A.B.
Senior Member
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The CBT that will be used is based on this paper by Dear, Chalder, Sharpe:
The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review
http://www.kcl.ac.uk/innovation/groups/projects/cfs/publications/assets/2007/deary.pdf
Some quotes
A model that can explain everything probably explains nothing.
The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review
http://www.kcl.ac.uk/innovation/groups/projects/cfs/publications/assets/2007/deary.pdf
Some quotes
The sine qua non of any CBT model is a vicious circle, the hypothesis that a self perpetuating interaction between different domains maintains symptoms, distress and disability. Irrespective of the symptom type (as Allen, Escobar, Lehrer, Gara, & Woolfolk, 2002 , noted, none of the theories are organ specific), the CBT models of MUS, IBS and CFS propose a model of perpetuation that is, to borrow a term from systems theory and cell biology, autopoietic . “ Autopoiesis: the process whereby an organization produces itself. An autopoietic organization is an autonomous and self-maintaining unity ... The components, through their interaction, generate recursively the same network of processes which produced them ” Valera (2005) .
An innate tendency to somatopsychic distress and ease of distress sensitisation, combined with childhood adversity, increase both the amount of symptoms experienced and lowers the threshold for their detection. Life events and stress lead to physiological changes which produce more symptoms and set up processes of sensitisation and selective attention. This further reduces the threshold of symptom detection. Lack of explanation or advice increases anxiety, symptoms and symptom focus. Stress cues become associated with symptoms through classical conditioning. Avoidance of symptom provocation, and symptom-led activity patterns, lead to further sensitisation through operant conditioning. The prolonged stress of the illness experience itself further activates physiological mechanisms, producing more symptoms, sensitisation, selective attention and avoidance. The individual can thereby become locked into a vicious cycle of symptom maintenance
There are varying degrees of evidence for each of the components of this model. What is lacking is solid proof of their interaction in vicious circles, although all the models reviewed assume this interaction
What makes the CBT model so difficult to test may also be one of its chief strengths: it is in many ways a meta-model, providing a skeleton structure to join the dots of whatever factors each patient presents.
A model that can explain everything probably explains nothing.