The relation between cognitive-behavioural responses to symptoms in patients with long term medical conditions and the outcome of cognitive behavioural therapy for fatigue - A secondary analysis of four RCTs.

BACKGROUND: Cognitive behavioural therapy (CBT) is effective in reducing fatigue across long-term conditions (LTCs). This study evaluated whether cognitive and behavioural responses to symptoms: 1) differ between LTCs and 2) moderate and/or mediate the effect of CBT on fatigue. METHOD: Data were used from four Randomized Controlled Trials testing the efficacy of CBT for fatigue in Chronic Fatigue Syndrome/ME (N = 240), Multiple Sclerosis (N = 90), Type 1 Diabetes Mellitus (N = 120) and Q-fever fatigue syndrome (N = 155). Fatigue severity, assessed with the Checklist Individual Strength, was the primary outcome. Differences in fatigue perpetuating factors, assessed with the Cognitive Behavioural Responses to Symptoms Questionnaire (CBRQ), between diagnostic groups were tested using ANCOVAs. Linear regression and mediation analyses were used to investigate moderation and mediation by CBRQ scores of the treatment effect. RESULTS: There were small to moderate differences in CBRQ scores between LTCs. Patients with higher scores on the subscales damage beliefs and avoidance/resting behaviour at baseline showed less improvement following CBT, irrespective of diagnosis. Reduction in fear avoidance, catastrophising and avoidance/resting behaviour mediated the positive effect of CBT on fatigue across diagnostic groups. DISCUSSION: The same cognitive-behavioural responses to fatigue moderate and mediate treatment outcome across conditions, supporting a transdiagnostic approach to fatigue.

Psychosocial aspects of obesity in adults with psoriasis: A systematic review.

Background: Excess weight is a common (30%-40%) multifactorial concern that remains understudied in adults with psoriasis. Objectives: This systematic review aimed to synthesise the evidence on the psychosocial factors associated with body weight in psoriasis and to use these findings to inform clinical practice. The review was registered with PROSPERO (registration number: CRD42020201138). Methods: Electronic databases, related reviews and associated reference lists were searched. Observational and experimental studies reporting on the relationship of psychosocial factors to weight-related outcomes in adults with body mass index (BMI) of ≥30 kg/m2 and psoriasis were eligible. The methodological quality of the included studies was assessed using the Critical Appraisal Skills Programme (CASP). Results: Eighteen studies were included in the review, the majority of which (n = 16) examined cross-sectional associations between psychosocial factors and weight outcomes. Although the strengths of the associations were heterogeneous, most studies confirmed the positive association between high BMI and increased reports of depression and anxiety, impaired quality of life, deteriorated sleep quality, sexual dysfunction, and daily functioning issues. Only four studies were rated as high quality. Conclusions: The current evidence of the association between psychosocial factors and weight-related outcomes is largely cross-sectional with unclear directionality of causality. Longitudinal studies are needed to examine the replicability and generalisability of the examined obesity-related psychosocial factors in psoriasis. Theoretical exploration of subgroup differences and similarities may pave the way towards intervention personalisation, and ultimately, improved patient outcomes.