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CBT and GET are more effective than both SMC alone and APT. APT is no different from SMC alone

The Power of Behavioural Change and the Role of Cognitions in symptom severity and disability: Research Questions.

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CBT and GET are more effective than both SMC alone and APT. APT is no different from SMC alone

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  1. 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

  2. Pacing, graded Activity, and Cognitive behaviour therapy; a randomised Evaluation (White et al The Lancet 2011) 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 70 30 60 28 26 Physical Function Score 50 24 Fatigue Score 22 40 20 30 18 12 weeks 24 weeks 52 weeks 0 weeks 12 weeks 24 weeks 52 weeks 0 weeks Time Time SMC GET SMC GET APT CBT APT CBT

  3. 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!

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