Experiences of a cognitive behavioural therapy (CBT) intervention for fatigue in patients receiving haemodialysis, 2022, Picariello, Moss-Morris et al

Abstract

Background
A feasibility randomised-controlled trial found that a cognitive-behavioural therapy intervention for renal fatigue has the potential to reduce fatigue in patients receiving haemodialysis, but uptake was low.

Objectives
Nested in the randomised-controlled trial (RC) qualitative interviews were undertaken to understand the acceptability of renal fatigue, the facilitators of, and barriers to, engagement, and the psychosocial processes of change.

Design
The trial included 24 participants at baseline. Semi-structured interviews were conducted with nine participants from the intervention arm (n = 12). Approach Interviews were carried out immediately following treatment (3 months post-randomisation). Data were analysed using inductive thematic analysis.

Findings
Five main themes were formulated. The overarching theme was a sense of coherence (whether the illness, symptoms and treatment made sense to individuals), which appeared to be central to acceptability and engagement. Two themes captured the key barriers and facilitators to engagement, cognitive and illness/treatment burdens and collaboration with the therapist. Participants described changes related to their activity, thoughts and social identity/interactions, which shaped perceptions of change in fatigue. Lastly, participants discussed the optimal delivery of the intervention.

Conclusions
This study revealed the importance of patients' understanding of fatigue and acceptance of the treatment model for the acceptability of and engagement with a cognitive-behavioural therapy-based intervention for fatigue. Overall, there was an indication that such an intervention is acceptable to patients and the mechanisms of change align with the proposed biopsychosocial model of fatigue. However, it needs to be delivered in a way that is appealing and practical to patients, acknowledging the illness and treatment burdens.

Open access, https://onlinelibrary.wiley.com/doi/10.1111/jorc.12418

 

I think this is a warning signal that it's not actually improving fatigue. If it did, participation in the therapy would be net energy gain.

 

We tried to do a trial of CBT (whatever that means in this instance) in renal fatigue but the patients thought we were stupid nosy-parkers. In the end some of them just about put up with us and our dumb theories - or pretended to. The results are consistent with the fact that nothing actually changes with CBT other than patients learning how to pretend to be nice to the therapists (what we call the psychosocial bit).

 

What CBT for fatigue means here:

Renal fatigue explained, Understanding renal fatigue and alternative explanations, Fatigue self-monitoring
Assessment of fatigue and personal model of fatigue
Finding balance in activities and rest, Patterns of rest and activity and their effects on the body, Activity difficulty task
Planning activity and rest , Activity and rest goal sheet
Exercise
Improving sleep , Sleep hygiene Sleep, activity and rest goal sheet
Maladaptive sleep patterns
Improving sleep
Learning to relax, Diaphragmatic breathing Relaxation diary
Progressive muscle relaxation (PMR)
Relaxation training: Step-by-step
Coping with emotions, Strategies to cope with negative emotions, Coping with negative emotions goal sheet
Self-assessment of negative emotions
Expressing emotions
Managing stress, General tips to reduce the impact stress on life, Managing stress goal sheet
Managing controllable and uncontrollable stressors
Mindfulness
Making use of social support, Creating a support network, Social support goal sheet
Disclosure versus keeping it to self
Social comparisons
Becoming aware of your thinking, Common unhelpful thoughts, Thought record
Identifying unhelpful thinking
Changing your thinking, Identifying alternative thoughts, Alternative thoughts goal sheet
Preparing for the future , Sustaining and building on improvements , Long-term goals worksheet
Developing future goals
Tips for everyday life

This is a summary of the chapter title, content and between session tasks.

 

This level of obsession and inability to stop is genuine mental illness, the real actual kind that operates within thoughts and beliefs and has no physiological counterpart. Seems like most mental health concepts these days are all about pathologizing normal reactions and behaviors while detaching them entirely from their context, often disease undetectable by current technology, a crudely superficial caricature of it anyway.

This here, however, this is genuine mental illness in the form of obsessive inability to perceive reality and do useless things while somehow believing it's substantial. Most of what makes up modern mental illness theory misses out on stuff like this, possibly because any level of self-examination should see how psychology fails precise at inability to unhook from obsessive thoughts and beliefs, psychological projection and false attribution error.

But in the end this is almost all abuse of power, abusing the fact of being to fabricate a record of what happens that is selectively edited and appraised to support the intent, regardless of what's actually happening. This is no better than law enforcement officers using the threat of imprisonment to coerce people into doing criminal activities, then using the threat of evidence of that activity to keep them quiet. It always comes down to the word of a person who has been discredited of the right to self-testify to their life experience, against a professional, or group of, who can write down whatever they feel like they perceived, whether true or not, it will usually what's good for them and their career and status.

Honestly, psychology is essentially in the process of being, uh, de-scienticized, can't find a real word for it. Like the whole discipline is more or less shambling back into demons and fairies stuff, more or less in the form of, well, this:



Modern mental health care can genuinely be compressed down to this silly nugget of a joke made for a movie. Everything said about us is obsessed with some imagined fear we have, of "standing", of "activity", of whatever. Then they tell us to do self-compassion, mindfulness, to find love within ourselves and think happy thoughts. It's the same thing with psychologizing Long Covid, everything is about fear, and lockdowns and stress and fear Fear FEAR.

This is supposed to be satire, and it effectively summarized about 90% of where clinical psychology has been stuck at for decades. This, right here, is the genuine stuff of "software" mental illness, and it's effectively squatting the whole discipline, dragging humanity down because belief in imagined powers of the mind is the last remaining bit of magical thinking modern society has.

 

Not that there is any possibility that the treatment actually works but I would be interested in knowing what they think they know about fatigue from this quote:

Perhaps I'm misreading but it seems like they (bPS) went to some length to explain to them how to think about / what fatigue is?

Yet this is all at the conceptual level. Is fatigue really understood at the biological level? I don't know that it is.

This may not be the issue I think it is but in any case since what they do here is the usual non-science nothing can be gleaned from it anyway.

 

I had 3x a week interactions (3-4 hrs on average per day's session) for twenty years with hemodialysis patients. They all complained of fatigue at EVERY session, except perhaps for those in their early twenties, who from time to time had energy to enjoy parts of regular life.

The lack of renal function and its associated abnormalities (a huge swath of them) result in fatigue.

Good luck CBT, sayonara!

 

These people, as a result of their "work" on ME/CFS, have created a monster. And the monster is them.