• Welcome to Phoenix Rising!

    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of and finding treatments for complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

    To become a member, simply click the Register button at the top right.

"Cognitive behavioral therapies" by Bleijenberg et al. (2003) (Nijmegen, Netherlands)

Dolphin

Senior Member
Messages
17,567
The protocol for the CBT for CFS that is performed by Nijmegen researcher is based on:
-----
Bleijenberg G, Prins J, Bazelmans E. Cognitive behavioral therapies.
In: Jason LA, Fennel PA, Taylor RR, eds. Handbook of chronic fatigue syndrome. Hoboken: Wiley and Sons, 2003: 493526.
-----

This can be read for free at: https://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind1009C&L=CO-CURE&P=R1774&I=-3

Unfortunately, it's long.

Amongst other studies, this is referenced in Nijhof et al. (2012)

These are not "moderate" people - they are "hardliners" e.g. the participant is encouraged to see themselves as an "ex-patient" at the end.
 

Dolphin

Senior Member
Messages
17,567
Extract

Based on actometer readings, patients are divided up into two groups

"Relatively Active CFS Patients" and "Passive CFS Patients".

This is part of the protocol for the latter group:

The initial daily frequency of the activity, however,
is higher and preferably set at 6 times a day (i.e., twice in the
morning, twice at noon, and twice in the evening). A 1-minute walk is
commonly chosen as a first activity. Low-active patients seldom opt
for cycling. A minute is added each day [Dolphin: i.e. 6 x 1 minutes added each day], with a total of 5 minutes per
week. This leaves 2 minutes to spare, allowing the patient to skip a
day or to refrain from raising the duration of the exercise.

It is important to point out to patients that a 1-minute increase is
absolutely safe and that there is no danger, whatsoever, of
overtaxation. Emphasize that with these small but consistent
increments, a great deal of progress can be made in only a few weeks,
barring exceptional circumstances (see Figure 23.3). It is common to
cut back the frequency of the walks from 6 times a day to 2 or 3 times
a day after several weeks. Even before reaching a certain level such
as a twice-a-day 60-minute walk, patients will find that they are now
able to undertake other activities. By then, patients will also have
noticed that recovery from an activity is much faster.

I think it's completely inappropriate. But I think gets across the attitude used.
 

charityfundraiser

Senior Member
Messages
140
Location
SF Bay Area
How I read the manual with a mental filter. The following are snippets. I think the example programs are just examples and the rest of the commentary explains that the program is adjusted as necessary according to how the client responds to it.

It was found that depression could not be fitted into the model. Depression does not seem to play an important role in perpetuating the complaints. This is in agreement with findings in follow-up studies on CFS

the model mainly applies to patients with a long duration of complaints. As yet, not all aspects of the model have been shown to be valid for CFS patients of relatively short duration. It is conceivable that patients do not start focusing on bodily symptoms until the complaints have existed for a longer period.

This suggests that the illness leads to an increase in the cognition of focusing on bodily symptoms, so even if they say that focusing on bodily symptoms supposedly is a factor in perpetuating the illness, the illness itself led to that in the first place.

CONTROLLED STUDIES INTO CBT FOR CFS

After conclusion of the CBT, the somatic attributions were unchanged, and they were not found to predict a poorer outcome.

To investigate whether gradually increasing the levels of physical activity alone suffices in treatment of CFS patients, Fulcher and White (1997) compared graded exercise therapy with a treatment combining flexibility and relaxation sessions. Whereas the rationale for most types of CBT for CFS is fear and avoidance of activity, the treatment proposed by Fulcher and White is based on a physiological model of deconditioning. For 3 months, their patients worked on their physical condition on a weekly basis. The gradual increase of physical activity resulted in a significantly greater number of self-reports claiming improvement than the combination of relaxation and flexibility exercises.

According to this, GET apparently works without CBT or any ideas about abnormal beliefs. On the other hand, according to this manual itself, GET apparently works without the idea of deconditioning either. Thus, it seems like the explanations put on top of GET are irrelevant except in that different explanations might motivate or demotivate different patients from trying GET at all.

DISTINCTION BETWEEN RELATIVELY ACTIVE AND PASSIVE CFS PATIENTS

Relatively active patients still are able to do some paid work for several hours per day, do some domestic chores, and are socially active to some extent or engage in certain leisure activities or hobbies. By contrast, passive patients mainly spend a lot of time in bed, seldom leave the house, and undertake few or no household tasks. Relatively active CFS patients mostly have cognitions that entail making high demands on themselves, wanting to do (too) much, and refusing to accept the current situation. Low-active CFS patients primarily exhibit anxious cognitions about the negative effect that activity may have on their symptoms.

HOMEWORK ASSIGNMENTS

When a patient finds a certain assignment too taxing, try to determine the specific problem. How does the patient perform the task? If possible, have the patient formulate a feasible alternative. It is the patient who sets the priorities. Emphasize that it is important to complete the homework assignments in ways that can be sustained over time.

RECOGNIZING AND RESPECTING LIMITATIONS

Many patients exceed their limits to such a degree that they cause or aggravate symptoms. In such cases, the peak-stop exercise is recommended for a limited period. The exercise is a short-term aid to bring down the patient's activity level and prevent peaks in activity and the resultant fatigue. It helps set an appropriate base level.

Some CFS patients tend to exceed their limits so frequently and to such an extent that the negative effects do not manifest themselves until after they have stopped their activities or even the day after. Patients and therapists here need to try to find an activity level that does not aggravate complaints. This allows patients to determine the duration of their activities in advance. They are taught to cease the activity in time to prevent any complaints from manifesting themselves.

ATTAINING AND MAINTAINING A BASE LEVEL

A proper application of the peak-stop exercise will allow the patient to determine a base level. By base level, we mean the total activities a person can do-spread over the day-without these causing extreme fatigue. In determining this base level, both the therapist and patient will get a clearer picture of what the patient's typical activities are on a normal day. Base-level activities include actions like getting up, taking a shower, getting dressed, preparing meals, doing the shopping, tidying, doing the dishes, taking the kids to and picking them up from school, spending time on domestic work or doing paid work. Which activities to include in the base level depends on the patient's personal circumstances, which differ from patient to patient. Some may still be able to go out to work a few hours per day, whereas others will have reached the base level after taking a shower, getting dressed, and eating breakfast. The essence of a good base level is that there are no activity peaks, nor activities that cause extreme fatigue. Determining the base level is about finding out which activities to include and how to spread them over the day. Activities that result in extreme fatigue should be omitted unless they can be divided and spread out. Furthermore, the base level should leave some room for maneuver. A base level is inflexible if it means the patient must function at maximum ability all the time and any extra activity will lead to extreme fatigue. Unexpected events or unforeseen activities-so much a part of life-need to fit within the set level. In addition, the base level needs to allow room for the activity program, to be described later.

If, after several sessions, a relatively active CFS patient is still seriously fatigued and has improved little since the start of treatment, an evaluation of the base level may reveal that the patient still does too much or for too long a period.

THE BASE LEVEL AND THE ENVIRONMENT

Since CFS patients, in the context of the base-level program, will try to reduce their activities, this may elicit negative reactions from the patient's environment. The patient no longer meets (presupposed) requirements and no longer lives up to perceived expectations. Generally, the best way to resolve this matter is to involve those in the patient's environment in the treatment and to jointly seek temporary solutions for any emerging problems. Involving the spouse or significant others may help the patient comply with the base level.

GRADED ACTIVITY PROGRAM

Activities can be divided into three categories: physical, mental, and social. In nearly all cases, treatment starts with a physical activity program. The patient selects a simple physical activity to perform every day and records its duration. The aim is to have the patient gradually and systematically increase the frequency or duration of this particular activity.

Walking and cycling are typical examples of such an activity. Swimming is less suitable since it is difficult to perform on a daily basis and involves many additional actions, such as going to the swimming pool, finding a cubicle, getting changed, and so on. The activity program needs to start at a realistic, manageable level. In general, a relatively active CFS patient starts with an activity that can be carried out twice a day and whose duration can be increased every day.

The raise in the duration of the activity is usually expressed in minutes. Starting with a 5-minute walk twice a day, the second day this is raised to 6, and the third day to 7 minutes twice daily, and so on. If necessary, the therapist may assure the patient that an increase by 1 minute will not constitute any danger. There is no strain, and there will be no negative consequences. An increase of 5 minutes per week is a cornmon target. This gives the patient the opportunity to skip the activity once or twice or to refrain from raising the walking time. The initial level will be realistic and feasible, as has been agreed on by both patient and therapist. For patients who think they can start with at least a 25-minute walk (which IS cornmon assumption by relatively active patients), the starting period should be set for half this estimated time at most. In practice, patients are best advised to begin with a 10-minute walk twice a day and should be asked to indicate the actual duration of each activity on a chart.

In general, the activity program will involve a maximum of 60 minutes of walking or cycling. By that time, most patients will have become aware that they are capable of doing more without experiencing extreme fatigue and that they recover faster than before. The original base level has by then already been automatically enhanced. Gradually, patients are now replacing walking or cycling with other activities. These often involve going back to work or resuming activities that are part of personal targets.

The activity program is likely to be fraught with difficulties. Patients may not stick to the program consistently and may make insufficient progress. A closer examination may reveal that they are undertaking additional activities that do not form part of the base level. That they have not complied with the agreed terms may imply that the base level was set too high and, consequently, was not flexible enough. In such cases, it is recommended to lower the base level so that it once again leaves patients room for maneuver, after which they can resume the program.

Another problem that may arise is that patients step up their activities faster than has been agreed. The kick in the teeth usually comes later: The patient can no longer sustain the program and either stops altogether ("The program is no use") or does very little ("I am at the end of my tether "). Once the setback has occurred, the only way forward is to have the patient start from scratch, at the agreed level, but this time with a safe daily buildup.

PHYSICAL ACTIVITY PROGRAM FOR LOW-ACTIVE CFS PATIENTS

If this is found to have been too fast, the patient is best advised to return to the last manageable level and to work back up from there.

MENTAL ACTIVITY PROGRAM FOR PASSIVE CFS PATIENTS

Once an activity program is under way, the patient and therapist concomitantly agree on and start a mental activity program. Many passive CFS patients experience difficulties performing activities that require concentration, such as reading, doing crossword puzzles, or working at a computer. At first, the activity should be carried out 2 or 3 times a day for perhaps 5 minutes. This is gradually increased so that at the end of the week the patient has doubled the time spent on the task.

The type of mental activity also plays a role. Certain patients may want to start with a textbook. This should be allowed, but patients are usually better off to choose less complex material. It may even be advisable to start with a children's book. The patient should make the final decision, however, because the program is about promoting a positive self-efficacy. Patients may also tend to spend more time on the activity (e.g., at the computer) than initially agreed on. By pointing out that the consequences are usually not felt until (much) later, it generally is easy to convince patients to stick to the program.

SOCIAL ACTIVITY PROGRAM FOR PASSIVE CFS PATIENTS

The social activity program for passive patients does not commence until they have made progress in the preceding areas. Activities such as making telephone calls, chatting with friends, or making social calls are added gradually according to the same principles as the other programs. It needs to be noted that some passive patients engage in lengthy telephone conversations regularly since this is their only opportunity to make contact with the outside world. They are not always aware how fatiguing these calls can be. It is recommended to make an early start in helping the patient adjust to having shorter calls several times a day. Since the social activity program also affects the patient's environment, the patient needs to inform others of the program. The patient decides on the content of the information.

FOLLOW-UP AND TREATMENT EVALUATION

Most patients who have been successfully treated will still report feeling tired frequently, although this no longer takes extreme forms and recovery occurs more quickly.

WHO SHOULD PRACTICE CBT?

It turned out that therapists with little experience in the treatment of patients suffering from somatic complaints have difficulty preventing patients from dropping out. This illustrates the importance of adequate training and preparation. Knowledge of and experience in applying cognitive-behavioral therapy with patients who have a somatic illness is a prerequisite. In addition, therapists must keep themselves informed of the current scientific research into CFS.

RECOVERY OR MANAGING THE FATIGUE?

Like an athlete who will never jump higher if he does not put the bar higher, the patient will, generally speaking, never be able to achieve more than the goal the therapist and patient have set for themselves.

This last analogy, I found to be surprisingly true. Four months after starting tai chi class from being bedridden, my teacher started asking me for a half an hour of practice every day at home. In my head, I was thinking, well, she doesn't understand about my illness. That's way too much too fast. I told her that I practiced a few minutes per day and explained that after every weekly class, it took me two days to recover. This happened a few times and I got kind of annoyed and frustrated and wondered if I could handle continuing with this teacher's expectations. So okay, I like testing things, so I thought I would probably prove that this was not possible for me at this time. The next week she asked how much I had practiced and I happily told her that I had managed to practice four times at half an hour. I did not succeed in practicing every day but it was a lot more than I thought I could do and would have set for myself. Four times might have been a tad much still and the following week, I toned it down slightly to about 15 minutes per day but that is still a lot more than I initially set out for myself at that time. I only found my upper limit by having someone set an expectation higher than that limit and higher than what I thought or felt like I could do.
 
Messages
13,774
It's possible that some patients do not mind being lied to and manipulated in order to be motivated in to behaving and thinking in a more 'functional' manner, or even find it to be 'helpful'. For myself, I find such an approach to be pretty disgusting, particularly when it is done, as it so often is, without informed consent.

Maybe it's reassuring to be encouraged to believe that:

If I get complaints by being active, it doesn't necessarily mean that I should stop doing what I'm doing; it's just a sign that it has been some time since I've been active, and my body simply needs to get used to it again.

For myself, unless there's some compelling evidence that such a claim is true, I would not want to be placed under the authority of quacks willing to promote such a view.

I think that the truth matters, and that patients should have a right to be spoken to honestly and clearly.

Even for those without any particular commitment to reality, the promotion of false and misleading views about CFS and the extent to which recovery is under the control of patients, can and does have profound effects upon the way in which those with CFS are viewed and treated. If the complaints CFS patients get following activity are just the result of deconditioning, then that justify much of the ways in which we have been treated. If it is not true, as it seems increasingly clear it is not, then treating CFS patients on the assumption that it is should be viewed as vile and disdainful.

Just look at the recent paper assessing patient/clinician interactions in the FINE trial, which promoted a similar view of CFS. Patients were being viewed as 'bastards who didn't want to get better" - and unsurprisingly so if clinicians had been trained to treat CFS in such a manner.

ps: I don't want to sound too harsh to someone defending the CBT approach to CFS, as I expect that may be something of a minority view here, and it would easy for a discussion to feel bullying... but an honest pursuit of truth is fairly important to me, and an approach to CFS which suggests those with the diagnosis should have their cognitions pragmatically managed would serve to justify the abuse and abandonment of everything that I think is valuable about my own humanity. Sorry if that means that I am coming across as more personally aggressive than I intend.

It could be that you've found that you were not previously pushing yourself to do as much as you could have, and this caused problems from deconditioning - I'm pleased to hear that a change in approach has helped you. But I do not see how that could make approach to CFS detailed above any more acceptable.
 

SilverbladeTE

Senior Member
Messages
3,043
Location
Somewhere near Glasgow, Scotland
As I have mentioned before, there's a famous psychological experiment, where an unsupecting volunteer is asked to participate in a "scientific study"
the scientists and "victim" in next room are both actors
the volunteer is asked to hit buttons, that will give increasingly powerful electric shocks to the "victim" in next room (unseen, but can be heard by the volunteer/"scientists")
eventually,the shocks start causing the "victim" to scream in pain (all faked of course)
eventually, the last button will kill the "victim"

about 80% of folk will hit that last button, because most folk are easily persuaded that a "professional must be obeyed, for the greater good" etc

In other worlds

THESE PSYCH STUDIES ARE A LOAD OF FRAUD, CRAP, USELESS BECAUSE OF SUCH!

done corrctly, one but especially two people, in a proessfional "guise/manner" can convince most folk to do/agree to almost any damn thing, provided it's done right, see hwo con artists work, for proof, or interrogators

Plus, lets be brutally honest here, these psychs are in deep, deep poo.
If they do not prove themselves, they are going to lose their medical licences, possibly got ot jail for criminal abuse of patients, fraud etc.
or, they are so blinded by their bullshit, they are zealots, and "there are none so blind as those who WILL not see"

Past 100 years shows that the claims by these kind of scumbags (*) that "patients suffering are purely all in their mind!", have NEVER EVER born out.
perfect, perosnal attested case of this:
my mum got her back severly damaged in an accident, psychiatrist told her her pain was "neurasthenia!"
as usual, total clueless incompetant, sociopathic moron
Mum's got scarring on the spinal cord causes excurciating pain which is shown on her X Rays! Since when the flying monkey poo, did psychological problems show up on X Rays, EH?!
(arachnoiditis, iirc, sigh, there's that and another one and my wonky brian can't recall which at the moment.....meh. Own mum, still can't recall which...blerg!! Oh well I maybe a moron nowadays, but I'm a higher functioning moron, unlike the psychs! :p)

(*) yes, they are bastards, grade A, died in the wool, goat fornicators deluxe :p
 

charityfundraiser

Senior Member
Messages
140
Location
SF Bay Area
Esther - I actually agree with you about that quote and others like it, as well as what you say about reality. I'm not defending CBT for CFS, mostly. As I've said many times, I don't believe in the deconditioning hypothesis nor most of the CBT stuff for CFS. I just think that it's possible that GET may help some people apart from CBT for the reasons I posted in the peanut thread. I think some of the medical/psychiatric views are similar to "positive thinking"/"New Thought" (which is like create your own reality by thinking it, and all diseases are caused by negative thoughts crap) which I believe are abusive. The one person who ever recommended that stuff to me is really abusive!

Also, it was not that I was not pushing myself, but previously I had been overdoing it with the walking without a real schedule and reaching PEM too much. Another possibility is that the activity choice matters and my improvement could be mainly due to that and the graded nature is secondary or would naturally arise from finding an activity that inherently has a positive cycle for that person (yoga, tai chi, stretching, and massage for me).
 

Enid

Senior Member
Messages
3,309
Location
UK
I must agree with many of Silverblade's points - and settle for being a higher functioning moron.:oops:
 
Messages
13,774
I just think that GET may help some people apart from CBT for the reasons I posted in the peanut thread.

Given the varying approaches to activity management which can be classed as 'GET', then I think that's almost certainly true. I expect that everyone in the world could alter their behaviour in a way which would improve their health, lives and their ability to pursue their own interests and desires.

I see the psychosocial approach to CFS, and the medicalisation of patient's cognitions and behaviour, as having made that harder for people, and I think it is a mistake to turn a playful and experimental approach to activity levels into a 'therapy' which is to be promoted by paid 'experts'.

This is a complicated topic that has probably been gone over a few times before though. Good luck with everything.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
The issues with CBT and GET are different, particularly if the CBT is based on a psychosomatic model.

Psychosomatic medicine has never proved its basic thesis: that many diseases are entirely caused by mind. This is a post-Freudian claim. Psycho-somatic means mind-body. In the early days of psychosomatic medicine it was about examining the mental side of physical illnesses, like stomach ulcers. I think thats a valid pursuit. The claim that mental issues cause physical disease in the form that currently comprises psychosomatic thinking is however unfounded. SilverbladeTE is correct: a century of trying to prove this has failed. Sure depression and anxiety can cause physical symptoms. Sure the mind and body are connect (to me the mind is an emergent property of brain though). That does not mean that aberrant thoughts are the cause. Even primary depression is now suspected of being neuroimmune. Anxiety is mostly neurological. They are physical states in which the thoughts modify the outcome. So psychiatry (particularly biopsychiatry) and counselling are ways to assist the patient. They are not directly addressing the underlying problem.

Now neuroscience may have a cure for PTSD. There is research on rats that is claimed to show how amygdala changes can be reversed, removing the problem. This has not been done on humans.

Exercise is another debate entirely. I think the evidence is now clear that for mildly affected patients that non-aerobic exercise can produce benefits if done in moderation. That is the point that differs with GET. GET aims to increase activity steadily over time. There is no concept that what would be considered moderate activity for a healthy person may be far too much for someone with ME.

So its not about exercise itself, its about how patients are induced to exercise and how much.

The rhetoric in the CBT and GET literature is all over the place. In practice in the UK I have heard many stories of how people are afraid of the psychiatric profession, they are being abused. Furthermore this abuse is used to induce them to do way more exercise than they can handle - I know of cases where this has happened. Patients are threatened with benefit loss or loss of general medical care if they do not comply. This is bully tactics, and the rhetoric on the ground is such that those working to "support" patients are trying to force patients to do more, sometimes much more. Even though some of the GET literature says otherwise, it is not what is being practiced for the most part.

What we need is research into exercise being conducted by exercise physiologists not psychiatrists. If its OK for psychiatrists to do this, then it should be equally OK for exercise physiologists to research psychiatry, surely? I wonder what psychiatrists would think of that idea?

Exercise physiology research, done by experts who are well aware of the physiological data on ME would produce results in time. We would work out how to assess capacity, advise on exercise, and support patients to exercise. This would be done based on evidence. Having psychiatrists try do this is absurd.

Studies done by Pacific Labs and the work by Nancy Klimas and the Lights are examples of this kind of research. We need more of that, and less of psychiatrists researching outside their expertise and making hyperbolic claims to media and government.

Bye, Alex
 
Messages
13,774
Psychosomatic medicine has never proved its basic thesis: that many diseases are entirely caused by mind. This is a post-Freudian claim.

Hi Alex. I don't think that this is the model of psychosomatic medicine which most psychosocial CFS researchers hold, eg: the role of deconditioning. I also get the impression that most recognise that all manner of biological mechanisms are likely to be involved, talk about the false division between mind and body, etc... then they attempt to justify their approach to CFS and the medicalisation of patient's cognitions on pragmatic grounds.

Please don't make me defend them though... I'm already in a bad mood.
 

charityfundraiser

Senior Member
Messages
140
Location
SF Bay Area
Alex - I pretty much agree with everything you said, especially good point on the last part about exercise science being done by exercise physiologists. What I was doing was like trying to pick through crap to find a few nuggets since the research done by exercise physiologists has been close to nonexistent until now. I think exercise physiology doesn't get as much respect as other fields but it seems to be improving. I have not seen a department of exercise science at any Ivy League level university and not too many in top tier universities which is unfortunate.

I don't know what the data is but at least for me, the non-aerobic exercise helped and I was not mildly affected. I was among the most severely affected (starting from bedridden 23 hrs/day and every moment was PEM). I'm thinking that the exercises that help me happen to be non-aerobic but that the reason they help might have to do more with relieving neuromuscular strain (Dr. Rowe's new project) and "cervical neuro-muscular syndrome" (there's a post in Other Health News). (Yoga and tai chi work on the spine a lot.) Thus they might be not just exercise but actually addressing part of the cause of some CFS. Anyways, I'm getting off-topic for the thread.
 

Enid

Senior Member
Messages
3,309
Location
UK
We want the cause and extent of pathologies to address not things that may or may not aid at particular stages in this illness - it is common sense to all to try to keep moving if possible - and the little talking to of the psycho lobby UK (listen to Pemberton eg). Are they stupid that they cannot absorb real science.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
Hi Alex. I don't think that this is the model of psychosomatic medicine which most psychosocial CFS researchers hold, eg: the role of deconditioning. I also get the impression that most recognise that all manner of biological mechanisms are likely to be involved, talk about the false division between mind and body, etc... then they attempt to justify their approach to CFS and the medicalisation of patient's cognitions on pragmatic grounds.

Hi Esther12, if they believed it was deconditioning that should have been debunked by all the studies that proved it wasn't deconditioning. Ditto for depression. We are being classified as having functional somatic syndrome, which used to be somataform disorder which is under the banner of somatic distress disorder.

The claim one thing in one place, claim something in another, speak about it another way somewhere else, and practice medicine with it some other way. So the reason we are deconditioned in some claims is we don't want to exercise, we are suffering some kind of psychological trauma. Dress it up however they want, they are still talking about a psychosomatic condition.

To be honest I am not sure what you are claiming in this post. Are you trying to say they primarily treat us as psychosomatic, or primarily as deconditioned? I think its the former, so if you do too we agree. Maybe you could clarify if this is the case?

Talking about the false division of mind and body is well enough, but its also misdirection: mind and body are connected, ergo its OK for us to mess with the minds of sick people even though they don't have a firm theoretical foundation to what they are doing. Its code for its ok to treat it as psychosomatic as the mind and body is connected, yes they acknowledge pshysical issues, but they are going to treat it as psychiatric anyway. The main reason for exercise, under this view, is to teach the patient that activity wont harm them ... but it frequently does the opposite. Rather than acknowledge the issue they dismiss it, or blame the patient, or claim they must be misdiagnosed, or just brush it off as "not everyone can get better". In any case these patients are left a lot sicker and without support or hope by the CBT/GET practitioners.

Now the exercise physiology people are doing something else. They are looking at the limits and causes of our physical capacities. As a consequence they are able to give advice based on objective data as to what kinds of exercise we can do. There is not psychosomatic theory in sight, its pure biophysical.

Bye, Alex
 
Messages
13,774
To be honest I am not sure what you are claiming in this post. Are you trying to say they primarily treat us as psychosomatic, or primarily as deconditioned?

I'm trying to say that treating CFS as 'psychosomatic' does not require a commitment to the notion that biological factors do not also play a role.

I quite agree with your point about the willingness of many of those adopting a psychosocial approach to CFS to adopt rather evasive and manipulative language when they discuss their views (which is another reason that I'm hesitant to attempt to defend their variable views), but I thought that your description was a bit off.
 

Enid

Senior Member
Messages
3,309
Location
UK
Who cares about personalities - this is pure science and findings for the relief and help for millions.
 

Dolphin

Senior Member
Messages
17,567
The issues with CBT and GET are different, particularly if the CBT is based on a psychosomatic model.
Like Esther12, I think the issues involved with GET and CBT for CFS are quite similar - CBT is often based on ideas about deconditioning.

(Although Nijmegen have tried to move a little away from the deconditioning hypothesis when they found the therapies didn't work as well at increasing activities)
 

Dolphin

Senior Member
Messages
17,567
The protocol for the CBT for CFS that is performed by Nijmegen researcher is based on:
-----
Bleijenberg G, Prins J, Bazelmans E. Cognitive behavioral therapies.
In: Jason LA, Fennel PA, Taylor RR, eds. Handbook of chronic fatigue syndrome. Hoboken: Wiley and Sons, 2003: 493526.
-----

This can be read for free at: https://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind1009C&L=CO-CURE&P=R1774&I=-3

Unfortunately, it's long.

Amongst other studies, this is referenced in Nijhof et al. (2012)

These are not "moderate" people - they are "hardliners" e.g. the participant is encouraged to see themselves as an "ex-patient" at the end.
Extracts from a related manual are in the first (and currently only) post in this thread: http://forums.phoenixrising.me/show...elatively-Active-and-for-Passive-CFS-patients