Illness perceptions and behavioural responses as mechanisms of change in problem-solving treatment for Veterans with Gulf War Illness 2026 McAndrew+

Andy

Andy

Senior Member (Voting rights)

Abstract​


Objective​

Persistent ‘medically unexplained’ physical symptoms and syndromes (PPS), an umbrella term for symptom-based conditions with poorly understood pathophysiology and aetiology, disproportionately impact Gulf War Veterans. Behavioural interventions are efficacious and recommended as first-line treatments for PPS, but the mechanisms by which these interventions work remain unknown. This study sought to identify mechanisms of change that make problem-solving treatment (PST) efficacious for Veterans living with Gulf War Illness (GWI), a common form of PPS among Veterans who served in Operations Desert Shield/Storm.


Methods​

Veterans with GWI were randomized to receive either PST or an active control intervention. Analyses focused on the 135 Veterans who were randomized to the PST condition. Outcomes of interest included disability, depressive symptoms, and physical symptoms. Threatening and protective illness perceptions as well as maladaptive and adaptive behavioural responses to illness were analysed as mechanisms of change (i.e., mediators) of these outcomes over time in single-arm mediation models.


Results​

All three outcomes were mediated by reduced threatening illness perceptions (p-values .032–.047) and reduced maladaptive behavioural responses (all-or-nothing and limiting responses; p-values .004–.007). Changes in protective illness perceptions and adaptive behavioural responses to illness were not significant mediators of PST outcomes.


Conclusions​

Consistent with the cognitive behavioural model of PPS and the Common-Sense Model of Self-Regulation, changes in negative illness perceptions and behavioural responses may act as mechanisms of change in PST for GWI.

Paywall
 
This whole ideology is built like some sort of evolutionary algorithm that doesn't implement mutations so every generation is a clone of the original but it doesn't matter because producing the same outcome every generation is framed as a success. There are kingdoms that lasted for centuries unchanged that went through more variations than this, and most of those were ruled by some nepo bay who simply added a number after the name of a dead guy.
 
Refs removed.

Persistent ‘medically unexplained’ physical symptoms and syndromes (PPS; e.g., fibromyalgia, chronic fatigue syndrome) can cause mild-to-severe disability and are prevalent across healthcare settings. Gulf War military Veterans are particularly impacted by PPS, with 30% experiencing Gulf War Illness (GWI). Symptoms of GWI include chronic fatigue and pain, as well as a constellation of skin-related, gastrointestinal, respiratory, mood, and neurocognitive symptoms.
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Research on the pathophysiology of GWI and PPS more broadly is ongoing, but several interacting factors are believed to contribute to the development and maintenance of these conditions. These include predisposing factors that confer increased risk for PPS (e.g., early life experiences), precipitating factors that immediately precede the onset of PPS (e.g., trauma, environmental exposures), and perpetuating factors that contribute to the maintenance of PPS (e.g., illness beliefs and behaviours).
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As previously said, that still doesn't explain why 30% of Gulf War veterans have this condition - and still have it 35 years later. (Also the non-combatant Iraqi civilian population that is unresearched and the prior Kurdish population gassing [Thread]). It's not like we don't have enough subsequent wars to compare it with.

Overall, the mechanisms through which behavioural treatments for PPS work are not well understood. Mechanisms of change are factors that explain treatment effects, that is, the processes through which a treatment works. We are aware of one scoping systematic review [that] identified 15 potential mechanisms of change, and evidence was identified for both cognitive (e.g., symptom acceptance and positive treatment expectations) and behavioural (e.g., coping strategies and avoidance reduction) mechanisms. The review also found that several mechanisms, including positive treatment expectations, have received little evaluation in the literature. The authors concluded that due to limited evidence for several of the studied cognitive and behavioural mechanisms, there is a need for additional research in this area.
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Examining cognitive and behavioural mechanisms of health behaviour change is also consistent with the Common-Sense Model of Self-Regulation, which proposes that individuals develop beliefs about their health conditions and use these perceptions to guide their behavioural responses to illness. Illness perceptions include threatening beliefs (e.g., PPS cause significant consequences, will never improve), as well as protective beliefs (e.g., PPS are controllable and understandable). Threatening illness perceptions can lead to maladaptive behavioural responses to illness, such as avoiding or ‘limiting’ behaviours due to fear of exacerbating symptoms or vacillating between over-extending and limiting activity, called ‘all-or-nothing’ behaviours.
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We hypothesized decreases in threatening illness perceptions and maladaptive behavioural responses would mediate decreases in disability, physical symptoms, and depressive symptoms over time from baseline to 12 weeks (end of treatment).
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The Illness Perception Questionnaire-Revised (IPQ-R) measured Veterans' perceptions of GWI. Following the Common-Sense Model of Self-Regulation, the IPQ-R evaluates seven illness perception domains, including beliefs about: what caused GWI, the timeline of GWI, negative consequences of GWI, personal control of GWI, GWI treatment control, coherent understanding of GWI, and the emotional impact of GWI.
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The Behavioural Responses to Illness Questionnaire (BRIQ) assessed Veterans' behavioural responses to GWI. The BRIQ evaluates four domains of behavioural responses: all-or-nothing behaviours, limiting behaviours, emotional support-seeking behaviours, and practical support-seeking behaviours. All-or-nothing behaviours and limiting behaviours are generally considered to be maladaptive responses to PPS, while emotional and practical support-seeking behaviours are generally considered to be adaptive.
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Inconsistent with our hypotheses, protective illness perceptions and support-seeking behaviours did not mediate changes in disability, physical symptoms, or depressive symptoms over time. Additionally, the overall endorsement of protective illness perceptions and support-seeking behaviours was low, particularly for the latter. This finding differs somewhat from previous studies, which have found associations, albeit with small-to-moderate effect sizes, between protective illness perceptions and/or adaptive behavioural responses with beneficial health outcomes among patients with PPS.
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We did not find evidence that protective illness beliefs or support-seeking behaviours mediated PST outcomes. Overall, the present findings suggest illness perceptions and behavioural responses to illness, particularly threatening perceptions and maladaptive behaviours, are important considerations in the care of individuals with persistent physical symptoms and may be driving factors in the success of behavioural interventions that target these conditions.
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The main implication is that reductions in threatening illness perceptions and maladaptive behavioural responses to PPS are candidate mechanisms through which PST reduces disability, physical symptoms, and negative mood (e.g., depression) in individuals living with PPS. Although more research is needed to increase confidence in these mechanisms, this evidence suggests clinicians may consider both initial and ongoing assessment of patients' threatening illness perceptions and maladaptive behavioural responses to illness to ‘take the temperature’ on the effectiveness of PST as treatment is ongoing.
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Specifically, clinicians may consider assessing patients' beliefs about the consequences of their illness (e.g., about their ability to achieve personal goals or maintain personal relationships), the emotional impact of their illness (e.g., feelings of anger, worry, or sadness about chronic physical symptoms), and the chronicity of their illness (e.g., as a permanent condition), as well as limiting behaviours (e.g., avoiding exercise) and all-or-nothing behaviours (e.g., cycles of overdoing and burning out). The present findings suggest that engaging in fewer of these unhelpful thoughts and behaviours may lead to a more favourable PST outcome for individuals living with PPS.
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It's been 35 years, so I think the patients are justified in remaining angry, sad and worried about it being a permanent condition with chronic physical symptoms. You've been trying this psychosocial nonsense for three decades+ in multiple guises and incarnations. Manipulating questionnaire responses is not exactly helping them.

Within this definition [Kansas GWI definition], Veterans with a comorbid condition that could account for GWI are excluded. To increase generalizability in an aging population, only comorbid conditions that could clearly account for GWI were excluded for the current trial (e.g., multiple sclerosis).
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It's all a bit too late for the <reads back> "30% experiencing Gulf War Illness".
 
We did not find evidence that protective illness beliefs or support-seeking behaviours mediated PST outcomes. Overall, the present findings suggest illness perceptions and behavioural responses to illness, particularly threatening perceptions and maladaptive behaviours, are important considerations in the care of individuals with persistent physical symptoms and may be driving factors in the success of behavioural interventions that target these conditions.
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How on earth do we counter such blatant inconsistency being endlessly allowed through the peer review process and mounting up as 'evidence'?

Does reality not matter at all anymore?
 
Wasn't it Wessely who started this nonsense about GWI being all in the mind and therefore amenable to psychological therapy? I feel so sad for the veterans still being subjected to this crap. The research clearly shows the whole paradigm is lies.
 
I have just glanced through the list of authors and the list of references. It's clearer to me now why the authors interpret their research in such a biased way. They are a bunch of psychologists and psychiatrists, it's published in a Health Psychology journal, and the reference list is stacked with MUS stuff, the usual suspects leading the charge - Chalder, MossMorris, Sharpe, Burton.

I rest case. This is not real research. This is propaganda for a failed paradigm.
 
Obviously if you dunk a witch in water, well, then clearly she must be a witch, otherwise why would any reasonable person do that? Aren't they reasonable people? So, there, that's all the evidence anyone needs. Now it becomes an official act, immune from any and all consequences. Unlike doing it in a personal capacity, which would be insane and criminal.

When you've been dunking witches in water for decades, thousands, millions, then obviously they can't not be witches because whew would that be embarrassing (and also just a little bit indistinguishable from criminally insane).

No need to see any magic. You just dunk them and bam! Witchery demonstrated. Look at them gurgling and screaming about not being a witch, only a witch would do that. They've all done that. Every last one of them has done that. This is how they know they're witches.

Seriously, though, this will need to be studied alongside phenomena like QAnon. It's clearly a derivative of the same problem, of echo chambers and the need for one's personal convictions to be correct, no matter the cost, especially with mounting, cumulative cost, no matter the evidence, in fact any conflicting evidence can only be confirmation that it must be true.
 
dave30th said:
Has anyone looked through W's work on GWI and Camelford and deconstructed what's wrong with them? Something I'd like to turn my attention to when I have a spare minute.
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It's clearly ongoing for GWI so doubtful, but the UK government (or a lower level?) did apologize for Camelford so presumably someone must have looked into that enough.

Add on to that 9/11-related illnesses as well, from which more died than from the attacks. The man has an incredible track record of being wrong, and it has been very profitable to him.
 
Trish said:
This is not real research. This is propaganda for a failed paradigm.
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Anti-science, par excellence.
rvallee said:
Add on to that 9/11-related illnesses as well, from which more died than from the attacks. The man has an incredible track record of being wrong, and it has been very profitable to him.
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Wessely's talent and skill are basically in politics and sophistry, not science or medicine.

Unfortunately he possesses that talent and skill in lavish abundance and has no hesitation to deploy them to his advantage.
 
JellyBabyKid said:
What the fresh hell is this nonsense..?!
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"The Common-Sense Model of Self-Regulation (CSM), developed by Howard Leventhal and colleagues, posits that individuals act as active problem-solvers who create cognitive and emotional "illness representations" to manage health threats. These personal perceptions guide how people interpret symptoms, choose coping strategies, and evaluate treatment success, influencing behavioral responses to illness."

:banghead: :x3: :rolleyes:

Edit to add: The Common-Sense Model of Self-Regulation (CSM) faces criticism for its small-to-moderate effect sizes, suggesting illness representations only partially explain behavioral changes

Edit to add: the above was copied from Googles AI overview as I was curious, but not enough to waste much energy on it.
 
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