Original article
Attentional bias towards health-threat information in chronic fatigue syndrome

https://doi.org/10.1016/j.jpsychores.2008.03.008Get rights and content

Abstract

Objective

To investigate whether individuals with chronic fatigue syndrome (CFS) show an attentional bias towards health-threat information.

Methods

Attentional bias (AB) was assessed in individuals with CFS and healthy controls using a visual probe task which presented health-threat and neutral words and pictures for 500 ms. Self-report questionnaires were used to assess CFS symptoms, depression, anxiety, and social desirability.

Results

Compared to a healthy control group, the CFS group showed an enhanced AB towards heath-threat stimuli relative to neutral stimuli. The AB was not influenced by the type of stimulus (pictures vs. words).

Conclusion

The finding of an AB towards health-threat information in individuals with CFS is supportive of models of CFS which underlie cognitive behavior therapy.

Introduction

Chronic fatigue syndrome (CFS) is characterized by debilitating and unexplained fatigue lasting at least 6 months, associated with profound impairment in daily functioning [1]. Recent cognitive-behavioral models of CFS, which provide the basis for effective cognitive behavior therapy [2], suggest that individuals with CFS have specific underlying cognitions (e.g., negative illness beliefs and biased interpretations of symptoms) which are important in both the onset and perpetuation of CFS [3], [4], [5], [6]. Most research into cognitive biases in CFS has relied on self-report measures. Consequently, the focus has been on the content of cognitions or beliefs rather than on processes which develop or maintain them. Processes such as an attentional bias (AB) to illness-related information may be particularly important in maintaining CFS because, if an individual selectively focuses attention on information related to potential health threats, this may amplify their subjective experience of ill-health out of their conscious awareness.

Any situation or factor that may represent a danger to the health of people is defined as a health threat [7]. High levels of self-reported health worry and preoccupation with health threats are common in CFS [8]. However, the evidence that CFS is associated with a processing bias for health threat-related information is mixed and limited; for example, evidence has been found for a negative bias in the interpretation of ambiguous health threat-related information, but not an AB [9]. However, AB has so far only been assessed using a modified Stroop task which assesses the distracting effect of task-irrelevant threat information. The aim of this preliminary study was to investigate whether individuals with CFS show an AB for health-threat information using a visual probe task, which has been widely used to assess AB for threat information in other conditions, such as anxiety and chronic pain [10], [11], [12]. The task presents pairs of stimuli (e.g., a threat and neutral picture), and one item of each stimulus pair is replaced by a probe (e.g., an arrow). Reaction times (RTs) to probes provide a measure of AB (as RTs are faster to probes which appear in attended spatial locations). We hypothesized that individuals with CFS would show an enhanced AB for health-threat information, relative to controls, and that this bias would be found across different stimulus types (words and pictures).

Section snippets

Participants

Fourteen participants with CFS were recruited from a local CFS/myalgic encephalomyelitis (ME) support group. All participants had a diagnosis of CFS from their general practitioners and met the Centers for Disease Control and Prevention diagnostic criteria [1]. Eighteen healthy controls with similar demographic characteristics were recruited through the University of Southampton and the community. Control participants had no history of CFS, and no current acute or chronic illnesses. One control

Group characteristics

The groups did not differ significantly in age, gender [X2(1)=0.20, P=.66], education status [university vs. non-university: X2(1)=1.47, P=.23], or employment status [employed vs. not working: X2(1)=1.29, P=.26]. The CFS group had significantly higher PFRS and HADS-depression scores than controls (see Table 1). There were no significant group differences in HADS-anxiety or SDS scores.

Visual probe task

CFS and control groups did not differ significantly in error rate (1% of trials) or amount of data excluded due

Discussion

This is the first study to demonstrate an AB towards health-threat stimuli in individuals with CFS using a visual probe task. In support of our hypothesis, this study found an AB towards both pictorial and linguistic health-threat stimuli in individuals with CFS, which was not evident in healthy controls. A bias in selective attention to health-threat information may lead to greater preoccupation with illness and thus perpetuate feelings of ill-health [17]. This may lead to greater disability,

Acknowledgments

The authors wish to thank Kathleen James for recruiting participants and conducting tests for this study.

References (17)

There are more references available in the full text version of this article.

Cited by (30)

  • Attending away from the body predicts increased physical symptom reports at six months in primary care patients

    2018, Journal of Psychosomatic Research
    Citation Excerpt :

    Consistent with this, evidence suggests that somatic symptom reports are associated with reduced interoceptive accuracy in patients with somatoform disorders (e.g., 68). Nevertheless, other studies suggest that increased engagement with and/or decreased disengagement from illness stimuli are also associated with MUS and symptom reporting [37–39, 48, 53], pointing to a complex role for attentional factors in these phenomena and the likelihood that a range of treatment strategies will be required [66]. We found no longitudinal relationships between tactile threshold, symptom reporting, health anxiety or healthcare utilization.

  • Greater specificity of activity memories in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: Implications for exercise-based treatment

    2018, Mental Health and Physical Activity
    Citation Excerpt :

    Increased attentional focus on somatic symptoms like fatigue and pain may lead to perception of increased severity of these symptoms following exertion, resulting in reduction of activity (Knoop et al., 2010). The evidence in CFS/ME so far points towards selective attention to health-threat and illness-related interpretation of ambiguous information at the later higher-level information-processing stages of elaboration, reflection and conscious effort (Hou, Moss-Morris, Bradley, Peveler, & Mogg, 2008; Hou et al., 2014; Hughes, Chalder, Hirsch, & Moss-Morris, 2017a; Hughes, Hirsch, Chalder, & Moss-Morris, 2016b; Hughes, et al., 2017b; Moss-Morris & Petrie, 2003) as opposed to the early preconscious stages of processing, where more automatic, quick orientation of attention and initial interpretation of novel information may be taking place (Martin & Alexeeva, 2010). This evidence implies that top-down processing may be taking place, where attentional focus and interpretation of somatic sensations, symptoms, and illness are directed by a higher-level negative illness schema, and that the information is filtered through this schema.

  • Symptoms and the body: Taking the inferential leap

    2017, Neuroscience and Biobehavioral Reviews
  • Attention processes in chronic fatigue syndrome: Attentional bias for health-related threat and the role of attentional control

    2014, Behaviour Research and Therapy
    Citation Excerpt :

    Using the modified Stroop task, Moss-Morris and Petrie (2003) failed to find an attentional bias for somatic words (e.g., sick, dizzy) in CFS individuals. In contrast, Hou, Moss-Morris, Bradley, Peveler, and Mogg (2008), using the VPT, demonstrated an attentional bias towards health-threat stimuli (words and pictures) in individuals with CFS compared to healthy controls. However, this study used a relatively small sample size (14 participants with CFS) and attentional bias was only assessed at a single duration (500 ms).

  • Chronic fatigue syndrome

    2013, Handbook of Clinical Neurology
    Citation Excerpt :

    For instance, when compared to other patient groups with illnesses such as rheumatoid arthritis and heart disease, CFS patients have stronger beliefs that the illness is largely physical in origin and has very serious consequences (Moss-Morris et al., 2002; Moss-Morris and Chalder, 2003). CFS patients also tend to be hypervigilant to illness and symptom information (Hou et al., 2008). They are often fearful of the aftermath of overactivity, which is reflected in two characteristic ways of coping with the illness including a passive disengagement response or an all-or-nothing erratic pattern of behavior.

View all citing articles on Scopus
View full text