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The Power of Behavioural Change and the Role of
Cognitions in symptom severity and disability:
Research Questions
• What treatments are effective for symptoms and
disability in the context of medically unexplained
symptoms and diseases i.e. Chronic Fatigue
Syndrome (CFS), Irritable Bowel Syndrome
(IBS) & Disease related fatigue
• What are the common mediators and predictors
of treatment outcomes and do our explanatory
models have something in common
Fatigue Score
18 20 22 24 26 28 30
30 40 50 60 70
Physical Function Score
Pacing, graded Activity, and Cognitive behaviour therapy; a
randomised Evaluation (White et al The Lancet 2011)
Time
SMC
APT
GET
CBT
Time
SMC
APT
GET
CBT
•
CBT and GET are more effective than both SMC alone and APT. APT is no
different from SMC alone
•
The effectiveness of CBT and GET is moderate in size (0.4)
•
The treatments are safe: serious adverse outcomes were uncommon and
similar across arms
Mediators and predictors of
outcome in IBS and CFS
•
We measure cognitive behavioural responses and examine whether they
mediate and predict treatment outcome in different conditions
•
In the context of a RCT changes in behaviour and then cognitions mediated
change in symptoms, disability, and anxiety in CBT for IBS (Reme et al 2010)
•
Embarrassment (shame) was associated with not working in CFS patients
in secondary care in a cross sectional study
(Knudsen et al 2011)
•
These results strengthen the validity of a cognitive behavioural model of
understanding symptom severity and disability
FUTURE DIRECTIONS: To examine predictors of fatigue and disability in other
diseases, develop and evaluate interventions focusing on symptom
management and disability and look at whether mechanisms of change are
similar across conditions and treatments: We will use the same model for
other MUS!