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

I'm sure my cortisol levels would rise too if I was subjected to the BS of this form of CBT.

 

it's a crap measure that I have a feeling they were trying to colonise/co-opt at the time (like they have done with any word/term we might need to explain our condition like calling 'deterioration' a relapse). And 'stress' could be as simple as a very hot or cold room (or list any other subtle things) in as far as that is defined with regard to temporary cortisol levels.

I think this article is an interesting read that I could find (it's hard getting past the filibuster of putting certain terms in and getting a load of wellness stuff), and whilst it might seem unusual is based on animals but does mention research in and comparators with human findings. Cortisol: often not the best indicator of stress and poor welfare - The Physiological Society

to use salivary cortisol feels weird and something I've mainly seen around that time to be used for things like stress, acute stress eg swabbing someone before a bunjee jump and then after. But in that instance it is total stress on the body, and it would be a very poor interpretation indeed for someone to suggest that was 'fear' and a misunderstanding of the purpose of cortisol. But I think it happened around then. And this misinterpretation and extrapolation of storytelling seems to only have got worse of recent times.

The thing with cortisol is that you need the right amount at the right time, otherwise you are in trouble, and it isn't just about high or low but having 'spare' hence synacthen tests. And it operates on a cycle when healthy. But illnesses and injuries demand cortisol to support the body dealing with pain and healing etc. And a number of health conditions or injuries can cause this not to be the case, including having eg Addisons where your body stops producing it just like diabetes is an issue with insulin (and sugar levels would cause 'stress'). If you look up Addisons you'll realise how irresponsible this suggestion is.

If you need to do a presentation or get an illness or accident or have to run for a bus and don't have it, or a system that can't increase it appropriately to get basic things like breathing and blood flow consistent with the needs your body has then at best adrenaline has to kick in to try and do its best. But to react to a certain number of people having lower cortisol as being psychological is such a naughty and erroneous thing to do that only the psychosomatics could try on - these can be serious health conditions that can't be substituted with CBT, certainly not to increase cortisol and I've no idea what time of day they were taking these samples because different times would allow for the ceiling effect of lower peak cortisol (of hypocortisolism) to be removed ie even those deficient could produce 'a bit more' if at a time of day where it isn't already as peak as they have available.

As the article above points out snapshot points, particularly increases, are not only easily influenced and requiring context but irrelevant regarding health picture (and totally pointless with no baseline measure). Long-term measures would/should not be done in this uncontrolled form. And goodness knows what they are actually trying to suggest the CBT 'does' but you wouldn't use cortisol to measure it, nevermind this method, unless you wanted something easily influencable (as simply as turning down or up the heating/removing a chair from a room/shutting off a lift so stairs have to be used).

Add to that the confrontational style of CBT - is there anything more blinking rude than someone else suggesting you are thinking wrong, or don't know your own body?

Cortisol isn't adrenaline or psychological/chronic stress and it seems bad psychology has tried to sell it as if it is and then 'gets stuck on' (rather than the stressors not turn off). I notice even the fight or flight storytelling seems to have been co-opted often to suggest it is cortisol when the original story was adrenaline ( read about this guy, who seems particularly interesting given his time was around 1900 and he was looking at methods for finding things out: Walter Bradford Cannon - Wikipedia ). And even then it was about predominantly physical stressors as much as anything more psychological.


And more recently it seems there are papers suggesting the hormone responsible for this is actually one that is in the skeleton, but I haven't looked up the replies or more recent critiques or follow-ups of this idea: Bone, Not Adrenaline, Drives Fight or Flight Response | Columbia University Irving Medical Center

 

Before I bang on about ME/CFS not being fatigue, and long-term timeframes, then depending upon the timeframe you are measuring it as I have been told to my face "everyone feels better on steroids" and certainly anyone who doesn't have enough cortisol theoretically should (except its a heck of a lot more complicated than that with ME/CFS because I think those who have it, whether those with 2 separate conditions or they are 'linked' as an effect or type, might have issues that contradict each other in need) so what the heck does this writer think they are inferring by saying 'can ameliorate fatigue in CFS'. And sure as heck that sounds like he hasn't made sure it does ameliorate it.

The sad thing is that these people could have suggested that synacthen tests and investigations and supportive treatment and follow-up should have been part of a guideline if these 'findings' they quote are true of some, as a responsible thing to do, but instead what happened was a guideline suggesting other investigations and treatment should be avoided which ensured anyone with this couldn't get treated and were seen as a hypochondriac even when they had such results.

We'd have at least for this some clinical experience in how different people respond should they have this situaiton but we are now stuck with a legacy of physios and other HCPs who aren't biomedical clinicians tryign their hand at pseudo psychology and embedding CBT to avoid informed consent and hedge the spirit of the new guideline, normally for a short one-way course. And still no suggestion of genuine clinical follow-up even if it were only every 2yrs.

And here's the sad thing, ill and injured people tend to find it will impact their cortisol because that is how the body works and it isn't supposed to be interfered with by 'the mind' but a sign there is a real grim illness going on. And I'm bored of differences being suggested to be behavioural without any testing, which would need to have been huge samples and very very carefully designed and implemented.

Many people who had CFS were having to try and continue full time jobs and the diagnosis brought less rather than more rest or leeway from others. It's frankly insulting how quickly people accept 'behaviour' even if such 'claims' would have been impossible vs being in said jobs at the time of testing - these people I doubt asked for context to check whether before asserting inactivity etc to write it off, that it was true.

 

Oh there is plenty of pushback.

Against us. For pointing this out as absurd and invalid. Which everyone who promotes this stuff is aware of since they automatically point out the same about other dodgy pseudoscience they don't believe in.

Lots and lots of pushback. In fact the pushback itself has made it into the ideology, self-fulfilling it with bootstraps aplenty. How us pushing back against obvious pseudoscience built entirely on logical fallacies only proves the ideology is correct. Which is insane, but it comes from the very people who decide who is sane and who isn't, which is a giant, and convenient, loophole.

A painful lesson about the allure of pseudoscientific ideologies, how even the medical profession itself can fall for it so thoroughly it will attack anyone criticizing them falling for obvious pseudoscience as, uh, "anti-recovery activists". Or whatever. Although in this case I'm not sure if the fact that the medical profession invented this pseudoscientific ideology any better than if it was some ancient mythology or faked UFO landings or whatever.

Especially as this ideology builds explicitly on stroking their egos, as any alluring ideology does. It tells them how they are so smart they can't possibly not know everything or miss anything. It gives them the delusion of having superior knowledge that can't be shown with evidence, that requires superior intuitive knowledge about things they can't explain, but will try at it for hours, exactly like any good conspiracy theory.