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Reliability of physiological, psychological & cognitive variables in CFS & role of graded exercise

Discussion in 'Latest ME/CFS Research' started by Dolphin, Jan 23, 2013.

  1. Dolphin

    Dolphin Senior Member

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    Free full text: http://www.jssm.org/vol4/n4/13/v4n4-13pdf.pdf

    I've just read the following. I think it's likely to only be of minority interest but might be of interest to people who are interested in scales, particularly the Chalder Fatigue Scale e.g. user9876 , Graham, maybe WillowJ, etc.



    *I've given each sentence its own paragraph
     
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  2. Dolphin

    Dolphin Senior Member

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    This paper should be confused with another title with a very similar title, with the same four authors and much of the same information (so very easy to mix up the two!):


     
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  3. WillowJ

    WillowJ Senior Member

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    thanks for tagging me, Dolphin :) I am interested in these, also in the bits on variation of fatigue.
     
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  4. Dolphin

    Dolphin Senior Member

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    I should say that Simon first highlighted this to me on the big PACE Trial thread, but I've only read the full paper just now.

    All I want to highlight is Table 1. Intraclass Correlation Coefficient (ICC) results at baseline and after interventions.

    These were based on scores taken over four weeks before the interventions and another set of scores taken four weeks after the intervention.

    Here is how they were analysing the data:

    The Chalder Fatigue Scale was scored 0-33 "Likert Scoring", broken down as 0-12 and 0-21 for mental and physical fatigue.

    The reason this might be interesting is if particular thresholds are used as outcome measures, a person might only reach that threshold temporarily. For example, those used for "improvement" and "fatigue in normal range" in the Lancet paper on the PACE Trial. Also, thresholds may be used in the upcoming recovery paper. If somebody's score can vary quite a bit, week by week, then it makes using a once-off score questionable. This is a particular problem if thresholds are not demanding.
     
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  5. Dolphin

    Dolphin Senior Member

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    (Less important, perhaps)
    They also say:
    Also, on a separate point:
    This has been described as pacing or paced exercise, rather than "graded exercise" which is about breaking vicious cycles of being under active due to symptoms (and so, one isn't supposed to reduce exercise due to symptoms).
     
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  6. user9876

    user9876 Senior Member

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    With the Chadler fatigue scale basically being a combination of at least two different thing (mental and physical fatigue) anything but separating these scores out is dishonest. Note that in their combination physical fatigue is weighted at roughtly twice that of mental fatigue hence a getting a small perceived decrease in physical fatigue accompanied with a bigger perceived increase in mental fatigue could lead to an improved score.

    I think their suggestion for repeat measure analysis is also important in that with fluctuations the timing of when a questionaire is completed is important. I think people will tend to fill out the questionaire when they have slightly more energy.
     
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  7. peggy-sue

    peggy-sue

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    I'm really not at all sure about seperating mental and physical. Surely, that is dualist!

    If seperation is to be done at all, surely the proper way to do it would be by dividing the body into functioning (or not!) systems.

    eg, digestive system, immune system, autonomic system, parasymathetic system, muscle systems and "cognitive" systems etc.

    But I do agree, several measures of functioning need to be taken, to take account of normal variability.
     
  8. user9876

    user9876 Senior Member

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    The point is that when you have a scale it needs to measure one thing otherwise its not really a scale. It may be that the mental and physical fatigue needs to be further subdivided. Scales can be constructed of combined concepts but this needs to be done explicitly - the EQ-5d scale does this for disabilty using a utility function with weights based on how society views different elements of disability.
     
  9. peggy-sue

    peggy-sue

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    I still think it is completely wrong to seperate "mental" and physical.
    It is a dualist position. It is unscientific. It is unjustified.

    Our problems are with energy, whether it is being supplied to the brain or elsewhere in the body.
    The brain is a physical organ. Probably the most complicated one we have, and it interacts with the rest of the body the whole time. You cannot seperate brain from body. (until after death)

    I do agree, scales should measure one thing only. :thumbsup:
    ergo, scales are a completely inappropriate tool.
     
  10. user9876

    user9876 Senior Member

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    As I would see it the body is a system which various things can be measured. For example, you can measure pulse rate, blood preasure and blood counts - you wouldn't give someone a measure where you add all the values together and they may vary indendantly even though they are part of the same system. It may even be that changes in each measure often correlate but not always hence they are measuring different things. Each measurement will say something about an aspect of the system.

    I see fatigue measurements in the same way. Although they are all labelled fatigue I would see mental and probably multiple aspects of physical fatigue as different aspects or effects from the bodies system.

    I've never understood this duelist argument I would agree with you that the brain is just another organ with the mind being the effect of the way the body works.
     
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  11. peggy-sue

    peggy-sue

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    The "mind" is merely an illusion of consciousness - it's just the easiest way for the brain to make things understandable in a simple way, in the same way as pain is the easiest way to get us to move away fast. :)
     
  12. alex3619

    alex3619 Senior Member

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    I basically agree with this though I put it differently. Mind is a description of an activity the brain performs. Its a process, not an object. The "conscious mind" is our reflective awareness of brain states, that assists with planning and reason. Its the brain watching itself. The "unconscious mind" is the rest of the brain and what it does, from regulating blood pressure to interpreting visual input. Its the part of the brain that is not accessible to rational monitoring. By rational I mean a process of the brain that acts on logic, reason, inference and words.

    Mind is a convenient label, not a reality. (I also think "psychogenic illnesses" are convenient labels, not reality.) However, its that very convenience that means it gets used. Its really a very complex process that emerges from the underlying brain architecture - its about as complex a process as we have ever studied.

    This position is called the monist position, as opposed to the dualist position on the mind/body problem.
     
  13. peggy-sue

    peggy-sue

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    Yes, Alex, but "logic, reasoning, inference and words" are all just parts of the "ongoing-mind-process". They come along AFTER the unconscious has already made the decisions.

    Emotion (and biological neccessity) rule everything. The "mind-process" is merely an afterthought in which we rationalise our behaviour to ourselves and others.
    "Free will" is an illusion too. I've got an easy test for anybody who thinks they have free will.
    Hold your breath until you become unconscious.

    One of the most interesting experiences I've had on this topic was in an argument I was having with Prof. Alan Kennedy (Dundee uni) while I was a student. He's a "cognitive scientist" and is into linguistics, although his degree qualifications were as a physicist.
    He is a dualist, he reckons psychology studies "the pure mind"; he does not subscribe to the notion that humans are just other animals. He really does have a whole load of belief systems which negate him from being any sort of scientist.
    However, he had difficulty in understanding my point of view that I do not have a mind, just a (highly individual) brain.
    (He thinks the brain is just the hardware the software of mind-programmes runs on.)

    As our conversation about "mind" versus brain (and the lack of importance of language - it's only a tiny wee bit of brain functioning) went on, he got angrier and angrier and angrier, he was spluttering and spitting feathers as I continued to argue my point, using evidence to back it up, calmly.

    He went absolutely purple and speechless when I pointed out to him the emotional state he'd got himself into!
    Ooooohhhhh - it was SO much fun, I really, really enjoyed that.:devil:

    This conversation was probably the reason he refused to let me do a PhD in that department - he told me "There are no lecturers suitably qualified to supervise you."
     
  14. Sean

    Sean Senior Member

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    The mind is what the brain does for a living.

    ;)
     
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  15. WillowJ

    WillowJ Senior Member

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    for those of us who haven't studied theory of mind in much depth, could you explain what the dualist position holds? Papers like to fuss about this and I'm not sure I understand what they are fussing about. Often I think the people who are doing the fussing are actually holding a dualist position (though they must not realize this themselves), but I am not altogether sure.
     
  16. Dolphin

    Dolphin Senior Member

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    I've heard people say that often when some psychiatrists and psychologists complain about dualism in CFS, their own position is dualist. However, I'm afraid I can't remember the reasoning at the moment.
     
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  17. alex3619

    alex3619 Senior Member

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    Warning: Philosophy Alert

    Hi Willow, I will try to answer your questions, though I am rusty on mind/body issues and find the position of many in BPS to be confusing - they claim to avoid dualism in theory while appearing to embrace it in practice.

    http://en.wikipedia.org/wiki/Mind–body_problem
    http://en.wikipedia.org/wiki/Dualism_(philosophy_of_mind)

    An even better discussion is here: http://www.simplypsychology.org/mindbodydebate.html
    "Definition: The mind is about mental processes, thought and consciousness. The body is about the physical aspects of the brain-neurons and how the brain is structured. The mind-body problem is about how these two interact."

    The basic tenet is that mind and body are two different things. It is never explained what the mind is, that is regarded as a mystery, but only that it has rules that are different to the body, it does different things. (Soul is something else again, and really has nothing to do with a mind/body discussion unless you equate soul with mind.)

    The mind is for thought, emotion, behaviour, the body is for action.The mind in turn is often considered divided into conscious and unconscious mind, though the expanations of what these are differ theory by theory. Rene Descartes tried to explain where consciousness fits with this, and is famous for saying (in Latin I think) "I think therefore I am" or "Cogito ergo sum". A more accurate translation is claimed to be: "I am thinking therefore I exist".

    Both the mind and the body can cause things to happen, though the explanations are very poor as to how this works. Its all about causality, what causes what. Psychoanalysis is all about mind, though for a while they played with ideas like ergone energy I think.

    Dualism argues that the mind is completely separate from the body, and either it has nothing to do with the body (the two run side by side) or that there is some (mystical) two way connection between body and mind. The interaction between mind and body is mysterious.

    In some modern psych -ology/-iatry they like to point out that the mind and body cannot be separated, and use this as an argument to show the mind can cause physical symptoms. Somehow though the discussion rarely gets around to the body causing psychiatric symptoms. Almost never does the discussion get around to the physical structure of the brain giving rise to the process that results in behaviour considered psychiatric, though there is work in depression, anxiety and PTSD aimed at examining this.

    In BPS they argue that biological (physical), psychological (mental), and social (system of minds in a physical world) factors work together to produce disease. They further argue the impact of the mind on this has been undervalued, and that biomedical research is overvalued. Social factors are important too but are discussed much less. The problem is that this model was intended for, and heavily embraced by, psychosomatic medicine. In practice they favour the mental side of things much more than the physical, and often dismiss or discredit the physical issues. Its why I call it bPs or bioPSYCHOsocial and so on.(I would also argue for BPSE, where E is the wider physical environment.)

    On the one hand the mind can cause disease, they argue, and because the are both the same thing (a claimed monist position, mind and body are one): its a rejection of dualism. However they then focus almost exclusively on the mind, essentially taking the view in practice that while the mind and body are one, its the mind that is really important. This is almost an Idealist position, which is one in which mind is everything. What it is in practice though is a variant dualist position. The mind and body are connected, the mind is a higher and more important factor, and the body is secondary. Deyz gotz a hamma, so deyz sure the nailz the most importent ting.

    The psychogenic hypothesis is that because psychosomatic illnesses have no detectable physical cause, therefore it must be psychological (mental). Its a fallacy. I have discussed this here: http://forums.phoenixrising.me/index.php?entries/the-witch-the-python-the-siren-and-the-bunny.1149/ This is all, in my opinion, vague mystical twaddle, which confuses rather than enhances understanding.

    Arguments along these lines, from dualism to psychosomatic medicine, are holdouts from the days of magic, alchemy and astrology. Its magical thinking given a modern day respectability largely because its traditional and still considered to be part of medicine. The rest of medicine gives it some respectability, as does the privilege medicine is given under law. BPS has its roots in some respectable ideas, but failed to develop these and advance. It could have transformed psychosomatic medicine into something scientific, but instead its driven psychosomatic medicine into dogma and pseudoscience, something I will be saying a lot more about in time.

    My own position is somewhere between a physicalist (there is only brain, sometimes called materialism) and neutral (brain action can be described as mind, though they are basically the same) monist. In reality I think the physicalist view is correct though I think it needs to differentiate between the object and its processes for full understanding, but the monist view has utility as a simplifying concept. I also reject the simplistic concept that the mind is analogous to software in the computer brain. Its a poor analogy. If I were to simplify my position excessively, I would say the mind is an emergent property of brain, its a process not a thing.

    In my view every psychiatric illness is a physical illness. The correct fields are neurology, neuro-immune etc. It gets murky though (and I am thinking about it) when involving false knowledge and beliefs, and maladaptive learned behaviour. This does not devalue talk therapy and general counselling if used appropriately. Indeed, it enhances their value in some ways, which I hope to talk about in my book. Talk therapy and counselling are tools, they do not of themselves prove the existence of psychogenic illness, nor can GET. The underlying hypotheses used in psychosomatic medicine are based on ancient mystical thinking, rhetoric and fallacies: nowhere are their psychogenic hypotheses tested. This is why its called nonscience.

    I hope I have not confused people further, or got anything too wrong. I might post more in a subsequent post, but I am busy today. Alex.
     
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  18. alex3619

    alex3619 Senior Member

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    Hi peggy-sue, I mostly agree with you. Not everything the brain does is unconscious though. We have consciousness for a reason: its the process in the brain that helps tie unconscious processes together. Its about reason, cause and effect, and how we deal with that. Its about word manipulation. Now words themselves are effectively just symbols, they have no meaning (but they do have definitions in a dictionary). Those words are connected in the brain to our neurologically encoded understanding of the world. When we manipulate those word symbols, the actual processing is unconscious, but we can still manipulate them consciously. Reason and logic are tools we use to manipulate those symbols.

    Thinking Fast and Slow discusses this in depth, its an interesting book.

    Bye, Alex.
     
  19. WillowJ

    WillowJ Senior Member

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    thanks, alex3619 . From that third link, it almost seems the bPs crowd could be described as a form of behavorists who think that people's thought processes can be inferred from their behaviour and, rather than inquire about and study thought (to some other psychologists people's self-narratives are important but not here) , it's more productive to examine and change behaviour.
     
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  20. Enid

    Enid Senior Member

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    Yes I agree with the discussion going on here from personal experience - consciousness and mind recalling my two stages in passing out (loss of consciousness). First as if a switch thrown I was aware of things around me though couldn't make sense of any of it (or process), then as if another switch thrown lost even that and consciousness. "Mind" is a useless description and I think it is more accurate to speak of brain as a functioning process and it's background awareness (or not in loss of consciousness).
     
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