Is there an association between insecure attachment & symptom severity in FSDs, & what is the role of mentalized affectivity, 2022, Airey

The ethics approval document is included as Appendix B in the thesis.

The ethics documents include this:
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Background and justification

Many people suffer from conditions such as chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia that have no simple medical explanation. Together, they are known as ‘Functional Somatic Disorders’ or FSD, and a combination of biological, social and psychological factors are thought to be important in understanding how they occur. These conditions are common, with up to a third of all consultations in primary care including FSD, and cause significant distress in those who suffer from them. A lack of understanding by medical professionals along with a lack of effective treatments often results in quite negative experiences of health care for people with FSD. There is little research about how FSD affect people who are older although some studies suggest that FSD can substantially lower quality of life for older people and increase the frequency with which they use health services.

‘Attachment’ describes the emotional connection that we make with other people. The ability to do this develops in infancy but is also affected by what happens to us later in life. In ideal circumstances, secure attachment allows the development of biological, social and psychological processes that help us to manage stress and cope with difficult experiences. There is evidence that these processes have been disrupted for people with FSD which causes their attachments to be less secure and changes how they experience distress. One possible consequence is that difficult experiences are not processed as emotions but are instead processed by the body as the physical symptoms that constitute an FSD. It has also been proposed that the distress caused by FSD symptoms contributes to making attachment less secure and perpetuating a vicious cycle.

The purpose of this study is to investigate whether there is a relationship between attachment security and severity of FSD symptoms and whether this can be explained by differences in the way emotions are processed, using the concept of ‘mentalized affectivity’. Depression and anxiety are often comorbid with FSD and the study will also explore this relationship further. The study will focus on people over the age of 45 because there is a lack of research regarding FSD in this age group, possibly because physical symptoms in older people are often assumed to be part of aging or other conditions. Understanding the factors that underly FSD is important as it may lead to more effective treatments that can help the many people whose lives are affected by these debilitating conditions.

The overall research aim is to investigate whether mentalized affectivity can explain the relationship between insecure attachment and FSD.
Research questions:
1. Does mentalized affectivity mediate the relationship between insecure attachment and severity of somatic symptoms in FSD?
2. Does mentalized affectivity mediate the relationship between attachment and depression/anxiety?
3. How is the proposed mediation model impacted by age?
4. Which of the three subcomponents of mentalized affectivity (identifying, processing and expressing emotions) plays the greatest role in any mediation?
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Procedure
Promotional materials will invite those interested in taking part in the study to follow a weblink to the online survey.

The online survey will consist of the following stages:
 Initial participant information sheet – appendix 2
 Consent form – appendix 3
 Providing demographic data – appendix 4
 Indicate which FSD they identify with and how long they have had these symptoms – appendix 5

 Complete the following standardised psychological measures:

o Experiences in close relationships-revised (ECR-R) (Fraley, Waller, & Brennan, 2000) – appendix 6

o The mentalized affectivity scale (MAS) (Greenberg et al., 2017) – appendix 7

o 15-item somatization module from the Patient Health Questionnaire (PHQ-15) – appendix 8

o Brief Illness Perceptions Questionnaire (Brief IPQ) (Broadbent, Petrie, Main, & Weinman, 2006) – appendix 9

o Depression Anxiety Stress Scales-21 (DASS-21) – appendix 10

 A debrief page – appendix 11

It is estimated that the surveys will take approximately 30 to 45 minutes to complete and will include the option to partially save and complete later.
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Edit: I looked for the appendices with the copies of the questionnaires, but they aren't there.

 

I wrote a brief email to Stuart Airey, the PhD student who did this research. He sent me a friendly reply and explained that having completed his PhD he is now working as a clinical psychologist, and not intending to do any further ME research. It therefore seemed pretty pointless to try to pick apart his thesis.

I sent him this:

Hi Stuart,

Thank you...[I've deleted an irrelevant bit]

I guess my main problems with your research are the assumption that ME/CFS is correctly classed as FSD. And the assumption that always seems to follow that if there is no clinical test in physical medicine to 'prove' we have a physical disease, the disease must have psychosocial aetiology. That may be the consensus among a relatively minor part of the medical world in their psychiatric / psychosomatic corner, however it is widely recognised by medical researchers and authorities such as NICE and the CDC as a physical disease.

ME/CFS is not just fatigue, it is specifically defined to include, among many other symptoms, post exertional malaise which can be demonstrated by 2 day cardio pulmonary exercise testing. Recent research on new onset ME/CFS among college students following EBV infection showed pre-tested psychological factors did not contribute to the development or severity of ME/CFS. Treatments based on the biopsychosocial model, namely graded exercise therapy and cognitive behavioural therapy do not work and in many cases make people with ME/CFS much sicker.

One can only conclude from those few pieces of information and the thousands of other studies, that psychology and psychiatry have no place in the diagnosis, study, interpretation, or treatment of ME/CFS. (Though of course people with comorbid psychiatric conditions may be helped by psychiatry or clinical psychology). I think you will be unsurprised by the vehemence with which I make this statement, given the gaslighting and harmful psych treatments we have been subjected to for over 30 years.

Also ME/CFS only has a prevalence of about 0.4% (increasing rapidly now with Long Covid) and in my experience among many people with ME/CFS, many of us are both too sick to make use of health services and are so badly treated and disbelieved that we avoid the NHS as much as possible. So the image your work portrays of ME/CFS as common and making high demands on the health service is false.

So from all that you can surely see that your papers in your thesis simply do not make any sense to someone with ME/CFS, especially, as in my case and others I discussed it with, I found the questionnaires totally inappropriate and not accurate indicators of the factors they purported to measure, for reasons I have already spelled out to you. Of course being very sick for many years has an impact on relationships. That is true for any chronic disabling disease. But this method of research cannot, by design, elucidate particular impacts accurately or provide new and useful information.

I can see that this is all pretty irrelevant to you now. You have used the goodwill of hundreds of sick people filling in your useless questionnaires in order to easily collect a mass of data that you could use to demonstrate your ability to crunch data and draw conclusions, even if those conclusions are almost completely meaningless and may lead to misuse to support inappropriate therapies.

I nearly deleted that last paragraph. I know it sounds harsh. I do understand that you had hoops to jump through in order to get your PhD and that your intention was good in terms of trying to find out useful information. My argument is not really with you personally, but with the way academic psychologists, CBT therapists and psychiatrists misuse inappropriate questionnaires to forward their own careers and bolster their prejudices, rather than doing the sort of studies patients actually want, which might contribute to better understanding and better care.

I guess my remarks would be better addressed to your supervisor rather than to you. I have therefore CC'd Tim Bird. There is, for example, a real need to design, in collaboration with expert patients, better instruments for measuring clinically meaningful improvement in clinical trials, and for assessing the effectiveness or otherwise of current clinics and care. There is a huge unmet need for better medical and personal care and support for people with ME/CFS.

Perhaps the most useful study psychologists and sociologists could do to help people with ME/CFS would be to study the views of their fellow clinicians of all specialisms about people with ME/CFS, and to tease out what it is in the personality and/or training of clinicians that leads them to gaslight us and insist their harmful therapies work. The history of treatment of people with ME/CFS is truly shocking. We have been accused of being militant activists, of threatening researchers, of not wanting CBT because we are prejudiced about mental illnesses, and we have been persuaded to exercise which made us much sicker etc etc. The story is horrific and is still going on.

That's quite enough from me. I wish you and your family well and will not bother you further. If Tim Bird wishes to continue the conversation, particularly if he as other students studying ME/CFS, he is welcome to do so.

Best wishes,

Trish