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The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review

  [ 167 votes ]   [ 6 Comments ]
By V Deary, et al. • www.ProHealth.com • September 6, 2007


[Note: This is the publisher's abstract of an article in Clinical Psychology Review.]

The article is a narrative review of the theoretical standing and empirical evidence for the cognitive behavioral model of medically unexplained symptoms (MUS) in general and for Chronic Fatigue Syndrome (CFS) and Irritable Bowel Syndrome (IBS) in particular.

A literature search of Medline and Psychinfo from 1966 to the present day was conducted using MUS and related terms as search terms. All relevant articles were reviewed. The search was then limited in stages, by cognitive behavioral therapy (CBT), condition, treatment and type of trial.

Evidence was found for genetic, neurological, psychophysiological, immunological, personality, attentional, attributional, affective, behavioral, social and inter-personal factors in the onset and maintenance of MUS.

The evidence for the contribution of individual factors, and their autopoietic interaction in MUS (as hypothesized by the cognitive behavioral model) is examined.

The evidence from the treatment trials of cognitive behavioral therapy for MUS, CFS and IBS is reviewed as an experimental test of the cognitive behavioral models.

We conclude that a broadly conceptualized cognitive behavioral model of MUS suggests a novel and plausible mechanism of symptom generation and has heuristic value. We offer suggestions for further research.

Source: Clinical Psychology Review. 2007 Jul 17; Vol 27, Issue 6 [E-publication ahead of print] PMID: 17707564, by Deary V, Chalder T, Sharpe M. Institute of Health and Society, University of Newcastle, Newcastle Upon Tyne, UK; Cognitive Behavioural Therapy Institute of Psychiatry, Department of Psychological Medicine, London, UK; Psychological Medicine and Symptoms Research School of Molecular and Clinical Medicine, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK . [E-mail: vincent.deary@ncl.ac.uk ]





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Article Comments Post a Comment

Psychiatric Training Manual For CFS Here
Posted by: katte
Sep 7, 2007
WHY, oh WHY, are you featuring this Training Manual for Psychiatric Treatment of CFS patients, while *simultaneously* promoting a "new name" as one that would alieve the abuse, neglect, and absence of medical care we have received for over 2 decades?! Your Home Page proudly proclaims that ProHealth/immunesupport.com receives 5 MILLION visitors a year, and includes 140,000 members. That you are THE place to go for patients and our Doctors for the World's best research available on CFS. While you have launched, and widely advertised this new name campaign Globally, clearly aimed to attract MORE patients and MORE Doctors to come to this site... Suddenly appears...a Manual of articles which clearly state it is finally, the truth, for the direct education of Psychologists that CFS is a MENTAL ILLNESS, to be treated, not medically, but Psychiatrically. How is this possible? How is this morally justifiable? Your "Reviewer", Vincent Deary, has an extreme conflict of interest as an evaluator of this Manual. For he is deeply entrenched, and partly responsible for the very concepts and "innovative" so-called treatment it is advertising. Yes, advertising, as the Product it (CBT) is. For the invented condition it purports to cure (MUS). This Corporately sponsored "product" is designed to deliberately DENY legitimate sufferers of a severe medical disease...medical treatment or even testing! For the sake of cost-cutting and profiteering for the very same...Corporate Interests. This made up product, for a made up condition is deliberately designed for the purpose of diverting large amounts of money into Corporate coffers and AWAY, forever, from legitimate Medical Research, already discovered, by some of the World's best and brightest Scientists today. Is this also the mission of ProHealth/immunesupport.com? Immediately parallel to this Article, is your own proud proclamation that YOUR products partially fund RESEARCH. Do you fund research that claims CFS is a Mental Illness?? Do your Disabled customers unwittingly contribute to research that has been found to, not only be of little use, but actually harmful to they themselves? Are your severely, sick and despairing members coming here for help, sending our doctors here for education, perhaps Psychologists we might consult, while surviving catastrophic disease...only for them to be told we must rise up from our beds and exercise, as we have a Mental Disease? That we have only imagined that we are actually sick? That it is our own Maladaptive Thinking that keeps us debilitated? The Reviewer and authors of these articles are closely allied colleagues. The "history" of the Syndrome called CFS, the made-up thing called MUS, and the patients stuck with these diagnoses, is patently false. The entire story contained here, and the very language and terms it uses, are a total, ever morphing fantasy, invented by the very authors themselves. WHY is this Psychology Training Manual featured here, by authors who fraudulently teach that Myalgic Encephlomyelitis, and Chronic Fatigue Syndrome...the name ME patients in the US and elswhere are stuck with...and all other sick people under this amorphous umbrella...have been found to have no evidence of a medical disease, but actually have a Mental Illness...a Personality Disorder...a condition the patients themselves are perpetuating? (pick a day, month, year for an actual ever-changing made-up definition. Both the UK, this very group of authors, and the US/CDC/Wm. Reeves keep changing it). And WHY NOW ??!! Do you feature this Psychiatric Manual meant to "educate" Psychologists we may go to for support some day, as we navigate daily survival with these catastrophic diseases. WHY NOW, when you invite Millions from across the Globe to come here and vote for a "new name" that is also invented? Presumedly, also countless Professionals to come here for "education" on CFS and celebration of this new name. They will find here, now, on your site, that this "new name", OR the "old name" refers to Mental Illnesses...to be treated only with the made up Corporate Product called Cognitive Behavioral Therapy. The reviewer and authors are not simply offering this research as a consideration. They are and have been promoting this as a done deal, a well investigated fact, for many years...this invented product...now developed into complex packages, videos, training seminars...carefully crafted and taught to SELL. To unwitting Professionals, for use on apparently dim-witted patients. Patients they know very well have and will suffer from it. As they are co-erced or forced into it. This is particularly repugnant, as it targets a population who will go to any lengths to get well, as has been illustrated for decades...yet, also who suffer from often severe cognitive impairments. Who are often living on the edge of Heart Failure, with untreated Infections, Crippling pain, Injured Immune Systems, Nerve Damage, Brain injury, and denied ANY relevant medical care, or minimal basic needs, respect, or the basic dignity of the Truth of these? This is a population of intelligent Human Beings...Engineers, Teachers, Athletes, Attorneys, Loving Parents, Dedicated Students, Construction Workers, Musicians, Artists, Accountants, Veterans, Landscapers, you name it. Every walk of Life, every age, race, religion, culture and country of origin. I was just meeting people here and learning from some of the posts. What am I to think now? MUS...what a name! CBT...What a product! What a money-saver and maker! What an interesting bunch of Maladaptive Responsibility-Phobic Personality Disordered people? What's next? Sick and Injured Soldiers as cowardly combatant avoidant? Oh, yes, that's been done...by the same Psychiatric Colleagues. What use is being made of the immunesupport.com's members...of ProHealth's customers, of the medical and emotional support system here, and the rest of the world's ME, CFS, CFIDS patients? WHY this Psychiatric Training Manual? And WHY NOW? What does the New Name Panel's Scientists and Promoters think of this? WHAT are YOU, Rich Carson, ProHealth,and immunesupport.com, thinking? Katrina
Reply Reply

This Flies in the Face of all the Good Biomedical Research Out There.
Posted by: 43
Sep 12, 2007
I have to wholeheartedly agree with Katrina on this. As a patient with ME (not CFS) from the UK, I can see at first hand the disastrous effect that the psychosocial-paradigm-believers are having on pwme in this country. Over here we have a Government which is deliberately, with the help of psychiatrists such as Simon Wessely and his little band of followers, subverting the burgeoning knowledge that genuine researchers into this illness have already found and are now discovering. Consequently all that pwme in the UK have to look forward to as a result of the recently published NICE Guidleines here, is a 'treatment' package of CBT and GET, which when looked at with appropriate patient cohorts, asking the right questions, can,in the instance of CBT, provide modest fleeting benefit at best and in a tiny proportion of patients, whilst in the instance of GET cause immesurable harm with patients becoming bed-bound when formerly they were not. The data that led to NICE making these reccommendations has been proven to be of poor quality, and the York review which carried out the meta analysis used a remit to ensure no biomedical research could be considered, and indeed changed it's opinion of their analysis from an initial review at the beginning of the millenium to that submitted to NICE. In their initial review their high opinions of RCTs using CBT and GET were far more critical, - looks like yet another instance of Government agencies being nobbled by the psyches (or I dare I say the psyches being used by Government agencies to ensure their aetiological view cannot be challenged). That Pro-Health is falling foul of this manipulation is very worrying and I will no longer feel it acceptable to be party to this and will withdraw from mailings from this site. R.C. (UK)
Reply Reply

 
this is the second time i have tried to post - am i being moderated?
Posted by: jennymw
Sep 14, 2007
-I have to agree with both RC and Katrina. I also suffer from ME. Since when has ME been a disease of Medically Unexplained Symptoms? It has been a classified neurological disease in the WHO directory since 1969. Just because the full understanding of its cause (and therefore the search for a cure) has not yet been reached by scientists, does not make it a *Medically Unexplained Symptom* or syndrome. Sadly, this disease can be progressive and fatal - Sophia Mirza was the first person sadly to be shown to have died from ME to my knowledge in the UK - she had evidence of inflammation in her spinal cord (hence the name ME). One wonders just how many more people have died from ME, and haven't had this subscribed to their actual disease.

The attempt to rename ME *CFS* was not a medical but a political act, as any further renaming would be. When the vested interests of corporate profit of the medical insurance industry began to take the role of paymasters to the field of psychiatry in both the US and the UK, ostensibly paying for the renaming as their liability to pay consumers with *mental* illness was considerably less than liability to pay out for physical disability due to physical illness, the renaming of ME was orchestrated to the detriment of patients everywhere. Fatigue is only one aspect of ME, and some patients do not even have fatigue at all. CFS is a smokescreen designed by the corporate interests and their questionably-motivated medical supporters to disenfranchise insurance consumers of their rightful benefits when diagnosed with chronic physical ill health. History will look back at this and those involved in it with the disgust that we within the ME community look at it now.

Would you go to a physchologist to cure you from cancer? From diabetes? From tuberculosis? From Multiple Sclerosis (pertinent to mention this as MS until recently was also disparaged as one of those diseases that is *all in the mind* and not real - ring any bells?). The answer is NO, you would not. You would not expect a psychologist to be capable of curing a physical disease...not unless perhaps you were a little challenged in the mental health department - it's just common sense; or perhaps you would pretend that psychologists could be useful simply because you were part of a great circular storm dragging patients into its very eye - a circular storm which refers patients to its own discipline in order to enrich itself. Why are psychiatrists so heavily involved in a neurological illness? Surely they are acting outside their areas of expertise, which is something they should not be doing (Roy Meadow anyone?) Why are the very psychiatrists investigating CFS (NOT ME whatever they try to claim) finding the only treatments that supposedly help ME patients are those very treatments they are responsible for providing? Does this not sound odd to anyone else?

Thank goodness for quality medical researchers and Professors who prioritise the pursuit of truth over self-aggrandisement, profit and undeclared vested interests. Thank goodness for Professor Hooper, thank goodness for Jonathan Kerr researching into discovering the gene signatures not only of all ME sufferers but of sub-groups as well so that treatment when available can be tailored exactly to the patient's need, thank goodness for Dr Paul Cheney whose excellent research has clearly and concisely pointed out that people with ME SHOULD NOT EXERCISE because they are making demands on a body which cannot meet those demands and will fail to the point of causing the patient's death...GET - not suitable for people with ME - GET IT? The ME community have quite rightly had enough of this nonsense peddled at it. Psychology cannot cure mental diseases, never mind physical ones! You don't need a professorship or a generous £8 million tax- payers monies to do useless psychological research into CBT and GET to know and understand that psychological approaches can not cure physical diseases - you just need an ounce of common sense!

JW (UK)

 

 
psychology cannot cure physical illnesses
Posted by: jennymw
Sep 12, 2007
I have to agree with both RC and Katrina. I also suffer from ME. Since when has ME been a disease of Medically Unexplained Symptoms? It has been a classified neurological disease in the WHO directory since 1969. Just because the full understanding of its cause (and therefore the search for a cure) has not yet been reached by scientists, does not make it a *Medically Unexplained Symptom* or syndrome. Sadly, this disease can be progressive and fatal - Sophia Mirza was the first person sadly to be shown to have died from ME to my knowledge in the UK - she had evidence of inflammation in her spinal cord (hence the name ME). One wonders just how many more people have died from ME, and haven't had this subscribed to their actual disease.

The attempt to rename ME *CFS* was not a medical but a political act, as any further renaming would be. When the vested interests of corporate profit of the medical insurance industry began to take the role of paymasters to the field of psychiatry in both the US and the UK, ostensibly paying for the renaming as their liability to pay consumers with *mental* illness was considerably less than liability to pay out for physical disability due to physical illness, the renaming of ME was orchestrated to the detriment of patients everywhere. Fatigue is only one aspect of ME, and some patients do not even have fatigue at all. CFS is a smokescreen designed by the corporate interests and their questionably-motivated medical supporters to disenfranchise insurance consumers of their rightful benefits when diagnosed with chronic physical ill health. History will look back at this and those involved in it with the disgust that we within the ME community look at it now.

Would you go to a physchologist to cure you from cancer? From diabetes? From tuberculosis? From Multiple Sclerosis (pertinent to mention this as MS until recently was also disparaged as one of those diseases that is *all in the mind* and not real - ring any bells?). The answer is NO, you would not. You would not expect a psychologist to be capable of curing a physical disease...not unless perhaps you were a little challenged in the mental health department - it's just common sense; or perhaps you would pretend that psychologists could be useful simply because you were part of a great circular storm dragging patients into its very eye - a circular storm which refers patients to its own discipline in order to enrich itself. Why are psychiatrists so heavily involved in a neurological illness? Surely they are acting outside their areas of expertise, which is something they should not be doing (Roy Meadow anyone?) Why are the very psychiatrists investigating CFS (NOT ME whatever they try to claim) finding the only treatments that supposedly help ME patients are those very treatments they are responsible for providing? Does this not sound odd to anyone else?

Thank goodness for quality medical researchers and Professors who prioritise the pursuit of truth over self-aggrandisement, profit and undeclared vested interests. Thank goodness for Professor Hooper, thank goodness for Jonathan Kerr researching into discovering the gene signatures not only of all ME sufferers but of sub-groups as well so that treatment when available can be tailored exactly to the patient's need, thank goodness for Dr Paul Cheney whose excellent research has clearly and concisely pointed out that people with ME SHOULD NOT EXERCISE because they are making demands on a body which cannot meet those demands and will fail to the point of causing the patient's death...GET - not suitable for people with ME - GET IT? The ME community have quite rightly had enough of this nonsense peddled at it. Psychology cannot cure mental diseases, never mind physical ones! You don't need a professorship or a generous £8 million tax-payers monies to do useless psychological research into CBT and GET to know and understand that psychological approaches can not cure physical diseases - you just need an ounce of common sense!

JW (England)

 


"medically unexplained symptoms" indicates authors on another page
Posted by: tansy
Sep 13, 2007
Deary, Chalder and Sharpe et al are well known in the UK for their hypotheses based upon MUS, maladaptive thinking, and physical deconditioning. Despite evidence to the contrary they continue to market their psycho/social based treatments that have resulted in a consistently high percentage of treatment failures and patients with ME being made more ill and disabled. Sharpe et al’s involvement in the Insurance Industry explains a great deal; accepting that patients with ME are genuinely ill and disabled would cost the industry dearly; no wonder they welcomed the cheaper option of insisting the well documented symptoms of ME are medically unexplained. Sharpe et al cherry pick the research, and conveniently ignore anything that counters their opinions; they have provided our Department of Work and Pensions a wonderful cop out too; the DWP’s guidelines are prejudicial and factually incorrect. Similarly unreliable and biased data was the basis of the NICE guidelines which have left doctors more confused than ever and their patients, who thought things couldn’t get any worse, feeling utterly betrayed. Many in the UK are calling for the Canadian Guidelines to be adopted here; the CG would help doctors diagnose ME (or not) correctly and enable them to prescribe more suitable treatments rather than relying on CBT and GET which are clearly not the answers.
Reply Reply

Gremlins at Prohealth too?
Posted by: 43
Sep 14, 2007
Having tried to donate 'thumbs up' to respondents on this story and found that any positive endorsement does not show up on screen, I am wondering if ProHealth has been 'nobbled' by the psyches too?
Reply Reply


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