Chronic Fatigue Syndrome the roles of perfectionism and metacognition in co-morbid depression and anxiety, 2020, Wright (D.Clin.Psy.)

Dolphin

Dolphin

Senior Member (Voting Rights)
Can be downloaded for free at these links:
https://livrepository.liverpool.ac.uk/3100418/1/201310670_June2020.pdf

https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.815650

Title: Chronic Fatigue Syndrome : the roles of perfectionism and metacognition in co-morbid depression and anxiety

Author: Wright, Amelia

Awarding Body: University of Liverpool

Current Institution: University of Liverpool

Date of Award: 2020

Availability of Full Text:

Access from EThOS:
Download

Access from Institution:

https://doi.org/10.17638/03100418

Abstract:

This thesis aims to increase clinical understanding of depression and anxiety in people living with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), a disabling longterm condition for which there is currently no known cure.

Two clinical papers are presented. Each examines potentially relevant psychological mechanisms.

Due to the lack of effective medical treatments for CFS/ME, clinical focus is presently the management of physical symptoms, primarily with a view to reducing levels of fatigue (White et al., 2011).

At a research level, there has been greater examination of factors associated with fatigue, with associated depression and anxiety being under-researched.

This is despite the high levels of reported co-morbidity (Larkin & Martin, 2017), and evidence for the dynamic interplay between mental and physical health (Kiecolt-Glaser et al., 2002)

The role of psychology in supporting people with CFS/ME is mired in controversy.

Examination of co-morbid mental health difficulties in CFS/ME has been hampered by symptomatic overlap with depression (Griffith & Zarrouf, 2008), methodological concerns regarding previous psychological research and treatment (Laws, 2017; Vink & Vink-Niese, 2019) and concerns raised by patient activist groups (Kelland, 2019).

On the one hand, critics caution of the 'psychologisation of physical illness' (Gaudsmit & Gadd, 1991; Richman & Jason, 2001); on the other, the rejection of psychology as a relevant discipline risks neglecting the research and treatment of co-morbid mental health difficulties.

Greater understanding of associated psychological factors could inform the development of evidence based, CFS/ME specific therapeutic interventions, aimed at reducing co-morbid depression and anxiety.

Such targeted interventions would complement a multi-disciplinary approach to CFS/ME and would not seek to refute potentially underlying organic pathology.

Potentially predisposing personality traits has been one controversial area of research into CFS/ME.

Perfectionism has attracted attention (Kempke et al., 2015), driven in part by clinical observations (Surawy et al., 1995) and arguably stereotyping (Deary & Chalder, 2008).

However, this may remain a valid area of research with regards to co-morbid depression and anxiety; perfectionism has been found to be a trans-diagnostic risk factor for a range of both physical and mental health conditions (Egan, Wade, Shafran, 2011), and higher levels of perfectionism have been evidenced in people living with CFS/ME (White & Schweitzer, 2000).

It is therefore clinically important to consider the potential relationship between perfectionism and emotional distress in physical health populations, including CFS/ME.

However, research to date has focussed on the relationship between perfectionism and fatigue, as well as perfectionism as a predisposing risk factor for CFS/ME.

Within the CFS/ME population, the association between perfectionism and depression and/or anxiety is under-researched, hence the selection of the question addressed in Chapter 1: What is the relationship between perfectionism and co-morbid depression and anxiety in people living with CFS/ME?

Chapter 1 systematically reviews the existing evidence of a relationship between perfectionism and either depression or anxiety, in this patient group.

This process identified 7 relevant studies reported in 8 papers. Several factors of perfectionism were explored.

Consistent with the wider literature and psychological theory, narrative synthesis indicated maladaptive perfectionism was consistently associated with depression.

However, evidence for associations with other aspects of perfectionism was inconsistent.

The relationship between perfectionism and anxiety in CFS/ME was identified as an under-researched area.

The review was prepared for submission to the Journal of Psychosomatic Research and formatted accordingly (see Appendix A).

The journal was chosen because of its focus upon the relevance of psychological processes in physical health.

Findings of the review are intended to guide directions for future research, in addition to therapeutic interventions which seek to reduce depression in this patient group.

Chapter 2 examines the potential applicability of the Self-Regulatory Executive Function (S-REF) model of emotional distress (Wells & Matthews 1994) to understanding depression and anxiety experienced alongside CFS/ME.

This model predicts that prolonged distress arises not from symptom-related appraisals or thought content per se, but rather metacognitive beliefs about worry and/or rumination, which drive unhelpful thought processes and responses; this is termed the cognitive-attentional syndrome (CAS; Wells & Matthews 1994).

Two types of metacognitive belief are theorised to be of particular importance in activating and maintaining the CAS: positive metacognitive beliefs about the usefulness of worry, e.g. 'Worrying helps me cope', and negative metacognitive beliefs about the uncontrollability and danger of worry, e.g. 'When I start worrying, I cannot stop'.

The study found metacognitive beliefs accounted for a significant proportion of the variance in both depression and anxiety, when controlling for demographic and clinical variables including level of fatigue.

Negative metacognitive beliefs, lack of cognitive confidence and cognitive self-consciousness and the CAS emerged as significant independent statistical predictors of depression.

Positive metacognitive beliefs, negative metacognitive beliefs and the CAS emerged as significant independent statistical predictors of anxiety. Overall, results provided support for the S-REF model.

The relationship between positive metacognitive beliefs and depression was fully mediated by the CAS.

Relationships between negative metacognitive beliefs and both depression and anxiety, and positive metacognitive beliefs and anxiety were partially mediated by the CAS.

The paper is intended for submission to the British Journal of Health Psychology (Appendix B), selected due to the focus on all aspects of psychology related to health, including the management of chronic illness.

Findings are intended to have implications for clinical interventions, specifically aiming to reduce co-morbid anxiety and/or depression in people living with CFS/ME.

Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.815650 DOI:
10.17638/03100418
Click to expand...
 
Poor dear. This piece of new research is going to feel very dated very quick. And it's the fault of her supervisors.

on the other, the rejection of psychology as a relevant discipline risks neglecting the research and treatment of co-morbid mental health difficulties.
Click to expand...

What she clearly doesn't understand is the fury over the fact that this (CBT) is ALL we've been offered for decades along with GET. There really are better things to do than rehash this endlessly.
 
Snowdrop said:
What she clearly doesn't understand is the fury over the fact that this (CBT) is ALL we've been offered for decades along with GET.
Click to expand...
Exactly. It is not anti-psych, it is anti-inappropriate psych.

Nobody is rejecting the existence of mental and social influences upon our lives. They are rejecting a particular morality-laden, politically charged, and unscientific interpretation and application of them, that is causing great harm to many people, for no good reason.

Which is a completely different argument. As the senior BPS clowns know all too well and having been doing everything they can to draw attention away from for 30 years.

The claim that we are anti-psych is a bald-faced lie, and always has been.
 
this thesis said:
Irrespective of aetiological debate, co- morbid depression and/or anxiety are frequently experienced [29]. Between 36%-70% of patients experience depression [30,31] and 32%-57% experience anxiety
Click to expand...

But these estimates are built on surveys that mix up the symptoms of ME with depression and anxiety.

Exercise alters brain activation in Gulf War Illness and ME/CFS. Washington et al. 2020
A sample of 38 people with ME/CFS found 18% had major depression.

Self-Management of Chronic Fatigue Syndrome in Adolescents, 2020, Katherine Rowe et al
"Anxiety and depression may also be present but when compared with population levels, were only mildly increased in prevalence, and generally did not precede the illness. They were understandably associated with diagnosis delay, not being believed or social isolation"

I could go on, that was just the first search items that came up - I think there was some Australian data on depression rates that were in line with population rates.

Amanda Wright does acknowledge the problem with the measurement tools for depression and anxiety, but then seems happy to accept the estimates of anxiety and depression prevalence they produce. And then, having erroneously identified these conditions as important problems to solve (edit - in the context of ME/CFS, I mean), seeks to blame patients' perfectionism for causing the conditions.
 
Last edited:
Page 21, (assessment of risk of bias in the systematic review)

Whilst increasing rigour regarding diagnosis confirmation, this introduces a selection bias; samples reflect a subset of patients, willing and able to access mainstream health services at a particular time point. Four studies, reported in five papers, recruited from the same hospitalbased CFS centre [68 - 72]. Only one study randomly selected participants from a waiting list [67].
Click to expand...

Strangely, these selection/participation biases were ignored when it came to discussing her own study.
 
It's really offputting to see psychologists ignoring the impact of the illness on patients and reducing depression and anxiety to a personality problem.

Life destroying illness. Loss of many things that enrich one's life. Uncertainty about the future with a probably bad prognosis. None of these seem to matter, it's a personality problem according to some psychologists.

How about addressing depression and anxiety in ME/CFS by giving patients real hope of a better life, better care and support?
 
Last edited:
Sean said:
Exactly. It is not anti-psych, it is anti-inappropriate psych.

Nobody is rejecting the existence of mental and social influences upon our lives. They are rejecting a particular morality-laden, politically charged, and unscientific interpretation and application of them, that is causing great harm to many people, for no good reason.

Which is a completely different argument. As the senior BPS clowns know all too well and having been doing everything they can to draw attention away from for 30 years.

The claim that we are anti-psych is a bald-faced lie, and always has been.
Click to expand...

What can they deliver e.g. if they've delivered the limited benefit they can then why not try something different? Simon Ponting's GWAS study offers an opportunity to understand the underlying genetic basis for ME. Given that these other approaches don't seem to return people to a normal life then why continue to pursue them?
When I think of the level of disability, of some people with ME, I think the obvious answer is that they have an underlying biochemical illness. Understanding ME might be a journey of discovery e.g. it might indicate the underlying genetic basis for some things currently labelled as personality traits etc. - perfectionism or whatever. However, if we have the tools to improve our understanding (GWAS etc.) then why not apply them?
@Simon M
 
Last edited:
Dolphin said:
Can be downloaded for free at these links:
https://livrepository.liverpool.ac.uk/3100418/1/201310670_June2020.pdf

https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.815650
Click to expand...


On the one hand, critics caution of the 'psychologisation of physical illness' (Gaudsmit & Gadd, 1991; Richman & Jason, 2001); on the other, the rejection of psychology as a relevant discipline risks neglecting the research and treatment of co-morbid mental health difficulties.
Click to expand...

Should be

Goudsmit & Gadd, 1991
 
Sean said:
Exactly. It is not anti-psych, it is anti-inappropriate psych.

Nobody is rejecting the existence of mental and social influences upon our lives. They are rejecting a particular morality-laden, politically charged, and unscientific interpretation and application of them, that is causing great harm to many people, for no good reason.

Which is a completely different argument. As the senior BPS clowns know all too well and having been doing everything they can to draw attention away from for 30 years.

The claim that we are anti-psych is a bald-faced lie, and always has been.
Click to expand...

Yes!! Exactly this.
 
In my view, if this person wants to do something constructive they'd better serve by turning their focus on the people who spend their entire careers denying reality.

What type of psychological traits make a person repeat the same interventions over and over, ignore and avoid the evidence of harms over and over.and still show up for work every day to do it all over again.

Why the need to deny reality and try to impose their own wishful thinking on the way things are? Regardless of how many get hurt.

What are these traits? How do they develop? If the field of psychology is as powerful in effect as they seem to believe then why isn't more done to ensure that those who put their own careers and interests above those of patients are not permitted to work with vulnerable people?

If the field as psychology wants to be seen as a grown up sibling from the medical family then why the failure to accept that the ability to cause positive affect when appropriately applied means the ability to cause harm when inappropriately applied? As an adult where there is freedom if choice there is also the responsibility to make the right choices - why does psychology constantly duck it's responsibilities?
 
Dolphin said:
Can be downloaded for free at these links:
https://livrepository.liverpool.ac.uk/3100418/1/201310670_June2020.pdf

https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.815650
Click to expand...

Just reading this summary, it doesn't sound too bad to me. I'm all for investigating how to better support the mental health of pwME (whilst also acknowledging that this is never going to be a treatment for the ME itself). Maladaptive perfectionism is generally linked to depression and anxiety. For people who have maladaptive perfectionist habits as well as ME, their experience of dealing with ME could be made even worse by their maladaptive perfectionism. How could we help those people improve their maladaptive perfectionism in order to make living wME slightly easier? - this seems like a reasonable question if that's what she's asking.

The bit that references the research into potentially predisposing personality traits worries me a bit - this research is so poor it seems pointless to even engage with it.

It's also a bit disappointing to me that a more accurate description of why patients reject the psychological theory of ME is not given. As Sean says above, it is not that we think that mental illness is not 'real' illness (this is an accusation aimed at us, it is not what we really think). It is the specific model of ME presented by the psychiatrists who have designed the treatments we are offered that we reject. This specific model does not reflect our experiences. As Sean says, we are not 'anti-psych', we are anti-inappropriate-psych'. I feel that it would be important to represent this in a thesis about mental health and ME. (I have only read this summary so I don't know if this is covered in the full paper.)

[Edited for clarity]
 
Invisible Woman said:
In my view, if this person wants to do something constructive they'd better serve by turning their focus on the people who spend their entire careers denying reality.

What type of psychological traits make a person repeat the same interventions over and over, ignore and avoid the evidence of harms over and over.and still show up for work every day to do it all over again.

Why the need to deny reality and try to impose their own wishful thinking on the way things are? Regardless of how many get hurt.

What are these traits? How do they develop? If the field of psychology is as powerful in effect as they seem to believe then why isn't more done to ensure that those who put their own careers and interests above those of patients are not permitted to work with vulnerable people?

If the field as psychology wants to be seen as a grown up sibling from the medical family then why the failure to accept that the ability to cause positive affect when appropriately applied means the ability to cause harm when inappropriately applied? As an adult where there is freedom if choice there is also the responsibility to make the right choices - why does psychology constantly duck it's responsibilities?
Click to expand...

I agree - this would be very interesting!
 
Tia said:
Maladaptive perfectionism is generally linked to depression and anxiety. For people who have maladaptive perfectionist habits as well as ME, their experience of dealing with ME could be made even worse by their maladaptive perfectionism. How could we help those people improve their maladaptive perfectionism in order to make living wME slightly easier? - this seems like a reasonable question if that's what she's asking.
Click to expand...

What is maladaptive perfectionism though?

In the case of a surgeon we would consider perfectionism to be a good thing. Perhaps in other walks of life where budget, time and other restraints are imposed on a person perfectionism might be a handicap.

People will tend to carry over traits from their professional life into their personal life. One of my parents was a healthcare professional. As a kid with one disabled parent I had to do my share of household chores and they were expected to be done to a certain, fairly high standard.

In my career, assessing potential problems and planning ahead to minimise risk and have backup plans in place was a key factor. So there was a degree of perfectionism. When I became sick part of my journey was learning that just because I wasn't at work it didn't mean my house had to be sparkling (though that's how I would like it to be).

I would imagine that for many of us part of our ME journey is that what we unthinkingly expected of ourselves and maybe the people around us had to change. I am far less the perfectionist than I used to be. My house doesn't sparkle and my floors aren't always clean. How do I prove that I have adapted though? If someone levels the accusation of maladaptive perfectionism at me today I have no means of proving I'm not. It's not falsifiable.

I would agree that some of us probably could have done with some psychological support, especially when first ill, because becoming chronically ill with something so debilitating is a huge adjustment. I think that support should be more to with helping people get the most out of their lives and accessing whatever social support and benefits are available to them than assuming character traits that will inevitably be true for a small percentage of people whatever sample size you choose. After all even a stopped clock is right twice a day & worse than useless the rest of the time because it's so misleading.
 
It's hardly surprising that a lot of ME patients suffer from Anxiety and Depression. It's normal, surely, to be anxious about losing your job - some people will have been in highly paid jobs, and will be worried about how to pay their Mortgage as one instance. I've been seeing a fair number of LongCovid folks on Twitter being told they "only have anxiety" by GPs too. Anxiety isn't an "only" in my view, it's horrible, and it's also not surprising people with LongCovid are anxious, but that attitude is just so horribly dismissive of their suffering.

As to Depression, I've suffered that in the past. It's very different to ME, though there are some overlapping symptoms (never sure if that should be signs or symptoms?). My sleep patterns are rubbish at present, early waking - which is supposed to be a red flag for Depression. While I feel sad over a lot of things at present, that is NOT the same as being Depressed. I feel sad I can't see my GrandKids, and don't know when I'll be able to see them. Which I think is a reasonable way to feel about that, and other stuff in my life currently too.

But I get plenty of laughs in life still too... Latest was just now, "Smothered by a meat pudding" from Barnaby in Midsomer Murders! OK, off topic, but it's strange where you can find a laugh or a smile sometimes! Laughing is good for your health - why don't the psychologists do some research into that instead of messing with our heads? (OK I'm sure some have done research into that, but don't have the energy to look it up right now)
 
You must log in or register to reply here.
Back
Top Bottom