Hughes Alicia, Hirsch Colette, Chalder Trudie, Moss-Morris Rona
Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
Department of Psychological Medicine, Weston Education Centre, King's College London, UK.
Br J Health Psychol. 2016 Nov;21(4):741-763. doi: 10.1111/bjhp.12207.
Chronic fatigue syndrome (CFS) is characterized by severe and debilitating fatigue. Studies based on self-report measures suggest negative illness representations, related symptom interpretations, and heightened symptom focusing are maintaining factors of fatigue. This study reviews studies which have investigated these cognitive biases using experimental methods, to (1) review the evidence for information processing biases in CFS; (2) determine the nature of these biases, that is the stages cognitive biases occur and for what type of stimuli; and (3) provide directions for future methodologies in this area.
Studies were included that measured attention and interpretation bias towards negative and illness-related information in people with CFS and in a comparison group of healthy controls. PubMed, Ovid, CINAHL, PsycINFO, Web of Science, and EThOS were searched until December 2014.
The evidence for cognitive biases was dependent on the methodology employed as well as the type and duration of the stimuli presented. Modified Stroop studies found weak evidence of an attentional bias in CFS populations, whereas visual-probe studies consistently found an attentional bias in CFS groups for health-threatening information presented for 500 ms or longer. Interpretative bias studies which required elaborative processing, as opposed to a spontaneous response, found an illness-related interpretive bias in the CFS group compared to controls.
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.
慢性疲劳综合征（CFS）的特征是严重且使人衰弱的疲劳。基于自我报告测量的研究表明，负面的疾病表征、相关症状解释以及对症状的过度关注是疲劳的维持因素。本研究回顾了使用实验方法调查这些认知偏差的研究，以（1）审查CFS中信息加工偏差的证据；（2）确定这些偏差的性质，即认知偏差发生的阶段以及针对何种类型的刺激；（3）为该领域未来的研究方法提供指导。
纳入了测量CFS患者以及健康对照比较组对负面和疾病相关信息的注意力和解释偏差的研究。检索了PubMed、Ovid、CINAHL、PsycINFO、科学引文索引和英国国家论文联合数据库，直至2014年12月。
认知偏差的证据取决于所采用的方法以及所呈现刺激的类型和持续时间。改良的斯特鲁普研究发现CFS人群中注意力偏差的证据较弱，而视觉探测研究一致发现，对于呈现500毫秒或更长时间的健康威胁信息，CFS组存在注意力偏差。与自发反应相反，需要精细加工的解释偏差研究发现，与对照组相比，CFS组存在与疾病相关的解释偏差。
一些CFS患者在关注和解释躯体信息的方式上存在偏差。这种认知加工偏差可能会维持CFS患者的疾病信念和症状。本综述强调了实验设计中的方法学问题，并提出了建议，以帮助未来的研究在认知加工研究中形成一致的方法。贡献声明关于该主题已知的内容有哪些？基于自我报告测量的研究表明，负面的疾病表征、相关症状解释以及对症状的过度关注有助于慢性疲劳的维持。在其他临床人群中，如焦虑、抑郁和慢性疼痛患者的实验研究已经确定了在信息的隐性关注和解释方式上存在特定疾病的偏差，这在这些病症中具有因果作用。本研究增加了什么内容？这是对慢性疲劳综合征（CFS）隐性认知过程的首次综述。持续的注意力和对躯体信息的负面解释可能会强化负面的疾病信念。认知过程在CFS的认知行为模型中发挥作用。
