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Chalder: CGT/GET is slechts werkzaam bij 18,3% van de mensen met "chronische vermoeidheid"/"CVS"

 

 

 

 


 

 

 

Een nieuwe studie van pleitbezorgers van de (bio)psychosociale gedachtengoed toont aan:

  • dat de NICE-richtlijnen betrekking hebben op "chronische vermoeidheid" (niet op CVS, laat
  • staan ME) slechts de helft van de mensen die aan de NICE-criteria voldoet aan de CVS-criteria ťn

  • dat CGT/GET leidt tot "herstel" bij 1 op de 5 mensen met chronische vermoeidheid ("CVS": 1 op 6).

Volgens de onderzoekers is "verbetering" m.b.tv. CGT/GET te voorspellen op basis van psycho-

sociale factoren. Maar als we die stellingname eens nader onderzoeken, blijft er weinig van over.

 

Als we "herstel" definiŽren op basis van het niet meer voldoen aan de CVS- of Oxford-criteria, blijkt dat

"herstel" niet gerelateerd is aan catastroferen, "alles-of-niets gedrag" of andere psychosociale factoren.

 

Als we "herstel" definiŽren in termen van "je veel beter voelen" blijkt dat

"ongezonde overtuigingen m.b.t. emoties" (emoties niet uiten) en depressie verbetering voorspellen.

 

Het eerste is, gelet op de wijze waarop patiŽnten behandeld worden vanuit het psychosociale "perspectief" (ziekte het gevolg van "onbehulpzame gedachten") en de maatschappij verklaarbaar,

het feit dat CGT/GET niet helpt als patiŽnten depressief zijn, lijkt me tegen CGT/GET pleitten...

 

De mate van invaliditeit was de enige factor die "herstel" in termen van vermoeidheid voorspelde,

terwijl de leeftijd de mate van herstel in termen van fysieke beperkingen "bepaalde".

 

 

Case closed, zou je zo zeggen, maar ja, de onderzoekers hebben daar heel andere ideeŽn over,

getuige de "uitsmijter":

 

[T]he number of sessions may need to be increased to facilitate a full recovery.

 

Vrij vertaald als de hamer niet werkt, dan hamer je gewoon vaker.

 

 


 

Relevante citaten uit het uitgebreide studieverslag:

 

 

While

72.2% met the Oxford criteria for CFS at pre-treatment assessment,

53.1% did so at the 6-month follow-up (Pearson chi square = 19.5, df = 1, p < 0.001).

 

Likewise, chi-square revealed

a significant reduction

in prevalence

from 52.6% of the participants meeting the CDC criteria

at the pre-treatment assessment

to 37.5%

at the 6-month follow-up

(Pearson chi square = 16.8, df = 1, p < 0.001).

 

...

 

Recovery was defined as

no longer meeting

either the CDC-criteria or the Oxford criteria.

 

...

 

[T]he following variables were associated with a reduced odds for recovery:

disability in terms of work and social adjustment (WSAS),

high levels of "catastrophizing" (CBRQ) and

increased symptoms of depression (HADS-D).

 

These significant predictors were included in the multivariate logistic regression analysis.

 

Additionally, the CBRQ subscale "All or nothing behaviour"

was included in the multivariate analysis as it had a p-value of below 0.1.

 

None of these significant results from the univariate analysis

remained significant in the multivariate analysis.

 

 


 

 

 

Prevalence and predictors of recovery from chronic fatigue syndrome in a routine clinical practice.

Behav Res Ther. 2014 Aug 26;63C:1-8. doi: 10.1016/j.brat.2014.08.013.

Flo E, Chalder T.

 

 

Abstract

 

Cognitive behavioural therapy (CBT)

is one of the treatments of choice

for patients with chronic fatigue syndrome (CFS).

 

However,

the factors

that predict recovery

are unknown.

 

The objective of this study was

to ascertain

the recovery rate

among CFS patients

receiving CBT

in routine practice and

to explore

possible predictors of

recovery.

 

Recovery was defined as

no longer meeting

Oxford or CDC criteria for CFS

measured at 6 months follow-up.

 

A composite score

representing

full recovery

additionally included

the perception of improvement, and

normal population levels

of fatigue and

of physical functioning.

 

Logistic regression was used

to examine

predictors of recovery.

 

 

Predictors included

age,

gender,

cognitive and behavioural responses to symptoms,

work and social adjustment,

beliefs about emotions,

perfectionism,

anxiety and

depression

at baseline.

 

At 6 months follow-up

37.5% of the patients

no longer met

either the Oxford

or the CDC criteria for CFS

while

18.3% were fully recovered.

 

Multivariate analyses showed that

worse scores on

the work and social adjustment scale,

unhelpful beliefs about emotions,

high levels of depression and

older age

were associated with

reduced odds for recovery.

 

Recovery rates in this routine practice

were comparable to

previous RCTs.

 

There was

a wide spectrum of

significant predictors for recovery.

 

 

KEYWORDS:

 

Chronic fatigue syndrome; Cognitive behavioural therapy; Follow-up; Longitudinal; Recovery

 

 

PMID: 25222752

 

 

 

Highlights:

  • This study investigates recovery from CFS in a routine practice.
  • Approximately 18% of people with CFS recover after CBT.
  • CBT in routine practice demonstrated recovery rates akin to RCTs.

 

 

http://www.sciencedirect.com/science/article/pii/S0005796714001429

 

http://ac.els-cdn.com/S0005796714001429/1-s2.0-S0005796714001429-main.pdf?

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