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Harvey and Wessely's (bio)psychosocial model versus a bio(psychosocial) model

Discussion in 'Latest ME/CFS Research' started by Frank, Jun 15, 2010.

  1. Frank

    Frank Senior Member

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    Chronic fatigue syndrome: Harvey and Wessely's (bio)psychosocial model versus a bio(psychosocial) model based on inflammatory and oxidative and nitrosative stress pathways

    Michael Maes and Frank NM Twisk
    BMC Medicine 2010, 8:35doi:10.1186/1741-7015-8-35

    Published: 15 June 2010
    Abstract (provisional)

    Background

    In a recently published paper, Harvey and Wessely put forward a 'biopsychosocial' explanatory model for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is proposed to be applicable to (chronic) fatigue even when apparent medical causes are present.
    Methods

    Here, we review the model proposed by Harvey and Wessely, which is the rationale for behaviourally oriented interventions, such as cognitive behaviour therapy (CBT) and graded exercise therapy (GET), and compare this model with a biological model, in which inflammatory, immune, oxidative and nitrosative (IO&NS) pathways are key elements.
    Discussion

    Although human and animal studies have established that the pathophysiology of ME/CFS includes IO&NS pathways, these abnormalities are not included in the model proposed by Harvey and Wessely. Activation of IO&NS pathways is known to induce fatigue and somatic (F&S) symptoms and can be induced or maintained by viral and bacterial infections, physical and psychosocial stressors, or organic disorders such as (auto)immune disorders. Studies have shown that ME/CFS and major depression are both clinical manifestations of shared IO&NS pathways, and that both disorders can be discriminated by specific symptoms and unshared or differentiating pathways. Interventions with CBT/GET are potentially harmful for many patients with ME/CFS, since the underlying pathophysiological abnormalities may be intensified by physical stressors.
    Conclusions

    In contrast to Harvey and Wessely's (bio)psychosocial model for ME/CFS a bio(psychosocial) model based upon IO&NS abnormalities is likely more appropriate to this complex disorder. In clinical practice, we suggest physicians should also explore the IO&NS pathophysiology by applying laboratory tests that examine the pathways involved.


    http://www.biomedcentral.com/1741-7015/8/35

    thankyou Frank Twisk for reporting this
    alex3619 likes this.
  2. Marco

    Marco Old blackguard

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    The full article is available as a provisional PDF and is well worth reading.

    Excellent stuff.

    My only gripe is that the authors use terms like probably, possibly, likely etc much too often whereas psychiatrists have no problems firmly stating the existence of processes such as somatization which can be neither experimentally demonstrated nor refuted.

    Where there is evidence of organic pathology, this stands on its own and needs no qualification.

    As the paper stands it seems to present, to the uncommited reader, the biological and psychosocial models as having comparable merit.
  3. Dolphin

    Dolphin Senior Member

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    Useful to hear others' thoughts and their overall impressions as I can get lost sometimes in the minutia of papers.

    I read the pre-publication history.
    The reviewers, particularly James Jones (CDC), were very tough on them. They were worn down a bit by them I think. I think at one stage they were criticised for being too definite.
  4. Marco

    Marco Old blackguard

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    Dolphin

    Thank you.

    I was unaware of the pre publication comments. They make interesting reading. I'll have to follow them up.

    Marco
  5. Dolphin

    Dolphin Senior Member

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    Thanks.
    When you know the doctor/researcher they can be particularly interesting. I'm interested in James Jones of the CDC so his set was interesting enough. Didn't know the other two.

    Just a little warning that the Twisk and Maes responses were a bit hard to follow at least where they put in new stuff and also a bit long. Sometimes it's a bit less work to read them.

    Just want to encourage people to keep an eye out for them (pre-publication history) in future as I've seen some interesting stuff in recent years.
  6. richvank

    richvank Senior Member

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    Hi, all.

    For what it's worth, I think that Maes and Twisk have included nearly all the factors that are important in producing onset of the various cases of CFS: genetic polymorphisms and a variety of stressors, including biological (viral and bacterial infections), physical stress, and psychological stress. However, they did omit chemical toxins, which I think are important in some of the cases. In the pathophysiology, they include the problems with the immune system and the gut, and they also include oxidative and nitrosative stress, depletion of antioxidants, and mito dysfunction. I'm happy to see this paper as a counter to the Harvey/Wessely paper, though I don't think that they have fully grasped the biochemical issues underlying the problems they described or linked them together in an accurate cause and effect tree. If anyone is interested in what I mean by that, you can explore the Glutathione Depletion--Methylation Cycle Block hypothesis at www.cfsresearch.org

    Best regards,

    Rich
  7. Dolphin

    Dolphin Senior Member

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    Thanks for that, Rich.

    Not sure if you know but with BMC journals like that, one can post comments. They are quite prominent as the articles are only read online (i.e. there isn't a print edition). These don't have to be formal replies - a few lines can do. Probably if somebody went off on a complete off-topic rant about something they wouldn't publish it but generally they put lots of things up. And guessing from the way you write, that they would put up whatever you wrote.

    So you could post something like what you just posted (no harm to keep in a bit of praise, I reckon).
  8. franktwisk

    franktwisk

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    Critique on the (bio)psychosocial model of Harvey and Wessely

    We were frustrated by BMC and our peer form the CDC in many ways.

    We were not allowed to use animal-like metaphors.
    We were not allowed to use very clear statements
    (we substantiate why Harvey and Wessely's (bio)psychosocial model is invalid).
    Our text was censored.
    etc.

    Wessely and Harvey were allowed to assert their opinion without substantiating anything and
    we had to formulate our view (backed up by numerous studies) in a very political way.

    Despite that the final version is satisfactory (we hope).

    Who said science is not political?

    Frank
    alex3619 likes this.
  9. shrewsbury

    shrewsbury member

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    Frank,

    Quite satisfactory I'd say.

    Thank you for becoming such a great politician. We so desparately need heroes like you (now no blushing) who will work their way through the morass to get substantiated opinions published.

    Especially now when it seems the psychs are creating all sorts of fluffy paper in an avalanch of publishing to try to substantiate their attempts to get ME/CFS reclassified in the DSM-5
  10. Sean

    Sean Senior Member

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    Seems to be the basic pattern over the years. If Wessely (or one of his like minded colleagues) pronounce it to be so, then it is largely accepted without serious question, no matter how speculative, selective and untestable it is. There is an obvious double standard operating here.
  11. Dolphin

    Dolphin Senior Member

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    Technically, an invited editorial often/usually doesn't go through peer review. But the focus then is who is getting chosen to do the editorials and why. With the British Medical Journal, for example, they have chosen over the last 15-20 years a collection of psychiatrists and others with similar "hardline" views.
  12. Marco

    Marco Old blackguard

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    Thank you so much for the explanation Frank.

    I'm sure we would all be very interested in reading an earlier version or an alternative version not subject to BMC restrictions.
  13. judderwocky

    judderwocky Senior Member

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    Ill just jump in here... I don't consider Pyschology an actual science. As a physics major in college, I know a number of real scientists that agree with me. Qualitative =/= Quantitative. Its more akin to mysticism... something like astrology. Generally they create overarching categories that are vaguely defined in terms of one another, and are generally applicable to any individual based on the interpretation of an observer. To be included in a category, one must only exhibit a certain number of the symptoms - the patient is ultmately pegged to a particular "disorder" because they share a subset of symptoms. They rationalize this by attempting to credit the methodology with which they "arrive" at a diagnosis. Each disorder ends up becoming an internally defined method of operation that is itself non-exclusionary towards other similar observational sets - A set of aggregate symptoms that is itself relative and unfixed. The person is essentially tailored to specific disorders which are naturally completely alien to their own personality. I find the entire terminology "social" science offensive to anybody that has taken any math class. In all cases they start with assumptions that other disease categories are inherently accurate. The only other group that I know of that can get away with this science, is the "creation" science crowd.

    Of course that's not to say it isn't helpful.... pastoral counselling can be very effective in helping people. But its not science.

    I studied a lot of philosophy for my master's degree. Its much closer to religion/mysticism than anything.

    >:-[


    Ill put it this way. When i was in high school I underwent a lot of therapy to "fix" the fact that I was gay. The psychologists I went to were convinced that it was something that could be altered through a sort of specialized form of CBT. FAIL. We now have multiple studies showing the exact region of the brain that develops in either the "I like guys" or "I like girls" impulse. I'm also OCD. Psychologists are constantly trying to "fix" OCD by changing the behaviour. FAIL. The fear and biological malfunctions of the disorder remain. It turns out now, they can cure mice with OCD, by giving them bone marrow transplants. Turns out it has nothing to do with the cognitive processes under the patient can control. Its an immune disorder. Now we get to CFS and once again the same group of @## HATS is trying to tell me I need more of their useless TAROT readings and more of them sitting in a coffee coloured room talking about how I respond to x and y stimuli, and how I can make that more like Z if only i tried harder. I'm sorry, but after having seen this song and dance OVER AND OVER AND OVER again my entire life, and after failing to receive ANY positive benefit from it personally, I have decided that the only real benefit of therapy is having someone that is friendly, understands you, and can talk with you.

    I say this as someone who, IMO, has suffered readily at the hand of psychologists and who is basically sick of it. Give me ONE psychologist that has ANY Math skills, and I will immediately conjure from the same room, any colour UNICORN you request.

    So, where does this leave us with CFS? Psychologists pick up CURSORY understandings of biology and chemistry. They pick and choose the pieces of the other disciplines that allow them to further their own. They are quick to dismiss anything that doesn't fit their model, because they really don't understand any of the other stuff. As a personal observation, its often times the people that can't do science, but still want to, that pick the "soft" sciences.

    Sorry if this is offensive... but frankly physicists find the entire notion of "clinical" psychology laughable and offensive to those that actually do REAL science... and after having gone through roughly 12 total years of various forms of CBT, and now having a REAL science degree, I can easily see the BS.

    PS. I don't hate therapists. It might surprise you to know I have a degree in Theology, which required a lot of pastoral counselling classes on dealing with people who are going through a number of emotional and physical circumstances. I fully support people getting therapy. I just don't think it is a "science" the way you go about helping someone. Its an art form. That is an important distinction. Really helping somebody through their troubles involves creativity, wisdom, and insight. Three things that science has NEVER been able to quantify. It does a disservice to both disciplines in my mind to blend the two.
    beaverfury and alex3619 like this.
  14. thegodofpleasure

    thegodofpleasure Player in a Greek Tragedy

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    I too would really like to see your original version Frank.
    Many thanks for the work that you have done to help to redress the balance in favour of good science.
    We need more output from people like you, in order to counter the falsehoods that are peddled in the name of "medical research".

    TGOP
  15. Dolphin

    Dolphin Senior Member

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    Ellen Goudsmit for example thinks that editorial bias in some major medical journals e.g. BMJ, Lancet, etc. is one of the key core issues we face (because of the articles and editorials that get published or get turned down, etc). I tend to think she is right.
  16. Galena1

    Galena1

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  17. franktwisk

    franktwisk

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    Answer to shrewsbury

    Thanks for your nice words.

    I am neither a good politician (too impatient) nor a hero (don't have the superman appereance),
    but just a patient who wants to get the facts straight and proper medical care (like many others).
  18. Marco

    Marco Old blackguard

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    THanks Galena1.


    Isn't No 15 Manuscript the edited version that appears in the initial link?

    For those interested in this paper specifically, and the peer review process generally, the reviewers' and authors' comments make fascinating reading.
  19. franktwisk

    franktwisk

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    You can find previous versions here:
    http://www.biomedcentral.com/1741-7015/8/35/prepub

    The original version with animal metaphors, e.g. the original title
    ME/CFS: Zebra's, horses, lions and elephants are all considered and treated identical in The Animal Kingdom of Harvey and Wessely
    was rejected (arguments: "too personal", "unsubstantiated", etc.)

    Some quotes of the first "accepted" version:
    http://www.biomedcentral.com/imedia/1002694956331896_manuscript.pdf


    Title:
    The (bio)psychosocial model of Harvey and Wessely for "chronic fatigue syndrome" is incoherent and incomplete,
    while the proposed behavorially oriented intervention programs, i.e. cognitive behavioral/graded exercise therapy,
    cause 'iatrogenic harm' to many ME/CFS patients.

    ...

    Contrary to Harvey and Wessely we conclude that clinicians are morally obliged to examine inflammatory markers; O&NS-induced damage to fatty acids, proteins and DNA; lowered antioxidants; gut-derived inflammation; mitochondrial dysfunction; autoimmune reactions; infections; etc.

    ...

    Conclusions.
    Our findings invalidate Harvey and Wesselys psychosocial model for ME/CFS and substantiate why treatments based on this model are not effective and may be harmful for many ME/CFS patients.

    ...

    It is, therefore, incomprehensible that Harvey and Wessely include symptoms such as prolonged bed rest, one of the dependent variables, as an explanatory variable in the model, while the real explanatory variables, e.g. the aberrations in the IO&NS pathways and bacterial infections, are not included.

    Harvey and Wesselys model still unjustifiably incorporates the notion that personality factors, periodic overactivity, deconditioning, etc perpetuate the ME/CFS. However, the central elements of their (bio)psychosocial model and the Vercoulen model [2,20], including kinesiophobia and personality traits, have been disproved by research results [2,20].




    Maes and I disagreed on some sentences in the first accepted version, but this were minor issues.
    The major chances were enforced....


    Hope this satisfies your curiosity!

    Frank
  20. Marco

    Marco Old blackguard

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    Yes it does - thank you.

    Would anyone like to speculate why these documented immune pathologies are not more widely reported and accepted (and I mean not just by the usual suspects)?

    Seems to me that any discussion of ME/CFS should start from these findings rather than ill-defined fatigue.

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