2014 Chalder chapter on CFS

[Esther12]

A lot of it is available on google docs... it's as you'd expect.

Some stuff on PACE recovery. The whole thing seems really fluffy, and one would hope that it would leave readers decidedly sceptical of it all... but the books editor decided to go with it. The book's not out yet. A few pages are missing, and it might be better to read on google books (it will be less blurry there): https://www.google.co.uk/search?q=Chronic Fatigue Syndrome: Rehabilitative Treatments and Mechanisms of Change 501 Trudie Chalder Mostofsky, David I. The Handbook of Behavioral Medicine&ie=utf-8&oe=utf-8&aq=t&rls

 

[Esther12]

 

[biophile]

No mention of objective outcomes (beyond the unimproved fitness of GET patients, which is solely mentioned to bolster the psychobabble), which is a rather dishonest omission.

 

[alex3619]

Sad. So very very sad.

 

[Sean]

...a rather dishonest omission.

Such persistent selectivity and misrepresentation is straight lying. There is no possible way she can plead ignorance about the full evidentiary picture, and the serious problems with her claims.

Chalder is a liar and a coward. She would rather sacrifice us than admit she is wrong.

Utterly contemptible.

 

[Valentijn]

Also no mention that the "physical function" improvements in PACE were on a questionnaire, not in actual, you know, "physical function".

 

[Bob]

Thanks Esther. I can't 'like' your posts. But I do appreciate your efforts.

I'm finding it impossible to find the right words to describe the text.

 

[Bob]

I think these sections needs requoting:

Cognitive Behavioral Model and Treatment of CFS
"In 1995, Surawy and colleagues (Surawy, Hackmann, Hawton, & Sharpe, 1995) described a cognitive model of understanding CFS. They suggested that a patent's interpretation of somatic symptoms such as fatigue as being physical as opposed to psycholoigcal was vital for the development and continuation of the disorder. The model advocated that these physical illness attributions may have evolved as a consequence of childhood experiences in which the expression of negative emotion would have been met with unsympathetic or hostile responses. The model proposed that a somatic attribution (attributing symptoms to a physical cause) makes the patients' symptoms and illness easier to understand. The diagnosis of CFS, in a sense, can be seen as a protective mechanism that the individual has employed in order to preserve identity and self-esteem. Over time, the individual's focus on the symptom of fatigue leads them to try and control it. The downside to this is that the individual then purportedly gets into a vicious circle in which the desire to control symptoms leads to avoidance in general. Although avoidant coping strategies may help in the short term, the long-term consequences are potentially extremelly unhelpful. The side effects of behavioral avoidance or inactivity are well understood, whether related to disease process or not."

Assessment
"It is also extremely helpful to elicit compassionately the patient's family and personal history. Previous trauma in childhood is associated with CFS in adulthood, and making links between trauma and fatigue may be helpful during the process of therapy."

 

[Bob]

Some notes.

"The CBT model attempts to incorporate the heterogeneous nature of the condition..."
...unless the patient has a biomedical illness.

Although plenty of discussion of the PACE trial, there is no mention that there was only 11-15% clinical response rate in the PACE trial, for self-reported outcomes only, and that CBT failed to improve objectively measured physical disability, employment data or welfare benefits claims.

As we know, the research re childhood trauma etc., is inconsistent and incredible. Considering the vast heterogeneity of CFS, it makes the vague discussions re childhood trauma etc. utterly devoid of meaning.

Chalder is clearly focusing on a small minority of her patients who she thinks respond to CBT. In other words, those patients who are receptive to CBT and who give positive feedback about it.

It doesn't seem surprising that patients who can accept the premise that they have a psychological illness may respond more positively to CBT, in self-reported outcomes, than those who know that they have a biomedical illness.
However, the objective evidence demonstrates that CBT does not improve physical disability in CFS, even though it is designed to do so.


"The evidence suggests that the most effective treatments for CFS are CBT and graded exercise therapy (GET). The CBT model attempts to incorporate the heterogeneous nature of the condition and stresses the role of perpetuating factors. The treatment for CFS therefore involves planned activity and rest, graded increases in activity, a sleep routine, and cognitive restructuring of unhelpful beliefs and assumptions."

Except that GET now tends to be a form of pacing, rather than 'graded increases in activity', because graded exercise doesn't work, thus undermining their whole pathetic model of illness.

 

[Esther12]

OT did you type that out bob, or find a way to copy and paste?

 

[Cheshire]

“Full recovery from untreated CFS is rare”

Hopefully, with CBT and GET the recovery rate is totally amazing!!

The median full recovery rate was 5% (range 0-31%)

That's the numbers we should see highlighted after the pace trial: 5% of total recovery, a triumph!

Their success is unexisting, “all in their mind”, but rather than allowing us to pace at our own rythm, they prefer make us feel guilty for our inability to get better when they aren’t able to help us.

 

[Bob]

OT did you type that out bob, or find a way to copy and paste?

I'm afraid I haven't found a clever way to copy and paste. I typed it. There's probably some typos!

 

[Esther12]

I've taught myself to touch type copying CFS stuff out from google books... would love to not have to!

 

[A.B.]

This material sounds similar to older texts about illnesses that were once considered partially or entirely psychosomatic. One difference is that the focus today is on thoughts and behavior rather than repressed emotions and character structure.

 

[SDSue]

We'd be better off if the author subscribed to the theories of Hippocrates in the 5th century BC. At lest Hippocrates believed there was a physical cause to seemingly unrelated symptoms:

The "bad uterus" takes to wandering around the body, causing various kinds of disorders such as anxiety, sense of suffocation, tremors, sometimes even convulsions and paralysis.

If the uterus has moved upwards, place malodorous and acrid substances near the woman’s mouth and nostrils, while scented ones were placed near her vagina; on the contrary, if the uterus has lowered, place the acrid substances near her vagina and the perfumed ones near her mouth and nostrils.
​

And so it goes in the wonderful world of ME/CFS "experts"

 

[alex3619]

This material sounds similar to older texts about illnesses that were once considered partially or entirely psychosomatic. One difference is that the focus today is on thoughts and behavior rather than repressed emotions and character structure.

Yes, Freudian babble with new bells and whistles.

 

[Sidereal]

This material sounds similar to older texts about illnesses that were once considered partially or entirely psychosomatic. One difference is that the focus today is on thoughts and behavior rather than repressed emotions and character structure.

And before that, moral failings.

 

[daisybell]

I'm speechless....

 

[A.B.]

Case in point:

Twenty-five women with peptic ulcers were studied from the psychosomatic point of view. All exhibited profound and overt personality disorders. The majority had been rejected by the mother and turned to the father for support. Ulcer symptoms were precipitated when the supporting figure failed them. Oral aggressive feelings played an important role and were often equated with denial of femininity. This group of women with peptic ulcers had a much higher incidence of overt personality disturbances than the majority of a comparative group of men peptic ulcer patients previously studied, although frustration of dependent wishes was equally important in both groups. The shift in the sex ratio of peptic ulcer during the past 50 years suggests that cultural factors may play a role in the development of this disease.

This was written in 1951. http://journals.psychiatryonline.org/article.aspx?articleid=144588

Now what happens if we replace peptic ulcers with CFS and replace terms from a psychoanalytical context with those from a biopsychosocial one?

Twenty-five women with CFS were studied from the biopsychosocial point of view. All exhibited profound and overt faulty illness beliefs. The majority had a history of childhood abuse. CFS symptoms were precipitated by stressful life events. Perfectionism played an important role and was often associated with stress sensitivity. This group of women with CFS had a much higher incidence of overt negative thinking patterns than the majority of a comparative group of men with CFS previously studied, although boom and bust activity patterns were equally important in both groups. The shift in the sex ratio of CFS during the past 50 years suggests that psychosocial factors may play a role in the development of this disorder.

 

[alex3619]

The thing is there are indeed cultural factors in peptic ulcers, and they are behavioral, but they are not psychological. How people live, and cook and prepare food has an impact, by increasing transmission rates of H. pylori.

The medical profession has had the means to prove ME is a severely debilitating physical illness since 1949. They failed. With some exceptions, they are still failing.