Invest in ME Conference 12: First Class in Every Way
OverTheHills wraps up our series of articles on this year's 12th Invest in ME International Conference (IIMEC12) in London with some reflections on her experience as a patient attending the conference for the first time.
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Whence Wyller? CBT/GET Proponent Uncovers Distinct Biological Signature (???)

Discussion in 'Latest ME/CFS Research' started by Cort, Sep 8, 2017.

  1. Cort

    Cort Phoenix Rising Founder

    It's hard to figure out Wyller! He's been a strong proponent of CBT/GET and has reportedly made a lot of problems in Norway but in his last study he actually proposed that Epstein-Barr virus played a role in ME/CFS and urged more research in that area.


    From that blog:

    Now Wyller believes he's found a distinct biological signature in the brains of his adolescent ME/CFS patients. We'll have to get the paper to know more but this statement "Immature FC of the right dAI-PPC in patients lacked associations with three known functional domains: cognition, pain and physical activity, which were observed in the healthy group" appears to suggest to me anyway that connections in the brain that regulate pain, cognition and physical activity are not working correctly in adolescent ME/CFS patients.

    Wyller's tying it to a network that is involved in motivation. That may tweak some but I'm pretty much fine with that given that he's finding biological correlates. It suggests, after all, that something that has gone wrong in the brain is the answer.


    PLoS One. 2017 Sep 7;12(9):e0184325. doi: 10.1371/journal.pone.0184325. eCollection 2017.Altered right anterior insular connectivity and loss of associated functions in adolescent chronic fatigue syndrome.
    Wortinger LA1,2, Glenne Øie M2,3, Endestad T2, Bruun Wyller V1.


    Abstract: https://www.ncbi.nlm.nih.gov/pubmed/28880891
     
    Last edited by a moderator: Sep 9, 2017
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  2. Jenny TipsforME

    Jenny TipsforME Senior Member

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    An optimistic interpretation is he is taking onboard the evidence and adapting his perception of the nature of what is going on.

    However, with a more pessimistic interpretation I think his take on the biological signature is a bit worrying. It is hard to understand without the full paper but seems to be linking motivation with differences in functional connectivity. I think it is inferring faulty perception of our internal being, or symptoms (somatisation). In other words, it's no longer down to our cognition, but now our neurobiology is now causing us to have false illness beliefs :bang-head:

    Of course if this is where robust science leads we'll have to accept it ;) But I see it as a new flavour of gas lighting.
     
    Last edited: Sep 8, 2017
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  3. Kalliope

    Kalliope Senior Member

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    I'm sure all threads will come together when his trial on CFS and music therapy is published o_O
    (the link is google-translated)
     
  4. A.B.

    A.B. Senior Member

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    Patients don't need a study to decide whether they find music helpful for relaxing or entertainment.

    This is likely to be more patient abuse in the form of grandiose claims based on the usual flawed methodology that is required to create the illusion of treatment efficacy.

    The new research funding allocation scheme in Norway should help prevent more of this nonsense, right?
     
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  5. Jenny TipsforME

    Jenny TipsforME Senior Member

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    Eg Symptom Perception, Awareness and Interpretation takes you on a journey from this type of neurobiology to Medically Unexplained Symptoms

    "Self-reported health complaints result from a complex integration of interoceptive
    (bottom-up) information emerging from peripheral physiological activity with (top-down) perceptual-cognitive and affective processes. Interoceptive signals have to be sensed, perceived, attended to, appreciated and interpreted, put into language and expressed, mostly in a social context...
    The interoceptive image is further re- represented in the right anterior insula, which is also involved in subjective awareness of feelings and emotions. This process of re-representing progresses from the posterior to the anterior parts implies a successively increasing “integration of homeostatic, environmental, hedonic, motivational, social and cognitive activity to produce a ‘global emotional moment’, which represents the sentient self” (Craig, 2009, p. 67). This allows for a bi-directional influence of emotion and interoception (Critchley et al., 2001; Zaki et al., 2012).
    ...( re Medically Unexplained Symptoms):
    "Other strategies rely on the idea that the critical mechanisms are centrally mediated distortions in the perception of one’s bodily state. While substantial evidence is consistently showing distortions in perceptual-cognitive mechanisms of symptom perception, cause-effect relationships remain often unclear and the critical hypothesized mechanisms remain untested (Rief & Broadbent, 2007)."

    BTW I have very rusty Health Psychology and neuropsychology, so I get the gist of what this means. If it needs translation let me know.


    Random result when googling:
    "Our results amplify recent evidence from functional neuroimaging, which suggests a prominent role of dorsal anterior insular cortex in the parasympathetic control of cardiac and autonomic function. Acute vascular damage of this insular subregion might lead to autonomic dysbalance and an upregulation of sympathetic function, thereby resulting in myocardial injury." Ann Neurol 2017;81:502-511.
     
    Last edited: Sep 8, 2017
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  6. alex3619

    alex3619 Senior Member

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    Music? I would rather beat my head with a golf club. When music is tied to something visual, like a game, or movie, or video clip, I find it OK to good. Just music is pure torture. I do not listen to music. I think this is some kind of sensory processing failure.
     
  7. Kalliope

    Kalliope Senior Member

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    The allocation from the Research Council on patient-identified ME-research was a one off. Wyller sent an application for a trial on ME and Lightning Process. :bang-head:

    The research project did not make it to the second round in the application process to the research council. However, on Monday there is an election in Norway, and if the social democratic party wins, their health political spokesman has promised to fight for money for this LP-trial. To his surprise, the politician's Facebook-annoncement on this a few months back was not very popular.. (I doubt the trial will ever happen).
     
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  8. Kalliope

    Kalliope Senior Member

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    From Plosone
    Altered right anterior insular connectivity and loss of associated functions in adolescent chronic fatigue syndrome


    Cumulative stress decreases right insular volume [
    99] and alters underlying dopaminergic function [100], which is important for the modulation of motivation and cognitive control interactions [100, 101], pain [102, 103], and self-awareness [104]. Inabilities to regulate stress have been observed across multiple systems of the body and collectively comprise the sustained arousal model of disease mechanisms in CFS [12]. Failures to regulate stress might be the cause of right dAI connectivity dysfunction, and combined physical inactivity might again add to the FC decreases—a vicious cycle that disrupts cognition and interoceptive interpretations, and maintains the disease. Although speculative, sustained arousal might explain the functional connectivity decreases and loss of associated functions across the three clinical domains studied here in adolescent CFS patients.
     
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  9. NelliePledge

    NelliePledge plodder

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    climbing on to the fence so he can jump down onto the other side as and when the wind changes
     
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  10. Jenny TipsforME

    Jenny TipsforME Senior Member

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    I don't think it's even that, it's firmly BioPsychoSocial.
     
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  11. Snow Leopard

    Snow Leopard Hibernating

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    Writing a manuscript is usually a negotiation and compromise between the authors. It is likely that Wyller still has the same beliefs, but that his co-authors have somewhat different beliefs leading to the quote you cited.
     
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  12. A.B.

    A.B. Senior Member

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    It seems to be fairly easy actually. He appears to be just another believer that doesn't mind sacrificing patient's best interests for his dream of finally proving the validity of some vague psychosomatic model.
     
  13. Cort

    Cort Phoenix Rising Founder

    Let's hope not
     
  14. Cort

    Cort Phoenix Rising Founder

    Yes, well there's the EBV paper as well (?????)

    A biological signature in the brain - no matter where it is - is biological Something deep in the brain that's different....That's better than some belief system gone awry. It is true that they could try to remedy it using CBT or something - that's been tried with brain abnormalities before. So not the safest ground I agree.

    Time will tell.
     
  15. Murph

    Murph :)

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    PLoS One. 2017 Sep 7;12(9):e0184325. doi: 10.1371/journal.pone.0184325. eCollection 2017.
    Altered right anterior insular connectivity and loss of associated functions in adolescent chronic fatigue syndrome.
    Wortinger LA1,2, Glenne Øie M2,3, Endestad T2, Bruun Wyller V1.
    Author information
    Abstract

    Impairments in cognition, pain intolerance, and physical inactivity characterize adolescent chronic fatigue syndrome (CFS), yet little is known about its neurobiology. The right dorsal anterior insular (dAI) connectivity of the salience network provides a motivational context to stimuli. In this study, we examined regional functional connectivity (FC) patterns of the right dAI in adolescent CFS patients and healthy participants. Eighteen adolescent patients with CFS and 18 aged-matched healthy adolescent control participants underwent resting-state functional magnetic resonance imaging. The right dAI region of interest was examined in a seed-to-voxel resting-state FC analysis using SPM and CONN toolbox. Relative to healthy adolescents, CFS patients demonstrated reduced FC of the right dAI to the right posterior parietal cortex (PPC) node of the central executive network. The decreased FC of the right dAI-PPC might indicate impaired cognitive control development in adolescent CFS. Immature FC of the right dAI-PPC in patients also lacked associations with three known functional domains: cognition, pain and physical activity, which were observed in the healthy group. These results suggest a distinct biological signature of adolescent CFS and might represent a fundamental role of the dAI in motivated behavior.

    Full text link at PloS One

    This is a Norwegian study but sadly the inclusion criteria here are broken: "In agreement with NICE clinical guidelines [50, 51], we applied a ‘broad’ case definition of CFS, requiring three months of unexplained, disabling chronic/relapsing fatigue of new onset."

    combined with the petite sample size this is one for the bin.
     
    Last edited: Sep 8, 2017
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  16. Murph

    Murph :)

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  17. Woolie

    Woolie Senior Member

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    This is a nice example of the how neural mechanisms and terminologies are being used to redescribe what are essentially 'psychological' accounts of MECFS. We're going to see more and more of this type of language, so its good to be able to read the subtext.

    Notice the focus on the 'salience network', which many psychosocial theorists believe is the neural circuit underpinning somatisation. That is, you have a disruption with your 'salience network' and this is why you feel pain when there is no bodily basis for it.

    The insula - considered to be part of the so-called salience network - usually plays a key role in these kinds of neural-psychological models. It's believed that the insula is involved in the interpretation and evaluation of emotional information, including physiological signals from the body. The idea is that we are interpreting these signals poorly, and that is why we have the experience of physical illness, even when there is none.

    In these sorts of neural-psychological frameworks, the dorsolateral prefrontal cortex and the anterior cingulate also often get a mention. These areas have been associated with motivated behaviour and control, and have been considered to be linked to depression, since a loss of initiative and motivation seem to be key features of depression. So the same logic is extended to CFS.

    I think there are so many other simpler reasons why connectivity patterns may be disrupted in MECFS. The disease affects your cardiovascular system, and this has an enormous influence on how your brain functions, especially prefrontal cortex. That's a much better and simpler explanation for these kinds of abnormalities than the neural-psychological one.
     
  18. Valentijn

    Valentijn The Diabolic Logic

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    @Cort - Could you please not color large portions of text? It makes it very difficult to read for those of us who need to use a dark background.

    Not really. Changes in the brain are usually used to suggest that the only problem is in the brain - basically that the physical symptoms aren't real, and just perceived due to the brain processing problems. Hence there's no problem with forcing us to work, or cutting off benefits, because we just need to learn to ignore the false information coming from the brain.

    @Woolie has a better analysis of this study at http://forums.phoenixrising.me/inde...unctions-in-adolescent-cfs.54125/#post-899947 . Also, it's a good idea to use a more descriptive title for research threads (the title of the paper), so that anyone starting a thread about the same study will have it automatically pop up before they they post. Otherwise we end up with multiple threads which the moderator needs to merge.
     
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  19. Marky90

    Marky90 Science breeds knowledge, opinion breeds ignorance

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    Even if we accept their premise, what in the world is not physical about the brain? Consciousness is just an extremely complicated chemical/electrical/biological- physical state.
     
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  20. Valentijn

    Valentijn The Diabolic Logic

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    A partially physical state, but it would be overlaid with an essentially psychosomatic state. The physical state may then cause the perception of disability, but it's wrong about the disability existing. So there is physical dysfunction in the brain, but no physical disability.

    If there's no physical disability, then physical disability offer no grounds for receiving insurance or social benefits. Physical damage is irrelevant for purposes of obtaining benefits if it's not causing actual physical disability.

    It removes the fault of causation from the patients, but it still leaves them responsible for curing themselves - or at least, for sucking it up and ignoring that wonky brain telling them they're in pain and exhausted. And CBT will help them alleviate their suffering ... but only if they really want it to and try hard enough. So if it doesn't work, they just need more motivation, which can be provided by cutting them off from financial, social, and emotional support.

    It might look a little better on paper, but it's still underlying a very twisted and repugnant ideology.
     
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