Generalised worry in patients with [CFS] following Cognitive Behavioural Therapy - a prospective cohort study in secondary care, 2022, Chalder et al

Full title: Generalised worry in patients with Chronic Fatigue Syndrome following Cognitive Behavioural Therapy - a prospective cohort study in secondary care

Highlights

• Generalised worry is highly prevalent in Chronic Fatigue Syndrome (CFS).
• Worry was linked with greater fatigue, anxiety and worse work and social adjustment.
• Avoidance behaviour mediated the association of worry with work and social adjustment.
• Cognitive Behavioural Therapy may need to focus more on generalised worry in CFS.

Abstract

Research has shown that generalised anxiety disorder is commonly associated with Chronic Fatigue Syndrome (CFS). This prospective cohort study aimed to investigate the prevalence of generalised worry in CFS patients and its relationship with fatigue, anxiety and social functioning, before and after Cognitive Behavioural Therapy (CBT). Our cohort consisted of 470 patients diagnosed with CFS who received CBT at a secondary care, specialist clinic. Patients completed self-report measures investigating levels of generalised worry, fatigue, work and social adjustment, anxiety and depression at baseline (pre-treatment), discharge from treatment, 3-month and 6-month follow up (post treatment). Analysis indicated a high prevalence of generalised worry (72.4%) at assessment. A significant reduction in worry following CBT (M=-3.42, p<.001, 95%CIs: 2.26, 4.57) was observed at discharge, which remained stable at follow-up. Severe baseline worriers had greater overall fatigue score (M=3.74, p=.026, 95%CIs: .33, 7.15) and worse overall work and social adjustment than mild worriers across time-points (M=5.42, p=.035 95%CIs: .27, 10.58). Avoidance behaviour mediated the association between generalised worry and work and social adjustment (95%bootstrap CIs: 013, .080). The majority of patients with CFS had comorbid generalised worry and severe worriers reported greater fatigue, anxiety and worse work and social adjustment. This suggests that CFS patients may benefit from targeting generalised worry during CBT.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0005789422000065

 

Because their livelihood depends on not seeing it.

 

People who have a disease that is not understood, is severe and disrupts their life, there is no treatment and they get told falsehoods by authority figures, and they are mistreated by friends and family - the people who need therapy are the ones who are not worried, concerned or anxious.

 

What do they mean by avoidant behaviour? This sounds as if they are still assuming that not exercising is due to a phobia instead of behaviour that leads to better health day to day.

 

It's literally not generalized when there is a specific reason for it, words mean something for a reason. That this passed multiple steps in a process makes that entire process a joke. As does the fact that here Chalder is harping a "treatment" for a generalized thing that she has been promoting as a targeted cure for the whole disease for decades. Academic research should not pretend that a researcher's entire career did not happen, asking questions so naïve it may as well be the very first ones they thought of, essentially abusing scientific neutrality, the academic version of making a very controversial statement and responding to criticism that they're just asking questions.

But the die was cast when medicine accepted the idea of "generalized" anxiety, when anxiety means worrying about something, so they simply gave it a qualifier that nullifies what the word means in the first place. Medicine is genuinely getting worse with time in everything dealing with chronic health problems, it's such an absurd reality where the problem is obsessively presented as the solution to itself.

It does provide a perfect template for incompetent pseudoscience, that Chalder has taken it to an art form. It's not even possible to satirize this, it has all the features of garbage pseudoscience, including a system so dysfunctional it either can't tell the difference or doesn't care.

 

https://twitter.com/user/status/1485994312986935300

 

It seems like Goldberg without the variations. It could have been written in 1990. It probably was.

 

This is also a preselected sample, people referred to a specialist service for CBT which could have implications for interpreting the results.

 

I really do begin to wonder if they truly don't realise there is a difference. It's perverse.

That these people call themselves scientists is just ... weird.

 

Oh, they do. They criticize any research they don't like if it features this. They just exempt themselves from it since they think pseudoscience is good enough for what they see as a pseudoillness. That's the main consequence of "de-medicalizing" a disease, it doesn't have to meet any standards whatsoever.

 

I can't access the paper.
Here's the Work and Social Adjustment Scale
https://www.networks.nhs.uk/nhs-net...missioning-networks-portal/documents/wsas.pdf

"People worried more when their ME/CFS caused worse problems with being able to work, socialise, manage a home and form close relationships.

Does this mean "avoiding activity because they were worried in general", or worried about making their health even worse? If the latter, are there sick controls?

 

Who would not worry when threatened with psych diagnosis, when facing homelessness because you can’t work, and when having trouble finding a doctor who believes you?

This is medical terrorism

 

After CBT

 

First thoughts after a very brief skim: the authors wrongly state that PEM is a required feature of the NICE 2007 guidelines (in fact, post-exertional fatigue was acceptable):

Curious as to how they determine suitability for CBT:

The questionnaires used: the Penn State Worry Questionnaire to assess "generalised worry", the CFQ to assess fatigue, WSAS for work and social adjustment, HADS for depression and anxiety, the fear-avoidance subscale of the CBRQ to assess "fear avoidance" and the avoidance/resting behaviour subscale of the CBRQ to assess "avoidance behaviour".

Isn't that an unusually high level of CBT sessions for an NHS clinic? I thought 6-12 was usual.

The authors acknowledge some of the obvious limitations of their study:

ETA: Figure 1 (p32) states that only 246 (which would be 52.34%) completed the 3-month follow-up and 252 (which would be 53.62%) completed the 6-month follow-up. Huge drop-out rates.

ETA2: A link to the Penn State Worry Questionnaire
ETA3: Link to the CBRQ subscales

 

When you’re beneath contempt, as we are in the eyes of the medical establishment, any attention bestowed upon us will appear benevolent. When we invariably illuminate the myriad flaws inherent in Chalder’s work, we’re branded ingrates.

I’ve seen Med Twitter flush with citations of the O’Sullivan “All in the Mind” missive. It’s such blatant groupthink it’s astounding. An echo chamber with such unbridled power to inflict misery and perpetuate poverty.

 

I may be missing something here, but there seems to be something curious about the demographic data (p27) - e.g. summing the "Occupational status" column, you get 370. There were 470 patients, so what about the other 100? If you sum the "Marital status" column, you get 460, which is probably explicable by 10 patients not answering the question, but what about the lack of occupational status data for 100 patients? Was this data not collected from the entire patient cohort?

 

Happened to spot that they originally submitted this around 10 months ago. I wonder what the differences were between the original version and the published one.

"Received 11 March 2021, Revised 6 January 2022, Accepted 12 January 2022, Available online 22 January 2022."