Biopsychosocial versus purely biological explanation for persistent physical symptoms following COVID-19: An experimental study…, 2027, Lebrun+

[SNT Gatchaman]

Biopsychosocial versus purely biological explanation for persistent physical symptoms following COVID-19: An experimental study with lay participants and healthcare professionals
Lebrun; Petzke; Stone; Ranque; Kachaner; Rouen; Léger; Gouraud; Ouazana-Vedrines; Ancellin-Geay; Lemogne; Pitron

This study aims to compare changes of attitudes regarding the causation, evolution, and treatment for persistent physical symptoms following COVID-19 after lay participants and healthcare professionals receive medical explanations presenting either a purely biological or a biopsychosocial account of symptoms.

METHODS
Participants completed an online questionnaire assessing their views on underlying physical and mental causation, chronicity, disability and annoyance of symptoms, required examinations, and appropriate treatments. Lay participants rated their feelings of offence and anxiety associated with symptoms, while healthcare professionals their feelings of competence and willingness to care for a patient with persistent physical symptoms following COVID-19. All participants were allocated alternatingly to watch a standardized video with distinct accounts: either purely biological or biopsychosocial. -tests were used to compare representations after explanations.

RESULTS
A total of 208 lay participants (mean age: 42; 74% women) and 104 healthcare professionals (mean age: 42; 68% women) were included. The two explanations were efficient in changing beliefs about mental and physical causation of persistent physical symptoms following COVID-19 in both participants’ groups. Compared to the purely biological explanation, the biopsychosocial explanation increased feelings of offence while at the same time decreasing lay participants’ views that symptoms are chronic and disabling and increasing views that symptoms can be improved with CBT and physical exercise therapy. In healthcare professionals, the biopsychosocial explanation increased feelings of competence and belief that symptoms can be improved with CBT.

CONCLUSION
A standardized biopsychosocial video explanation may help promoting integrative care.

Practical implication: Results suggest that explaining the biopsychosocial approach can modulate healthcare professionals’ and lay people’s attitudes towards persistent physical symptoms following COVID-19. Future research should investigate how explaining the biopsychosocial approach can be further improved to promote more sustained changes in attitudes over time.

HIGHLIGHTS
• We assess biopsychosocial vs. biomedical accounts for COVID-19 persistent symptoms.

• With biopsychosocial account, lay people report more anxiety but less disability.

• They report increased acceptance of CBT and physical exercise as treatments.

• Professionals report enhanced feelings of competence and effectiveness of CBT.

Web | DOI | Patient Education and Counseling | Open Access

 

[SNT Gatchaman]

Several limitations should be considered in this study. This study was not preregistered. […] Furthermore, lays participants in this study were not selected on their clinical status and therefore likely only imagining living with persistent physical symptoms after COVID - not truly experiencing them.

There was no post-hoc verification that videos were watched and paid attention to.

In addition, 17 lay participants had a PhD in the purely biological video group, while only six did in the biopsychosocial video group. These different education levels might have biased between-participant group comparisons, but there were no overall statistical differences between allocation groups. Also, the study sample was highly educated (two thirds of lay participants hold a Master or higher degree), which limits representativeness as does cultural specificity of a French-speaking sample.

 

[Hoopoe]

Being willing to believe a narrative that says it can be treated doesn't mean that the treatment will help or that the belief is a constructive one. If the treatment doesn't work, then in addition to the feeling of offense, there will be loss of trust and increased sense of lack of control.

I'm sure most of us believed in various treatments and then discovered we were wrong.

If the "biopsychosocial narrative" included claims about psychotherapy being effective, then it's no surprise that participants were influenced and more willing to believe CBT would be effective. In this case the study just shows that people are influenced by what they hear.

Also, re. the participants imagining living with symptoms while not having lived experience. What is the point of assessing the fantasies of healthy people about a chronic illness?

 

[Liii]

I'd like to see those videos...

 

[TiredMathematician]

I'd like to see those videos...

Verbatim transcriptions of the videos:

Video that provided a biological account of long COVID: “To date, several accounts can explain why certain people develop prolonged symptoms after an episode of COVID. During the initial episode, the Sars-Cov-2 virus can directly damage certain tissues in the body, sometimes causing side effects that can cause prolonged symptoms. The immune cells that fight the virus can also damage body tissues cause side effects. After the initial infection, prolonged symptoms may be caused by the persistence of the virus in the body or the persistence of inflammatory mechanisms. For example, the virus may remain stored in the body and continue to damage tissue as it did during the initial infection. Pieces of the virus can continue to activate immune cells, resulting in prolonged symptoms. Alternatively, immune cells can also lose control of their own activity and continue to activate and produce symptoms even though there is no longer a virus to fight.”.

Full-length video (in French):

Video that provided a biopsychosocial account of long COVID: “To date, several accounts can explain why certain people develop prolonged symptoms after an episode of COVID. After the end of the initial episode, the prolongation of symptoms probably has several intertwined causes: biological, psychological and social factors are involved. Biologically, the virus can persist in the body in several forms. There may be physical side effects of the initial infection, or dysregulated inflammatory mechanisms, which can create persistent symptoms. Psychological mechanisms are also at play: the fear of being affected by serious illness (and subsequent down feeling), as well as the multiplication of medical examinations and consultations can contribute in perpetuating the symptoms. The apprehension of resuming physical activity after the initial infection episode also promotes a vicious circle of symptom perpetuation due to exercise deconditioning. Finally, social mechanisms are also involved, notably alarming information conveyed by the media and social networks or financial difficulties secondary to work sick leave may increase the suffering associated with physical symptoms.”.

Full-length video (in French):

 

[Peter T]

Would you expect to need such a volume of literature investigating how to get people to believe one specific theoretical approach works, if you had adequate evidence of that theory’s relevance and the efficacy of the resultant treatments?

I am sure that services would be over run by people clamouring for CBT and exercise therapy if they had the curative effect these advocates believe them to have. If ME/CFS is anything to go by people clamour for any and every possible intervention, biomedical and psycho-behavioural, none of which so far have any serious evidence for significant long term change in health status, until they eventually give up on the quest.

 

[Turtle]

"annoyance of symptoms" translation problem or just denegrating?
To be published in 2027 and still this lot (Stone, Ranque) know nothing about NICE.
And still go for CBT and GET.
Possibly all these researchers need educational video's about NICE and how harmful GET can be.

 

[skronen]

"annoyance of symptoms" translation problem or just denegrating?
To be published in 2027 and still this lot (Stone, Ranque) know nothing about NICE.
And still go for CBT and GET.
Possibly all these researchers need educational video's about NICE and how harmful GET can be.

I was gonna ask if that was a technical term because it's such odd language.

 

[NelliePledge]

Crawleyesque. Chalderesque.

 

[rvallee]

Obviously patient reports cannot be used in such a way when those reports are the target of the intervention. This is exactly like the AI skeptic meme where if you prompt an LLM to say "I am alive" it will tell you "I am alive". Except even dumber.

If you lie to people from a position of authority some people will report things differently. Obviously experts should not do that. The entire premise that this is meaningful is so dumb it's frankly insulting, and that's on top of being all about being insulting in the first place.

Would you expect to need such a volume of literature investigating how to get people to believe one specific theoretical approach works, if you had adequate evidence of that theory’s relevance and the efficacy of the resultant treatments?

Even more so when their whole evidence is literally this, making up fake explanations and having people report slightly different things because they were told it would make them feel better. This is their whole evidence.

 

[Utsikt]

In healthcare professionals, the biopsychosocial explanation increased feelings of competence and belief that symptoms can be improved with CBT.

I think they might have stumbled upon an important clue to why BPS is so popular: ego.

 

[Axel]

Results suggest that

people can be taken for simpletons.

 

[Sean]

I think they might have stumbled upon an important clue to why BPS is so popular: ego.

Also very convenient. Lets clinicians avoid having to admit ignorance and the responsibility for dealing with it.

 

[neurophusion]

The phrase "annoyance of symptoms" is consistent with the biopsychosocial interpretation that people with ME/CFS misinterpret benign bodily sensations as obnoxious and/or worry too much about symptoms.

 

[rvallee]

Also very convenient. Lets clinicians avoid having to admit ignorance and the responsibility for dealing with it.

And the systems, institutions and governments. The "right to health care" magically goes away when a medical issue is framed as not a medical issue. Regardless of everything else, I'm pretty sure this is about 99% of it. Very few people in the industry actually believe in this stuff, they're simply comfortable with the fact that it frees their workload and that they don't have to think about it. They're not negligent or failing anyone, they're just not responsible.

Works at every level, from a junior therapist all the way to health ministers and the heads of ruling bodies. Some are just more comfortable with being on the forefront, but it's mainly because they are certain that if they end up being wrong about it, something they don't even consider, they know they will be protected from all liability because the institutions and governments are just as guilty of it.

When this bubble pops, hardly anyone will pretend otherwise, most will admit that they didn't really think about it much and weren't really convinced but since it made no difference, since it wasn't graded on the exam, and it involved zero actual responsibility from them they simply overlooked it. They're all busy enough to make it sound convincing.

It's a lot like the weird stuff about "the sick role" they project on us, except what it does is free them from the clinician role, where there is actual responsibility involved. A standard that can't even meet "just following orders", it's more of a "didn't think it mattered" thing.

 

[bobbler]

If this study was not pre-registered how does it work regarding ethics?

Are we into the territory of it being literally pure propaganda now being allowed into literature that infers something to do with medicine, when actually noone at all is checking that the guise of pretending that it is 'medical information' is actually the case - and not 'information on how to harm'

I mean what would people be doing if this was racist or ageist diatribe in place of this tropeism about those with a specific medical condition? Or plain sexist stuff? Or proposing this stuff about people with something like cancer? Because the end game might be that this bunch want to get there eventually for all illness and disability 'benefitting from it somewhat' the whole 'no illness is not psychological in some way' crap.

Is it training or marketing ideology if what it is training in is an ideology and it is neither proven useful anything nor testing whether it is correct or harmful to those on the receiving end of those who are being trained it so that at the end they aren't deprogrammed from the 'experiment'?

Is this really just an excuse to get to hit people twice with the messages they wanted to brainwash them with in order that the second time it sounded more feasible and at the same time those being brainwashed weren't thinking 'is this going to do any good' or 'is this correct or proven methodologically' but instead focusing on a distractor of 'does this open B sound more feasible than option A' to stop them critically thinking about whether both are bunkum and what is teh agenda of the researchers?

Theoretically, but also I think it has been actually been deliberately used/done to huge amounts of the medical profession allieds, those training and those who hold purse strings for care, this seems to have been picked up specifically by bps proponents only from what I know, as a loophole way of mistraining people by pretending it is 'research' when actually the trojan horse is finding an excuse to deliver untruths to people.

Both options are telling them all the wrong stuff about people with the illness. None of it has proof. All of the personality and psych stuff is harmful in all sorts of ways but in particular excruciatingly dangerous inferring they have 'false beliefs' as if the patients are the deluded ones and not those who invented and propagate this. To people who have powers to remove rights and freedom and access to care and compel inappropriate forms of brainwashing onto patients.

And what is even the ethics in other literatures where it is harmful ideas and content due to tropes and spreading of misinformation to cause discrimination and harmful services to be supported that is being 'experimented on' as to how it can be most efficiently brainwashed into the population?

And by it appearing in literature getting to claim anything to do with medicine it is by that very action misleading.

 

[bobbler]

Compared to the purely biological explanation, the biopsychosocial explanation increased feelings of offence while at the same time decreasing lay participants’ views that symptoms are chronic and disabling and increasing views that symptoms can be improved with CBT and physical exercise therapy. In healthcare professionals, the biopsychosocial explanation increased feelings of competence and belief that symptoms can be improved with CBT.

A standardized biopsychosocial video explanation may help promoting integrative care.

Results suggest that explaining the biopsychosocial approach can modulate healthcare professionals’ and lay people’s attitudes towards persistent physical symptoms

Future research should investigate how explaining the biopsychosocial approach can be further improved to promote more sustained changes in attitudes over time.

Terrifying - is this basically confessing that the aims of this ideology and group are to increase offence towards patients and decrease lay person's views that symptoms are chronic and disabling?

In order to basically get bystanders incited to OK something that is highly damaging as a 'treatment'?

And not only are they saying the most important thing they report is their 'training' can modulate people's attitudes towards these types of symptoms ie I guess see them with disbelief and believe rude offensive things about those who get them, inaccurately with no evidence offered.

But that they propose future research should aim to increase this 'change in attitude' to be more sustained - so it was definitely their main aim?


Have they confirmed that this bps 'approach' was never medicine, or about help or 'care' but about getting away with something else by inciting physicians and laypersons to permit something that isn't care by spreading untrue facts to minimise symptoms by changing beliefs and attitudes to be inaccurate?

Who sees that they have introduced offence and thinks they've done well? Is this worth double-checking in the translation and if it is correct passing onto the 'beliefs and attitudes group' as evidence that a few word changes isn't the problem but sadly a clearing out of a deliberate ideology is required and for training in this crap to be confirmed as beyond even normal discrimination, ruled unacceptable and pruned out of the literature - to be moved into somewhere as a historical artefact of a time 'never to be repeated again' where such things were allowed in etc. but that can't be misread by anyone as if the manifestos and propaganda charading as if research or 'medicine' ever were or are?

 

[neurophusion]

We see certain flavours of biopsychosocial approaches as patronising and harmful, but those who support them do not, well, at least no harmful. Because they believe any "harm" is a nocebo effect or an illusion, like Garner woofing on about PEM being a self-fulfilling prophesy, which he stared down with his powerful cognitions (i.e. boasting about winning a coin toss, since roughly half of people at his stage of post-viral symptoms recover anyway).

When it comes to patronising, I believe they do not care about that, because they think we are like helpless little children who are lost in a world of our own making and need advice on how to think and behave. And if we find their "truth" offensive, it is because they are correct and telling us harsh truths that we do not want to hear.

The manner in which the biopsychosocial approaches to ME/CFS have undermined anything we say is the most pervasive, insidious and dangerous anti-catalyst of all. The manner in which those supporting the cognitive-behavioural model of ME/CFS in particular leveraged this anti-catalyst to stamp out criticism is an unforgivable factor in why this garbage ideology continues to delay progress despite several decades of failure.