The role of illness perception and behaviour in the treatment of adolescents with multisystem functional somatic disorders:... 2025 Kallesøe et al

[Andy]

Full title: The role of illness perception and behaviour in the treatment of adolescents with multisystem functional somatic disorders: a post hoc mediation analysis of the AHEAD trial

ABSTRACT​

Psychological interventions can reduce symptom load and disability in adolescents with various functional somatic disorders (FSD). However, mechanisms of change are less investigated, especially in those with multisystem symptomatology.

In a post-hoc analysis, illness perception, illness behaviour, and psychological inflexibility (experiential avoidance and fusion) were examined as mediators of changes in self-perceived physical health in adolescents 3 months after receiving group-based Acceptance and Commitment Therapy versus Enhanced Usual Care. Baseline levels of proposed mediators were also assessed for moderation effects. Data from 91 adolescents (15–19 years) with multisystem FSD (duration ≥1 year) from the RCT “ACT for Health in Adolescents” (AHEAD) were used in a classic mediation analysis. Mediators were measured at baseline (before assessment), 5.5 months (2 weeks after end-of-treatment), and 8 months (3 months after end-of-treatment).

Improvements in negative illness perceptions and psychological inflexibility (experiential avoidance) mediated the effect of AHEAD on physical health at 8 months. The mediation effect increased with higher baseline levels, but the moderation effects were non-significant. AHEAD reduced negative illness perception and psychological inflexibility (experiential avoidance) and, consequently, improved physical health in adolescents with multisystem FSD. Reducing these factors may be important treatment targets in future treatment programmes for adolescents with FSD.

Open access

 

[Andy]

Depending on the main symptom presentation and the medical specialisation’s classification system, FSD covers a spectrum of symptom descriptors and functional somatic syndromes in somatic health care or bodily distress disorder (ICD-11) and somatic symptom disorder (DSM-5) in psychiatric health care (Burton et al., Citation2020). The most prevailing diagnoses in the paediatric populations include chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), tension-type headache, idiopathic pain, and juvenile fibromyalgia.

 

[rvallee]

So this seems to be a strategy in recent years, of doing disguised 'pragmatic trials' that get presented as some sort of study. They still do the traditional trials thing with the same traditional content, but they add some layer of pretending to be studying another concept, all rolled into one.

It avoids the negatives of reporting on failed trials, while pretending like they're doing research, even though the only thing that changed is how they frame it. But of course if they ever have a tiny positive blip, by chance or with enough bias, they can report is as a successful trial. Very devious and dishonorable, but that's "Imagine a world"-based medicine for ya.

 

[Snow Leopard]

More authors who don't understand that scale responses are not symptoms themselves. They never seem to acknowledge the role of altered cognitions during interventions in inducing increased response biases on scales.

 

[Utsikt]

More authors who don't understand that scale responses are not symptoms themselves. They never seem to acknowledge the role of altered cognitions during interventions in inducing increased response biases on scales.

Exactly.

«They got better».

No, they answered differently on a questionnaire. After a treatment that is suited to alter the response on said questionnaire in a certain direction, regardless of any actual changes to their symptoms.

This is at most high school level insight and accuracy in use of language.

 

[rvallee]

Exactly.

«They got better».

No, they answered differently on a questionnaire. After a treatment that is suited to alter the response on said questionnaire in a certain direction, regardless of any actual changes to their symptoms.

This is at most high school level insight and accuracy in use of language.

The baffling thing about this is that everyone involved in this stuff understands this, and apply it to every other alternative medicine. You could present them all the same claims about acupuncture, homeopathy, or any other stuff, and they wouldn't even care about methodology, about recruitment, analysis, any of that. They'd simply say it's irrelevant for the same reasons we dismiss their work.

I'll never understand this. Out there, in the wild, with random people, sure, whatever. But the whole point of professionals is to do better than this. And they almost always do. Except for psychosomatic stuff, or anything with a scent of it. They're fine with the same claims out of yoga, as long as it has some BS psychobehavioral component. It just needs to be blessed with the EBM touch, or something.

It's one of the best predictors of something being bullshit, when the reaction to identical facts can change completely based on irrelevant aspects, such as who did it, or what flavor or color it is. And yet almost all professionals and skeptics fail at it here, and only here.

In hindsight it will look even worse than medicine dismissing the germ theory of disease, but frankly I don't care how history judges people here. I would like for the present to be judged based on facts, and that's clearly way too much to ask for.