A precarious balance: using a self-regulation model to conceptualize and treat chronic fatigue syndrome

The problem posed by chronic fatigue syndrome (CFS) to the affected individual can be conceptualized, using Leventhal's common sense model, as a health threat to be encoded and coped with accordingly. The current paper adopts an alternative use of self-regulation theory. It is hypothesized that in CFS the health threat is no longer the illness, but anything that threatens to disrupt a precarious accommodation to it. It is argued that attempts at threat regulation may become inadvertently self-defeating, promoting the threats they attempt to diminish. Evidence is presented for homeostatic mechanisms in physiological, neurocognitive and affective domains, and for their potential to become locked in vicious circles. It is further argued that illness attributions, rather than being independent cognitive processes, may be intimately linked with emotional and somatic processes. Damasio's somatic marker hypothesis is used to suggest ways in which the self-regulation of highly interconnected somatic, affective, and cognitive states may be substantially implicated in the maintenance of CFS. This perspective is used to reconsider effective treatment and to suggest new interventions. The self-regulation model is a potentially powerful explanatory framework for the consideration and treatment of CFS and medically unexplained symptoms in general.