School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
Centre for the Psychology of Learning and Experimental Psychopathology, Department of Psychology, University of Leuven, Leuven, Belgium.
Behav Res Ther. 2018 Jan;100:54-66. doi: 10.1016/j.brat.2017.11.004. Epub 2017 Nov 22.
Chronic fatigue complaints are frequently reported in the general population and fatigue ranks among the most commonly reported symptoms in chronic disease. In contrast to its high prevalence and impact on quality of life, relatively little is understood about the etiology of chronic fatigue. We present a cognitive-behavioral framework, the 'ALT+F' model, that conceptualizes fatigue from an associative learning perspective, and we will evaluate the current evidence for this position. Central to this framework is the notion that interoceptive and exteroceptive stimuli can become associated with the fatigue experience. Consequently, these stimuli may acquire the capacity to elicit fatigue as well as anticipatory fear-related avoidance behavior. We will argue that associative learning processes may contribute to the development of chronic fatigue, fear of fatigue, avoidance of fatigue and activity, and eventually, functional disability. The extent to which associative learning processes give rise to chronic fatigue and fear-related avoidance behavior may depend on a number of risk factors, including perceptual-cognitive biases, sensitization, fatigue catastrophizing, and excessive generalization. The presented framework offers a new window on treatment and intervention options for chronic fatigue.
慢性疲劳在一般人群中经常被报告，并且疲劳是慢性疾病中最常报告的症状之一。与它的高患病率和对生活质量的影响相比，人们对慢性疲劳的病因知之甚少。我们提出了一个认知行为框架，即“ALT+F”模型，从联想学习的角度来概念化疲劳，并将评估这一立场的现有证据。这个框架的核心是这样一种观点，即内感受和外感受刺激可以与疲劳体验相关联。因此，这些刺激可能获得引发疲劳以及与疲劳相关的预期回避行为的能力。我们将认为，联想学习过程可能导致慢性疲劳、对疲劳的恐惧、对疲劳和活动的回避，最终导致功能障碍。联想学习过程引起慢性疲劳和与疲劳相关的回避行为的程度可能取决于许多风险因素，包括感知认知偏见、敏感化、疲劳灾难化和过度泛化。所提出的框架为慢性疲劳的治疗和干预选择提供了一个新的视角。
