Chronic fatigue syndrome/fibromyalgia: a “stress-adaptation” model

[Simon]

Aims to "demonstrate the theoretical and clinical value of a biopsychosocially-oriented ‘stress-adaptation’ model for this multi-symptom illness"

Chronic fatigue syndrome/fibromyalgia: a “stress-adaptation” model - Fatigue: Biomedicine, Health & Behavior
Boudewijn Van Houdenhovea*, Patrick Luytenbc & Stefan Kempkeb

Abstract

Background: A symptom cluster consisting of ‘medically-unexplained’ chronic fatigue, effort intolerance and widespread pain is a complex and still poorly understood condition.

Purpose: To demonstrate the theoretical and clinical value of a biopsychosocially-oriented ‘stress-adaptation’ model for this multi-symptom illness.

Methods: Clinical observation and review of the relevant literature.

Results: Symptoms and functional limitations of these patients may reflect a loss of normal physical, mental and emotional adaptability, primarily based on stress system dysregulation.

Conclusions: The proposed stress-adaptation model may facilitate diagnosis, defy dualistic causal thinking, and offer tailor-made treatment options to help patients find a better balance in their lives

Paywalled.

 

[biophile]

Chronic fatigue syndrome/fibromyalgia: a “stress-adaptation” model

Aims to "demonstrate the theoretical and clinical value of a biopsychosocially-oriented ‘stress-adaptation’ model for this multi-symptom illness"

It is good to have aims in life. Whether or not they are achieved is another story.

 

[Gijs]

''primarily based on stress system dysregulation''. This mechanisme HPA-as is broken in ME/CVS i think. It can be the key driver. But i don not see any objective markers for this hypothesis. He must proof his concept based on objective markers. I think that this system is physical damaged or disturbed not by mental factors. You can not handel stimuli.

 

[A.B.]

Sounds a lot like the usual psychological dribble which pathologizes the survivability behavior observed in patients with serious illness.

Then again, I haven't actually read the paper and the abstract doesn't say a whole lot.

 

[Mithriel]

Yet another paper that ignores the fact that ME came in EPIDEMICS. Many of us were perfectly well one day, took an infection and became ill with the same disease we still have years later.

And I bet they call themselves scientists despite ignoring the most important data.

Mithriel

 

[Enid]

Big sigh.

 

[alex3619]

Yet another paper that ignores the fact that ME came in EPIDEMICS. Many of us were perfectly well one day, took an infection and became ill with the same disease we still have years later.

And I bet they call themselves scientists despite ignoring the most important data.

Mithriel

This is the fault of McEvedy and Beard (1970) who convinced much of the medical world that outbreaks were just mass hysteria. Actually Speight wrote about this here, in a Saudi Arabian medical journal:

http://www.sjmms.net/article.asp?is...me=1;issue=1;spage=11;epage=13;aulast=Speight

This was very poor medicine and science, but very pursuasive to those who believe in psychogenic illness. I now think that it was McEvedy and Beard who set the world up for dismissal of cluster outbreaks and the creation of the term CFS itself, as well as the rise of modern psychogenic medicine in the form of CBT/GET for CFS. Ramsay apparently wrote about some of this in a book, but I don't have that book yet.

 

[adreno]

Lovely stuff.

 

[Richie]

Would like to read the full paper but:
They will not address HPA probs if they
a) see all such probs as a disordered response rather than a (somewhat) ordered response to e.g. infection, toxicity etc
b) if they ignore all pathological inputs apart form the psychological ones.

But being BIOpsychosocial in outlook, we can rest assured that they will be fully appreciative and knowledgeable of all the biologically based problems in ME/CFS/FM, can't we?

 

[alex3619]

Engel's view of biopsychosocial was put forward as a balanced approach to medicine, and in opposition to biomedicine, based on good ideas from systems theory. However his focus was primarily psychosomatic medicine. So far as I can see much of the biopsychosocial approach is psychosomatic medicine, not at all balanced. It further lends itself to concepts around social engineering, concepts which have historically failed in countries that have tried it.

We currently see the result of this in the UK with respect to disability politics. Its a disaster. It is estimated (but not proven) that large numbers of the disabled are dying as a result of this, quite often from suicide. Yet the government does not seem to care - and the government opposition is not really opposing it.

These approaches promise cheap and simple answers, politically popular answers with some demographics. They typically do not work however. Indeed I think they are more expensive, and make the situation even more complex and intractable.

So don't expect most following the biopsychosocial approach to have anything to do with biomedicine, hard evidence, or reason. This is an ideological movement more than its medicine.

Richie , I do get that you made a sarcastic comment. I just wanted to add to your point.

Anyone who is interested in BPS might like to read my blog on the topic:

http://forums.phoenixrising.me/inde...e-and-fall-of-the-biopsychosocial-model.1075/

http://forums.phoenixrising.me/index.php?entries/the-fall-of-the-biopsychosocial-model.1081/

http://forums.phoenixrising.me/index.php?entries/part-three-what-next.1099/

 

[Richie]

No worries Alex

 

[Dolphin]

Here's an extract that I thought was a little bit interesting:

What about the cognitive-behavioral model of CFS?

Some researchers assume that, although CFS may be precipitated by a physical event (such as a viral infection), the illness is subsequently perpetuated by psychological and behavioral factors. According to this model, faulty cognitions (e.g., rigid somatic attributions and catastrophizing), sensory hypervigilance, activity avoidance, and enhanced interoception may play a key role in the etio-pathogenesis of the illness.[54,55]

Certainly, a cognitive-perceptual bias and inadequate coping behavior have been demonstrated in some CFS patients [56] but these findings have not always been con¬firmed. [57] Moreover, a purely cognitive-behavioral model of CFS seems less explanatory for the pathophysiological disturbances identified so far and more difficult to relate to findings about the patients' history, personality, and premorbid lifestyle (as reviewed above).

Nonetheless, the latter model is the main rationale of cognitive-behavioral therapy (CBT) and graded exercise training (GET), which are currently both recommended as first-line treatments in CFS/FM. Particularly in the CFS literature, it has been stated that patients should be informed about the possibility that CBT may lead to "full recovery," in order to enhance outcome.[58] Although there is evidence to support the efficacy and effectiveness of CBT and GET in subsets of CFS/FM patients,[59,60] these treatments have also been strongly criticized — not in the least by members of the ME community — since relevant studies may be flawed because of diagnostic heterogeneity, recruitment bias, the use of outcome criteria with too little relevance for "real life" functioning, and the questionable definition of "recovery."[14,61]

[14] Hooper M. Magical medicine. How to make a disease disappear [Internet]. Available from: http://www.meactionuk.org.uk/magical-medicine.pdf.

[54] Knoop H, Prins JB, Moss-Morris R, Bleijenberg G. The central role of cognitive processes in the peipetuation of chronic fatigue syndrome. J Psychosom Res. 2010;68:489-494.
[55] White PD. What causes chronic fatigue syndrome? BMJ. 2004;329:928-929.
[56] Wiborg IF, Knoop H, Frank LE, Bleijenberg G. Towards an evidence-based treatment model for cognitive behavioral interventions focusing on chronic fatigue syndrome. I Psychosom Res. 2012;72:399-404.
[57] Nijs J, Meeus M, HeMs M, Knoop H, Moorkens G, Bleijenberg G. Kinesiophobia, catastrophiz-ing and anticipated symptoms before stair climbing in chronic fatigue syndrome: an experimen¬tal study. Disabil Rehabil. 2012;34:1299-1305.
[58] Knoop H, Bleijenberg G, Gielissen MF, van der Meer JW, White PD. Is a full recovery possible after cognitive behavioural therapy for chronic fatigue syndrome? Psychother Psychosom. 2007;76:171-176.
[59] White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, Baber HL, Burgess M, Clark LV, Cox DL, Bavinton J, Angus BJ, Murphy G, Murphy M, O'Dowd H, Wilks D, McCrone P, Chalder T, Sharpe M, PACE trial management group. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomized trial. Lancet. 2011;377:823-836.
[60] Thieme K, Turk DC. Cognitive-behavioral and operant-behavioral therapy for people with fibro¬myalgia. Reumatismo. 2012;64:275-285.

[61] Kemp P. The Pace Trial recovery rates [Internet]. Available from: hftp://www.scribd.com/doc/ 115343781/The-PACE-Trial-Recovery-Rates.

 

[Dolphin]

Although not as explicit as some of us might like, there is some questioning of CBT/GET in this (although probably not that exciting):

Patients need an adequate illness theory

According to qualitative studies, many CFS/FM patients fear disbelief or stigmatiza-tion, which may be reinforced by a too narrow psychological view of their illness. [65,66] In contrast, the stress-adaptation model can be used as a theoretical framework that unambiguously validates the reality and biological basis of the patient's suffering. Moreover, the model provides a "common ground" within the therapeutic relationship, and offers a realistic perspective on recovery. Indeed, the stress-adaptation model is perfectly suitable as a starting point for patients' active engagement in treatment, since several perpetuating factors — often sources of external or self-generated stress which negatively affects the illness course — are (at least in part) under personal control and amenable to therapeutic change.

CBT, by focusing on maladaptive cognitions and behaviors, may foster this therapeutic process and a regular — but modest and flexible — regime of aerobic exercises may (at least in some patients) be useful to prevent deconditioning and increase physcal and mental resilience. [67] However, the stress-adaptation model of CFS/FM calls the current predominance of the CBT/GET treatment paradigm into question.

 

[Esther12]

Thanks for looking at the full paper d.

Personally, I don't have any interest in an illness theory being presented to me by a doctor. I want to be spoken to honestly and clearly about what the evidence shows, and then left to decide for myself how to respond to the uncertainty that surrounds CFS. Clinicians who want to claim to be 'CFS experts' have far more need of an illness model than patients do, and these models, at least with CFS, tend to cause more harm than good for patients. Just present the limited evidence - don't try to engage me in an empowering therapeutic alliance around a pragmatically constructed narrative of illness - I'll never forgive you if you try.

Interesting to see that they were aware of, and reported, patient concerns about the way in which 'recovery' is being redefined. That's cheering.