title: The central role of cognitive processes in the perpetuation of chronic fatigue syndrome.
abstract: OBJECTIVE
  Chronic fatigue syndrome (CFS) is considered to be one of the functional somatic syndromes (FSS). Cognitions and behavior are thought to perpetuate the symptoms of CFS. Behavioral interventions based on the existing models of perpetuating factors are quite successful in reducing fatigue and disabilities. The evidence is reviewed that cognitive processes, particularly those that determine the perception of fatigue and its effect on behavior, play a central role in the maintenance of symptoms.
  
  
  METHODS
  Narrative review.
  
  
  RESULTS
  Findings from treatment studies suggest that cognitive factors mediate the positive effect of behavioral interventions on fatigue. Increased fitness or increased physical activity does not seem to mediate the treatment response. Additional evidence for the role of cognitive processes is found in studies comparing the subjective beliefs patients have of their functioning with their actual performance and in neurobiological research.
  
  
  CONCLUSIONS
  Three different cognitive processes may play a role in the perpetuation of CFS symptoms. The first is a general cognitive representation in which fatigue is perceived as something negative and aversive and CFS is seen as an illness that is difficult to influence. The second process involved is the focusing on fatigue. The third element is formed by specific dysfunctional beliefs about activity and fatigue.
authors.affiliation: Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands. j.knoop@nkcv.umcn.nl
authors.forename: Hans
authors.initials: H
authors.lastname: Knoop
authors.forename: Judith B
authors.initials: JB
authors.lastname: Prins
authors.forename: Rona
authors.initials: R
authors.lastname: Moss-Morris
authors.forename: Gijs
authors.initials: G
authors.lastname: Bleijenberg
mesh_terms: D001294:Attitude to Health; D001521:Behavior Therapy; D003071:Cognition; D015673:Fatigue Syndrome, Chronic / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D006801:Humans; D010465:Perception; D016896:Treatment Outcome