The prevalence and treatment of health anxiety in Chronic Fatigue Syndrome (CFS) - Jo Daniels 2018

Sly Saint

Sly Saint

Senior Member (Voting Rights)
Presentation (PDF Available) · July 2018 with 37 Reads
DOI: 10.13140/RG.2.2.29883.52009
British Association of Behavioural and Cognitive Psychotherapy, DOI:10.13140/RG.2.2.29883.52009

ABSTRACT
Introduction: Chronic Fatigue Syndrome (CFS) is a debilitating condition that affects 0.2–0.4% of the population. First-line treatments are Cognitive Behaviour Therapy or graded exercise therapy; however these evidence based treatments yield only moderate effect sizes.

Emerging research suggests that anxiety about health is common across medical complaints, with small scale studies suggesting it may be common in CFS.

The aim of this study was to identify the prevalence of health anxiety in a CFS sample, and assess whether anxiety, depression and health anxiety account for the in primary outcome variables (physical functioning, fatigue).

A secondary aim was to test the acceptability and effectiveness of an adapted CBT intervention for health anxiety (CBT-HA).

Method:

Firstly, a cross sectional questionnaire study was used to assess prevalence of health anxiety in CFS. Data were taken from the Short Health Anxiety Inventory (SHAI) and the Hospital Anxiety and Depression Scale. Primary outcome variables included physical functioning and fatigue.

Secondly, a consecutive case-series design was used to assess effectiveness and acceptability of the CBT-HA treatment model for CFS and health anxiety. Participants were those who scored in the clinical range on the SHAI (>18) with a positive diagnosis of CFS.

Results: 42% of the CFS sample demonstrated clinically severe health anxiety(HA) (>18). T-tests grouping low and high HA indicated that those with high HA scored significantly poorer across all physical and psychological measures than those with low health anxiety. Significant associations between between anxiety, depression and health anxiety and outcome variables physical functioning, fatigue were in expected directions.

Stepwise regression analyses indicated that in a single factor model, physical functioning accounted for 12% of the variance in fatigue. Health anxiety, anxiety and depression were non-significant predictors.

For physical functioning, a three-factor model including depression (r2=.21) fatigue (.057) and health anxiety (.023), accounting for 28.3% of the variance, indicating a moderating effect of health anxiety, but not anxiety.

All ten patients completed 5 or more sessions of therapy, with two participants (20%) withdrawing at session 6. Of those who completed a full course of therapy, 100% achieved reliable and clinically significant change in both fatigue and health anxiety excepting one who did not achieve significant change in fatigue (Reliable Change Index).

Half of those who completed therapy no longer met criteria for CFS on a Fukuda checklist.

Conclusions:

This is the first study to robustly examine high prevalence of health anxiety in CFS, acting as a larger scale replica of earlier studies by the same research group.

This study supports the use of the SHAI as a useful tool in the CFS population for purposes of identification, and also use of an empirically grounded, evidence based treatment model for co-morbid anxiety. This offers a novel treatment option easily implemented and utilised in other CFS services through use of the protocolised CBT-HA.
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https://www.researchgate.net/public...ealth_anxiety_in_Chronic_Fatigue_Syndrome_CFS

10 patients.
This is the Dr Jo Daniels on the NICE guidelines committee(?)
 
I've uploaded a copy of the health anxiety questionaire they used for everyone to look at but here are some of of the statements on the questionaire that indicate high health anxiety;

I worry a lot about by my health.

I am aware of aches and pains in my body constantly

I constantly see images of myself being ill

I usually think I am seriously ill

I am not relieved when the doctor reassures me that nothing is wrong.

I can see how these would indicate health anxiety in some one who was healthy and able to work but anyone who had a chronic illness would score highly on these questions.

Also apparently fear of going to the doctors or having treatment in a hospital indicate hypochondriacal tendencies and are not a completely understandable reaction to the poor treatment CFS/me patients receive.

This is why I hate self report questionnaires internal consistency and reliability mean f**k all if you don't bother to check that they are measuring what you think they are measuring.
 

Attachments

It is interesting to compare and contrast the present paper with this one from 1991

Journal of Infection (x99I) z3, 263-269

Biopsychosocial aspects of chronic fatigue syndrome (myalgic encephalomyelitis)

J. D. I. Yeomans* and S. P. Conwayt * Department of Psychiatry, Roundhay Wing, St James's University Hospital, Beckett St, Leeds LS9 7 TF and t Department of Infectious Diseases, Seacroft Hospital, York Road, Leeds LSI4 6UH, U.K.
sci-hub.tw/10.1016/0163-4453(91)92864-2#


Summary

Fifteen patients, with a primary complaint of chronic fatigue, were referred to a physician by their general practitioners. Psychological distress, measured by simple psychiatric rating scales was common, but specific psychiatric diagnoses, derived from a comprehensive diagnostic interview, occurred less frequently. One questionnaire (Montgomery-Asberg depression rating scale) found emotional distress in 93 %, but the diagnostic instrument (Present State Examination) suggested depressive syndromes in only two patients (I3 %). There were significant occupational difficulties in 87 %. No consistently abnormal indices of biochemical or immunological function were found, nor evidence of acute or chronic infection. Chronic fatigue syndrome (CFS) is associated with physical, psychological and social distress. The illness cannot be defined using just one of these dimensions. Such a unilateral approach has resulted in unnecessary controversy over the nature of the 'real' core of CFS. A problem- oriented approach, recognising the multi-factorial and overlapping cause and effect issues in CFS, may be of more benefit to patients

It does appear that in 1991 there were alternative routes down which a biopsychosocial approach to psychiatry might have proceeded.
 
Emerging research suggests that anxiety about health is common across medical complaints, with small scale studies suggesting it may be common in CFS.
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Well blow me down - surely if you have a "medical complaint" it's only natural to be anxious about your health? Oh, of course not, you should believe the docs can make you better ("Just like that" as Tommy Cooper would have said). So hardly surprising it's common in CFS. :rolleyes: And they call this research? :banghead:

What a waste of funds. :mad:
 
Participants were those who scored in the clinical range on the SHAI (>18) with a positive diagnosis of CFS. Results: 42% of the CFS sample demonstrated clinically severe health anxiety(HA) (>18).
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What am I misunderstanding here. To me the first sentence seems to be saying all the participants had an anxiety score > 18 and all had CFS. The second sentence see to be saying the same thing except 42% not 100%. I know I'm misreading this but not sure how.
 
obeat said:
As usual poor statistics. Drop outs should be counted in the final figures as failures. They must have been extremely mildly affected to be better after 5 sessions of CBT.!!!!!
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No, there were at least 6 sessions, but don't seem to say how many total. Only that 2/10 pulled out at session 6.
 
Barry said:
From this ...

http://www.archivespp.pl/uploads/images/2016_18_3/68Kocjan__Archives_PP_3_2016.pdf

... the SHAI scoring looks to be ...
The result is interpreted as follows: <17 points no anxiety, 18–24 points mild severity, 25–30 moderate severity and >30 points severe anxiety disorders [18,19]
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Participants were those who scored in the clinical range on the SHAI (>18) with a positive diagnosis of CFS. Results: 42% of the CFS sample demonstrated clinically severe health anxiety(HA) (>18).
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So they eliminated people with no anxiety from their cohort, and then said that people in the cohort had unusual levels of anxiety? Am I missing something?

Edit:
Secondly, a consecutive case-series design was used to assess effectiveness and acceptability of the CBT-HA treatment model for CFS and health anxiety. Participants were those who scored in the clinical range on the SHAI (>18) with a positive diagnosis of CFS.

Results: 42% of the CFS sample demonstrated clinically severe health anxiety(HA) (>18).
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So it seems the 4% are those who scored >18 on the SHAI, not a selected cohort inside that group.

My bad.
 
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