Thesis The effects of symptomatic and intervention-specific heterogeneity on outcomes for patients with Chronic Fatigue Syndrome, 2023, May

[Dolphin]

Source: University of Miami Date: May 25, 2023 URL: https://scholarship.miami.edu/esploro/outputs/991031825412302976

Embargoed Access, Embargo ends: 2025-01-21

The effects of symptomatic and intervention-specific heterogeneity on outcomes for patients with Chronic Fatigue Syndrome

---------------------------------------------------------------------
Marcella May - A&S - Psychology, University of Miami, USA

Abstract

Abstract

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating disorder characterized by persistent fatigue that is unresponsive to rest. Despite extensive intervention research, no gold standard treatment for ME/CFS has yet been identified, although Cognitive-Behavioral Therapy (CBT)-based intervention approaches have shown some promise. This dissertation evaluated Cognitive Behavioral Stress Management (CBSM) for patients diagnosed with CFS and their partners. CBSM is based on a neuroimmune model of CFS, in which symptoms are seen as prompting distress reactions and cyclically intensifying symptoms. CBSM is intended to facilitate the development of stress management skills to interrupt this cycle. Previous trials of CBSM for patients diagnosed with CFS have yielded mixed results.

We explored whether symptomatic and intervention-specific heterogeneity influenced CBSM efficacy. First, variations in ME/CFS case definitions yield a heterogeneous patient group. Notably, despite that post-exertional malaise (PEM) is considered a cardinal feature of the disorder, it is not a required symptom according to the commonly applied 1994 Centers for Disease Control and Prevention case definition for CFS. We considered whether patients' PEM status moderated effects of CBSM. Second, therapist adherence and competence in terms of delivering interventions are likely to impact outcomes. We adapted a fidelity rating system for audio recordings of group CBT to video recordings of group CBSM, with sessions double-coded to assess interrater reliability. We then evaluated whether adherence and competence variables were associated with patient outcomes at follow-up.

Keywords: Myalgic encephalomyelitis/chronic fatigue syndrome, Cognitive behavioral stress management, post-exertional malaise, adherence, competence

--------

 

[rvallee]

Cognitive-Behavioral Therapy (CBT)-based intervention approaches have shown some promise.

No. Things are not "promising" for decades after they've been put into standard clinical use, with widespread adoption in guidelines in many countries. This is completely ridiculous.

CBSM is based on a neuroimmune model of CFS

Get out of here with this crap. It's not. It's based on a biopsychosocial model that posits "unhelpful illness beliefs", "fear avoidance" and other complete nonsense that lead to deconditioning, which someone fluctuates wildly and can set in in days.

This is a thesis? Fail.

 

[Jonathan Edwards]

If only...

Abstract

Abstract (sic)
Hey guys. I was writing this PhD thing about intervention-specific heterogeneity and all that stuff about chronic fatigue and what do you know!!
I found this amazing patient website called S4ME and I read a few bits. Then I read quite a lot of bits and hey - I realised that my PhD was complete cow manure.
So now I am re-writing this as a critique of how so much research into, actually ME/CFS, is cow manure. It's really interesting. I just hope I don't get failed...

 

[Trish]

I don't understand why psychologists are allowed to do this sort of stuff as PhD's. It's so clear from that abstract that the writer doesn't have a clue what ME/CFS is, or what they are doing or why.

It feels like they are doing a parody of science.

 

[Hutan]

Miami didn't initially register on my mental map of CFS psychobabble.

Michael H. Antoni seems likely to be the supervisor of this student. He appears to have been promoting cognitive behavioural therapy for people with cancer, HIV, and CFS for some time.
e.g.

Mcintosh, R., Ironson. G., Antoni, M.H., Lai, B., Kumar, M., Fletcher, M.A. & Schneiderman, N. (in press, 2017). Psychological distress mediates the effects of alexithymia on 2-year change in HIV viral load. International Journal of Behavioral Medicine.

Milrad, S., Hall, D., Jutagir, D., Lattie, E., Czaja, S., Perdomo, D., Fletcher, M.A., Klimas, N. & Antoni, M.H. (in press, 2017). Poor Sleep Quality is Associated with Greater Circulating Pro-Inflammatory Cytokines and Severity and Frequency of Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis (CFS/ME) Symptoms in Women. Journal of Neuroimmunology. NIHMSID 839586.

Hall, D., Lattie, E., Milrad, S., Czaja, S., Fletcher, M.A., Klimas, N., Perdomo, D., & Antoni, M.H. (in press, 2017). Telephone-Administered versus Live Group Cognitive Behavioral Stress Management for Adults with CFS. Journal of Psychosomatic Research.

Antoni, M.H., Bouchard, L.C., Jacobs, J.M., Lechner, S.C., Jutagir, D.R., Gudenkauf, L.M., Carver, C.S., Lutgendorf, S., Cole, S.W., Lippman, M., & Blomberg, B.B. (2016). Stress management, leukocyte transcriptional changes and breast cancer recurrence in a randomized trial: An exploratory analysis. Psychoneuroendocrinology, 74, 269 - 277.

What's most interesting with his publications is that he has co-authored some of those with Nancy Klimas and Mary-Anne? Fletcher.

MEPedia tells me

Antoni serves on the editorial board of the journal, Fatigue: Biomedicine, Health & Behavior, published on behalf of the IACFS/ME.[3]

Why am I not surprised? (IACFS/ME being, in case anyone wasn't aware, the international organisation of professionals working on 'CFS/ME'. The Fatigue journal, which I now see Antoni is a part of, published a Crawley paper. It would be soul-destroying if it wasn't a bit laughable. @hope123)