A 4-day mindfulness-based cognitive behavioural intervention program for CFS/ME. An open study, with one-year follow-up, 2018, Stubhaug et al

chrisb said:
Chronic fatigue. Michael Sharp. in Science and Practice of Cognitive Behaviour Therapy (1997) edited by David M Clark and Christopher G Fairburn @p400
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I can't seem to access that particular page to extract the quote.

Was any one else able to locate it?
 
Here's a reply he got from a Stephen Soumerai - twitter presentation: Professor of Population Medicine, Founding/Former Director of the Div Hth Policy and Insurance Research Harvard Med School,Harvard Pilgrim Health Care Institute
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This is exactly the sort of person we need to get onto the scent.

People that Wessely et al can't so easily dismiss or ignore.
 
ScottTriGuy said:
I can't seem to access that particular page to extract the quote.

Was any one else able to locate it?
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The full paragraph reads:

Planning therapy

It is useful at this point to consider how much treatment the patient needs. Some patients find the initial formulation not only acceptable but a revelation. They may immediately start making suggestions about how they could change their attitudes, behaviour, and lifestyle in a way that will unlock them from the vicious circles they now perceive. These patients may only need encouragement and follow-up to check that they remain on course. I have known patients who have recovered after a single telephone conversation that enabled them to reconceptualise their illness, reduce their fear of symptoms, and overcome their avoidance.

It may be helpful and fair to continue with continue with the description of more intractable cases

The difficulties of other patients are so long standing and rooted in intractable social or personality difficulties that brief cognitive behaviour therapy may be appropriate. For these patients, one strategy is to manage them within a cognitive behavioural framework but to do so in a "slow motion" way, seeing them intermittently for months or even years.

Most of the patients will fall into a middle group. These are patients who had a good pre-morbid functioning, but who need help in re-evaluating their understanding of the illness, improving their coping behaviour, and perhaps also making occupational, social and lifestyle changes. This is the group we will focus on in the following account of therapy.

It is surprising that the alleged success with the first group does not lead to any doubt as to the categorisation or diagnosis. It is also surprising that the possibility of unrecognised illness is considered in the difficult cases. Social and personality deficiencies is the only show in town.
 
Kalliope said:
under Education

A coping model with focus on stress expectation, positive outcome expectancy and active regulation of health complaints and symptoms was introduced (50). We tried to communicate clearly that regardless of causes, regulation of symptoms and change might be possible. However, a willingness to challenge existing illness perceptions and illness behavior is needed, as well as a commitment to test suggested coping strategies.

So it all comes down to the patient's own commitment and willingness to change. When will this ever end? :banghead:
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Isn't this basicly LP? "Stop 'doing' ME" and ingrain in people that their attitude will be determinent in their chance of recovery.

Then ask people about how they feel and what they think about the intervention - guess what they will answer....? Oh - and also, in LP-style, make sure to beforehand exclude anyone that don't belive in the treatment .

Add only subjectiv measurements in an unblinded trial, the bias of the main author also beeing the main (only?) therapist, the COI of the main author owning the center offering the treatment. /sigh.... :-/
 
inox said:
Isn't this basicly LP? "Stop 'doing' ME" and ingrain in people that their attitude will be determinent in their chance of recovery.

Then ask people about how they feel and what they think about the intervention - guess what they will answer....? Oh - and also, in LP-style, make sure to beforehand exclude anyone that don't belive in the treatment .

Add only subjectiv measurements in an unblinded trial, the bias of the main author also beeing the main (only?) therapist, the COI of the main author owning the center offering the treatment. /sigh.... :-/
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I've never considered going myself, but I've talked to a few who have been there. Apparently Stubhaug is an opponent to Lightning Process (TM), but the biggest LP-coach and Recovery Norge on the other hand seems to be very enthusiastic over him. I think the main difference is that Stubhaug's programme is free for patients (but not for tax payers).

Another anecdote about Stubhaug is he claims that all fatigue is the same, and ME is just a down period. According to Stubhaug one can have ME for instance in a marriage :confused:

Edited for clarity.
 
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LEVIOSAAA!

positive outcome expectancy
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Literally wishful thinking

active regulation of health complaints and symptoms
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What does that even mean? Is this like chakra realignment or immune system modulation through crystallography optimization?

Fatigue? That's ME. Coughing on a hairball? That's ME. Brain freeze from eating ice cream too fast? That's definitely ME.
 
Kalliope said:
The website for the public health care region where Stubhaug works, Helse Fonna, has an enthusiastic article about the research paper.

Helse Fonna: Nytt behandlingsprogram gir håp til pasientar med kronisk utmatting
Google translation: New treatment program gives hope to patients with chronic fatigue
A new four-day treatment program significantly improved overall 80 percent of patients in the study in a recent article published by researchers in Helse Fonna.

- The results are startling. Most studies on the treatment of CFS / ME have shown only low or moderate efficacy. Here, we see significant improvement in 80 per cent of patients, even one year after the treatment is completed, says psychiatrist and researcher Bjarte Stubhaug who has led the study.
...
The researchers also have data on further changes in health problems and physical function in patients who returned and participated in follow-up programs after one year, with up to three years of follow-up. The material is not yet analyzed. Those findings that has been published, are the first in what is likely to become a number of articles based on a larger, long-term study between 2009 and 2017, where 900 patients with CFS / ME have participated in similar treatment.


Facebook post says: A new treatment program gives hope to patients with CFS/ME, also known as chronic fatigue syndrome. As many as 80% of the patients in the study became significantly better after just four days - and the effect is long lasting. The psychiatrists Bjarte Stubhaug and Haldis Lier are two of the authors behind the study.
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Helse Fonna Fonna is a local health trust which Stubhaug has a contract with. All patients with suspected ME in this area will be referred to him (if I've understood things correctly). Patients from other areas can come too. There's an ongoing debate about their article on Stubhaug' publication on their Facebook page. This is what they wrote today when trying to answer some of the questions asked about Stubhaug and his study (translated mainly by google):

• The diagnosis of CFS / ME may be given after it is excluded that the patient may have other diseases as an explanation for the symptoms. The Norwegian Directorate of Health's national guideline for CFS / ME has no requirement that neurologists should diagnose or diagnose patients in this group. The guideline points out that assessment and diagnosis take place at the GP. Psychiatry is a medical education, so it is not contrary to the guideline that a psychiatrist is responsible for the assessment and treatment of this patient group.

• Patients in Health Fonna with symptoms of CFS / ME may be referred to the Clinic for Stress Medicine for assessment and treatment. Patients are therefore referred from GPs and hospital doctors. Patients from other enterprises in Helse Vest can also be referred to the clinic. This treatment is part of the Norwegian public health system.

• The study that has been published was carried out during the period 2009-2013. After this, the Norwegian Directorate of Health has recommended that Canadian criteria be used to diagnose CFS / ME, but the Directorate emphasizes that there is no research-related evidence to say that one of the diagnostic criteria is better than others to identify patients with specific "only organic" disease. There are also several publications that show that there are no biological differences between those that satisfy stricter criteria and those that do not. Obviously, we are following research on CFS / ME closely and will carry out knowledge-based dissemination and treatment in line with national guideline. The article is critically evaluated by international peers who believe the study meets the requirements for good research and that the article is good and well worth publishing.
 
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Andy said:
Really? Would be interesting to find out what references they give for that claim.
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It's our local bps-brigade in action :sick:

Here's the current national guidelines (last updated 2015), only available in norwegian and pdf-format, :
https://helsedirektoratet.no/Lists/...944-Nasjonal-Veileder-CFS-ME-Hovedversjon.pdf

Here's the bit they are refeering to - page 14-15 (via google translate):

Edit: "Kunnskapssenteret" = Norwegian Institute of Public Health, also the home of Cochrane Norway.

It is questioned whether studies referred to in the guide have been done on patients with CFS / ME or other patients with fatigue. It has been expressed a desire to state which diagnostic criteria are used in the various studies. A publication from the Kunnskapssenteret (BMJ Open. 2014 Feb 7; 4 (2): e003973. Doi: 10.1136 / bmjopen-2013-003973. Case definitions for chronic fatigue syndrome / myalgic encephalomyelitis (CFS / ME): a systematic review. et al) conclude that there is no evidence to say that one of the diagnostic criteria is better than others to identify patients with specific "organic" disease only.

Last year, there have also been several publications that show that there are no biological differences between those who satisfy stricter criteria and those who do not. (Brain Behav Immun. 2015 May; 46: 80-6. Doi: 10.1016 / j.bbi.2014.12.025. Plasma cytokine expression in adolescent chronic fatigue syndrome. Wyller VB et al.; Acta Pediatrics 2015 May; 104 (5 ): 498-503 doi: 10.1111 / apa.12950 Study findings challenge the content validity of the Canadian Consensus Criteria for Adolescent Chronic Fatigue Syndrome Asprusten TT et al) It is therefore considered that there is no need at present to Specify the diagnostic criteria used in the different studies. (May 2015)
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[bolding and line break mine]
 
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Esther12 said:
I'd assume that they're referring to this, from Larun & co of the piss-poor Cochrane exercise review: https://bmjopen.bmj.com/content/4/2/e003973

I have seen criticism of the above paper, but I can't remember the details.
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Thought there was a thred on phonix rising, that I always ment to read, but never got around to - couldn't find it now.

Also this: http://occupyme.net/2014/03/06/systematic-overreaching/


Edit:
The Brurberg, Larun paper contains among other gems this quote, (no wonder the feeling of bias in the Cochrane reviews.....):

“Unfortunately, patient groups and researchers with vested interests in the belief that ME is a distinct somatic disease seem unwilling to leave the position that ME is an organic disease only. This position has damaged the research and practice for patients suffering from CFS/ME.
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”
 
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