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Psychosocial Profiles of Adolescents with Chronic Fatigue Syndrome: Correlations with Fatigue Severity and FITNET Treatment Outcome

Discussion in 'PsychoSocial ME/CFS News' started by MeSci, Jul 24, 2018.

  1. MeSci

    MeSci Senior Member (Voting Rights)

    Messages:
    3,225
    Location:
    Cornwall, UK
    More crap (Note highlighted bit):

    Source: Utrecht University

    Date: June 30, 2017

    URL:
    https://dspace.library.uu.nl/bitstream/handle/1874/365826/Berkelbach van der Sprenkel, E.pdf

    Psychosocial Profiles of Adolescents with Chronic Fatigue Syndrome: Correlations with Fatigue Severity and FITNET Treatment Outcome
    ----------------------------------------------------------
    Emma Berkelbach van der Sprenkel

    - Clinical and Health Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, The Netherlands

    Abstract

    Objectives

    To further improve the treatment and prognosis of adolescent chronic fatigue syndrome (CFS), it is essential to consider the heterogeneity of the patient population and identify factors that contribute to treatment effectiveness or are associated with nonrecovery. Although Fatigue In Teenagers on the interNET (FITNET) is considered an effective treatment for adolescent CFS, still one-third of the patient population does not recover. Profiles of co-occurring psychosocial factors may suggest potential targets for the treatment of CFS. The aim of this study was

    1) to identify these psychosocial profiles in patients with CFS,

    2) to assess the associated levels of fatigue before treatment initiation and

    3) to examine whether the outcome of FITNET can be predicted using the psychosocial profiles.

    Methods

    Participants were 120 adolescent patients with CFS who underwent FITNET treatment in the Wilhelmina Children's Hospital (mean age 15.8 years old, 81.7% female). Baseline measurements included a broad set of adolescent and parental psychosocial variables, quantified by (subscales of) validated questionnaires, and adolescent activity levels measured using an actometer. Fatigue score and psychiatric comorbidities were assessed before inclusion. Treatment efficacy was determined by examination of fatigue severity, physical functioning, school presence and self-rated improvement. Exploratory factor analysis and cluster analysis were conducted to identify the psychosocial profiles.

    Results

    Principal factor analysis (oblimin rotation) yielded four factors: Maternal Psychopathology, Paternal Psychopathology, Rearing Behaviour and Child Psychopathology. Cluster analysis based on these four factors identified four profiles: no psychopathology within system (n=57), deviant rearing behaviour (n=24), maternal psychopathology (n=21) and paternal psychopathology (n=18). High Child Psychopathology factor scores were related with elevated baseline fatigue scores [p=.048]. High factor scores on Maternal Psychopathology were related with recovery from CFS [p=.040] in subjects that completed all FITNET modules (n=78).

    Identified profiles were neither found to be predicting for fatigue severity before treatment nor for effectiveness of the FITNET intervention.

    Conclusions

    Heterogeneity of CFS among adolescents was indicated by four clinically distinguishable profiles comprised of four factors. However, most included variables were not found to be distinctly predictive for fatigue severity or treatment outcome. Our study did not find an indication to develop personalized treatment forms for the adolescent with CFS, thus application of evidence-based therapy, such as FITNET, remain the preferred decision.
     
    Skycloud, Woolie, Melanie and 7 others like this.
  2. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

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    2,389
    What a pile of bollox. Another null result dressed up as proof of whatever they wanted to show in the first place.
     
    Cheshire, Woolie, Lisa108 and 8 others like this.
  3. Trish

    Trish Moderator Staff Member

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    35,797
    Location:
    UK
    Looks like it's a Masters' degree thesis. It seems to conclude that all those psychological factors they looked at don't influence the outcome of treatment, so don't indicate any new therapeutic approach. In that sense it's a good thing - showing all that sticking their noses into the psyche's of patients and their parents is unwarranted.
    Have I read that right?
     
  4. Hutan

    Hutan Moderator Staff Member

    Messages:
    16,044
    Location:
    New Zealand
    It's actually quite a well done and well reported thesis. It is a shame that so many of the foundational premises are so very wrong.

    My conclusion is that Emma Berkelbach van der Sprenkel could be a good researcher if removed from the psychopathology of her mentors and disabused of some false beliefs.
     
  5. Woolie

    Woolie Senior Member

    Messages:
    2,826
    I can't read the main thing - that link just goes dead for me. But isn't this the wrong way around?
    That is, higher maternal psychopathology positively correlates with recovery? So the more fucked up your mum is, the more likely you are to recover?

    I wonder if they had any predictions - or whether they just threw a lot of mud and hoped that something would stick? We were just talking on another thread about the problems with this approach. You need to have a prediction ahead of time as to what direction you expect the effect to go in, otherwise, you can spin the result either way.

    Plus of course, nothing would have been significant if they had corrected for the number of comparisons they performed. Which doesn't appear to have been done (but I can't look at the thesis, so can't say for sure).
     
  6. Hutan

    Hutan Moderator Staff Member

    Messages:
    16,044
    Location:
    New Zealand
    @Woolie, the file went straight to my downloads.

    I believe they expected that young people from the four dysfunctions (mother, father, child and rearing) would show some different responses to fitnet and that therefore they could justify some extra 'fixing' of child and family in order to make fitnet be more effective.

    Yes, I think it's fair to say that they were not expecting the young people with problem mothers to be the recovery stars.... Here's the discussion about it.


    First, maternal psychopathology can be a response to the health state of the child, as the impact of chronic illness is known to extend to the entire family of a patient (Christin, Akre, Berchtold, & Suris, 2016; Missen, Hollingworth, Eaton, & Crawley, 2012; van de Putte et al., 2006). Perhaps maternal psychopathology is especially high in children that show an unpredictable and variable pattern of fatigue that waxes and wanes. If these children respond most to therapy, it might explain why therapy was more beneficial in adolescents with a mother with more psychopathology. This suggestion is tentative and needs more research.

    Another suggestion that could not be examined with our data is that psychopathological symptoms of the mother diminish once the triggering factor, in this case the CFS, is reduced by therapy. Besides that, one could argue that mothers are taught novel illness attitudes and coping strategies through the FITNET therapy which may increase acceptance and enhance the mother-child interaction concerning the chronic fatigue (Brace, Smith, McCauley, & Sherry, 2000; Garralda & Chalder, 2005). This may ultimately lead to less disease burden within the family-system and lower maternal psychopathology (Garralda & Chalder, 2005; Missen et al., 2012). However, parental follow-up measurements were not performed and therefore this suggestion cannot be ascertained.

    Conversely and perhaps more likely as an explanation of our findings is that the family’s functioning in terms of psychological well-being also impact the child and may perpetuate the CFS symptoms (Brace et al., 2000; Christin et al., 2016). Possibly specific attitudes and dysfunctional cognitions that are targeted in treatment were shaped by maternal psychopathology. Through therapy, these disturbed cognitions might be challenged or affected in a different way than in children who grew up in a family-system without psychopathological influences. Furthermore, emotional involvement is known to be high among parents of CFS patients, possibly involving enhanced focus on bodily symptoms of the child causing reinforcement of illness- behaviour (Brace et al., 2000; Rangel et al., 2005). These behaviours are perhaps amended through treatment, especially in children that are commonly living in a pathological system.

    Even though clear explanation cannot be given based on these results, the importance of maintaining a system-approach in treating CFS in a paediatric sample is neither emphasized nor rejected. However, as the only significant predictor for a beneficial outcome was more psychopathology of the mother, a standard implementation of comprehensive psychological assessments for family members or system-adjusted treatment forms do not seem to be of extra value to increase therapy effectiveness.​
     
  7. Amw66

    Amw66 Senior Member (Voting Rights)

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    4,711
    What is the definition of "maternal psychopathology" - given the realities of this illness and the gulf between reality and treatment options, it may not be surprising that mothers with a higher degree of " psychopathology" would have children who had greater improvement. Any comments @chicaguapa ?
     
  8. Liv aka Mrs Sowester

    Liv aka Mrs Sowester Senior Member (Voting Rights)

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    1,201
    Which makes sense, doesn't it? Isn't this a problem caused by conflation of ME with fatigue? Fucked up parents can be quite chaotic and don't tend to enforce regular routines. Their kids would be bound to respond really well to sleep hygiene and regular routines, but they wouldn't have had ME to start with, they were simply fatigued.
     
    Woolie, Hutan, Trish and 6 others like this.

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