Discussion in 'Latest ME/CFS Research' started by Dolphin, Mar 18, 2013.
* I gave each sentence its own paragraph
I had filed this in my mental filing cabinet as a PACE Trial paper. However, it only deals with baseline data which makes it less interesting for me.
None of the comments in this message or the next message by me are probably that interesting so feel free not to read.
Overview: this paper is purely based on looking at the illness from the viewpoint of a "CBT therapist" and "GET therapist". Like the Lancet paper on the PACE Trial (White et al., 2011), I don't think it references any findings of biological abnormalities anywhere.
The results are all about this questionnaire:
Unfortunately, I don't have access to the questionnaire. Often those who advocate CBT and GET for ME/CFS portray certain beliefs and behaviours as maladaptive, when patients or sympathetic professionals might disagree with this interpretation.
<Comments part 2 (I know some people might not read very long messages - I sometimes don't)>
Very often in CFS I see simple phobias (e.g. fear of spiders) not being counted as having a psychiatric disorder. Perhaps it is still the case and the SCID with psychotic screen (SCID i/P; First et al. 2002) does make a distinction.
This is probably good. Possibly more papers should do this or look at it. The CFS-Dep and CFS-Anx&Dep had statistically worse scores on both of these (and the CFS-Anx group had intermediate scores) so without these adjustments, one might wonder whether what is being observed is simply severity.
Here are the main results. I've added in bits in green
(Aside: Apart from two minor (non-significant) differences for CFS (no psych) vs CFS-Anx (Fear avoidance 0.16 (-0.60 to 0.92) and All or nothing: 0.10 (-0.78 to 0.98)), all the other differences were negative i.e. in the same direction as the statistically significant differences).
Not really sure if the paper justifies this fully. Presuming they are talking about CFS-specific CBT (rather than CBT to treat any anxiety or depressive disorders), White et al. (2011) said there was no difference in responses in those with CFS and depression (also no differences with ME (London) which was virtually all those who didn't have a psych diagnosis). If the CBT model was correct, one might expect a difference; what one might argue then is that the lack of difference suggests these factors are not important. Of course, all we're talking about are the chalder fatigue questionnaire and SF-36 Physical functioning scores when ideally one would like information on more objective measures. But then on the 6 minute walking test, CBT flopped, with no difference with the no therapy group (the no therapy group indeed improved a tiny bit more numerically).
What they said:
What they should have said:
Cognitions and behaviours hypothesized to perpetuate CFS were not common in CFS patients, and hence could not possibly explain perpetuation in the vast majority of patients.
Thanks. Sounded like a paper that may not have had interesting results, but could be interesting for revealing their spin/assumptions. Your points seemed fair too. I've not read a new CFS paper in ages... I've just got a growing list of one's I'd be interested in!
Sean : lol
The full name of the CBSQ/CBRQ/CBRSQ is "Cognitive Behavioural Response Questionnaire", "Cognitive and Behavioural Responses Questionnaire", or "Cognitive and Behavioural Responses to Symptoms Questionnaire". A related questionnaire also by Moss-Morris (the BRIQ: Behavioural Responses to Illness Questionnaire) seems like it might have some of the same sections and/or be an earlier version of the CBSQ.
The CBRSQ is listed as being "in development" in 2009 and 2010 or later, so it's a very new questionnaire.
The cognitive subscale purports to measure: Fear avoidance, Damage beliefs, Catastrophising, Symptom focusing, and Embarrassment avoidance. The behavior subscale purports to measure: All-or-nothing, and Avoidance/rest (probably corresponding with the first two sections of the BRIQ). Based on the little that can be seen on the BRIQ, someone answering positively to any behavior (doing less OR pushing themselves to do the same amount) is doing something "unhelpful" - there doesn't seem to be any possibility of a normal response to limitations.
http://bjp.rcpsych.org/content/suppl/2011/08/30/bjp.bp.110.082974.DC1/ds82974.pdf has brief descriptions of the categories and one question example per category.
But basically the questionnaire doesn't seem to be available anywhere outside of the group that created it and is using it. So they came up with some questions, don't tell anyone what the questions are, and try to pretend it means something.
Also anxiety and depression were diagnosed using an interview with the DSM-IV as a guide - so no specific questions, just the researcher using their highly subjective skills and opinions. Also, the DSM-IV criterion for depression are pretty stupid if you ignore that there is a physical illness. For example, you can deny feeling depressed, but inability to read, watch TV, or socialize are specifically mentioned as indicating depression, as well as insomnia, hypersomnia, mild or severe cognitive problems, feeling weak, and being totally drained after minimal physical activity. Underlying medical conditions can rule out symptoms being attributed to depression, but only if there's proof of the medical condition.
Major Depression with Atypical Features allows for normal mood responses to positive events.
Regarding anxiety, the symptoms in a panic attack are quite similar to POTS or other OI problems, aside from fear of going insane and impending death (well, after the first one anyhow, when we realize we fall over or sit down and life goes on). But as long as it's unexpected, has a fast onset, is not in response to a "real" threat, and you have to change your behavior to avoid the symptoms, then it's a panic attack. Again, only proven medical conditions can provide for an exception to a Panic Disorder diagnosis. Managing to go out with a companion or taking measures to avoid making a scene in public due to an attack also fit in nicely with the definition.
And they could have easily excluded most ME patients from PACE using the somatoform disorder diagnostic guidelines. Physical symptoms + no proof of cause + impact on life = somatoform disorder.
Just love how they get to default everything to a psych diagnosis. Where do I get a gig like that?
You can also try a Google Site Search
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