• Welcome to Phoenix Rising!

    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of and finding treatments for complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

    To become a member, simply click the Register button at the top right.

Same, Same But Different? CBT Approaches for Paediatric CFS/ME and Depression

hixxy

Senior Member
Messages
1,229
Location
Australia
Behav Cogn Psychother. 2017 Mar 9:1-16. doi: 10.1017/S1352465817000108. [Epub ahead of print]

Same, Same But Different? Cognitive Behavioural Treatment Approaches for Paediatric CFS/ME and Depression.

Loades ME, Chalder T.

Abstract

BACKGROUND:
Approximately one in three children and young people with chronic fatigue syndrome (CFS/ME) also have probable depression. Cognitive behaviour therapy (CBT) has a growing evidence base as an effective treatment approach for CFS/ME and for depression in this population.

AIMS:
Given the high degree of co-morbidity, this discussion paper aims to compare and contrast CBT for CFS/ME and CBT for depression in children and young people.

METHOD:
The existing literature on CBT for depression and CBT for CFS/ME, in relation to children and young people was reviewed.

RESULTS:
Whilst there are commonalities to both treatments, the cognitive behavioural model of CFS/ME maintenance includes different factors and has a different emphasis to the cognitive behavioural model of depression, resulting in different intervention targets and strategies in a different sequence.

CONCLUSIONS:
A collaborative, formulation-driven approach to intervention should inform the intervention targets and treatment strategies.

KEYWORDS:
CBT; CFS/ME; depression; mood; paediatric

https://www.ncbi.nlm.nih.gov/pubmed/28274290
https://www.cambridge.org/core/jour...pressiondiv/9EE80EC1C4B6375278EFF42E26ACFC51#
 

Mohawk1995

Senior Member
Messages
287
I am going to be really blunt (for me): NO KIDDING Kids with ME/CFS have depression! You have one of the worst diseases ever on planet earth and you have yet to develop effective coping mechanisms....Duh! I am surprised that they only mention that it is 1 in 3. Makes me wonder what kind of tool they are using to assess depression. Don't get me wrong, for the vast majority of people who have ME/CFS their Depression came on as a result of the disease and not prior to the Disease. Also it did not cause the Disease and so by definition CBT or any other Psychological based treatment is not a cure for the disease. Could some really unbiased, practical, support based and compassionate "CBT" help people with ME/CFS ...sure. It is a devastating disease! Could some assistance with coping with the disease help especially with children....absolutely. Not sure we needed a dime spent on research to determine that!

This is not intended as an insult to those who performed the research. I am not even going to look at the quality of the research in this case. Perhaps they are well intended, but they appear to have no idea how such a devastating disease would impact someone physically, emotionally or spiritually. AND if their motive is to continue to advance the notion that CBT is the gold standard of treatment for ME/CFS, they are delusional or worse!

What does this mean anyway? "Approximately one in three children and young people with chronic fatigue syndrome (CFS/ME) also have probable depression. "
 

TiredSam

The wise nematode hibernates
Messages
2,677
Location
Germany
Cognitive behaviour therapy (CBT) has a growing evidence base as an effective treatment approach for CFS/ME and for depression in this population.
By "growing evidence base" I think she's referring to the large volume of poor quality studies that she and her small clique of colleagues seem desperate to churn out before the real growing evidence base from the USA, Norway and rest of the planet makes them and their careers irrelevant.
 

Dolphin

Senior Member
Messages
17,567
CBT for CFS/ME in adolescents typically consists of a behavioural element, which aims to gradually and consistently increase activity, and a cognitive component, which targets thoughts, assumptions and beliefs about the young person’s illness and symptoms (Mackenzie and Wray, 2013).
Though research on adults suggest that many/most/all (?) don't consistently increase their total activity. Their walk may get a bit longer but they may be cutting back on other activities.
 

Dolphin

Senior Member
Messages
17,567
The behavioural component may focus on sleep habits and interventions to promote sleep quality (for example, anchoring the bedtime and wake-up time), as well as monitoring high energy activity and boom-and-bust cycles, aiming to do instead do a consistent amount of high energy activity every day, regardless of symptoms, and gradually increasing this (Browne and Chalder, 2006).

So it's not just total activity, you're expected to do a consistent amount of high-energy activity every day regardless of symptoms. If you stick to this it's a recipe for relapse I think.
 

Dolphin

Senior Member
Messages
17,567
(1) Formulation of problem development is different, specifically with regard to precipitating factors. In CFS/ME, precipitating factors are assumed to include infections with an immune response, and subsequent physical deconditioning (White et al., 2001). However, evidence for deconditioning is questionable as CFS/ME patients have been found to be similarly deconditioned to sedentary controls, and a recent mediation analysis showed that in adults, change in fear avoidance beliefs rather than physical function was the strongest mediator of treatment outcome (Chalder et al., 2015). Depression tends to be predicted by a combination of significant life events, an emotional personality and past psychiatric history.
Small but interesting admission that they say "evidence for deconditioning is questionable" but their model basically is still based around it.
 
Last edited:

Dolphin

Senior Member
Messages
17,567
The activity management approach (Browne and Chalder, 2006; NICE, 2007) aims to establish a baseline of activities that a young person is able to do every day, by determining the midpoint between what they are able to do on the best day and what they are able to do on the worst day.
Seems a pretty arbitrary way to set a baseline.

Once this baseline has been established, the young person would then gradually increase the amount of activity, by approximately 10% every fortnight.
 

me/cfs 27931

Guest
Messages
1,294
So it's not just total activity, you're expected to do a consistent amount of high-energy activity every day regardless of symptoms. If you stick to this it's a recipe for relapse I think.
Sad that so little has changed in the 40 years since I had this treatment. Hopefully, those whose careers are built on tormenting sick children will be out of a job soon.
 

Alvin2

The good news is patients don't die the bad news..
Messages
2,997
Nonsense, nonsense and nonsense. Lets use a little bit of common sense, if you can't live normally and suffer greatly will telling yourself your symptoms don't exist so you shouldn't feel bad fix the underlying problem?
Anyone who says yes has the intelligence of a grapefruit [facepalm]
 

Dolphin

Senior Member
Messages
17,567

A.B.

Senior Member
Messages
3,780
Another poor victim of misleading research and false claims. She probably honestly thinks that the cognitive behavioural model can explain the illness and that CBT/GET are useful and improving the lives of patients. By now she has invested considerable time and resources into going down this path and it's going to end in disappointment, or maybe resentment towards "prejudiced activists".
 
Last edited:

Cinders66

Senior Member
Messages
494
Small but interesting admission that they say "evidence for deconditioning is questionable" but their model basically is still based around it.


So if deconditioning isn't causing the multiple distressing symptoms and debilitation , what do they actually think is? Fear /avoidance just relates to the level of activity a patient is prepared to do, it doesn't explain why they feel ill and in pain in first place. Sleep disturbance surely didn't explain it either so how are they explaining it?
 

Alvin2

The good news is patients don't die the bad news..
Messages
2,997
So if deconditioning isn't causing the multiple distressing symptoms and debilitation , what do they actually think is? Fear /avoidance just relates to the level of activity a patient is prepared to do, it doesn't explain why they feel ill and in pain in first place. Sleep disturbance surely didn't explain it either so how are they explaining it?
Remember neurosis can explain "anything" and if you deny evidence then you can keep nonsense alive easily. The default explanation for failure is to blame the patient, treatment doesn't work its not because the premise is flawed its the patient's doing, not trying hard enough, giving up on the treatment (because the patient realizes its not fixing anything), not believing the genius "therapist" and so forth
 

RogerBlack

Senior Member
Messages
902
Once this baseline has been established, the young person would then gradually increase the amount of activity, by approximately 10% every fortnight.
Seems a pretty arbitrary way to set a baseline.

You have missed the most important part and revolutionary aspect to the treatment of CFS by this method.
In just two years, many patients are performing at 400% of their baseline, and shattering olympic records.
 

Alvin2

The good news is patients don't die the bad news..
Messages
2,997
You have missed the most important part and revolutionary aspect to the treatment of CFS by this method.
In just two years, many patients are performing at 400% of their baseline, and shattering olympic records.
Actually at 10% increase every two weeks in one year they are at 11.91x (which is 1,191%) their original endurance and in two years its 129.13x (or 12,913%).
Pretty soon they will be leaping tall buildings in a single bound and soon thereafter they can leap into orbit, by sheer muscle power. Superman is a lightweight compared to these results :woot:
 

Snow Leopard

Hibernating
Messages
5,902
Location
South Australia
Actually at 10% increase every two weeks in one year they are at 11.91x (which is 1,191%) their original endurance and in two years its 129.13x (or 12,913%).
Pretty soon they will be leaping tall buildings in a single bound and soon thereafter they can leap into orbit, by sheer muscle power. Superman is a lightweight compared to these results :woot:

That's my experience. Don't settle for anything less! :rocket: