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Biopsychosocial model
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== BPS model in chronic fatigue syndrome == [[File:ChronicFatigueSyndrome-BPS-model-CBT-GET.jpg|none|thumb|'''The biopsychosocial model for [[ME/CFS]] by Vercoulen et al (1998).'''<br> Fatigue: the subjective feeling of fatigue; fatigue subscale of the Checklist Individual Strength. Focusing on (Bodily) Symptoms: somatisation subscale of the Symptom Checklist. (Level of) Physical Activity: Sickness Impact Profile (SIP) subscale mobility (SIP-MOB) and the Physical Activities Rating Scale. (Functional) Impairment: impairment in daily life; subscale of activities at home of the SIP. Sense of Control (over Symptoms): selected items of the modified Pain Cognition List on a specific five-point scale. Causal Attributions: Causal Attributions List (high scores: physical attributions, low scores: psychosocial attributions).<br /> ''Source: Maes, M., & Twisk, F. N. (2010). Chronic fatigue syndrome: Harvey and Wessely's (bio) psychosocial model versus a bio (psychosocial) model based on inflammatory and oxidative and nitrosative stress pathways. BMC medicine, 8(1), 35. License: CC-BY-2.0'']] Vercoulen et al (1998) created a highly influential biopsychosocial (BPS)model for "chronic (subjective) fatigue" which was used for [[myalgic encephalomyelitis]]/[[chronic fatigue syndrome]], and justified the use of both [[cognitive behavioral therapy]] and [[graded exercise therapy]] as treatments.<ref name="Vercoulen1998" /><ref name="Maes2010" /> However, Vercoulen et al's BPS was developed using patients that did not meet any recognized diagnostic criteria for CFS, instead they selected a mix of patients with [[idiopathic chronic fatigue]] and [[chronic fatigue syndrome]];<ref name="Vercoulen1998" /> only 68% of these patients experienced [[post-exertional malaise]], which later became regarded as the hallmark symptom of ME/CFS.<ref name="Vercoulen1998" /> [[File:ChronicFatigueSyndrome-BPS-Wessleymodel.jpg|none|thumb|'''The (bio)psychosocial model of 'chronic fatigue' by Wessely and Harvey, which is used to justify [[cognitive behavioral therapy]] and [[graded exercise therapy]] treatments for [[chronic fatigue syndrome]]''' ''Source: Maes, M., & Twisk, F. N. (2010). Chronic fatigue syndrome: Harvey and Wessely's (bio) psychosocial model versus a bio (psychosocial) model based on inflammatory and oxidative and nitrosative stress pathways. BMC medicine, 8(1), 35. License: CC-BY-2.0'']] [[Simon Wessely|Wessely]] and [[Samuel Harvey |Harvey]] (2009) proposed a development of Vercoulen's biopsychosocial model for not only chronic fatigue syndrome, but for ''all'' causes of fatigue, including psychiatric disorders, biological illnesses including AIDS, and fatigue without a known cause.<ref name="Wessely2009" /> Wessely and Harvey's model has been referred to as a psychosocial model.<ref name="Wessely2009" /><ref name="Maes2010" /> This theoretical model proposed that the all chronic fatigue syndrome and all fatigue was caused by [[Cognitive behavioral model#threeps|the 3Ps]]: '''predisposing factors''' (e.g. [[personality traits and patient attitudes in ME/CFS|personality traits]] or other pre-existing [[risk factors]]), '''precipitating factors''' (e.g. a virus, stress or other trigger) and '''perpetuating factors''' (psychological or behavorial factors, e.g., too much rest, being excessively focused on symptoms, beliefs about the illness being caused by a virus, or the patients' other thoughts and behaviors). It did not recognize a [[genetics of chronic fatigue syndrome|genetic predisposition]] for CFS. <ref name="Maes2010" />
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