Medically unexplained syndromes (MUS) are both prevalent and disabling. While illness beliefs and behaviors are thought to maintain MUS-related disability, little is known about which specific behavioral responses to MUS are related to disability or the way in which beliefs and behaviors interact to impact functioning. The purpose of the present study was to examine the relationship between illness beliefs and disability among patients with MUS, and assess the extent to which behaviors mediate this relationship.
The study examined data from the baseline assessment of a multi-site randomized controlled trial (RCT). Participants were 248 veterans with MUS. Illness beliefs, behavioral responses to illness, and disability were assessed through self-report questionnaire. Data were analyzed using mediation analysis.
Threat-related beliefs predicted greater disability through decreased activity and increased practical support seeking. Protective beliefs predicted less disability through reductions in all-or-nothing behavior and limiting behavior.
These outcomes suggest that all-or-nothing behavior, limiting behavior, and practical support seeking are important in the perpetuation of disability among those with MUS. This has implications for improving MUS treatment by highlighting potential treatment targets.
ClinicalTrials.gov Identifier: NCT02161133
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Haller H, Cramer H, Lauche R, Dobos G. Somatoform disorders and medically unexplained symptoms in primary care: a systematic review and meta-analysis of prevalence. Dtsch Arztebl Int. 2015;112:279–87. https://doi.org/10.3238/arztebl.2015.0279.
Deary V, Chalder T, Sharpe M. The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clin Psychol Rev. 2006;27(7):781–97. https://doi.org/10.1016/j.cpr.2007.07.002.
van Dessel N, den Boeft M, van der Wouden JC, Kleinstäuber M, Leone SS, Terluin B, et al. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev. 2014;11:CD011142. https://doi.org/10.1002/14651858.CD011142.pub2.
Sumathipala A. What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies. Psychosom Med. 2007;69:889–900. https://doi.org/10.1097/PSY.0b013e31815b5cf6.
Geraghty KJ, Blease C. Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: a narrative review on efficacy and informed consent. J Health Psychol. 2018;23(1):127–38. https://doi.org/10.1177/1359105316667798.
Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2017;4:CD003200. https://doi.org/10.1002/14651858.CD003200.pub7.
Donta ST, Clauw DJ, Engel CC, et al. Cognitive behavioral therapy and aerobic exercise for Gulf War Veterans’ Illnesses: a randomized controlled trial. JAMA. 2003;289(11):1396–404.
Geraghty KJ, Hann M, Kurtev S. Myalgic encephalomyelitis/chronic fatigue syndrome patients’ reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: analysis of a primary survey compared with secondary surveys. J Health Psychol. 2017;24:1–16. https://doi.org/10.1177/1359105317726152.
Geraghty KJ. ‘PACE-Gate’: when clinical trial evidence meets open data access. J Health Psychol. 2017;22(9):1106–12. https://doi.org/10.1177/1359105316675213.
Mitchell AJ. Controversy over exercise therapy for chronic fatigue syndrome: key lessons for clinicians and academics. BJPsych Adv. 2017;23:145–8. https://doi.org/10.1192/apt.bp.116.016261.
Spence M, Moss-Morris R, Chalder T. The Behavioural Responses to Illness Questionnaire (BRIQ): a new predictive measure of medically unexplained symptoms following acute infection. Psychol Med. 2005;35:583–93. https://doi.org/10.1017/S0033291704003484.
Moss-Morris R, Spence MJ, Hou R. The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map? Psychol Med. 2011;41(5):1099–107. https://doi.org/10.1017/S003329171000139X.
Spence MJ, Moss-Morris R. The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis. Gut. 2007;56(8):1066–71. https://doi.org/10.1136/gut.2006.108811.
Nater UM, Wagner D, Solomon L, et al. Coping styles in people with chronic fatigue syndrome identified from the general population of Wichita KS. J Psychosom Res. 2006;60(6):567–73. https://doi.org/10.1016/j.jpsychores.2006.04.001.
Martin A, Rief W. Relevance of cognitive and behavioral factors in medically unexplained syndromes and somatoform disorders. Psychiatr Clin N Am. 2011;34(3):565–78. https://doi.org/10.1016/j.psc.2011.05.007.
Skerrett TN, Moss-Morris R. Fatigue and social impairment in multiple sclerosis: the role of patients’ cognitive and behavioral responses to their symptoms. J Psychosom Res. 2006;61:587–93.
Kindermans HPJ, Roelofs J, Goossens MEJB, Huijnen IPJ, Verbunt JA, Vlaeyen NWS. Activity patterns in chronic pain: underlying dimensions and associations with disability and depressed mood. J Pain. 2011;12(10):1049–58.
Leventhal H, Meyer D, Nerenz D. The common sense representation of illness danger. In: Rachman SJ, editor. Contributions to medical psychology. New York: Pergamon; 1980. p. 7–30.
Hagger M, Orbell S. A meta-analytic review of the common-sense model of illness representations. Psychol Health. 2003;18(2):141–84. https://doi.org/10.1080/088704403100081321.
Moss-Morris R, Petrie KJ, Weinman J. Functioning in chronic fatigue syndrome: do illness perceptions play a regulatory role? Br J Health Psychol. 1996;1(1):15–25. https://doi.org/10.1111/j.2044-8287.1996.tb00488.x.
Rutter CL, Rutter DR. Longitudinal analysis of the illness representation model in patients with irritable bowel syndrome (IBS). J Health Psychol. 2007;12(1):141–8. https://doi.org/10.1177/1359105307071748.
Van Der Have M, Brakenhoff L, Van Erp S, et al. Back/joint pain, illness perceptions and coping are important predictors of quality of life and work productivity in patients with inflammatory bowel disease: a 12-month longitudinal study. J Crohn's Colitis. 2015;9(3):276–83. https://doi.org/10.1093/ecco-jcc/jju025.
McAndrew LM, Crede M, Maestro K, Slotkin S, Kimber J, Phillips LA. Using the common-sense model to understand health outcomes for medically unexplained symptoms: a meta-analysis. Health Psychol Rev. 2018:1–20. https://doi.org/10.1080/17437199.2018.1521730.
Dorrian A, Dempster M, Adair P. Adjustment to inflammatory bowel disease: the relative influence of illness perceptions and coping. Inflamm Bowel Dis. 2008;15(1):47–55. https://doi.org/10.1002/ibd.20583.
Heijmans M. Coping and adaptive outcome in chronic fatigue syndrome: importance of illness cognitions. J Psychosom Res. 1998;45(1):39–51. https://doi.org/10.1016/S0022-3999(97)00265-1.
Heijmans M. The role of patients’ illness representations in coping and functioning with Addison’s disease. Br J Health Psychol. 1999;4(2):137–49. https://doi.org/10.1348/135910799168533.
Knoop H, Prins JB, Moss-Morris R, Bleijenberg G. The central role of cognitive processes in the perpetuation of chronic fatigue syndrome. J Psychosom Res. 2010;68(5):489–95. https://doi.org/10.1016/j.jpsychores.2010.01.022.
Rutter CL, Rutter DR. Illness representation, coping and outcome in irritable bowel syndrome (IBS). Br J Health Psychol. 2002;7(4):377–91. https://doi.org/10.1348/135910702320645372.
Stanculete MF, Matu S, Pojoga C, Dumitrascu DL. Coping strategies and irrational beliefs as mediators of the health-related quality of life impairments in irritable bowel syndrome. J Gastrointestin Liver Dis. 2015;24(2):159–64. https://doi.org/10.15403/jgld.2014.1121.242.strt.
Dursa E, Barth S, Porter B, Schneiderman A. Gulf War Illness in the 1991 Gulf war and Gulf era veteran population: an application of the centers for disease control and prevention and Kansas case definitions to historical data. J Mil Veterans Health. 2018;26(2):43–50.
Üstün TB, Kostanjsek N, Chatterji S, Rehm J. Measuring health and disability: manual for WHO disability assessment schedule WHODAS 2.0. World Health Organization; 2010.
Steele L. Prevalence and patterns of Gulf War Illness in Kansas veterans: association of symptoms with characteristics of person, place, and time of military service. Am J Epidemiol. 2000;152(10):992–1002.
Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The Revised Illness Perception Questionnaire (IPQ-R). Psychol Health. 2002;17(1):1–16. https://doi.org/10.1080/08870440290001494.
Hayes AF. In: Kenny DA, Little TD, editors. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: The Guilford Press; 2018.
Hayes AF. PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling. [White paper]. 2012. Retrieved from http://www.afhayes.com/public/process2012.pdf. Accessed 12 Sept 2018.
Deale A, Chalder T, Wessely S. Illness beliefs and treatment outcome in chronic fatigue syndrome. J Psychosom Res. 1998;45(1):77–83. https://doi.org/10.1016/S0022-3999(98)00021-X.
Gask L, Dowrick C, Salmon P, Peters S, Morriss R. Reattribution reconsidered: narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings. J Psychosom Res. 2011;71(5):325–34. https://doi.org/10.1016/j.jpsychores.2011.05.008.
Zundel CG, Krengel MH, Heeren T, Yee MK, Grasso CM, Janulewicz Lloyd PA, et al. Rates of chronic medical conditions in 1991 Gulf War Veterans compared to the general population. Int J Environ Res Public Health. 2019;16:949. https://doi.org/10.3390/ijerph16060949.
Nettleman M. Gulf War Illness: challenges persist. Trans Am Clin Climatol Assoc. 2015;126:237–47.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
This work was supported by Merit Review Award #I01CX001053 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development, and a Career Development Award # IK2HX001369 from VA Health Services Research and Development Program. It was also supported by the VA NJ War Related Illness and Injury Study Center and VA Office of Academic Affiliation. ClinicalTrials.gov Identifier: NCT02161133.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Sullivan, N., Phillips, L.A., Pigeon, W.R. et al. Coping with Medically Unexplained Physical Symptoms: the Role of Illness Beliefs and Behaviors. Int.J. Behav. Med. 26, 665–672 (2019). https://doi.org/10.1007/s12529-019-09817-z
- Illness beliefs
- Illness behaviors