Learning to feel tired: A learning trajectory towards chronic fatigue. (January 2018)

• Record Type: Journal Article
• Authors: Lenaert, Bert; Boddez, Yannick; Vlaeyen, Johan W.S.; van Heugten, Caroline M.
• Is Part Of: Behaviour research and therapy. Volume 100(2018)
• Page Start: 54
• Page End: 66
• Publication Date: 2018-01
• Subjects: Chronic fatigue -- Associative learning -- Classical conditioning -- Fear -- Avoidance; Cognitive therapy -- Periodicals; Psychotherapy -- Periodicals; 616.891
• DOI: 10.1016/j.brat.2017.11.004
• Languages: English
• ISSNs: 0005-7967

Abstract

Abstract: Chronic fatigue complaints are frequently reported in the general population and fatigue ranks among the most commonly reported symptoms in chronic disease. In contrast to its high prevalence and impact on quality of life, relatively little is understood about the etiology of chronic fatigue. We present a cognitive-behavioral framework, the 'ALT+F' model, that conceptualizes fatigue from an associative learning perspective, and we will evaluate the current evidence for this position. Central to this framework is the notion that interoceptive and exteroceptive stimuli can become associated with the fatigue experience. Consequently, these stimuli may acquire the capacity to elicit fatigue as well as anticipatory fear-related avoidance behavior. We will argue that associative learning processes may contribute to the development of chronic fatigue, fear of fatigue, avoidance of fatigue and activity, and eventually, functional disability. The extent to which associative learning processes give rise to chronic fatigue and fear-related avoidance behavior may depend on a number of risk factors, including perceptual-cognitive biases, sensitization, fatigue catastrophizing, and excessive generalization. The presented framework offers a new window on treatment and intervention options for chronic fatigue. Highlights: Associative learning can help clarify the trajectory towards chronic fatigue. Intero-/exteroceptive stimuli can become associated with fatigue through learning. These stimuli may evoke behavioral change, including fear, avoidance, and fatigue. Our theoretical model describes these learning processes and related risk factors. The 'ALT + F' model offers a new window on etiology and treatment.