New paper from the Netherlands: the treatment of CFS

alex3619

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This reminds me of the terrible pictures of thousands upon thousands of persecuted Jews being herded to their death while the mocking giant metal saying Albeit Macht Frei cast on ominous shadow over those sentenced to starvation, hard labour and torture by the German government. The mentality and ethics of our present governments seem to be emulating the terrible behaviour that characterised National Socialism in the 30s.
Expect to hear the phase Godwin's Law a lot in the coming years. Godwin's law is not a law but an observation that long conversations on the net tend to make comparisons to Nazis etc. It is then used irrationally by many to claim all comparisons are wrong.

I am expecting to see two trends in this century. A continuing rise of national socialist rhetoric, and a counter movement in socialist rhetoric. Governments are at risk of going to extreme.

I would not be surprised if the kinds of naysayers who defend extreme political views played a significant part in the rise of National Socialism and the Nazi party. These extreme views have three things usually.

First, they offer simple answers ... though more usually promises of answers which usually are not delivered. Instead they wind up scapegoating and doing nothing to fix things.

Second, they play on hate and division. Its hate politics gone amok. That is happening in many countries right now.

Third, there are powerful vested interests backing it. Often this is from an industrial lobby.

Democracy relies, at its core, on informed public debate. In an era of public relations, spin, and declining journalism, we are at danger of being ill informed on decisions that will impact our futures.

To date only the internet is providing a growing opportunity to debate this stuff. Which is maybe why naysayers like Godwin's Law?
 

JaimeS

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It's THE answer, guys. The answer to EVERYTHING.

Want students to do better in school?
Treat them like their learning difficulties are beneath your notice.

Want your workers to be more productive?
Treat them like their work is meaningless.

Want your patients to get better?
Be sure to treat the voicing of their concerns like the buzzing of an irritating insect. And make sure everyone else in their life treats them the same way.

They will wander away, and with them, your problems.

And if they've gone, they must be cured. :rolleyes:

IT'S THE ROSETTA STONE FOR LIFE, THE UNIVERSE, AND EVERYTHING. Treat people badly and the rest works itself out!

If only I'd had this vital information earlier! My life would have turned out very differently! Someone might've murdered me by now! :angel:

-J
 

jimells

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Third, there are powerful vested interests backing it. Often this is from an industrial lobby.
This most important part of the story of 20th century fascism has been suppressed. We're supposed to believe that an undistinguished, low-ranking former officer in the German Army built one of the world's most vicious killing machines simply by being a compelling speaker. We are most certainly not supposed to acknowledge the role played by American and European capitalists:

Saving Private Power said:
It wasn't just the Rockefellers who admired Nazi ingenuity. Among the major U.S. corporations who invested in Germany during the 1920s were Ford, General Motors, General Electric, Standard Oil, Texaco, International Harvester, ITT, and IBM - all of whom were more than happy to see the German labor movement and working-class parties smashed. For many of these companies, operations in Germany continued during the war (even if it meant the use of concentration camp slave labor) with overt U.S. government support.

"Pilots were given instructions not to hit factories in Germany that were owned by U.S. firms," says author Michael Parenti. "Thus Cologne was almost leveled by Allied bombing but its Ford plant, providing equipment for the Nazi army, was untouched; indeed, German civilians began using the plant as an air raid shelter."

Author: Michael Zezima
Published by: Soft Skull Press, New York, April 2000
 

Dolphin

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The introduction has some information on background findings which might be of use to somebody.

Prins et al.(2004) found that CFS patients’ perceived lack of social support perpetuated fatigue. Further, negative social interactions seem to encourage illness behaviour in the sense that CFS patients often try to prove that they are indeed ill (van Houdenhove & Luyten,2008).

Some studies suggest that CFS patients become more reliant on close family members and partners for support due to a decreased social network (Anderson & Ferrans,1997; Kelly et al. 1999). Of all the people in the CFS patients’ social network, it is likely that spouses or partners are the most influential. Partners adapt to the illness by forming their own illness perceptions and developing ways of coping. Adaptive mechanisms of patient and partner interact, becoming manifest in behavioural and communication patterns. Recent research findings suggest that the quality of this dyadic adjustment is associated with patients’ daily functioning and symptoms (Blazquez et al. 2012). Not all of the partners’ adaptive behaviours may be beneficial for the patient–in fact, they may perpetuate patients’ fatigue and impairments.
A cross sectional study showed that solicitous behaviour of the partner was related to more symptoms, illness behaviour, and worse functioning of CFS patients
(Romano et al.2009). Solicitous behaviour was defined as exhibiting concern for the other’s physical condition, comforting the patient, and discouraging the patient from activity. Such responses may have a negative impact on the patient’s treatment outcome. Further, the solicitous behaviour of the partner is likely influenced by his/her perception of the illness. If a partner perceives CFS as a severe illness, they might be more inclined to be solicitous. The attribution of symptoms by the partner can also influence their response to the patient. White et al.(2006) found that close others who attributed the illness of their partner to internal psychological causes were inclined to offer less support. Partners who attribute CFS to physical causes might be inclined to be more supportive towards their ill partner.

When considering the role of the partner, it is relevant to take into consideration that the relationship may be challenged by the CFS, and relationship dissatisfaction may become a stressor on its own and therefore a perpetuating factor of fatigue and functional impairments. Studies have shown that women with CFS presented more symptoms when they had conflicts with their partners (Goodwin,2000). Research in other chronic illnesses showed that positive relationship interactions predicted reduction of pain and fatigue (DiMatteo, 2004; Cano et al.2010; Stadler et al.2012)
 

Dolphin

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As somebody pointed out, what was measured in this trial were subjective outcome measures (questionnaire scores). These have been found not to translate to objective improvements in activity levels in a review of three Dutch CBT intervention studies (Wiborg et al., 2010).
 

Dolphin

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Main result
Testing the hypothesis that partners’ solicitous responses and relationship dissatisfaction of partner and patient has a negative effect on treatment outcome

Patients whose partners reported solicitous responses showed less often an improvement in fatigue. The more patients were dissatisfied with their relationship, the less likely they were to show an improvement in fatigue. This latter relationship was only marginally significant.* Together, partners’ solicitous responses and patients’ relationship dissatisfaction explained 7% of the variance in treatment outcome with respect to fatigue (Table 2). Reporting more solicitous responses by the partner also predicted less clinically significant improvement of functional impairments. Partners’ solicitous responses and patients’ functional impairments at baseline explained 16% of the variance of post-treatment clinically significant improvement of functional impairments (Table 2). Relationship dissatisfaction was not related to improvement in functional impairment.
*The marginal significant result was p<0.1 which one doesn't see that much in papers (usually the threshold is stricter: p<0.05)
 

Dolphin

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Testing the hypothesis that the more partners perceive CFS as a serious condition and the more partners attribute CFS to physical causes, the more partners show solicitous responses

In a linear regression analysis with partners’ solicitous responses as dependent variable, partners’ perception of seriousness of illness was significantly related to their solicitous responses. The more partners viewed CFS as a severe condition, the more they showed solicitous responses. The perception of the partner of the seriousness of the illness explained 8% of the variance of partners’ solicitous responses. Partners’ psychological or physical attributions were not related to their solicitous responses (Table 3).
 

Dolphin

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Annoying esp. as CBT is very unlikely to bring about true recovery:
These findings may suggest that partners who are solicitous may unintentionally stimulate unhealthy behaviour in the patient. Although it is important for CFS patients to feel supported, overly solicitous partner responses may make it difficult for the patient to actively engage in CBT and work towards recovery.
 

Dolphin

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Translation: partners of patients who are really really sick treat them better and they are less likely to recover.

Comment: So what?

PS Good on the partners of these patients!
An alternative translation would be peoples partners attitudes help reflect on how they can be persuaded to fill out surveys saying they feel better after CBT.
You won't be surprised to hear that they didn't mention this sort of possibility!

Yes, one could speculate that people who don't have "solicitous" spouses might perhaps be more focused on the relationship with the therapist and want to please him or her more? Or alternatively they might prefer to hope/fool themselves that they're doing well and hopefully then not have to continue dealing with a difficult situation with regard to their significant other?
 
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Effi

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Therapists may therefore assess these responses and perceptions before starting CBT and actively change perceptions and responses of the partner if these do not facilitate change in the patient. This, in turn, could improve the outcome of CBT.
They don't want the patient to get better, they want the CBT to look better on paper.