Preprint Putting the Vicious Cycle to the Test: Evidence for the Cognitive Behavioral Model of Persistent Somatic Symptoms from an Online Study, 2023, Sahm

[Dolphin]

https://psyarxiv.com/7c4yf/

Putting the Vicious Cycle to the Test: Evidence for the Cognitive Behavioral Model of Persistent Somatic Symptoms from an Online Study

Alexander H. J. Sahm1* , M.Sc., https://orcid.org/0000-0002-1401-4329 Michael Witthöft2 , PhD, https://orcid.org/0000-0002-4928-4222 Josef Bailer3 , PhD, https://orcid.org/0000-0002-2196-2482 & Daniela Mier1 , PhD, https://orcid.org/0000-0003-2518-7492

1 Department of Psychology, University of Konstanz, Konstanz, Germany
2 Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Mainz, Germany
3 Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg / Medical Faculty Mannheim, Mannheim, Germany

Abstract

Objective:

In clinical practice, persistent somatic symptoms are regularly explained using a cognitive-behavioral model (CBM).

In the CBM, predisposing, perpetuating, and precipitating factors are assumed to interact and to cause the onset and endurance of somatic symptoms.

However, these models are rarely investigated in their entirety.

Methods:

We conducted an online-survey during the Corona pandemic.

2,114 participants from the general German population completed a number of questionnaires that measured different factors of the CBM.

We used negative affectivity and neuroticism as predisposing factors, the fear of a COVID-19 infection as precipitating factor, and somatic symptoms, misinterpretation of bodily symptoms, attention allocation to bodily symptoms, and health anxiety as perpetuating factors.

Moreover, we added behavioral variables (safety and avoidance behavior) as endpoints to the model. We tested the assumptions of the CBM by evaluating a structural equation model (SEM) that incorporated all factors of the model.

Further, we conducted a psychological network analysis to exploratively study the relationships between the model’s different factors.

Results:

Our SEM showed adequate fit.

Network analyses revealed clustering in our data: Health anxiety and different cognitive factors are closely related, while somatic symptoms and negative affectivity are strongly associated.

Conclusions:

Our findings from a confirmatory and an exploratory approach give empirical support for the CBM, suggesting it as a suitable model to guide clinical practice.

The network model additionally demonstrates the necessity to apply an individualized CBM for patients, depending on a preponderance of either PSS or health concerns.

 

[Hutan]

Umm, is

from a confirmatory and an exploratory approach

a fancy way of saying 'fishing exercise to confirm our prejudices?

 

[SNT Gatchaman]

<Rant ahead>

In clinical practice, persistent somatic symptoms are regularly explained using a cognitive-behavioral model (CBM).

With no valid objective evidence.

In the CBM, predisposing, perpetuating, and precipitating factors are assumed to interact and to cause the onset and endurance of somatic symptoms.

With no valid objective evidence.

However, these models are rarely investigated in their entirety.

So no valid objective evidence then? Yep, the model and therapies based on the model never actually seem to work end-to-end do they? The middle bit (CBM) most certainly is investigated ad nauseum with subjective, 'questionnaire-able' research which incredibly always seems to support the researchers' proposed theory. "Promising".

We conducted an online-survey during the Corona pandemic.

So again, no valid objective evidence. Great job advancing understanding, people. (Also in the science biz we say 'SARS-CoV-2', 'Covid' or 'coronavirus'. This is not a pandemic of Mexican beer, more's the pity.)

We used negative affectivity and neuroticism as predisposing factors, the fear of a COVID-19 infection as precipitating factor, and somatic symptoms, misinterpretation of bodily symptoms, attention allocation to bodily symptoms, and health anxiety as perpetuating factors.

"We used negative affectivity and neuroticism fear as predisposing factors, the fear of a COVID-19 infection as precipitating factor, and somatic symptoms, misinterpretation of bodily symptoms, attention allocation to bodily symptoms, and health anxiety fear as perpetuating factors."

So if I've got this right, your model proposes that: a predisposition to fear precipitates fear which leads to a perpetuation of fear. Well, I propose that a predisposition to BS precipitates BS which leads to a perpetuation of BS — which sounds like a real vicious cycle.

 

[Hutan]

<Rant ahead>

I read 'rant ahead' and went and liked your post SNT. And then settled in to read the post. Because, the paper is drivel and rants are a rational response.

Even a very poor and prejudiced study I've just ranted about managed to get more right, noting that negative affectivity was not associated with the persistence of symptoms after 12 weeks, and, even if it had been, the directions of causality would be questionable.

The Dubbo study found no grounds for psychological parameters being risk factors for persisting symptoms after infection. Even the most rabid BPS statistician only managed to come up with a recovery odds ratio of 0.99 or something like that for neuroticism from that study, and of course there's all sorts of confounders going on, with people who express concerns about the future or their health often having very valid reasons to do so. We haven't seen any paper that stands up as evidence of personality factors being risks for persistent symptoms.

I can imagine these authors struggling to deal with real patients, desperately drawing their circles on paper like some ritual to ward off patient contempt.

 

[alex3619]

Well, I propose that a predisposition to BS precipitates BS which leads to a perpetuation of BS — which sounds like a real vicious cycle.

Pretty well sums up the whole BPS movement.

 

[Trish]

I have done a quick skim of the paper. Several things I picked up.

First, this was a cross sectional study, which means it was done at a single time point. All they did was ask anyone online to fill in a bunch of questionnaires at some point during the Covid-19 pandemic. In which case how can they assess whether any psychological or behavioural factor predisposed, precipitated or perpetuated physical symptoms?
They say so themselves in the limitations section:

...here we modelled a dynamic, temporal process with cross-sectional data, which can greatly affect our results.

Secondly, I have not looked at the specific collection of questionnaires they used, but we have seen many such questionnaires, and found that, for example, anxiety questionnaires include some physical symptoms which may in some patients have nothing to do with anxiety, such as sweating or raised heart rate, and we have seen that there are overlaps in the type of things asked in questionnaires for different assumed psychological and behavioural traits. From that I conclude that a lot of the associations their fancy model purports to show are simply associations between questions asked - an artefact of the method, not a real research finding about people.

Thirdly, in an attempt at longtitudinal data, they include some odd things like asking people to predict how they will feel:

In addition, a three-item scale measuringcurrent and assumed prospective COVID-19 fear was included (‘How strong is your fear of aCOVID-infection?’, ‘How strong will your fear of a COVID-infection be in four weeks?’, ‘How strong will your fear of a COVID-infection be in eight weeks?’).

And finally they inevitably found so many associations between all the different factors that they could make up pretty well any model they liked to explain them. They admit this in the limitations section:

Limitations
Several limitations hamper the interpretation of these results. First and foremost, in the context of SEMs evidence in favor of a certain model is not equivalent to evidence against other possible models. In fact, many different models can lead to a comparable fit to the data (Bollen, 1989),
obscuring the interpretation of our present results. Thus, based on this data we can only conclude that one possible operationalization of the CBM fit our data, not that this is the true data-generating process explaining the correlations between our observed variables.

So I conclude that they have collected a lot of responses to psych questionnaires at a single time point in a non random self selected online sample, used a fancy stats package to draw some pretty diagrams for them, and drawn conclusions in favour of their preferred model, even though they admit themselves that other models would fit equally well, and they would need longitudinal data, not single time point data to test their model.

So a pointless exercise in confirming prejudices, not science.

 

[rvallee]

LMAO, ChatGPT is already smarter than this.

And not just smarter, wiser, too. And it's not especially either. But far above whatever this... thing here is.

For sure there's a vicious cycle going on alright. Although it would be more fair to speak of an infinite loop. Also something ChatGPT is a lot smarter at.