Attention processes in chronic fatigue syndrome: Attentional bias for health-related threat and the role of attentional control Ruihua Hou a , Rona Moss-Morris b, * , Anna Risdale c , Jeannette Lynch d , Preshan Jeevaratnam a , Brendan P. Bradley c , Karin Mogg c a Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom b Health Psychology Section, Psychology Department, Institute of Psychiatry, King’s College London, London Bridge, London SE1 9RT, United Kingdom c Psychology, University of Southampton, Southampton, United Kingdom d University of Southampton, Primary Medical Care, Aldermoor Health Centre, Southampton, United Kingdom article info Article history: Received 15 May 2013 Received in revised form 9 October 2013 Accepted 14 October 2013 Keywords: Chronic fatigue syndrome Attentional bias Executive attention control Visual Probe Task Attention Network Test abstract Cognitive behavioural models of chronic fatigue syndrome (CFS) propose that attention processes, specifically, enhanced selective attention to health-threat related cues, may play an important role in symptom maintenance. The current study investigated attentional bias towards health-threat stimuli in CFS. It also examined whether individuals with CFS have impaired executive attention, and whether this was related to attentional bias. 27 participants with CFS and 35 healthy controls completed a Visual Probe Task measuring attentional bias, and an Attention Network Test measuring executive attention, alerting and orienting. Participants also completed self-report measures of CFS and mood symptoms. Compared to the control group, the CFS group showed greater attentional bias for health-threat words than pictures; and the CFS group was significantly impaired in executive attention. Furthermore, CFS individuals with poor executive attention showed greater attentional bias to health-threat related words, compared not only to controls but also to CFS individuals with good executive attention. Thus, this study revealed a significant relationship between attentional bias and executive attention in CFS: attentional bias to threat was primarily evident in those with impaired executive attention control. Taking account of individual differences in executive attention control in current intervention models may be beneficial for CFS. Ó 2013 Elsevier Ltd. All rights reserved. Introduction Chronic fatigue syndrome (CFS) is characterised by recurrent or persistent disabling fatigue which has been present for at least 6 months (Fukuda et al., 1994). The psychological versus biological pathogenesis of the condition has been hotly debated. However, there is increasing consensus that CFS is multifaceted and hetero- geneous in nature. The cognitive behavioural model of CFS at- tempts to incorporate this heterogeneity through describing the interaction between biological and psychosocial factors. The model suggests that factors such as genetics, high perfectionist ten- dencies, and/or a history of psychological distress predispose individuals to CFS. The initial symptoms are then precipitated through events such as an acute infection and/or stress. Cognitive and behavioural factors such as negative illness beliefs and all-or- nothing behaviour perpetuate the symptoms and associated disability (Moss-Morris, 1997; Moss-Morris & Petrie, 2003; Surawy, Hackman, Hawton, & Sharpe, 1995; Wessely, Butler, Chalder, & David, 1991). The perpetuating factors are seen as key to the model and are the focus of successful treatments for CFS (Castell, Kazantzis, & Moss-Morris, 2011). There has also been considerable empirical support for the content of the illness cognitions hypothesised to be important in the maintenance of CFS, including negative beliefs about the consequences, timeline and controllability of the condi- tion (Moss-Morris, 2005; Moss-Morris, Spence, & Hou, 2011). Little research has, however, been conducted into the cognitive processes that may develop or maintain particular cognitions or beliefs. It is believed that distortions or biases in cognitive processing (e.g., selective attention to health-threat information, negative bias in the interpretation of somatic information) may influence the Abbreviations: CFS, chronic fatigue syndrome; ANT, Attention Network Test; VPT, Visual Probe Task; CDC, Centre for Disease Control; RT, reaction time; HADS, Hospital Anxiety and Depression Scale; SPSS, Statistical Package for Social Sciences; ANOVA, analysis of variance. * Corresponding author. E-mail address: rona.moss-morris@kcl.ac.uk (R. Moss-Morris). Contents lists available at ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.brat.2013.10.005 Behaviour Research and Therapy 52 (2014) 9e16