Cognitive behavioural therapy for MS-related fatigue explained: A longitudinal mediation analysis, 2018, van den Akker et al

Paywalled at https://www.sciencedirect.com/science/article/pii/S0022399917304361

 

I'd be interested to know what "perceived physical activity" is?

 

Are there any objective measures, or is this another questionnaire bonanza?

 

Yep, it's the same clowns who conducted the laughably funny CBT studies for CFS patients in The Netherlands - https://www.researchgate.net/public...atigue_syndrome_The_role_of_physical_activity

These guys are such bozos.

Only a psychiatrist would be surprised that focusing on improving fatigue perceptions, perceived physical activity, daytime sleepiness, helplessness, and physical functioning will improve a patients self-reported measure on the same outcomes.

 

It's not any sort of objective measure of activity levels that were used.

I couldn't be bothered to read this. It would probably be good to have people critically engaging with this research though:

http://www.sciencedirect.com.https.sci-hub.tv/science/article/pii/S0022399917304361

 

I'm pretty sure CBT is regarded as possibly being helpful in a variety of physical conditions, including Cancer related fatigue (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2360364/), Lupus (https://resources.lupus.org/entry/cognitive-behavioral-therapy-benefits-people-with-lupus), asthma (http://www.cochrane.org/CD011818/AIRWAYS_cognitive-behavioural-therapy-people-asthma) and Parkinson's (http://ebmh.bmj.com/content/20/1/15).

Whether it is actually helpful is another question, but it seems to be something that is pretty commonly applied for highly disabling conditions.

 

Yea, CBT is good for whatever ails you. That's the joy of non-blinded studies relying on patient self-report. Homeopathy has proven benefits too, if you study it the same way (you don't blind patients to what medicine they got and you ask them to report how they feel).

 

It's not clear which form of CBT you're talking about. The normal form used in biomedical conditions is aimed at coping. The form studied in ME/CFS is based on denial of symptoms.

The denial-based CBT has been expanded into other diseases by the same people who have applied it to ME. In those cases they are saying that while there is a biomedical disease, there are also symptoms that they believe are excessive or not caused by the disease at all. Basically they are layering a psychosomatic diagnosis onto the biomedical one, usually in regards to pain or fatigue.

This is a rather dangerous development, since it can very much impact how people with cancer, MS, etc, are treated by insurance companies and disability services. They can say that yes, there is a biomedical disease, but the actual disability is partly or entirely due to the supposedly psychosomatic symptoms instead. This can mean that someone badly disabled by a biomedical disease could have insurance or benefits denied or reduced by claiming that their disability is psychological and/or curable.

 

Cancer related fatigue is another one where objective measures of activity show no improvement. It's funny reading them try to explain this when their CBT model assumed it would help by encouraging people to increase their activity levels. They suggested patients may have increased their activity... but only at the points in time when their activity levels were not being measured. Those sneaky cancer patients!

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3360858/

It looks like a load of quackery to me.

 

Well in most of the cases with the physical illnesses, they just think it's a bit helpful, and I don't think they're saying anything about whether it's psychological.

Plus, from what I've heard from most practitioners, a lot of CBT aimed at CFS is about coping. I mean, plenty of CBT done is probably about denial, but I get the impression there's a fair bit that's about coping and managing (from people that have a relatively sane attitude towards CFS.). I've seen two CBT psychologists that specialized in CFS, and they only focused on managing, not denying.

 

The claims made are still quite different - the researchers aren't claiming that CBT leads to recovery for these conditions.

 

From the abstract:

Its like saying "Little is known about exactly how long fairies' legs are".

Both questions seem to rest on a huge elephant of an assumption.

 

If the primary goal is to reduce self-reported fatigue or pain, it's not about coping. Coping would focus on helping patients to accept and adapt to their limitations, not to deny that those limitations exist.

There has been almost no research into coping-based CBT for ME patients, so there's no evidence that it's of any benefit. Accordingly, there is no basis to recommend coping-based CBT for ME specifically.

 

Article today in the Guardian: Workplaces should cater for menopause as they do for pregnancy

Guess how?
- CBT!
Says who?
- Myra Hunter, emeritus professor of clinical health psychology at King's College London

The call comes as Hunter and colleagues publish the results of one of the first major studies looking at how symptoms such as hot flushes affect women at work. The study, which tracked 124 female employees in the public and private sectors, found that such symptoms could have a significant impact, but that following a simple programme of cognitive behavioural therapy, delivered via a self-help booklet, hugely reduced the degree to which women felt their symptoms were problematic.

 

Whether CBT is about curing or coping depends on the context. If the researchers/therapists are promoting their therapy, they will claim it can cure by changing the perpetuating factors. When they are responding to criticism the CBT is suddenly about coping.