Prevalence and Treatment of Chronic Fatigue Syndrome/ME and Co-morbid Severe Health Anxiety, 2019, Daniels et al

Sorry. I was deliberately obscure. There is a delicate balance to hold, and I do not propose to say more. Apologies if it leaves you confused.

 

Ahaa... No worries

 

Agreed. Most of us chronically avoid the GP for years on end. They have made it rationale, albeit also increasing risks as a consequence.

 

The whole thing is very confused because it speaks of co-morbid depression and anxiety on a model that essentially frames CFS as health anxiety leading to depression. Or something like that, it's very vague and confused.

So I guess we can add "co-morbid" to the list of words that had to be stripped of all useful meaning. Which kinda makes me think we may need to do a urban dictionary type of modifified definitions in the BPS model.

 

Sadly, this is the only absurd trial that has been successfully stopped in its tracks. I'm not even sure it's actually the worst of them all, but this is the only one that was killed by ridicule.

This happened not long before Daniels was approved on the NICE committee. Real nice slap to the face, pun you very much.

 

Daniels was (presumably) featured on an article. Pretty sure it's her. She has a rare disease that requires constant eye drops made from male blood (for a specific protein, I think) or she will lose her sight.

So her life depends on good science and medicine while she works hard at denying both to us. Which is frankly vile, but to each their own.

 

I posted some reasons for concern about this paper, but I think we should stay away from any personal stuff about other peoples' health problems.

 

So this study wanted to test wether health anxiety is a signfificant factor in ME/CFS, one that perhaps should get more attention in treatment. It is interesting that they say:

So a focus on health anxiety is proposed as a way to increase the efficacy of CBT.

Both the 14-item Short Health Anxiety Inventory and the 14-item Hospital Anxiety and Depression Scale indicated that around 40% of their large sample ( n = 172) met the clinical cut-off for definite case health anxiety.

But when they looked at regression and correlations, anxiety added only 3.2% to the model for physical function when fatigue and depression were controlled for and it wasn't a predictor at all in the model for fatigue. That doesn't seem like health anxiety is an important factor in determining disability, contrary to their hypothesis.

The changes seen in the 10 patients who received CBT for health anxiety were remarkable: a reduction of 11 points on the Chalder fatigue scale: patients went from severely fatigue to almost normal scores.

 

https://twitter.com/user/status/1274262112223756288

 

You can have a severe nerological disorder and severe health anxiety, what would be surprising about that?

 

Trial By Error: Now There’s CBT for ‘Health Anxiety’ in CFS, https://www.virology.ws/2020/07/02/trial-by-error-now-theres-cbt-for-health-anxiety-in-cfs/

 

David Tuller:

Reminds me of a 'safe-cruise-across-the-atlantic'-analogy.

 

That this CBT for health anxiety is so similar to the PACE trial CBT reveals they believe that the substance of the idea is correct and only cosmetic changes are needed.

I didn't look closely but the same is probably true for how they go about testing the treatment.

I'm tempted to make a joke about false beliefs perpetuating vicious cycles .

 

David Tuller:

Can't access their own previous work Daniels et al cite to check whether they referred to PACE there. Or to the Cochrane review on CBT?

Also it's hard to check how they deal with potential inconsistencies in the findings on (health) anxiety in the abundance of Crawley's and other PACE adherents' papers.

Don't know where to put the following, but could fit here to compare the findings with the Crawley/White prospective treatment study (2013) Keith twittered about:

https://twitter.com/user/status/1278436125141536772

Code:

https://twitter.com/keithgeraghty/status/1278436125141536772

(Didn't check whether Keith spotted the correction [the one on factual errors not the one on ethical appoval -- all a bit confusing with those studies co-authored by Crawley and Sterne ...])

https://academic.oup.com/qjmed/article/106/6/567/1541333

From the paper:

E Crawley, S M Collin, P D White, K Rimes, J A C Sterne, M T May, CFS/ME National Outcomes Database, Treatment outcome in adults with chronic fatigue syndrome: a prospective study in England based on the CFS/ME National Outcomes Database, QJM: An International Journal of Medicine, Volume 106, Issue 6, June 2013, Pages 555–565, https://doi.org/10.1093/qjmed/hct061

Edit: Thread on the Crawley/White/ Sterne study here.

 

and the best line is.........
"CBT-HA is simply the PACE CBT strategy in lipstick and a tutu"

 

I suppose we should be grateful to these ubermensch for explaining to us our frailties.

When my stomach is stronger I must try to reread the chapter by Salkovskis and Bass on Hypochondriasis in the Science and Practice of Cognitive Behaviour Therapy. It looks to cover the same ground. You'll remember the book. It's the one in which Sharpe said he knew of patients who have recovered after a single telephone conversation that enabled them to reconceptualise their illness, reduce their fear of symptoms, and overcome their avoidance. And this was CFS he was talking about. Page 400 if you don't believe me.

Gelder has a lot to answer for.

 

yes that did occur to me.