Mediation analysis re: cognitive behavioural therapy in Q fever fatigue syndrome, 2019, Knoop et al

Dolphin

Dolphin

Senior Member (Voting Rights)
https://www.sciencedirect.com/science/article/abs/pii/S0022399919305410

Journal of Psychosomatic Research
Available online 23 October 2019, 109841
In Press, Journal Pre-proof
What are Journal Pre-proof articles?

Mediation analysis shows that a decline in self-efficacy mediates the increase in fatigue severity following an initial positive response to cognitive behavioural therapy in Q fever fatigue syndrome
Evi M.C.Breukersa
Ruud P.H.RaijmakersabP.T.NieuwkerkcGijsBleijenbergaJos W.M.van der MeerabChantal P.Bleeker-RoversabStephan P.KeijmelabHansKnoopcd
https://doi.org/10.1016/j.jpsychores.2019.109841Get rights and content

Highlights


•
The decrease in fatigue severity in patients with QFS during CBT is mediated by an increase in self-efficacy.

•
The relapse in fatigue severity after cessation of CBT is partly mediated by a decrease in self-efficacy following treatment.

•
The findings suggest that booster sessions, following completion of treatment and aimed at durable changes of dysfunctional fatigue beliefs, might be a useful approach to improve the long-term effectiveness of CBT in QFS.



Abstract
Objective
Q fever fatigue syndrome (QFS) is characterized by chronic fatigue following acute Q fever. Previously, it was shown that cognitive behavioural therapy (CBT), and not doxycycline, was significantly more effective than placebo in reducing fatigue severity in QFS patients. However, this effect was not maintained after one year. The aim of this study is to elucidate the cognitive and behavioural variables which mediate the positive effect of CBT on fatigue during the treatment and the relapse of fatigue after completion of CBT, by using multiple mediation analysis.

Methods
Additional analyses were performed on data of a randomized controlled trial that investigated the efficacy of CBT and antibiotics compared to placebo for QFS (Keijmel et al., 2013a [1]). Only those patients in the CBT group who completed the allocated CBT treatment, and those patients in the medication group who did not follow additional CBT during follow-up, were included in this study. Two mediation models were tested, using respectively assessments at baseline and end-of-treatment (EOT), and EOT and follow-up, comparing the CBT group (n = 43) with the medication group (n = 89).

Results
During treatment, the decrease in fatigue brought on by CBT was completely mediated by an increase in self-efficacy with respect to fatigue. A reduction in self-efficacy partly mediated the increase in fatigue at follow-up in the CBT group.

Conclusions
Given the decline in self efficacy, booster sessions focussing on restoration and maintenance of self-efficacy with respect to fatigue, may lead to elongation of the initial positive effects of CBT for QFS.

Keywords
CBT
Cognitive behavioural therapy
Coxiella burnetii
Mediation analysis
Q fever fatigue syndrome
Treatment
Click to expand...
 
This is so damn pathetic. How are people not embarrassed enough to bury this putrefied corpse and let it rot there where it belongs? Decades of doing the exact same 2 pieces of research with small variations, loads and loads of speculation and poor attempts at justifying that it's not the treatment that failed the patients it's the patients that failed the treatment. In the end all it will do is associate their precious CBT with so much quackery it will be entirely discredited because of the overabundance of nonsense surrounding it all.

Such a level of incompetence is almost exaggerated, it belongs in satirical accounts. There are many alternative medicine practitioners out there who wouldn't even dare be this ridiculous, have too much self-respect for it and understand the limits of their practice.

Knoop is a lost cause, whatever, quacks are a dime a dozen, but continuing to sanction his work and allowing him to keep a medical license is plain malpractice.
 
Mithriel said:
And what do they mean by self efficacy?
Click to expand...
Ironically in this context it is interchangeable with dis/ability so basically they are pointing at disability caused by illness being the problem but because of a belief system that rejects this they invent a magical explanation instead and run with it and use hand-wavy words that can mean anything.

Exactly like every other pseudoscience out there does. But they can't see that. Even when they deride those pseudosciences doing the same thing they are doing. Dunning-Kruger at work, which clearly has little to do with intelligence but rather wisdom since so many otherwise smart people seem to act exactly as bad as the dumbest out there. The common link is an aggressive inability for self-reflection.
 
From Wikipedia:
https://en.wikipedia.org/wiki/Self-efficacy

Self-efficacy is, according to psychologist Albert Bandura who originally proposed the concept, a personal judgment of "how well one can execute courses of action required to deal with prospective situations".[1] Expectations of self-efficacy determine whether an individual will be able to exhibit coping behavior and how long effort will be sustained in the face of obstacles
Click to expand...

Self-efficacy affects every area of human endeavor. By determining the beliefs a person holds regarding their power to affect situations, it strongly influences both the power a person actually has to face challenges competently and the choices a person is most likely to make. These effects are particularly apparent, and compelling, with regard to behaviors affecting health
Click to expand...

My interpretation in this context is they ask you questions about whether you think you are able to cope with your pain, then they ask you how bad the pain is. Not surprisingly those who say they can cope report less pain.

Seems like magical thinking on the part of the psychologists to me.

Doesn't seem to occur to them that all they are doing is persuading people to fill in questionniares to get the 'right' answer.
 
Snow Leopard said:
Behaviour of participants answering on one questionnaire is associated with similar bias in behaviour on a related questionnaire! Wow, what a ground breaking finding!

A finger pointing to the sun is not the sun itself.
Click to expand...
Not sure how well the movie is known outside of the French world but I love this similar (roughly translated) quote from Amélie Poulain:
When a finger is pointing up to the sky only a fool looks at the finger
Click to expand...
These people aren't just obsessing over the finger, they built an entire belief system out of the finger being the only thing that exists and the sky being the illusion.

This isn't regular foolishness, it's advanced foolishness.
 
James Morris-Lent said:
Hopefully we are, in fact, at Rock Bottom.
Click to expand...
Probably, considering it's been the same tune for 30 years, itself not much different than the stuff in the decades that preceded it. At least being stuck in deep ruts means it's hard to spoil any more places.

Probably the latest innovation was being openly deceitful about it, the whole pretending to acknowledge what patients report but only to build (and then destroy) trust. FND is probably the most blatant about it, saying one thing in public and the complete opposite in "private", except it's not entirely private. But even that dates back to early 20th century so it's more like bringing old tunes as sampled remixes.

I get a mental image of Vanilla ice explaining how the beginning of Ice ice baby is different from Under pressure: "it's dun-dun-dun-tsss, not dun-dunn-dun-tsss, completely different, see music is hard to tell apart* when you're not an expert." (*it's not, we see right through you)

Lately I've seen some discussion about trying different times, like maybe doing the gaslighting early on would be beneficial, but kind of hard after having invented the 6 months of fatigue diagnosis, making early intervention basically ignore what they spent decades to build up. Not that I expect anyone other than us would object to the blatant hypocrisy and inconsistency.
 
You must log in or register to reply here.
Back
Top Bottom