Symptoms,impairment and illness intrusiveness–their relationship with depression in women with CFS/ME

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is an illness in which physiological and psychological factors are believed to interact to cause and maintain CFS/ME in an individual predisposed to it. The various symptoms and impairments associated with CFS/ME have a large impact on quality of life. The purpose of the present study was to identify the extent to which the core symptoms and impairments associated with CFS/ME relate to depression in women with CFS/ME, and to discover whether these relationships were mediated by illness intrusiveness. CFS/ME was found to be a highly intrusive illness, intruding into more life domains and to a greater degree than other illnesses. The effects of both symptoms and impairment on depression were, in part, mediated by illness intrusiveness. Although symptoms severity and impairment had both direct and indirect effects on depression, illness intrusiveness was the strongest predictor of depression.     

Prevalence and treatment of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and co-morbid severe health anxiety

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a debilitating condition that affects 0.2–0.4% of the population. Health focussed anxiety is common across medical conditions, and may be relevant in CFS/ME. This study sought to identify the prevalence and impact of health anxiety (HA) in CFS/ME and evaluate the effectiveness of Cognitive Behavioural Therapy for HA in CFS/ME. Cross-sectional questionnaire methods and case-series design were used to achieve study aims. Analysis indicated that 41.9% of the CFS/ME clinic sample experienced threshold levels of health anxiety, which was associated with elevated symptom severity across several dimensions. Stepwise multiple regression indicated physical functioning and depression accounted for 23.8% of variance in fatigue; depression, fatigue and HA, accounted for 32.9% of variance in physical functioning. Large effect sizes and clinically significant changes were generated in the treatment study. HA is common in CFS/ME and likely to exacerbate fatigue and physical functioning. This study identifies HA as an important target for treatment, trial findings should be further replicated on a larger scale.     

A View of the violence contained in chronic fatigue syndrome

In this paper I ask whether there might be any one particular psychopathology likely to be linked specifically with the physical illness known as chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), and whether CFS/ME aids and abets and 'fits' an original mental state. I think the question cannot yet be answered. However it is my hypothesis that in some personality structures the onset of CFS/ME following a physical illness exacerbates negativity and is an aspect of ordinary depression where there is a lowering of energy levels and a loss of zest for life, or it may reveal the pathological aspect of unresolved rage.
Depending on the degree of pathological disturbance, working with and through the rage may or may not result in a resolution of the symptoms of ME. In this paper I consider some of the problems in the transference and countertransference relationship, which make it extremely difficult to separate out reality from phantasy. There is then the further problem of the denial of the psyche by the patient as part of the violence inherent in the illness.
One case is presented, an example of ME in a borderline male patient in whom resolution could not be achieved.     

Extended network learning error: A new way of conceptualising chronic fatigue syndrome

Abstract

The cause of chronic fatigue syndrome (CFS) is controversial: psychological, hypothalamic and immune mechanisms have been proposed as well as the possibility of some form of interaction between these mechanisms. Patients' own conceptual models vary and sometimes adversely affect self-management. This paper suggests an interactional way of conceptualising CFS using developments in complexity theory (networks, parallel processing or connectionism). I propose that the neurological, immune and endocrine systems are pan of a single, self-regulatory, extended brain-body network. Furthermore, that CFS is caused by self-organisational change in this extended network created by normally adaptive error-sensitive learning rules that malfunction when physiological and psychological challenges coincide. This psychoneuroimniunoendocrinological model shows how previously proposed mechanisms could interact to cause CFS. explains the heterogeneity of the presentation of the disease, and provides a conceptual model that may be acceptable to patients but is also consistent with effective self-management.     

Detecting Chronic Fatigue Syndrome: The Role of Counselors

Chronic fatigue syndrome (CFS) is a physical illness, the cause of which is unknown. Known also as chronic fatigue immune dysfunction syndrome and myalgic encepalomyelitis, the illness has a probable incidence of 2 to 3 per 1,000 among adults and adolescents and is seen also in children. Only a small minority of cases are diagnosed, and only 25% of those suffering from CFS suspect this as the diagnosis. For this reason, counselors often see persons with unsuspected cases and may play an important role in detecting and referring these clients appropriately. Case histories are used to illustrate how suspected cases of CFS can be distinguished from depression and other mental health conditions in counseling practice.     

Therapist effects and the dissemination of cognitive behavior therapy for chronic fatigue syndrome in community-based mental health care

ObjectiveThe purpose of the present study was to explore the role of the therapist in the dissemination of manualized cognitive behavior therapy (CBT) for chronic fatigue syndrome (CFS) outside specialized treatment settings.MethodWe used the routinely collected outcome data of three community-based mental health care centers (MHCs) which implemented and sustained CBT for CFS during the course of the study. Ten therapists, who all received the same training in CBT for CFS, and 103 patients with CFS were included.ResultsRandom effects modeling revealed a significant difference in mean post-treatment fatigue between therapists. The effect of the therapist accounted for 21% of the total variance in post-treatment fatigue in our sample. This effect could be explained by the therapists’ attitude toward working with evidence-based treatment manuals as well as by the MHC where CBT for CFS was delivered.ConclusionThe context in which CBT for CFS is delivered may play an important role in the accomplishment of established therapy effects outside specialized treatment settings. Due to the small sample size of MHCs and the different implementation scenarios in which they were engaged, our findings should be interpreted as preliminary results which are in need for replication.     

Chronisches Ersch?pfungssyndrom

The treatment of chronic fatigue syndrome (CFS) may pose a challenge as controversial concepts of its aetiology are discussed. Psychotherapy and graded exercise therapy have been suggested for the treatment of CFS. The aim of the present literature review is to summarize the evidence for these treatments based on two meta-analyses and more recently published randomized controlled trials. There is robust evidence for the efficacy of cognitive-behavioural therapy for CFS, showing moderate effects especially on fatigue severity and physical functioning at post-treatment and at short to medium term follow-up. Other psychological treatments have mainly been tested as control conditions and not as bona fide psychotherapy; however, single trials suggest benefits of non-directive counselling and psycho-education. To further improve treatment results and their maintenance, relapse prevention strategies are important and a stronger empirical foundation of long-term effects is needed.     

To Serve or Not to Serve: Ethical and Policy Implications

The Institute of Medicine (IOM) is one of the nation's more influential health‐related non‐profit organizations. It plays a large role in shaping health policy by commissioning panels to develop “white papers” describing research and recommendations on a variety of health topics. These white paper publications are often used to help make policy decisions at the legislative and executive levels. Such a prominent institution might seem like a natural ally for policy‐related collaborative efforts. As community psychologists, we strongly endorse efforts to positively influence public policy at the national level. However, while serving on influential panels and commissions like the IOM might seem to be very much part of the ethos of our discipline, there are occasions when such institutions are pursuing a mission that inadvertently has the potential to instigate divisive friction among community activists and organizations. A case study is presented whereby I describe my decision not to accept an invitation to serve on a controversial IOM panel. I explore the ethical challenges regarding maintaining my independence from this institution and its attempt to redefine chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME), as well as the process of searching for alternative avenues for collaborating with community activists to influence policy related to these debilitating illnesses.     

Attention network test: Assessment of cognitive function in chronic fatigue syndrome

Information processing difficulties are common in patients with chronic fatigue syndrome (CFS). It has been shown that the time it takes to process a complex cognitive task, rather than error rate, may be the critical variable underlying CFS patients' cognitive complaints. The Attention Network Task (ANT) developed by Fan and colleagues may be of clinical utility to assess cognitive function in CFS, because it allows for simultaneous assessment of mental response speed, also called information processing speed, and error rate under three conditions challenging the attention system. Comparison of data from two groups of CFS patients (those with and without comorbid major depressive disorder; n = 19 and 22, respectively) to controls (n = 29) consistently showed that error rates did not differ among groups across conditions, but speed of information processing did. Processing time was prolonged in both CFS groups and most significantly affected in response to the most complex task conditions. For simpler tasks, processing time was only prolonged in CFS participants with depression. The data suggest that the ANT may be a task that could be used clinically to assess information processing deficits in individuals with CFS.     

Does Location Uncertainty Modulate Unconscious Processing Under Continuous Flash Suppression?

Previous research suggests that selective spatial attention is a determining factor for unconscious processing under continuous flash suppression (CFS), and specifically, that inattention toward stimulus location facilitates its unconscious processing by reducing the depth of CFS (Eo et al., 2016). The aim of our study was to further examine this modulation-by-attention model of CFS using a number priming paradigm. Participants (N = 26) performed a number comparison task on a visible target number (“compare target to five”). Prime-target pairs were either congruent (both smaller or larger than five) or incongruent. Spatial attention toward the primes was varied by manipulating the uncertainty of the primes’ location. Based on the modulation-by-attention model, we hypothesized the following: In trials with uncertain prime location, RTs for congruent prime-target pairs should be faster than for incongruent ones. In trials with certain prime location, RTs for congruent versus incongruent prime-target pairs should not differ. We analyzed our data with sequential Bayes factors (BFs). Our data showed no effect of location uncertainty on unconscious priming under CFS (BF0+ = 5.16). However, even visible primes only weakly influenced RTs. Possible reasons for the absence of robust number priming effects in our study are discussed. Based on exploratory analyses, we conclude that the numerical order of prime and target resulted in a response conflict and interfered with the predicted priming effect.     

书写和阅读中的镜像错误及其脑机制

镜像书写是指对单个字母、整个词或者字母串进行反方向书写,当将这些字母或者字投射到镜子上时,这些字母或者字可以被正常阅读。镜像书写现象有时伴随镜像阅读,二者在研究中统称“镜像错误”。非随意的镜像错误已经在儿童以及脑损伤病人身上被发现,并且与利手、基因、智商及书写系统等因素有联系,但对该现象的发生发展及脑机制的解释目前尚不确定。对该现象的研究和解释将有助于我们深入理解文字的加工机制、文字书写的习得以及物体识别系统的加工与组织原则。 本文系统评述了对镜像书写的理论解释,综合各方面研究阐述了镜像书写现象与利手、基因、智商等因素的关系,并探讨了该现象产生的潜在神经机制。     

Psycho-physiological impact on women with chronic fatigue syndrome in the context of their couple relationship

The quality of dyadic adjustment is likely to play an important role in patients' relational problems and may also be associated with the clinical presentation of chronic fatigue syndrome (CFS) symptoms. The objective of this study was (1) to determine whether CFS patients and their partners have similar perceptions of their dyadic adjustment and (2) to evaluate whether the influence of dyadic satisfaction in women with CFS, as well as common psychological parameters such as anxiety, may correlate with physiological responses at rest and/or when performing very low intensity exercise. Forty females with CFS and their partners completed the Dyadic Adjustment Scale, the State-Trait Anxiety Inventory, and the Hospital Anxiety and Depression scale. The cardiovascular adaptation of patients was evaluated during resting conditions and on a precalibrated cycle ergometer while performing very low intensity exercise. Patients and partners had similar perceptions of their marital relationship. Both at rest and during very low workload, various physiological parameters in the patient group showed statistical correlations with certain psychological parameters. Several psychological variables, such as anxiety and dyadic adjustment, were associated with the cardioventilatory response monitored at rest and during very low intensity exercise. Further studies are needed to determine the nature of this association.     

Symptoms of Meares-Irlen/Visual Stress Syndrome in subjects diagnosed with Chronic Fatigue Syndrome

Several diagnostic symptoms of the visual-processing deficit Meares-Irlen/Visual Stress Syndrome are remarkably similar to symptom manifestations reported by individuals with chronic fatigue syndrome (CFS). We surveyed the specific incidences of nine widely-recognised symptoms of visual stress (VS) in a group of subjects (n = 20) previously diagnosed with CFS. The presence of each symptom of VS in the CFS group was compared to its respective presence in both an age and sex matched healthy comparison group (n = 46), and an age and sex matched group comprised of individuals (n = 14) diagnosed with VS. Results showed the frequencies of all nine VS symptoms in the CFS-diagnosed group to be significantly higher (p = .032 – p < .0005) than in the comparison group, with only two symptoms being statistically less frequent in the CFS group than in the VS-diagnosed group. The average number of VS symptoms reported by the CFS group was also significantly higher than the comparison group, yet not significantly different from the VS group. Thus, the occurrence of VS symptoms in subjects diagnosed with CFS appears to be far greater than previously reported, which in turn may indicate the interplay of some yet to be identified underlying factor(s) common to both conditions.     

An under‐active or over‐active internal world?

This paper explores the dynamics brought into analytic work when there is a symmetric fusion between psyche and soma within the patient. It will consider how such a fusion may emerge from reverberations between physical constitution and a lack of maternal attunement, containment and reflective function. I will describe the work with a patient, Jane, who was diagnosed with Myalgic Encephalomyelitis (ME) during the course of her analysis. The dynamic of her physical symptoms within the analytic work, and the impact of her internal affects and internal 'objects' within the transference and countertransference, indicated a difficulty in finding an homeostatic balance resulting in overactivity and underactivity at both somatic and psychological levels. Using the clinical work with Jane this paper will also examine the interrelationship between mother-infant attachment, an inadequate internalized maternal reflective function, affect dysregulation, unconscious fusion, the lack of psyche-soma differentiation and the impact of the latter in relation to internal regulation systems, or lack of, in patients with Chronic Fatigue Syndrome (CFS) and Myalgic Encephalomyelitis (ME). I will draw on similar work carried out by Holland (1997), Simpson (1997) and Simpson et al. (1997). The paper will also employ the concept of the reflective function (Fonagy 2001; Knox 2003), and consider Matte-Blanco's (1999) concepts of generalization and unconscious symmetry in relation to the patient's internal world. I go on to consider how analysis provides a point outside the 'fusion' that can enable the 'deadlock' to be broken.     

An economical,humane, and effective method for short—term suppression of hand mouthing

Self-injurious behavior (SIB) is a serious health hazard, especially among individuals with severe and profound mental retardation, sometimes leading to drastic therapeutic measures. Environments in which there are long periods with minimal opportunities for constructive activity are conducive to the development of SIB, but even highly motivated, hard-working caregivers sometimes have difficulty providing sufficient personal interactions to prevent it. In this case study, one person's self-injurious hand mouthing was significantly reduced by analyzing her toy play and consistently providing her with preferred toys. The results showed that careful and consistent attention to assuring that preferred materials are available for self-entertainment may be an effective and efficient method for managing some cases of SIB during times when other activities and treatments are unavailable.     

Evaluation of two physical guidance procedures in the treatment of pediatric feeding disorder

Children with pediatric feeding disorder may refuse to consume an adequate variety and/or volume of food to maintain expected growth. They can consume food but may actively or passively refuse, resulting in escape or avoidance of eating. Behavioral interventions like positive reinforcement with escape extinction can increase consumption. However, sometimes these interventions are insufficient, especially in treating passive refusal. In these cases, physical guidance may be used to prompt an open mouth to deposit food. Research indicates open-mouth prompts are effective and rated as acceptable. This study replicated an existing physical guidance procedure, the finger prompt, and compared its efficacy and acceptability with that of a spoon prompt. This study extended research by defining and measuring passive refusal as a dependent variable and assessing social validity among different stakeholders and times. Both prompts were effective in treating food refusal, and caregivers rated the finger prompt as more preferred.     

Writing about psychoanalysis: II. Analysts who write, patients who read

When we make a decision to lecture, or to write for publication, we have begun an activity that will affect every one of our patients. If they attend our lectures, or read our published works, they cannot help being influenced. Even if they do not, they will have some reaction to the focusing of our interest on particular phases of the analysis. This will be true whether or not we intend to present clinical material. These considerations inevitably affect the analyst himself, sometimes inhibiting his writing altogether, sometimes constricting its scope, or worst of all, degrading its quality. The analyst's writing is also almost certain to influence whether and with what success his patient may choose to write. Lest these considerations suggest that we avoid writing altogether, I emphasize that such a sacrifice is by no means desirable or necessary. Problems of discretion will arise, and may in some cases be virtually insoluble; but there are ways of writing that can overcome most such objections. The analyst's interest in writing should be recognized and its effects, if any, brought into the analysis; so long as the writing itself is done with due regard to the conduct of the analysis and the welfare of the patient, it need have no adverse effects on either.     

Few Gender Differences Exist Between Women and Men with Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is generally considered to be a women's health issue, but the illness occurs also in men. The research objective of this study was to determine if illness patterns and functional status differed between the sexes. Because our own data showed that women with CFS have significantly more comorbid fibromyalgia or multiple chemical sensitivity than men, we eliminated patients with these comorbid conditions from our evaluation. Women with CFS were quite similar to men with CFS in terms of demographics, psychiatric status, functional status, and assessments of disability. Women reported more infectious/flu-like symptoms (represented by a factor derived from factor analysis) than men, but these differences were insignificant after controlling for other variables. Cluster analysis revealed that women were more likely than men to fall in the cluster characterized by symptom severity. Differences found were those of degree rather than of type; strikingly different illness patterns—suggestive of different pathophysiological processes between the sexes—were not found.     

Characteristics of the indirect McCollough effect

Induction of contingent color aftereffects with a single chromatic grid sometimes results in an illusory color on a grid different from the one presented during induction. Such illusory color, contingently elicited by a noninduced grid, has been termed the indirect McCollough effect (indirect ME). We show that the indirect ME occurs only when the color complementary to the grid color is present during induction (either physically present or as a color afterimage), and that the indirect ME is seen only on gratings that are orthogonal to the induction orientation. These findings are in accord with the account of the indirect ME proposed by Humphrey, Dodwell, and Emerson (1989). We also show that characteristics of the indirect ME (seen following one-grid induction), both on induced and orthogonal orientations, are similar to those observed with the direct ME (seen following the usual two-grid induction procedure). Both procedures result in contingent aftereffects that display substantial retention and that do not display interocular transfer.     

Characteristics of the indirect McCollough effect.

Induction of contingent color aftereffects with a single chromatic grid sometimes results in an illusory color on a grid different from the one presented during induction. Such illusory color, contingently elicited by a noninduced grid, has been termed the indirect McCollough effect (indirect ME). We show that the indirect ME occurs only when the color complementary to the grid color is present during induction (either physically present or as a color afterimage), and that the indirect ME is seen only on gratings that are orthogonal to the induction orientation. These findings are in accord with the account of the indirect ME proposed by Humphrey, Dodwell, and Emerson (1989). We also show that characteristics of the indirect ME (seen following one-grid induction), both on induced and orthogonal orientations, are similar to those observed with the direct ME (seen following the usual two-grid induction procedure). Both procedures result in contingent aftereffects that display substantial retention and that do not display interocular transfer.