Generalised worry in patients with [CFS] following Cognitive Behavioural Therapy - a prospective cohort study in secondary care, 2022, Chalder et al

It does look like they have a lot of missing data - it may be that they never collected/recorded everything or people just didn't fill out the forms. But they are not being clear about it. I also thought the "polytechnic" catagory in education was a bit weird as they became univerities many years ago so there is an implicit age thing there as well as an academic bias - also no further education catagory.

 

I think the time line may be interesting. If they ask people about anxiety prior to them getting a solid diagnosis and then after CBT they can't rule out other things such as the importance of having a diagnosis (which can help and getting one can be really stressful). It seems sloppy (but I've not read the paper).

 

@dave30th can you take a look at this one. It's paywalled, so most of us can't read it.

 

If patients are worried early on as diagnosis happens it could be useful for a doctor to find out specific things that are worrying them and provide better information and advice. For example, someone could be worried about work and how to deal with occupational health so advice on this could be useful.

But a general 'worried' isn't really a useful concept.

 

I think it shows how deluded the people writing this paper are to talk about worry as a general concept with the idea that if you tell people not to worry they will get better. But I do think as a practical thing doctors who can recognize specific worries and deal with them in practical ways can be helpful. If they were doing valuable research then they may pick up on something like that but they aren't they just want to publish papers that raise their publication count and try to dismiss patients.

 

Links to some of the questionnaires used

Penn State Worry Questionnaire (PSWQ)

The Work and Social Adjustment Scale

Hospital Anxiety and Depression Scale (HADS)

 

Comments
The Penn State Worry Questionnaire gives scores ranging from 16 to 80 where 16 means you chose the lowest scoring option on each of 16 statements, and 80 is the highest level of worry.
They chose 45 as the cut off point for significant worry. Yet they categorise everyone scoring 16 to 45 as 'mild generalised worry'. So on that basis, everyone in the world is worried, even if they report they are never worried.
Most of the statements you are asked to respond to could be influenced by the life changes ME/CFS forces on the person and the lack of support and care they are getting, not by any psychological worry disorder. Who wouldn't be worried if they are struggling to keep a job and work rate because of physical illness and are getting no support, and being told by their therapist that their symptoms are the result of fear avoidance.

I had a look at the Hospital Anxiety and Depression Scale (HADS). It's completely inappropriate for measuring anxiety and depression in ME/CFS because many of the questions are about activities, which for someone with ME/CFS are likely to be limited by physical and/or cognitive disability, not by anxiety or depression. It's no wonder they keep insisting so many of us have comorbid anxiety and depression disorders.

The Chalder Fatigue questionnaire we've discussed multiple times. We know it's seriously flawed.

 

I did a search for
The fear avoidance subscale of the 40-item Cognitive and Behavioural Responses Questionnaire (CBRQ)

I found this:
https://kclpure.kcl.ac.uk/portal/fi...actor_RYAN_Accepted4October2017_GREEN_AAM.pdf
It's by Chalder's team and from 2017. It seems to be a study based on the same patient set and on the PACE trial participants.
Edit: We have a thread on it here:
https://www.s4me.info/threads/ryan-...behavioural-responses-questionnaire-cbrq.921/

On page 36 the list of statements for each subscale is listed. The one referred to in this study is this:

The other subscale used was this one:

That's not fear avoidance. For someone with ME/CFS who gets PEM, that's sensible pacing advice.

The more I look into this the worse it gets.

 

I believe HADs is one of the questionnaires they used at the CFS clinics I went to.

 

I have attempted to wade through the paper, with rising indignation at all the assumptions being made.

I don't know what to make of this in the discussion (my bolding):

And yet in the conclusion:

I've lost the will to live on this one. I hope someone else will pick it apart more effectively than I can and challenge it.