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Cognitive and behavioral coping in people with CFS: An exploratory study...

Surprised this hasn't been posted already, let me know if I missed it.
Cognitive and behavioral coping in people with Chronic fatigue syndrome: An exploratory study searching for intervention targets for depressive symptoms.
Kraaij V1, Bik J1, Garnefski N1.
Author information

Abstract

The aim of the study was to find relevant coping factors for the development of psychological interventions for people with chronic fatigue syndrome who suffer from depressive symptoms. A total of 30 adults with chronic fatigue syndrome filled in the Cognitive Emotion Regulation Questionnaire, the COPE and the Hospital Anxiety and Depression Scale. The findings suggested that cognitive coping strategies have a stronger influence than behavioral coping strategies on depressive symptoms. Especially, the cognitive coping strategies refocusing positive, positive reappraisal and catastrophizing were of importance. These findings suggest that these coping strategies should be part of psychological programs for people with chronic fatigue syndrome.
Full access here http://journals.sagepub.com/doi/full/10.1177/1359105317707259
 

Manganus

Senior Member
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Canary islands
Once a diagnostic tool is widely accepted, this kind of studies might provide good help.

Until then, ... this paper is far too vague. Particularly the inclusion criteria makes it only slightly more convincing than an experienced clinicians educated guesses.
 
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3,263
Its a fairly sympathetic study.

The results were that two coping strategies were associated with lower depression scores. They were positive refocusing, which refers to thinking about joyful and pleasant issues instead of thinking about the CFS; and positive reappraisal, which refers to thoughts of attaching a positive meaning to the CFS in terms of personal growth.

That's mildly interesting. I certainly find the first strategy gives me some comfort. F**d though if I'll consider it a personal growth experience!

Their scale also included a measure of 'catastrophising', described as 'thoughts of explicitly emphasizing the terror of the CFS'. This was positively assocaited with depression (the more you did it, the higher your depression score). But that's not a strategy, is it? The strategy would be if you actively engage distraction techniques to reduce those thoughts. Besides, catstrophising seems to be inextricably linked to the depression - probably a product of it, not a cause. So the idea that if we stop the catstrophising we won't be depressed is kind of arse backwards.

(I suddenly had a ridiculous thought of a cartoon guy in front of a firing squad, he's yelling 'I'm gonna die!', and his psychologist behind him is saying 'see, you're catastrophising again, Frank!'.)

Cautionary note: they examined a heck of a lot of variables on just 36 patients.
 
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(I suddenly had a ridiculous thought of a cartoon guy in front of a firing squad, he's yelling 'I'm gonna die!', and his psychologist behind him is saying 'see, you're catastrophising again, Frank!'.)

I suppose that is the final treatment for the hopeless cases....don't tell the BPS crew they will write a paper on it. I can imagine the FOI case to get the data on that one...ends up 100% improved with the hopeless cases removed from the data set and the planet.
 
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2,158
That's mildly interesting. I certainly find the first strategy gives me some comfort. F**d though if I'll consider it a personal growth experience!

It seemed to me from reading the abstract that they really hadn't discovered anything except the fact that their questionnaires measuring positive thinking and catastrophising were correlating with their measures respectively of not depressed and depressed.

Since people who are not depressed are likely to have at least some positive thoughts and people who are depressed are likely to have negative/catastrophising thoughts by definition, surely all they were doing was showing one type of questioning gave the same answer as the other type of questioning.

Am I making any sense here? I can't see that this advances us at all. Surely the same results would apply for anyone answering these questionnaires, not just ME patients.

And I agree, @Woolie , I can't see that I've gained anything in 'personal growth' from being ill for 27 years. And if I thought I should try, I'd be doomed to failure and another layer of guilt to be added. No thanks.

I feel very lucky not to be depressed as well, but take no personal credit for that.
 
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3,263
I suppose that is the final treatment for the hopeless cases....don't tell the BPS crew they will write a paper on it. I can imagine the FOI case to get the data on that one...ends up 100% improved with the hopeless cases removed from the data set and the planet.
Haha, yea. Health care utilisation ad benefits receipt were both reduced following treatment. Unfortuntaley, the patient was lost to follow up,
 

ash0787

Senior Member
Messages
308
I don't get why its part of cfs research, its an extremely common psychological problem to the point where its almost a factor of everyday life, and psychology people already know how to approach it or at least they should if they studied for their qualifications properly, are they trying to suggest that the nature of the phenomenon somehow differs in origin or nature in CFS so as to warrant separate investigation ?
 
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3,263
I don't get why its part of cfs research,
Its of some modest value to discover if there are any coping strategies that help reduce distress in MECFS specifically. We're not able to engage in some of the ones 'healthies' use.

Plus, MECFS is a particular situational stressor that might present different challenges to people, than, say, depression with no identifiable precipitating events, or depression due to loss of a loved one, unemployment, etc.
 

Starsister

Senior Member
Messages
834
Location
US
It seemed to me from reading the abstract that they really hadn't discovered anything except the fact that their questionnaires measuring positive thinking and catastrophising were correlating with their measures respectively of not depressed and depressed.

Since people who are not depressed are likely to have at least some positive thoughts and people who are depressed are likely to have negative/catastrophising thoughts by definition, surely all they were doing was showing one type of questioning gave the same answer as the other type of questioning.

Am I making any sense here? I can't see that this advances us at all. Surely the same results would apply for anyone answering these questionnaires, not just ME patients.

And I agree, @Woolie , I can't see that I've gained anything in 'personal growth' from being ill for 27 years. And if I thought I should try, I'd be doomed to failure and another layer of guilt to be added. No thanks.

I feel very lucky not to be depressed as well, but take no personal credit for that.
Not to give these writers any credit for the concept, but I do understand the value of finding something positive to come from the CFS. I've been sick for over 35 yrs, symptoms started mild, and with episodes of remission, but what has been most helpful to me with the grief, loss, depression and dispair has been my recent reframing if my life where I can derive meaning from my condition by trying to help others. What else can one do when we can't change the immediate situation? I'm 63 and facing problems of aging as well, and looking to make sense of my life before I die.

I've been a mental health provider nearly 30 yrs and realized recently I'd been in denial of the emotional toll it has taken on me, and by understanding that better, I am now incorporating that knowledge into how I work with my clients with chronic health issues. Rather than feeling that my life and career is over and that my future is over, I at least feel there is something I can take from the experience to help others, or to advance the cause by speaking up, raising awareness, advocating for research funding etc. In the stages of grief, those being denial, anger, bargaining (what could I have done better) acceptance, and reinvestment, I feel that at least I have more of a handle on reinvesting in my life and a future.

It has spurred a renewal of my spiritual exploration, and forced me to reach out to others and ask for help, which I've never been good at, thereby decreasing my social isolation.

I'm reminded of Dr Bernie Siegle's studies with persons with cancer and AIDS, and how some patients described emotional and spiritual transformations from dealing with their illness, often describing how they became happier people, regardless of whether they got well or not. If someone who had NOT been through hell with their health would say this to me, I'd want to punch them in the face. If the medical system and government tried to use this as an excuse for not trying to find a cure, I'd fight like hell. But personally, I try to find value and meaning in my situation, while I continue to work toward health.
 

Dolphin

Senior Member
Messages
17,567
http://www.enhertsccg.nhs.uk/sites/...ital Anxiety and Depression Scale (HADS).docx

Depression questions from Hospital Anxiety and Depression Scale (HADS)


0-3 for each item

The items that relate to depression are:

  • [*]I still enjoy the things I used to enjoy
    [*]I can laugh and see the funny side of things
    [*]I feel cheerful
    [*]I feel as if I am slowed down
    [*]I have lost interest in my appearance
    [*]I look forward with enjoyment to things
    [*]I can enjoy a good book or radio or TV programme
 

Dolphin

Senior Member
Messages
17,567
Since people who are not depressed are likely to have at least some positive thoughts and people who are depressed are likely to have negative/catastrophising thoughts by definition, surely all they were doing was showing one type of questioning gave the same answer as the other type of questioning.
They do mention this briefly:
The second limitation of this study results from the cross-sectional design. No conclusions can be drawn regarding the causality or temporal order of the cognitive coping strategies and depressive symptoms. One might lead to the other or they might influence each other. However, in order to bring about change or break this cycle, one could well intervene on the coping strategies.

Finally, a limitation was that all variables were measured by self-report, which may have caused bias.
 
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Dolphin

Senior Member
Messages
17,567
I can't see that this advances us at all. Surely the same results would apply for anyone answering these questionnaires, not just ME patients.

I don't get why its part of cfs research, its an extremely common psychological problem to the point where its almost a factor of everyday life, and psychology people already know how to approach it or at least they should if they studied for their qualifications properly, are they trying to suggest that the nature of the phenomenon somehow differs in origin or nature in CFS so as to warrant separate investigation ?
They do discuss how the results relate to the general public:

First, the bivariate relationships were studied. Various coping techniques appeared to be related to depressive symptoms. When looking closer at the different forms of coping strategies, it is interesting to see that the cognitive coping strategies were especially important: self-blame, positive refocusing, positive reappraisal, and catastrophizing were all related to the level of depressive symptoms. These findings are in line with earlier studies among the general population (Garnefski and Kraaij, 2006, 2007, 2009). In contrast, none of the behavioral coping strategies were significantly related to depression. This is not in line with earlier research, where both problem-focused coping and seeking social support (Heijmans, 1998) were related to better mental health in people with CFS. However, one should keep in mind that in this study, the power is rather low. Active coping showed a (non-significant) small to moderate relationship with depressive symptoms. Finally, in the exploratory model, especially, positive refocusing, positive reappraisal, and catastrophizing were important. Together, they explained a large amount of the variance, indicating that they might be important intervention targets.

If our findings can be replicated, they suggest that cognitive coping strategies have a stronger influence than behavioral coping strategies on symptoms of depression in people with CFS. Possibly, this has to do with the fact that people with CFS experience severe fatigue, making it hard to successfully cope with the condition in a behavioral way. In addition, for many people, CFS is a chronic condition for which no physical cause has been found so far. Patients cannot take specific actions that will cure them from having CFS. Coping strategies such as thinking about joyful and pleasant issues instead of thinking about the CFS and attaching a positive meaning to the CFS in terms of personal growth may be more effective methods for successfully adjusting to living with this (often) chronic condition. In addition, catastrophizing and selfblaming thoughts about the CFS should be avoided. If the findings of this study can be confirmed, they would have important clinical implications. They suggest that these specific coping strategies are relevant for the development of new evidence-based psychological treatment programs for depression (e.g. coping skills training), specifically tailored for people with CFS. In addition, existing programs for people with CFS could be adapted in order to focus on these specific coping strategies.
Also from the introduction:

A few studies have been performed on the way people cope with CFS and its relationship with emotional problems. Coping strategies such as problem-focused coping and seeking social support (Heijmans, 1998) have been found to be related to better mental health in people with CFS. Coping strategies such as cognitive avoidance (Heijmans, 1998) and behavioral disengagement (Ray et al., 1995) have been related to poorer mental health in this group. Various coping strategies have remained unstudied. Lately, cognitive coping strategies have been studied intensively. Studies among people from the general population showed significant relations between the following cognitive coping strategies and depressive symptoms: self-blame, rumination, positive reappraisal (inversely), positive refocusing (inversely), and catastrophizing (Garnefski and Kraaij, 2006, 2007, 2009). Whether these strategies are related to depressive symptoms in people with CFS remains to be studied.
 
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Dolphin

Senior Member
Messages
17,567
I'm reminded of somebody who developed depression and anxiety alongside their ME. They tried to die by suicide a few times and eventually did take their own life.

I was unimpressed with the approach I heard the mental health professionals were taking in her case. They were encouraging her to do normal activities such as taking a part-time job, going back to full-time education and other behavioural suggestions. While these might suit some people with depression and anxiety, they didn't seem to suit somebody with ME as well.
 

Dolphin

Senior Member
Messages
17,567
Messages
3,263
but what has been most helpful to me with the grief, loss, depression and dispair has been my recent reframing if my life where I can derive meaning from my condition by trying to help others.
You know, you're right @Starsister. I can think of insights I've gained from having the disease. Compassion, definitely. And withholding of judgement about others. A much more nuanced view of the world. And insight into the dangers that loose thinking in Psychology can do.

And I was a smug git before I got sick. Sailed effortlessly through life never realising how much luck I had working in my favour.

I still refuse to interpret CFS as a life lesson, but I have to admit there are a few (modest) pluses to have come of it.

I was recently talking to a person with fibro. She is often in pain, and never knows when it will strike. She said if she had the power to go back and change her life so she never had FM, she wouldn't do it. She feels that enduring FM has made her the person she is today. I certainly don't think that. But still, you gotta respect it.