Significant others and patient symptom maintenance in CFS/ME Seminar

Cognitive-behavioural models propose that several factors interact to perpetuate and maintain Chronic Fatigue Syndrome (CFS/ME), including social factors. A review of the previous empirical evidence suggested the presence of at least two potential interpersonal processes; we propose the significant other beliefs and responses, dyadic relationship quality, and patient outcomes associated with each mechanism are different. Expressed Emotion (EE) is a well-validated, methodological and theoretical framework for understanding the impact of normal family experiences in adjustment to illness. In a study of 55 dyads, we focussed on two key constructs, criticism and emotional over-involvement (EOI), as key predictors of patient outcome in with the proposed interpersonal processes. Longitudinally, significant other criticism predicted greater fatigue severity; further analyses indicated that depression mediated this relationship. High EOI was also predictive of greater fatigue severity at follow-up.

Significant other illness models were important in contributing to the development of high-EE, particularly negative beliefs about the consequences associated with the condition, and negative emotional representations. 50% of the significant other sample reported significant (caseness) levels of distress. The results suggest that significant other focussed interventions may be beneficial for both patient and significant other outcomes.