AL et al. for the PACE trial management groupComparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011; 377: 823-836 Summary Full Text Full Text PDF PubMed Scopus (627) Google Scholar A minority fully recovers after these interventions, but most do not, 1 Knoop H Bleijenberg G Gielissen MFM Van der Meer JWM White PD Is a full recovery possible after cognitive behavioural therapy for chronic fatigue syndrome?. Psychother Psychosom. 2007; 76: 171-176 Crossref PubMed Scopus (118) Google Scholar , 2 White PD Goldsmith K Johnson AL Chalder T Sharpe M Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychol Med. 2013; 43: 2227-2235 Crossref PubMed Scopus (86) Google Scholar and quite a few patients do not profit at all. 3 White PD Goldsmith KA Johnson AL et al. for the PACE trial management groupComparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011; 377: 823-836 Summary Full Text Full Text PDF PubMed Scopus (627) Google Scholar Therefore, outcome has substantial room for further improvement. Mediation analysis of intervention studies can help to identify the variables that bring on a reduction in chronic fatigue syndrome symptoms. With this knowledge, interventions could be improved and more patients could fully benefit from treatment. Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trialOur main finding was that fear avoidance beliefs were the strongest mediator for both CBT and GET. Changes in both beliefs and behaviour mediated the effects of both CBT and GET, but more so for GET. The results support a treatment model in which both beliefs and behaviour play a part in perpetuating fatigue and disability in chronic fatigue syndrome. Full-Text PDF
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