NHS: The Improving Access to Psychological Therapies Manual, June 2018

adambeyoncelowe said:
More recent studies put co-morbid mood disorders at about 40% in ME, which is comparable to other chronic illnesses.
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The problem with some studies is that they use questionnaire where the questions are not designed to separate not being able to do stuff from not wanting to do stuff. So things like HADS is bad at this. It has the depression quesions
The items that relate to depression are:

  • I still enjoy the things I used to enjoy
  • I can laugh and see the funny side of things
  • I feel cheerful
  • I feel as if I am slowed down
  • I have lost interest in my appearance
  • I look forward with enjoyment to things
  • I can enjoy a good book or radio or TV programme
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So the ones I've bolded could be due to illness or being depressed and hence any research based on these questions will be wrong. So there is bad research out there that inflates the figures.
 
chrisb said:
That is useful. I think that what I was trying to show is that this problem was known to the creators of this whole house of cards, and should not now come as surprise.
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I think part of the problem is the questionnaires that always get used. They claim to be measuring certain aspects of 'fatigue', but psychologists interpret some answers as signs of depression.

I think it's probably also the case that a person may have one or two symptoms that overlap with a mood disorder, and researchers (lazily) assume this means they have a full mood disorder. It's like how Crawley now uses the symptom of 'chronic disabling fatigue' to stand in for CFS in her studies.
 
Adrian said:
The problem with some studies is that they use questionnaire where the questions are not designed to separate not being able to do stuff from not wanting to do stuff. So things like HADS is bad at this. It has the depression quesions


So the ones I've bolded could be due to illness or being depressed and hence any research based on these questions will be wrong. So there is bad research out there that inflates the figures.
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Oops! Our posts crossed. This, too. HADS is a problem, as is the Chalder Fatigue Scale and similar questionnaires which supposedly capture 'mental' fatigue as well as physical fatigue.
 
I've pulled up these links from the big MUS, PPS and IAPT thread on another platform:

https://forums.phoenixrising.me/ind...pening-across-the-uk.48710/page-6#post-802239


Some of these "early implementer" sites had included development of services for CFS and ME:

https://www.england.nhs.uk/mental-health/adults/iapt/mus/


"Call to bid" document from December 2016 included bids for developing services for MUS, LTCs, IBS and CFS.

https://www.england.nhs.uk/wp-content/uploads/2016/12/mental-health-call-to-bid.pdf

Page 3:

bid-call.png



https://www.ncbi.nlm.nih.gov/books/NBK83456/

6.1.1. Definitions of low-intensity interventions
Although there is no agreed definition on exactly what constitutes a low-intensity intervention they share several common characteristics. Low-intensity interventions use fewer resources (virtually none in the case of non-facilitated self-help) in terms of healthcare professional time than conventional psychological therapies. However the interventions are not necessarily less intensive (for example, the time taken to go through the self-help materials) for the individuals using them. These interventions are often delivered and/or supported by mental health workers without formal mental health professional training, who have been specifically trained to deliver low-intensity interventions (including primary care graduate mental health workers and psychological wellbeing practitioners).


https://www.healthcareers.nhs.uk/ex...ical-therapies/roles/high-intensity-therapist

High-intensity therapists
 
Not sure if this was noticed and discussed when it came out but the IAPT Manual links to this:
NATIONAL CURRICULUM FOR CBT IN THE CONTEXT OF LONG TERM PERSISTENT AND DISTRESSING HEALTH CONDITIONS Version 2.0 June 2017

Which includes a unit on CFS/ME and these under "Competences to be demonstrated in this unit":
Ability to draw on knowledge of factors considered to contribute to the development of CFS/ME (including physical illness/ serious infections (such as glandular fever), lifestyle, stress, perfectionism and distress)

Ability to draw on knowledge of factors considered to maintain CFS/ME (such as patterns of activity characterised by boom and bust cycles, unhelpful fear avoidance beliefs leading to avoidance of activity), attentional biases towards symptoms) and how these link to physiological mechanisms including poor sleep and deconditioning

Ability to ensure that a focus on graded exercise is integrated into the intervention​
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Anyways, I just wanted to make a record of this. I'm not surprised this is still being taught to CBT therapists, but I'll never stop being shocked.
 
Gecko said:
Not sure if this was noticed and discussed when it came out but the IAPT Manual links to this:
NATIONAL CURRICULUM FOR CBT IN THE CONTEXT OF LONG TERM PERSISTENT AND DISTRESSING HEALTH CONDITIONS Version 2.0 June 2017
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A nice demonstration of just how transparent the bullshit is (to mix metaphors) when you see how they chat about it. Not only should the student know the non-facts but they should be able to draw on this knowledge. Presumably that means deciding that it was the perfectionism that caused Mary's ME and telling her so - very useful no doubt. In other words demonstrating superior knowledge to patients in such a way as to make them feel small - what they call empathising I think.
 
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