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The '''illness beliefs''' hypothesis posits that specific beliefs relating to [[ME/CFS]] are found in patients, and that these beliefs are [[maintaining factors]] which prevent recovery, and may even increase the severity of the illness.<ref name="Sharpe1995">{{Cite journal | last = Sharpe | first = Michael | authorlink = Michael Sharpe | date = April 1995 | title = Cognitive Behavioural Therapy for Chronic Fatigue Syndrome: To the Editor |url =https://www.amjmed.com/article/S0002-9343(99)80332-5/pdf|journal=American Journal of Medicine|volume=98|pages=|quote=We have found that patients' belief that their symptoms are a result of physical disease and require medical treatment is also an important factor perpetuating illness[2] by preventing the patient working on psychological and social problems inhibiting recovery.|via=}}</ref> These illness beliefs have been described as "negative thoughts", "dysfunctional" or "unhelpful" beliefs which, according to this hypothesis, result in "maladaptive" behaviors that prevent people recovering from ME/CFS.<ref name="Sharpe1995Fibro">{{Cite book | url =https://books.google.co.uk/books?id=Da0jf7agNvgC&pg=PA111 | title = Fibromyalgia, Chronic Fatigue Syndrome, and Repetitive Strain Injury: Current Concepts in Diagnosis, Management, Disability, and Health Economics | last = Sharpe | first = Michael | date = 1995|publisher=Psychology Press|isbn=9781560247449|editor-last = Chalmers|editor-first = Andrew|location=|pages=141-146|language=en|chapter=Cognitive Behavioural Therapy and the Treatment of Chronic Fatigue Syndrome | authorlink = Michael Sharpe}}</ref><ref name="keith">{{Cite journal | last = Geraghty | first = Keith J | author-link = Keith Geraghty | last2 = Blease | first2 = Charlotte | authorlink2 = Charlotte Blease | date = 2016-09-15 | title = Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent | url = https://www.researchgate.net/profile/Keith_Geraghty/publication/308181085_Cognitive_behavioural_therapy_in_the_treatment_of_chronic_fatigue_syndrome_A_narrative_review_on_efficacy_and_informed_consent/links/5a15a37e4585153b546ca7c7/Cognitive-behavioural-therapy-in-the-treatment-of-chronic-fatigue-syndrome-A-narrative-review-on-efficacy-and-informed-consent.pdf | journal=Journal of Health Psychology|volume=23|issue=1|pages=127β138|doi=10.1177/1359105316667798|issn=1359-1053|via=}}</ref> The illness beliefs hypothesis is part of the [[biopsychosocial model]] (BPS) and is used to justify the use of [[cognitive behavioral therapy]] (CBT) as a primary treatment for [[myalgic encephalomyelitis]] (ME) and [[chronic fatigue syndrome]] (CFS), rather than its use as a treatment only for patients with [[depression]], [[anxiety]] or [[Emotional dysfunction|emotional problems]] resulting from CFS. For example in the [[PACE trial]] CBT was tested to determine whether it helped people could "recover" from ME/CFS, with improvements in depression or anxiety considered to be secondary outcomes.<ref name="pacetrial">{{Cite journal | last = White | first = PeterD. | authorlink = Peter White | last2 = Sharpe | first2 = Michael C. | authorlink2 = Michael Sharpe | last3 = Chalder | first3 = Trudie | authorlink3 = Trudie Chalder | last4 = DeCesare | first4 = Julia C. | last5 = Walwyn | first5 = Rebecca | last6 = PACE trial group | authorlink6 = PACE Trial Management Group | date = 2007-03-08 | title = Protocol for the PACE trial: a randomised controlled trial of adaptive pacing, cognitive behaviour therapy, and graded exercise, as supplements to standardised specialist medical care versus standardised specialist medical care alone for patients with the chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy | url = https://www.ncbi.nlm.nih.gov/pubmed/17397525|journal=BMC neurology|volume=7 | pages = 6|doi=10.1186/1471-2377-7-6|issn=1471-2377|pmc=2147058|pmid=17397525|issue=|via=|quote= | authorlink4 = Julia DeCesare | authorlink5 = Rebecca Walwyn}}</ref> The same illness beliefs hypothesis was used with [[Severe and very severe ME|severely ill]] patients in the similar [[FINE trial]].<ref name="FINE, 2006">{{Cite journal | last1 = Wearden | first1 = A. | authorlink1 = Alison Wearden | last2 =Riste | first2 = L. | authorlink2 = Lisa Riste | last3 = Dowrick | first3 = C. | authorlink3 = Christopher Dowrick | last4 =Chew-Graham | first4 = C. | authorlink4 = Carolyn Chew-Graham | last5 = Bentall | first5 = R. | authorlink5 = Richard Bentall | last6 = Morriss | first6 = R. | authorlink6 = Richard Morriss | last7 = Peters | first7 = S. | authorlink7 = Sarah Peters | last8 = Dunn | first8 = G. | authorlink8 = Grahan Dunn | last9 = Richardson | first9 = G. | author-link9 = Gerry Richardson | last10 =Lovell | first10 = K. | authorlink10 = Karina Lovell | last11 = Powell | first11 = P. | authorlink11 = Pauline Powell | title = Fatigue Intervention by Nurses Evaluation β The FINE Trial. A randomised controlled trial of nurse led self-help treatment for patients in primary care with chronic fatigue syndrome: study protocol. [ISRCTN74156610] | journal = BMC Medicine | volume = 4 | issue = 9 | page = | date = 2006 | pmid = 16603058 | doi = 10.1186/1741-7015-4-9 | url = https://www.ncbi.nlm.nih.gov/pubmed/16603058 }}</ref> ==Theory== Patients are expected to identify their own dysfunctional illness beliefs, but those referred to by proponents of this hypothesis controversially include: * The belief that ME/CFS symptoms are the result of a physical illness * The belief that ME/CFS needs medical treatment (physical treatment only)<ref name="Sharpe1995" /> * The belief that exercise or too much activity has "harmful effects"<ref name="Moss-Morris2002">{{Cite book | url =https://books.google.co.uk/books?id=5VqGAgAAQBAJ&pg=PT24 | title = Chronic Fatigue Syndrome: Experience of illness | last = Moss-Morris | first = Rona | last2 = Petrie | first2 = Keith J. | date = 2002-01-04|publisher=Routledge|isbn=9781134632831|location=|pages=12-28|language=en|chapter=Contemporary chronic fatigue syndrome: A unique entity? | author-link = Rona Moss-Morris | authorlink2 = Keith Petrie}}</ref> which leads to "fear of exercise" (kinesiophobia) A patient's belief does not in any way reduce the severe and sometimes debilitating symptoms that they experience on a daily basis. However, many of these proposed "dysfunctional beliefs" are scientific facts supported by evidence, rather than false beliefs. For example, the [[Institute of Medicine report]] in 2015 described ME/CFS as serious, complex, chronic biological (physical) disease.<ref name="SEID-IOM2015">{{Cite book | last = Institute of Medicine | authorlink = Institute of Medicine | title = Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness|location=Washington, DC|publisher=The National Academies Press | date = 2015 | url=https://www.ncbi.nlm.nih.gov/books/NBK284902/|isbn=0309316898|pmid = 25695122|doi = 10.17226/19012 }}</ref> and in recent years the [[Centers for Disease Control and Prevention|CDC]] and the UK's [[National Health Service]] have both described ME/CFS in similar terms.<ref name="CDC-clinicians">{{Cite web | url = https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/index.html | title = Presentation and Clinical Course of ME/CFS {{!}} Information for Healthcare Providers {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS | last = Centers for Disease Control and Prevention | first = | authorlink = Centers for Disease Control and Prevention | date = 2019-11-19 | website = CDC|language=en-us|archive-url=|archive-date=|url-status=|access-date=2021-12-18}}</ref><ref name="niceng206">{{Cite web | url = https://www.nice.org.uk/guidance/ng206 | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last = NICE Guideline Development Group | first = | authorlink = |publisher=[[National Institute for Health and Care Excellence]] | date = 2021-10-29}}</ref> ==Evidence== A study in the [[Netherlands]] by [[Jo Nijs|Nijs]] et al. (2004) was unable to find an association between fear of [[exercise]] and level of disability or exercise capacity in people with CFS who experienced [[Myalgia|muscle]] or [[Arthralgia|joint pain]].<ref name="Nijs2004" /> A study by Gallagher et al. (2005), which included Peter White, a proponent of this theory, reached a similar conclusion, stating that:{{Quote2|The data suggest that CFS patients without a comorbid psychiatric disorder do not have an exercise phobia.|[[Arlene Gallagher]], [[Adam Colridge]], [[Brian Hedge]], [[William Weir]] & [[Peter White]]|Is the Chronic Fatigue Syndrome an exercise phobia? A case control study.}} ==Criticism == Challenging patients' experience of their illness and its symptoms may result in harm, distress and patient dissatisfaction.<ref name="GeraghtyEsmail2016">{{Cite journal | last = Geraghty | first = Keith J. | last2 = Esmail | first2 = Aneez | authorlink2 = Esmail Aneez | authorlink =Keith Geraghty | date = 2016-08-01 | title = Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm? | url = https://bjgp.org/content/66/649/437|journal=Br J Gen Pract|language=en|volume=66|issue=649 | pages = 437β438|doi=10.3399/bjgp16X686473|issn=0960-1643|pmid=27481982}}</ref><ref name="GeraghtyBPS2018">{{Cite journal | last = Geraghty | first = Keith J. | authorlink =Keith Geraghty | authorlink2 =Charlotte Blease | last2 = Blease | first2 = Charlotte | date = 2018-06-21 | title = Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter |url =https://www.tandfonline.com/doi/abs/10.1080/09638288.2018.1481149?scroll=top&needAccess=true&journalCode=idre20&|journal=Disability and Rehabilitation|language=en|pages=1β10|doi=10.1080/09638288.2018.1481149|issn=0963-8288}}</ref> ==Treatment== CBT is proposed to encourage the person to challenge and alter their illness beliefs, and any behaviors that result from these beliefs. The illness beliefs may be referred to as "unhelpful thoughts", which the person should work to identify, and then look at evidence for or against each belief, then re-evaluate these beliefs. CBT involves finding actions (behaviors) that result from the unhelpful thoughts (illness beliefs) and deciding which behaviors to change. The CBT model also states that changing behaviors related to the illness can change the thoughts linked to those behaviors. The CBT used for ME/CFS is specific to the illness, and has components not found in CBT that has been used with patients who have [[cancer]], [[Multiple sclerosis]] (MS) or other chronic illnesses. ==Notable studies== *1998, Illness beliefs and treatment outcome in Chronic Fatigue Syndrome<ref name="deale1998">{{Cite journal | last = Deale | first = A. | authorlink = Alicia Deale | last2 = Chalder | first2 = T. | authorlink2 = Trudie Chalder | last3 = Wessely | first3 = S. | authorlink3 = Simon Wessely | date = Jul 1998 | title = Illness beliefs and treatment outcome in chronic fatigue syndrome | url = https://www.ncbi.nlm.nih.gov/pubmed/9720857|journal=Journal of Psychosomatic Research|volume=45|issue=1 | pages = 77β83|issn=0022-3999|pmid=9720857}}</ref> [https://www.sciencedirect.com/science/article/pii/S002239999800021X (Abstract)] *2004, [https://doi.org/10.1093/ptj/84.8.696 Chronic Fatigue Syndrome: Lack of Association between Pain-Related Fear of Movement and Exercise Capacity and Disability] <ref name="Nijs2004">{{Cite journal | last = Nijs | first = Jo | author-link =Jo Nijs | last2 = Vanherberghen | first2 = Katrien | authorlink2 = Katrien Vanherberghen | last3 = Duquet | first3 = William | authorlink3 = William Duquet | last4 = De Meirleir | first4 = Kenny | authorlink4 = Kenny De Meirleir | date = 2004-08-01 | title = Chronic Fatigue Syndrome: Lack of Association Between Pain-Related Fear of Movement and Exercise Capacity and Disability | url = https://doi.org/10.1093/ptj/84.8.696|journal=Physical Therapy|language=en|volume=84|issue=8|pages=|doi=10.1093/ptj/84.8.696|issn=1538-6724|quote=These results indicate a lack of correlation between kinesiophobia and exercise capacity, activity limitations, or participation restrictions, at least in patients with CFS who are experiencing widespread muscle or joint pain.|via=}}</ref> * 2005, Is the Chronic Fatigue Syndrome an exercise phobia? A case control study.<ref name="Gallagher2005">{{Cite journal | last = Gallagher | first = A.M. | last2 = Coldrick | first2 = A.R. | last3 = Hedge | first3 = B. | last4 = Weir | first4 = W.R.C. | last5 = White | first5 = P.D. | authorlink5 = Peter White | date = April 2005 | title = Is the chronic fatigue syndrome an exercise phobia? A case control study | url = https://www.jpsychores.com/article/S0022-3999(05)00014-0/fulltext|journal=Journal of Psychosomatic Research|language=English|volume=58|issue=4 | pages = 367β373|doi=10.1016/j.jpsychores.2005.02.002|issn=0022-3999|quote=The data suggest that CFS patients without a comorbid psychiatric disorder do not have an exercise phobia.|via= | author-link = Arlene Gallagher | authorlink2 = Aruna Coldrick | authorlink3 = Barbara Hedge | authorlink4 = William Weir}}</ref> [https://www.jpsychores.com/article/S0022-3999(05)00014-0/fulltext (Full text)] *2017, Contesting the psychiatric framing of ME/CFS<ref name="Spandler2017">{{Cite journal | last = Spandler | first = Helen | authorlink = Helen Spandler | last2 = Allen | first2 = Meg | authorlink2 = Meg Allen | date = Aug 16, 2017 | title = Contesting the psychiatric framing of ME/CFS | url = https://www.researchgate.net/profile/Helen_Spandler/publication/319157873_Contesting_the_psychiatric_framing_of_MECFS/links/599b082545851574f4ac5ba0/Contesting-the-psychiatric-framing-of-ME-CFS.pdf | journal=Social Theory & Health|language=en|volume=16|issue=2|pages=127β141|doi=10.1057/s41285-017-0047-0|issn=1477-8211|quote=|via=}}</ref> [https://www.researchgate.net/profile/Helen_Spandler/publication/319157873_Contesting_the_psychiatric_framing_of_MECFS/links/599b082545851574f4ac5ba0/Contesting-the-psychiatric-framing-of-ME-CFS.pdf (Full text)] ==Studies critical of the role of illness beliefs== *2016, [http://bjgp.org/content/66/649/437 "Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?"]<ref name="GeraghtyEsmail2016" /> * 2018, Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter<ref name="GeraghtyBPS2018" /> [https://www.tandfonline.com/doi/full/10.1080/09638288.2018.1481149 (Full text)] ==See also== * [[Hypochondriasis]] (hypochondria or illness anxiety disorder) * [[Psychologization]] * [[Cognitive behavioral therapy]] * [[Kinesiophobia]] * [[Biopsychosocial model]] * [[Hysteria]] * [[Graded exercise therapy]] * [[PACE trial]] * [[Wessely school]] ==Learn more== * [https://www.researchgate.net/profile/Keith_Geraghty/publication/308181085_Cognitive_behavioural_therapy_in_the_treatment_of_chronic_fatigue_syndrome_A_narrative_review_on_efficacy_and_informed_consent/links/5a15a37e4585153b546ca7c7 Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent]<ref name="keith" /> * [[:File:PACE-cbt-participant-manual.pdf | PACE trial Cognitive Behavioral Therapy manual for participants]] ==References== {{Reflist}} [[Category:Medical hypotheses]] [[Category:Psychological paradigm]]
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