There Chronic effort syndrome (Chronic Fatigue Syndrome, CFS) is a complex pathological condition characterized by prolonged, persistent and disabling tiredness and other non -specific symptoms, with negative and restrictive consequences on physical and psychological functioning.
It must be present for at least 6 months, with a course not necessarily permanent, but with a defined debut (Sharpe et al., 1991). There is currently no tool that allows to evaluate the presence of the syndrome. For this reason, it is a diagnosis that is made mainly by the exclusion of other psychopathologies.
Even if the Chronic effort syndrome And depression can appear in some respects as superimposable, the research suggested that the first has distinct cognitive characteristics (Moss-Morris & Petrie, 2001).
However, research has also discovered that anxiety, depression and transient negative affectivity are significantly associated with the aggravation of tiredness in Chronic effort syndrome (Sohl & Friedberg, 2008).
Currently, no specific biological etiology has been identified for the CFS and can thus be considered within the spectrum of clinically inexplicable symptoms.
A large number of studies have focused on cognitive processes involved in this syndrome. Some of these have found in patients with Chronic effort syndrome An association between the self-refined tendency to focus on symptoms and disability related to the disease (Ray, Jefferies, and Weir, 1995, 1997; Varcoulen et al., 1998).
In addition, recent studies have supported the hypothesis that the CFS can be characterized by a persevering and dysfunctional thought process associated with the CAS (Cognitive Attentional Syndrome).
In fact, there would be an interpretative bias in the processing of somatic information (Moss-Morris & Petrie, 2003), high levels of mullionedlist to health related to health threats (Rancarwal, McBeth, Zakrzewska, Lunt, & Macfarlane, 2006).
Finally, in patients with Chronic effort syndrome Attentive bias would be present in the elaboration of threatening stimuli for health (Hou, Moss-Morris, Bradley, Peveler, and Mogg, 2008). These discoveries were useful to explain the crucial role of cognitive and attentive processes implicated in Chronic effort syndrome; However, the beliefs through which these processes are influenced must still be specified.
Two types of metacognitive beliefs have been hypothesized useful for predicting the severity of chronic effort symptoms and compromise in physical functioning (Maher -Edwards, Fernie, Murphy, Wells, & Spada, 2011):
- beliefs about the need to control thoughts, which could contribute to the maintenance of persistent and negative interpretations about the symptoms and activation of maladative coping strategies (e.g. rumination, suppression of thought and mobble) that would contribute to cognitive overload, executive disability and feelings of mental and psychological effort;
- beliefs about the lack of trust in cognitive competence, which would contribute to the seriousness of the symptoms, limiting the choice and implementation of adaptive coping strategies.
Starting from these discoveries, several studies have dealt with the main cognitive-behavioral imprint treatments, potentially implicated in the treatment of CFS.
The main ones are the cognitive-behavioral therapy model (CBT) and the therapy model based on the execution of gradual physical exercises (GET). The CBT model deals with the factors that can prepare (e.g. Perfectionism), trigger (e.g. viruses, stress and/or trauma) and maintain (e.g. stress, negative emotions, or models of all-nulla) the symptoms in the Chronic effort syndrome.
Changes in avoidance behaviors and related beliefs are associated with a good outcome in the CBT (Deale, Charder and Wessely, 1998).
The Get model for the CFS is based on the concept of deconditioning. After exposure to an initial trigger to the CFS (e.g. a viral infection), the maladative responses of coping (e.g. sleeping to restore) are deconditated.
Patients are encouraged to establish a “baseline exercise” (for a duration of the year that does not lead to exacerbate the symptoms) and gradually increase the duration and then the intensity.
The mechanism of change in the GET is based on the modification of the interpretation about the somatic sensations (Moss-Morris, Sharon, Tobin and Baldi, 2005). Randomized controlled trials (RCT) have shown the evidence of effectiveness of these treatments (Moss-Morris et al., 2005; Prins et al., 2001).
Recent research (Fernie, Murphy, Wells, Nikcevic & Spada, 2016) has made it possible to compare these two Treatments for chronic effort syndrome Considered more effective in clinical practice, the CBT (Cognitive Behavioral Therapy) and the GET (Graded Except Therapy), based on the discoveries of the Pace Trial (White et al., 2011).
They also provided the evidence of the effectiveness of these treatments, which seem to reduce fatigue, anxiety, depression, as well as increasing physical functioning.
Previous studies had already shown how to support the Cognitive behavioral therapy (CBT) and the execution of gradual physical exercises (GET) to specialist medical care (therapies based on antidepressants and non -steroidal anti -inflammatory drugs with low dosage, SMC) a recovery of chronic tired symptoms was obtained three times higher than SMC therapy only (Sharpe et al., 2015).
The 2016 study by Fernie et al. He also examined whether the metacognitive change, measured with the Metacognitions Questionnaire-30 (MCQ-30), could be considered a significant predictor of the outcome of the treatment.
However, while it is possible that the hypothesized meta-inredments were indirectly addressed in the CBT, it is unlikely that they were in the GET (Wells, 2011).
Negative beliefs about the thoughts of uncontrollability and danger could lead to negative assessments of cognitive experiences, such as to activate perseverative thought processes (e.g. mobble) and physical changes capable of altering perceived physical effort and beneficial properties of rest, as well as contributing to mental fatigue.
Otherwise, the relationship between these beliefs and the changes in the severity of fatigue could reflect a decrease in the brooding and in the symptoms of concern, variables that seem to mediate the outcome outcome in the GET (Moss-Morris et al., 2005).
Meta-food relative to cognitive incompetence could reflect the cognitive difficulties reported by the subjects with Chronic effort syndrome. Improvements in these cognitive factors could be due to the reduction of the effort itself and the consequent improvement of executive functions such as concentration and memory.
On the other hand, the negative meta-redescences on the cognitive trust of patients may involve an inhibition of coping strategies when fatigued.
Despite these considerations, further studies are needed to investigate the role of metacognitive beliefs in the gravity levels of the Chronic effort syndrome and the predictive effect they have, net of other variables considered. In other research, other mediators were considered implicated in therapeutic change.
In particular, the modification of beliefs relating to the progress of fear (e.g. the fear that exercise or physical activity could worsen the symptoms and the consequent avoidance of physical activity) and the hyper-focalization on fatigue, were considered important to predict the outcome of the treatment (Charder, Goldsmith, White, Sharpe and Pickles, 2015).
In conclusion, both CBT and GET (Fernie et al., 2016) have met high levels of satisfaction by patients, which suggests that these treatments are well accepted despite the disputes to which they are sometimes associated in the randomized controlled studies.
Finally, these studies suggest the importance of the search for specific metacognitive factors that could be implicated in the CFS and determine an in -depth analysis of this condition, also from a therapeutic point of view.
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