Dutch CBT manual (from 2003) (Bleijenberg, Prins & Bazelmans)

Dolphin

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http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind1009C&L=CO-CURE&P=R1774&I=-3

Bleijenberg G, Prins JB, Bazelmans E (2003). Cognitive-behavioral therapies. In Handbook of
Chronic Fatigue Syndrome (ed. L. A. Jason, P. A. Fennell and R. R. Taylor), pp. 493526. Wiley: New York
Ellen Goudsmit PhD critiques this section in her review of the book at: http://freespace.virgin.net/david.axford/bookrev8.htm .

Gijs Bleijenberg was regularly involved in CDC discussions on CFS in the 2000s (one of the international representatives).
 
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With regards to the deleted post, I thought I'd posted in the wrong thread.

Anyway, it is interesting that Ellen Goudsmit's point about the difference in the actometer readings being small, was later shown to be correct in the meta review of the Nijmegen CBT articles.

One point that needs to be discussed more is the fact that CBT can never be 'placebo controlled'. In fact one of its primary objectives of certain schools of thought is 'changing illness beliefs''. Belief of self-efficacy is not the same as actual efficacy. Hence the emphasis by you and others on the importance of objective measures of treatment success, such as the aforementioned actometer readings.
There may of course be other minor temporary benefits from better pacing of activity, better sleep regulation etc. It is also interesting that when a CBT trial is negative - the 1993 Lloyd et al. trial for example, which also trialed pharmaceutical treatments, certain prominent psychiatrists merely make excuses. To paraphrase - they're doing it wrong (due to poor training, treatment period not long enough and every other excuse you can think of), or comparison to the pharmaceutical treatments prevents magically prevents CBT from working. Or maybe providing the alternative better controls for the placebo effect. Very few psychiatrists seem to discuss why CBT has consistently failed to be proven as curative for a large majority of patients. I guess they don't like talking about their failures.
 

Berthe

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Thank you Andrew. Fascinating! The dubieus and grimy nature of research concerning CBT. (and CFS). I also read the study of the meta-analysis on a dutch forum. It was hillarious. Do you know where this meta-analysis was published? It tought it was made by Roessingh. But I can't find it in the published form. The conlusion was that patients with CFS were moving less than healthy people. Roessingh is now looking for patints who are willing to carry around a actometer, to measure their movements. What I can read from their website is that they try to treat patients from a distance.The patient will get immediate feedback on their movements. A little PDA will advice them what to do (based on healthy controls) to find the right balance.:eek:

Because this advice is based on healthy controls it will demotivate some patients. Roessingh is therefor studying the norm for movement scientifically:confused:
They think that improving the norm for movement, will motivate people with CFS to better follow the guidelines for moving.

This is a brandnew study. It makes me feel sick to my stomach.

What a waste of money and time. They remain total oblivious for the post-exertional malaise that comes with moving to much.

Love,
Berthe

http://www.onwilliglichaam.blogspot.com
 

Dolphin

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Thank you Andrew. Fascinating! The dubieus and grimy nature of research concerning CBT. (and CFS). I also read the study of the meta-analysis on a dutch forum. It was hillarious. Do you know where this meta-analysis was published? It tought it was made by Roessingh. But I can't find it in the published form. The conlusion was that patients with CFS were moving less than healthy people. Roessingh is now looking for patints who are willing to carry around a actometer, to measure their movements. What I can read from their website is that they try to treat patients from a distance.The patient will get immediate feedback on their movements. A little PDA will advice them what to do (based on healthy controls) to find the right balance.:eek:

Because this advice is based on healthy controls it will demotivate some patients. Roessingh is therefor studying the norm for movement scientifically:confused:
They think that improving the norm for movement, will motivate people with CFS to better follow the guidelines for moving.

This is a brandnew study. It makes me feel sick to my stomach.

What a waste of money and time. They remain total oblivious for the post-exertional malaise that comes with moving to much.

Love,
Berthe

http://www.onwilliglichaam.blogspot.com
I think Andrew1 is referring to this paper:

Psychol Med. 2010 Aug;40(8):1281-7. Epub 2010 Jan 5.

How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity.

Wiborg JF, Knoop H, Stulemeijer M, Prins JB, Bleijenberg G.

Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Expert Centre Chronic Fatigue, The Netherlands. j.wiborg@nkcv.umcn.nl

Abstract
BACKGROUND: Cognitive behaviour therapy (CBT) is known to reduce fatigue severity in chronic fatigue syndrome (CFS). How this change in symptomatology is accomplished is not yet understood. The purpose of the present study was to determine whether the effect of CBT on fatigue is mediated by an increase in physical activity.

METHOD: Three randomized controlled trials were reanalysed, previously conducted to evaluate the efficacy of CBT for CFS. In all samples, actigraphy was used to assess the level of physical activity prior and subsequent to treatment or a control group period. The mediation hypothesis was analysed according to guidelines of Baron & Kenny [Journal of Personality and Social Psychology (1986)51, 1173-1182]. A non-parametric bootstrap approach was used to test statistical significance of the mediation effect.

RESULTS: Although CBT effectively reduced fatigue, it did not change the level of physical activity. Furthermore, changes in physical activity were not related to changes in fatigue. Across the samples, the mean mediation effect of physical activity averaged about 1% of the total treatment effect. This effect did not yield significance in any of the samples.

CONCLUSIONS: The effect of CBT on fatigue in CFS is not mediated by a persistent increase in physical activity.
 

Berthe

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Thank you Dolphin,

My brain is like Swiss Emmentaler cheese:D
I actually find the article again on the dutch forum. It is ahead of print, that's probably the reason why I can't find it yet. Well read and weep.

Clin Rehabil. 2010 Oct 13. [Epub ahead of print]
Daily physical activity of patients with the chronic fatigue syndrome: a systematic review.
Evering RM, van Weering MG, Groothuis-Oudshoorn KC, Vollenbroek-Hutten MM.
Roessingh Research and Development, Enschede, The Netherlands.
Abstract
Objective: To give an overview of the physical activity level of patients with chronic fatigue syndrome in comparison with asymptomatic controls. Data sources: MEDLINE, Web of Science, EMBASE, PsycINFO, Picarta, the Cochrane Controlled Trial Register that is included in the Cochrane Library and reference tracking. Review methods: A systematic literature search was conducted focusing on studies concerning physical activity levels of patients with chronic fatigue syndrome compared to controls. A meta-analysis was performed to pool data of the studies. Results: Seventeen studies were included with 22 different comparisons between patients with chronic fatigue syndrome and controls. Fourteen studies, including 18 comparisons, showed lower physical activity levels in patients with chronic fatigue syndrome as compared to controls. Four studies, including four comparisons, showed no differences between both groups. The meta-analysis included seven studies and showed a daily physical activity level in patients with chronic fatigue syndrome of only 68% of the physical activity level observed in control subjects. The pooled mean coefficient of variation in patients with chronic fatigue syndrome was higher as compared to control subjects (34.3% versus 31.5%), but this difference did not reach significance. Conclusion: Patients with chronic fatigue syndrome appear to be less physically active compared with asymptomatic controls. There is no difference in variation of physical activity levels between patients with chronic fatigue syndrome and healthy control subjects, but the validity and reliability of some methods of measuring physical activity is questionable or unknown.
PMID: 20943713 [PubMed - as supplied by publisher]

I also love the last sentence after the comma.

Love,
Berthe

http://www.onwilliglichaam.blogspot.com
 
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I have skimed the discussion of the Evering et al. paper and it's definitely weep-worthy.

This is the last few paragraphs (the worst of it)

It is important to break through the negative vicious circle of inadequate low physical activity
levels in the chronic fatigue syndrome.15 In general, the risk for development of chronic diseases is
increased when the physical activity level is inadequate low. Physical activity is often recommended
as secondary prevention against chronic diseases and prescribed as therapeutic medicine.49–51
However, in order to treat inadequate low physical activity levels effectively in the chronic fatigue
syndrome we need to know why patients with the chronic fatigue syndrome are less physically
active. Van Houdenhove et al.52 proposed reduced ‘effort tolerance’ as the primary disturbance in
chronic fatigue syndrome resulting in low motor performance. Treating low ‘effort tolerance’ and
low ‘effort capacity’ might be helpful in increasing physical activity levels and breaking through the
negative vicious circle.

Furthermore, we need to know how patients with chronic fatigue syndrome can increase their
physical activity patterns to come to healthy patterns. This can be achieved with more knowledge
about the physical activity pattern of patients with chronic fatigue syndrome. Two studies included in
this review studying physical activity patterns reported less intense and shorter activity peaks,
less time spent in high level activities and longer average rest periods after peaks in subjects with
chronic fatigue syndrome compared with control subjects.35,41 These differences could indicate
disturbances in daily physical activity patterns in patients with chronic fatigue syndrome, and targeting
these disturbances might improve their physical activity patterns and decline their health
complaints. In graded exercise therapy different therapeutic approaches are outlined specified to
different fitness levels between patients with chronic fatigue syndrome.53 Differences in daily
physical activity levels between patients with chronic fatigue syndrome might also be of importance
in determining more individualized treatment protocols and contributing to the
optimization of treatment procedures like cognitive behavioural therapy and graded exercise therapy.
However, more insight is needed into inadequate physical activity patterns in the chronic
fatigue syndrome and the relation with symptoms and cognitions.
I'm hypothesizing they have zero actual experience in treating our disease.
http://www.rrd.nl/
See also: http://www.rrd.nl/publications/posters/Schreurs K - Measuring daily activity in fibromyalgia.pdf

Someone should write a letter to the editor. :tongue: