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Salivary cortisol output before and after cognitive behavioural therapy for chronic fatigue syndrome, 2008, Roberts

Discussion in 'PsychoSocial ME/CFS Research' started by dreampop, Jul 21, 2020.

  1. dreampop

    dreampop Senior Member (Voting Rights)

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    https://www.kcl.ac.uk/ioppn/depts/pm/research/cfs/publications/assets/2009/Robertssalivary.pdf
     
  2. dreampop

    dreampop Senior Member (Voting Rights)

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    This is a small, self-controlled study with a long, variable treatment (CBT ofc) duration up to 6 months. 47% were "responders" to CBT. (sidenote: in this case, I believe as the outcomes are subjective by the therapist rather than the patient). The authors include Wessley and Chalder.

    The response to CBT was not consistent with the change in cortisol levels, undermining the hypothesis involving the pathophysiology of the HPA axis. Both non-responders and responders showed an increase in total daily cortisol output. In fact, non-responders showed greater increases in cortisol (+12.8 vs +8)

    CBT responders were nearly 6 points higher in total output, almost as much as the increase from CBT, suggesting a slightly better off treatment group to begin with.

    Ok, so +16% total output refers to *responders and non-responders* to CBT.

    CBT responders experienced an +11.2% costisol outpot and non-responders experienced a +19.6% change !

    Not only is this conclusion very deceitful, the following is a pure contradiction when combined with Wessley's own results. If cortisol increased more in patients that didn't respond to therapy either the therapy or the cortisol finding is being misinterpreted.

    Except that the larger change coincided with the unresponsiveness to CBT. So, how can that be. And how can the HPA axis, lifestile and deconditioning *not* be correlated with responsiveness to CBT if BPS model holds.

    ...


    Final conclusion:

     
    Last edited: Jul 21, 2020
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  3. Sarah94

    Sarah94 Senior Member (Voting Rights)

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    Doesn't cortisol reflect stress? So CBT made them more stressed
     
  4. dreampop

    dreampop Senior Member (Voting Rights)

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    Anyone on twitter (I am not) might want to show this paper to Dr. Keith Geraghty as it seems very relevant to the question he asked. Ironically, it's a BPS paper that seems to undermine the position he was querying.
     
  5. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

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    Cortisol is a feed-forward metabolic hormone, it's purpose is to provide sufficient blood glucose upon wakening and smooth the blood glucose level over the day given anticipated activity demands (insulin is a feed-back metabolic hormone...).

    Despite all the pop-psychology on the contrary, it's more correct to say that cortisol levels reflect sleep-wake and activity patterns than "stress".
     
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  6. obeat

    obeat Senior Member (Voting Rights)

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    Done
     
  7. Aslaug

    Aslaug Senior Member (Voting Rights)

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    alktipping likes this.

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