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

Andy

Andy

Retired committee member
Highlights
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Little is known about the process of change during CBT for MS-related fatigue.

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Perception, physical activities, sleepiness and helplessness can benefit CBT.

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Physical activity, concentration and sleep patterns can help maintain CBT effects.

Abstract
Background
Cognitive behavioural therapy (CBT) effectively reduces fatigue directly following treatment in patients with Multiple Sclerosis (MS), but little is known about the process of change during and after CBT.

Design
Additional analysis of a randomized clinical trial.

Objective
To investigate which psychological factors mediate change in fatigue during and after CBT.

Methods
TREFAMS-CBT studied the effectiveness of a 16-week CBT treatment for MS-related fatigue. Ninety-one patients were randomized (44 to CBT, 47 to the MS-nurse consultations). Mediation during CBT treatment was studied using assessments at baseline, 8 and 16 weeks. Mediation of the change in fatigue from post-treatment to follow-up was studied separately using assessments at 16, 26 and 52 weeks. Proposed mediators were: changes in illness cognitions, general self-efficacy, coping styles, daytime sleepiness, concentration and physical activity, fear of disease progression, fatigue perceptions, depression and physical functioning. Mediators were separately analysed according to the product-of-coefficients approach. Confidence intervals were calculated with a bootstrap procedure.

Results
During treatment the decrease in fatigue brought on by CBT was mediated by improved fatigue perceptions, increased physical activity, less sleepiness, less helplessness, and improved physical functioning. Post-treatment increases in fatigue levels were mediated by reduced physical activity, reduced concentration, and increased sleepiness.

Conclusion
These results suggests that focusing on improving fatigue perceptions, perceived physical activity, daytime sleepiness, helplessness, and physical functioning may further improve the effectiveness of CBT for fatigue in patients with MS. Maintenance of treatment effects may be obtained by focusing on improving physical activity, concentration and sleepiness.
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Paywalled at https://www.sciencedirect.com/science/article/pii/S0022399917304361
 
Are they they same Dutch team who do crap CBT/GET studies on ME? Some of the authors' names look familiar.

Now they are screwing around in the heads of MS sufferers. Oh dear. I wonder what measures they used - Chalder Fatigue Scale, anyone?

Does anyone have access to the full paper?
 
Trish said:
Are they they same Dutch team who do crap CBT/GET studies on ME? Some of the authors' names look familiar.

Now they are screwing around in the heads of MS sufferers. Oh dear. I wonder what measures they used - Chalder Fatigue Scale, anyone?

Does anyone have access to the full paper?
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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.

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

Concentration and physical activities
Concentration and physical activities were measured using the identically named subscales of the CIS20r [23]. All items are answered on a 7-point Likert scale. The concentration subscale consists of 5 items (5–35) and the physical activities subscale consists of 3 items (3−21). Concentration is a treatment outcome of the TREFAMS-CBT module ‘regulation of mental activity’, while the physical activities subscale is relatedtothegradedactivityprogramthatispartoftheTREFAMS-CBT
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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.
 
petrichor said:
I'm pretty sure CBT is regarded as possibly being helpful in a variety of physical conditions, including Cancer related fatigue
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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).
 
petrichor said:
Whether it is actually helpful is another question, but it seems to be something that is pretty commonly applied for highly disabling conditions.
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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.
 
petrichor said:
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/)
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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.
 
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Valentijn said:
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.
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Which is why they must be stopped. This slippery subjective anti-evidence madness goes way past just ME and MUS. We are just the means for them to impose it on the wider world.

Esther12 said:
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.
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That is truly pathetic and contemptible. :grumpy:
 
Valentijn said:
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.
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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.
 
petrichor said:
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.)
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Lucky that there has never been any objection in the patient community to that type of support, for those who wish to use it.

We are not anti-psych. We are anti-pseudoscience.
 
petrichor said:
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.
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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.

petrichor said:
Plus, from what I've heard from most practitioners, a lot of CBT aimed at CFS is about coping.
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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.
 
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Kalliope said:
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.
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Pathologize normality.
Offer your useless therapies that do not work.
Then make people feel guilty because they don't get better.
Build up a nice career on this pile of shite.

:sick::sick::sick:
 
petrichor said:
Plus, from what I've heard from most practitioners, a lot of CBT aimed at CFS is about coping.
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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.
 
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