Prevalence and Treatment of Chronic Fatigue Syndrome/ME and Co-morbid Severe Health Anxiety, 2019, Daniels et al

Invisible Woman said:
I fail to understand how "Bags" Daniels or anyone else who has had contact with anyone with ME (apart from the very mildest and most recent onset) doesn't learn the opposite is true.

Most of us are too sick to interact much with the NHS at all. They tend to make it difficult. I know I have put off getting things checked out and I doubt I'm alone in that.

A GP has actually said to me - we haven't seen you for ages.... Or nag about going to breast clinic assessments, smear tests, blood tests that I have let slide until I feel well enough to get them done & doing them won't knock me back for weeks.

Health anxiety, my rear.....
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Agreed. Most of us chronically avoid the GP for years on end. They have made it rationale, albeit also increasing risks as a consequence.
 
Trish said:
Fukuda criteria used, high proportion with comorbid depression and/or anxiety. No mention of how many if any had PEM. I don't believe the patients who apparently improved so dramatically on CFQ and SF-36 PF in so short a time had ME.
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The whole thing is very confused because it speaks of co-morbid depression and anxiety on a model that essentially frames CFS as health anxiety leading to depression. Or something like that, it's very vague and confused.

So I guess we can add "co-morbid" to the list of words that had to be stripped of all useful meaning. Which kinda makes me think we may need to do a urban dictionary type of modifified definitions in the BPS model.
 
InfiniteRubix said:
In the name of all that is holy..... This person is dumb. Really dumb. Frankly the ignorance seems proactive. Proactive ignorance. It's giving me a headache just thinking about how dumb someone can be.

(Thank you for the link)
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Sadly, this is the only absurd trial that has been successfully stopped in its tracks. I'm not even sure it's actually the worst of them all, but this is the only one that was killed by ridicule.

This happened not long before Daniels was approved on the NICE committee. Real nice slap to the face, pun you very much.
 
InfiniteRubix said:
Sorry, I am lost as to what you mean. I am brain fogged.... :(
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Daniels was (presumably) featured on an article. Pretty sure it's her. She has a rare disease that requires constant eye drops made from male blood (for a specific protein, I think) or she will lose her sight.

So her life depends on good science and medicine while she works hard at denying both to us. Which is frankly vile, but to each their own.
 
So this study wanted to test wether health anxiety is a signfificant factor in ME/CFS, one that perhaps should get more attention in treatment. It is interesting that they say:
Despite a number of large CFS/ME treatment trials, a recent meta-analysis (Castell, Kazantzis, & Moss-Morris, 2011) suggests current treatment options such as Cognitive Behavioural Therapy (CBT) (National Institute for Health and Care Excellence NICE, 2007) result in only moderate improvements (g = 0.33), contrasting with larger effect sizes for CBT in the treatment of other conditions such as anxiety (Olatunji, Cisler, & Deacon, 2010)
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So a focus on health anxiety is proposed as a way to increase the efficacy of CBT.

Both the 14-item Short Health Anxiety Inventory and the 14-item Hospital Anxiety and Depression Scale indicated that around 40% of their large sample ( n = 172) met the clinical cut-off for definite case health anxiety.

But when they looked at regression and correlations, anxiety added only 3.2% to the model for physical function when fatigue and depression were controlled for and it wasn't a predictor at all in the model for fatigue. That doesn't seem like health anxiety is an important factor in determining disability, contrary to their hypothesis.

The changes seen in the 10 patients who received CBT for health anxiety were remarkable: a reduction of 11 points on the Chalder fatigue scale: patients went from severely fatigue to almost normal scores.
 
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David Tuller:
In advocating for a randomized controlled trial, the investigators assert that it “would generate further evidence to support the utility of CBT-HA in CFS/ME.”

This is an odd statement. The purpose of a clinical trial is to examine whether something does or does not happen, not to prove what is already known to be true. In this case, the investigators have virtually promised that a full trial would provide “further evidence to support the utility” of their custom-tailored intervention. That categorical declaration suggests the kind of allegiance to a pre-determined outcome that can seriously undermine the objectivity and integrity of scientific research.
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Reminds me of a 'safe-cruise-across-the-atlantic'-analogy.
 
That this CBT for health anxiety is so similar to the PACE trial CBT reveals they believe that the substance of the idea is correct and only cosmetic changes are needed.

I didn't look closely but the same is probably true for how they go about testing the treatment.

I'm tempted to make a joke about false beliefs perpetuating vicious cycles ;).
 
David Tuller:
Let’s be clear. This is a hypothesis. As with PACE’s similar claims, there is no credible evidence that “health-focused anxiety serves to exacerbate” the course of the illness. The investigators apparently believe that their new paper provides that credible evidence. It does not. Interestingly, they do not mention or cite PACE.
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Can't access their own previous work Daniels et al cite to check whether they referred to PACE there. Or to the Cochrane review on CBT?

Also it's hard to check how they deal with potential inconsistencies in the findings on (health) anxiety in the abundance of Crawley's and other PACE adherents' papers.

Don't know where to put the following, but could fit here to compare the findings with the Crawley/White prospective treatment study (2013) Keith twittered about:



Code: 
https://twitter.com/keithgeraghty/status/1278436125141536772

(Didn't check whether Keith spotted the correction [the one on factual errors not the one on ethical appoval -- all a bit confusing with those studies co-authored by Crawley and Sterne ...])

https://academic.oup.com/qjmed/article/106/6/567/1541333

From the paper:
In a model that was adjusted for all baseline measures, fatigue, physical function and pain, but not anxiety or depression scores, were associated with fatigue at 8–20 months. Similarly, older age, physical function and pain, were associated with physical function at 8–20 months. There was little evidence that anxiety and depression were associated with physical function at follow-up (Table 4).
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E Crawley, S M Collin, P D White, K Rimes, J A C Sterne, M T May, CFS/ME National Outcomes Database, Treatment outcome in adults with chronic fatigue syndrome: a prospective study in England based on the CFS/ME National Outcomes Database, QJM: An International Journal of Medicine, Volume 106, Issue 6, June 2013, Pages 555–565, https://doi.org/10.1093/qjmed/hct061

Edit: Thread on the Crawley/White/ Sterne study here.
 
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I think we need read no further, @dave30th has spotted the main rationale for this 'new' approach.
Perhaps that’s an effort to present the hypothesis as an intellectual or conceptual advance demanding exploration and its own funding stream.
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It's all about money and the ongoing careers of the researchers. Nothing to do with helping patients.
And I agree, the Wessely image of making sure the ship reaches the required destination is apt.
 
this Daniels 2019 study said:
According to the original paper, the conceptual construct of health anxiety is based on the principle that distress arises due to an enduring predisposition to misinterpret ambiguous normal bodily variations or physiological stimuli as indicators of physical illness (which may also extend to medical information).
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(bolding mine)

The Dubbo study (and even the appalling 2019 re-hash of the Dubbo data that was determined to find some sort of psychological failing in people with post-viral fatigue syndrome/CFS) did not find any link between 'hypochondriasis in the couple of months after a precipitating infection' and 'the continuation of fatigue symptoms'.

That was a big prospective study. The BPS crowd looked very hard at the data. They found nothing.
 
I suppose we should be grateful to these ubermensch for explaining to us our frailties.

When my stomach is stronger I must try to reread the chapter by Salkovskis and Bass on Hypochondriasis in the Science and Practice of Cognitive Behaviour Therapy. It looks to cover the same ground. You'll remember the book. It's the one in which Sharpe said he knew of patients who have recovered after a single telephone conversation that enabled them to reconceptualise their illness, reduce their fear of symptoms, and overcome their avoidance. And this was CFS he was talking about. Page 400 if you don't believe me.

Gelder has a lot to answer for.
 
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