Journal of Behavioral Medicine

, Volume 39, Issue 5, pp 815–822 | Cite as

Explaining fatigue in multiple sclerosis: cross-validation of a biopsychosocial model

  • Melloney L. M. Wijenberg
  • Sven Z. Stapert
  • Sebastian Köhler
  • Yvonne BolEmail author


Fatigue is a common and disabling symptom in patients with multiple sclerosis (MS), but its pathogenesis is still poorly understood and consequently evidence-based treatment options are limited. Bol et al. (J Behav Med 33(5):355–363, 2010) suggested a new model, which explains fatigue in MS from a biopsychosocial perspective, including cognitive-behavioral factors. For purposes of generalization to clinical practice, cross-validation of this model in another sample of 218 patients with MS was performed using structural equation modeling. Path analysis indicated a close and adequate global fit (RMSEA = 0.053 and CFI = 0.992). The cross-validated model indicates a significant role for disease severity, depression and a fear-avoidance cycle in explaining MS-related fatigue. Modifiable factors, such as depression and catastrophizing thoughts, propose targets for treatment options. Our findings are in line with recent evidence for the effectiveness of a new generation of cognitive behavioral therapy, including acceptance and mindfulness-based interventions, and provide a theoretical framework for treating fatigue in MS.


Multiple sclerosis Fatigue Catastrophizing Physical disability Structural equation modelling Biopsychosocial model 



We would like to thank all the patients who took part in this study; the therapists, psychological assistants and MS nurses of Zuyderland Medical Center; Dr. Myreen Moors for her effort in gathering and monitoring the data acquisition; Prof. Dr. Raymond Hupperts for his kind cooperation and time investment.

Compliance with ethical standards

Conflict of interest

Melloney L. M. Wijenberg, Sven Z. Stapert, Sebastian Köhler and Yvonne Bol declare that they do not have any conflict of interest.

Human and animal rights and Informed consent

All procedures were approved by and in accordance with the ethical standard of the medical ethics committee of Zuyderland Medical Center and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all patients for being included in the study.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Melloney L. M. Wijenberg
    • 1
    • 3
  • Sven Z. Stapert
    • 1
    • 3
  • Sebastian Köhler
    • 2
  • Yvonne Bol
    • 3
    Email author
  1. 1.Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
  2. 2.Faculty of Health, Medicine and Life Sciences, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
  3. 3.Department of Medical Psychology/Academic MS Center LimburgZuyderland Medical CenterSittard-GeleenThe Netherlands

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