Attentional and interpretive bias towards illness‐related information in chronic fatigue syndrome: A systematic review

Abstract

Some people with CFS have biases in the way they attend to and interpret somatic information. Such cognitive processing biases may maintain illness beliefs and symptoms in people with CFS. This review highlights methodological issues in experimental design and makes recommendations to aid future research to forge a consistent approach in cognitive processing research. Statement of contribution What is already known on this subject? Studies based on self-report measures suggest negative illness representations, related symptom interpretations, and heightened symptom focusing contribute to the maintenance of chronic fatigue. Experimental studies in other clinical populations, such as patients with anxiety, depression, and chronic pain, have identified illness-specific biases in how information is implicitly attended to and interpreted, which has a causal role in these conditions. What does this study add? This is the first review of implicit cognitive processes in chronic fatigue syndrome (CFS). Sustained attention and negative interpretations of somatic information may reinforce negative illness beliefs. Cognitive processes have a role to play in the cognitive behavioural model of CFS.

Maximizing potential impact of experimental research into cognitive processes in health psychology: A systematic approach to material development

“…Several decades of research in clinical psychology have identified that how people process incoming information, specifically having an attentional bias (AB) to threatening information (AB) and a bias to interpret ambiguous information in a negative way (interpretation bias), plays a central role in the onset and maintenance of anxiety and depression (Beck, 2002;Beck & Clark, 1997;MacLeod, Mathews, & Tata, 1986;Mathews & MacLeod, 2005;Mogg, Mathews, & Eysenck, 1992;Wilson, MacLeod, Mathews, & Rutherford, 2006). Within health psychology, there is burgeoning interest in applying these experimental methods to assess potential cognitive processing biases in physical health conditions, such as chronic pain (Pincus & Morley, 2001;Schoth, Nunes, & Liossi, 2012), chronic fatigue syndrome (Hughes, Hirsch, Chalder, & Moss-Morris, 2016), irritable bowel syndrome and cancer (Chan, Ho, Tedeschi, & Leung, 2011) as well as health behaviours such as eating (Beard, Sawyer, & Hofmann, 2012;Dobson & Dozois, 2004;van Beurden, Greaves, Smith, & Abraham, 2016), smoking (Bradley, Mogg, Wright, & Field, 2003), and alcohol use (Field, Mogg, & Bradley, 2005;Wiers, Eberl, Rinck, Becker, & Lindenmeyer, 2011). Experimental research in these areas could inform theoretical development by enabling access to levels and types of information processing that may underpin unhelpful illness representations and influence health behaviours (Sheeran et al, 2016).…”

“…The chronic pain literature, in particular, has employed these experimental methods to test the role of hypervigilance to pain (Crombez, Van Ryckeghem, Eccleston, & Van Damme, 2013) as well as pain-related interpretations of ambiguous information (Schoth & Liossi, 2016). Experimental research has begun to be carried out in other long-term conditions such as chronic fatigue syndrome (CFS) (Hughes et al, 2016), irritable bowel syndrome (Afzal, Potokar, Probert, & Munaf o, 2006;Chapman & Martin, 2011;Tkalcic, Domijan, Pletikosic, Setic, & Hauser, 2014), and fear of cancer recurrence (Butow et al, 2015;Custers et al, 2015;DiBonaventura, Erblich, Sloan, & Bovbjerg, 2010;Miles, Voorwinden, Mathews, Hoppitt, & Wardle, 2009). However, to date, evidence for cognitive biases in these areas has been mixed.…”

“…However, to date, evidence for cognitive biases in these areas has been mixed. One reason for the heterogeneous findings may be the suboptimal selection of stimuli materials to tap into salient concepts of the target population (Hendrikse et al, 2015;Hughes et al, 2016). Some studies have used materials developed for other populations; for example, studies of ABs in CFS (Hou, Moss-Morris, Bradley, Peveler, & Mogg, 2008;Hou et al, 2014) have used materials developed for the general population to tap into heath threats (Lees, Mogg, & Bradley, 2005), which may not be integral to the specific concerns of the population.…”

Psychometric Properties and Factor Structure of a Long and Shortened Version of the Cognitive and Behavioural Responses Questionnaire

“…Shortly after its recognition as an illness (6,7), clinical researchers postulated a cognitive behavioural model of CFS that hypothesised that CFS symptoms are perpetuated by the patients' cognitive and behavioural responses to the illness (8,9). Some of the unhelpful cognitive responses in patients with CFS include excessive focusing on fatigue symptoms (10), and catastrophic interpretations of symptoms which involves worrying about worst-case potential consequences (11). These cognitive responses are also associated with behavioural responses in CFS patients, which include reducing or avoiding activities to alleviate fatigue (12,13), or alternating between high levels of activity when feeling well and resting excessively in response to symptoms.…”

Efectos de la fatiga anticipatoria y la sintomatología emocional en la percepción de fatiga física y cognitiva

“…CFS cases with depression involve more inappropriate cognitions and behaviors (Cella, White, Sharpe, & Chalder, 2013). However, a recent review on CFS emphasized cognitive biases in processing information related to the disorder's symptoms regardless of anxiety and depression symptoms, attentional and interpretive biases from the effort of assimilating and organizing the information on the illness (Hughes, Hirsch, Chalder, & Moss-Morris, 2016). All in all, in this study we referred to a component of expectation which could have a different function in outset and maintenance of general fatigue symptoms.…”