The biopsychosocial model

[Yann04]

Is this a related phenomenon to what we see with "functional disorder"? A conscious attempt by some parts of psychology to use obtuse terminology of hide what they are doing?

Very likely, and has probably been the case for a while. They benefit from conflation of CBTs. From conflation of chronic fatigue and “CFS”, from conflation of PEM PESE and PEF, from conflation of Pacing and “pacing up” etc.

I don’t know how conscious these conflations are. But the rhetorical tricks they use as quite sophisticated and definitely not random.

 

[Utsikt]

Why do people use the term "CBT" when discussing treatment f or ME/CFS (and other conditions)?

CBT can have wildly different content and goals. People need to specify the contents of the therapy!

It seems extraordinary sloppy to speak about simply "CBT", especially in a scientific context.

People could use for example "AEA-CBT", Anti Exertion Avoidance CBT (made up term) if that is what they mean.

Or "LLTI-CBT", Living with Long-Term Illness CBT (made up term) for something that aims to help people accept and manage their condition.

All CBT is used with the intention of changing behaviours and/or thoughts of the patient.

So when CBT is used for ME/CFS, it means any therapies that focuses on changing the thoughts or behaviours of pwME/CFS.

The general distinctions are between supportive and curative CBT for ME/CFS.

Various curative approaches have consistently failed every time they have been tested in trials. Supportive has not been tested and there is no basis for recommending it for pwME/CFS specifically.

When people say CBT in the context of ME/CFS, it almost always refers to curative CBT.

Is this a related phenomenon to what we see with "functional disorder"? A conscious attempt by some parts of psychology to use obtuse terminology of hide what they are doing?

I’m not sure they know themselves what they are doing. I suspect all of the mess is due to their own confusion. It all seems very incoherent to me.

 

[Lou B Lou]

The Canadian Consensus Criteria (CCC) suggests that some Drs wrongly call coping skills 'CBT'.

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.investinme.org/Documents/PDFdocuments/Canadian_ME_Overview_A4.pdf

Page 10:
'Some physicians, who are cognizant of the biological pathophysiology of ME/CFS, teach patients coping skills but call them “CBT”. We urge such doctors to use the term “Self-Help Strategies” and avoid using the terms “Cognitive Behaviour Therapy” and “Cognitive Retraining Therapy”.'

.

 

[Liie]

I don’t know how conscious these conflations are.

I suspect all of the mess is due to their own confusion.

Even if I don't agree with it I can understand their rational when they do this towards patients and for advocacy.

What I really don't understand is that people do this in scientific research. Are there no understanding and norms in the field that it is important to be clear about what they are taking?

It seems sloppy and unprofessional.

It's not only psychosomatic proponents, either. Critical articles, such as this one, also mention only "CBT" without qualifying.

 

[poetinsf]

Engel reminded us that the value of a scientific model should be measured not by whether it is right or wrong, but how useful it is.

In science, being "right" only means being able to predict correctly. If a model can't predict correctly, it can't possibly be useful. Conversely, if a model is useful, it would be considered correct, at least till it is proven otherwise or until a more general or simpler model arrives.

By itself, BPS appears to be more a philosophy than a science; it does not make any specific prediction that you can test to prove or refute it. To talk about its usefulness when it is not even a science would be a nonsense. (Unless he meant "useful" in the same way religion is useful...) When applied to a specific disease like ME/CFS however, claiming that it is useful would be flat out wrong because we know that things like CBT or GET based on BPS model doesn't improve the fundamental condition.

 

[Trish]

Why do people use the term "CBT" when discussing treatment f or ME/CFS (and other conditions)?

CBT can have wildly different content and goals. People need to specify the contents of the therapy!

It seems extraordinary sloppy to speak about simply "CBT", especially in a scientific context.

Some people in the ME/CFS world refer to the sort of CBT beloved of the psychobehavioural group 'directive CBT' because the therapist is using what it in effect attempts at brainwashing the pwME into thinking their symptoms are not real and their own fault, and they need to change their thoughts and behaviour.

The alternative they like to pretend they are using is the more benign sounding 'supportive CBT' which is intended to be the therapist enabling the pwME to manage their activity to avoid PEM. In fact for many it still seems to be about the therapist thinking they know what's best and guiding the pwME towards seeing their symptoms and behaviour differently.

 

[Utsikt]

In fact for many it still seems to be about the therapist thinking they know what's best and guiding the pwME towards seeing their symptoms and behaviour differently.

Good point. My «supportive physiotherapy» consists of a physio telling me that I don’t understand my ME/CFS, PEM and how to pace.

They are apparently not treating me, even though they keep insisting they can make me better.

 

[Liie]

By itself, BPS appears to be more a philosophy than a science ... When applied to a specific disease like ME/CFS however, claiming that it is useful would be flat out wrong because we know that things like CBT or GET based on BPS model doesn't improve the fundamental condition.

To me it seems like a bio-psycho-social perspective could be useful for ME/CFS, if it wasn't for the fact that some psychologists have made up their mind that the condition is caused by the psycho-social part.

In itself BPS seems to mean simply that various aspects of a patient's like affect each other.

BPS could for example be used as a framework to understand how a ME/CFS as a bio-medical condition affects a persons social life, which affects their psychological well-being, and so on.

It could be great to help people understand how ME/CFS affects various aspects of peoples lives. But it has not been used that way.

 

[poetinsf]

I can accept that usefulness can sometimes become apparent long before some theory is proven to be right or not, but in that instance it is most certainly not a scientific model!

That probably depends on what you mean by "proven" or "right". A scientific model only needs to predict "what" correctly; it does not need to explain how or why. If proven to be right is about the ultimate "truth" on the other hand, we'd be getting more into the territory of philosophy or religion.

Back in history metal workers found that they could work iron in ways to make it much stronger that just the raw iron.

That seems more like an observation than a theory. If it is a theory, it still would be scientifically valid since the proposition of "adding carbon and heat treatment to iron will yield an alloy that is x times stronger" can be tested and proven true.

 

[Utsikt]

To me it seems like a bio-psycho-social perspective could be useful for ME/CFS, if it wasn't for the fact that some psychologists have made up their mind that the condition is caused by the psycho-social part.

In itself BPS seems to mean simply that various aspects of a patient's like affect each other.

BPS could for example be used as a framework to understand how a ME/CFS as a bio-medical condition affects a persons social life, which affects their psychological well-being, and so on.

It could be great to help people understand how ME/CFS affects various aspects of peoples lives. But it has not been used that way.

You wouldn’t be able to test any of the hypotheses that were generated by that kind of approach, so I doubt they would be of any value.

 

[Peter T]

To me it seems like a bio-psycho-social perspective could be useful for ME/CFS, if it wasn't for the fact that some psychologists have made up their mind that the condition is caused by the psycho-social part.

In itself BPS seems to mean simply that various aspects of a patient's like affect each other.

BPS could for example be used as a framework to understand how a ME/CFS as a bio-medical condition affects a persons social life, which affects their psychological well-being, and so on.

It could be great to help people understand how ME/CFS affects various aspects of peoples lives. But it has not been used that way.

Yes, the problem is not the idea that every condition has biological, psychological and social aspects, but rather that the supposed advocates of the bps approach to ME/CFS (or CFS as they prefer to call it) are in fact focusing only on their belief that the condition can be improved and/or cured by psychological and/or behavioural intervention and deny any ongoing biological contribution beyond any triggering event.

Further they tend to regard ME/CFS as solely fatigue and want to lump it together with other supposed psychosomatic conditions including functional neurological disorders, conversion disorder, IBS, idiopathic chronic fatigue and even for some anxiety or depression, proposing the same interventions for all of these.

 

[rvallee]

To me it seems like a bio-psycho-social perspective could be useful for ME/CFS, if it wasn't for the fact that some psychologists have made up their mind that the condition is caused by the psycho-social part.

In itself BPS seems to mean simply that various aspects of a patient's like affect each other.

BPS could for example be used as a framework to understand how a ME/CFS as a bio-medical condition affects a persons social life, which affects their psychological well-being, and so on.

It could be great to help people understand how ME/CFS affects various aspects of peoples lives. But it has not been used that way.

This would be the exact opposite of how it's used, and I absolutely agree it would be useful. Clearly most health care professionals think it works both ways, but that's part of the propaganda. What you're referring to probably falls more in disability studies, but that's not even part of medicine or health care, does not seem to interest anyone who isn't personally affected by it.

What's most tragic is that the flawed application, literally doing it backwards, has made it impossible to do the correct version, but that would conflict with psychosomatic ideology, and the current application of the biopsychosocial model is mainly about insisting that psychosomatic ideology is correct. I can't say I have seen any other possible application it could have in its current state.

It's possible, though I don't find it convincing, that the original intent was about doing it the right way, but it very quickly became obvious that it was too useful as a tool to promote psychosomatic beliefs, and I haven't come across anything that deviates from that.

 

[Lou B Lou]

To me it seems like a bio-psycho-social perspective could be useful for ME/CFS, if it wasn't for the fact that some psychologists have made up their mind that the condition is caused by the psycho-social part.

In itself BPS seems to mean simply that various aspects of a patient's like affect each other.

BPS could for example be used as a framework to understand how a ME/CFS as a bio-medical condition affects a persons social life, which affects their psychological well-being, and so on.

It could be great to help people understand how ME/CFS affects various aspects of peoples lives. But it has not been used that way.

No. Bio Psycho Social is Code for psychosomatic. It's not reasonable, rational or balanced.

The term is too tainted to be useful.