Review: 'Through the Shadowlands’ describes Julie Rehmeyer's ME/CFS Odyssey
I should note at the outset that this review is based on an audio version of the galleys and the epilogue from the finished work. Julie Rehmeyer sent me the final version as a PDF, but for some reason my text to voice software (Kurzweil) had issues with it. I understand that it is...
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Daniels: A Novel Approach to Treating CFS and Co-morbid Health Anxiety: A Case Study

Discussion in 'Latest ME/CFS Research' started by mango, Oct 8, 2016.

  1. mango

    mango Senior Member

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    A Novel Approach to Treating CFS and Co-morbid Health Anxiety: A Case Study

    Daniels J
    1,2, Loades ME 3.

    Author information
    1 Department of Psychology, University of Bath, Bath, UK.
    2 Bristol Chronic Fatigue Syndrome/ME Service, Southmead Hospital, Bristol, UK.
    3 Department of Psychology, University of Bath, Bath, UK.

    Clin Psychol Psychother. 2016 Oct 6. doi: 10.1002/cpp.2042. [Epub ahead of print]

    Abstract

    OBJECTIVES:
    Chronic Fatigue Syndrome (CFS) is a debilitating condition that affects 0.2-0.4% of the population. First-line treatments are Cognitive Behaviour Therapy or graded exercise therapy; however, these treatments yield only moderate effect sizes.

    Emerging research suggests that anxiety about health may be common in CFS. Health anxiety treatment models demonstrate good therapeutic outcomes; however, these models have yet to be applied to CFS.

    This paper describes the application of a novel cognitive behavioural approach to the treatment of both physical and anxiety related symptoms in a patient with CFS and, furthermore, presents a conceptual hypothesis regarding the mutually maintaining relationship between these two co-occurring conditions.

    DESIGN:
    A single-case design was used, with pre-data, post-data and follow-up data. The cognitive behavioural model of health anxiety was adapted and delivered as an eight-session intervention. The intervention was driven by an individualized formulation developed collaboratively with the patient.

    RESULTS:
    The application of this approach generated reliable and clinically significant reductions in physical and psychological symptoms, which were maintained at 12-month follow-up. The participant no longer fulfilled the criteria for CFS or health anxiety following eight treatment sessions. The treatment approach was found to be agreeable to the patient. All treatment hypotheses were supported.

    CONCLUSIONS:
    An adapted cognitive behavioural approach to treating CFS and health anxiety yields positive results and shows promise for application to the broader CFS population. Copyright © 2016 John Wiley & Sons, Ltd.

    KEY PRACTITIONER MESSAGES:
    Chronic Fatigue Syndrome (CFS) is a debilitating condition that is difficult to treat successfully; first-line recommended treatments achieve only moderate effect sizes. Anxiety, particularly about health, is reported to be common in CFS. However, anxiety is not specifically targeted within treatment and may negatively influence outcome due to the potentially mutually maintaining nature of these complex conditions.

    The present study demonstrates that an integrated treatment approach designed to encompass physical and psychological symptoms yields reliable and clinically significant outcomes in 50% of time recommend for first line treatments. Results reflected non-case level status for both CFS and health anxiety at end of treatment, in addition to reductions across all clinical measures.

    This study demonstrates the fundamental importance of an individualized, rather than generic, treatment approach to complex cases; the 'meaning' of experience is a central tenet within a cognitive approach that should be reflected in treatment.

    KEYWORDS: CFS/ME; Chronic Fatigue Syndrome; Cognitive Behaviour Therapy; health anxiety

    https://www.ncbi.nlm.nih.gov/pubmed/27714891
     
  2. Valentijn

    Valentijn Senior Member

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    Back to case studies ... quite an unusual sort of progress :p
     
  3. RogerBlack

    RogerBlack Senior Member

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    It quite surprises me that it took three people to write this.
    Need we ask if they'd have published if they had a negative result, and perhaps even if they have other patients that did not meet this that they have silently elided when writing this up as they did not fit the criteria?

    Peer review?
    Are case reports actually peer reviewed at all. Then again, it is a psych journal.
     
    Last edited: Oct 8, 2016
  4. flybro

    flybro Senior Member

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    pluto
    gggrrrrrr and MEGA slappy slap slaps
     
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  5. Woolie

    Woolie Senior Member

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    Haha, health anxiety. Which is of course, worrying about your health to a degree considered excessive by your doctor or therapist.

    And of course, you can bet they're going to think our worries are excessive, since we don't even have an actual physical disease.

    Its very circular, the concept of health anxiety, as its about worry relative to severity, as perceived by the practitioner. If you have RA or epilepsy, the worry is normal - you have a "real" illness and it is natural to be concerned.

    Its also worth pointing out that worry is likely to be lessened if you have a health professional who understands your condition, can explain symptoms, can offer treatments that help, and can guide you through the fears and concerns you may have. Many of us have none of that. We walk alone.

    You've got to hand it to these kind of researchers. They argue:
    1. Some CFS people are really worried about their health
    2. But there's no need to address the content of their worries - no! We can simply "train" them to stop worrying.

    It reminds me of an old CBT story. Patient says to therapist, "I'm 80, my life partner died last year, I am sick and cannot get out of the house, do the things I enjoy doing, I have no money except my pension, few friends or relatives left alive, and life just doesn't really offer me much joy any more.

    The therapist - who is 32, grew up in a nice suburb, with wonderful family, had the best of educational opportunities, has a partner and children, plenty of money and friends and a great job - says "Hmmm, the problem is that you are thinking too negatively about your life. You need to reframe your thinking to focus on the positives!"
     
    Last edited: Oct 8, 2016
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  6. Woolie

    Woolie Senior Member

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    Also worth pointing out that this research is not just about reducing anxiety. They hope that in doing so, they will help patients recover. They explicitly state that they beleive the anxiety "perpetuates" the illness. Its clear they have a strong belief in psychosocial explanations of CFS.
     
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  7. daisybell

    daisybell Senior Member

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    No surprise given the authors are from Bath and Bristol.....
     
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  8. Art Vandelay

    Art Vandelay Senior Member

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    What's next? "Publishing" testimonials of their quack cures on Youtube and claiming that this is credible science? Oh, I forget, some pseudoscientist has already done that.
     
    Last edited: Oct 9, 2016
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  9. taniaaust1

    taniaaust1 Senior Member

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    nods Im worried that we may suddenly find a heap of psych studies headed in this direction seeing the CBT and GET are being proven not to work. Those psych people (with insurance company connections) arent going to give up and are just going to keep wasting money on psych research. So I find this latest direction to things disturbing. Everytime one psych myth is disproven, they can start up another and keep doing this
     
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  10. Snow Leopard

    Snow Leopard Hibernating

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    Measures: (entirely self-report)
    Chalder Fatigue Scale
    Visual Analogue Scale
    Self-efficacy Questionnaire
    Hospital Anxiety and Depression Scale
    SF-36 Measure of Functioning
    Epworth Sleepiness Scale
    Health Anxiety Inventory

    The authors seem to fail to understand the difference between changing cognitions that leads to a change in how they answered the questionnaire which cannot be assumed to be the same as a change in underlying health. I'm not convinced this patient is any better health-wise, but simply they were more optimistic when answering the questionnaires. It is also possible that the patient simply improved spontaneously - this is why blinded control groups are used!!!!
     
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  11. Countrygirl

    Countrygirl Senior Member

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    Bath! ..............where ME children who have failed to recover in six months have been labelled with Pervasive Refusal Syndrome by a certain lady doctor we all know. :bang-head:
     
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  12. trishrhymes

    trishrhymes Senior Member

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    I can't believe they only tried this with one patient over a whole year. Which leads me to the completely unscientific hypothesis that they have cherry picked the one patient for whom the treatment worked!

    Is there any way of seeing the whole paper, not just the abstract? Questions like what diagnostic criteria were used, what were the actual figures for all their questionnaire results, did they pre specify recovery criteria?

    And why no objective measures? (let me guess....).

    This is not science. How on earth does it get published?
     
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  13. Sidereal

    Sidereal Senior Member

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    Was the patient off all benefits after treatment and restored to work capacity? Was his VO2max increased?
     
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  14. A.B.

    A.B. Senior Member

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    Somatisation is difficult to treat, let's not expect so much. :rolleyes:

    (this is a joke)
     
  15. alex3619

    alex3619 Senior Member

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    Quintessential quackery operates like this: test a whole lot of patients and report on the one or few apparent successes. Usually its done with testimonials, but case studies could work too.

    Objective outcomes are essential, not optional, if research like this is to be taken seriously. That also means we need to be sure the diagnostic protocol, with possible exclusions, was adequate. Further, a few cases or case series are just a step toward a controlled case series then a randomized clinical trial. They have value only if the obvious improvement is huge. In real life terms this means a full return to previous lifestyle, otherwise only a partial improvement can be claimed. If someone is fully restored they should be able to show it using a 2 day CPET protocol.
     
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  16. worldbackwards

    worldbackwards A unique snowflake

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    What exactly is so novel about telling someone that there's nothing wrong with them and not to worry their pretty little head about it? I had that years ago.
     
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  17. user9876

    user9876 Senior Member

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    No this looks like Bath university along with the old Frenchey CFS service which will have moved to southmead as they merged the hospitals and closed Frenchey (which I think was one of the PACE sites).
     
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  18. RogerBlack

    RogerBlack Senior Member

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    The case report (that is, in general, not this one) is a valid and important bit of medicine.
    https://www.ncbi.nlm.nih.gov/pubmed/27718438 - for example.
    This raises concern about not finding fast injuries from bone fragments in the bladder during accidents.
    https://www.ncbi.nlm.nih.gov/pubmed/27718333 Or an unusual way to treat a metastatic eye tumor that as I understand might normally lead to loss of the eye.

    Writing up your case report as if it was a clinical trial, and worse using inappropriate measures is science not worthy of shampoo commercial 'science bits'.
     
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  19. Ysabelle-S

    Ysabelle-S Highly Vexatious

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    More claptrap. And the rubbish Chalder Scale again? ME patients would worry less if all funding to psychology and psychiatry was cut off and redirected to appropriate areas of science and medicine. ME patients have died, or become paralysed and bedridden, unable to swallow, yet these 'researchers' have the audacity to talk about anxiety.

    This paper should have been titled, "A not so novel approach to quackery." The standard of psychological research in the UK really is abysmal. Also, if they followed one patient, how did they know that person had real ME/cfs? Is it another case of someone with an undiagnosed condition with fatigue who has found themselves with a CFS label? And how did they determine they no longer fitted the criteria at the end of the treatment? What measure did they use there?

    These people probably don't read biomedical research papers.They're so clever, they don't have to.
     
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  20. RogerBlack

    RogerBlack Senior Member

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    The damn shame of it is CBT probably can help some CFS people with their anxiety and sleep. And indeed in some people reducing those may help their symptoms as it's removing a large stress.

    But, with CBT aiming at a complete cure - no.
     
    Jan likes this.

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