All-or-Nothing Behavior and Catastrophic Thinking Predict Fatigue in Inflammatory Bowel Disease: A Prospective Cohort Study 2023 Moulton Chalder et al

[bobbler]

Also from the referenced paper of Artom et al (2016) that found no correlation with fatigue in general, and no causation:

https://onlinelibrary.wiley.com/doi/full/10.1111/apt.13870

Predictors of the outcome variables
Based on findings in other conditions a decision was made to explore a number of emotional (anxiety and depression, stress and distress), cognitive (illness perceptions and symptom beliefs) and behavioural factors (avoidance and all-or-nothing behaviours, and daytime sleepiness) as potential predictors of the outcome variables.

The Hospital Anxiety and Depression Scale (HADS),60 Cohen Perceived Stress Scale (PSS)61 and the Inflammatory Bowel Disease-Distress Scale (IBD-DS)62 were used to assess potential emotional factors associated with the outcome variables. The HADS was selected for this study as it was originally developed for physically ill patients and no items about somatic symptoms are included.63

Cognitive factors were assessed using The Brief Illness Perceptions Questionnaire (BIPQ)66 and the cognitive subscales of the Cognitive Behavioural Response to Symptoms Questionnaire (CBSQ).33 The study utilised a modified version of the BIPQ consisting of eight items: five assess cognitive illness representations (consequences, timeline, personal control, treatment control and identity); two emotional representations (concern and emotions) and one item assesses illness comprehensibility. The open-ended response item assessing the causal representation of fatigue was excluded from the questionnaire. In line with recommendations from the authors of the scale,67 to make the questionnaire more relevant to the IBD patient group, the word ‘illness’ was replaced with ‘fatigue’. This has been done in other studies68-70 assessing clinical and psychosocial outcomes in patients with long-term conditions to make the questions more specific to their topic of research. Each item is rated on a 0–10 scale. Given the known limitations of assessing content validity with single item measures71 and the increased risk of type 1 errors when using multiple testing,72 a total sum Fatigue perception score (ranging 0–80) was calculated as opposed to calculating scores for the individual subscales. Higher sum scores indicated more negative, unhelpful representations of IBD-fatigue. The CBSQ measures patients’ cognitive and behavioural responses to their symptoms (of fatigue). It contains 40 items measured on a 5-point Likert scale. Items are added to form five cognitive subscales (fear avoidance,embarrassment avoidance, damage beliefs, symptom focus and catastrophising about symptoms). Higher scores indicate more negative cognitive responses to fatigue symptoms.

Behavioural factors associated with fatigue and QoL were assessed with the behavioural subscales of the CBSQ (resting and avoidance of activity and all-or-nothing behaviour) and the Epworth Sleepiness Scale (ESS).73

My bolding. Again the impression seems to be (and there is more detail on the other scales but I didn't want to paste too much) very careful consideration of using the measures both specifically to the conditions being studied and for them to be analysed appropriately for the Artem et al (2016) paper.

This [Moulton et al, 2023] paper uses just the CBSQ (it seems to be the same scale from the long form writing out of its title, even though it uses the acronym CBRQ) and for the same CBSQ measure notes:

Behavioral responses to symptoms were assessed by the 2 behavioral subscales of the Cognitive and Behavioral Responses to Symptoms Questionnaire (CBRQ).7 ......Higher subscale scores indicate more unhelpful behaviors. Internal consistency for each subscale was high (Cronbach’s α ranging from 0.8 to 0.9). ..........Cognitive responses to symptoms were assessed by the 5 cognitive subscales of the CBRQ.

 

[NelliePledge]

These psychosomatic people choose to read normal human reactions to difficult situations as “catastrophisation”. I choose to read it as common sense learning from experience.

 

[tornandfrayed]

Interesting that the whole psychosomatic/catastrophism theory basically starts with the premise that you don't do things even if you could, and when you find evidence of the opposite (patients desperately trying to do a lot of things in a short time to catch up on life when they feel better) it somehow confirms your belief.

It's heads we win, tails you lose. Any & all personality types or traits they can shoehorn us into are signs of our wrongness, even if these are two diametrically opposed types/traits simultaneously.

More generally, I always wonder if the BPS lot go through life without ever experiencing illness, or it's, if they do, the framework they impose on everyone else doesn't apply, because they're special. I suspect they make a huge fuss about sniffles or paper cuts, but it would be interesting to know.

 

[Hoopoe]

More generally, I always wonder if the BPS lot go through life without ever experiencing illness, or it's, if they do, the framework they impose on everyone else doesn't apply, because they're special. I suspect they make a huge fuss about sniffles or paper cuts, but it would be interesting to know.

I feel sorry for them because on some level they probably treat themselves they way they treat us, or extrapolate from themselves to us.

That would suggest huge problems with accepting disability, chronic illness, and physical defects. Perhaps an obsession with constantly "overcoming themselves" instead of accepting themselves. Problems with trusting their own thoughts and judgments. Or perhaps a lot of hypochondria, false illness beliefs, and laziness, or faking medical illness for attention that they didn't receive enough of.

 

[oldtimer]

Maybe it boils down to plain old 'othering' which is something they should be very aware of, being so highly educated in the field of human behaviour.

The people they study seem to be the 'out group' that is homogenised as per the ingroup/outgroup effect (Billig & Tajfel, 1973).
"In short, this effect speaks to how we differentially treat those whom we see as "in our group" versus those whom we see as some kind of "other," meaning someone who is defined as in "some group other than my own group." "
https://www.psychologytoday.com/au/blog/darwins-subterranean-world/201904/the-psychology-othering

We see members of our own group as fascinating human beings and different in all sorts of ways but other groups as being all much the same as each other. It is common to everyone and not easy to shake.

It's hard not believe you are being shoe-horned into an homogeneous 'other' category when answering questionnaires or talking to a doctor or therapist etc.

 

[dave30th]

These psychosomatic people choose to read normal human reactions to difficult situations as “catastrophisation”. I choose to read it as common sense learning from experience.

Of course! The construct is ridiculous when you're talking about people with serious illnesses. Their realistic appraisals will be read as "catastrophizing" if you don't think they're really sick.

 

[Sean]

yes. they could just as easily switched it around and said fatigue predicts catastrophizing and all-or-nothing behavior,

These psychosomatic people choose to read normal human reactions to difficult situations as “catastrophisation”. I choose to read it as common sense learning from experience.

Of course! The construct is ridiculous when you're talking about people with serious illnesses. Their realistic appraisals will be read as "catastrophizing" if you don't think they're really sick.

Their whole conceptualisation of these psycho-behavioural features as pathological (catastrophising, all-or-nothing) and needing to be 'fixed' is arbitrary.

They either have no idea what that behaviour means, or do but can't admit it.

 

[rvallee]

Of course! The construct is ridiculous when you're talking about people with serious illnesses. Their realistic appraisals will be read as "catastrophizing" if you don't think they're really sick.

Except I guess this doesn't matter anymore, since IBD is definitely perceived as a serious disease. But it looks like this is where the separation between disease and illness is going, the junk Sharpe was bleating about in his op-ed: disease is real, it can be seen and understood by doctors and is serious, life-threatening, whereas illness is just what patients are afraid of.

If they have a disease, then it's their fear of what the disease will do to them that causes illness. And if they don't have a disease, well then it's fear of what it could do to them if they had one and that's scaaaary. Unless there's some tissue clearly being injured somewhere, but that's always temporary, the body always repairs perfectly. Somehow. Even though that's obviously wrong. But it feels so much better to believe in it. Well, for them, not for us. Definitely not for us.

Basically, illness has become fully synonymous with fear. It's just fear, nothing else. You can't feel disease, shouldn't be able to know if you have a different gene or some process or another. That's only for doctors to know about, knowledge they would withhold from us if they weren't obligated by law. Which they routinely do when they don't have such obligations. So if you feel ill, it's only because you know or think you have some disease, so it's good to withhold this knowledge from us, as it allows us not to worry our pretty little non-expert heads about it.

It's really not any different from Catholic mass held in latin. Can't criticize the book if you don't even know what's in it. And the change in the future will need to be as radical, because the priests won't let go of their power, it will only be taken away from them. Likely by much smarter machines. That'll be a sight to behold. The bruise on their egos...

 

[dave30th]

https://virology.ws/2023/09/04/trial-by-error-just-the-latest-gibberish-from-professor-chalder/

 

[duncan]

You're a good writer, @dave30th .

 

[dave30th]

You're a good writer, @dave30th .

thanks! I appreciate that.

 

[NelliePledge]

Spot on

 

[Hutan]

However banal and inconsequential, this sort of statistical finding is catnip for Professor Chalder. She seems never to have met an association she couldn’t try to spin as a causal relationship in order to justify the promotion of CBT as a solution. In this case, she seems to interpret this very minimal association to mean that these two identified patterns—all-or-nothing behavior and catastrophic thinking—are major factors in generating the reported worsening of fatigue.

This interpretation is implied, although not stated explicitly, in the headline: “All-or-Nothing Behavior and Catastrophic Thinking Predict Fatigue in Inflammatory Bowel Disease: A Prospective Cohort Study.” The word “predict” is doing a lot of work here. It creates the impression that these cognitive and behavioral patterns are to blame for the reported fatigue. But the association itself cannot be construed as evidence of that.

In reality, logic and common sense suggest that any causal relationships, however small, could easily run in the opposite direction than that presumed by Professor Chalder and her colleagues–that is, the fatigue itself is likely leading to the reported behavioral and cognitive patterns. Given fluctuating or worsening levels of fatigue, it makes sense that IBD patients would try to get as much done as possible when they felt well and less so when they felt worse. Moreover, if someone with pronounced or worsening levels of fatigue responds to questionnaires with a realistic appraisal of their condition, it could easily be interpreted by Professor Chalder and similarly biased investigators as “catastrophizing.”

 

[Andy]

"Is there no mercy in this world for those of us forced by professional obligations to read this unceasing stream of sewage?"

You absolutely have my sympathy but just think what it is like then for those of us who don't even have professional obligations, but are forced by a potentially illusionary sense that if this sort of garbage is highlighted then it might eventually lead to an improvement in the quality of research and how patients are treated in the future.

 

[shak8]

How easy is the game of mix and match.

Take CBT and match the list of cognitive distortions to any and every known category to man. Obtain an odds ratio of under 1.1 and call it an association when it is most likely artifact and certainly not clinically significant.

Take pride in seeing your name in publication after publication, justifying your claims. How sad and pernicious.

How about research on catastrophizing in astronauts facing sudden incipient catastrophy?

 

[Trish]

My brain's on a go-slow day, so not a good one for trying to get my head around this study. What follows it a bit of a muddle and ramble, feel free to ignore or tell me where I've gone wrong.

As far as I understand it, they asked the patients to fill in a bank of questionnaires on the first occasion, including the psychobehavioural stuff as well as baseline data about age etc and fatigue using CFQ and whether their IBD was active or not and depression/anxiety.

Then, 3 months later, without any psychobehavioural treatment, they filled in another batch of questionnaires, some of them overlapping with the first bunch.

The purpose of the 3 month gap being to enable them to find any effects of how you thought and behaved 3 months ago on whether you're fatigued now. In other words not just an association, but a prediction.

That seems completely daft to me. Thinking in terms of my ME, why would my thoughts and behaviour 3 months ago have any influence on my fatigue today? If they are assuming how I thought and acted 3 months ago hasn't changed, why not test me now? And if they have changed, then test for that.

I'm muddling myself here. I think what I'm trying to say is, if you want to test whether and individual changing from catastrophising to not catastrophising (or vice versa) changes their fatigue status, you need to give them the catastrophising and fatigue tests on both occasions and look at individuals' direction of change on both factors.

If you want to test a whole group on whether there is an association between catastrophising and fatigue, you only need to do it on one occasion. I note they don't give the data to check that. They only compare psychobehavioural data with fatigue 3 months later, not at the same time.

What the also completely ignore in the conclusions is that by far the biggest influence on fatigue in the initial questionnaires was whether they had active disease or not.
_____________Fatigue/Not fatigue
Disease activity
HBI/SCCAI ≥5 | 104 / 9
HBI/SCCAI <5 | 41 / 43 p<.001

If I'm understanding how to calculate odds ratios correctly, the OR for being fatigued if they had active disease compared with no active disease is:
(104/9) / (41/43) = 12.1
Compared to that, an OR of about 1.2 for whether they were catastrophising or all or nothing 3 months ago is irrelevant.

So I conclude if they were looking for singificant factors influencing whether someone with IBD is fatigued they should be comparing their psychobehavioural factors from 3 months ago with whether the disease is currently active or inactive. If they did that, surely they should conclude that the psych factors are trivial in comparison to physical symptoms in influencing fatigue.

Rather than concluding, as always, that their research justifies CBT for IBD, they should have concluded that psychologists should step away from trying to psychologise people with debilitating chronic physical diseases and leave it to doctors to try to find medical approaches to reduce the disease symptoms, and fatigue level will follow that.