US gov't guidelines for medical professionals

[IreneF]

"CBT is a much publicized and debated psychotherapeutic intervention for ME/CFS that addresses the interactions between thinking, feeling and behavior. It focuses on current problems and follows a structured style of intervention that usually includes a graded activity program. CBT may improve coping strategies and/or assist in rehabilitation, but the premise that cognitive therapy (e.g., changing "illness beliefs") and graded activity can "reverse" or cure the illness is not supported by post-intervention outcome data.

In routine medical practice, CBT has not yielded clinically significant outcomes for patients with ME/CFS. Furthermore, the lack of CBT providers who specialize in this illness (psychologist, social worker, or nurse) indicates that CBT may not be an option for many patients with ME/CFS. More detailed information on CBT protocols and the controversy surrounding its application in ME/CFS is presented elsewhere."

From http://www.guideline.gov/content.aspx?id=38316

I think I will point my new primary care doc to this.

 

[WillowJ]

this is from the IACFS/ME primer (yay IACFS/ME!). CFSAC got it listed on the site (yay CFSAC!). It was before the ICC primer (yay international consensus panel!) came out (so they didn't have to debate about which one to list).

 

[Tired of being sick]

When did this go in effect?

 

[IreneF]

The date I found is Sept 2012, which I think is the date of the IACFS/ME primer from which the .gov guideline is extracted. The fact that it's supported by the Dept of Health & Human Services is a great step forward in rational treatment, and away from psychologizing of a somatic (bodily) condition.

My new PCP did ask me about the amount of overlap between depression--I have a history of it--and CFS, and seemed satisfied with my answer of "none". I also brought my husband with me, and he explained how finding an effective antidepressant was a night and day experience and had no effect on my CFS.

If I ever see him without a companion I will be sure to record the visit.

 

[Tired of being sick]

@IreneF

Reason I ask is my "therapist" who I've been seeing since last November to cope and vent all my frustrations of my horrid at best medical treatment, has all of the sudden told me that she no longer wants to hear it.

She told me and I quote,"insurance will only pay for your treatment if you are being treated with mental conditions as your primary illness or axis I..

So now my CFS and physical illnesses are not only not secondary or axis II,but they are axis III and IIII and so on!!

She wants to now focus therapy starting solely with my childhood on through life because she believes there are many underlying issues!!
So until now because of my ADD that causes only half of my anxiety, frustrations of my physical illnesses and treatment,my phycal illness causes the other half,she has not gotten a word in edge wise since day one..

I can not wait to disprove her theory on every single level!

She will definitely need a shrink before I'm done,Lol.....

Because of my ADD/CFS I have to be obsessively interested to create energy in order to focus on everything/anything I do.

She has not a prayer in Hell to hold my attention.,,Lol......

I just might literally fall asleep..

 

[IreneF]

@IreneF

Reason I ask is my "therapist" who I've been seeing since last November to cope and vent all my frustrations of my horrid at best medical treatment, has all of the sudden told me that she no longer wants to hear it.

She told me and I quote,"insurance will only pay for your treatment if you are being treated with mental conditions as your primary illness or axis I..

So now my CFS and physical illnesses are not only not secondary or axis II,but they are axis III and IIII and so on!!

She wants to now focus therapy starting solely with my childhood on through life because she believes there are many underlying issues!!
So until now because of my ADD that causes only half of my anxiety, frustrations of my physical illnesses and treatment,my phycal illness causes the other half,she has not gotten a word in edge wise since day one..

I can not wait to disprove her theory on every single level!

She will definitely need a shrink before I'm done,Lol.....

Because of my ADD/CFS I have to be obsessively interested to create energy in order to focus on everything/anything I do.

She has not a prayer in Hell to hold my attention.,,Lol......

I just might literally fall asleep..

I don't know if the .gov guidelines are anything more than just guidelines. I don't think they define a standard of care, for example.

Do you have ADD or ADHD? My kids are both ADD, altho it's gotten better as they've gotten older.

You should be able to find out from your insurance co. what they cover and what they don't cover, and what percentage coverage they provide. For example, our dental coverage is 80% for fillings and only 50% for crowns. It doesn't need to make sense. Sometimes you can find this info on-line so you don't have to talk to them and accidentally cause problems for yourself, and you have the information in black and white. They also have people called case managers. I tried to use one once and it didn't really work out. I kept getting shunted around to different ones and they were all clueless. That doesn't mean they all are, though.

I don't understand all the Axis I, II, III stuff. I've also never gotten anywhere with a therapist. They say stuff like, "That must be hard to deal with." Well duh. That's why I'm here.

 

[Tired of being sick]

@IreneF

Axis I = Primary illness which can most likely be responsible for causing Axises II III III


In my case the primary or Axis I is

Axis I CFS/ME/Chronic Severe Pain
Axis II POTS
Axis III Major Depression
Axis IIII ADD

My therapist is trying to badger me into.

I shit you not

Axis I Major Depression
Axis II ADD
Axis III CFS/ME/Chronic Severe Pain
Axis IIII Pots

Now that I have actually wrote this down.Her logic looks even more hideous.Lol

I'm actually going to print this to take to my next session , hand it to her then I will say..

"Look this over then tell me while looking at me with a straight face that this is your treatment plan for me"

 

[IreneF]

@IreneF

Axis I = Primary illness which can most likely be responsible for causing Axises II III III


In my case the primary or Axis I is

Axis I CFS/ME/Chronic Severe Pain
Axis II POTS
Axis III Major Depression
Axis IIII ADD

My therapist is trying to badger me into.

I shit you not

Axis I Major Depression
Axis II ADD
Axis III CFS/ME/Chronic Severe Pain
Axis IIII Pots

Now that I have actually wrote this down.Her logic looks even more hideous.Lol

I'm actually going to print this to take to my next session , hand it to her then I will say..

"Look this over then tell me while looking at me with a straight face that this is your treatment plan for me"

I finally looked this stuff up. Actually, her logic works according to the "rules" laid out by the
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)
(Sorry for the bolding. A consequence of the cut & paste.)

The DSM applies to mental disorders, so Axis I must be a mental disorder. Placing CFS/ME in that position would be claiming it is a mental disorder. Wrong.

Axis II are developmental or personality disorders. What we used to call mental retardation, autism, stuff like that, and also things like narcissism, paranoia, sociopathology… Not really accurate here in my description, but you can look it up if you're interested.

Axis III are physical disorders that affect the above. As, what we have.

Axis IV are psychosocial. As you just got divorced, your dog died, you lost your job, and your house burned down.

I got this information from an older edition of the DSM, so it may not be up to date. Also, the DSM is used for billing and insurance purposes, and its relationship to reality is questionable.

 

[Tired of being sick]

@IreneF

Whoa,come again?

Could you dumb your post down in a way that I can understand it?

As of now I'm overwhelmed(information overload)

Thanks

 

[IreneF]

@IreneF

Whoa,come again?

Could you dumb your post down in a way that I can understand it?

As of now I'm overwhelmed(information overload)

Thanks

Let me try.

The DSM is a series of diagnostic categories used by the psych crowd. Medical disorders are secondary in the DSM.

So, does the patient have A,B, or C? Or A, B, and C?

Because this is used by psychologists and psychologists, the primary category must be a mental disorder. (A non-psychiatrist medical doctor does not use the DSM.)

So Axis I is the principal mental diagnosis.

 

[xchocoholic]

Good news. I was very impressed with the list of recommended testing. ☺tc .. x