A Reexamination of the Cognitive Behavioral Model of Chronic Fatigue Syndrome: Investigating the Cogency of the Model’s Behavioral Pathway

Cognitive behavioral theories of chronic fatigue syndrome (CFS) assert that cognitions and behaviors perpetuate the fatigue and impairment that individuals with CFS experience (Wessely, Butler, Chalder, & David, 1991). Vercoulen and colleagues (1998) utilized structural equation modeling to empirically develop a cognitive behavioral model of CFS. The resulting model indicated that attributing symptoms to a physical cause, focusing on symptoms, and feeling less control over symptoms were associated with increased fatigue. Additionally, individuals who attributed symptoms to a physical cause reported lower activity levels and more fatigue and impairment. However, in an attempt to replicate this model, Song and Jason (2005) demonstrated that the model displayed inadequate fit statistics for a well-characterized group of individuals with CFS; the model resulted in appropriate fit for individuals with chronic fatigue from psychiatric conditions. Despite uncertainty surrounding the model’s validity, it continues to be cited to support the application of cognitive behavioral and graded exercise therapies to individuals with CFS (White et al., 2011). The current study utilized second-stage conditional process modeling (i.e., moderated mediation) to reexamine the behavioral pathway of the Vercoulen et al. (1998) model. This pathway is characterized by the association among causal attribution for symptoms, activity level, and fatigue and impairment. The use of a large sample allowed for a robust examination of the pathway, and moderators isolated potential factors that contributed to previous studies’ discrepant results. Findings were generally inconsistent with the Vercoulen et al. (1998) model. Results indicated that individuals did not reduce their activity level due to illness beliefs. Although activity level and impairment were significantly correlated, this correlation decreased as case definition stringency increased. Furthermore, a canonical correlation analysis demonstrated that activity level, impairment, and fatigue could be conceptualized as indicators of illness severity. Rather than implicating activity level as the cause of fatigue and impairment, the relation among these variables may be due to their shared association with the latent construct of illness severity. This study represents the second attempt to replicate the Vercoulen et al. (1998) model; neither the Song and Jason (2005) nor the current study resulted in findings consistent with the original model. As this model provides the theoretical foundation for cognitive behavioral and graded exercise treatments for ME and CFS, these failed replication attempts support patient-expressed concerns about the appropriateness and efficacy of these treatments

The Development of the DePaul Symptom Questionnaire: Original, Expanded, Brief, and Pediatric Versions

One of the key requirements of a reliable case definition is the use of standardized procedures for assessing symptoms. This article chronicles the development of the DePaul Symptom Questionnaire (DSQ) to assess symptoms of the major chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) case definitions. The original questionnaire has been modified and expanded over time to more fully capture symptoms from various adult case definitions, and a brief as well as pediatric version have also been developed. The DSQ has demonstrated very good psychometric properties in terms of test-retest reliability and sensitivity/specificity, as well as construct, predictive, and discriminant validity. The DSQ allows for a clear characterization of a patient's illness and allows scientists and clinicians to improve diagnostic reliability and validity when employing case definitions of ME and CFS

Addressing the Community Psychology Competency Dialectic through Participatory Pedagogy

Ongoing discussions persist regarding the potential usefulness and/or harmfulness of a defined set of core competencies in the field of community psychology. The competency thesis is that identification of core competencies can help define the field and distinguish the capabilities of community psychologists (Dalton & Wolfe, 2012). A set of competencies has implications for training and education, including clarity regarding what skills current and future students can expect to learn and what community psychologists may be expected to do. However, others have criticized the nature of standardized competencies. Presenting the antithesis to the competency thesis, Dzidic, Breen and Bishop (2013) question if compartmentalized competencies focus too much on static, individually oriented skills. They may distract from considerations of context, ethics and power within the dynamic ecologies of community psychology practice. Community psychology education and training programs are challenged with exposing students to a variety of central competencies while preparing them to engage in value-based research and practice in context. This article focuses on three applications of participatory pedagogy within the classroom that sought to synthesize the dialectic between core competencies and values-based, dynamic community psychology practice. Instructional materials for all three sessions are appended both for readers’ perusal as examples and for possible future adaptation and use in other community psychology courses. Participatory pedagogical approaches seek to foster student engagement, reflection, and collaboration to promote critical thinking, knowledge application and problem solving. In so doing, participatory pedagogy can bridge the gap between competencies and context, and offer at least a partial synthesis for the competency dialectic in community psychology education and training

Addressing the Community Psychology Competency Dialectic through Participatory Pedagogy

Ongoing discussions persist regarding the potential usefulness and/or harmfulness of a defined set of core competencies in the field of community psychology. The competency thesis is that identification of core competencies can help define the field and distinguish the capabilities of community psychologists (Dalton & Wolfe, 2012). A set of competencies has implications for training and education, including clarity regarding what skills current and future students can expect to learn and what community psychologists may be expected to do. However, others have criticized the nature of standardized competencies. Presenting the antithesis to the competency thesis, Dzidic, Breen and Bishop (2013) question if compartmentalized competencies focus too much on static, individually oriented skills. They may distract from considerations of context, ethics and power within the dynamic ecologies of community psychology practice. Community psychology education and training programs are challenged with exposing students to a variety of central competencies while preparing them to engage in value-based research and practice in context. This article focuses on three applications of participatory pedagogy within the classroom that sought to synthesize the dialectic between core competencies and values-based, dynamic community psychology practice. Instructional materials for all three sessions are appended both for readers’ perusal as examples and for possible future adaptation and use in other community psychology courses. Participatory pedagogical approaches seek to foster student engagement, reflection, and collaboration to promote critical thinking, knowledge application and problem solving. In so doing, participatory pedagogy can bridge the gap between competencies and context, and offer at least a partial synthesis for the competency dialectic in community psychology education and training

Unintended Consequences of not Specifying Exclusionary Illnesses for Systemic Exertion Intolerance Disease

The Institute of Medicine recently proposed a new case definition for chronic fatigue syndrome (CFS), as well as a new name, Systemic Exertion Intolerance Disease (SEID). Contrary to the Fukuda et al.’s CFS case definition, there are few exclusionary illnesses specified for this new SEID case definition. The current study explored this decision regarding exclusionary illnesses using the SEID criteria with four distinct data sets involving patients who had been identified as having CFS, as well as healthy controls, community controls, and other illness groups. The findings indicate that many individuals from major depressive disorder illness groups as well as other medical illnesses were categorized as having SEID. The past CFS Fukuda et al. prevalence rate in a community based sample of 0.42 increased by 2.8 times with the new SEID criteria. The consequences for this broadening of the case definition are discussed

Mistaken conclusions about systemic exertion intolerance disease being comparable to research case definitions of CFS: A rebuttal to Chu et al

The recent article by Chu et al. contrasted different case definitions that have been used to describe chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME). In particular, their study compared the new Institute of Medicine (IOM) criteria for systemic exertion intolerance disease (SEID) with three other ME and CFS case definitions. We appreciate these investigators attempting to use and operationalize the new IOM criteria; however, we disagree with their main conclusion that the percentage of patients selected by the IOM criteria is comparable to the percentage selected by other research case definitions. This conclusion could potentially encourage investigators to use the IOM criteria for research purposes. In this commentary, we discuss our observations of the Chu et al. article with respect to their methodology, illustrating how the conclusions of an investigation can be influenced by the manner in which case definitions are operationalized

A Prospective Study of Infectious Mononucleosis in College Students

Background The present study aims to prospectively investigate possible biological and psychological factors present in college students who will go on to develop chronic fatigue syndrome (CFS) following Infectious Mononucleosis (IM). Identification of risk factors predisposing patients towards developing CFS may help to understand the underlying mechanisms and ultimately prevent its occurrence. Our study is enrolling healthy college students over the age of 18. Enrollment began in March of 2013 and is ongoing. Methods Biological and psychological data are collected when students are well (Stage 1), when they develop IM (Stage 2), and approximately 6 months after IM diagnosis (Stage 3). Results Two case studies demonstrate the progression of student symptomology across all three stages. Conclusion The Case Studies presented illustrate the usefulness of a prospective research design that tracks healthy students, following their trajectory of IM illness to either a) full recovery or b) diagnosis with CFS