"Is fatigue a disease-specific or generic symptom in chronic medical conditions?" (Dutch CBT proponents involved)

Dolphin

Dolphin

Senior Member (Voting Rights)
http://psycnet.apa.org/record/2018-23402-001

Is fatigue a disease-specific or generic symptom in chronic medical conditions?




Journal Article
Database: PsycARTICLES


Menting, Juliane Tack, Cees J. Bleijenberg, Gijs Donders, Rogier Droogleever Fortuyn, Hal A. Fransen, Jaap Goedendorp, Martine M. Kalkman, Joke S. Strik-Albers, Riet van Alfen, Nens van der Werf, Sieberen P. Voermans, Nicol C. van Engelen, Baziel G. Knoop, Hans
Citation
Menting, J., Tack, C. J., Bleijenberg, G., Donders, R., Droogleever Fortuyn, H. A., Fransen, J., . . . Knoop, H. (2018). Is fatigue a disease-specific or generic symptom in chronic medical conditions? Health Psychology, 37(6), 530-543.
http://dx.doi.org/10.1037/hea0000598

Abstract

Objective:

Severe fatigue is highly prevalent in various chronic diseases.

Disease-specific fatigue models have been developed, but it is possible that fatigue-related factors in these models are similar across diseases.

The purpose of the current study was to determine the amount of variance in fatigue severity explained by:
(a) the specific disease,
(b) factors associated with fatigue across different chronic diseases (transdiagnostic factors), and
(c) the interactions between these factors and specific diseases.

Method:

Data from 15 studies that included 1696 patients with common chronic diseases and disorders that cause long-term disabilities were analyzed.

Linear regression analysis with the generalized least-squares technique was used to determine fatigue-related factors associated with fatigue severity, that is, demographic variables, health-related symptoms and psychosocial variables.

Results:

Type of chronic disease explained 11% of the variance noted in fatigue severity.

The explained variance increased to 55% when the transdiagnostic factors were added to the model.

These factors were female sex, age, motivational and concentration problems, pain, sleep disturbances, physical functioning, reduced activity and lower self-efficacy concerning fatigue.

The predicted variance increased to 61% when interaction terms were added.

Analysis of the interactions revealed that the relationship between fatigue severity and relevant predictors mainly differed in strength, not in direction.

Conclusions:

Fatigue severity can largely be explained by transdiagnostic factors; the associations vary between chronic diseases in strength and significance.

This suggests that severely fatigued patients with different chronic diseases can probably benefit from a transdiagnostic fatigue-approach which focuses on individual patient needs rather than a specific disease. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
 
Only looked at the abstract.

Fatigue severity can largely be explained by transdiagnostic factors; the associations vary between chronic diseases in strength and significance.
Click to expand...

Are they claiming associations are explanations? Seems odd when the associations are between things like 'fatigue', 'reduced activity', 'concentration problems', etc.

It's like a doctor saying 'we have an explanation for your fatigue - you have chronic fatigue syndrome'. Fatigue can be explained by the symptoms of fatigue.
 
Dolphin said:
Type of chronic disease explained 11% of the variance noted in fatigue severity.

The explained variance increased to 55% when the transdiagnostic factors were added to the model.

These factors were female sex, age, motivational and concentration problems, pain, sleep disturbances, physical functioning, reduced activity and lower self-efficacy concerning fatigue.
Click to expand...
I honestly can't believe what I'm reading here. Unbelievably, these authors have "explained" the variance in self-reported fatigue using measures that heavily overlap with self-reported fatigue. How ridiculous to present lower physical function and reduced activity as causes of fatigue.

Can't believe how far up their own ****s these researchers are. It really is appalling. This piece should never have been published; Health Psychology should be ashamed of themselves.
 
How can we put a stop to this? There is clearly a systemic problem with researchers just spewing self serving bullshit instead of doing a proper job.

You don't need to read their studies anymore because you know that the conclusion will inevitably be: CBT can treat everything effectively and everyone needs CBT. Children need CBT at school to do well, adults need CBT to do well at work and in private life, patients with medical illnesses need CBT for their fatigue, patients with mental illnesses need CBT for their thoughts and emotions and so on.

If they could, they would create a huge CBT empire with themselves on top, reaping all the profits.
 
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I had to look up the definition of "transdiagnostic factors". It seems to mean that certain symptoms can be found across a number of conditions and used mostly in psych disorders by the look of it. For instance PTSD diagnostic factors overlap with the symptoms that are diagnostic of depression. That sort of thing. I'm having a little more trouble trying to put that fairly reasonable concept onto this.

Are they saying that a large amount of fatigue in chronic illnesses are 'generic' as the title suggests. I can understand that some fatigue is specific to a disease such as muscle weakness in degenerative neuromuscular diseases, for example, or tremor in Parkinsonism. Then there would be symptoms that all of the diseases have and it is these ones that can be described as 'generic' and thereby treated similarly in all patients, just as depression has the same characteristics and can be treated the same way in many different illnesses. Surely they're not saying it's just overlapping with chronic fatigue! Surely!

I really don't get what's with the mention of "female sex"? As much as it may be statistically significant, how is it a diagnostic factor of fatigue?
 
Well, as someone who has an underactive thyroid, been very anaemic lots of times and has ME, I can tell you that not all fatigue is the same.

All three feel markedly different. Okay, we don't know what to do about ME yet, beyond pacing and not exercising, but it's no good treating anaemia related fatigue and underactive thyroid fatigue as the same. Unless they don't want patients to get better....
 
strategist said:
How can we put a stop to this? There is clearly a systemic problem with researchers just spewing self serving bullshit instead of doing a proper job.

You don't need to read their studies anymore because you know that the conclusion will inevitably be: CBT can treat everything effectively and everyone needs CBT.
Click to expand...

Probably would still be helpful to have people reading them carefully, writing letters to journals pointing out the problems, etc? It is dispiriting that standards in journals aren't already higher, and letters are such a poor why of having any meaningful debate, but if they keep coming, and the researchers never have worthwhile responses, hopefully that will help increase people's scepticism over time.
 
jeckylberry said:
I really don't get what's with the mention of "female sex"? As much as it may be statistically significant, how is it a diagnostic factor of fatigue?
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The implication is that if you can link a symptom to female gender, then in many of these people's minds that proves it is psychological. Because women are believed to be more prone to somatisation.

There are female coauthors on this article. I can't understand why they buy this patronising and mysogynistic bullshit. Perhaps the men have the excuse of ignorance. The women don't - shame on you for signing your name to this garbage!
 
Invisible Woman said:
They really don't think much of women do they?
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Fixed it for you.

Woolie said:
Perhaps the men have the excuse of ignorance.
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Well, we used to, and probably not even then. It's not like women are a recent invention. It's more that men just haven't ever been bothered to actually read the instruction manual. But women already knew that.
 
Woolie said:
There are female coauthors on this article. I can't understand why they buy this patronising and mysogynistic bullshit. Perhaps the men have the excuse of ignorance. The women don't - shame on you for signing your name to this garbage!
Click to expand...

I think this happens the same way a lot of healthy people, regardless of sex, seem to find comfort in psychological explanations for ME - if it’s in our heads that means they probably won’t get it themselves, or at least they can tell themselves they would be able to ‘snap out of it’ with some positive thinking and mindfulness. Health risk denial 101.
 
strategist said:
How can we put a stop to this? There is clearly a systemic problem with researchers just spewing self serving bullshit instead of doing a proper job.

You don't need to read their studies anymore because you know that the conclusion will inevitably be: CBT can treat everything effectively and everyone needs CBT. Children need CBT at school to do well, adults need CBT to do well at work and in private life, patients with medical illnesses need CBT for their fatigue, patients with mental illnesses need CBT for their thoughts and emotions and so on.

If they could, they would create a huge CBT empire with themselves on top, reaping all the profits.
Click to expand...
IAPT roll out
 
A Letter to the Editor Regarding Menting et al. (2018)
Ali, Matcham, Irving, & Chalder

We read with interest the recently published article by Menting et al. (2018). This study has
made a significant contribution to the field by providing evidence that fatigue severity in the
context of several different chronic illnesses can be explained by a number of transdiagnostic factors.
We would like to point the authors, and the readers of this journal, to our earlier study (Ali,
Matcham, Irving, & Chalder, 2017), which reported similar findings. In this study we
investigated fatigue and a number of psychosocial variables in participants with a range of
different autoimmune rheumatic disease (ARD) diagnoses, including rheumatoid arthritis
(RA), seronegative spondyloarthropathy (SpA) and connective tissue disease (CTD) as well
as participants with chronic fatigue syndrome (CFS). We compared the RA, SpA and CTD
groups with each other.

There were no significant differences between them in terms of fatigue, social adjustment, or cognitive-behavioural responses. In other words the responses were transdiagnostic. We therefore combined the RA, SpA and CTD groups into a larger ARD group and compared this with the group of participants with CFS. We found that both ARD and CFS groups showed significant associations between fatigue and symptom-related cognitions and behaviours such as fear-avoidance beliefs and symptom focusing. The associations varied in strength and significance, a finding highlighted by Menting et al.(2018).

This suggests that cognitive-behavioural responses maybe important in the perpetuation of fatigue for all disorders and are therefore transdiagnostic. One particular exception was that CFS patients reported higher levels of lack of acceptance of symptoms than ARD patients, suggesting a need to consider specific factors.
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full letter here:
http://www.apa.org/pubs/journals/features/hea-letter-to-editor-menting-2018.pdf
 
This study has
made a significant contribution to the field by providing evidence that fatigue severity in the
context of several different chronic illnesses can be explained by a number of transdiagnostic factors.
Click to expand...

So Chalder's also claiming this research means that fatigue severity can be explained.

That sounded like BS:

Esther12 said:
Only looked at the abstract.
Are they claiming associations are explanations? Seems odd when the associations are between things like 'fatigue', 'reduced activity', 'concentration problems', etc.

It's like a doctor saying 'we have an explanation for your fatigue - you have chronic fatigue syndrome'. Fatigue can be explained by the symptoms of fatigue.
Click to expand...

Am I going to have to read this paper? I really don't want to. It looks like such worthless drivel.
 
Also, can someone please remind them that some ME patients do not have chronic fatigue, they have energy deficits and many other symptoms. Fatigue is not a universal issue, just a common one and easily identified in a five minute medical interview. Energy related issues, which can include fatigue, are however mandatory.
 
We found that both ARD and CFS groups showed significant associations between fatigue and symptom-related cognitions and behaviours such as fear-avoidance beliefs and symptom focusing... This suggests that cognitive-behavioural responses may be important in the perpetuation of fatigue for all disorders and are therefore transdiagnostic.
Click to expand...
'We found people who report worse fatigue report focusing more on their fatigue and report more avoidance of doing things that they feel exacerbates their fatigue. Therefore, if they stop focusing on their fatigue and don't avoid things that they feel exacerbate their fatigue, they will be less fatigued.'

I'm not sure about this logic. Let's try it with something else.

'We found that people with worse congestive heart failure report focusing more on their heart failure and report more avoidance of doing things that they feel exacerbates their heart failure symptoms. Therefore, if they stop focusing on their heart failure and don't avoid things that they feel exacerbate their heart failure symptoms, they will have less congestive heart failure.'

Okay, logic checks out. Carry on.
 
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