Just sharing this message today from Koroshetz, for visibility, when I had asked for paper amendment of ‘effort preference’ term (mods I left in both channels but feel free to edit or delete where you see fit).
“Understand the anxiety but it’s very important that the community understands the finding.
To simplify how the brain works I could say that the brain circuits are constantly estimating the difference between the effort required and the reward to be gained from executing an action. This applies to all behaviors, even to what I am typing now. This is easier to understand in estimating the degree of force you need to exert to pick something up something, but even the more automatic behaviors like whether we are “hungry” enough to eat. So the finding is very important. In the persons with ME/CFS the circuits that do this estimation of effort are malfunctioning. They even see an abnormality in brain activation related to this finding. They see alterations in dopamine metabolites (potentially related to the reward signals). And they speculate that it is abnormalities in the immune system that are driving the abnormality.
So this has nothing to do with “psychological”, this is a real abnormal finding in how our neural systems are supposed to work.
Planning a hybrid workshop to explain the findings to the subjects and the general community soon.”
Hmm interesting, I've as a very lay non-expert, questions on a few issues here.
Could you point me to what you specifically said when you asked for this?
Apologies as this is just a bit of a riffing/brainstorming thoughts. It seems another case of having to 'get to the bottom of' what is being talked about here, as if understanding the EEfRT wasn't enough of an odyssey. I probably also need to look at the grip strength stuff they've combined in too (and that thread), but there is also the papers where they've combined the two trying to claim '5 ways of looking at effort' or something.
Firstly the response seems to have side-stepped the 'operationalisation of wanting' focus of the EEfRT and be trying to focus (clue being in 'force') on the grip-strength side of things. Whilst then mixing in bits about reward that they didn't measure in the grip test (only in the EEfRT test) and that they failed to contextualise properly (as evidenced by the completion rate findings)?
If we are going to have to go down this road with unpicking it getting mixed in with these terms with the grip-strength stuff...
I can't remember the exact name of the module back then but the closest now seems to be something like neuropsychology of action/movement.
Anyway even in that undergraduate module the thing that was clear is that 'how the brain works' is that it has
both forward
and backward processing when executing an action. Examples used were indeed people who perhaps had a stroke or a disease where their balance was off or they were reaching to the left of the actual object, said people then get information going back to the brain that they'd 'missed the object' from eg what their hand felt or didn't feel when it went to grip, as well of course 'sight' seeing the vase smash to the ground.
Isn't it that backward processing that probably means the mirror-trick works for phantom limb syndrome? :
Mirror Therapy for Phantom Limb Pain | NEJM
EDIT: I feel compelled here to note that the mirror (in those it does help) can only fix 'the pains' and doesn't, of course, solve the missing leg - a metaphor/misunderstanding that I can't help but think of re: certain areas vs ME/CFS.
ANd we all know hunger is about leptin and grellin. Again forward
and backward information as you eat something and feel full-up and satisfied or don't appropriately. Problems with either of these can cause issues. But you can also have eg an IBD that means you aren't absorbing things or there are digestion issues in other ways and so on that would be likely to produce some sort of feedback into the loop?
EDIT: but I'm not sure what that one 'has got to do with the price of eggs' [
What does that have to do with the price of eggs - Idioms by The Free Dictionary ] here at all?
Anyway as your body gets used to disability that information will impute into the calculations too. Sorry this isn't strictly right, but as it popped into my head for a moment as levity I thought I'd say it: I've got a picture in my head of when you get a puppy that grows really fast into being a pretty huge dog and still thinks it can curl up on the small lap of a person. Who is swamped under them. When I think of their 'mismatch' stuff.
Anyway
None of the tasks used were a 'one-off reach for the vase', or 'put it down on x marks the spot' so that backwards loop is even more relevant in their examples used than their forward one. And I'm not sure if it was a forward processing issue that you would have seen a downward curve rather than too low a force right off the bat? That backwards loop will of course be the one that is communicating the fatiguability information and I'm not convinced they've managed to nail the inference that information 'must be wrong' or that the effort calculation has somehow got the wrong multipliers in there or something.
And a grip strength test is less about holding a vase and then dropping it because your brain didn't calculate how hard you need to grip it, and more like eg how long can you hold the hot saucepan handle? the feedback sensations related to fatiguing/fatiguability, and a test where something heavy
isn't going to drop on your foot, or something smash as part of the calculations of the 'pros vs cons' (and in the case of those two scenarios, how long you've got to put it down somewhere calculation for action)?
Anyway eventually your 'automatic' function (if your conscious one also doesn't)
should if it is working right release your grip from that hot saucepan handle when it begins to burn the hand too badly. Even if you are just cm from getting to the sink. There is a lot less of a downside of loosening a grip on a grip-test where people are just looking at what you can do than hot water going down your legs
So, apologies if lots of other people are more up with understanding this but I'm trying to put together the pieces of info that they
did measure and what they mean as a bit of a jigsaw puzzle of this mismatch thing
It's all very well trying to minimise out disability (which seems to be one issue with the completion stuff for EEfRT) and use a tone inferring you are doing it 'because the reader must be unable to understand' but that clearly isn't why they are saying things that are incorrect.
The dopamine note is interesting, but is that being interpreted in the 'psych-neuro' sense rather than being seen potentially as a 'downstream' given that there are lots of conditions where dopamine is affected and of course said conditions (like Parkinsons) have specific motor issues.
