Psychometric properties of the Cognitive and Behavioural Responses Questionnaire (CBRQ) in adolescents with CFS, 2019, Loades, Chalder et al

Andy said:
Err, what? There's presumably something I'm not understanding, because that would seem to confirm that their questionnaire isn't valid for CFS, but is for depression. Or is it just the same topsy-turvey logic that the BPSers tend to use anyway?
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Following the underwear stealing gnomes model:
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The secret is step 2 is using your imagination. Also: "it's valid because we like it".
 
chrisb said:
It is interesting that they seem to have introduced a dichotomy in discussing "cognitive and behavioural responses to symptoms". This is becoming complicated. It was beyond difficult when there were just cognitive and behavioural symptoms to consider. How do they distinguish the symptoms from the responses, and are the responses just a new set of symptoms?
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Obviously, you ask the unicorn to smoke signal the angels dancing on hairpins, then use the seer crystals to reflect onto one of those illusion paintings and if you squint hard enough you can just see the outline of the magical 8-ball that points to the proper constellation alignment that will spell the distinction very clearly.

That's just basic sciencey stuff, pay attention.
 
Andy said:
The CBRQ scores were strongly associated with depression, anxiety, school and social functioning, but weakly associated with fatigue and physical functioning, providing evidence of validity.
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Err, what? There's presumably something I'm not understanding, because that would seem to confirm that their questionnaire isn't valid for CFS, but is for depression. Or is it just the same topsy-turvey logic that the BPSers tend to use anyway?
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Although it doesn't state evidence of validity for what, I assumed they are saying it's valid for assessing depression etc, and coyly avoiding saying it is not valid for CFS.
 
https://www.cambridge.org/core/serv...ng_patients_with_chronic_fatigue_syndrome.pdf
This may accentuate any embarrassment over symptoms or fears that symptoms may get out of control. Such reactions, when combined with a tendency towards avoidant responses may contribute to an increasing spiral of avoidance of all social situations including work.
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Ermmm am I barking up the wrong tree here, (edit but to) by the way I interpret that statement is that we are embarrassed by/fear symptoms and we then use avoidance of both work and social situations? Please tell me I read this wrong lol. It just seems unbelievable!
 
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Meanwhile evidence that CFS is perpetuated by thoughts and behaviours is yet to be produced.

The tricky part is showing that these thoughts and behaviours are not a normal or appropriate response to being ill. You have to take all the factors that are specific to ME/CFS into account. The high impact of the illness, the uncertainty and skepticism, the hopelessness, the way society views people that don't do much during the day.
 
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arewenearlythereyet said:
I don’t know why I’m doing this to myself but I searched through the claimed validation of the questionnaire with PWCFS (ref 29). Guess what I found:



So what we have is a lack of transparent reporting ..since the reference 29 claiming that the questionnaire is validated actually takes you to another churned out report (on a separate subject) also using the questionnaire . The reference isn’t about validation of the questionnaire as claimed rather the reference paper infers the same but this takes you to a request for information from the author. So it can only be proven as true if you can access the data which conveniently is controlled via a request to T Chalder.

This is not very transparent ..in fact I would say it is highly misleading. If it’s validated why not let people see the results of the validation?

Full paper here if you can bear to read it:

https://www.cambridge.org/core/serv...ng_patients_with_chronic_fatigue_syndrome.pdf
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One for those on NICE guidelines group to highlight.
 
Validated against what? They didn't ask patients whether they thought the questions made sense or whether they represented their illness experience. They didn't validate against any objective measures of functioning. Their "validity" is based on self-reference (similar bias applying to all the questions).
 
Snow Leopard said:
Validated against what? They didn't ask patients whether they thought the questions made sense or whether they represented their illness experience. They didn't validate against any objective measures of functioning. Their "validity" is based on self-reference (similar bias applying to all the questions).
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Yes that is what intrigued me in the first place...how you can validate Catastrophising for example ...the main problem I can see is it’s not even a word let alone something that can be measured as real ...it’s just a made up word to describe Trudies opinion of another person.
 
The submitted version of this article can now be seen here: SLAM_Paper_6_CBRQ_Psychometric_Properties_R2_BCP_v1.3_CLEAN.pdf (bath.ac.uk)
and the supplementary materials can be downloaded here:
Psychometric properties of the Cognitive and Behavioural Responses Questionnaire (CBRQ) in adolescents with chronic fatigue syndrome | Behavioural and Cognitive Psychotherapy | Cambridge Core

Here is the short form of the CBRQ:
Table 1. Items included on the 18-item CBRQ-S Item Label CBRQ Statement posed to participant with response options ‘strongly disagree’, ‘disagree’, ‘neither agree nor disagree’, ‘agree’, ‘strongly agree’

FA1 I am afraid that I will make my symptoms worse if I exercise

FA2 (R) My symptoms would be relieved if I were to exercise

DB4 The severity of my symptoms must mean there is something serious going on in my body

DB9 (R) Even though I experience symptoms, I don’t think they are actually harming me

DB10 When I experience symptoms, my body is telling me that there is something seriously wrong.

FA12 Physical activity makes my symptoms worse

SF5 I think a great deal about my symptoms

SF9 My symptoms are always at the back of my mind

SF12 I spend a lot of time thinking about my illness

EA1 I am embarrassed about my symptoms

EA2 I worry that people will think badly of me because of my symptoms

EA5 I am ashamed of my symptoms

CBRQ Statement posed to participant with response options ‘never’, ‘sometimes’, ‘quite often’, ‘very often’, ‘all the time’

AL1 I tend to overdo things when I feel energetic

AL2 I find myself rushing to get things done before I crash

AL3 I tend to overdo things and then rest up for a while

L2 I stay in bed to control my symptoms

L7 I tend to nap during the day to control my symptoms

L9 I sleep when I'm tired in order to control my symptoms

AL = All or nothing behaviour, EA = Embarrassment Avoidance Subscale, FA= Fear Avoidance Subscale, DB = Damage Beliefs Subscale, L = Avoidance/Resting Behaviour, SF = Symptom Focusing Subscale; Items denoted with ‘R’ are reverse scored
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See table S3 in the supplementary materials for how each subscale of the CBRQ correlates (or not) with measures like the Chalder Fatigue Scale and the Short Form 36 Physical Function scale. No subscale of the CBRQ correlates moderately or strongly with the Chalder scale at p<0.001.

Only one subscale of the CBRQ - the fear avoidance subscale - correlates moderately or strongly with the SF36PF - the fear avoidance subscale scale, and it correlates moderately and negatively, meaning that adolescents who report worse physical function agree more with FA1 and FA12 below and less with FA2 below (FA2 is scored in reverse):

FA1 I am afraid that I will make my symptoms worse if I exercise

FA12 Physical activity makes my symptoms worse

FA2 (R) My symptoms would be relieved if I were to exercise
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Which looks a lot like adolescents reporting more post-exertional malaise report worse physical function.

This is from the discussion:
It is a more surprising finding that the CBRQ total score did not correlate with physical functioning (SF36PFS)...It may be that the items on the SF36PFS, designed to assess activities of daily living in adults (e.g. the item ‘lifting or carrying groceries’), are not as relevant to adolescents. An item such as ‘lifting or carrying a heavy school bag’ may be more appropriate.
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Apart from fear avoidance/post-exertional malaise, none of the other subscales of these pesky beliefs we are saddled with correlate significantly with these pesky symptoms and disability we persist in reporting.

Did the whole CBT model just tumble down?
 
Those questions are completely ridiculous. I don't think there is a level of bias above this, it's not even pretending to be serious.
 
Table 1. Items included on the 18-item CBRQ-S Item Label CBRQ Statement posed to participant with response options ‘strongly disagree’, ‘disagree’, ‘neither agree nor disagree’, ‘agree’, ‘strongly agree’

FA1 I am afraid that I will make my symptoms worse if I exercise

FA2 (R) My symptoms would be relieved if I were to exercise

DB4 The severity of my symptoms must mean there is something serious going on in my body

DB9 (R) Even though I experience symptoms, I don’t think they are actually harming me

DB10 When I experience symptoms, my body is telling me that there is something seriously wrong.

FA12 Physical activity makes my symptoms worse

SF5 I think a great deal about my symptoms

SF9 My symptoms are always at the back of my mind

SF12 I spend a lot of time thinking about my illness

EA1 I am embarrassed about my symptoms

EA2 I worry that people will think badly of me because of my symptoms

EA5 I am ashamed of my symptoms

CBRQ Statement posed to participant with response options ‘never’, ‘sometimes’, ‘quite often’, ‘very often’, ‘all the time’

AL1 I tend to overdo things when I feel energetic

AL2 I find myself rushing to get things done before I crash

AL3 I tend to overdo things and then rest up for a while

L2 I stay in bed to control my symptoms

L7 I tend to nap during the day to control my symptoms

L9 I sleep when I'm tired in order to control my symptoms

AL = All or nothing behaviour, EA = Embarrassment Avoidance Subscale, FA= Fear Avoidance Subscale, DB = Damage Beliefs Subscale, L = Avoidance/Resting Behaviour, SF = Symptom Focusing Subscale; Items denoted with ‘R’ are reverse scored
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Feels like the prosecution's questions in a mediaeval witch trial.
 
Medicine by gotcha.

FA1 I am afraid that I will make my symptoms worse if I exercise​

Good example of how to bias from the start. Compare and contrast with this alternative, more neutral version:

FA1 I believe that I will make my symptoms worse if I exercise​

Which, in turn, is a separate question from why you hold that belief. A question studiously avoided by the BPS club.
 
Trish said:
Or even better:
When I exercise my symptoms worsen. It's not a fear or a belief, it's repeated experience.
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Indeed. What they are trying to do is portray the problem as being with our predictive mechanisms. But they have offered no robust proof that we are wrong, and given the consequences if they are wrong then the proof better be very robust indeed.

To repeat a story I have told here before: A friend of mine had persistent bowel problems, and had it all repeatedly written off as nothing important, and a psych issue. Until it was bowel cancer, diagnosed too late, and it killed them at 35 yo. This is in the Australian health system, which is supposed to be one of the best in the world.

I am guessing you all won't be surprised to learn my friend was female.
 
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