Deale A, Chalder T, Wessely S
Department of Psychological Medicine, Kings College Hospital, and Institute of Psychiatry, London, UK.
J Psychosom Res. 1998 Jul;45(1):77-83. doi: 10.1016/s0022-3999(98)00021-x.
Longitudinal studies have shown that physical illness attributions are associated with poor prognosis in chronic fatigue syndrome (CFS). Speculation exists over whether such attributions influence treatment outcome. This study reports the effect of illness beliefs on outcome in a randomized controlled trial of cognitive-behavior therapy versus relaxation. Causal attributions and beliefs about exercise, activity, and rest were recorded before and after treatment in 60 CFS patients recruited to the trial. Physical illness attributions were widespread, did not change with treatment, and were not associated with poor outcome in either the cognitive-behavior therapy group or the control group. Beliefs about avoidance of exercise and activity changed in the cognitive behavior therapy group, but not in the control group. This change was associated with improved outcome. These findings suggest that physical illness attributions are less important in determining outcome (at least in treatment studies) than has been previously thought. In this study, good outcome is associated with change in avoidance behavior, and related beliefs, rather than causal attributions.
纵向研究表明，在慢性疲劳综合征（CFS）中，对身体疾病的归因与预后不良有关。对于此类归因是否会影响治疗结果，人们存在猜测。本研究报告了在一项认知行为疗法与放松疗法的随机对照试验中，疾病信念对治疗结果的影响。在该试验招募的60名CFS患者中，记录了治疗前后对运动、活动和休息的因果归因及信念。对身体疾病的归因很普遍，不会随治疗而改变，并且在认知行为疗法组或对照组中均与不良预后无关。认知行为疗法组中关于避免运动和活动的信念发生了改变，但对照组未改变。这一变化与治疗结果改善相关。这些发现表明，在决定治疗结果方面（至少在治疗研究中），对身体疾病的归因没有之前认为的那么重要。在本研究中，良好的治疗结果与回避行为及相关信念的改变有关，而非与因果归因有关。
