Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Amsterdam Public Health, Global Health, Amsterdam, The Netherlands.
Int J Behav Med. 2023 Aug;30(4):473-485. doi: 10.1007/s12529-022-10111-8. Epub 2022 Jul 22.
Cognitive behavioral therapy (CBT) is an evidence-based intervention for severe fatigue. Changes in patients' fatigue scores following CBT might reflect not only the intended relief in fatigue but also response shift, a change in the meaning of patients' self-evaluation. Objectives were to (1) identify the occurrence of response shift in patients undergoing CBT, (2) determine the impact of response shift on the intervention effect, and (3) investigate whether changes in fatigue-related cognitions and perceptions, targeted during CBT, are associated with response shift.
Data of three randomized controlled trials testing the efficacy of CBT in individuals with chronic fatigue syndrome (CFS, n = 222), cancer (n = 123), and diabetes (n = 107) were re-analyzed. Fatigue severity was measured with 8 items from the Checklist Individual Strength, a valid and widely used self-report questionnaire. Structural equation modelling was applied to assess lack of longitudinal measurement invariance, as indication of response shift.
As expected, in all three trials, response shift was indicated in the CBT groups, not the control groups. Response shift through reprioritization was indicated for the items "Physically, I feel exhausted" (CFS) and "I tire easily" (cancer, diabetes), which became less vs. more important to the measurement of fatigue, respectively. However, this did not affect the intervention effects. Some changes in cognitions and perceptions were associated with the response shifts.
CBT seems to induce response shift through reprioritization across patient groups, but its occurrence does not affect the intervention effect. Future research should corroborate these findings and investigate whether patients indeed change their understanding of fatigue.
认知行为疗法（CBT）是一种针对严重疲劳的循证干预措施。CBT 后患者疲劳评分的变化不仅反映了疲劳的预期缓解，还反映了反应转移，即患者自我评估的意义发生了变化。目的是：（1）确定接受 CBT 的患者是否存在反应转移；（2）确定反应转移对干预效果的影响；（3）调查 CBT 中针对疲劳相关认知和感知的改变是否与反应转移有关。
重新分析了三项随机对照试验的数据，这些试验测试了 CBT 对慢性疲劳综合征（CFS，n=222）、癌症（n=123）和糖尿病（n=107）患者的疗效。疲劳严重程度采用 Checklist Individual Strength 的 8 项进行测量，该量表是一种有效且广泛使用的自评问卷。结构方程模型用于评估缺乏纵向测量不变性，这是反应转移的指标。
正如预期的那样，在所有三项试验中，CBT 组均存在反应转移，而对照组则没有。通过重新优先排序表明存在反应转移，对于“生理上，我感到筋疲力尽”（CFS）和“我很容易疲劳”（癌症、糖尿病）这两个项目，它们对疲劳测量的重要性分别降低和增加。然而，这并没有影响干预效果。认知和感知的一些变化与反应转移有关。
CBT 似乎通过重新优先排序在患者群体中引起反应转移，但它的发生并不影响干预效果。未来的研究应证实这些发现，并研究患者是否确实改变了他们对疲劳的理解。
