Persistent Physical Symptoms Reduction INtervention: a System Change & Evaluation (PRINCE Primary)

[A.B.]

The CBT that will be used is based on this paper by Dear, Chalder, Sharpe:

The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review

http://www.kcl.ac.uk/innovation/groups/projects/cfs/publications/assets/2007/deary.pdf

Some quotes

The sine qua non of any CBT model is a vicious circle, the hypothesis that a self perpetuating interaction between different domains maintains symptoms, distress and disability. Irrespective of the symptom type (as Allen, Escobar, Lehrer, Gara, & Woolfolk, 2002 , noted, none of the theories are organ specific), the CBT models of MUS, IBS and CFS propose a model of perpetuation that is, to borrow a term from systems theory and cell biology, autopoietic . “ Autopoiesis: the process whereby an organization produces itself. An autopoietic organization is an autonomous and self-maintaining unity ... The components, through their interaction, generate recursively the same network of processes which produced them ” Valera (2005) .

An innate tendency to somatopsychic distress and ease of distress sensitisation, combined with childhood adversity, increase both the amount of symptoms experienced and lowers the threshold for their detection. Life events and stress lead to physiological changes which produce more symptoms and set up processes of sensitisation and selective attention. This further reduces the threshold of symptom detection. Lack of explanation or advice increases anxiety, symptoms and symptom focus. Stress cues become associated with symptoms through classical conditioning. Avoidance of symptom provocation, and symptom-led activity patterns, lead to further sensitisation through operant conditioning. The prolonged stress of the illness experience itself further activates physiological mechanisms, producing more symptoms, sensitisation, selective attention and avoidance. The individual can thereby become locked into a vicious cycle of symptom maintenance

There are varying degrees of evidence for each of the components of this model. What is lacking is solid proof of their interaction in vicious circles, although all the models reviewed assume this interaction

What makes the CBT model so difficult to test may also be one of its chief strengths: it is in many ways a meta-model, providing a skeleton structure to join the dots of whatever factors each patient presents.

A model that can explain everything probably explains nothing.

 

[worldbackwards]

Ah PRINCE, the condition formerly known as........

If only this was the one that had died.

 

[worldbackwards]

If PRINCE were to change it's name to a symbol, what would it be?

 

[A.B.]

If PRINCE were to change it's name to a symbol, what would it be?

A meth crystal to symbolize the altered mental state of its authors? One where they think they just "know" the answer and come up with grandiose universal explanations for all unexplained physical symptoms.

 

[AndyPandy]

If PRINCE were to change it's name to a symbol, what would it be?

 

[BurnA]

The CBT that will be used is based on this paper by Dear, Chalder, Sharpe:

The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review

http://www.kcl.ac.uk/innovation/groups/projects/cfs/publications/assets/2007/deary.pdf

Some quotes

A model that can explain everything probably explains nothing.

What makes the CBT model so difficult to test may also be one of its chief strengths:

It's definitely a strength if it means you can spend your whole career testing it.

 

[Chrisb]

Remind me again, what was it someone said about a group of researchers not having the necessary skill sets?

 

[TiredSam]

From the slide:

Persistent physical symptoms Reduction INtervention: a system Change & Evaluation (PRINCE]

Not only is this the crappiest acronym ever, it also appears to have been made up in a hurry / panic, as whoever invented it couldn’t even decide whether they were using round or square brackets at the end.

I thought an acronym had to use the first letter of each word, but as usual the BPS brigade have re-invented the rules to suit themselves (now any letter from any word will do], and come up with some badly thought out rubbish that makes them look stupid but has the potential to cause considerable harm.

Whilst under the new rules there are still plenty of words it’s not possible to come up with (I would have liked to see a few ‘F’s in there, and perhaps a ‘W’], I think they could have done better. Some alternative suggestions for their next rebranding campaign:

persistent pHYSical sympToms reduction intERventIon: a system Change & evALuation (HYSTERICAL]

perSistent pHysicAl sympToms reduction interventiON: a system chAnGe & evaluAtIoN (SHAT ON AGAIN]

etc. there are other possibilities and I could play this game all day, but I think I’ll leave it there. How much time do these shysters think I have to do their job for them?

 

[alex3619]

The honest thing to do when faced with unexplained symptoms is to tell the person that you do not know what the cause is so have no idea what to do. Unfortunately some medical professionals feel threatened by having to be so honest. One of them said so at the RSM meeting we had last year.

Yes. This is the rational approach to uncertainty and lack of knowledge. Its honest. About the only other thing that can be said by the doctor is that they will work with the patient to try to manage symptoms.

 

[alex3619]

The sine qua non of any CBT model is a vicious circle, the hypothesis that a self perpetuating interaction between different domains maintains symptoms, distress and disability.

This is flat out false. CBT is about assisting managing and coping style. NOTHING requires it treat causal interaction. So it can help manage symptom distress, but it is not about managing what maintains those symptoms. In some cases it might help do that, which is as yet unproven, but its unlikely to be the vast majority of cases. Of course when they say CBT model they mean something that has a very different focus to CBT therapy itself.

Let me call their model what it is, an unproven hypothesis of dubious validity. They rest their claim on the supposed clinical outcomes of their approach, yet they fail to provide evidence of such outcomes and we know CBT claims are often shown invalid when objective measures are used.

Any such claim demonstrates bias. If they argued they were looking to improve quality of life, and only quality of life, there would not be so much criticism.

 

[worldbackwards]

New
Organisational
Training for the

Re
Evaluation of
Activity
Levels for
Life quality
Yearly progress

Significant
Intervention through
Cognitive
K - K - bugger

 

[chipmunk1]

Cognitive Behavioural Therapy Institute of Psychiatry, Department of Psychological Medicine, Cutcombe Road, London SE59RJ, UK

Wasn't that KCL Institute close or identical to the KCL Institute that assured smokers that smoking wouldn't cause cancer and that lung cancer was a "mental" illness?

How did that "medical" advice work out? Did they ever apologize to the families of the victims?

http://www.independent.co.uk/news/eysenck-took-pounds-800000-tobacco-funds-1361007.html

More "gems" from KCL stars:

http://www.amazon.com/IQ-argument-race-intelligence-education/dp/0912050160

 

[worldbackwards]

Cognitive
Health
Evaluation
Endpoint
Renewal

Unmasking
Priorities

(Yearly
Overview
Undertaking)

Basic
Upgrading of
General
Graded
Exercise
Rehabilitation
Strategies.

Nailed it!

 

[Comet]

I forget now... which one of us is the group with deeply ingrained systemic false illness beliefs?

 

[waiting]

New
Organisational
Training for the

Re
Evaluation of
Activity
Levels for
Life quality
Yearly progress

Significant
Intervention through
Cognitive
K - K - bugger

Significant
Intervention through
Cognitive
Kryptonite

Ok, kryptonite is a pretty tenuous (slang) term, but it kind of fits. THEIR version of CBT, not the usual definition of it, causes PWME's cardinal symptom -- PEM (intense weakness (harm).).

A definition of kryptonite:
"The definition of kryptonite is Superman's ultimate weakness, or anything that causes someone's ultimate weakness."

http://www.yourdictionary.com/kryptonite

 

[Sean]

Let me call their model what it is, an unproven hypothesis of dubious validity.

I think we can go further than that after the results from their "definitive" PACE study, which clearly disproved their model.

Any such claim demonstrates bias. If they argued they were looking to improve quality of life, and only quality of life, there would not be so much criticism.

Agree. There is no in principle problem with helping patients better cope with chronic illness, as a secondary palliative treatment, to the extent that psych can currently do so.

Though the current generation of BPS psychs are not the ones who should be doing it as they are too invested in the current version of the BPS model.

 

[Little Bluestem]

(I'm still waiting for that trial of CBT for car engine problems). As long as the trial is designed so as to be unable to distinguish CBT brainwashing from genuine improvement.

I would be really impressed if they could brainwash someone into believing that their car was running properly.

 

[A.B.]

I would be really impressed if they could brainwash someone into believing that their car was running properly.

You just have to define "believing the car runs properly" as slight improvement on a questionnaire. If every week, a compassionate mechanic tells the car owner that these strange engine noises are perfectly normal and that there is nothing to worry about, I'm pretty sure that will result in a shift in questionnaire answers towards the desired results.

 

[Little Bluestem]

it is in many ways a meta-model, providing a skeleton structure to join the dots of whatever factors each patient presents.

Translation: Whatever factors each patient presents, we will cram them into our model.

 

[Little Bluestem]

How much time do these shysters think I have to do their job for them?

Especially since you have your Charite Saga to write. I think you pretty well nailed it with the second one anyway.