• 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.

Attentional and interpretive bias towards illness-related information in chronic fatigue syndrome

halcyon

Senior Member
Messages
2,482
Attentional and interpretive bias towards illness-related information in chronic fatigue syndrome: A systematic review.
Hughes A1, Hirsch C1, Chalder T2, Moss-Morris R1.
Author information
  • 1Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
  • 2Department of Psychological Medicine, Weston Education Centre, King's College London, UK.
Abstract
PURPOSE:

Chronic fatigue syndrome (CFS) is characterized by severe and debilitating fatigue. Studies based on self-report measures suggest negative illness representations, related symptom interpretations, and heightened symptom focusing are maintaining factors of fatigue. This study reviews studies which have investigated these cognitive biases using experimental methods, to (1) review the evidence for information processing biases in CFS; (2) determine the nature of these biases, that is the stages cognitive biases occur and for what type of stimuli; and (3) provide directions for future methodologies in this area.

METHODS:
Studies were included that measured attention and interpretation bias towards negative and illness-related information in people with CFS and in a comparison group of healthy controls. PubMed, Ovid, CINAHL, PsycINFO, Web of Science, and EThOS were searched until December 2014.

RESULTS:
The evidence for cognitive biases was dependent on the methodology employed as well as the type and duration of the stimuli presented. Modified Stroop studies found weak evidence of an attentional bias in CFS populations, whereas visual-probe studies consistently found an attentional bias in CFS groups for health-threatening information presented for 500 ms or longer. Interpretative bias studies which required elaborative processing, as opposed to a spontaneous response, found an illness-related interpretive bias in the CFS group compared to controls.

CONCLUSIONS:
Some people with CFS have biases in the way they attend to and interpret somatic information. Such cognitive processing biases may maintain illness beliefs and symptoms in people with CFS. This review highlights methodological issues in experimental design and makes recommendations to aid future research to forge a consistent approach in cognitive processing research. Statement of contribution What is already known on this subject? Studies based on self-report measures suggest negative illness representations, related symptom interpretations, and heightened symptom focusing contribute to the maintenance of chronic fatigue. Experimental studies in other clinical populations, such as patients with anxiety, depression, and chronic pain, have identified illness-specific biases in how information is implicitly attended to and interpreted, which has a causal role in these conditions. What does this study add? This is the first review of implicit cognitive processes in chronic fatigue syndrome (CFS). Sustained attention and negative interpretations of somatic information may reinforce negative illness beliefs. Cognitive processes have a role to play in the cognitive behavioural model of CFS.
 

Chrisb

Senior Member
Messages
1,051
CONCLUSIONS:
Some people with CFS have biases in the way they attend to and interpret somatic information. Such cognitive processing biases may maintain illness beliefs and symptoms in people with CFS.

Some people have biases therefore all people may have illness beliefs maintained by such biases.

An interesting form of syllogistic reasoning.
 

sarah darwins

Senior Member
Messages
2,508
Location
Cornwall, UK
On the plus side, they're starting to sound quite insane now. There's a sort of demented, euphoric mania about the tone of this. I have visions of them, gathered in the BPS bunker while the forces of reason converge on them, churning out paper for all they're worth and cackling to themselves. I think they know their goose is cooked and they're totally losing the plot.
 

A.B.

Senior Member
Messages
3,780
On the plus side, they're starting to sound quite insane now. There's a sort of demented, euphoric mania about the tone of this. I have visions of them, gathered in the BPS bunker while the forces of reason converge on them, churning out paper for all they're worth and cackling to themselves. I think they know their goose is cooked and they're totally losing the plot.

I think they earn money selling CBT/GET training to therapists, so it doesn't matter if it's ridiculous nonsense as long as gullible therapists buy it, which in turn might also be aware that it's ridiculous nonsense but don't care if it increases their earning potential thanks to the politics of the NHS which might also be aware that it's ridiculous nonsense but doesn't care because they have to be seen as doing something and CBT/GET is the infalsifiable, cheap option. Especially if it's so hated by patients because that reduces service usage which means an even greater reduction of costs.

The status quo is completely acceptable to these parties, so why change anything?

Some random cynical thoughts which may or may not have any relation to reality.
 

duncan

Senior Member
Messages
2,240
Chronic fatigue syndrome (CFS) is characterized by severe and debilitating fatigue.

No. (Obviously @halcyon didn't say this - I can't copy it the correct way.)

The very first sentence is wrong. They got it wrong out of the starting gate. How absurd is that??

This is like saying Winter is characterized by geese flying south. Sure, geese do fly south in the Winter, but it is so much more than this.

Now, everyone knows this. Everyone. So why does this gang psychs act like they don't?
 

Comet

I'm Not Imaginary
Messages
692
Of course one could also conclude that the reason we have 'heightened symptom focusing' is because we are desperately trying to get someone to help and believe us. But almost no one will. And the ones who pretend to be helping completely distort the truth. Leaving us suffering for decades. :jaw-drop: But, nah, that's just crazy talk! :aghhh:
 
Messages
5,238
Location
Sofa, UK
On the plus side, they're starting to sound quite insane now.
I agree. On the minus side, I think this is the most vile and abusive abstract I've ever read. Yes, over the last couple of years or so the UK psych papers seem to have entered some kind of 'reductio ad absurdam' phase. It's a reflection of the fact that they're losing the argument and real science is catching up with them, but that doesn't make it any easier for me to read. Just disgusting.
 
Messages
13,774
When I was failing to find the full text for this I found this from a phd dissertation that could be of interest:

Attentional Bias and Physical Symptom Reporting

2015

Sarah Scott

Results
Chronic Fatigue Syndrome
There is very limited evidence for an attentional bias towards body relevant information in individuals with CFS according to the findings of the reviewed studies. Although this has been explored using a range of paradigms (exogenous cueing task, emotional Stroop task and dot-probe task), attentional bias has only been observed in one study using the dot-probe task with an SOA of 500ms in CFS patients compared to healthy controls. Hou, Moss-Morris, Bradley, Peveler, and Mogg (2008) found that CFS participants were faster to respond when the threat stimulus and probe were in the same position relative to when these were in different positions; this implies that the threatening information had a facilitating effect. The effect was not influenced by mode of presentation and was unrelated to anxiety, depression and psychomotor speed. In contrast, Hou et al. (2014) did not find evidence of an attentional bias to health threat information on a dot-probe task with the same stimuli when participants with CFS with poor executive control were excluded. Thus, the attentional bias effect appeared to be dependent reflect poor executive attention in the CFS participants; however, there was no comparison with non-CFS participants with poor executive attention, making it difficult to draw firm conclusions. No effects at an SOA of 1250ms were found.

Using an unmasked emotional Stroop task, Moss-Morris and Petrie (2003) did not find evidence of an attentional bias towards threatening information at later stages of information processing. Another study using an adapted modified exogenous cueing task with threatening health-related, social threat and neutral words with an SOA of 150ms found no evidence of an attentional bias in people with CFS compared to healthy controls at an early stage of automatic processing (Martin & Alexeeva, 2010). This study attempted to manipulate attentional focus on bodily sensations by incorporating ‘rumination’ and ‘distraction’ conditions and this was not found to influence performance.

Using the quality assessment tool (see Table 3), two of the studies in CFS were rates as being of high quality (Hou et al., 2014; Martin & Alexeeva, 2010) and the other two as acceptable in quality (Hou et al., 2008; Moss-Morris & Petrie, 2003). All studies recruited participants on the basis of diagnosis by a medical professional and with reference to standardised criteria such as the Centres for Disease Control and Prevention diagnostic criteria (Fukuda et al., 1994). The study by Hou et al. (2014) was the strongest study in terms of participant characteristics and diagnostic ascertainment. They recruited participants from a specialist gastrointestinal outpatient clinic and participants received a diagnosis of CFS from a specialist CFS practitioner and with reference to the Chalder Fatigue Scale (Chalder et al., 1993) and the Centres for Disease Control and Prevention diagnostic criteria (Fukuda et al., 1994). This strict approach to diagnostic ascertainment would have reduced potential sampling bias by reducing the likelihood of individuals without CFS being included in the experimental group. Two of the studies recruited CFS participants from CFS support groups (Hou et al., 2008; Martin & Alexeeva, 2010).

Individuals with CFS choosing to attend a support group may differ from CFS patients in the wider community in terms of degree of impairment (Sharpe, Hawton, Seagroatt, & Pasvol, 1992). The negative valence of health threat information, and thus its propensity to capture attention, may be perceived as greater by individuals with higher levels of functional impairment. This calls into question the generalisability of the findings from these studies to individuals with CFS not attending a support group. The positive finding of an attentional bias to health-threat information in individuals with CFS recruited from a support group (Hou et al., 2008) can thus only be taken as evidence of an attentional bias in this specific population rather than individuals with CFS more generally.

All of the studies attempted to match the control group for age, gender and educational attainment and all attempted to account for potentially relevant confounding variables such as anxiety, depression and concurrent medical conditions. None of the studies accounted for medication use which could be a potentially important factor. The studies all compared CFS patients with healthy controls. The inclusion of an illness control group would have enabled conclusions to be made as to whether any differences in attentional bias were due to the condition of interest or due to a more general effect of experiencing unpleasant symptoms. All studies used well-validated and established experimental tasks to measure bias. Dependent variables were described with operational precision and bias was minimised. Only one study raised doubts about potential bias with regards to the measurement of attentional bias (Moss-Morris & Petrie, 2003). In this study, Stroop stimuli were presented on pieces of card rather than electronically, meaning that reaction times were measured manually by the experimenter operating a stop-watch. The authors did not clarify whether the experimenter was blind to condition allocation, which clearly introduces the potential for experimenter error and bias, raising some doubts as to the reliability and validity of the findings from this study.

Statistical analyses were conducted appropriately with data being transformed to correct skewed data prior to conducting parametric analysis (Hou et al., 2014) or analysing data using non-parametric test if data did not meet assumptions for parametric analysis (Moss-Morris & Petrie, 2003).

It is worth noting that the threatening health relevant stimuli used in the studies were related to general health concerns and were not specific to CFS-related concerns. It may be that in order for threatening stimuli to trigger an attentional bias it needs to be pertinent and salient to the specific health concerns of the individual. Future studies should manipulate the content of the threat-relevant stimuli to address this.

The findings from these studies suggest that the evidence for an attentional bias for health-threat information in CFS is equivocal. All of the studies, with the exception of Hou et al., (2014) had some specific methodological issues relating to validity and reliability which should be acknowledged when interpreting the findings from these studies. Future studies should recruit individuals from wider sources so that samples are more representative. Participant recruitment should also involve strict inclusion criteria for CFS participants, specifically diagnosed by a CFS specialist and with reference to objective criteria. Future research would also benefit from larger sample sizes with consideration of functional ability, stage of illness and number of symptoms experienced.
 

taniaaust1

Senior Member
Messages
13,054
Location
Sth Australia
I cried when I read the original thread post here, are we really moving forward with this illness or has no ground be gained in science yet at all? It's like the psychs are getting worst and not better with it. For many years they have been trying to discuse their views in a twisted kind of manner but this latest is so in our face of what they truely do think.

I clicked this link as when I read the heading, I'd actually thought it was going to be a positive study on how psych CFS researchers and doctors are biased towards those who have ME/Cfs and often go about interpretive this illness wrong, how these researchers have attentional biases towards the wrong symptoms in ME/CFS. **sighs, i was too positive again.. reading what this was actually about then like slammed me**
 
Messages
5,238
Location
Sofa, UK
I cried when I read the original thread post here
This is exactly what worried me when I read the abstract and called it abusive. It angered me for several reasons, but I'm acutely aware of how upsetting this content can be for many patients who are really struggling. To be described in such naked terms as being a burden on society, and to be taken to task for focusing on their symptoms....this is thinly veiled indeed and it gets hard to avoid comparisons with the worst episodes in human history when it gets this blatant. I used the word abusive after some consideration: that's exactly what this is. I do agree with Sarah about the positive side: this sort of thing is indicative of a movement that is falling apart, reduced to absurdity and ever more transparent in that absurdity and in its utter disrespect of sufferers. But I worry about the effect on vulnerable people who may come into contact with this kind of garbage.