Do patients with chronic fatigue syndrome have impairments in coping?

A study published in the current issue of Psychotherapy and Psychosomatics examined the coping skills in a population of patients with chronic fatigue syndrome(CFS). CFS is a common and debilitating illness. As yet the pathophysiology of CFS remains inchoate, so pharmacologic management aims to alleviate symptoms and is not curative. Cognitive-behavioral therapy and graded exercise therapy appear to be the most effective treatments for CFS. In this current population based study, a group of investigators examined coping styles in CFS and how these are affected by depression and anxiety. Study participants were identified during a survey of unwellness in metropolitan, urban, and rural populations of Georgia. To identify medical conditions considered exclusionary for CFS, participants completed past medical history questionnaires underwent a standardized physical examination, and provided blood and urine specimens for routine clinical laboratory screening. To identify exclusionary psychiatric conditions, participants completed the SCID, a standardized interview. Researchers diagnosed CFS as recommended by the International CFS Study Group. Well controls had no medical or psychiatric conditions considered exclusionary for CFS. 113 CFS suffers and 124 ‘well’ controls were included in the analyses. The Ways of Coping Questionnaire (WCQ) to measure coping styles was used . Self-Rating Depression Scale was used to quantify depressive symptoms, based on 20 items. Anxiety was assessed using the State Anxiety Inventory that provides a continuous score based on 20 items. Demographic features were similar among participants with CFS and well controls. The two groups differed significantly regarding depressive symptoms (p<0.001) and anxiety (p<0.001).

Coping strategies also differed significantly between the two groups. A multivariate analysis indicated an overall difference (p<0.001). Relative to the well group, those with CFS had statistically significantly higher mean scores in the escape-avoidance, confrontive, distancing, self-controlling, and accepting responsibility coping styles. All differences remained significant after controlling for age, sex, race, and education level. Effect sizes were of medium strength for those coping styles that differed significantly, with distancing being the exception. Several other studies have documented dysfunctional or maladaptive coping styles in CFS. In accordance with a previous study, escape-avoidance emerged as the most prominent coping style in CFS. People utilizing this coping style incorporated behavioral efforts to escape or avoid a specific problem. Further, confrontive coping, which was also used more often in CFS, is characterized by aggressive efforts to alter a stressful situation (‘I expressed anger to the person who caused the problem’). High scores in selfcontrolling coping indicate increased efforts to regulate an individual’s emotions (‘I tried to keep my feelings to myself’), and, finally, high scores in accepting responsibility indicate that someone acknowledges his or her own role in the problem (‘I criticized or lectured myself’). As these coping styles are not inherently negative, it can be assumed that they can turn maladaptive when predominantly used in solving everyday problems. Finally, the question arises of whether coping patterns found in CFS are similar to other chronic illnesses. Although some studies indicate that this might not be the case, future studies should ascertain whether coping styles found in this study are specific for CFS or not. Importantly, researchers found that discrepancies between the two groups could not be explained by the presence of depressive symptoms or anxiety, despite of high levels of psychopathology in individuals with CFS.

These findings have important consequences for treatment strategies in CFS. Interventions such as cognitive-behavioral therapy and graded exercise therapy aim at improving adaptive coping capabilities. These treatment approaches will most likely be successful without taking concomitant psychopathology into account. Future studies should now incorporate longitudinal designs in order to determine causal pathways between coping and illness.

Full bibliographic information


Urs M. Nater , Elizabeth Maloney , Jin-Mann S. Lin, Christine Heim, William C. Reeves. Coping Styles in Chronic Fatigue Syndrome: Findings from a Population-Based Study. Psychother Psychosom 2012;81:127–129

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