Explaining fatigue in multiple sclerosis: cross validation of a biopsychosocial model
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.
Journal of Behavioral Medicine