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Cognitive behaviour therapy for chronic fatigue syndrome: Differences in treatment outcome between a

Messages
724
Location
Yorkshire, England
What a freakin load of shit. I have a phobia - of needles. It causes extreme distress, sometimes fainting afterwards - or a need to 'escape' - to exit the area as quickly as possible and relax elsewhere. This is very very different to the reasons why anyone I have ever known chooses not to exercise.
Exactly!

Until recently, GET seemed to me to be a disguised version of exposure therapy. I suspect that was why they were more cavalier about ignoring physical symptoms while doing it. That is what I had to do when I had CBT and exposure therapy.

I have an easy way to test the hypothesis of exercise phobia. Strap Snow Leopard and Myself and others like us into "Lie Detector" equipment. Interview us while we watch a film to do with our phobia, "Dentists at work", "A Day at the Blood Blank", "Top 10 Spider attacks", "World's Deadliest Snakes". "Highest Bridges In The World", etc etc.

Then interview us while we watch a film of the Tour de France, on the most brutal climbs, with the greatest amount of rider suffering you can find. (Or similar)

Then compare the measurements.

I can tell you that no amount of inducement would get me to watch anything about needles or spiders, yet I watch the Tour de France, every year, for fun.
 

barbc56

Senior Member
Messages
3,657
The thing with many bahavioral therapies, unless your a very young child, a rat or dog, not only does the effect diminish over time, it doesn't necessarily carry over to other settings. How many times have people walked out of a therapist office feeling motivated yet you get home and some of that feeling disappears. Don't get me wrong, therapy can be very helpful but it takes time and work..

When I worked with students with emotional problems I could do all the charts, positive reinforcemeny, incentives whatever you call them and yet there there were often other factors that often be stronger than the cute little charts. You can help a child build self esreem in the classroom but if you don't change the environment such as home situations where the parents may be barely keeping their heads above water, social situations, not taking medications on a consistent basis for those who need them or , even the classroom atmosphere it can truely is an uphill battle. This doesn't mean you shouldn't try or that it's worthless to work with these students but it does mean it's a lot more complicated than a star on a chart. Sometimes it might be a beginning* but it's only a only a small part of a therapuetic process. Best of all, though sometimes few and far between there can be success and much more often relative progress.

Don't even get me started.about accusing someone that they're doing something for attention. Yes it happens but you have to ask why someone is choosing to seek attention or even if the behavior has that purpose.

I could write a book.

Part Deux

My brother in law is a doctor yet has a fear of needles, maybe not so much a fear of needles but he has been known to pass out after a shot or getting blood drawn. I guess he kind of tenses his body in these situations. Actually, I think that is a fear of needles! However, he is also six four and tall people can have a tendency to do this. Take out the tallness and this sounds familiar, doesn't it?. Though rarely, he has been known to do this when going from a sitting to a standing position but he now prevents this by standing.slowly, yet that rarely happens now.. Yet, fortunately for him, he is healthy and very active. Should we all be so well.

I think I had a point here but can't remember what. I think it had something to do with making SL and LB as well as others I may have left out, feel a bit better.. Otherwise, Ive lost my srring of thought. Maybe I was going to make a cute smiley face chart to clear their fear of needles, right up! Maybe M& Ms.

*When I worked with thirteen to fifteen yeat old students with ED which in a way is an oxymoron, as that is a development stage that can make a parent tear out their hair, I think you could take a cattle prod and it wouldn't necessarily be an incentive to change a behavior. However that is aversion therapy which is very different and frowned upon. Unfortunately, at one time it wasn't.

Oh, do you know giraffes have a short lifespan because of their long necks. Just a random thought.

Sorry for the rant. I miss my job. I may go and have a therapeutic cry and eat some M&Ms
 

IreneF

Senior Member
Messages
1,552
Location
San Francisco
Chalder and colleagues have argued that CFS is exercise phobia. As usual their statements are vague but they do seem to think that it's at least a big component.

'Fear of exercise' is biggest barrier to chronic fatigue syndrome recovery
http://www.medicalnewstoday.com/articles/287972.php

Side question: can CBT cure phobia of reading biomedical literature? Or is that less phobia and more willful ignorance?
Has any of the Chalder crowd explained why people who used to be active are now supposedly afraid to be active? People expect exercise to be tiring; they don't expect it to flatten them. It's as if we're not fully competant adults and don't have years of experience in what's normal or not normal. It's a variety of patronizing infantilization.
 
Messages
724
Location
Yorkshire, England
I think it had something to do with making SL and LB as well as others I may have left out, feel a bit better..
I got the sentiment behind it @barbc56, thank you. :hug:

Yes, apart from the tallness, it's a lot like your brother.
I fainted at my medical for the NHS when they took blood. :rofl: Good luck I was only in admin.

Same. I also have been known to ride my electric bike up hills!
Ha! That proves it to me, It would be pretty special to be able to ride a bike while having an anxiety attack, it's hard enough to walk in a straight line.
 
Messages
15,786
Then interview us while we watch a film of the Tour de France, on the most brutal climbs, with the greatest amount of rider suffering you can find. (Or similar)
Usually I find it too boring to watch, but I do love the huge "crashes" :woot:

OMG, maybe that does mean I'm averse to exercise and have a tendency to make myself really ill and "crash" just like the bicycles do during the fun bits! I need the CBT!!!!!!!!!!
 

Snowdrop

Rebel without a biscuit
Messages
2,933
When I worked with students with emotional problems I could do all the charts, positive reinforcemeny, incentives whatever you call them and yet there there were often other factors that often be stronger than the cute little charts. You can help a child build self esreem in the classroom but if you don't change the environment such as home situations where the parents may be barely keeping their heads above water, social situations, not taking medications on a consistent basis for those who need them or , even the classroom atmosphere it can truely is an uphill battle. This doesn't mean you shouldn't try or that it's worthless to work with these students but it does mean it's a lot more complicated than a star on a chart. Sometimes it might be a beginning* but it's only a only a small part of a therapuetic process. Best of all, though sometimes few and far between there can be success and much more often relative progress.

I'd like to expand on that thought as I've been thinking about it earlier while reading this thread.
It's a valid point @barb56. It's the 'social' in the BPS and it too is undermined as the focus is really 'psycho'. They acknowledge that there is a social component but then go on to treat it like it was psychological because CBT does not treat the very real social ills that may be a part of very (in the situation) adaptive functioning.

What is done -- and why I detest the use of CBT--is the person is asked to adjust to an ill situation which removes all culpability on the part of the social structure around them to improve. Now sometimes--especially in the short term--this needs to be done but one could argue that this has already been accomplished if perhaps not perfectly. But nobodies perfect. And people adapt to the best of their abilities.

A person faced with helping someone needs to come to the conclusion that other issues are involved and that lobbying hard to change those factors--while more difficult than admin'ing a little CBT is nevertheless necessary for a better outcome.

And although the word is bandied about and a hot button one might even entertain the idea that to expect people to adapt so thoroughly to their situ is just a little bit fascist. I know that employers of CBT are using it in a limited sense --what they would view as discreet specific corrections but since they are employing them on people not objects --like rearranging furniture-- I think it's fair to say that at least some of the offending behaviours will be tied up in issues outside of the persons control. To apply CBT to 'fix' their thinking is offensive. It's geared to having them think as if their lives were very much like the people behind the ideology that underpins the 'fixed' responses. What I mean specifically by that is "We are not ill and we hypothesize that if we were we would not behave so' and so on. 'We are not in situ 'x' but if we were we would behave. . . it has the potential of easily overstepping what a person might in fact need by way of adjusted thinking.


Has any of the Chalder crowd explained why people who used to be active are now supposedly afraid to be active? People expect exercise to be tiring; they don't expect it to flatten them. It's as if we're not fully competant adults and don't have years of experience in what's normal or not normal. It's a variety of patronizing infantilization.

Exactly. I've said it before--it is very patronising. And with the application of CBT there is little to no room for debating the fundamental points--one can discuss them--but only in the context of how to get to applying them.

In my opinion there is little use for CBT. Occasionally someone will benefit by finding something they had not thought to do in a situ but unless they are completely alone with no one else to turn to (I realise that this applies at times to us) adapting to the vagaries of life and learning to cope as best we can is best done in the security of a established good relationship where there is continued support. The kind of therapy offered by CBT is in no way special enough to warrant it's use as the way to deal with these issues.

And if someone is alone how much better for a service to function with the mandate to create stronger community ties for shut-ins. Money better spent.

Although nothing is quite so cheap as CBT.
 

SilverbladeTE

Senior Member
Messages
3,043
Location
Somewhere near Glasgow, Scotland
Chalder and colleagues have argued that CFS is exercise phobia. As usual their statements are vague but they do seem to think that it's at least a big component.

'Fear of exercise' is biggest barrier to chronic fatigue syndrome recovery
http://www.medicalnewstoday.com/articles/287972.php

Side question: can CBT cure phobia of reading biomedical literature? Or is that less phobia and more willful ignorance?
I used to have 3/4 weight training riutine, martial arts, walked the dog couple of miles a day and WALKED everywhere except going to Glasgow
I used to wear out a pair of boots every 3 months or so

Fear of exercise?
More like fear of feeling like hearing another oxygen thief spout such imbecilic balony my head will explode from being near someone so dense they become a frikkin gravitational collapsar!

Seriously, where do they get thse numbnuts?
Oxbutt University for the Chronically inbred?
Acetone Old Peculiar Uni, home of the Glue Sniffers Cricket and ferret lickers club?
Magdalene College for the Twisted Mullet Lovers?

:p
 

msf

Senior Member
Messages
3,650
Can someone please get a journal to publish an article with the title: ´an IQ of 75 is biggest barrier to Chalder discovery´?
 

A.B.

Senior Member
Messages
3,780
Which phobia produces symptoms for 24 hours or longer after exposure to the object of fear has ended but not during or in anticipation of the exposure? It's like these people are making an extreme effort to avoid checking the validity of their own ideas, and unfortunately they seem to be very good at it.
 

msf

Senior Member
Messages
3,650
Exactly!

Until recently, GET seemed to me to be a disguised version of exposure therapy. I suspect that was why they were more cavalier about ignoring physical symptoms while doing it. That is what I had to do when I had CBT and exposure therapy.

I have an easy way to test the hypothesis of exercise phobia. Strap Snow Leopard and Myself and others like us into "Lie Detector" equipment. Interview us while we watch a film to do with our phobia, "Dentists at work", "A Day at the Blood Blank", "Top 10 Spider attacks", "World's Deadliest Snakes". "Highest Bridges In The World", etc etc.

Then interview us while we watch a film of the Tour de France, on the most brutal climbs, with the greatest amount of rider suffering you can find. (Or similar)

Then compare the measurements.

I can tell you that no amount of inducement would get me to watch anything about needles or spiders, yet I watch the Tour de France, every year, for fun.

This is a sign that you think you need drugs to help you exercise.

JK.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
Which phobia produces symptoms for 24 hours or longer after exposure to the object of fear has ended but not during or in anticipation of the exposure? It's like these people are making an extreme effort to avoid checking the validity of their own ideas, and unfortunately they seem to be very good at it.
As I said elsewhere, failure to ground hypotheses in evidence and designing studies to avoid such evidence is indicative of pseudoscience.
 

SilverbladeTE

Senior Member
Messages
3,043
Location
Somewhere near Glasgow, Scotland
As I said elsewhere, failure to ground hypotheses in evidence and designing studies to avoid such evidence is indicative of pseudoscience.

actually I'd say it is indicative of deliberate fraud

if it's not actual evidence based, it's not science
if you know it's not science, it's done for personal advancement of some kind
if personal advancement put patients' lives at risk, it's serious criminality
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
There is just too much contrary evidence at this point for 'experts' to not see, imo. It's unconscionable and unacceptable.
We have this myth that people are rational creatures. It underpins much of economic theory for example. Yet the evidence shows otherwise.

To prove deliberate fraud etc. requires evidence. We may now have that for PACE, but I am unaware of anyone pursuing this currently. If my brain were working better I would be pursuing that angle.

I suspect most cases of fraud are people fooling themselves, though deliberate scientific fraud is often found. Take a typical charlatan offering a quack treatment. Sure, many will be deliberately misrepresenting, but I think many cases are from doctors or others who find something they think works, and are blind to contrary evidence because they become committed to their belief. They focus on apparent successes, and ignore failures, and surround themselves with True Believers, i.e. patients who think they have been helped.

Small schools within psychiatry sometimes follow that path.

I am also concerned that along with citation circles we need to be concerned with review circles. If only True Believers review their papers then they could all be published regardless of genuine merit.

In the case of low grade psychiatry we have a long history of nonscience, pseudoscience, and psychobabble. Psychiatry, more than any other professional discipline, needs to clean up its act. Major systemic methodological flaws basically guarantee bad science at best for much of psychiatry, and fraud at worst. Either psychiatry is scientific or it isn't. Under a scientific claim almost all diagnoses vanish because very very few are provably well founded.

There is a move afoot in the US, NIMH I think, to completely revamp diagnostic criteria, essentially starting from scratch. There needs to be a movement to switch to objective evidence and rigorous scientific methodology. If I were being treated for a psychiatric disorder I would want objective and indisputable positive outcomes in the literature. Psychiatry systematically fails to deliver those. The problem is that most of psychiatry would be under threat if that happened, as most of it is either unscientific or of dubious scientific providence, and so there could be expected to be massive systemic resistance from psychiatrists.

Psychiatrists are not immune to becoming self-deluding.