BPS attempts at psychologizing Long Covid

rvallee said:
Yeah.

"DOOM AND GLOOM PEOPLE ARE AFRAID AND THAT'S MAKING THEM 'SICK'"

Also: "why won't people wear masks? why are people congregating at pubs? don't they see there's a pandemic under way? why are people not social distancing? WHY ARE PEOPLE GOING SHOPPING? WHY AREN'T THEY TAKING THIS SERIOUSLY?!"

Very serious people. Cognitive dissonance is good. Up is red. Down is A#.
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Case in point:

 
Not a recommendation

Is Chronic Fatigue in Your Head?
Yes, psychological understanding could actually help you.

Some people are now getting lasting fatigue in response to Covid-19. I have some fatigue post-Covid myself, though it has waxed and waned and wouldn't qualify as chronic fatigue. At least not yet.

Is it damage from the virus, an auto-immune response, or our brains trying to protect us from being even more overwhelmed?

My answer: Explore the psychology and any medical solutions you can find. This isn't an either/or. Many conditions seem to involve feedback loops. Instead of mind/body, implying two distinct worlds, think mindbodymindbody.

Covid-19 is new to us. Chronic fatigue syndrome (CFS), now called Myalgic encephalomyelitis, is also one of those illnesses we don't understand. About half of all CFS/ME patients had some kind of infection as a trigger. About one in ten people who become infected with Epstein-Barr virus, Ross River virus, or Coxiella burnetti develop symptoms that suggest CFS/ME, especially if their infection prompted severe symptoms.

So note that infections are involved--but if the statistics are even close to right, most people don't get exhaustion from these infections and many people get exhaustion with no known infection as a trigger. Several irregularities in the immune system may contribute, including low-functioning natural killer cells and malfunctioning T-cells. Evidence suggests an auto-immune problem, though again not necessarily in all patients.
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https://www.psychologytoday.com/ie/blog/open-gently/202009/is-chronic-fatigue-in-your-head
 
John Mac said:
Not a recommendation


https://www.psychologytoday.com/ie/blog/open-gently/202009/is-chronic-fatigue-in-your-head
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This article is on the Psychology Today blogger platform, which provides individual blogs to hundreds of practitioners working in the field of psychology, counselling and therapy for promoting their professional practices, their publications, courses, online therapies etc. Edward Shorter's blog is on the same blogger platform.

Here is the US blogger platform Index: https://www.psychologytoday.com/us/blog/index

Although bloggers on these platforms are subject to Psychology Today's Terms of Usage, there is no editorial control of content by Psychology Today's editors and the articles on them are not commissioned by Psychology Today.

The owners of these blogs have admin access to edit already published content, take down posts entirely (as Shorter did a few years ago with his hate piece about the IOM Report and ME, CFS patients), set the comments to no comments, remove or edit existing comments, or close a post to further comments.
 
Kalliope said:
Last week the Norwegian newspaper Dagsavisen had an interview with journalist Jørgen Jelstad about ME. The article also mentioned the possibility of an increase of ME patients due to the pandemic. The interview was shared in the thread: Possibility of ME or PVFS after COVID-19, Long Covid here

Jörgen Malmquist, a Swedish retired MD who has just published a BPS-book about ME (discussed here) has written an opinion piece objecting to the article.

Skremselspropaganda om ME i Dagsavisen
google translation: Intimidation propaganda about ME in Dagsavisen

The mass media has a strong influential (suggestive) effect, and incorrect information and gloomy predictions can arouse anxious thoughts in those who become ill.

"Will this happen to me?"

This natural worry can actually help maintain symptoms such as fatigue, and that it becomes as one fears.

Both worry and symptoms can be transmitted through "social infection" to colleagues, friends, family members and others, by sharing worry and fear for symptoms.

Thus, increasing numbers of people may begin to have the same experience of feeling sick, exhausted or the like. In this way, the media contribute to creating a social epidemic.
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Jørgen Jelstad has written an excellent reply referring to Fauci, Paul Garner and media articles from Science, Nature and The Atlantic.

"Donald Trump ville ikke høre på Anthony Fauci. Det vil ikke Jörgen Malmquist heller"
Google translation: "Donald Trump would not listen to Anthony Fauci. Neither does Jörgen Malmquist"

We do not yet know if covid-19 may be one of several infectious diseases that appear to be able to trigger ME. But both previous research on other infections, and the many stories of long-term illnesses that are now emerging, suggest that it may be possible.

Thus, covid-19 can be a unique opportunity to find out why some people become seriously long-term sick after certain infections.

Perhaps the tragic pandemic could at least lead to a long-ignored group of patients finally getting the research they deserve.
 
Kalliope said:
Jørgen Jelstad has written an excellent reply referring to Fauci, Paul Garner and media articles from Science, Nature and The Atlantic.

"Donald Trump ville ikke høre på Anthony Fauci. Det vil ikke Jörgen Malmquist heller"
Google translation: "Donald Trump would not listen to Anthony Fauci. Neither does Jörgen Malmquist"

We do not yet know if covid-19 may be one of several infectious diseases that appear to be able to trigger ME. But both previous research on other infections, and the many stories of long-term illnesses that are now emerging, suggest that it may be possible.

Thus, covid-19 can be a unique opportunity to find out why some people become seriously long-term sick after certain infections.

Perhaps the tragic pandemic could at least lead to a long-ignored group of patients finally getting the research they deserve.
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It certainly would be great if, failing to grasp the whole thing, medicine could at least acknowledge the reality of infectious diseases requiring longer than a few days' recovery, that in some cases it requires months and that recovery clearly cannot be precipitated (nor is there any evidence that it should, still obsessing over the absurdity of sudden magical deconditioning without cause). Without having to acknowledge the possibility of this being chronic and permanent, at the very least it could allow up to 6 months, or something to that effect.

But no, not even that. The tiniest of steps and there is still total paralysis, pervasive refusal one might even say. I've never seen a more dysfunctional field of expertise fare so poorly given every opportunity to succeed. Nascent industries have their affairs more in order than this, I just don't get how no one within seems to find flaws that require fixing.
 
And the copy-paste research machines copies and pastes on. The machine is also clearly deaf, as it is not listening to anything the patients are telling them. But all the machine does is copy-and-paste, and that is how the machine is judged, and so the machine is good, because it copies and pastes very well. The machine learns nothing from what it copies and pastes but it knows nothing else and thus will continue to copy-and-paste until the end of time.

Looks like a clone of FITNET on most aspects. It's quite notable that this makes no reference whatsoever to the identical body of evidence that the NHS asserts is effective at rehabilitating from this exact course of illness. As if it does not exist, even though it is claimed to be effective to the point of having virtually eliminated CFS (well, you don't hear much about it so isn't that the same? no? oh well). Kind of odd to use this PROMIS questionnaire when the MUS/BPS machine always uses the SF-36.


Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN)

https://fundingawards.nihr.ac.uk/award/NIHR132046

Background: Many survivors of novel coronavirus infections (SARS-Cov and MERS-Cov) had substantial physical, psychological and neurological morbidity for up to 12 months. Similar longer-term consequences of COVID-19 are now apparent. Case level mental health diagnoses along with disabling fatigue, breathlessness and muscle weakness are commonly reported. There is a large population of COVID-19 survivors in the UK with persistently reduced quality of life, even after several months of recovery. Exercise and psychological rehabilitation may help but existing NHS rehabilitation services have insufficient capacity. Alternative delivery models must be tested.

Design/setting: Two-arm multi-centre RCT with parallel process evaluation and 1-month internal pilot (n=35). Treatment allocation of 1:1.03 randomised by minimisation based on age, assisted ventilation, and case level mental health disorder.

Population: Adults recovering from COVID-19, more than 3 months after hospital discharge with continued physical and/or mental health sequelae, and access to internet video. Exclusions are exercise contraindications and severe mental health problems preventing engagement.

Health Technology Assessment: The Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN' (REGAIN) intervention is an eight-week, on-line, supervised, home-based, exercise rehabilitation programme with behavioural, motivational and mental health support. REGAIN includes: 1) individual assessment; 2) supervised home-based exercise programme with pre-recorded and live sessions; 3) one-to-one and group on-line psychosocial and motivational support and education.

Control: Single, on-line, one-to-one, practitioner consultation with general advice on safe and effective physical activity. Outcomes. All measures completed on-line at baseline and 3 (post-intervention), 6- and 12-months post-randomisation.

Primary: PROMIS® 29+2 Quality of Life questionnaire at 3 months.

Secondary: dyspnoea, EQ-5D-5L, anxiety/depression, PTSD symptom severity, cognitive function, work status, physical activity, health and social care use, cost-effectiveness.

Sample size: Allowing for 10% loss to follow-up, 535 (263 control, 272 intervention) participants are required to achieve 90% power at 5% significance level; based on standardised mean effect size of 0.3 (i.e. three points), intervention group size of 8 and an intra cluster coefficient of 0.01. Analysis. Summarised/reported as per CONSORT, using intention-to-treat analyses. Treatment effects (with 95% CI) estimated with hierarchical linear regression models, adjusted for patient-level covariates. We will estimate and adjust for site effects as a random variable in the model. Categorical data analysed using logistic regression models. Pre-specified, exploratory sub-group analyses will examine the interaction of treatment assignment. Prospective cost-effectiveness assessed as incremental cost per QALY estimates and credible intervals, cost-effectiveness acceptability curve and value-of-information analyses.

Team: Lay partners, ICUsteps charity, clinical exercise physiology, physiotherapy, health psychology, psychiatry, critical care and respiratory medicine, general practice, statistics, health economics, clinical trialists.

Timeline (month): set-up (0-1); internal pilot (2-3); recruitment (2-9); primary outcome (5-12); analysis/dissemination (13-14), 6-month follow-up (8-15), 12-month follow-up (15-22).
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But reading through this, it seems that the hypothesis is that since gyms are closed, people can't access gyms and therefore are unable to exercise (I guess I missed the UK passing a law that forbids exercise outside of gyms) and thus are paralyzed by not being able to exercise in a gym, even though most people do not exercise in gyms.

 
John Mac said:
Not a recommendation
https://www.psychologytoday.com/ie/blog/open-gently/202009/is-chronic-fatigue-in-your-head
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from email:

Psychology Today fails in its duty of care to people with ME
#MEAction UK has written to the online publication Psychology Today asking for the retraction of a stigmatising blog post.

We believe publications such as this have a duty of care to their readers and those who they write about. In this instance that duty of care was neglected. The blog post in question fell back on outdated tropes that should have long ago been relegated to the past.

We have chosen not to include the link to this blog post here, so as not to increase traffic to this post.

Read our letter to the editor requesting retraction of the blog below:
Dear Editor,

On 23 September 2020 Psychology Today published a blog by Temma Ehrenfeld titled “Is Chronic Fatigue in your Head?” – now changed to “How Does Chronic Fatigue Develop?”.

This blog has drawn strong criticism from people with Myalgic Encephalomyelitis (ME). In consideration of the points set out below, #MEAction UK requests that the blog be withdrawn from the publication. We would welcome its replacement with writing that is more balanced in its information, more precise in evidencing its claims and does not conflate ME with the single symptom of fatigue.

It is commendable that Ehrenfeld has highlighted the severity of ME, noted the prevalence of viral triggers and cited some published research and information from the CDC. The author has also noted that immune system irregularities and autoimmunity are indicated in the disease. However “chronic fatigue” and “exhaustion” are inaccurately conflated with ME through the article, adding to the stigmatisation and dismissal that people with ME already suffer.

While Ehrenfeld does not deny that ME has physical results, she appears to argue that these are actually warning signals from the brain that can be overcome by the will of the individual if they really wanted to: “if your house was on fire, you’d find the energy to get up”. Such tropes have long meant that people with ME aren’t given the support they require and deserve, from their friends and families through to healthcare, access to benefits and more. They ignore the cardinal symptom of ME – post exertional malaise – that means that even where someone could act in instances of extreme danger they would suffer severe consequences from doing so. Further, this ignores the significant minority who are bedbound and unable to move in any way.

Unfortunately, this article does not constructively contribute to the debate about treatments that may be helpful to this patient group. Proposing exercise as a useful response goes against the mass of data showing significant deterioration in people with ME undertaking exercise programmes, and the recent National Institute for Health and Care Excellence statement that graded exercise therapy should not be assumed to be applicable to people with post-COVID fatigue.

Fundamentally, this blog’s substance helps to further muddy the waters of opinion around whether ME needs to be treated as a disease that requires biomedical research to identify its underlying causes. The article assumes emotional instigation as the definitive underlying cause of ME, without offering substantive evidence to back up this claim. Given the history of the disease and how people with ME have had to fight tooth and nail for years to be taken seriously by the medical profession, such writing is irresponsible.

We hope you will take swift action to address this, and look forward to hearing from you.

Yours sincerely,

#MEAction UK
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So it seems like donkey medicine, assumptions-based evidence, has been normalized enough to now be a standard, with unblinded trials with no objective outcomes and vague goals. Poorly assessing cost efficacy without controls based entirely on assumptions that rehabilitation must be effective. Still not a single person has yet argued on what grounds they believe rehabilitation is needed.

It seems to be entirely based on the assumption that this is classic deconditioning. What is being rehabilitated? The exertion intolerance manifests itself in the first few days and most patients are never bed-bound, this is not how deconditioning works at all, there is clear anchoring on the severe ICU patients here. This clearly cannot be deconditioning, it fluctuates too wildly and is present at onset. Just because they waited months for it to magically go away doesn't mean they can use those months to retroactively explain the symptoms present initially.





Evidence-based medicine is a disaster, a gigantic loophole for low-quality science to launder people's personal opinions.
 
I think Vogt is doing a fantastic job - of demonstrating exactly the kind of zealotry we're up against.

Someone makes a reasonable criticism and instead of arguing the point Vogt becomes personal while telling the other person to take that back.

The guy's like a bad caricature of.....something.
 
The exploitation of Long Covid

https://www.spiked-online.com/2020/10/06/the-exploitation-of-long-covid/

This presentation of Long Covid is intended to be frightening. That is its purpose. Towards the end of the Institute for Global Change report, the authors actually state: ‘We recommend [Long Covid] be highlighted in government awareness campaigns. We believe doing so would help drive compliance with containment measures such as the use of masks.’ In other words, Long Covid performs a useful function – it makes Covid appear more threatening than people think it is, and therefore might scare people into ‘compliance’.
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This whole anchoring with ICU patients on ventilators is really getting boring. This is very easy to falsify and people just don't bother because they want to believe.


'Brain fog' following COVID-19 recovery may indicate PTSD

https://www.uclahealth.org/brain-fog-following-covid-19-recovery-may-indicate-ptsd

A new report suggests that lingering "brain fog" and other neurological symptoms after COVID -19 recovery may be due to post-traumatic stress disorder (PTSD), an effect observed in past human coronavirus outbreaks such as SARS and MERS.

People who have recovered from COVID-19 sometimes experience lingering difficulties in concentration, as well as headaches, anxiety, fatigue or sleep disruptions. Patients may fear that the infection has permanently damaged their brains, but researchers say that’s not necessarily the case.
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"The idea is to raise awareness among neuropsychologists that PTSD is something you might want to consider when evaluating persistent cognitive and emotional difficulties among COVID-19 survivors," said Dr. Levine.

"When we see someone for neuropsychological testing, we expect them to be at their best, relatively speaking," Dr. Levine said. "If we identify a psychiatric illness during our evaluation, and if we believe that condition's symptoms are interfering with their ability to perform at their best, we would want that treated first, and then retest them once it’s under control."
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Bodies do not max out at one specific disease. It's possible to have brain fog with PTSD or no PTSD and PTSD with no brain fog. The science on PTSD is not exactly on a high bar.
 
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