Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Board on the Health of Select Populations Copyright © 2015 National Academy of Sciences. INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Although there was sufficient evidence with which to carry out the first steps of its task, the committee was struck by the relative paucity of research on ME/CFS conducted to date. Remarkably little research fund- ing has been made available to study the etiology, pathophysiology, and effective treatment of this disease, especially given the number of people afflicted. Thus, the committee was unable to define subgroups of patients or even to clearly define the natural history of the disease. More research is essential. Principles of Behaviour Change in Health & Illness Wednesday, 02 September 2015- Symposiums | Go Back Symposium Fatigue and pain in longterm conditions across the life span A Wearden', *, R. Moss-Morris’, T. Chalder*, H. Knoop”, J. Menting* ‘University of Manchester, School of Pyschological Sciences, United Kingdom ?Manchester Centre for Health Psychology, United Kingdom *King’s College London, United Kingdom ‘Kings’ College London, United Kingdom “Expert Centre for Chronic Fatigue, Nimegen, Netherlands Aims The aim of this symposium is to illustrate some of the psychological processes that are related to symptom experience, focusing particularly on fatigue and pain, across a range of long term conditions (diabetes, multiple sclerosis and chronic fatigue syndrome), and in participants at different stages of the life span. Delegates attending the symposium will learn about the cognitions, behaviours and emotional factors that are thought to maintain symptoms of pain and fatigue across conditions, the process of developing a treatment model, and factors which are important in determining the effects of treatment, Rationale This symposium is distinctive in that it demonstrates how symptoms across a range of conditions can be understood in terms of common processes, which can in tum inform treatment models. Summary The symposium starts with a report of a prospective study (Chalder) which shows how cognitive and behavioural factors maintain fatigue in adolescents with chronic fatigue syndrome. The importance of fatigue related cognitions in the perpetuation of severe fatigue in diabetes is picked up in paper 2 (Menting), which also demonstrates the interrelations between pain and fatigue in this condition. Paper 3 (Moss-Morris) reports on the development of a model explaining pain in multiple sclerosis on the basis of cognitive, behavioural and emotional factors, and shows how this model has informed a self-help intervention. Paper 4 (Knoop) focuses on how interpersonal factors, particularly solicitous Tesponding on the part of a significant other, may predict symptomatic response to treatment for fatigue in chronic fatigue syndrome. Finally, paper 5 (Wearden) reports on associations between sleep problems and fatigue in chronic fatigue syndrome, and shows how improvements in sleep partially mediate the effect of treatment on fatigue. Symposium Abstracts Unhelpful cognitive and behavioural responses are associated with symptoms in adolescents with chronic fatigue syndrome T. Chalder’, K. Lievesley’, K. Rimes“ Kings College London, United Kingdom 2King’s College London, United Kingdom Background Using a cognitive behavioural model of chronic fatigue syndrome the objective of this prospective study was to test the hypothesis that cognitive (i.e.symptom focusing, fear avoidance beliefs) and behavioural responses (i.e avoidance of activity, all or nothing behaviours) would be associated with fatigue and physical functioning in CFS participants. Methods Adolescents with CFS (N=85) completed self report measures at time 1 and outcomes of fatigue and physical functioning 8 weeks later (time 2). Findings a Multiple regression analyses revealed that all or nothing behaviour was associated with fatigue and physical functioning at time 2. Negative beliefs about engaging in activity were also associated with physical functioning at time 2. Discussion This prospective study provides some evidence consistent with the hypothesis that cognitive and behavioural factors proposed as maintaining factors in a cognitive behavioural approach to CFS at time 1 were associated with fatigue and physical functioning eight weeks later. These should be specifically targeted in the context of cognitive behaviour therapy. Symposium Abstracts Role of partner and relationship satisfaction in treatment outcome of patients with chronic fatigue syndrome H. Knoop’, J. Verspaandonk‘, M. Coenders’, G. Bleijenberg’, J. Lobbestaef* “Expert Center for Chronic Fatigue, Radboud University Medical Center, Netherlands Institute for Mental Health, Reinier van Arkelgroep, Netherlands ?Faculty of Social and Behavioural Sciences, Utrecht University, Netherlands “Faculty of Clinical Psychological Science, Maastricht University, Netherlands Background Responses of partners of patients with chronic fatigue syndrome (CFS) can influence symptoms. Cognitive behaviour therapy (CBT) leads to a significant decrease of CFS symptoms. Objective of this study was to explore if partner's solicitous responses and patients’ and partners’ relationship satisfaction predicted treatment outcome. Methods Treatment outcome was studied in a cohort of 204 CFS-patients. At baseline, partner's solictous responses, and partners’ and CFS-patients’ relationship satisfaction were assessed. Patients completed pre- and post treatment the Checklist Individual Strength, assessing fatigue, and the ‘Sickness Impact Profile, assessing disability. Logistic regression analyses were conducted with clinical significant improvement on outcome measures as dependent measure and solicitous responses and relationship satisfaction as predictors. Findings More solcitous responses were associated with less clinical significant improvement in fatigue and disability. Partners reported more solicitous responses when they perceived CFS as a more severe condition. Patients’ relationship dissatisfaction was negatively associated with improvement in fatigue. Discussion Partners’ responses and relationship satisfaction affect outcome of CBT. The iliness perceptions of the partner are related to their solicitous responses. These findings have implications for treatment. Symposium Abstracts The relationship between sleep problems and fatigue in chronic fatigue syndrome (CFS) A Wearden', “, S. Kyle’, 4, R. Emsiey', ? {University of Manchester, School of Psychological Sciences, United Kingdom ‘Manchester Centre for Health Psychology, United Kingdom *University of Manchester, Institute of Population Health, United Kingdom Background Sleep symptoms are common in chronic fatigue syndrome (CFS). We aimed to describe sleep symptoms and their relationship to fatigue, and to determine whether improvements in sleep mediated treatment effects on fatigue. Methods 296 adult participants in a randomized controlled trial which compared pragmatic rehabilitation with treatment as usual for CFS completed questionnaire measures of sleep symptoms and fatigue at baseline, end of treatment (20 weeks) and 70 weeks follow up. Findings At baseline, 274 (93%) patients scored within the clinical range for at least one sleep symptom, with 260 (88%) reporting waking unrefreshed. Sleep symptoms and fatigue were weakly correlated (1.192). Regression analyses, controlling for relevant baseline variables and treatment allocation, showed that the beneficial effect of pragmatic rehabilitation on fatigue at follow up was partially mediated (29%) by improvements in sleep at the end of treatment (effect size -0.94, SE= 0.44, P=.034), Discussion Improvements in sleep may be one mechanism by which pragmatic rehabilitation improves fatigue. Future work will test multiple mediation models including sleep and previously described cognitive mediators of pragmatic rehabilitation. Thursday, 03 September 2015 — Oral Presentation Abstracts | Go Back Oral Presentation Abstracts Implicit processing of symptom and illness-related information in chronic fatigue syndrome: a systematic review A. Hughes’, C. Hirsch’, T. Chalder', R. Moss-Morris' ‘King's College London, United Kingdom Background Cognitive behavioural models propose that the way in which people with Chronic Fatigue Syndrome (CFS) process information, specifically how they attend to and interpret illness related information, may play an important role in symptom maintenance. This systematic review investigates whether people with CFS have implicit biases in how they process information. Methods Electronic databases were searched using CFS and experimental methodology search terms. Twelve studies measured attention and interpretative bias for illness related information in CFS. Findings The evidence for implicit biases was dependant on the methodology employed as well as the type and duration of the stimuli presented, There was preliminary evidence to suggest that people with CFS have illness related top down processing biases which affects how information is interpreted and attended to. Discussion A clinical implication of these findings is that such processing biases may maintain negative iliness beliefs and symptoms in people with CFS. This review highlights methodological issues in experimental design and makes recommendations for future research to forge a consistent approach in implicit processing research. Friday, 04 September 2015 ~ Poster Presentation Abstracts s | Go Back Poster Presentation Abstracts Health-threatening interpretation of ambiguity early on: risk or protective factor? Comparing CFS/ME and healthy individuals |. Alexeeva', M. Martin’ ‘University of Oxford, United Kingdom Background A cognitive account of the persistence of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) proposes biased interpretation may distort symptom perception and undermine recovery. Interpretation of somatic information that favours health-threatening meaning may lead to negative and maladaptive iliness cognitions and prolonged suffering. The study aimed to measure an online interpretive bias in CFS/ME, the interpretations made at the moment of encounter of ambiguous information at an early stage of information processing. Methods 33 CFS/ME and 33 healthy matched controls completed a lexical decision task that measured preferences in the interpretation of ambiguity. Findings CFS/ME individuals did not have an interpretive bias towards health-threatening meaning following presentation of ambiguous information F (6, 384) = .662, p = .680, np2 = .010. Heathy participants showed a bias towards Illness prime threat compared with the neutral primes, t (32) = 2.54, p = .016. Discussion The experiment showed an absence of interpretation biases in the early stages of information processing among CFS/ME individuals, but suggested that healthy individuals may be susceptible to the potentially threatening meaning of the ambiguous illness prime. Friday, 04 September 2015 — Poster Presentation Abstracts s | Go Back Poster Presentation Abstracts Attentional bias for health-threat in CFS/ME following depressed mood |. Alexeeva’, M. Martin ‘University of Oxford, United Kingdom ?University of Oxfprd, United Kingdom Background A cognitive account of the persistence of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) proposes amplified attention towards somatic information may distort symptom perception and maintain symptoms. Negative mood may further affect cognitive processing by dwelling on health. threat further amplifying attention to symptoms. The study aims to measure an attentional bias towards health-threat in CFS/ME following a depressed or neutral mood induction. Methods. 16 CFS/ME and 34 healthy and 29 asthma participants completed an attentional task that measured allocation and shifting of attention in response to health-threat or neutral information. Findings CFS group similar to healthy controls, but unlike asthma, is showing an attentional bias towards healththreat F (2, 61) = 4.06, p = .022, np2 = .118. Against the prediction, the negative mood appears to decrease the magnitude of the attentional bias in CFS participants. Discussion Attentional bias manifests under the higher mental load for CFS/ME and healthy individuals, but not for asthma. Depressed mood decreases the bias, against the expectation that it would ampiffy the focus on somatic symptoms.