The whole point of all of the article content is to come to the conclusion that CBT is a very reasonable therapy that should be pursued (be not afraid) by people with ME. She lays the groundwork for this reasonable conclusion by showing how 'balanced' her views are in including opinions from clinicians who take a biological view.
How to unpack this? She has no idea how frequent MD is in the ME population:
In an email interview, Susan K. Johnson, PhD, professor of psychological science, University of North Carolina, Charlotte, told Psychiatry Advisor that prevalence estimates of depression in patients with ME/CFS span a wide range, from a low of 5% to as high as 80%. “This wide range is likely due to the coding assumptions applied to psychiatric interviews. It is possible to overestimate the prevalence of psychiatric disorders in CFS when there are so many overlapping symptoms that, depending on coding assumptions, can be attributed to somatic or psychiatric causes.”
but the article opens with this nugget:
Anxiety and mood disorders, especially
major depressive disorder (MDD), are highly prevalent in patients with the condition known as chronic fatigue syndrome or myalgic encephalomyelitis (ME/CFS), also sometimes called Chronic Fatigue Immune Dysfunction (CFIDS) or Systemic Exertion Intolerance Disease (SEID).
The 'major depressive disorder' link takes us to:
Clinical Outcomes Assessed for Major Depressive Disorder With Psychotic Features
I'm not clear on the relevance of this very short post to the topic at hand.
So we have no idea how many PwME have MDD as a co-morbid condition.
We are told from the author quoting a clinician with a biological view (it's all biological but meaning here leaving out the psychological bits that BPS see as fundamental) that depression in ME is most often situational from having with a life altering illness.
Eric Gordon, MD, a physician whose California-based practice focuses on complex chronic illnesses, told Psychiatry Advisor that depression should not be regarded as an integral feature of CFS.
Patients with CFS may have an element of situational depression because their lives are interrupted and their friends and family may treat them as malingerers; however, this is not in any way a defining characteristic of CFIDS patients. Many are not any more depressed than anyone else with a chronic disease.”
Yet I see this POV as being dismissed despite it's inclusion as she embeds this quote in the middle:
“There are CFS patients who also have depression. Depression is often an example of the inflammatory response in certain people’s central nervous system, and since inflammation may be part of CFS, we see this type of depression in some patients with CFIDS.
I'm not even sure what that means. But it seems to contradict the previous statements on depression made by Dr Gordon.
Then she offers up the real 'valid' point. The one where BPS researchers take more holistic approach by inclusion of psychological factors. This is seen as the reasonable approach. The PwME are unreasonable in that their underlying assumptions about the physical nature of the illness prevent them from seeing CBT as a reasonable source of help for the condition.
Dr Johnson noted that many people with ME/CFS have objections to the biopsychosocial model, as it may imply that the syndrome is primarily a result of psychosocial factors instead of an underlying pathobiological process.
It's never made explicit but it's clear the CBT is not for coping with the situation--implied by a biological model. The reference to MDD and the link along with the very reasonable BPS view of a more holistic approach and is a result of the implied psychosocial factors. This shows us what the author thinks:
The biopsychosocial model of CFS, endorsed by a number of researchers in the field, conceptualizes CFS as a multidimensional experience in which both physiological and psychological factors combine to precipitate and perpetuate the illness.
The 'balanced view' part is interesting. She includes the perspective:
Some also argue that graded exercise can be harmful because exercise intolerance is a hallmark of the disease.” Graded exercise therapy, which involves a gradual increase of physical activity over time, is intended to address the presumed deconditioning effects of CFS, whereas cognitive behavioral therapy is meant to challenge patients’ purported fears of exertion, maladaptive illness beliefs, and overfocus on symptoms.10,11
The 'balanced view' part is interesting. She includes the perspective:
Some also argue that graded exercise can be harmful because exercise intolerance is a hallmark of the disease.” Graded exercise therapy, which involves a gradual increase of physical activity over time, is intended to address the presumed deconditioning effects of CFS, whereas cognitive behavioral therapy is meant to challenge patients’ purported fears of exertion, maladaptive illness beliefs, and overfocus on symptoms.10,11
Then she undermines the argument by following this with:
Dr Johnson told Psychiatry Advisor that people with CFS are unlikely to seek help from mental health professionals. “Community studies of CFS find that while many people endorse depression symptoms, they tend to seek help from physicians for these symptoms. Patients who are seeking treatment from a mental health provider will likely be more open to CBT approaches which have been shown to be helpful. CBT requires that the patient be willing to examine and change their beliefs about the illness and its disability
This is the point. The whole article is to lead to this conclusion as the only reasonable way to think about the issues of major depression and ME.
So Snowdrop cranky pants here thinks
the whole thing is garbage.
Again, even I'm getting tired of being cranky but this garbage needs to stop. It's nonsense with no basis in fact.
Depression is as biological as any other illness. CBT to alter beliefs is rather more limited than BPS proponents would have us believe. And it does nothing for the symptoms of ME. You know, the major thing affecting people with ME.
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