Trial Report Individual Video-Based Case Formulation for ... Persistent Physical Symptoms Associated With Indoor Environment or Chronic Fatigue, 2024, Keinonen

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Free fulltext: https://www.sciencedirect.com/science/article/pii/S1077722924000221

Cognitive and Behavioral Practice
Available online 8 February 2024

Individual Video-Based Case Formulation for Participants With Persistent Physical Symptoms Associated With Indoor Environment or Chronic Fatigue
Katariina Keinonen, Päivi Lappalainen, Raimo Lappalainen, Sanna
Selinheimo, Aki Vuokko, Sanna Liesto, Markku Sainio, Tiina Paunio


https://doi.org/10.1016/j.cbpra.2023.12.012Get rights and content


Highlights

• FACCD was used to understand persistent physical symptoms (PPS).
  
  
• Participants had PPS related with indoor environment and/or prolonged fatigue.
  
  
• The FACCD was found to be acceptable and useful in identifying these problems.
  
  
• Case examples illustrate the complexity of life situations of individuals with PPS.
  
  
• Psychological assessment may complement medical assessment of PPS.

Abstract

Persistent physical symptoms (PPS) refer to a wide range of symptoms that cannot be fully explained by traditional medical assessment of bodily pathology or environmental factors.

The aim of the current study was to illustrate the application of an online interview and Functional Analytic Clinical Conceptualization to describe psychological and life problems perceived by participants with PPS and to give examples of how a functional analysis approach to case formulation could assist in their treatment.

We applied the Functional Analytic Clinical Case Model (FACCM) in the assessment of participants with PPS (n = 50), including three focus groups:
those with PPS related to the indoor environment (n = 11),
those with PPS related to prolonged fatigue (n = 28),
and those with both symptoms (n = 11).

Among the 50 participants with PPS, a typical amount of concurrent psychological and life problems was 9.

In addition to PPS, the most typical problems reported were symptoms of stress and burnout (74%), low mood (68%), narrowing of daily life (58%), and worrying (52%).

The results highlight the complexity of the participants’ life situations.

We found that the FACCM was acceptable and useful in identifying potential individual treatment targets.

Keywords
persistent physical symptoms
indoor-environment-related symptoms
chronic fatigue syndrome
case formulation
functional analytic clinical case diagram

 

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Quote:

"Clinically, the functional analysis and the FACCM are considered most useful when assessing complex clinical cases such as patients with multiple problem areas and multiple interacting causal variables and when standardized treatment is ineffective (Haynes et al., 2011, Lappalainen and Tuomisto, 2005, Lappalainen et al., 2009).

A psychiatric diagnosis is often insufficient to explain the individual variation of the problems and the complexity of the situation (Hofmann and Hayes, 2019, Lappalainen et al., 2009). For example, “chronic fatigue syndrome” (CFS) is often too nonspecific to provide information about the etiology of the problem, what maintains the problem, how the behavior/problem varies across situations and contexts, and how different problems the patient experiences interact with each other (Lappalainen and Tuomisto, 2005, Lappalainen et al., 2009).

In contrast, a functional analysis considers individual differences and emphasizes potential causal relations, aiming at collaboratively identifying the need for change and ensuring a shared understanding of the factors central to treatment (Haynes and Williams, 2003, Lappalainen et al., 2009). Based on these considerations presented in previous literature on the need for individualized assessment of PPS and opportunities that the FACCM offers, patients with PPS and professionals working with them could benefit from a functional analysis and the FACCM."