How does pain influence the outcome of CBT in patients with CFS/ME?, Kvam, 2021 (Master thesis)

A master thesis on ME from 2021 at NTNU, I think the patients are from Copernio rehab centre:

https://twitter.com/user/status/1613561271378448384


Translation of the text in the image (reformatted by me):
The patients are separated into four subgroups, based on a screening of individual needs and goals. These subgroups are as follows: Avoidant, illness focused, achievement-oriented and confused identity.

Those that are categorised as avoidant can have avoidance behavior in social situations, where the CFS/ME diagnosis is related to the distancing to others. Treatment in the avoidant group will focus on teaching the patients to take care of their own needs. This is done by showing the patients how they can relate to others in a good way, without getting a bad conscience.

Those in the illness focused group can have a tendency to be afraid of symptoms, where they avoid all activity that cause a worsening of symptoms. Treatment of those in this group will be focused on testing catastrophizing thoughts against reality, and challenge thoughts with the help of behavior experiments and different cognitive questioning techniques.

Those in the achievement-oriented group, that also can be categorised as dutiful/perfectionist is dominated by those with high standards of quality. The treatment is to gradually build up activity while teaching the patient cognitive techniques to lower the nervous' system autonomous activation before, during and after physical and mental effort.

The last group that is categorised as having a confused identity can contain individuals that have been young, promising athletes that are no longer able to perform. They can ask themselves questions as "who am I now" because they have lost their role or identity as as the physically strong and active individual they were before illness struck. Treatment for this group is focused on acknowledging ones own needs, like becoming better at separating different feelings that arise in different social situations, and making the patients understand why unmet needs can cause different feelings

In hindsight I should have made the English more readable, but I am angry at reading this and might have wanted to keep an essence of bad Norwegian in the translation..

 

The whole thesis can be found here: https://ntnuopen.ntnu.no/ntnu-xmlui/handle/11250/2776122

English translation of the abstract:
Many patients with CFS/ME have trouble with chronic pain. Still Nijs et al (2012) found that clinicians often ignore the patients' pain symptoms, even if pain is one of the central fatigue symptoms in CFS/ME. In a subgroup of Norwegian patients (N=236) the effect of cognitive behaviour therapy in CFS/ME patients that experience pain was examined.

The master thesis is focused on examining the treatment success of CBT as well as a short CBT after and one year after treatment end, where patients' self-reported general health status will be used as outcome.

I found partial support for my expectation that pain was negatively associated with the outcome of cognitive behavior therapy. In the primary analyses both treatment methods were analysed, and showed that pain was non-significant after treatment. On the other hand pain was significant one year after treatment, which means the results must be interpreted with caution. Change in pain showed a stronger association with general health, with significant values both after and one year after treatment. There were interactions between pain and treatment methods, and between change in pain and general health. This led to individual analyses of short CBT and CBT. The results of the individual analyses showed differences in how pain influences different forms of cognitive behavior therapy. I found significant associations between pain and general health in short-CBT, but not CBT. On the other hand an association between change in pain and general health was significant in CBT, but only partially so with short-CBT.

 

The attitude to patients that seems to underlie that categorisation into 4 groups seems to me to be ridiculously simplistic and breathtakingly arrogant.

How can they possibly know what is best for an individual on the basis probably of a batch of questionnaires to determine which of these imaginary categories we belong to? Humans and their lives are much more complex than that, let alone when we have chronic illness to cope with.

Why not just listen to the patient with no preconceptions, and help the patient work out for themselves what they need help with - and it's quite likely to be help with getting appropriate medical care and practical support, not messing with their heads.

I see the title is:
How does pain influence the outcome of CBT in patients with CFS/ME?
Can any of our Norwegians give us a clue what answer the writer comes up with in their thesis.

 

The conclusion in the thesis is that change in pain levels is the largest contributing factor to patients reporting improved general health one year after CBT. The association between pain and general health was apparently only visible for those that had "short CBT", which is a flavor of CBT developed by the supervisor on the thesis (and I think it is as simple as it being of shorter duration, why use 14 weeks on a patients when eight will do). The example used for short-CBT for pwME was a quicker gradual increase in activity levels back to "normal" than what is used in general CBT.

The CBT included self-esteem boosting advice to help patients regain control over their daily lives, such as recommending short walks in the morning and evening and "slowly increase the challenges"

I am loving that the first reason for why subjective general health was chosen as the outcome is "it is one outcome that has shown to be positively affected by short CBT and CBT"

 

In circumstances when you have little choice about undergoing CBT there’s definitely one positive about the concept of short CBT.

On IAPT I was given the opportunity of finishing after 6 sessions rather than 8 - which wasn’t something I hesitated over

 

The relief of not having to attend any more gaslighting CBT gives a temporary boost to one's mood I guess.