Metacognitions and negative emotions as predictors of symptom severity in CFS

Dolphin

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If anyone had the time (I don't atm) this could be challenged.

http://www.jpsychores.com/article/S0022-3999(10)00379-X/abstract

Metacognitions and negative emotions as predictors of symptom severity in
chronic fatigue syndrome

Lorraine Maher-Edwardsa, Bruce A. Ferniea, Gabrielle Murphya, Adrian Wellsb,
Marcantonio M. Spadacd

Received 6 April 2010; received in revised form 21 September 2010; accepted
28 September 2010. published online 19 November 2010.
Corrected Proof

Abstract

Objective

Chronic fatigue syndrome (CFS) describes a condition that is primarily
characterized by fatigue and flu-like symptoms that are not alleviated by
rest. This study investigated the relationship among metacognitions,
negative emotions, and symptom severity in CFS.

Methods
A total of 96 patients who had received a diagnosis of CFS according to the
Oxford Criteria completed a battery of self-report measures that consisted
of the Depression Anxiety Stress Scales, the 30-Item Metacognitions
Questionnaire, the Chalder Fatigue Questionnaire (CFQ), and the RAND 36-Item
Short-Form Health Survey-Physical Functioning.

Results
Correlation analyses showed that negative emotions and metacognitions were
positively correlated with measures of symptom severity and that
metacognitions were a better predictor of symptom severity than anxiety and
depression. Hierarchical regression analyses indicated that (1) lack of
cognitive confidence predicted both mental and physical factors of the CFQ
and physical functioning independently of negative emotions and (2) beliefs
about the need to control thoughts predicted the mental factor of the CFQ
independently of negative emotions and lack of cognitive confidence.

Conclusion
The data support the potential application of the metacognitive model of
psychological disorder to understanding CFS.

Keywords: Chronic fatigue syndrome, Metacognitions, Negative emotions,
Symptom severity
a Fatigue Service, Royal Free Hospital, London, UK

b University of Manchester, Manchester, UK

c London South Bank University, London, UK

d North East London NHS Foundation Trust, London, UK

Corresponding author. Department of Mental Health and Learning Disabilities,
Faculty of Health and Social Care, London South Bank University, 103 Borough
Road, SE1 0AA London, UK. Tel.: +44 020 7815 6758.

PII: S0022-3999(10)00379-X
 
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Use of the much unloved Oxford Criteria makes any conclusions rather suspect. Does the paper say how strong the correlations are?
 

Dolphin

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This gives an idea where they are coming from:
The role of cognitive processes in MUSs has been
conceptualized by Brown [25], who has put forward a model
in which two cognitive systems determine the selection of
information to be processed: the primary attentional system
(PAS), which operates below the level of consciousness, and
the secondary attentional system (SAS), which is amenable
to executive control [25]. In terms of MUSs, the PAS
automatically selects information for processing, activating
schemata that lead to a misinterpretation of the sensory world
(i.e., symptoms). The PAS is primed to process information
in this way because of chronic activation of stored
representations relating to illness. Crucially, this results in
a subjective experience of symptoms indistinguishable from
those with a biological or organic cause.
Once such schemata
are activated, the individual may then attempt to control
cognition via the SAS. Such attempts are invariably
unsuccessful because the locus of attention has already
been determined by the PAS, contributing to the sustained
activation of problematic stored representations [25].
 

Dolphin

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Implications (in the authors' minds)

Implications (in the authors' minds):
From a therapeutic perspective, the present findings
suggest that the techniques and principles of metacognitive
therapy [29] may be helpful in managing, or in reducing,
symptom severity in CFS. Metacognitive therapy modifies
the beliefs that individuals have about their thoughts and
introduces flexible and alternative ways of relating to mental
events. Examples of this include the modification of beliefs
through restructuring exercises and the facilitation of skills
that promote a direct change in aspects of the CAS (for
instance, interventions aimed at modifying attentional
control or interrupting rumination and worry). Patients are
helped to regain flexibility in thinking so that they can
continue with positive goal-directed behaviors and disengage
from the unhelpful features of the CAS in response to
unwanted inner events.
 
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"Implications (in the authors' minds):From a therapeutic perspective, the present findings suggest that the techniques and principles of metacognitive therapy [29] may be helpful in managing, or in reducing, symptom severity in CFS.
Well, at least "managing or reducing symptom severity" is recognising he limitations of such an approach rather than suggesting anything remotely curative.
 

Dolphin

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Study limitations (according to authors)

Study limitations (according to authors):
This study has several limitations that will have to be
addressed by future research. First, social desirability, selfreport
biases, context effects, and poor recall may have
contributed to errors in the self-report measurements.
Second, the CFQ asks about a change in symptom severity
over the previous month; it is plausible to assume that some
patients may have been chronically ill for several years,
entailing that a response to the item “no worse than usual”
may still indicate severe experience of symptoms. Third, a
cross-sectional design was adopted, and this does not allow
causal inferences. Fourth, the sample was moderate in size
and several patients had received CBT, which may have
exposed them to the identification and exploration of
cognitive constructs. However, standard CBT for CFS
does not typically include the examination of metacognitions
assessed here. Thus, the experience of treatment may not be
particularly significant in explaining the current findings.
Finally, the absence of a comparison group of patients who
did not have a diagnosis of CFS entails that these findings
only apply to symptom severity within CFS and not to
predicting classification of the condition. For all these
reasons, the findings should be viewed with caution.
I think some of those points are quite good and could be made again about other studies.

I have seen the Chalder Fatigue Scale questionnaire adapted so instead of asking about the last month, it asked something about before your bout of illness (wording may not be anything like that).

37 (38.5%) of the 96 had previously had CBT. I have to wonder if the results were a lot different for this group whether we would be told about it - it doesn't give an indication.
 

Dolphin

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This is the point I'd make if I was writing a letter. Other people can feel free to make it if they want to write a letter:

The 30-Item Metacognitions Questionnaire 30 (MCQ-30)
[31] is a self-report measure that assesses five factors
pertaining to metacognition: [..] (3) lack of cognitive
confidence (e.g., my memory can mislead me at times);
I presume these are the 6 questions for that factor:

8. I have little confidence in my memory for words and names
14. My memory can mislead me at times
17. I have a poor memory
24. I have little confidence in my memory for places
26. I do not trust my memory
29. I have little confidence in my memory for actions
These could be due to the person having actual cognitive (memory) problems due to ME/CFS.

This is important as this is the factor that popped out using Hierarchical multiple regression analyses:

The results (see Table 2) revealed that lack of
cognitive confidence predicted CFQ-Physical and RAND
SF-36 PF scores independently of negative emotions and that
both lack of cognitive confidence and beliefs about the need
to control thoughts predicted CFQ-Mental independently of
negative emotions. Examination of the statistics in the final
step of each equation showed that negative emotions did not
explain unique variance in CFQ-Mental and CFQ-Physical.
So lack of cognitive confidence predicted Chalder Fatigue Questionnaire-Physical, Chalder Fatigue Questionnaire-Mental (as in mental fatigue) and SF-36 physical functioning scores.

If one assumes, cognitive confidence is proportional to lack of cognitive problems due to ME/CFS, then all this shows (from what I can see) is that in ME/CFS, cognitive impairment in ME/CFS is proportional to worse scores (functioning) on Fatigue Questionnaire-Physical, Chalder Fatigue Questionnaire-Mental (as in mental fatigue) and SF-36 physical functioning.
 

Esther12

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So more seriously ill people tend to worry more?

edit: Actually... I don't really understand many of the statements in that questionnaire:

eg: "I cannot ignore my worrying thoughts"

Isn't that a truism? I can choose to spend my time on something other than worrying, but when you are having a worrying thought, surely that means you are engaging with the worry?

Things like this : "My memory can mislead me at times" are definitely true for everyone.

"My worrying could make me go mad"... personally, I don't spend much time worrying... but as an abstract discussion of possibilities, I entirely agree that my worrying COULD make me go mad.

When you start to look at psychology questionnaires, they're really not that useful.
 
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So lack of cognitive confidence predicted Chalder Fatigue Questionnaire-Physical, Chalder Fatigue Questionnaire-Mental (as in mental fatigue) and SF-36 physical functioning scores.

If one assumes, cognitive confidence is proportional to lack of cognitive problems due to ME/CFS, then all this shows (from what I can see) is that in ME/CFS, cognitive impairment in ME/CFS is proportional to worse scores (functioning) on Fatigue Questionnaire-Physical, Chalder Fatigue Questionnaire-Mental (as in mental fatigue) and SF-36 physical functioning.
That's an excellent point. Also the authors seem to have done a good job of pointing out why their study was really pretty flaky (esp re CFQ) - not sure why the journal would want to publish something like this.

I'd still be interested to know how strong the correlation was :)
 
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So more seriously ill people tend to worry more?

When you start to look at psychology questionnaires, they're really not that useful.
Agreed: it's not at all clear if they are measuring anything meaningful. I don't really understand how 'Validation' of questionnaire works but it seems to involve checking for repeat reliability, correlation with other made-up questionnaires and within the questionnaire - it never seems to involve proving that the questionnaire is measuring something meaningful and doing it accurately.
 

Dolphin

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Agreed: it's not at all clear if they are measuring anything meaningful. I don't really understand how 'Validation' of questionnaire works but it seems to involve checking for repeat reliability, correlation with other made-up questionnaires and within the questionnaire - it never seems to involve proving that the questionnaire is measuring something meaningful and doing it accurately.
Yes, I have picked up that impression also. Feel I need to read up more to see if there are flaws in how they are doing it compared to how they are supposed to do it.

Regarding this paper, I wonder have metacognitions been looked at for other "physical" illnesses. I reckon it might "fall down" with, for example, neurological conditions that affect brain functioning.
 

Enid

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Much enjoyed the "study limitations" and "findings with caution" - Quite so and for all the reasons.
 

Esther12

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Yes, I have picked up that impression also. Feel I need to read up more to see if there are flaws in how they are doing it compared to how they are supposed to do it.

Regarding this paper, I wonder have metacognitions been looked at for other "physical" illnesses. I reckon it might "fall down" with, for example, neurological conditions that affect brain functioning.
All these CFS studies should have somthing like an MS control group imo.

(It is a bit unfair on MS patients though... If the results keep being the same then I think a lot of doctors would be rather assume MS patients were psychologically disturbed than start treating their CFS patients as if they were not)
 
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Yes, I have picked up that impression also. Feel I need to read up more to see if there are flaws in how they are doing it compared to how they are supposed to do it.
Me too. Though I think the 'how they are supposed to be doing it' might also prove to be unconvincing. When I;ve finished the joys of my biostatistics textbook I might feel up to this kind of work.
 

Dolphin

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All these CFS studies should have somthing like an MS control group imo.

(It is a bit unfair on MS patients though... If the results keep being the same then I think a lot of doctors would be rather assume MS patients were psychologically disturbed than start treating their CFS patients as if they were not)
:D (message now 10 chars).