Impact of symptom focusing and somatosensory amplification on persistent physical symptoms: A three-year follow-up study, 2020, Barends et al

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0022399919306300
Sci hub, https://sci-hub.tw/10.1016/j.jpsychores.2020.110131

 

I think what the study authors lack for this study to be meaningful is -- a personal experience of long term pain or other distressing symptoms.

I think this more than anything would inform their 'theories' and maybe provide insight into cause and effect.

 

I think I'd also like to add a little anecdote to illustrate symptom focussing and symptom severity issues.

I have had tinnitus for 50+ years. In the early years I at first didn't realise that I had tinnitus all the time. Without me doing anything consciously my brain adapted. I did one day realise that if I paid attention (and then I did this several times over time) the tinnitus was always there but I was not attending to it.

Now decades later my tinnitus is quite a bit louder and harder to not attend to. It is more distressing in that outside ambient sounds are more difficult to cope with because of all this noise emanating (if that's the word) from my head.

Nevertheless I don't go through my day attending to the noise in my head more. I carry on quite as usual -- after all -- I've had 50+ years of practice in not attending to the sound. So I do not attend to it any more then I ever did. It is just that it is more intrusive and presents more difficulties in that it is particularly noticeable when trying to fall asleep (as it's dark and quiet).

I occasionally find myself pressed to speak inside the lines (rules) but these people are full on idiots* with their armchair musings on other peoples suffering.

* credit where credit is due -- I'm being nice here.

 

The theory is intuitively wrong, even at its most, and there are no empirical hints either.

A possible explanation:

Any living being wants success. This should even be even the definition of an intention. And the success is wanted for itself.

Pain diminishes the intention, or even better, is the diminishing of intention. Any being or intention will avoid anything which is painful.

Human beings differ to other beings in that they have quite a big thematic self reference (with its special successes). But still pain will diminish intention, and if there is no other success, it will not happen that pain is choosen (as it is not choosen by animals that have no additional thematic self reference). So, where is the success?

 

Ridiculous. There is no way to measure focus in any meaningful way and obviously stronger symptoms are more noticeable. Good grief this is so juvenile in its incompetence how these people are even allowed to work on important matters is beyond reason.

One of the most fundamental problems in science is being able to tell whether something is a cause or an effect. When you explicitly and deliberately fail at this you simply prove you don't have the skills necessary to work in science.

Not a single measurement in sight, only bad questionnaire scoring. Words have meaning. This is pathetic.

 

They are trying to explain why some people have persistent physical symptoms that can't be explained by medicine.

There's more but text can't be copied properly so I'm not going to copy all the important parts here.

Anyway I find this idea very questionable. There is a limit to how much you can increase your own perception of symptoms, and it's an active process meaning you have to essentially work hard to make it happen. And patients learn quickly to try and distrac themselves from pain instead of "cultivating" it. As explanation it doesn't seem to fit intense and persistent symptoms, where this idea is applied because these are so frustrating.

Personal opinion aside, the effect that the authors have found is quite small (Cohen's d of 0.10).

 

They are doing what studies of FND have done. They assume that their theory is right when they misdiagnose people, then years later they make the same misdiagnosis.

Somehow, they think that this proves they were right all along

If I decide epilepsy is caused by demons then test the same people after 10 years, if they still have epilepsy I will again believe this means they have demons. This DOES NOT MEAN demons are involved.

 

It's pretty clear that the authors have never developed a tooth infection requiring root canal on a Friday evening after their dentist has left for the weekend. By Sunday, I can assure that their views on symptom focusing would be better informed and they'd be seeking an emergency appointment.

 

Yes, I guess one could say minuscule. The Cohen d they report are all below 0.32. That would already suggest that these aren't the key factors in determining the persistent physical symptoms of these patients.

It also seems that the authors didn't correct for baseline symptom severity? I think they only controlled for age, gender, education level and somatic diseases (number of self-reported somatic diseases at baseline). I suspect there wouldn't be much left of their results if they controlled for symptom severity.

 

There are some other interesting things in this paper. It explains that 40 years ago a guy called Arthur Barsky invented the 'somatosensory amplification theory' "by describing the proneness to focus on and amplify bodily sensations and symptoms as an explanation for individual differences in experienced physical symptoms."

Normally researchers mention and discuss similar research in the opening paragraph of their paper as a sort of background to their study. Here the authors write:

So that's interesting to know.

The discussion section says:

It also says that the questionnaire used to measure somatosensory amplification (the somatosensory amplification scale or SSAS) has been criticized.

These references might be interesting:

[8] ] K.R. Aronson, L.F. Barrett, K.S. Quigley, Feeling your body or feeling badly: evidence for the limited validity of the somatosensory amplification scale as an index of somatic sensitivity, J. Psychosom. Res. 51 (1) (2001) 387–394

[44] ] K.R. Aronson, L.F. Barrett, K.S. Quigley, Emotional reactivity and the overreport of somatic symptoms: Somatic sensitivity or negative reporting style? J. Psychosom. Res. 60 (5) (2006) 521–530​

So overall there seems to be very little evidence for Barsky's somatosensory amplification theory, doesn't it? Would be interesting if someone could study why these ideas seem to remain popular among researchers and clinicians.

 

Something that is really easy to show in a formal way. Would actually be great to do that. Not sure it would change anything since BPS beliefs are impervious to evidence but at least it should be done.

But we're kind of stuck in a place where we have so little funds that it would be a waste to do this knowing it would not change anyone's opinion. And yet it is necessary and should have been done a long time ago by the people pushing this tripe but they know it's false and don't care anyway. Because every dollar spent has the opportunity cost of not going to research that could be a breakthrough moment. So the myths just keep on persisting because beliefs supersede evidence.

What an absolute mess.

 

Continuing on with what Michiel mentioned, the full quote:

Mhmm... Which means the "symptom amplification" hypothesis (that attentional bias or hypervigilance actually increases somatosensory signals or "heightened perceived threat and vulnerability") has no basis and it is simply questionnaire answers being correlated with other questionnaire answers.

If they tested functioning objectively, they might have had an acceptable study on their hands, but as published, it is junk.