Do adolescents w/CFS/ME & co-morbid anxiety &/or depressive symptoms think differently to those who do not have co-morbid psychopathology?,2020,Loades

[Sly Saint]

Do adolescents with chronic fatigue syndrome (CFS/ME) and co-morbid anxiety and/or depressive symptoms think differently to those who do not have co-morbid psychopathology?

2020
Loades, Crawley et al

Abstract
Background
Co-morbid anxiety and/or depression is common in adolescents with Chronic Fatigue Syndrome (CFS/ME). Adolescents with psychopathology typically endorse more negative cognitive errors. We do not know whether they make negative cognitive errors in response to fatigue. We examined the thinking patterns of adolescents with CFS/ME and co-morbid psychopathology compared to those without this co-morbidity.

Methods
This cross-sectional study recruited 205 adolescents (age 11–18) with CFS/ME, who completed measures of anxiety and depression, information processing biases and responses to fatigue. We grouped participants as having co-morbid psychopathology (or not) by applying a threshold score. We compared groups’ thinking pattern subscale scores using independent samples T tests. We examined the association between psychopathology and general negative thinking and specific responses to fatigue symptoms.

Results
Adolescents with CFS/ME with co-morbid psychopathology more strongly endorsed general negative cognitive errors (d = 0.61–1.31). They also more strongly endorsed damage beliefs (d = 0.49), embarrassment avoidance (d = 1.05), catastrophising (d = 0.97) and symptom focusing (d = 0.75) in response to fatigue but did not differ significantly on fear avoidance from those without co-morbid psychopathology. Both negative cognitive errors and unhelpful responses to symptoms explained 43% of the variance in psychopathology.

Conclusions
Adolescents with CFS/ME with co-morbid psychopathology tend to be negatively biased in their thinking, both generally and about their symptoms of fatigue specifically. This may have implications for the sequencing of cognitive and behavioural strategies to address both fatigue and psychopathology.

https://www.sciencedirect.com/science/article/pii/S0165032719334561?via=ihub

see also
https://www.s4me.info/threads/fitnet-nhs-esther-crawley-5th-protocol-out-now.8053/#post-187750

 

[Trish]

Is it just me, or is this stuff from Crawley and Loades getting increasingly ridiculous, and dangerous for the children in their care.

First of all they find that kids who have negative thoughts have negative thoughts. Who knew?! Hold the front page...

And they make the amazing discovery that if a patient is suffering from a mental health disorder, they may need some help coping with it. Surely that's medicine 101.

Then they judge their thoughts as 'negative cognitive errors', 'catastrophising' etc.

Maybe, just maybe, those kids' thoughts are an accurate interpretation of their physical symptoms and sensible caution about the effects trying to increase activity will have on their physical health.

What am I missing here?

(note - I have only read the abstract. I can't face it the full article. I leave that to those with stronger stomachs)

 

[JemPD]

1) So they need a study to tell them that people who have depression are inclined to think more negatively? I'm not going to read it because i have heard it all before & better things to spend my energy on. But I cant believe for a second that they did this study to explore anything or test anything, nobody could be so dim as to need a study to tell them that people with depression have a tendency towards negativity. Thats like doing a study to see if people with headaches experience more pain in their heads than people without. So whats the motive? Actually?

I suggest it might be to be able to say "studies show" that a child with ME + depression will catastrophise more & lean towards being negative about their fatigue - this supports the use of CBT to disabuse them of their 'cognitive errors' - ie believing they are ill.

2) Who decides what a 'cognitive error' is? And what qualifies them to make such a judgement?

edited for spelling

 

[Jan]

It would be interesting if these children could see a psychiatrist unconnected to this to see how many actually do even have depression. We know BPS over diagnose depression when it’s a normal reaction to being unwell.

 

[chrisb]

It's clearly all the fault of a troubled chldhood. All those stories of nearly drowning when taken swimming in impending storm.

 

[Evergreen]

‘We were surprised to see that fear avoidance beliefs did not differ between the groups.’

I’m not. The need to reduce or modify or ‘avoid’ certain activities is essential for people with ME/CFS whether they also have depression/anxiety or not; it’s not a ‘negative cognitive error’ and no therapist should be trying to fix it. It ain’t broke.

I think it’s entirely natural to want to refer to your own work – it’s bound to be relevant - but Loades does it, ahem, loads in this paper. 20 times: 18 times for 6 papers she’s first author on, and once each for co-authored articles with Brigden and Stoll.

This is from a different study by Loades, the 2019 one, here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7099937/
- to me, the first part of this sentence sounded fishy, and bore no relation to the second part:

‘In a qualitative study, adolescents with CFS talked about how beliefs about activity contributed to the exacerbation of their CFS symptoms; for example, participants reported that doing too much was unhelpful for managing their illness (Richards, Chaplin, Starkey, & Turk, 2006).’

So I looked up the Richards et al 2006 study being referred to and here’s what the participants said:

‘[bolding and capitalisation in the original]
Q2: Treatment and management

Activity levels

Twelve parents and 11 young people reported that
Doing too much was unhelpful in managing symptoms.

_If I do too much in one day then I know I’ll be ill_. (YP17)

Five parents and 9 young people described the need to
Avoid exercise.

_I find that exercise is terrible, it makes me feel really ill and
really absolutely exhausted._ (YP5)

_He can’t do too much on the physical side…walking._ (P9)

Eleven parents and 8 young people felt that Rest was
helpful.

_Because she stayed in bed and didn’t do any lessons or
anything for about a year, she has made a better recovery
from it._ (P14)

_I do find if I rest quite a lot, even just in not doing anything
not necessarily going to bed, but then I can feel a bit better._
(YP5)’

So adolescents did not say that ‘beliefs about activity contributed to the exacerbation of their CFS symptoms’. They and their parents said that activity contributed to the exacerbation of their symptoms, unsurprisingly. So a bit of a switcheroo by Loades, there.

Edit: Just reformatting so it's easier to read.

 

[Jonathan Edwards]

Is it just me, or is this stuff from Crawley and Loades getting increasingly ridiculous, and dangerous for the children in their care.

You have to understand, @Trish, that we live in The Matrix, except that it is a sort of slime mould of interacting human minds forming a guey sheet that slimes over the earth. Every so often the slime mould buds off new blubs of interacting minds that float out into the aether across the surface. One of those blubs is S4ME and it has an unusual property which we might call 'sanity'. There is no guarantee that Darwinian pressures will favour the survival of this blub but it can have a go.

While autonomous, the S4ME blub will tend to rub shoulders with the main blub or other blubs and pick up sort of cognitive pheromoans indicating level of intellectual activity. Since being a slime mould requires hardly any intellectual activity at all the experience may seem dire. Moreover, as time goes by it may seem worse. But this may be what in the trade is known as 'getting older'.

Always remember though that, as some wise Americans said, when there are unknown unknowns stuff happens. (I thought it was important to end my post with something completely irrelevant.)

 

[Trish]

Thanks for making me laugh, @Jonathan Edwards.

 

[Peter T]

So they need a study to tell them that people who have depression are inclined to think more negatively?

I vaguely remember a study on depression from well over forty five years ago, I can not remember the details or how good a study it was, however I thought the findings telling.

They were testing the hypothesis that people were depressed because they were irrationally pessimistic, but came to the conclusion that people who were depressed were in fact more realistic than the non depressed controls who were irrationally optimistic.

Unless the researchers have access to independent objective measures they have no idea whether the supposed negative cognitions are a rational realistic response or unhelpful false cognitions.

 

[Willow]

I’m not. The need to reduce or modify or ‘avoid’ certain activities is essential for people with ME/CFS whether they also have depression/anxiety or not; it’s not a ‘negative cognitive error’ and no therapist should be trying to fix it. It ain’t broke.

I think it’s entirely natural to want to refer to your own work – it’s bound to be relevant - but Loades does it, ahem, loads in this paper. 20 times: 18 times for 6 papers she’s first author on, and once each for co-authored articles with Brigden and Stoll.

This is from a different study by Loades, the 2019 one, here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7099937/
- to me, the first part of this sentence sounded fishy, and bore no relation to the second part:



So I looked up the Richards et al 2006 study being referred to and here’s what the participants said:



So adolescents did not say that ‘beliefs about activity contributed to the exacerbation of their CFS symptoms’. They and their parents said that activity contributed to the exacerbation of their symptoms, unsurprisingly. So a bit of a switcheroo by Loades, there.

Again, it's not the patients' beliefs about their illness that is the problem. It is the beliefs about this disease on the part of certain doctors/researchers/therapists that is the fundamental problem. That needs to change. But how does one change the biased views of those who refuse to see and accept the reality patients deal with every day. They continue to see the ME/CFS world through distorted psychological glasses and twist reality into misperceptions that patients need to continually fight against. Their searching and searching to find ways to validate their theories and support their "research" only compounds the suffering of patients. I pray that their nonsense will stop and patients finally will be free of the added burdens they bring to patients' lives.

 

[Barry]

Is it just me, or is this stuff from Crawley and Loades getting increasingly ridiculous, and dangerous for the children in their care.

Maybe it's the insatiable desire for getting published that is becoming ever more starved of things to publish.

 

[Amw66]

This pair should carry a health warning .

To completely misunderstand a condition for so long ( in EC' s case) : to suffer such cognitive dissonance when interacting with actual kids suffering from such a crap illness .... unprofessional dosn' t quite cut it.

Does noone actually listen.

 

[JemPD]

They were testing the hypothesis that people were depressed because they were irrationally pessimistic

Every depressed person i know (which admittedly is only 4) plus myself at times, when they are very low, tends to feel less optimistic & about things in general, but i was under the impression, that this was *because they/I am in a bout of depression. Not the other way around.
Put more plainly, & acknowledging that of course depression is more than feeling miserable... its hard to feel optimistic when you're bloody miserable. But i wouldnt be at all surprised if a child stating a fact that a lot of people dont want to/are unable to acknoledge as true, is interpreted (in error) as being 'negative', when it's simply just a child being courageously realistic.

Unless the researchers have access to independent objective measures they have no idea whether the supposed negative cognitions are a rational realistic response or unhelpful false cognitions.

Exactly... who made them the arbiter of what is a 'cognitive error'.

Again, it's not the patients' beliefs about their illness that is the problem. It is the beliefs about this disease on the part of certain doctors/researchers/therapists that is the fundamental problem.

Precisely. The people policing the cognitions are the ones with the faulty cognitions, they are not qualified to judge what is a cognitive error when the cognitions are about this disease. Quite the reverse.

 

[Sean]

They were testing the hypothesis that people were depressed because they were irrationally pessimistic, but came to the conclusion that people who were depressed were in fact more realistic than the non depressed controls who were irrationally optimistic.

Wear that 'depression' like a champ.

Unless the researchers have access to independent objective measures they have no idea whether the supposed negative cognitions are a rational realistic response or unhelpful false cognitions.

This is the core of the problem with that claim. To be able to make such judgements requires those making them to have some grand sweeping view of the human condition and experience that is simply impossible.

Extraordinary claims need extraordinary evidence, and they have completely failed to come up with it, about either ME or depression.

 

[Ukmum]

It's such an easy question. Yes if course they think differently to adolescents without me/cfs. They know through daily living that if even if they do very little they will be fatigued and feel ill and if they overdo it they will feel even worse. That's the hallmark of the the illness. Not a bloomin unhelpful cognition. What's unhelpful is thinking you can make people better with a treatment that doesn't take activity intolerance into account. And using questionnaires that ask about fatigue and activities.

 

[MEMarge]

You have to understand, @Trish, that we live in The Matrix, except that it is a sort of slime mould of interacting human minds forming a guey sheet that slimes over the earth. Every so often the slime mould buds off new blubs of interacting minds that float out into the aether across the surface. One of those blubs is S4ME and it has an unusual property which we might call 'sanity'. There is no guarantee that Darwinian pressures will favour the survival of this blub but it can have a go.

While autonomous, the S4ME blub will tend to rub shoulders with the main blub or other blubs and pick up sort of cognitive pheromoans indicating level of intellectual activity. Since being a slime mould requires hardly any intellectual activity at all the experience may seem dire. Moreover, as time goes by it may seem worse. But this may be what in the trade is known as 'getting older'.

Always remember though that, as some wise Americans said, when there are unknown unknowns stuff happens. (I thought it was important to end my post with something completely irrelevant.)

I love this view of the BPS cabal as slime mould.

 

[Sly Saint]

It's clearly all the fault of a troubled chldhood. All those stories of nearly drowning when taken swimming in impending storm.

I'm guessing that might be a reference to EC childhood story at her TEDx talk?

 

[chrisb]

Well, if childhood trauma plays such a part in a person's development...whether or not it does I am, of course, unqualified to judge, but certain authorities have it so.

 

[ME/CFS Skeptic]

quote from the paper:

"This was cross-sectional study using data collected at baseline in the FITNET-NHS trial."

 

[ME/CFS Skeptic]

Here's the questionnaire they used to determine the cutoff between ME/CFS patients with and without co-morbid anxiety and/or depressive symptoms: The Revised Children's Anxiety and Depression Scale (RCADS) with 47 items.

"Respondents are given 4 response options, which are scored on a 0 (not at all) to 3 (always) scale. Scores on each item are summed, and total scores range from 0 to 141. Higher scores indicate greater endorsement of symptoms of psychopathology (anxiety and/or depression)."

Link : https://www.corc.uk.net/media/1225/rcads-childreported_8-18.pdf