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Twisk:

Studie Chalder e.a.

bevestigt dat

het Vercoulen/NKCV-model

totaal onjuist is

 

 

 

 


 

 

 

Als de psycholeuten zelfs elkaar gaan tegenspreken, dan wordt het helemaal een puinhoop....

 

Mijn ingezonden brief in response op een recent verschenen artikel van Trudie Chalder e.a.

werd afgewezen voor publicatie ("not in scope in terms of publication within the journal"),

maar werd wel als commentaar bij het betreffende artikel op de website van BABCP geplaatst.

 

Het eerste bezwaar tegen de studie, maar dat geldt voor bijna alle studies van 'biopsychosocialisten',

is dat de studie betrekking had op mensen met chronische vermoeidheid, niet op CVS-patiënten.

 

Los van die diagnosekwestie blijkt dat Maar zelfs al we die diagnose 'CVS' zoude accepteren,

ingnog mooier, de bevindingen

 

De 'vermoeidheid' én de 'fysieke beperkingen' van de patiënten zijn niet gerelateerd

aan drie van de vier benoemde 'dysfunctionele' ('herstelbelemmerende') cognities (overtuigingen):

  • 'causale attributie'/'somatisatie' ('damage beliefs'):
  • symptomen toeschrijven aan organische afwijkingen,

  • overdreven aandacht voor symptomen ('symptom focusing') en
  • schaamtegevoel ('embarrassment avoidance').

of aan

  • vermijdingsgedrag: inactiviteit/te veel rusten ('avoidance/resting behaviour').

Vermoeidheid en de 'fysieke beperkingen' zijn wel gerelateerd aan

angst voor verergering van symptomen door fysieke inspanning (‘fear avoidance’),

terwijl (alleen) vermoeidheid samenhangt met alles-of-niets gedrag. ('all-or-nothing behaviour').

 

Waar de auteurs uiteraard de 'symptomen' toeschrijven aan deze factoren,

stel ik dat een statistisch verband niets zegt over de oorzaak-en-gevolg-relatie.

 

De samenhang kan aannemelijk verklaard wordt door het verschijnsel post-exertionele malaise:

verergering van symptomen door fysieke/mentale inspanning en emotionele stress.

 

Van het (bio)psychosociale verklaringsmodel van Vercoulen e.a. (NKCV) (zie onder) blijft

ook op basis van de bevindingen van 'geloofsgenoten' (bovengenoemde studie) weinig over.

 

 

 

 


 

 

 

New study again shows the cognitive behavorial model for CFS is invalid.

Frank Twisk.

http://orcid.org/0000-0002-2912-3245

 

A response to:

 

Psychometric properties of the Cognitive and Behavioural Responses Questionnaire (CBRQ)

in adolescents with chronic fatigue syndrome.

Behav Cogn Psychother. 2019 May 22. doi: 10.1017/S1352465819000390.

Loades ME, Vitoratou S, Rimes KA, Ali S, Chalder T.  

 

 

 

An article recently published by Loades and colleagues

(Loades, Vitoratou, Rimes, Ali, & Chalder, 2019) affirms that

cognitive-behavorial explanatory model(s) for chronic fatigue syndrome (CFS) are not valid.

 

According to this model the symptoms of CFS are perpetuated by

'unhelpful beliefs' and subsequent behaviour e.g. prolonged rest.

 

The interventions justified by this model are

cognitive-behavorial therapy (CBT), aimed at reversing 'unhelpful beliefs', and

graded exercise therapy (GET), aimed at gradually increasing activity levels

(Surawy, Hackmann, Hawton, & Sharpe, 1995).

 

This presumes that the symptoms are sustained by

'unhelpful beliefs' (cognitions) and activity avoidance,

resulting in deconditioning, and all-or-nothing behaviour

 

Firstly, the diagnostic criteria used by the authors (Loades, Vitoratou, Rimes, Ali, & Chalder, 2019),

the NICE criteria, do not define CFS (Fukuda, et al., 1994), but chronic fatigue ('CFS').

 

To meet the diagnosis CFS (Fukuda, et al., 1994)

chronic fatigue must be accompanied by at least four out of eight other symptoms,

e.g. muscle pain, substantial impairment in short-term memory or concentration.

 

According to a recent redefinition (IOM (Institute of Medicine), 2015)

post-exertional malaise ("an exacerbation of some or all of an individual's .. symptoms

after physical or cognitive exertion, or orthostatic stress") is a distinctive symptom of

‘Systemic Exertion Intolerance Disease’.

 

Secondly, according to the authors

the only mandatory symptom of 'CFS' is "severe fatigue,

which results in a significant reduction in functioning"

(Loades, Vitoratou, Rimes, Ali, & Chalder, 2019).

 

The findings of the study (Loades, Vitoratou, Rimes, Ali, & Chalder, 2019) show that

fatigue was not strongly associated with unhelpful cognitive responses to symptoms

(damage beliefs, symptom focusing, catastrophizing and embarrassment avoidance),

nor with more avoidance/resting behaviour.

 

The Cognitive and Behavioural Responses Questionnaire total score

did not correlate with (physical) functioning,

nor with the embarrassment avoidance, symptom focusing,

damage beliefs, and all-or-nothing and avoidance/resting behavior.

 

With respect to fatigue and (physical) functioning

only three correlations were found:

fear avoidance was associated with both fatigue and physical functioning, and

all-or-nothing behaviour was associated with fatigue.

 

These associations can plausibly explained by

the phenomenon post-exertional malaise (Institute of Medicine), 2015).

 

"Fear avoidance in patients with post-exertional malaise

is a reasonable and learned response,

serving as a rational defence mechanism

to avoid long-lasting relapses."

(Twisk, 2015).

 

The position that "fear avoidance may be key in a model of CFS in adolescents"

(Loades, Vitoratou, Rimes, Ali, & Chalder, 2019)

is an example of interpreting correlations

as a cause-and-effect relationship without justification.

 

In summary, the findings by the authors invalidate

the correctness of the cognitive-behavorial model of 'CFS'

proposed by them and others

(Surawy, Hackmann, Hawton, & Sharpe, 1995; Vercoulen, et al., 1998).

 

For that reason it is not surprising that

CBT and GET have shown to be ineffective over the years

(Twisk, 2015).

 

 

  • Fukuda, K., Straus, S. E., Hickie, I., Sharpe, M., Dobbins, J. G., & Komaroff, A. L. (1994).
  • The chronic fatigue syndrome: a comprehensive approach to its definition and study.

    Ann Intern Med, 121, 953-959.

    PMID: 7978722. doi: 10.7326/0003-4819-121-12-199412150-00009.

  • Institute of Medicine (2015).
  • Beyond Myalgic Encephalomyelitis/chronic fatigue syndrome: Redefining an illness.

    Washington, DC: The National Academies Press.

    PMID: 25695122. doi: 10.17226/19012.

  • Loades, M. E., Vitoratou, S., Rimes, K. A., Ali, S., & Chalder, T. (2019).
  • Psychometric properties of the Cognitive and Behavioural Responses Questionnaire (CBRQ)

    in adolescents with chronic fatigue syndrome.

    Behav Cogn Psychother, 2019 May 22.

    doi: 10.1017/S1352465819000390.

  • Surawy, C., Hackmann, A., Hawton, K., & Sharpe, M. (1995).
  • Chronic fatigue syndrome: a cognitive approach.

    Behav Res Ther, 33, 535-544.

    PMID: 7598674. doi: 10.1016/0005-7967(94)00077-W.

  • Twisk, F. N. M. (2015).
  • Post-exertional malaise in chronic fatigue syndrome.

    Lancet Psychiatry, 2, e8-e9.

    PMID: 26360098. doi: 10.1016/S2215-0366(15)00044-9.

  • Vercoulen, J. H., Swanink, C. M., Galama, J. M., Fennis, J. F., Jongen, ... & Bleijenberg, G. (1998).
  • The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis:

    Development of a model.

    J Psychosom Res, 45, 507-517.

    PMID: 9859853. doi: 10.1016/S0022-3999(98)00023-3.

 

https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/psychometric-properties-of-the-cognitive-and-behavioural-responses-questionnaire-cbrq-in-adolescents-with-chronic-fatigue-syndrome/81B2DF53804857C7AF1FB459392F62E6#fndtn-comments