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Process of CBT for CFS: Which perpetuating cognitions & behaviour changes related to fatigue reductn

Discussion in 'Latest ME/CFS Research' started by Dolphin, Jul 22, 2013.

  1. Dolphin

    Dolphin Senior Member

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    Possibly a minority interest.

    * I gave each sentence its own paragraph
  2. Dolphin

    Dolphin Senior Member

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    So improvements/reductions in fatigue aren't related to doing more. Given fatigue isn't an objective measure, this means all the fatigue reduction they have talked about over the years may not be that interesting - it may simply due to patients answering questionnaires differently.
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  3. Firestormm

    Firestormm Senior Member

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    Taken at face value and without reading the full crap paper:

    I actually think this is good. Good because - if considered applicable to all CBT - it does reveal it's true nature. CBT does not 'treat' any disease. It enables some to better live with their condition.

    You are not asking a patient: are you recovered? In the sense that any normal person would understand the word 'recover'. You are asking a patient: do you think less about your condition now? Do you stress less about your symptoms etc.

    In other words CBT attempt to help patients reach an accommodation with their condition. If and when actual treatments come on line i.e. drugs; the reliance on CBT and any form of graded activity will diminish.

    The whole problem with these therapies is the lack of bloody honesty. I am fed up thinking about the damn things.
    Sean likes this.
  4. Dolphin

    Dolphin Senior Member

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    Unfortunately, I'm not sure how praiseworthy this group are. They believe the aim of CBT should be recovery.

    The manual is available here: https://listserv.nodak.edu/cgi-bin/...CO-CURE&P=R1774&I=-3&d=No Match;Match;Matches

    Here's an extract:


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  5. peggy-sue

    peggy-sue

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    I see it comes from an "expert" centre. I've already used this definition today, but will go public with it now.:p
    ex = a has been
    spurt = what comes from a pipe with a big leak
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  6. Sean

    Sean Senior Member

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    Translation: You are psychopathological if you do, and also if you don't. Only the therapist knows which is which, and they are always right, even when they are wrong.

    All this bullshit about 'negotiating goals', what a bunch of dishonest obscurantist crap, designed to give the appearance of patients being 'equal' partners in the process, while really just allowing the psychs to run the show and still pin blame for failure on the patient.
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  7. Dolphin

    Dolphin Senior Member

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    Also, with regard to dividing patients up into active and patients patients and over them different therapy, another group found this isn't so easy:



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  8. Firestormm

    Firestormm Senior Member

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    Thanks Dolphin. I read that interpretation of 'recovery' as being rather different to White and PACE. But it has been so long now since I read their manuals - but it does seem that even White has now acknowledged a difficulty exists in this area - though I still can't help but feel he and they expected much more from PACE than they got. You know I was surprised and oddly reassured with that explanation for the 6 minute walking test thing he provided in his letter. I always had the impression that PACE forced people to do things - but in this regard at least apparently not. And if people were left to walk for example at their own pace and the results were not worthy of inclusion - because they were less than satisfactory for recovery purposes - doesn't it add to the indictment that PACE was a disappointment? That they hadn't managed to convince PATIENTS of their recovery or if they had that this didn't translate into objective data.
  9. Bob

    Bob

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    How does this last sentence fit into the 'fear' and 'avoidance' of activity theories?

    Talk about Contradiction City!

    First they talk about patients being debilitated by anxiety, and then they say that relatively active patients tend to set themselves targets that are too high. Why would they do that if they were debilitated by anxiety?

    When they say that they set targets that are too high, what do they mean? Too high for what? Too high so that their ambitious targets cause their symptoms to flare up due to post-exertional malaise? Or are they trying to say that if you have 'deconditioning' then being ambitious about activity is counter-productive? What a load of bloody nonsense. (How long is deconditioning supposed to last if you set yourself ambitious targets every day?)

    There's clearly no anxiety or avoidance behaviour problems with those patients.
    The problem is that they suffer from persistent pain, malaise and exhaustion and their symptoms flare up in reaction to exertion.

    You would have thought that if someone was consistently over-ambitious, then deconditioning would not be a problem.
    But these ideologues can't accept that actually it's not deconditioning that's the problem with these patients, but it's a biomedical disease which has post-exertional malaise as a symptom, that is the problem.

    Rant over. Grrrrr.
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  10. Sean

    Sean Senior Member

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    Translation: We don't know shit.
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  11. Valentijn

    Valentijn Activity Level: 3

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    I think the explanation stems from some Nijmegen BS. To answer these questions, they have decreed that there must be two dysfunctional types of responses to psychosomatic deconditioning or whatever the hell they're assuming we have.

    One group is (too) passive, and one is (over-)active. The passive ones supposedly do too little due to fear, etc, and the active ones consistently do too much due to being obsessive perfectionist over-achievers :rolleyes:

    This is all pure speculation on their part, and conveniently ignores evidence of biological dysfunction, including actometer results in their own studies. They also don't seem to realize that by separating ME patients into two separate groups based on their type of "dysfunctional" reactions, they are essentially saying that there are two completely different (psychological) illnesses somehow arising in response to the same trigger.

    Basically they have had to back-peddle and re-invent their theories when various parts are proven wrong, resulting in ever stranger and less credible explanations. The active/passive dichotomy is just one more step along that dead-end path.
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  12. Bob

    Bob

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    Thanks for the explanation, Valentijn.

    So we have pathological fear and deconditioning whether we do too much or too little?!?
    How ridiculously convenient for them! :rolleyes:

    Like Sean said, we just can't get it right! They're going to pathologize our behaviour, whatever course of action we take.
    It seems like a very creepy approach to medicine.

    We can't possibly have a biomedical illness, with symptoms of exhaustion, pain, and post-exertional malaise, where some patients respond by pushing at their pain boundaries etc, and others respond by limiting their activities in order to reduce and modulate their symptoms. No, it absolutely has to be a behavioural disorder. A biomedical illness is not a possibility, despite the evidence. Ideology, ideology, ideology.

    (Sorry, I seem to be ranting a lot today!)

    Maybe there's some hope that their theories are slowly imploding!
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  13. Dolphin

    Dolphin Senior Member

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    This is something Fred Friedberg is good on and has written about which can be useful to quote: the deconditioning/fear avoidance model doesn't fit more mobile patients (he seems to be inclined to think it does fit, to some extent anyway, the more severely affected).
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  14. alex3619

    alex3619 Senior Member

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    Historically that is about what happens, again and again and again, and yet psychogenic medicine goes on, ignoring the lessons, the evidence and reason. Neurasthenia died about a century ago, yet was still lingering in London up to the end of WW2. Its still used in China, and Simon resurrected it to apply to ME. Hysteria has been discredited repeatedly, but refuses to go away, no matter how little evidence there is for it, nor how irrational their thinking has to be to diagnose it.

    Look at all the diseases that we now know are biomedical, not psychiatric, from gastrointestinal ulcers to diabetes and MS. Once they were "obviously" psychosomatic. Then the science advanced. Now only the most bold psychogenic theorists would want to claim diabetes, or lupus, or rheumatoid arthritis are psychiatric disorders. Gastric ulcers still have a few psychogenic hold-outs, but in time they will go the way of the dodo and nobody will remember them.

    The same will happen with ME. The question is: how soon, and how can we make it happen sooner?
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  15. SOC

    SOC Moderator and Senior Member

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    Has this group just published what we all know and have been saying for years about this illness -- there's no F-ing way to win with activity/exercise in ME/CFS?
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  16. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    Dear Psychoquacks (if I may be so familiar),

    Are you aware of different personality types? Are you aware that people with different personality-types can nevertheless get the same illnesses?

    Sincerely, but definitely not yours,

    MeSci
    Bob likes this.
  17. Snow Leopard

    Snow Leopard Senior Member

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    Got it in one. There is a commentary soon to be published in Clinical Psychology: Science and Practice on this topic too...
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  18. biophile

    biophile Places I'd rather be.

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    If a picture is worth 1000 words, this is what I want to say on the subject:

    [​IMG]
  19. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    I just hope you're right.
  20. Esther12

    Esther12 Senior Member

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    Has anyone read the full paper on this? It's always funny t watch them spinning the actigraphic data.
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