Psychiatric conference in Norway nov. 2019 themed "Stressology" (Wyller among lecturers)

I'm creating a separate thread for this, as I believe there will be some articles and additional information of interest before, during and after this conference.

There's been a large annual psychiatric conference in Stavanger, Norway called "The Schizophrenia Days" since 1989. It has grown into a big happening, and is an important meeting place for health personell.

This year the theme is "Stressology".

It worries me to see prof. Wyller in the programme. For those unfamiliar with him, he is a strong advocate for a biopsychosocial approach to ME and for ME patients receiving treatments as GET/CBT and Lightning Process. He believes ME is sustained by an activated stress response.

This is the conference's presentation of "Stressology" (translated mostly by Google)

How can stress be understood as both a cause and a result of suffering?
How can stress both be harmful and a source to mobilisation and power?
How kan knowledge about stress show us how tightly mind and body are connected?
How can we reduce stress and accommodate for mastering and meaning when suffering arise?
How kan increased knowledge about stress and connections between mind and body create better health service and better help?
In order words - how can we think as a whole, and not in piece by piece?

This year's theme is how recent interdisciplinary knowledge about stress forms a core of a modern understanding of mental health in various forms. We will examine stress as a causal factor, both predisposing and triggering, but also as a sustaining factor in mental disorder.

This year's theme also focuses on an area of the field that is under-prioritized and has considerable development potential, and is in line with the authorities' desire to ensure good follow-up of somatic health in mental health care and good mental health in somatic health services. This is due to the fact that mental and physical health problems often occur simultaneously and affect each other. Almost every third with a long-term somatic disease has mental health problems and almost half of those with mental health problems have a long-term somatic disease. At the same time, psychological and somatic difficulties mutually reinforce each other, affect treatment, are related to premature death, inflict significant suffering on individuals, and have major financial consequences for society.

Stress is a basic condition of life, but through epidemiological research (see, among others, Unnur Valdimarsdottir from Karolinska / Harvard)) and neuroscience (Martin Teicher from Harvard), we will gain a more nuanced understanding of how different types of stress affect developmental pathways to disease. We will also explore evidence-based methods of recovery and recovery after the disorder has occurred (see, for example, Kim Mueser, Susan Gingerich of Boston in terms of IMR and Susan McGurk in cognitive training), and these are methods that are part of national guidelines, but which are only partially or poorly implemented in Norway.

In addition, we will explore the connection between body and mind via a focus on understanding and treating disorders that lie in the gray zone between body and mind, functional disorders (Jon Stone from Edinburgh) psychosomatic disorders (see eg Trond Diseth, Vegard Wyller, Helene Helgeland) sleep disorders (Ane Wilhelmsen), hypochondria (Ingvard Wilhelmsen) and physical activity in the treatment of mental disorders (eg Paul Joachim Bloch Thorsen.)

We will also focus on evidence-based psychotherapeutic approaches for stress disorders such as complex PTSD; DBT for PTSD (Martin Bohus from Mannheim) and ISTDP (Allan Abbass from Canada). As always, we will also include the user perspective on stress disorders, with psychiatry professor Kay Redfield Jamison of John Hopkins as the most prominent speaker of the year. Finally, we will also include some exciting new breakthrough work in the field of stress with digital and virtual therapies, as well as a newer understanding of the role of the immune system in mental disorders (eg via Ed Bullmore from Cambridge).

 

Some of the lectures in the program

A section called "Psychosomatic" have these 3 lectures:

• Linn Getz “Biology, biography and allostatic load - a language to describe accommodations, catering and the price to survive"
• Vegard Bruun Bratholm Wyller “Chronic fatigue: An integrated biopsychosocial perspective"
• Helene Helgeland “Hypnosis and hypnotic communication: a useful skill for health personell"

Other lectures:

- Senior doctor and psychiatrist for children/adolescents Helene Helgeland: "Functional bodily symptoms and conditions in children and adolescents. Broad understanding - a premise for good treatment"

- Roald Omdal and Vegar Bruun Bratholm Wyller: "Fatigue - from understanding to clinical practice"

- Prof. Jon Stone “Explanation as treatment for functional neurological disorders”
and “Functional Neurological Disorders (FND): Merging mind and brain”
(additional information about this lecture:
Functional Neurological Disorder, one of the commonest reasons for a referral to a neurologist, previously called conversion disorder and before that hysteria has a difficult and chequered history at the interface between neurology and psychiatry. In this lecture Professor Stone, who has been researching FND for over 20 years will explain how the field has moved on over that time from a diagnosis of exclusion, dominated by Freudian theory, to one in which the diagnosis is made positively, using clinical features such as Hoovers sign of functional leg paralysis and tremor entrainment test. New understanding of how neurobiology interacts with psychiatric vulnerability and multidisciplinary approaches to treatment are revolutionising care for this group of patients who have also found their own voice for the first time in patient led organisations.
Resources: www.neurosymptoms.org, www.fndsociety,org , www.fndhope.org, www.fndaction.org.uk
Hallett M, Stone J, Carson A (eds. . Functional Neurologic Disorders: Handbook of Clinical Neurology (Volume 139). Amsterdam: Elsevier; 2016.)

 

Ooooo, the are making all the right noises. They are positively embracing (I's say squeezing the life out of) biological research. We should take them really seriously.

What I no longer understand is: do they think they are treating the somatic illness or the stress it causes?

And if there is biology and real scientific research involved then why is it that they seem happy to own the whole responsibility for treatment and to only therefore be able to offer psychological solutions?

If their desire really is to offer the best options to create the best outcomes why are they not saying one word about tangible support services (other than rehabilitative) that would reduce stress?

The problem of course is in the word 'somatic'. So long as they can subsume illnesses of unknown origin and lacking an appropriate treatment as somatic then they can pretend that none of these illnesses would be better served by research into their biological underpinnings. Somatic is like a magical word that changes the nature of the way to view illness.

If an illness is somatic there is no need to investigate further. No need to consider the biology beyond the central sensitisation model (which itself can magically be applied to anything).

Lately, from a number of new threads I've been struck by what seems like real conviction on their part as if they really believe this stuff. I've often wondered about this. Yet there is so much that is obviously wrong with the model and the approach.

These are smart people. I'm coming to the opinion that this area attracts people with such big egos that their clever minds are no match for their overwhelming need to own every illness and make every solution one where they are powerfully central.

 

It's just people trying to convince others of their own personal opinion, there isn't much else. This is little different than natural philosophers promoting their viewpoint about the nature of light or heat before modern physics. It's all conjecture and speculation, basically pre-science "research".

A rare admission. @Diane O'Leary may find that interesting.

This will all look so dumb in hindsight, hardly different than the metaphorical cavemen arguing about the shadows on the cave wall and insisting they absolutely see depth and color. Eventually someone will develop technology to actually measure what we commonly refer to as anxiety, a vague and very fungible concept, and it will make all of this confident speculation look idiotic. Most of it is strictly autonomic and cannot be affected by thoughts anymore than thoughts can grow an entire new limb.

Until we can actually see and measure anxiety all of this is purely speculative. It's 100x more vague and unreliable than even the early research on ME, let alone the current body of evidence. Seems more like a vanity project than anything else, people eager to be the next pop psychology superstar. In truth it has exactly the same evidence base as The Secret. What a completely stupid waste.

 

I can't help but chuckle at the word "stressology". The problem with stress is the more people who use the word in ever increasing range of contexts, the less specific the meaning seems to be and the less useful the word is as a result.

Despite the fact that he has tried to test this hypothesis in a variety of ways and keeps failing to confirm it.

 

And as if there ever was a period in all our species' history when we were free of stress. If stress caused illness the way it is claimed we would have never survived. Despite everything there is far less stress today than there ever was. I was as free of stress when I got sick than it is humanly possible to be. Way more focus and obsession over it but far less of it.

Same with anxiety. Everything is anxiety these days. The word has been stripped of all meaning and you can't even measure it anyway so all of this is pure conjecture and personal opinion. It's used so lazily, too.

 

Well, if you stop thinking about mind and body as pieces it might help.

 

Nah they provide the chair you just provide the £200 an hour every time they
talk shit to you.

 

Have never visited Stone's website before, and this might already have been shared on the forum, but find it unsettling that he links to Henrik Vogt and recovery Norge when writing about fatigue and CFS/ME
https://www.neurosymptoms.org/fatigue/4594358000

ETA: He also claims (my bold):
This website is not designed to discuss chronic fatigue syndrome / M.E. in detail

Fatigue may occur as part of anxiety or depression, although its important to say that you don’t need to be anxious or depressed to have persistent and severe fatigue

However, many of the principles of treating CFS/ME which have been proven to be effective in clinical trials are likely to be effective in patients with functional neurological symptoms

 

This is the presentation of Jon Stone on the website for the upcoming conference. Didn't know his PhD was supervised by Michael Sharpe.
https://my.eventbuizz.com/event/schizofrenidagene-2019/detail/speaker_detail/461790

 

Many people with ME and other chronic conditions in and around Edinburgh are having FND added to their diagnoses and records.
Sadly many do not know what this is - functional creates a false sense of security for patients. It makes things seem " real".

 

Unfortunately, I've got another conference to attend on the same date. We will be discussing whether it is possible to evaluate a single slice of a system without taking the whole into account.
After a joint presentation we will be breaking up into smaller groups of 6, 8, 10 or 12 researchers.

 

If anyone wonders why there is such strong defense of PACE and similar garbage trials, the Cochrane reviews as well, this is mostly it. The whole MUS/FND/new hysteria is a house of cards where all the cards are stringed to one another. Pull one far enough and the whole thing falls down. This creates strong incentives for the whole to defend each individual part. Also a hallmark of belief systems.

 

I was able to attend Wyller's two lectures at this conference and took notes.

I've only read interviews, papers and debate articles from him, never attended a lecture before, so was curious what he would say when he had a big stage and and hour in total at his disposal.

I was not very impressed by his explanatory model for ME, and surprised that he still defends the PACE trial and recommends Lightning Process.
Here are some of the notes translated into English.

Fatigue model
Wyller did underline that what he has to offer is a model, that a lot of his research is based upon that model, and that they are far from being able to draw any conclusions.

The brain has automatic interpretations of what is happening in the body and expectations to what is going to happen. Sometimes they can be mistaken.

Whether an alarm is activated in an appropriate or inappropriate way, it will give a bodily stress response, as these are signals of danger. This again will lead to a change in the autonomic nerve activity, of the cortisol system and the immune system.

The immune system is not only what can cause fatigue, it's also affected by stress. The communication goes both ways. Our brain and hormonal system also controls the immune system.

Based on this they have suggested a complex model for fatigue. They try to put together everything they know empirically to a whole where personality, infections and life events cause the alarm to get jammed. This results into symptoms and a bodily stress respons, a sustained arousal which again leads to cognitive changes, autonomic changes, hormonal changes and in fact a low degree inflammation.

The patients
Many of these patients are ambitious, conscientious, a bit perfectionist. He meets many who will continue to study medicine or psychology or something similar, and exercise and have a thousand friends on Facebook. They do all this despite being sick. We are like animals in the sense of Pavlov’s rats (sic). We too have automatic learning. If you continue to expose yourself for strain that makes you tired while you have an infection, it’s easier to imagine that you via classical conditioning start to associate differently. Suddenly the infection has vanished, but then you get unusually tired from other things, because you have made a connection to it in your brain with having an infection.

He talks about a patient who had sent him a letter saying:
I went in and out of the hospital for two months due to mononucleosis. I became very attentive to my own body and started to consider myself as fragile. I became a master in listening to my body. If I experienced that something made me worse, I became more careful next time. Everything was about cause and effect. Mental training made me question my ideas on cause and effect. It made me do things I previously had thought were beyond my limits, without believing or being afraid of getting a reaction. And then I didn’t get a reaction.

This patient had been 1 1/2 years in a nursing home as a severe ME patient and recovered by Lightning Process. Wyller thinks this is a non medical version of the meaning of rumination.

Predicting future fatigue in patients with mononucleosis
He talked among other about his trial on mononucleosis and ME where adolescents were followed up for 6 month after the infection. He said that how you experience your symptoms in the beginning, how sensitive you are for light and sound for instance, predicts how tired you are after six months.
And more important; how anxious you are. If you worry a lot when you have mononucleosis, you will become more tired after six months. And also how well you remember. If you have a good memory, you will be more tired. He believes this corresponds with fatigue being an alarm caught in a jam. If you worry a lot, you will feel more fatigue. You will worry it won't pass, then start to expect it won't pass.

Criteria and prognosis
He believes fatigue is fatigue. It makes no sense to try splitting the long lasting fatigues into a lot of sub groups based on diagnoses. He prefers simple diagnostic criteria and criticises the Canadian criteria.
He believes that if you have a long term fatigue consequential for daily activities which can't be explained by other current physiological or psychological illnesses, then you have an unexplained fatigue or what is called CFS/ME. A lot of British researchers agree with him.

It’s important to offer empathy, hope and explanations. It’s a serious condition and there’s no solutions as simply thinking oneself better. But one can recover.
Many children and adolescents, in fact most of them, recover. It's important to tell them that, considering the importance of expectations.

Treatments, PACE and Lightning Process
Cognitive behaviour therapy is not just about dealing with a situation. With psychotherapy you can change the brain’s chemistry and function. Therefore cognitive therapy is just as good treatment as drugs.

Fatigue is real and not imaginary, even if it can’t be measured.

It’s important to underline that talking about body, mind and social structures is science and no capitulation for alternative medicine. In a biopsychosocial context, dividing treatment and coping is meaningless. Coping is treatment. Psychotherapy has biological consequenses and vice versa.

Cognitive therapy is the only thing that has been properly documented scientifically.
Many know of the PACE trial from 2011. A big British study that clearly showed cognitive behavioural therapy was better than other treatments. The PACE trial has been much critisised. Completely unreasonably and it has been absolved legally, ethically. It’s a great study. Published in the Lancet and still standing as an important study in this field.
He then went on to praise the FITNET study.

The LP study shows the same. LP is a phenomenon with cognitive techniques and other things, as positive psychology, etc. It is based in a bit alternative tradition, but has gradually gotten a pretty good academic, theoretical basis and has proven empirically to be useful. One of the things that can make Lightning Process very useful is that it makes patients experience that they can do something without becoming tired. It’s a learning-psychological effect in being tricked into do an activity and experience it as positive and suddenly no longer thinking about actually not being able to do it due to negative expectations. All of a sudden you’ve done it after all, and by that learned something different.

These patients deteriorate by advice as going for a run. Many will do that, because they are conscientious but then they just become worse. Then the reaction often is the opposite to lay oneself flat down and not daring to do anything, and obviously no one will get better by such approach.

 

Wyller also did a short interview on radio in connection with the conference.

He said that an important reason for the harsh debate is that many believe ME is either psychological or biological. He believes research shows it's both.

It's not about conscious thoughts, but automatic responses that can't be controlled but may be influenced.

Recommends trying variations of mental techniques as Lightning Process.

People are researching in their own little fields. But one must look at the whole picture.

Most patients experience that body and mind are intertwined. The medical community on the other hand is quite divided on this and there's a long way to go.

 

MD, Phd and professor Linn Getz gave a lecture just before professor Wyller. She was quite critical to the biopsychosocial approach and I really liked this quote from her:

I will define biopsychosocial as an ambitious, but unclarified 1970-notion, which has confused generations of experts and students ever since.

 

Anybody could make that stuff up. The more I hear of Wyller the more he seems a dull lightweight. Not even a spark of a mad idea. Just boring drivel.

 

That is more like it - and quite witty too.