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Jo Daniels (on CBT, ME/CFS and Long Covid)

Discussion in 'PsychoSocial ME/CFS News' started by John Mac, Nov 8, 2020.

  1. John Mac

    John Mac Senior Member (Voting Rights)

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    Long Covid: what teachers and pupils need to know
    https://www.tes.com/news/long-covid-what-teachers-and-pupils-need-know



    (Split thread:
    Jo Daniels is quoted, defending CBT for ME/CFS and for Longcovid. Her quotes come towards the end of the article.)


     
    Last edited by a moderator: Nov 14, 2020
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  2. Andy

    Andy Committee Member (& Outreach when energy allows)

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    Jo Daniels mis-representing CBT for ME again @dave30th
     
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  3. alex3619

    alex3619 Senior Member (Voting Rights)

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    The claim skirts the issue, each point is more or less correct, but the implications are not. The author did not state the implications, surely its not their fault if people misinterpret the statements? I have to wonder if this is deliberate or simply lack of awareness? My suspicion is its carefully done.

    In either case its worth noting the shift to the classic view of CBT, which is different from CBT in the PACE trial.
     
    Last edited: Nov 8, 2020
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  4. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    From Daniels:
    “The point of CBT is to improve quality of life and reduce psychological distress. The main focus isn’t to ameliorate physical health symptoms, although this is a common misunderstanding. We do see improvements in symptoms, but this is not the primary target.”

    She believes CBT may be a useful treatment for symptoms associated with long Covid, too.


    At least things have got to a point where CBT enthusiasts have to go through this sort of intellectual contortion to justify their recommendations.

    It isn't really for symptoms but it might help - and of course it might help them in Long Covid too. This is really solid evidence-based thinking.
     
  5. strategist

    strategist Senior Member (Voting Rights)

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    I think it's motte-and-bailey fallacy.

    The motte-and-bailey fallacy (named after the motte-and-bailey castle) is a form of argument and an informal fallacy where an arguer conflates two positions which share similarities, one modest and easy to defend (the "motte") and one much more controversial (the "bailey").[1] The arguer advances the controversial position, but when challenged, they insist that they are only advancing the more modest position.[2][3] Upon retreating to the motte, the arguer can claim that the bailey has not been refuted (because the critic refused to attack the motte)[1] or that the critic is unreasonable (by equating an attack on the bailey with an attack on the motte).

    https://en.wikipedia.org/wiki/Motte-and-bailey_fallacy

    When they promote CBT for MUS/CFS/etc to the broader public or when debating critics, they present it as similar to supportive counseling (goal is reduce distress, not cure patients). They can then claim that the critics are unreasonable or misunderstand the therapy. Who could possible disagree with giving patients in distress access to therapist to talk about their situation?

    When they promote it other medics and policy makers and publish in journals, they make these absurd claims of CBT targeting the causes of the illness and leading to improvement in the illness and even recovery.

    It's obvious what they really believe. They're feigning innocent and reasonable views so they can better deliver their harmful and unreasonable views.
     
    Last edited: Nov 8, 2020
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  6. Wonko

    Wonko Senior Member (Voting Rights)

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    I think I'd prefer to try another approach, that isn't really for symptoms, but might help me feel better.

    Instead of a course of CBT, can I have cash? A few million should be enough to see if it has a measurable effect on my short, medium, and long term sense of well being.
     
  7. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    I was wondering too about this formidable evidence base for CBT for Everyotherchronicconditionknowntoman. Surely if it is not for symptoms the outcome measure must just be 'did the nice therapist make you feel happier?' administered as a questionnaire by the nice therapist. Not even any objectively measurable things to forget to measure (or decide not to measure after all) here. And not very blinded.

    I am also wondering, though, because I suffer from a chronic condition characterised by persistent pain in more than three places, fatigue, poor sleep, tinnitus, poor vision, difficulty getting up off the floor if I fall over, inability to remember things or concentrate for very long and so on. I suspect about 25% of the population also have this. It is called getting older. Surely CBT would help me understand that all these things are really just unhelpful thoughts of mine. It would save me going to the GP when I get cancer and stuff like that.
     
  8. alex3619

    alex3619 Senior Member (Voting Rights)

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    If they gave us all a couple of million and we donated half to research we could solve the problem. :ninja:
     
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  9. Sean

    Sean Senior Member (Voting Rights)

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    That's the study I want to see, and be in. :D

    One thing having ME has taught me is that social interaction (and I include politics in that) is a huge part of what human brains are set up to do. Even the most enjoyable socialising is very draining for me.
     
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  10. FMMM1

    FMMM1 Senior Member (Voting Rights)

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    Bits of this were hilariously funny --- some not so! Thank you very much for summarising it so accurately.
     
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  11. Joan Crawford

    Joan Crawford Senior Member (Voting Rights)

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    "“Psychological therapy is useful for a range of medical conditions, with a strong underpinning evidence-base supporting its use."

    This is classic Doublespeak! Misleading. Me thinks she is a politician :)

    Yes, psychological therapy is used for a range of medical conditions - but it is not used to try and cure them - that is a massive difference between Wessely School CBT and what goes on in supportive psychological care (can be CBT based) for, for example, pwCancer, Heart Disease etc who are distressed. Also, people with such diseases are not having CBT foisted upon them ALL. pwME/CFS are, which is offensive to some - understandably so. Many patients are managing incredibly well and are highly resilient people in the face of enormous debility, suffering and so forth. Undermining that is not helpful :)
     
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  12. Joan Crawford

    Joan Crawford Senior Member (Voting Rights)

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    "The main focus isn’t to ameliorate physical health symptoms, although this is a common misunderstanding."

    That is a complete misunderstanding of what Wessely School (WS) aimed to do and what has been foisted on my pwME/CFS. WS aimed to cure patients. Period. That is their model. To pretend this did not happen is to erase history. The history needs to be approached, examined, cast aside and then patients can move on. Ignoring this because it might feel uncomfortable or difficult is not helpful.
     
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  13. Joan Crawford

    Joan Crawford Senior Member (Voting Rights)

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    That's good :)
     
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  14. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    hmm
    Recovery from chronic fatigue syndrome after treatments given in the PACE trial
    https://pubmed.ncbi.nlm.nih.gov/23363640/
     
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  15. Hutan

    Hutan Moderator Staff Member

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    Here are the relevant bits from the very long article quoted in the original post:

    How is long Covid treated?
    Treatment is a thorny area when it comes to conditions where biological causes are undetermined. For ME/CFS and PVFS, it’s the reason there can be so much misunderstanding among the general public. Because for the most part, treatment is psychological in nature.

    “There is no tablet or injection we can give people to cure them,” says Vickers. “So it becomes about managing the symptoms, about helping people get on productively with their life despite those symptoms.”

    Jo Daniels, senior lecturer at the University of Bath and a specialist clinical psychologist, is one of the leading experts in the treatment of ME/CFS and PVFS in the UK and sits on the NICE guidelines panel for ME/CFS. She believes the use of psychological treatment in medical conditions is widely misunderstood.

    “We need to debunk the myths that are out there,” she says. “Psychological therapy is useful for a range of medical conditions, with a strong underpinning evidence-base supporting its use.

    “The use of psychological therapy does not by any means infer a psychological or psychiatric root cause, but rather an acknowledgement of the fact that living with a long-term condition is very distressing and very disabling.”

    Key among the strategies used for ME/CFS patients is cognitive behavioural therapy (CBT).

    “Psychologically based therapies such as CBT have a strong evidence base for supporting people with medical conditions to adapt to and manage their health,” Daniels explains. “Psychological therapy does not infer that a physical experience is psychological, it suggests that physical health problems can be distressing.

    “The point of CBT is to improve quality of life and reduce psychological distress. The main focus isn’t to ameliorate physical health symptoms, although this is a common misunderstanding. We do see improvements in symptoms, but this is not the primary target.”

    She believes CBT may be a useful treatment for symptoms associated with long Covid, too.

    “I would expect to see anxiety and depression emerging in those with long-haul Covid; that would be a very understandable response to suffering a very unpleasant illness and then living with protracted symptoms of unknown duration. CBT is likely to be useful in Covid-19 long haul as it would be in other medical conditions.”

    ...

    Thirdly, Daniels feels schools really need to try to understand the individual pathway these teachers will be on.

    “Long-haul Covid appears to be taking different forms so a one-size-fits-all approach is unlikely to work well,” she says. “What’s really very important is that heads view every teacher who has long Covid on an individual level and case-by-case basis, and that they ensure the relevant services are involved. Occupational health involvement can be very useful, as can GP input.”

    She says that heads should be particularly cautious around return to work plans.

    “We have seen in other post-viral syndromes that a premature return to work is often problematic,” says Daniels. “We should resist blanket timeframes as a school or comparing individual teachers progress and assuming recovery from long Covid will be anything like what we have seen before. We just don’t know enough yet.

    “What is important is that people are empowered to make decisions about their own bodies and behaviour; while we are learning about this new condition, those suffering need support, understanding and validation if they are to achieve whatever recovery is possible.”


    ...

    Daniels agrees that schools mistaking post-viral conditions to be school refusal is a real issue.

    “We hear a lot that children are often mistaken for school refusers, with not enough time taken to consider what the underlying problem may be,” she says. “Depending on their cognitive and emotional developmental stage, some children may find it difficult to articulate their internal world, what is happening in their bodies and their emotional experiences. Which means it is harder to immediately establish what is going on for that child.

    “What we can sometimes see in fatigue is that children can appear to become withdrawn, they may seem like they're being difficult by refusing to engage in activities such as PE for example, or in the classroom. Whereas they may actually be experiencing fatigue, and a range of symptoms that they have no words for.

    ...

    “Children may often complain of feeling tired or having tummy ache, so it can be a challenge to differentiate what is normal childhood bodily variations, mood related or physical.

    “Looking out for a definite ‘change’ in behaviour can be a helpful clue, particularly post virus. Active monitoring is important, particularly as we don't know yet how/if children will be affected by Covid in a long-haul way as adults are.

    “We must be vigilant to signs of ongoing illness in some form or other and consider the possibility that they may be developing Covid long haul. Involvement with other services such as the GP or paediatrician should be considered if ongoing physical symptoms are present.”
     
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