Pust Gesa E A, Randerath Jennifer, Goetzmann Lutz, Weierstall Roland, Korzinski Michael, Gold Stefan M, Dettmers Christian, Ruettner Barbara, Schmidt Roger
Department of Psychology, University of Konstanz, Konstanz, Germany.
Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Front Neurol. 2021 Apr 7;12:652177. doi: 10.3389/fneur.2021.652177. eCollection 2021.
Fatigue in persons with multiple sclerosis (PwMS) is severely disabling. However, the underlying mechanisms remain incompletely understood. Recent research suggests a link to early childhood adversities and psychological trait variables. In line with these studies, this paper took a psychodynamic perspective on MS-fatigue. It was hypothesized that fatigue could represent a manifestation of maladaptive coping with intense emotions. The schema therapeutic mode model served as a theoretical and empirically validated framework, linking psychodynamic theory and empirical research methods. The study was based on a data set of = 571 PwMS that has also served as the basis for another publication. Data was collected online. The Schema Mode Inventory was used to quantify regulatory strategies to cope with emotionally stressful experiences. In addition, depressive symptoms (Beck's Depression Inventory - FastScreen), physical disability (Patient Determined Disease Steps), alexithymia (Toronto Alexithymia Scale-26), adverse childhood experiences (Childhood Trauma Questionnaire), and self-reported fatigue (Fatigue Scale for Motor and Cognitive Functions) were assessed. Latent profile analysis revealed three distinct groups of PwMS, based on their coping mode profiles: (1) PwMS with low maladaptive coping, (2) PwMS with avoidant/submissive coping styles, and (3) PwMS with avoidant/overcompensatory coping styles. Multivariate comparisons showed no significant difference in physical disability across the three groups. However, heightened levels of self-reported fatigue and depression symptoms occurred in PwMS with maladaptive coping styles. A path model uncovered that self-reported fatigue was robustly related to physical disability (β = 0.33) and detached/avoidant coping (Detached Protector; β = 0.34). There was no specific relation between any of the maladaptive coping modes and depression symptoms. Detached/avoidant coping was in turn predicted by childhood emotional abuse and neglect. The results indicate that childhood adversity and detached/avoidant coping styles may be associated with variability in MS-fatigue severity: PwMS that resort to detached/avoidant coping in response to negative emotions also tend to report heightened levels of fatigue, although they do not differ in their perceived disability from PwMS with low levels of fatigue and maladaptive coping. A link between MS-fatigue and the psychodynamic traumatic conversion model is discussed. The implications of these findings for therapeutic interventions require further study.
多发性硬化症患者（PwMS）的疲劳具有严重的致残性。然而，其潜在机制仍未完全明确。近期研究表明，这与儿童早期逆境及心理特质变量有关。与这些研究一致，本文从心理动力学角度探讨了多发性硬化症相关性疲劳。研究假设疲劳可能是对强烈情绪进行适应不良应对的一种表现。图式治疗模式模型作为一个经过理论和实证验证的框架，将心理动力学理论与实证研究方法联系起来。该研究基于一个包含571名PwMS的数据集，该数据集也是另一篇论文的基础。数据通过在线方式收集。使用图式模式量表来量化应对情绪压力经历的调节策略。此外，还评估了抑郁症状（贝克抑郁量表 - 快速筛查版）、身体残疾（患者自评疾病阶段）、述情障碍（多伦多述情障碍量表 - 26项）、童年不良经历（童年创伤问卷）以及自我报告的疲劳（运动和认知功能疲劳量表）。潜在剖面分析基于应对模式剖面揭示了三组不同的PwMS：（1）适应不良应对水平低的PwMS，（2）具有回避/顺从应对方式的PwMS，以及（3）具有回避/过度补偿应对方式的PwMS。多变量比较显示，三组之间在身体残疾方面无显著差异。然而，适应不良应对方式的PwMS自我报告的疲劳和抑郁症状水平更高。一个路径模型发现，自我报告的疲劳与身体残疾（β = 0.33）以及分离/回避应对（分离保护者；β = 0.34）密切相关。任何适应不良应对模式与抑郁症状之间均无特定关联。分离/回避应对又由童年期情感虐待和忽视所预测。结果表明，童年逆境和分离/回避应对方式可能与多发性硬化症相关性疲劳严重程度的差异有关：面对负面情绪时采用分离/回避应对的PwMS也往往报告更高水平的疲劳，尽管他们在感知到的残疾程度上与疲劳水平低且适应不良应对的PwMS并无差异。本文讨论了多发性硬化症相关性疲劳与心理动力学创伤转换模型之间的联系。这些发现对治疗干预的意义需要进一步研究。
