Childhood maltreatment and the response to cognitive behavior therapy for CFS (Heins)

[Dolphin]

This study did what it says on the tin. Of course, I think they should use (or report if they do use) objective outcome measures, etc. So I'm not saying I'm a fan, just posting it to highlight the point in my second message in this thread.

Childhood maltreatment and the response to cognitive behavior therapy for chronic fatigue syndrome.

J Psychosom Res. 2011 Dec;71(6):404-10. Epub 2011 Jun 30.

Heins MJ, Knoop H, Lobbestael J, Bleijenberg G.

Source
Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, The Netherlands.

Abstract*

OBJECTIVE:
To examine the relationship between a history of childhood maltreatment and the treatment response to cognitive behavior therapy for chronic fatigue syndrome (CFS).

METHODS:

A cohort study in a tertiary care clinic with a referred sample of 216 adult patients meeting the Centers for Disease Control and Prevention criteria for CFS, and starting cognitive behavior therapy.

Main outcome measures changes between pre- and post therapy in fatigue (Checklist Individual Strength fatigue subscale), disabilities (Sickness Impact Profile total score), physical functioning (short form 36 health survey subscale) and psychological distress (Symptom checklist 90 total score).

RESULTS:

At baseline, patients with a history of childhood maltreatment had significantly more limitations and a higher level of psychological distress, but were not more severely fatigued.

Change scores on the outcome measures after cognitive behavior therapy did not differ significantly between patients with or without a history of childhood maltreatment, or between the different types of childhood maltreatment.

However, patients with a history of childhood maltreatment still experienced more limitations and a higher level of psychological distress after CBT.

CONCLUSIONS:

A history of childhood maltreatment was not related to the treatment response of cognitive behavior therapy for CFS.

In patients with a history of childhood maltreatment CFS symptoms can be treated with CBT just as well as those without.

Copyright 2011 Elsevier Inc. All rights reserved. PMID: 22118383 [PubMed - in process]

*I've given each sentence its own paragraph.

 

[Nielk]

What a waste of time and money. I'm sick of these useless, meaningless studies! Do they perform these studies on cancer patients?
The few studies that are put out for CFS are so nonsensical. Really? They couldn't come up with anything else?

 

[Dolphin]

What a waste of time and money. I'm sick of these useless, meaningless studies! Do they perform these studies on cancer patients?
The few studies that are put out for CFS are so nonsensical. Really? They couldn't come up with anything else?

They have one treatment and want to claim its suitable and useful for each and every patient.

 

[Dolphin]

Childhood Maltreatment percentages quoted

Buried in the full text are some statistics on abuse:

Eighty of the 216 CFS patients (37%) and 37 of the 227 controls (16%) reported childhood maltreatment. Especially a history of emotional abuse and neglect, and physical abuse was more common in CFS patients (see Table 1).

This means 63% didn't report maltreatment.

Below is the "small print" on this but a lot of people can probably skip it.

------

Assessment of childhood maltreatment

Childhood maltreatment was assessed before therapy using the
Dutch version of the Childhood Trauma Questionnaire-Short Form
(CTQ-SF) [37,38]. This self-report questionnaire, previously used by
Heim et al. in their studies on CFS and childhood maltreatment [5,6],
consists of 28 items measured on a 5 point Likert-scale. Five
dimensions are discerned: 1) Physical Abuse 2) Emotional Abuse 3)
Sexual Abuse 4) Physical Neglect 5) Emotional Neglect. Each subscale
comprises 5 items and scores range from 5 to 25. For each subscale,
cut-off scores for none-to-low, low-to-moderate and moderate-tosevere
maltreatment are available. The Dutch version of the CTQ-SF
has recently been validated in a sample of clinical and non-clinical
patients and showed excellent reliability (Cronbach's alpha .91 for
Physical Abuse, .89 for Emotional Abuse, .95 for Sexual Abuse, .63 for
Physical Neglect and .91 for Emotional Neglect) [38].
We used the cut-off scores for moderate-to-severe maltreatment
to classify individuals as positive on a given subscale. These are !13
for Emotional Abuse, !10 for Physical Abuse, !8 for Sexual Abuse,
!15 for Emotional Neglect, and !10 for Physical Neglect [39]. Norms
were derived from six samples, three of which comprise 2001 of the
2201 individuals in the CTQ norm group: (a) 1225 all female, mostly
White HMO members (b) 378 mostly Black, male inpatient substance
abusers; and (c) 398 adolescent psychiatric inpatients.

Here's the info on the subjects:

Subjects
The study population was selected from patients referred to our
tertiary care CFS clinic for individual CBT. We included the 216
consecutively referred patients starting CBT between March 2008 and
June 2009 who fulfilled the CDC criteria for CFS, were between 18 and
65 years of age and were able to read and write Dutch. Patients had to
be severely fatigued, operationalized as having a score of 35 or higher
on the subscale fatigue of the Checklist Individual Strength [26], and
severely disabled, operationalized as having a score of 700 or higher
on the Sickness Impact Profile [2729]. All referred patients received a
standard medical examination at the outpatient clinic of our
department of internal medicine, to rule out any somatic or
psychiatric disorder that excludes the diagnosis of CFS. If patients
had already been extensively medically examined prior to referral and
somatic and psychiatric disorders that could explain the fatigue had
already been ruled out, they were immediately referred to our
treatment center. After this, all patients underwent a standard
diagnostic procedure, consisting of a set of self-report questionnaires
(including the questionnaires used for this study) and an interview
with an experienced clinical psychologist. In this unstructured clinical
interview, the psychiatric evaluation was extended to rule out current
psychiatric disorders that excluded the diagnosis of CFS according to
CDC criteria [3]. Patients who were currently applying for a disability
claim were excluded until their application was completed, as this has
been found to predict a poor therapy response [30].

Authors make one comment on overall rate of childhood maltreatment:
---

The cut-off scores we used to define childhood maltreatment have been calculated based on a population from the US. Mean scores on the CTQ-SF in the Dutch population are somewhat lower [38], so these cut-off scores might have been too strict for our study. This could have led to an underestimation of the percentage of patients with childhood maltreatment.

---
but sample size is small (227). Don't know much about how the sample of controls was selected (see abstract below; I can't find the full text).

On the paper on the controls (people don't have to read):

http://www.eric.ed.gov/ERICWebPorta...&ERICExtSearch_SearchType_0=no&accno=EJ856597

Title: A Validation Study of the Dutch Childhood Trauma Questionnaire-Short

Form: Factor Structure, Reliability, and Known-Groups Validity Full-Text Availability Options:

Help Finding Full Text | Find in a Library | Publisher's Web Site

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Title: A Validation Study of the Dutch Childhood Trauma Questionnaire-Short

Form: Factor Structure, Reliability, and Known-Groups Validity

Authors: Thombs, Brett D.; Bernstein, David P.; Lobbestael, Jill;
Arntz, Arnoud

Descriptors: Test Reliability; Sexual Abuse; Mental Health; Test Validity; Factor Structure; Children; Questionnaires; Factor Analysis; Foreign Countries; Child Abuse; Indo European Languages; Health Services; Patients

Source: Child Abuse & Neglect: The International Journal, v33 n8 p518-523 Aug 2009

Peer-Reviewed: Yes

Publisher: Elsevier. 6277 Sea Harbor Drive, Orlando, FL 32887-4800.

Tel: 877-839-7126 ; Tel: 407-345-4020 ;

Fax: 407-363-1354; e-mail: usjcs@elsevier.com; Web site:

http://www.elsevier.com

Publication Date: 2009-08-00

Pages: 6

Pub Types: Journal Articles; Reports - Evaluative

Abstract:

Objective: The 28-item Childhood Trauma Questionnaire-Short Form (CTQ-SF) has been translated into at least 10 different languages. The validity of translated versions of the CTQ-SF, however, has generally not been examined. The objective of this study was to investigate the factor structure, internal consistency reliability, and known-groups validity of the Dutch CTQ-SF. Methods: A total of 261 patients receiving mental health treatment and 227 non-clinical controls were administered the Dutch CTQ-SF.

Confirmatory factor analysis (CFA) was done with Mplus for ordinal data to test the 5-factor structure of the CTQ-SF. Cronbach's alpha was computed, and known-groups validity was assessed by comparing CFA latent factor levels between clinical and non-clinical respondents.

Results: The 5-factor model fit well, although one item (I believe I was molested) was removed due to high levels of missing data and because it loaded on the Physical Abuse factor rather than the intended Sexual Abuse factor. Cronbach's alpha was 0.91 for Physical Abuse, 0.89 for Emotional Abuse, 0.95 for Sexual Abuse, 0.63 for Physical Neglect, and 0.91 for Emotional Neglect. Latent factor levels were more than one standard deviation higher (p less than 0.001) for patients receiving mental health treatment than controls for all CTQ-SF five scales.

Conclusions: The findings from this study provide evidence for the validity and reliability of the 24-item Dutch CTQ-SF, but showed that one item translated from the 25-item English CTQ-SF, I believe I was molested, was not a valid indicator of childhood sexual abuse in the Dutch version and should not be used. Practice Implications: Researchers and clinicians should use the 24-item version of the Dutch CTQ-SF. (Contains 2 tables.)

Abstractor: As Provided

Reference Count: 0

Note: N/A

Identifiers: Netherlands

Record Type: Journal

Level: N/A

Institutions: N/A

Sponsors: N/A

ISBN: N/A

ISSN: ISSN-0145-2134

Audiences: N/A

Languages: English

Education Level: N/A

Direct Link: http://dx.doi.org/10.1016/j.chiabu.2009.03.001

 

[Enid]

One wonders just how long they are going on with these mumbo jumbo "studies".

 

[sianrecovery]

particularly as they serve neither those who have had abusive childhoods or those with ME. As long as they need to justify their existence and research grants I suspect

 

[Nielk]

If they are so bent on this topic, I would want to see them comparing CFS patients to any other illness - being cancer, heart disease, any autoimmune disease.
I would pretty much guarantee that the numbers would be the same if not larger in other illnesses. Yes, PSTDs affect one's health. They didn't invent the wheel here.

In addition, now that they know this, (who knows what criteria they used for this study?) what will they do with this information? How does this help the patient to get better? If you didn't have PSTDs in your childhood, you don't have CFS? This whole thing is so absurd!! It riles me up big time.