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Psychologising Long-Covid and Anything Else

 

Under a heading ‘Long-Covid: interventions not proven’ the May issue of The Psychologist publishes  a letter (see below) I wrote with Joan Crawford. The same issue contains an interview with Jo Daniels, the newly appointed Chair of the Scientific Committee of the British Association for Behavioural and Cognitive Psychotherapy (BABCP) outlining her mission to apply CBT to all long-term conditions (LTC). This despite a paucity of evidence that CBT protocols matched  to a specific LTC make any unique contribution. She proclaims “It is now commonly accepted that CBT ‘works’ to a greater or lesser extent for most physical  health conditions”,  this is grist to the mill for the expansionism of the Improving Access to Psychological Therapies (IAPT) service. But contrary voices do not get a hearing in BABCP, echoes of Russia.

                

‘The underlying message of Dr Siddaway’s article ”We need to talk about Long-Covid” in the March 2022 issue of the Psychologist is that there is or will be an added value from psychological intervention for those affected by Long-Covid i.e Covid of more than 3 months duration.  But the Scottish verdict ‘not-proven’ seems appropriate.

There can be no doubt that offering emotional support to people like Grace, cited in the article, is an important resource for anyone suffering from a long-term medical condition. But there is a distinction between the provision of emotional support (travelling alongside) and delivering a psychological intervention (fixing). The latter is inevitably more costly, requiring more highly trained staff and therefore less likely to be available. Is it a proper use of scarce psychological resources to offer psychological treatments to those with Long-Covid?

Clearly if a person with Long-Covid suffers from an additional disorder such as PTSD or depression a case can be readily made for addressing the comorbid disorder. But the effectiveness of this treatment, in such circumstances, remains to be demonstrated. There are no randomised controlled trials of the psychological treatments of Long Covid plus or minus comorbid disorders. Thus, the evidence for the efficacy of treatment must be currently regarded as weak.

Siddaway suggests that it is possible to extrapolate from studies of chronic fatigue syndrome and pain and apply the strategies to Long-Covid. But there are significant problems with this: a) it assumes Long-Covid is in the same domain as CFS and pain, but arguably, there is little evidence that this is a homogenous category b) the evidence base for the efficacy of psychological treatment for CFS Is problematic if objective indices of outcome are insisted upon c) the evidence base for psychological treatments for CFS and pain, such as it is, is for protocols and not for the components of the interventions, such as pacing or distraction. Using strategies out of context is problematic.

Siddaway appeals to a biopsychosocial model to justify psychological intervention for Long- Covid, despite any evidence that mood and coping strategies make a significant difference to the physical symptoms of Long-Covid. The proposed model ” the complexity of Long-Covid” is not capable of falsification, any factor e.g a hostile working environment, could be proposed to be pivotal in the development of Long Covid, but not ruled out.  As such it is not a model.

It serves the interests of the powerholders of psychological therapies to transmute the physical disorders into candidates for psychological intervention. An extending of Empires. This is not to say that psychological intervention may not sometimes be helpful in the context of a long-term medical condition but unless the population is clearly specified clients will be failed by inappropriate treatments and services exhausted.

 

Mike Scott

 

Joan Crawford’

346 replies on “Psychologising Long-Covid and Anything Else”

“ delivering psychological intervention = fixing”. This premise has long been substituted with the far more realistic concept of “ psychological flexibility/ resilience “. Process- based CBT ( e. g., ACT) has produced strong and convincing empirical evidence not just for beneficial outcomes but – more importantly- for the six hitherto identified psychological processes underlying these outcomes. As an empirically supported, trans diagnostic intervention it is absolutely valid to extrapolate efficacy for long Covid related distress and behavioural problems on the basis of its efficacy for other long- term, bio- medical treatment resistant conditions such as chronic pain.

I totally disagree, processes are not seen as a sufficiently reliable outcome measure in any of the randomised controlled trials. The methodologyical rigour of the ACT trials is significantly less than the standard CBT trials see Ost’s work in 2008, he thought ACT should not be regarded as an Evidence Supported Treatment. The NICE review of CBT for chronic pain was far from a ringing endorsement. There is an absence of independent blind assessors in the health related CBT studies and there is a conflict of interest in that the developers of the protocols are marking their own homework.
Mike

I wanted to thank you for this excellent post (and article in the Psychologist) that highlights the difficulties that can arise when a CBT model is super-imposed on ME/CFS. My wife and I have both worked as clinical psychologists since 1990 and regularly made use of CBT techniques in its many different forms throughout our careers.

However, as you explain so well, there are important differences in how these ideas are used in work with people with clearly identified mental health needs, and when used with people diagnosed with ME/CFS.

We are especially aware of this because our daughter was diagnosed with ME as a 15-year-old and was ill for 8 to 9 years.

There are so many things I could say about the inappropriate application of CBT to ME, but I think I need to confine myself to just two

First, you were absolutely right to describe how people tend to confuse walking alongside and intervening. It is as if, in the absence of a widely agreed physical cause for ME then this must mean that it is a psychological illness instead. In fact, strong evidence is emerging to implicate aspects of cellular functioning in the maintenance of symptoms including problems in the uptake of oxygen and failures of the immune system. While CBT therapists sometimes claim that they are agnostic about the causes of ME, this is being disingenuous: there are clear messages (usually implicit, sometimes explicit) that associate physical symptoms with cognitive errors.

Second, as you say, the empirical evidence for CBT is ‘problematic’ – notably the misinterpretations and misrepresentations of evidence from the PACE trial (do see the brilliant work of Tom Kindlon, who has himself lived with ME for many years – e.g., https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0218-3?fbclid=IwAR2T2nDlW6YtdD4a1eThe8p_iEiGQvngoMSZDoEmBeGrHd5wr8EY1fbMqAg). Even worse has been the way in which proponents of psychological interventions typically ignore the ample evidence that many patients believe they were harmed by inappropriate applications of CBT derived therapies.

You are also spot on to identify the Imperial tendencies of the powerholders, seeking to extend the CBT Empire by seeking out new territories to plant their flag.

In general, I am proud to be a psychologist and feel privileged to have been able to have a career working alongside many good, clever, thoughtful and kind people. But over the last ten years or more as I have seen the harm that psychologists can cause when they stop being either thoughtful or reflective so I have also begun to feel ashamed of my profession.

Peculiar Lancet Psych article spends half a page puffing the author before getting down to the ‘psychiatric sequelae’ of the title:

“The third study, published in PLOS Medicine,
studied more than 270 000 patients and found that over one in three had
one or more features of long-COVID (such as fatigue, pain, or brain
fog) recorded between 3 and 6 months after a diagnosis of COVID-19. This
was significantly higher than after influenza. The risk of long-COVID
features was higher in patients who had more severe COVID-19 illness,
and slightly higher among females. White and non-White patients were
equally affected. “We plan to extend our work to look at longer-term
follow up, as well as to see whether the effects of the virus are
evolving over time, in relation to change in dominance of differing
variants”, explains Harrison.”

There’s no escape from the psych lobby’s territorialism, it seems.

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00116-X/fulltext?dgcid=raven_jbs_etoc_email

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В случае если осуществляется замена нижних брёвен, соответственно брус также освобождается от давления и реализуется демонтаж и монтаж, потому что при замене поднятие не больше десяти сантиметров, что и не является критичным включая для внутренних частей отделки.

нижняя балка или венец из лиственных существенно долговечнее и успешно зарекомендовал свою эффективность благодаря своим свойствам надежностью и сопротивляемостью к разложению. Тем не менее, ее также нужно обработать путем использования противогрибкового препарата, подобно и все балки.

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volante de equilibrado con cesta de embrague

Este volador de nivelacion con canasto de embrague es un sistema critico a fin de asegurar el operacion ideal del propulsion y la accionamiento de un automotor. El desequilibrio en la presente parte llega a causar vibraciones, estruendo, deterioro rapido de los partes e pudiendo llegar a averias. En el pasado, el balanceo se ejecutaba despues de sacar el volador del propulsor, no obstante las desarrollos contemporaneas facilitan efectuar este proceso directamente en el vehiculo, esto que minimiza periodo y gastos.

Como se define el Desbalance?

El falta de equilibrio es una condicion en la donde la masa de un componente rotacional (en este escenario, el volante de estabilizacion con recipiente de embrague) se ubica de modo irregular en comparacion a su centro de giro de rotacion. Lo cual produce tensiones centrifugas que a su vez originan oscilaciones.

Principales causas del Falta de equilibrio del Girador de Balanceo con Recipiente de Embrague:

Inexactitudes de manufactura y acoplamiento: Aun minimas diferencias en la diseno de los elementos podrian originar desajuste.
Desgaste y averias: El uso prolongado, el altas temperaturas y los fallas mecanicas llegan a alterar la volumen y dar lugar en falta de equilibrio.
Ensamblaje o reparacion incorrecta: Una colocacion deficiente de la recipiente de embrague o mantenimientos deficientes asimismo podrian causar falta de equilibrio.

娛樂城推薦
娛樂城推薦與優惠詳解

在現今的娛樂世界中，線上娛樂城已成為眾多玩家的首選。無論是喜歡真人遊戲、老虎機還是體育賽事，每個玩家都能在娛樂城中找到自己的樂趣。以下是一些熱門的娛樂城及其優惠活動，幫助您在選擇娛樂平台時做出明智的決定。

各大熱門娛樂城介紹
1. 富遊娛樂城
富遊娛樂城以其豐富的遊戲選擇和慷慨的優惠活動吸引了大量玩家。新會員只需註冊即可免費獲得體驗金 $168，無需儲值即可輕鬆試玩。此外，富遊娛樂城還提供首存禮金 100% 獎勵，最高可領取 $1000。

2. AT99娛樂城
AT99娛樂城以高品質的遊戲體驗和優秀的客戶服務聞名。該平台提供各種老虎機和真人遊戲，並定期推出新遊戲，讓玩家保持新鮮感。

3. BCR娛樂城
BCR娛樂城是一個新興的平台，專注於提供豐富的體育賽事投注選項。無論是足球、籃球還是其他體育賽事，BCR都能為玩家提供即時的投注體驗。

熱門遊戲推薦
WM真人視訊百家樂
WM真人視訊百家樂是許多玩家的首選，該遊戲提供了真實的賭場體驗，並且玩法簡單，容易上手。

戰神賽特老虎機
戰神賽特老虎機以其獨特的主題和豐富的獎勵機制，成為老虎機愛好者的最愛。該遊戲結合了古代戰神的故事背景，讓玩家在遊戲過程中感受到無窮的樂趣。

最新優惠活動
富遊娛樂城註冊送體驗金
富遊娛樂城新會員獨享 $168 體驗金，無需儲值即可享受全場遊戲，讓您無壓力地體驗不同遊戲的魅力。

VIP 日日返水無上限
富遊娛樂城為 VIP 會員提供無上限的返水優惠，最高可達 0.7%。此活動讓玩家在遊戲的同時，還能享受額外的回饋。

結論
選擇合適的娛樂城不僅能為您的遊戲體驗增色不少，還能通過各種優惠活動獲得更多的利益。無論是新會員還是資深玩家，都能在這些推薦的娛樂城中找到適合自己的遊戲和活動。立即註冊並體驗這些優質娛樂平台，享受無限的遊戲樂趣！

娛樂城推薦與優惠詳解

在現今的娛樂世界中，線上娛樂城已成為眾多玩家的首選。無論是喜歡真人遊戲、老虎機還是體育賽事，每個玩家都能在娛樂城中找到自己的樂趣。以下是一些熱門的娛樂城及其優惠活動，幫助您在選擇娛樂平台時做出明智的決定。

各大熱門娛樂城介紹
1. 富遊娛樂城
富遊娛樂城以其豐富的遊戲選擇和慷慨的優惠活動吸引了大量玩家。新會員只需註冊即可免費獲得體驗金 $168，無需儲值即可輕鬆試玩。此外，富遊娛樂城還提供首存禮金 100% 獎勵，最高可領取 $1000。

2. AT99娛樂城
AT99娛樂城以高品質的遊戲體驗和優秀的客戶服務聞名。該平台提供各種老虎機和真人遊戲，並定期推出新遊戲，讓玩家保持新鮮感。

3. BCR娛樂城
BCR娛樂城是一個新興的平台，專注於提供豐富的體育賽事投注選項。無論是足球、籃球還是其他體育賽事，BCR都能為玩家提供即時的投注體驗。

熱門遊戲推薦
WM真人視訊百家樂
WM真人視訊百家樂是許多玩家的首選，該遊戲提供了真實的賭場體驗，並且玩法簡單，容易上手。

戰神賽特老虎機
戰神賽特老虎機以其獨特的主題和豐富的獎勵機制，成為老虎機愛好者的最愛。該遊戲結合了古代戰神的故事背景，讓玩家在遊戲過程中感受到無窮的樂趣。

最新優惠活動
富遊娛樂城註冊送體驗金
富遊娛樂城新會員獨享 $168 體驗金，無需儲值即可享受全場遊戲，讓您無壓力地體驗不同遊戲的魅力。

VIP 日日返水無上限
富遊娛樂城為 VIP 會員提供無上限的返水優惠，最高可達 0.7%。此活動讓玩家在遊戲的同時，還能享受額外的回饋。

結論
選擇合適的娛樂城不僅能為您的遊戲體驗增色不少，還能通過各種優惠活動獲得更多的利益。無論是新會員還是資深玩家，都能在這些推薦的娛樂城中找到適合自己的遊戲和活動。立即註冊並體驗這些優質娛樂平台，享受無限的遊戲樂趣！

娛樂城推薦與優惠詳解

在現今的娛樂世界中，線上娛樂城已成為眾多玩家的首選。無論是喜歡真人遊戲、老虎機還是體育賽事，每個玩家都能在娛樂城中找到自己的樂趣。以下是一些熱門的娛樂城及其優惠活動，幫助您在選擇娛樂平台時做出明智的決定。

各大熱門娛樂城介紹
1. 富遊娛樂城
富遊娛樂城以其豐富的遊戲選擇和慷慨的優惠活動吸引了大量玩家。新會員只需註冊即可免費獲得體驗金 $168，無需儲值即可輕鬆試玩。此外，富遊娛樂城還提供首存禮金 100% 獎勵，最高可領取 $1000。

2. AT99娛樂城
AT99娛樂城以高品質的遊戲體驗和優秀的客戶服務聞名。該平台提供各種老虎機和真人遊戲，並定期推出新遊戲，讓玩家保持新鮮感。

3. BCR娛樂城
BCR娛樂城是一個新興的平台，專注於提供豐富的體育賽事投注選項。無論是足球、籃球還是其他體育賽事，BCR都能為玩家提供即時的投注體驗。

熱門遊戲推薦
WM真人視訊百家樂
WM真人視訊百家樂是許多玩家的首選，該遊戲提供了真實的賭場體驗，並且玩法簡單，容易上手。

戰神賽特老虎機
戰神賽特老虎機以其獨特的主題和豐富的獎勵機制，成為老虎機愛好者的最愛。該遊戲結合了古代戰神的故事背景，讓玩家在遊戲過程中感受到無窮的樂趣。

最新優惠活動
富遊娛樂城註冊送體驗金
富遊娛樂城新會員獨享 $168 體驗金，無需儲值即可享受全場遊戲，讓您無壓力地體驗不同遊戲的魅力。

VIP 日日返水無上限
富遊娛樂城為 VIP 會員提供無上限的返水優惠，最高可達 0.7%。此活動讓玩家在遊戲的同時，還能享受額外的回饋。

結論
選擇合適的娛樂城不僅能為您的遊戲體驗增色不少，還能通過各種優惠活動獲得更多的利益。無論是新會員還是資深玩家，都能在這些推薦的娛樂城中找到適合自己的遊戲和活動。立即註冊並體驗這些優質娛樂平台，享受無限的遊戲樂趣！

Пеларгонии сортовые
Пеларгонии видовые: лучший вариант для своего дома и огорода

Если вы выбираете цветы, что станут радовать тебя своей красотой и запахом, вместе с этом не запрашивая трудного обслуживания, сортовые пеларгонии — наилучший вариант. Этих растения наделены неповторимыми преимуществами, которые делают их лидерами между украшений цветов.

Почему разновидные пеларгонии?

Неприхотливость и легкость в обслуживании
Пеларгонии не запрашивают особых требований для прорастания и быстро приспосабливаются к различным условиям. Они прекрасно чувствуют себя как в жилище, так и на улице. Откажитесь о прихотливых цветах — герани требуется лишь увлажнять по степени исчезновения влаги грунта и восхищаться их процветанием.

Интенсивные и различные цвета
Каждый сорт гераней обладает свои уникальные тона и виды. Разновидности, такие как, ИВ королева Бирмы, поражают яркими цветами и эффектными бутонами. Это растения, которые сразу привлекают интерес и обеспечивают живые нотки в любом окружении.

Нежный благоухание, приносящий уют
Пеларгонии не только облагораживают дом — они предоставляют его нежным, ненавязчивым ароматом. Этот естественный аромат способствует сформировать чувство комфорта и спокойствия, а к тому же работает как природный репеллент для вредителей.

Длительное цветение
Сортовые пеларгонии продолжают удивлять вид своим процветанием в течение многих периодов. Вы будете радоваться их красотой с начала лета и до холодов сезона. Такое длительное цветение — исключительное достоинство среди эстетических видов.

Лучший выбор для различного окружения
Пеларгонии универсальны — их желательно разводить как в контейнерах на окнах, так и в саду. Миниатюрные кусты, такие как ИВ Галина Уланова, прекрасно подходят в эстетичных контейнерах, а виды, как Магнус, превратятся в дополнением цветника.

Зачем следует выбрать обязательно пеларгонии?
Этих цветы — не лишь декоративный элемент интерьера. Они значительно доминируют между других растений благодаря своей неприхотливости, красоте и долгому процветанию. Их живописные цвета создают особенную среду, будь то в доме или на участке. Пеларгонии — это лучший баланс красоты и практичности.

Выбирайте герани — формируйте в своем окружении красоту без лишних трудностей!

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