title: Explaining fatigue in multiple sclerosis: cross-validation of a biopsychosocial model.
abstract: Fatigue is a common and disabling symptom in patients with multiple sclerosis (MS), but its pathogenesis is still poorly understood and consequently evidence-based treatment options are limited. Bol et al. (J Behav Med 33(5):355-363, 2010) suggested a new model, which explains fatigue in MS from a biopsychosocial perspective, including cognitive-behavioral factors. For purposes of generalization to clinical practice, cross-validation of this model in another sample of 218 patients with MS was performed using structural equation modeling. Path analysis indicated a close and adequate global fit (RMSEA = 0.053 and CFI = 0.992). The cross-validated model indicates a significant role for disease severity, depression and a fear-avoidance cycle in explaining MS-related fatigue. Modifiable factors, such as depression and catastrophizing thoughts, propose targets for treatment options. Our findings are in line with recent evidence for the effectiveness of a new generation of cognitive behavioral therapy, including acceptance and mindfulness-based interventions, and provide a theoretical framework for treating fatigue in MS.
authors.affiliation: Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.|Department of Medical Psychology/Academic MS Center Limburg, Zuyderland Medical Center, PO Box 5500, 6130 MB, Sittard-Geleen, The Netherlands.
authors.forename: Melloney L M
authors.initials: ML
authors.lastname: Wijenberg
authors.affiliation: Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.|Department of Medical Psychology/Academic MS Center Limburg, Zuyderland Medical Center, PO Box 5500, 6130 MB, Sittard-Geleen, The Netherlands.
authors.forename: Sven Z
authors.initials: SZ
authors.lastname: Stapert
authors.affiliation: Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Köhler
authors.affiliation: Department of Medical Psychology/Academic MS Center Limburg, Zuyderland Medical Center, PO Box 5500, 6130 MB, Sittard-Geleen, The Netherlands. y.bol@zuyderland.nl.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Bol
mesh_terms: D000328:Adult; D058443:Catastrophization / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology; D006233:Persons with Disabilities / Q000523:psychology*; D005221:Fatigue / Q000209:etiology / Q000523:psychology* / Q000628:therapy*; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009103:Multiple Sclerosis / Q000150:complications / Q000523:psychology*; D057566:Self Report
keywords: Biopsychosocial model; Catastrophizing; Fatigue; Multiple sclerosis; Physical disability; Structural equation modelling