Salivary cortisol output before and after cognitive behavioural therapy for chronic fatigue syndrome, 2008, Roberts, Wessely, Chalder, Cleare

https://www.kcl.ac.uk/ioppn/depts/pm/research/cfs/publications/assets/2009/Robertssalivary.pdf

 

This is a small, self-controlled study with a long, variable treatment (CBT ofc) duration up to 6 months. 47% were "responders" to CBT. (sidenote: in this case, I believe as the outcomes are subjective by the therapist rather than the patient). The authors include Wessley and Chalder.

The response to CBT was not consistent with the change in cortisol levels, undermining the hypothesis involving the pathophysiology of the HPA axis. Both non-responders and responders showed an increase in total daily cortisol output. In fact, non-responders showed greater increases in cortisol (+12.8 vs +8)

CBT responders were nearly 6 points higher in total output, almost as much as the increase from CBT, suggesting a slightly better off treatment group to begin with.

Ok, so +16% total output refers to *responders and non-responders* to CBT.

CBT responders experienced an +11.2% costisol outpot and non-responders experienced a +19.6% change !

Not only is this conclusion very deceitful, the following is a pure contradiction when combined with Wessley's own results. If cortisol increased more in patients that didn't respond to therapy either the therapy or the cortisol finding is being misinterpreted.

Except that the larger change coincided with the unresponsiveness to CBT. So, how can that be. And how can the HPA axis, lifestile and deconditioning *not* be correlated with responsiveness to CBT if BPS model holds.

...

Final conclusion:

 

Doesn't cortisol reflect stress? So CBT made them more stressed

 

Anyone on twitter (I am not) might want to show this paper to Dr. Keith Geraghty as it seems very relevant to the question he asked. Ironically, it's a BPS paper that seems to undermine the position he was querying.

 

Cortisol is a feed-forward metabolic hormone, it's purpose is to provide sufficient blood glucose upon wakening and smooth the blood glucose level over the day given anticipated activity demands (insulin is a feed-back metabolic hormone...).

Despite all the pop-psychology on the contrary, it's more correct to say that cortisol levels reflect sleep-wake and activity patterns than "stress".

 

Done

 

For the cited review, I didn't look too closely, but Table 1 has 17 studies. Out of these, 9 found lower cortisol in CFS, 7 found no difference, and 1 found higher cortisol.

 

The worst thing about all this is that there is a basic standard fir testing of hypocortisolism - the synacthen test

and that has nothing to do with either timings or behaviour. It’s ’how Much is the max your body can actually produce in response to acth’.

if people don’t have that it’s a sign that’s nothing to do with training

just like those with Addisons or diabetes just don’t have what is needed being produced. They’ll have low morning cortisol too even if they live in a retreat in utopia doing nothing but mindfulness. It’s not a useful measure but a misleading one used as a stooge fir sophism unless taken with other proper measures over long time periods on a 24hr basis with huge samples they have someone who isn’t biased taking the history and diary of.

m but no one’s ever done proper designs on these ever so somehow they’ve entitled themselves as that being permission to make up truisms as being true when they aren’t even for healthy people. So this is nonsense. A snapshot cortisol level only tells you how much stress ie exertion that body is under as a proportion of their max cortisol and an idea of if it’s enough that you’d literally be unable to get up out of bed easily is the reason for the 9am. If it’s not that suggesting it’s because you behave wrong is outrageous but somehow accepted as an assumption that brutalises some people yet is allowed to slip thru because it’s only some people.

I can understand due to their agenda why this bunch pretend it doesn’t exist and gloss over that basic existing but why isn’t it being the standard being mentioned in all our conversations?

this is all just psychosomatic narrative with selective ‘props’ being chosen just like the old days alchemist might have a vandergraff generator on their stage to give the air/impression of being sciencey.

this is just a manifesto for ‘one must do routines we approve of’ justified by lies that makes anyone ‘healthy’ or ‘happy’ (also not proven) taken to an utter disability bigotry level by trying to use sophism to suggest people being ill just need to behave right is ‘proven to work’ . I would have called it a hypothesis rather than a lie if anyone phrased it as a question and then tested it properly in an open-minded way. But on this area it feels it is never called out.

the simple point that it has nothing to do with causing me/cfs is that those lucky enough their routine or way their body behaves fits with the approved timetable when it feels ok aren’t well and recovered. And they should care that those forced thru this get much worst incredibly quickly. So this is very dangerous stuff veiled as if it’s harmless and a starting point tick box. The most dangerous kind.

As I’ve seen many times elsewhere on this forum there are likely to be upstream and downstream things some of which are the body breaking more in certain individuals others are important adaptations to stop other bits breaking more/keep it ‘standing’ despite the broken bits.

all this awful manifesto stuff is making me feel so dreadfully sad about the world and how this vicious brutal hold of people who write this sort of thing will never be ignored and go away and will continue to leave me with never having any basic rights others don’t even realise are privileges they enjoy because they are so fundamental

I’m hoping this has been put up to be critiqued but finding these all being dumped in a big sudden batch very confronting and worrying as if it gives the impression it’s ’well researched’ given the incitement this crud has caused.

 

The shocking thing is they are pretending as if the measure they are using is some biological measure of ‘fatigue’ and fatigue alone - like it’s not even in storytelling bs land at least in a curve and needing to be calibrated (because cortisol has other functions so if you need x amount to stay breathing whilst you sleep cos of injuries or other illness the daytime reading being less than that but higher than other peoples means what?)

then of course there’s the me/cfs is about nit deteriorating long term not getting people to push thru and feel upbeat for a few hours at the expense of their future heakth then call it a cure because you won’t measure the actual heakth impact. Which is the long term but we all can’t undo thanks to them and this tosh if thinking beliefs.

 

All of which even in their bs sophism works could have been interpreted a different way: it’s not scientific but if you follow their warped logic they could/should if they are honest be just as much saying that it shows pwcfs therefore manage stress better than norms and are still ill despite that so it’s nothing to do with theur thinking or coping

but they never do report such which I think is indicative of a dishonest fishing type mindset towards ‘research’ - even if it is still bs it’s just as ‘valid’ as what they chose so stinks if cherrypicking and doing research only to put a one-liner alongside a claim they already want to make?