Cross-Cultural Study of Information Processing Biases in CFS

[Dolphin]

Int J Behav Med. 2017 Aug 23. doi: 10.1007/s12529-017-9682-z. [Epub ahead of print]
Cross-Cultural Study of Information Processing Biases in Chronic Fatigue Syndrome: Comparison of Dutch and UK Chronic Fatigue Patients.
Hughes AM1, Hirsch CR1, Nikolaus S2, Chalder T3, Knoop H2,4, Moss-Morris R5.
Author information
1
Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
2
Expert Centre for Chronic Fatigue, Radboud University Medical Centre, Nijmegen, The Netherlands.
3
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
4
Department of Medical Psychology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands.
5
Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Rona.moss-morris@kcl.ac.uk.
Abstract
PURPOSE:
This study aims to replicate a UK study, with a Dutch sample to explore whether attention and interpretation biases and general attentional control deficits in chronic fatigue syndrome (CFS) are similar across populations and cultures.

METHOD:
Thirty eight Dutch CFS participants were compared to 52 CFS and 51 healthy participants recruited from the UK. Participants completed self-report measures of symptoms, functioning, and mood, as well as three experimental tasks (i) visual-probe task measuring attentional bias to illness (somatic symptoms and disability) versus neutral words, (ii) interpretive bias task measuring positive versus somatic interpretations of ambiguous information, and (iii) the Attention Network Test measuring general attentional control.

RESULTS:
Compared to controls, Dutch and UK participants with CFS showed a significant attentional bias for illness-related words and were significantly more likely to interpret ambiguous information in a somatic way. These effects were not moderated by attentional control. There were no significant differences between the Dutch and UK CFS groups on attentional bias, interpretation bias, or attentional control scores.

CONCLUSION:
This study replicated the main findings of the UK study, with a Dutch CFS population, indicating that across these two cultures, people with CFS demonstrate biases in how somatic information is attended to and interpreted. These illness-specific biases appear to be unrelated to general attentional control deficits.

KEYWORDS:
Attentional bias; Attentional control; Chronic fatigue syndrome; Cross-cultural study; Interpretation bias

PMID:

28836119

DOI:

10.1007/s12529-017-9682-z

 

[Dolphin]

I know this is in the wrong forum but I can't currently post in the psychosocial forum.

 

[Dolphin]

2. Recognition task [28] assessed interpretation bias (IB). Participants read 10 ambiguously phrased scenarios, followed by a short comprehension question. After reading all 10 scenarios, participants are presented with the title of each scenario in turn and asked to rate four new sentences in terms of how similar or dissimilar they are to the original text (1=not at all similar to 4=very similar). The sentences contain a positive interpretation and an illness-related interpretation of the original scenario. Recognition items also include two Bfoils^ or false statements. Foils are included so that not all items are related to the original text, thereby providing greater face validity for the task. For the purpose of this study, we analyzed mean scores on the interpretation items only. An IB index was also calculated as mean similarity ratings of illness-related interpretations minus positive interpretations. Higher scores indicate an increased somatic interpretation.

3. Attention network task (ANT) [29] assessed general attentional control.2 Participants are presented with a string of five congruent (→→→→→) or incongruent (→→←→→) arrows. Participants’ identify the direction of the central arrow by pressing different keys. Attentional control is calculated by subtracting the mean RT on congruent trials from the mean RT on incongruent trials. Higher scores indicate poorer attentional control.

2 The attention network task measures three aspects of attention: orientation, altering, and attentional control. For the purpose of this study, we have reported only the trials which correspond to the attentional control score.

I am left wondering whether there is selective reporting here.

 

[Dolphin]

VPT: Attentional Bias in UK and Dutch CFS Groups and Healthy Controls

A one-way ANOVA with AB scores showed a significant main effect of group, F(2, 136) = 3.46; p = .03; ηp 2 = .05. Compared to healthy controls, the Dutch CFS group had a significant AB towards illness-related stimuli, F(1, 84) = 4.98; p = .03; ηp 2 = .06. There were no differences in AB scores between Dutch and UK CFS groups, F(1, 86) = .07; p = .80; ηp 2 = .001. The main effect remained when controlling for anxiety, F(3, 136) = 3.25 p = .04; ηp 2 = .05, but disappeared when controlling for depression, F(3, 136) = 1.17; p = .31; ηp 2 = .02.

In this study, differences between groups in AB disappeared when controlling for depressed mood using the HADS. This is atypical of depression, where AB is found at longer stimuli presentation durations than used here [30].

Does the "atypical" sentence mean attentional bias does not occur in depression in this situation rose simply that it has not been measured in this scenario?

Furthermore, the original study found AB was independent of comorbid distress [11], as measured by a clinical interview schedule [31]. These differences may be a reflection of the HADS capturing fluctuating mood whereas the CIS-R assessed clinical psychological comorbidity. A psychometric analysis of the HADS suggests it is best viewed as a measure of distress rather than anxiety and depression per say [32].

I'm not sure I recall this group critiquing the HADS before this finding. They don't discuss this finding any further.

"per say" should presumably be "per se"

 

[Dolphin]

However, the current study is limited by a lack of Dutch healthy control group and differences in baseline characteristics of the CFS populations, namely level of education. However, controlling for level of education had no impact on the main effects observed; thus, it does not appear that differences in education attainment are attributed to the cognitive biases observed. It seems likely that this education difference represents differences in the education system rather than something intrinsically different about these populations. Given the differences in the education systems, the categorization of low and high education levels may have been imprecise.

I don't know enough about the cohorts to comment.

 

[Dolphin]

In addition, a clinical comparison group would be enlightening to further explore whether attention and interpretation biases occur in other fatigued populations or are due to the chronicity of illness.

Seems reasonable

Replication studies such as this pave the way for progress in theory and treatment development.

I am not at all convinced this will make much difference in terms of developing efficacious treatments.

Longitudinal studies should build upon this basic research to explore whether these cognitive processes change over time, following interventions and in comparison to other chronic conditions.

Seems reasonable

 

[Valentijn]

I don't know enough about the cohorts to comment.

The Dutch education system is very different. Starting around age 11-12, students go to three different types of high schools, basically geared at either going to trade school at 16 with some apprenticeship, normal university at 17, or a research/science university at 18.

Which track they end up on in high school depends on both their teacher-rated performance in elementary school and test scores at the end of elementary school. It sounds like bias sometimes plays a role in ratings by teacher, based on the child's ethnicity and/or socioeconomic status.

So yeah, it gets pretty complicated in the Dutch system Can't just add up the years in school.

 

[MeSci]

This seems to be a thesis by the same main author:

Source: King's College London

Date: February 2017, September 21, 2017, online Januari 11, 2019

URL: https://ethos.bl.uk/OrderDetails.do?did=5&uin=uk.bl.ethos.762335

https://kclpure.kcl.ac.uk/portal/en...me(cc5c9646-8a72-49bd-97b4-ba2df2bee0e1).html

https://kclpure.kcl.ac.uk/portal/files/103728835/2017_Hughes_Alicia_1253313_ethesis.pdf

A longitudinal investigation of information processing biases and self-reported cognitions and behaviours in Chronic Fatigue Syndrome
----------------------------------------------------------
Alicia Maria Hughes

- Psychology Department, King's College London, London, U.K.

Abstract

Cognitive behavioural models propose the way in which people with chronic fatigue syndrome (CFS) perceive and respond to symptoms and other illness-related information, contributes to the maintenance of fatigue and disability. Self-report studies exploring a number of these factors have proved fruitful. However, data regarding cognitions and behaviours that may occur at earlier, more implicit levels of processing is lacking. This thesis presents a series of experimental studies to investigate the manner in which people with CFS process information. The main work in this thesis is based on a large cross sectional cohort of people with CFS, compared to healthy controls; followed by a nested longitudinal study of the patients who underwent cognitive behavioural treatments for CFS, namely cognitive behavioural therapy (CBT) and graded exercise therapy (GET).

Study 1: A systematic review of attention and interpretation biases found mixed evidence for information processing biases in CFS and highlights methodological issues in experimental design.

Study 2: A published article addresses one of the key methodical issues highlighted in the review, the lack of illness-specific materials, by detailing a step-by-step process of comprehensive/robust stimuli development for experimental research.

Study 3: A published quasi-experimental study indicates that, when using illness-specific materials, people with CFS (n=52) demonstrate attention and interpretation biases, compared to healthy individuals (n=51); which are associated with unhelpful responses to symptoms, but independent of comorbid mood disorder and attentional control deficits.

Study 4: A replication study with a Dutch cohort of CFS participants (n=38) indicates that cognitive biases are a robust finding across cultures and CFS populations, and confirms that these biases are independent of attentional control.

Study 5: A nested longitudinal study (n=26) found that, pre-existing attentional biases, as well as a high capacity to develop an attentional bias (i.e. attention malleability), predicts better functioning, but not fatigue post treatment for CFS. Pre-treatment interpretation biases do not appear to predict treatment outcomes in CFS.

Study 6: A small follow-up up study (n=20) found that attentional control capacity significantly improves following treatment for CFS.

Whilst attention and interpretation biases did not significantly change across this treated sample, the degree to which they changed was associated with more helpful cognitions and behaviours.

By exploring the more implicit factors within the cognitive behavioural model of CFS, this body of experimental work has added another dimension to the CFS literature and contributes to a more comprehensive and nuanced understanding of information processing in CFS.

--------
(c) 2017, 2019 King's College London

 

[Esther12]

This seems to be a thesis by the same main author

Reading the PhD theses of these people is really depressing. I've stopped doing it now. The next generation is looking to be even worse than what we have now - they're the followers of quacks!

Thanks for the link though - good to have these things available to people.

 

[rvallee]

Reading the PhD theses of these people is really depressing. I've stopped doing it now. The next generation is looking to be even worse than what we have now - they're the followers of quacks!

Thanks for the link though - good to have these things available to people.

I think it would be worth the exercise to take decades-old papers about the psychosomatic model of ulcers, asthma, autism or any of the other diseases that have had that label before they stopped being denied, just change a few words to apply it to MUS or any of the dozens of stupid acronyms and submit them to the psychosomatic journals. I doubt anyone would be able to tell the difference. The only reason it could fail is eminence, because it's all based on who wrote it and whether it validates preexisting biases, not the content itself.

There is a diagram that I often post on Twitter showing the psychosomatic model of peptic ulcers. It's almost identical to the ones used for the ME model. It's not similar or close, it's nearly identical. The end of the world is coming January, 2000. No, make that October, 2002. Actually, we meant June, 2006. Nevermind, it's actually 2020, we've got plenty of time to prepare and this time we got this right so sell all your stuff and begin the end of the world party!

Nothing has changed since the golden years. Decades of stagnation using the same circular logical fallacies and it's still going strong as a default explanation that cannot be challenged because objecting to it is just as much evidence that it's right as submitting to it is. Even in the best cases they merely provide marginal help to a few, nothing that standard supportive therapy couldn't achieve, leaving in their wake suffering on a scale that normally only continent-wide war can achieve. The risk-reward of this field is atrocious. Psychosomatic medicine seriously needs to be put on ice for a few decades, it's a complete disaster.

 

[Invisible Woman]

it's a complete disaster.

....but only for the patients. Nice little earner for those inflicting the damage, but they don't mind and so we don't matter.