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Trial Report The presence of attentional and interpretation biases in patients with severe MS-related fatigue (also ME/CFS), 2024, Knoop, Moss-Morris et al

Discussion in 'Psychosomatic research - ME/CFS and Long Covid' started by Dolphin, Mar 30, 2024.

  1. Dolphin

    Dolphin Senior Member (Voting Rights)

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    https://kclpure.kcl.ac.uk/portal/en...ntional-and-interpretation-biases-in-patients

    Access to Document


    The presence of attentional and interpretation biases in patients with severe MS-related fatigue


    Marieke de Gier, Joukje M Oosterman, Alicia Hughes, Rona Moss-Morris, Colette Hirsch, Heleen Beckerman, Vincent de Groot, Hans Knoop

    Abstract

    Objective:

    Severe fatigue is a prevalent and disabling symptom in Multiple Sclerosis (MS). This study tested if a fatigue and physical activity-related attentional bias (AB), and a somatic interpretation bias (IB) is present in severely fatigued patients with MS, compared to healthy controls and patients with chronic fatigue syndrome (CFS/ME).

    Method:

    Severely fatigued patients with MS or CFS/ME and healthy controls completed a Visual Probe Task (VPT) assessing fatigue and physical activity-related AB, and an IB task that assesses the tendency to interpret ambiguous information in either a somatically threatening way or in a more neutral manner. The VPT was completed by 38 MS patients, 44 CFS/ME patients, and 46 healthy controls, the IB task by respectively 156, 40 and 46 participants.

    Results:

    ANOVA showed no statistical significant group differences in a fatigue-related AB or physical activity-related AB (omnibus test of interaction between topic*condition: F2,125 = 1.87; p = .159). Both patient groups showed a tendency to interpret ambiguous information in a somatically threatening way compared to healthy controls (F1,2 = 27.61, p < .001). This IB was significantly stronger in MS patients compared to ME/CFS patients. IB was significantly correlated with cognitive responses to symptoms in MS patients.

    Conclusion:

    MS patients tend to interpret ambiguous information in a somatically threatening way. This may feed into unhelpful ways of dealing with symptoms, possibly contributing to perpetuation of severe fatigue in MS.

    Keywords: attentional bias, interpretation bias, fatigue, multiple sclerosis
    Original language English
    Number of pages 33
    Journal British Journal of Health Psychology
    Publication status Published - 26 Mar 2024

     
    Peter Trewhitt, MSEsperanza and Hutan like this.
  2. Hutan

    Hutan Moderator Staff Member

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    Brought to you by the Journal of Health Psychology, Kings College London. (in press)
    I think this could be a good paper to look at, I suspect the investigators were disappointed that the chronic fatigue people did not look as different from healthy controls as the MS people did.


    Oh, for goodness sake, look at that bias. They allow that pain is salient (definition of salient - noticeable, important). But the authors are suggesting that fatigue only becomes salient when someone has a chronic condition and has debilitating fatigue. What rubbish - fatigue in anyone is salient, because the body is sending a signal 'take note, you need a rest'. It's sort of tautological - the sensation of fatigue only exists when it is noticed, in the same way that pain only exists when it is noticed.
     
    Last edited: Mar 30, 2024
  3. Hutan

    Hutan Moderator Staff Member

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    There are two parts to the study: Attention bias and interpretation bias. First, the attention bias:

    Attention bias
    Ugh. They really really don't get it, do they.

    A Visual Probe Task (VPT)
    24 pairs of fatigue-related words + neutral words; 24 pairs of activity-related words + neutral words. A pair of words appears on the screen, like this

    Tired
    +
    Custard

    And then the words disappear
    and there is something like this:

    <-
    +

    So, in that case, you are supposed to press c because the arrow points left, as opposed to m when the arrow points right. And the time it takes you to press the c or m is supposed to be related to how actively you were drawn to or away from the fatigue word or the activity word.

    So, another example might be

    Parsnip
    +
    somersaulting

    followed by

    ->
    +


    The idea is that the attention of people with chronic fatigue is drawn towards the fatigue words (indicating hypervigilence) and away from the activity words (indicating fear avoidance), and so they will be looking or not looking at the place where the words were, and that will affect how quickly they respond to the arrow that appears where one word was.

    I find it hard to believe that anyone thinks this exercise says anything about whether someone pays too much attention to the fatigue signals their body sends them. It seems laughable. They wrap it all up in fancy words - attentional behaviour and visual probe. But, it seems as scientific as a horoscope.

    Here's the discussion about the lack of difference between people with ME/CFS and MS:
    But, but, the authors cry, we know those ME/CFS people really do have attentional bias. The authors even admit that maybe their test isn't that great, because it isn't picking up the abnormality the they know is there.

    As for the MS people:
    Yep, they didn't look different to the healthy controls either.

    Some more hand-wringing rationalisation:
    Make of that what you will. Something about maybe physical activity isn't that scary for people with fatigue as the consequence comes later and fatigue isn't that bad. And something about a top-down cognitive process being at work, rather than a rapid bottom-up process - which they presumably think is not cognitive. Maybe we have to have more time to realise that we are afraid of running. They don't seem to know what is going on, but, despite the lack of evidence from their study, they just know that fear-avoidance perpetuates fatigue.

    There is more avoidance going on with the authors refusing to face up to the fact that their prejudices are baseless than there is in both the ME/CFS and MS cohorts combined.


    I wonder if patients really understood how the data was going to be used.
     
  4. Sean

    Sean Moderator Staff Member

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    Although fear-avoidance has been found to play an important role in the perpetuation of fatigue,

    Well it certainly has been endlessly asserted to have such a role. Which is a very different thing.
     
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  5. Eleanor

    Eleanor Established Member (Voting Rights)

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    "Further investigation and replication is warranted"

    gotta keep that grant money coming.
     
  6. Blueskytoo

    Blueskytoo Senior Member (Voting Rights)

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    If only these people would *finally* get as fucking sick of the sound of their own voices as we are….
     
  7. Trish

    Trish Moderator Staff Member

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    It's high time these people were stopped from playing silly psychological games with sick people, and, worse, drawing unwarranted conclusions from them. It's harmful, insulting and not good science.
     
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  8. MSEsperanza

    MSEsperanza Senior Member (Voting Rights)

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    From the quotes Hutan on which commented above
    "Several studies in ME/CFS, which is defined by severe and debilitating fatigue with no known underlying pathology, found people with ME/CFS to have a tendency to direct attention towards fatigue-related stimuli, when compared to healthy individuals (Hughes et al., 2016; Hughes et al., 2017; Hughes et al., 2018). This AB in CFS patients is thought to reflect a strategy to continually monitor threats in the environment, in this case bodily signals, as opposed to an initial orientation or hypervigilance to threat which is found in patients with anxiety disorders (Hughes et al., 2016; Hughes et al., 2017)."

    That's cool -- refer to "several studies" but all by the same principal investigator and by co-authors which are now authors of the presented trial [*]

    I would suggest instead: "A team of health psychologists of which most happen to be also authors of this trial report repeatedly reported to have found..."

    by the British Journal of Health Psychology


    ---
    [*] The references:

    Hughes, A., Hirsch, C., Chalder, T., & Moss-Morris, R. (2016). Attentional and interpretive bias
    towards illness-related information in chronic fatigue syndrome: A systematic review. Br J
    Health Psychol, 21(4), 741-763. https://doi.org/10.1111/bjhp.12207

    Hughes, A. M., Chalder, T., Hirsch, C. R., & Moss-Morris, R. (2017). An attention and interpretation
    bias for illness-specific information in chronic fatigue syndrome. Psychol Med, 47(5), 853-
    865. https://doi.org/10.1017/s0033291716002890

    Hughes, A. M., Hirsch, C. R., Nikolaus, S., Chalder, T., Knoop, H., & Moss-Morris, R. (2018). Cross-
    Cultural Study of Information Processing Biases in Chronic Fatigue Syndrome: Comparison of
    Dutch and UK Chronic Fatigue Patients. Int J Behav Med, 25(1), 49-54.
    https://doi.org/10.1007/s12529-017-9682-z

    (And Hughes is also co-author of this trial report)
     
  9. bobbler

    bobbler Senior Member (Voting Rights)

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    Yep it’s one thing if it were a student paying other students but the amount of effort for severe MS patients to have been dragged in for this makes me think there is a major ethical issue that isn’t unique to ME and needs us to get on board other charities to form a charter of acceptability and if it’s due to lack of adjustments so they understand the ‘potential harm’ spell it to them that if you get sick people in it needs to be more worthwhile and adjusted so it isn’t taking advantage of their fragility physically to get results or vulnerability to impose coercion etc

    I don’t have the words for this the design it is such utter unjustifiable nonsense with no understanding of any literature to have done it this way that it’s embarrassing they have jobs in institutions calling themselves academic
     
  10. rvallee

    rvallee Senior Member (Voting Rights)

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    Same old laughable rubbish that actually makes the Stanford Prison Experiment look tame and wise by comparison. None of this even makes sense.

    They present their BPS stuff as holistic, but then go on pretending like a few millisecond more or less pressing a button when presented arbitrary words can be used to interpret an entire person's life experience. And they are willing to interpret anything.

    But they still get money for it. And will keep on getting more money for it. Because the lack of results is irrelevant, continuing to ask the questions is all that matters, as it keeps their lies influential. No different than some opinion-havers writing dozens and dozens of editorials about the same topic, how some group of people is ruining society and other nonsense. They're the "just asking questions" crowd. Questions that don't need to be asked.
     
  11. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    People with diabetes have a tendency to direct attention towards glucose-containing foods, when compared to healthy controls.
     
  12. Amw66

    Amw66 Senior Member (Voting Rights)

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    So no knowledge of peripheral.vision issues and the effect of fatigue on eyesight ( there have been studies on this ) .
    Not even trying

    ETA spelling
     
    Last edited: Mar 30, 2024
  13. Hutan

    Hutan Moderator Staff Member

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    Well, they do comment on reaction times obliquely, and the reaction times are reported in Table 2. For me, that would be one big and real result of the study.
    Mean reaction time of the ME/CFS group was about 628 ms, regardless of what they were reacting to in the Attention bias game. Mean reaction time of the MS group was about 670. Mean reaction time of the healthy controls was about 528.

    They found a measurable difference in reaction times between groups, and that is completely glossed over.

    The way the game was set up, those peripheral vision issues and effect of fatigue on eyesight didn't matter, because mean reaction in and of itself, didn't matter. It was just the comparison between neutral words and the words supposedly triggering hypervigilance or avoidance.

    (They also mention that they had a problem with their healthy controls,, with abnormally high rates of missed responses. They chucked out a substantial percentage of their healthy control data out because of this.)
     
  14. Sean

    Sean Moderator Staff Member

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    People with everything to lose if the rest of the world learns how dodgy they are tend to try diverting the world's attention away from how dodgy they are.
     
  15. Sid

    Sid Senior Member (Voting Rights)

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    Does not follow from the results in the slightest.
     
  16. bobbler

    bobbler Senior Member (Voting Rights)

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    That one utterly makes sense guven I assume when first diagnosed reading ingredients lists for those terms is important. And given they are small print and lots of items often in said list you’d be training yourself to actively spot those words?

    there is a reason they put allergens in bold now to make it easier
     
  17. bobbler

    bobbler Senior Member (Voting Rights)

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    It’s appalling isn’t it to imagine these people deliver thee assertions AT people and their ideas have created forced imposition of awful things based on their madness ie it sounds deluded, is deluded and silly but boy is the impact on those targeted not left at small by these people sadly
     
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  18. rvallee

    rvallee Senior Member (Voting Rights)

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    Or even make any sense.
     
  19. Hutan

    Hutan Moderator Staff Member

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    Onto interpretation bias:
    The problematic information processing biases are taken as a given in ME/CFS, with the aim being to compare and contrast.


    Implicit Interpretation bias task
    To summarise, for each of 12 ambiguous scenarios, participants had to rate how similar 4 sentences were to the scenario. One sentence put a positive interpretation on the scenario, one a negative somatic interpretation. The other two sentences were not designed to not be plausible representations of the scenario.

    Here are the results:

    Mean (and SD) of interpretations of all groups

    Similarity rating................................... ME/CFS (n=40).................MS (n=156)................Healthy controls (N=46)

    Similarity rating of positive interpretation....2.85 (0.42)................ 2.82 (046) ...................2.96 (0.50)
    Similarity rating of somatic interpretation.....2.23 (0.52)............... 2.47 (0.57) ...................1.81 (0.38)
    Similarity rating of positive foil ...................1.35 (0.32) ...............1.39 (0.40) ...................1.42 (0.36)
    Similarity rating of negative foil...................1.18 (0.18) ................1.26 (0.25) ..................1.22 (0.24)

    Values of statistical significance for result comparisons are not reported. Also, I'm not sure about the size of the MS samples - there were two MS samples. Is it possible they recruited more people in order to find some sort of a result?

    Anyway. All three groups were equally likely to think a positive interpretation of the scenario was reasonable.

    Both disease groups were more likely than healthy controls to think that a negative somatic interpretation of the scenario was reasonable, with the multiple sclerosis people rating those interpretations as more similar than the ME/CFS people. I don't think the ME/CFS results on this were significantly different from the healthy controls.
    It is completely understandable and reasonable for the disease groups to rate a negative somatic interpretation as possible - they have had vivid personal experience of bodies not working well. But the difference is quite small.

    And, it's such a huge leap in logic from there to 'manufacturing feelings of fatigue out of non-harmful normal body sensations'.

    It would be laughable if people weren't actually paying attention to these investigators, and paying them to provide CBT sessions to cure people of their fatigue.
     
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  20. Hutan

    Hutan Moderator Staff Member

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    I do wonder about the informed consent - did participants really understand that the results would be used to try to label their fatigue as a product of attentional and interpretational biases?

    I laughed about the comment about the welfare of animals. Because humans are animals and the authors have not considered the considerable harm that will flow from this study and its suggestion that people with MS can cure their fatigue by thinking differently about it.

    And, as for the conflicts of interest, how can there not be a conflict of interest? The authors are in the business of providing CBT to fix false illness/symptom beliefs. And they did their best to find some false illness/symptom beliefs to fix.

    That conflict of interest is plastered all over this study, including the way a lack of a difference between the ME/CFS participants and the healthy controls in so-called attentional and interpretational bias is minimised. Those findings for ME/CFS participants blow a giant hole in the basis for CBT to correct false-illness beliefs.

     
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