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Inducing somatic symptoms in functional syndrome patients

Cheshire

Senior Member
Messages
1,129
Inducing somatic symptoms in functional syndrome patients: Effects of manipulating state negative affect.
Van Den Houte, Maaike MSc; Bogaerts, Katleen PhD; Van Diest, Ilse PhD; De Bie, Jozef MD; Persoons, Philippe MD, PhD; Van Oudenhove, Lukas MD, PhD; Van den Bergh, Omer PhD

Objective: Induction of negative affective states can enhance bodily symptoms in high habitual symptom reporters among healthy persons, and in patients with irritable bowel syndrome. The aim of this study was to replicate this effect in patients with fibromyalgia and chronic fatigue syndrome and to investigate the role of moderators, focusing on alexithymia, negative affectivity (NA) and absorption.

Methods: Patients with fibromyalgia and/or chronic fatigue syndrome (N=81) and healthy controls (HC, N=41) viewed series of neutral, positive and negative affective pictures. After every picture series, participants filled out a somatic symptom checklist and rated emotions experienced during the picture series on valence, arousal and perceived control.

Results: Patients reported more somatic symptoms after viewing negative pictures (least square mean (LSM) = 19.40, standard error (SE) = 0.50) compared to neutral (LSM = 17.59, SE = 0.42; p < 0.001) or positive (LSM = 17.04, SE = 0.41; p < 0.001) pictures, while somatic symptom ratings of HC after viewing negative picture series (LSM = 12.07, SE = 0.71) did not differ from ratings after viewing neutral (LSM = 11.07; SE = 0.59; p = 0.065) or positive (LSM = 11.10, SE = 0.58; p = 0.93) pictures. NA did not moderate the symptom-enhancing effect of negative affective pictures, whereas the alexithymia factor 'difficulty identifying feelings (DIF)' and absorption did (p = 0.016 and p = 0.006, respectively).

Conclusion: Negative affective states elicit elevated somatic symptom reports in patients suffering from fibromyalgia and/or chronic fatigue syndrome. This symptom-enhancing effect is greater in patients having higher difficulty to identify feelings and higher absorption scores. The results are discussed in a predictive coding framework of symptom perception.

http://sci-hub.cc/10.1097/PSY.0000000000000527

Not sure if it deserves its own thread, but I'd be curious to get your wise comments.
 
Messages
15,786
4 of the 81 FM and/or CFS patients had neither FM nor CFS :confused:

They used a lot of physiological measurements (heart rate, breathing, etc) but none of those varied compared to the controls, only responses to a single type of images. Basically patients with more symptoms were more upset by the "negative" category of pictures.
 

Demepivo

Dolores Abernathy
Messages
411
Are any of the authors collaborators with Esther Crawley or involved in the Dutch FITNET trial?
 

TakMak

Coughs and sneezles spread diseasels
Messages
24
Location
Cumbria, UK
They should also have looked at a third group of people - those with a chronic illness that even the authors accept as non psychosomatic such as MS or RA. I would have thought it obvious that people with any chronic illness are going to be a little more reactive than perfectly healthy people.
 

Sean

Senior Member
Messages
7,378
I would have thought it obvious that people with any chronic illness are going to be a little more reactive than perfectly healthy people.
Exactly.

Not to mention that, courtesy of the way the medical profession has long treated ME patients, the rates of iatrogenic PTSD are likely to be high, and further provoked and exacerbated by exactly this sort of circle-jerking research.
 

Hutan

Senior Member
Messages
1,099
Location
New Zealand
Of the 81 patients, only two met their criteria for having CFS alone. Around half met the criteria for having both CFS and fibromyalgia. Four patients didn't meet the criteria for having either CFS or fibromyalgia.

Because these four patients had a recent doctor-based diagnosis, they were not excluded from the study.

(I suspect that if these four patients had not helped swing the results in the direction the authors hoped for, they would have been excluded).

The authors comment on the higher rates of anxiety and depression in the patient group. These are described in Table 2 (which isn't shown in the draft). The healthy controls have no psychological issues.

Another issue is that the patient and control group differed inherently on variables such as medication use, and the presence of psychiatric illnesses such as depression and anxiety disorders. This is inevitable when recruiting a patient group representative of the FMS/CFS population, but it may complicate the interpretation of the results.
 
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Hutan

Senior Member
Messages
1,099
Location
New Zealand
Despite the messy sample, confounded by depression and anxiety,

In contrast to our expectations, the group x picture category interaction effect did not reach significance, suggesting an equal effect of negative mood on symptom reporting for patients and HC.

Yep, they found no significant difference between the healthy controls and the patients on the impact of the nature of the pictures on number of symptoms reported. !!

But they want a positive result, so they did some 'follow-up analyses'.

However, the interpretation of this interaction effect is complicated by the unbalanced design. Follow-up analyses indicated that the effect of picture category on symptom reporting was significant in the patient group but not in the healthy control group, confirming our first two hypotheses.

The unbalanced design refers to the fact that they had more patients than controls.

I'd like to hear from our experts in statistical analysis about what was done.
 
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Orla

Senior Member
Messages
708
Location
Ireland
Confession time

I studied psychology in my first year at college (I was doing an arts degree and this was one of my first year subjects). The third year psychology students would do research projects and would sometimes ask other psychology students to volunteer as guinea pigs on their studies.

I was a guinea pig for a few of them. It was fun to do them. One of them was on about colours and mood, I think whether colours affected mood, or something like that.

So we were given sheets of paper with different colours and we were meant to say if, and what, mood it would induce in us. I am pretty sure this was what she was actually testing, and not something else that she was "hiding" from us (sometimes they lie as to tell you what they are looking for can affect the subjects behaviour).

There was a major design flaw in how the student was running this study as as far as I can remember a few of us were in the same room looking at the sheets at the same time, and could easily influence one another.

To be honest I didn't feel any mood from looking at the sheets (as why would I?), but I liked the person doing the study and didn't have the heart to tell her this, and potentially screw her study up, so I just pretended to feel a mood from the colours, and just suggested whatever mood I would have associated with a colour, say if I was reading or writing poetry e.g. a grey mood meaning not happy. :oops:

Don't shoot me, this wasn't going to be published or anything. :p But it has always made me question psychological studies where the subject knows, or has a very good idea, of what the therapist or researcher is looking for.

I've only read a bit of the study above but this stood out to me:

"After every picture series, participants rated the picture series on valence, arousal and perceived control using the SAM ratings scale, and filled out the symptom checklist. There was a one-minute break in between the ratings and the start of the new picture series After every picture series, participants rated the picture series on valence, arousal and perceived control using the SAM ratings scale, and filled out the symptom checklist."

Hmm sounds a bit too like the study I was in.

Edited to add, I did not have ME when I was in college.
 
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Snowdrop

Rebel without a biscuit
Messages
2,933
I would like PR to become a place where people know to come and evaluate whether it would be sensible/reasonable to volunteer their time and energy as lab rats for for a study.

Questions like what would the study be able to show (one way or the other) with confidence given the set-up? And many other things I can't presently think of.
 

Orla

Senior Member
Messages
708
Location
Ireland
Yeah I know sometimes some of the patient groups would be research they would advertise to patients, but of course there are always the crap groups who are happy to suck up to the psyches.
 
Messages
15,786
Honestly, this one's an obvious non-starter. It literally does not require having FM or CFS to be in the FM/CFS group. The results are completely irrelevant when the recruitment criteria they claim to be using are ignored to the extent that 5% of the patients can't be diagnosed.

They're trying to dodge that by calling it "Functional Syndrome", but they don't define that either, except to make the uncited claim that it includes CFS and FM.