• 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.

Densham et al: Enhanced psychological flexibility and improved quality of life in CFS

mango

Senior Member
Messages
905
Enhanced psychological flexibility and improved quality of life in chronic fatigue syndrome/myalgic encephalomyelitis

Sarah Densham, Deborah Williams, Anne Johnson, Julie M. Turner-Cobb

DOI: http://dx.doi.org/10.1016/j.jpsychores.2016.07.009
Journal of Psychosomatic Research September 2016 Volume 88, Pages 42–47
Published Online: July 19, 2016

Highlights
* Interdisciplinary group treatment may improve quality of life in CFS/ME.
* Psychological Flexibility (PF) has applied utility in the treatment of CFS/ME.
* Changes in PF activity/occupational engagement suggest greatest benefit in CFS/ME.

Abstract

OBJECTIVE
Psychological Flexibility (PF) is a relatively new concept in physical health. It can be defined as an overarching process of being able to accept the presence of wanted/unwanted experiences, choosing whether to change or persist in behaviour in response to those experiences.

Associations between processes of PF and quality of life (QoL) have been found in long-term health conditions such as chronic pain, PF has not yet been applied to Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME).

METHODS
Changes in PF, fatigue severity and QoL were examined in one hundred and sixty-five patients with CFS/ME engaged in a six-week outpatient interdisciplinary group treatment programme. Participants were assessed using a series of self-report measures at the start of the start (T1) and end of a six-week programme (T2) and at six months follow up (T3).

RESULTS
Significant changes in PF and QoL were observed from pre-treatment (T1) to post treatment follow-up (T2 and T3); changes in fatigue severity were observed from T1 to T3 only. Controlling for fatigue severity, changes in the PF dimension of activity/occupational engagement were associated with improvement in QoL at six month follow up (T3) but not at six weeks post programme (T2).

CONCLUSION
Findings indicate an interdisciplinary group treatment approach for people with CFS/ME may be associated with improved QoL, processes of PF and fatigue severity, supporting a link between PF and long term health conditions. Results highlight links between PF and patient QoL in CFS/ME and the value of interdisciplinary treatment approaches in this patient population.

http://www.jpsychores.com/article/S0022-3999(16)30350-6/abstract
 

Research 1st

Severe ME, POTS & MCAS.
Messages
768
This thought insertion idea of overcoming CFS disabilities by restructuring cognitive processes by Densham et al, reads somewhat like religious text, because the treatment outcome proposed is based on a belief, by the therapist, that it works (there are no objective measures)!

So irrespective if you name a therapy for CFS: PF, or CBT, or GET, or Xyz, the outcome will be the same. Still, lets go through this quickly, regarding this 'new' idea of PF, based on a client ''accepting'' symptoms and thus altering their behavioral responses to it:

''Psychological Flexibility (PF) is a relatively new concept in physical health. It can be defined as an overarching process of being able to accept the presence of wanted/unwanted experiences, choosing whether to change or persist in behaviour in response to those experiences''.

Using the logic in the text box above, if you punch yourself in the face (not advised), it doesn't hurt because pain is just an experience you can chose to reject if you so wish. Pain in CFS is common, and so the pain in CFS (using PF) can also be ignored and clients no longer need to take Lyrica or have a morphine pump for their neurological disorders, that come with having CFS.

If this was true, boxing would be a non contact sport and we can safely administer hershey bars to diabetic sufferers, knowing that by not testing their blood glucose, it is safe to do so and to recommend this as an effetive therapy. Except that's not allowed for obvious reasons.

With CFS, there is should be no difference when it comes to therapeutic interventions based on faith (relgion of BPS). No one know what core disease CFS is, but they do no many with CFS have multiple co-morbid disorders. Ergo, even if CFS was psychological, the proposed therapy of 'Psychological Flexibility' FP, would not work, due to these other disorders (that CFS sufferers have), not responding to them.

E.g:

Chronic Migraine
Chronic dizzyness/vertigo
Dysautonomia/POTS
Allergies
Asthma
Arthritis
Endocrine disorders
PCOS
Cancer
Heart failure
Liver/Kidney problems
Chronic infections and inflammation.

This is the problem of psychology proposing therapies as being effective for CFS (with no objective scientific robust evidence), when inside CFS are many crippling chronic disorders, never mind the core disease itself (ME CFS), which is yet to be adequately researched, defined or aided with a single evidence based treatment.

A simple analogy would be this, even if CFS was entirely psychological no one could or would respond to the psychological therapies as the other disorders patients suffer with, aren't psychological and are often highly disabling.

Thus the proposed tool of PF, does NOT and could NOT treat CFS effectively, thus, the idea is silly and silliness should be associated to Science which is why Science, not psychology, requires hard evidence of a 'thing' actually being one, not an imagined one that might be one, because we think it is, without showing it is.

Amen.
 

ahmo

Senior Member
Messages
4,805
Location
Northcoast NSW, Australia
:bang-head: As if we're not daily dealing w/ psychological flexibility to yield reasonable Quality of Life.:mad:

OK, speak for myself: It's a rare day that I'm not stretching my psychological flexibility. For example, to not get into a state reading what idiots like this spend their time and someone's money on. Or, not going into disappointment that I can't go for a walk, again today, and fear that yes, my bones are probably dissolving because I can't exercise enough. And no, it never ends. That's why we don't all just top ourselves.
 
Messages
724
Location
Yorkshire, England
Psychological Flexibility (PF) is a relatively new concept in physical health. It can be defined as an overarching process of being able to accept the presence of wanted/unwanted experiences, choosing whether to change or persist in behaviour in response to those experiences.

New except for any mystical religion I have ever read about.
 

Dolphin

Senior Member
Messages
17,567
In accordance with previous research, PF was measured using items in the Chronic Pain Values Inventory (CPVI) [33], that assessed ‘success in value based living’. The CPVI wording was adapted to reflect the presence of fatigue as opposed to pain (recommended in the CPVI appendix).


https://www.researchgate.net/profil...ronic_pain/links/5617c93208ae88df90e01af5.pdf

Appendix A. CPVI

Many people with chronic pain find that their pain and other symptoms are barriers to engaging in activities that are personally important to them. These people have ‘‘VALUES’’ but they are not living according to their values.

For example, you may want to be a loving partner, a warm and supportive parent, a helpful and reliable friend, a person who keeps physically fit and able, or a person who is always learning new skills, but you may find yourself in circumstances where you are not living that way.

For each of the areas listed below consider how you most want to live your life. Then rate how IMPORTANT each domain is for you. This is NOT about how well you are doing in each area – it is about how important it is to you. Rate the importance you place in each domain using any number on the scale from 0 (not at all important) to 5 (very important). Each area need not be important to you – rate an area low if it is not important to you personally.

0 Not at all important
1 Slightly important
2 Somewhat important
3 Moderately important
4 Very important
5 Extremely important

Consider each area according to your values, the important ways that you most want to live your life in each domain

IMPORTANCE of this domain to you

1. Family: Participation in your relationships with your parents, children, other close relatives, people you live with, or whoever is your ‘‘family’’

2. Intimate relations: Being the kind of partner you want to be for your husband/wife or closest partner in life

3. Friends: Spending time with friends, doing what you need to maintain friendships, or providing help and support for others as a friend

4. Work: Engaging in whatever is your occupation, your job, volunteer work, community service, education, or your, work around your own home

5. Health: Keeping yourself fit, physically able, and healthy just as you would most want to do

6. Growth and learning: Learning new skills or gaining knowledge, or improving yourself as a person as you would most want

Appendix B. CPVI-continued

In this section, we want you to look at how much SUCCESS you have had in living according to your values. Many times when people have chronic pain they find it difficult to live their life as they want to live it.

For each of the areas of life listed below consider again how you most want to live your life. Then rate how SUCCESSFUL you have been living according your values during the past two weeks. These questions are NOT asking how successful you want to be but how successful you have been. Rate your success using any number on the scale from 0 (not at all successful) to 5 (very successful).

0 Not at all important
1 Slightly important
2 Somewhat important
3 Moderately important
4 Very important
5 Extremely important

Consider each area according to your values, the important ways that you most want to live your life in each domain

SUCCESS at living your values

1. Family: Participation in your relationships with your parents, children, other close relatives, people you live with, or whoever is your ‘‘family’’

2. Intimate relations. Being the kind of partner you want to be for your husband/wife or closest partner in life

3. Friends: Spending time with friends, doing what you need to maintain friendships, or providing help and support for others as a friend

4. Work: Engaging in whatever is your occupation, your job, volunteer work, community service, education, or your work around your own home

5. Health: Keeping yourself fit, physically able, and healthy just as you would most want to do

6. Growth and learning: Learning new skills or gaining knowledge, or improving yourself as a person as you would most want
 

Dolphin

Senior Member
Messages
17,567
PF was also measured using a previously adapted version of the Chronic Pain Acceptance Questionnaire (CPAQ) [33], the Fatigue Acceptance Questionnaire (FAQ) that replaces the word ‘pain’ with ‘fatigue’ [34]. The FAQ is made up of two subscales: ‘activity engagement’ reflects the pursuit of meaningful activities in the presence of fatigue; and ‘fatigue willingness’ reflects a relative absence of attempts to avoid or control fatigue. Separate scores from the two subscales were used to measure PF for the analyses in the present study.

From the cited paper:
(Lack of) Acceptance

The study used a slightly adapted version of the Chronic Pain Acceptance Questionnaire or CPAQ [34]. The original questionnaire is divided into two factors—activity engagement and pain willingness. For the purposes of this study, only the pain willingness subscale was used, and the word ‘pain’ was replaced with ‘fatigue’. The concept of willingness refers to the recognition that avoidance and control of pain are often not viable. So, fatigue willingness refers to feeling little need to attempt to avoid or control fatigue. Nine items, including statements such as “Keeping my fatigue level under control takes first priority whenever I'm doing something” and “I need to concentrate on getting rid of my fatigue” are scored on a 7-point Likert scale (where 0=‘never true’ and 6=‘always true’) so the higher the score, the higher the lack of acceptance. Cronbach's alpha was high in this study (.83).

https://www.researchgate.net/profil...-analysis-and-a-revised-assessment-method.pdf

Appendix. CPAQ

Directions: below you will find a list of statements. Please rate the truth of each statement as it applies to you. Use the following rating scale to make your choices. For instance, if you believe a statement is ‘Always True,’ you would write a 6 in the blank next to that statement

0 Never true
1 Very rarely true
2 Seldom true
3 Sometimes true
4 Often true
5 Almost always true
6 Always true

1. I am getting on with the business of living no matter what my level of pain is ………

2. My life is going well, even though I have chronic pain ………

3. It’s OK to experience pain ………

4. I would gladly sacrifice important things in my life to control this pain better ………

5. It’s not necessary for me to control my pain in order to handle my life well ………

6. Although things have changed, I am living a normal life despite my chronic pain ………

7. I need to concentrate on getting rid of my pain ………

8. There are many activities I do when I feel pain ………

9. I lead a full life even though I have chronic pain ………

10. Controlling pain is less important than any other goals in my life ………

11. My thoughts and feelings about pain must change before I can take important steps in my life ………

12. Despite the pain, I am now sticking to a certain course in my life ………

13. Keeping my pain level under control takes first priority whenever I’m doing something ………

14. Before I can make any serious plans, I have to get some control over my pain ………

15. When my pain increases, I can still take care of my responsibilities ………

16. I will have better control over my life if I can control my negative thoughts about pain ………

17. I avoid putting myself in situations where my pain might increase ………

18. My worries and fears about what pain will do to me are true ………

19. It’s a relief to realize that I don’t have to change my pain to get on with my life ………

20. I have to struggle to do things when I have pain ………

Scoring:

Activities engagement: Sum items 1, 2, 3, 5, 6, 8, 9, 10, 12, 15, 19.

Pain willingness: reverse score items 4, 7, 11, 13, 14, 16, 17, 18, 20 and sum.

Total: activity engagement + pain willingness
 
Last edited:

Dolphin

Senior Member
Messages
17,567
As the authors acknowledge in the limitations, this is an uncontrolled study so one doesn't know how what the results would have been for a group that did not receive any therapy.

-----

Here are the results on the conventional outcome measures. I'm not so familiar with the quality of life scale (particularly the scoring system used here) but the change in fatigue severity scores does not seem particularly impressive.

Fatigue severity
Pre intervention (T1): 6.02 (1.5)
Post intervention (6 weeks) (T2): 5.99 (1.6)
Post intervention 6 months (T3): 5.65* (1.86)

Quality of life
Pre intervention (T1): 0.21 (0.09)
Post intervention (6 weeks) (T2): 0.19* (0.11)
Post intervention 6 months (T3): 0.17** (0.1)

2.5. Fatigue severity

Average fatigue severity over the past week was assessed using a Visual Analogue Scale (VAS) employing a 0 (no fatigue) to 10 (worst possible fatigue) numerical rating scale. Sample items included “how fatigued are you right now?” and “how fatigued have you usually been this week?” The use of this measure was based on the clinical practice used by the service delivery team.

2.4. Quality of life

Perceived QoL was assessed using the Sickness Impact Profile (SIP) [35], a well established behaviourally based measure. It reflects perceived QoL in 12 areas of activity including home management, social interaction and emotional behaviour, comprising 136 statements in total. Items on the SIP are weighted to enable an overall score to be calculated that reflects physical and psychosocial dimensions accumulatively. Higher scores mean more functional disability, reflecting lower QoL. The SIP is frequently used in healthcare settings as a measure of QoL and has demonstrated good construct validity and internal consistency reliability (Cronbach's alpha = 0.92) [36].

SIP.png
 
Last edited:

Dolphin

Senior Member
Messages
17,567
Here are details of the therapy programme
The treatment programme adopted the recommendations of the UK NICE guidelines 2007 [4] for the treatment and management of CFS/ME. It employed the evidence base of cognitive behavioural therapy (CBT principles), an activity management approach (comparable to Graded Exercise Therapy), goal setting, relaxation techniques, communication skills and third wave CBT approaches, such as mindfulness, alongside pharmacological treatment delivered by the patient's GP if appropriate. Aspects of the treatment programme incorporated the facilitation of developing PF. The ethos of the programme was centred on the principles of occupational science [31,32], enabling an interdisciplinary and holistic approach to treatment with an emphasis on the importance of action/ doing for the individual. The interdisciplinary team comprised Occupational Therapists, Physiotherapists, and Practitioner Psychologists. Following individual tailored assessment the group treatment sessions were 2 h long, once a week, for 6 weeks,with one follow up group session held 6 months after the last session. Average group size comprised of eight patients.

Using data collected at initial assessment (pre-treatment/T1), at the end of the six week programme (post treatment/T2) and six months after the programme finished (six month follow up/T3) provided an investigation of PF over time, situating the research within the current evidence base for CFS/ME in adults [4].
As they say in the paper, they didn't specifically target "psychological flexibility".
 

ash0787

Senior Member
Messages
308
" Psychological Flexibility (PF) is a relatively new concept in physical health. "

Is it though ? or is it related to the concept of neuroplasticity ? which is possibly a facet of IQ,
the ability of the person to learn a variety of completely different skills, I mean there may be other factors
meaning people don't get the opportunity to try different things because they are tied to one job or possible social factors etc but perhaps its what separates geniuses from simple craftsman and merchants ?

If you think of a skill that you can't do and then what separates you from doing it, whats the difference in thought process / ability between someone that is successful at that skill and someone who isn't ... whats their exact methodology etc

For example I tried to learn how to draw and I found that I can copy something perfectly but trying to draw from imagination was very difficult, so I started to try and look for geometrical patterns in the things I wanted to draw, which might be useful, but I noticed that in general after a while I was naturally paying more attention to the shapes of objects and patterns in everything that I did, so in that sense the mind is reprogrammed temporarily.

So I guess in essence these researchers are questioning our IQ ? what grounds they think they have to do so, I don't know ... shall we compare talents with them ? based on the papers they produce I am not very intimidated ...