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

A test of the adaptive network explanation of functional disorders using a machine learning analysis of symptoms

The classification and etiology of functional disorders is controversial. Evidence supports both psychological and biological (disease) models that show, respectively, that functional disorders should be classified as one (bodily distress syndrome) and many (e.g., irritable bowel syndrome (IBS), fibromyalgia syndrome (FMS), and chronic fatigue syndrome (CFS)). Two network models (symptom network and adaptive network) can explain the specificity and covariation of symptomatology, but only the adaptive network model can explain the covariation of the somatic symptoms of functional disorders. The adaptive network model is based on the premise that a network of biological mechanisms has emergent properties and can exhibit adaptation. The purpose of this study was to test the predictions that symptom similarity increases with pathology and that network connection strengths vary with pathology, as this would be consistent with the notion that functional disorder pathology arises from network adaptation. We conducted a symptom internet survey followed by machine learning analysis. Participants were 1751 people reporting IBS, FMS or CFS diagnosis who completed a 61-item symptom questionnaire. Eleven symptom clusters were identified. Differences in symptom clusters between IBS, FMS and CFS groups decreased as overall symptom frequency increased. The strength of outgoing connections between clusters varied as a function of symptom frequency and single versus multiple diagnoses. The findings suggest that the pathology of functional disorders involves an increase in the activity and causal connections between several symptom causing mechanisms. The data provide support for the proposal that the body is capable of complex adaptation and that functional disorders result when rules that normally improve adaptation create maladaptive change.

Heart rate variability biofeedback therapy and graded exercise training in management of chronic fatigue syndrome: An exploratory pilot study

OBJECTIVE

Chronic fatigue syndrome (CFS) is characterised by persistent fatigue, exhaustion, and several physical complaints. Research has shown cognitive behavioural therapy (CBT) and graded exercise training (GET) to be the most effective treatments. In a first step we aimed to assess the efficacy of heart rate variability biofeedback therapy (HRV-BF) as a treatment method comprising cognitive and behavioural strategies and GET in the pilot trial. In a second step we aimed to compare both interventions with regard to specific parameters.

METHODS

The study was conducted in an outpatient treatment setting. A total of 28 women with CFS (50.3±9.3years) were randomly assigned to receive either eight sessions of HRV-BF or GET. The primary outcome was fatigue severity. Secondary outcomes were mental and physical quality of life and depression. Data were collected before and after the intervention as well as at a 5-month follow-up.

RESULTS

General fatigue improved significantly after both HRV-BF and GET. Specific cognitive components of fatigue, mental quality of life, and depression improved significantly after HRV-BF only. Physical quality of life improved significantly after GET. There were significant differences between groups regarding mental quality of life and depression favouring HRV-BF.

CONCLUSION

Both interventions reduce fatigue. HRV-BF seems to have additional effects on components of mental health, including depression, whereas GET seems to emphasise components of physical health. These data offer implications for further research on combining HRV-BF and GET in patients with CFS.

TRIAL REGISTRATION

The described trial has been registered at the International Clinical Trials Registry Platform following the number DRKS00005445.

Chronic Fatigue Syndrome

Fifty-three chronic fatigue syndrome patients treated at a complementary medical centre were assessed over 12 months. Measures included the Chalder Fatigue scale, the General Health Questionnaire (GHQ) and positivity in illness (Silver Lining Questionnaire, SLQ). The SLQ measured at 6 and 9 months predicted ( p < .01) mental (but not physical) fatigue at 12 months independently of current mental fatigue, initial mental fatigue, duration since diagnosis and time between start of treatment and entry to the study. The GHQ did not predict fatigue at any time point. The results suggest that a caring therapeutic intervention increases positive interpretations of illness prior to improvements in mental fatigue, but that positivity does not play a causal role in the reduction of fatigue.

Explaining unexplained pain to fibromyalgia patients: finding a narrative that is acceptable to patients and provides a rationale for evidence based interventions

As the cause of fibromyalgia is controversial, communicating with patients can be challenging, particularly if the patient adopts the narrative 'I am damaged and so I need a more powerful pain killer'. Research shows that providing patients with alternative narratives can be helpful, but it remains unclear what particular narratives are most acceptable to patients and at the same time provide a rationale for evidence based psychological and exercise interventions. This article described the development of a new narrative and the written comments made about the narrative by fibromyalgia patients. The narrative derives from a complexity theory model and provides an alternative to biogenic and psychogenic models. The model was presented to 15 patients whose comments about comprehensibility led to the final format of the narrative. In the final form, the body is presented as 'a very, very clever computer' where fibromyalgia is caused by a software rather than a hardware problem. The software problem is caused by the body adapting when people have to 'keep going' despite 'stop signals', such as pain and fatigue. The narrative provides a rationale for engaging in psychological and exercise interventions as a way of correcting the body's software. This way of explaining fibromyalgia was evaluated by a further 25 patients attending a 7-week 'body reprogramming' intervention, where the therapy was presented as correcting the body's software, and included both exercise and psychological components. Attendance at the course was 85%. Thematic analysis of written patient feedback collected after each session showed that patients found the model believable and informative, it provided hope and was empowering. Patients also indicated that they had started to implement lifestyle change with perceived benefit. Fibromyalgia patients appear to respond positively to a technology-derived narrative based on the analogy of the body as a computer.

Prevalence and clinical specificity of fatigue symptoms in chronic fatigue syndrome, multiple sclerosis, and myasthenia gravis

This article provides a critical review of the psychological and related literature on fatigue resulting in both mental and physical experiences. On one hand, prolonged severe fatigue is a prominent disabling symptom in various diseases of different aetiology – psychiatric (e.g. depression), somatic (e.g. some infections) and neurologic (e.g. multiple sclerosis, myasthenia gravis). For instance, fatigue is a main symptom of myasthenia that leads to pathological skeletal muscle weakness. Furthermore, 40 to 90 per cent of individuals suffering from multiple sclerosis confirm they have experienced fatigue, which impairs their cognitive functioning. In both multiple sclerosis and myasthenia, fatigue has not only a physical but also a psychological dimension. On the other hand, fatigue can be seen as an isolated set of symptoms of unknown origin called the chronic fatigue syndrome (CFS). The development of the concept, diagnostic criteria and some strategies of coping with CFS are presented. Various somatic disorders, as well as subjective cognitive and emotional complaints, are common and well documented in patients with CFS. The most typical include depression, as well as problems with concentration of attention, decision-making and reasoning in complex situations. However, general intellectual abilities and higher order cognitive skills are intact. Directions for future research are outlined.

The intelligent body and its discontents

The traditional view is that mind is intelligent and the body is stupid. Recent research suggests that the whole body, and not just the brain, acts as a complex parallel processing system. If the whole body is intelligent, then intelligent processes normally attributed to psychology may occur in the non-brain body. This article shows how self-organizing learning error in a brain-body system creates the potential for a new type of pathology, network pathology, that is distributed across over the whole body. The intelligent body concept is illustrated with four examples: chemical sensitivity, asthma, chronic fatigue syndrome and obesity. Network pathology develops when normally adaptive self-organizational processes malfunction so that control system parameters are altered in a way that creates suboptimal self-regulation. Subtle therapies are needed, in addition to the conventional robust therapies to correct network pathology.

Research on homeopathy: state of the art

In this paper, we review research on homeopathy from four perspectives, focusing on reviews and some landmark studies. These perspectives are laboratory studies, clinical trials, observational studies, and theoretical work. In laboratory models, numerous effects and anomalies have been reported. However, no single model has been sufficiently widely replicated. Instead, researchers have focused on ever-new models and experiments, leaving the picture of scattered anomalies without coherence. Basic research, trying to elucidate a purported difference between homeopathic remedies and control solutions has also produced some encouraging results, but again, series of independent replications are missing. While there are nearly 200 reports on clinical trials, few series have been conducted for single conditions. Some of these series document clinically useful effects and differences against placebo and some series do not. Observational research into uncontrolled homeopathic practice documents consistently strong therapeutic effects and sustained satisfaction in patients. We suggest that this scattered picture has to do with the fourth line of research: lack of a good theory. Some of the extant theoretical models are reviewed, including placebo, water structure, silica contamination, energy models, and entanglement models. It emerges that local models, suggesting some change in structure in the solvent, are far from convincing. The nonlocal models proposed would predict that it is impossible to nail down homeopathic effects with direct experimental testing and this places homeopathy in a scientific dilemma. We close with some suggestions for potentially fruitful research.

Generalized Entanglement: A New Theoretical Model for Understanding the Effects of Complementary and Alternative Medicine

BACKGROUND AND PROBLEM: A main problem for the acceptance of many methods belonging to the broad spectrum of complementary and alternative medicine (CAM) is that there is no conceivable theoretical bridge between the mainstream biomedical model and CAM theories and practice. Although empirical evidence is one important side of the coin of credibility, theoretical feasibility is the other. History of science teaches that no amount of empirical evidence will convince sceptics and followers of more conventional paradigms as long as there is no good theoretical model to make empirical findings plausible.

METHODS AND SOLUTION

I therefore propose to broaden the spectrum of theoretical concepts beyond the reigning local-causalist model toward a non-local model that encompasses effects as encountered in CAM. Such a model can be derived from a generalized and weaker version of quantum theory recently developed and published by my colleagues and I as weak quantum theory (WQT). This theoretical model predicts nonlocal correlations analogous to Einstein-Podolsky-Rosen (EPR)-like correlations in quantum mechanics proper. The discerning moment, though, is that these nonlocal correlations within WQT are not EPR correlations postulated to extend into the classical world, but a broader, generalized version of entanglement not dependent on the strict quantum nature of the system under question. WQT predicts entanglement between elements of a system if two variables or observables are complementary: one describing a global and one the local aspects of the system. Entanglement then ensues between those local elements of a system that are complementary to the global description or observable of that system.

DISCUSSION AND CONCLUSIONS

This paper explores this rather abstract and general notion and expands it into more concrete examples. It is at the moment a purely explanatory structure, which, however, lends itself to exact empirical testing due to rather precise predictions, which will be developed. Because this structure of generalized entanglement is ubiquitous and also operative in conventional medicine, and because it is derived from one of the strongest theories that science has developed so far, it would constitute a theoretical bridge between the different medical and scientific traditions.

Extended Network Generalized Entanglement Theory: therapeutic mechanisms, empirical predictions, and investigations

Extended Network Generalized Entanglement Theory (Entanglement Theory for short) combines two earlier theories based on complexity theory and quantum mechanics. The theory's assumptions are: the body is a complex, self-organizing system (the extended network) that self-organizes so as to achieve genetically defined patterns (where patterns include morphologic as well as lifestyle patterns). These pattern-specifying genes require feedback that is provided by generalized quantum entanglement. Additionally, generalized entanglement has evolved as a form of communication between people (and animals) and can be used in healing. Entanglement Theory suggests that several processes are involved in complementary and alternative medicine (CAM). Direct subtle therapy creates network change either through lifestyle management, some manual therapies, and psychologically mediated effects of therapy. Indirect subtle therapy is a process of entanglement with other people or physical entities (e.g., remedies, healing sites). Both types of subtle therapy create two kinds of information within the network--either that the network is more disregulated than it is and the network then compensates for this error, or as a guide for network change leading to healing. Most CAM therapies involve a combination of indirect and direct therapies, making empirical evaluation complex. Empirical predictions from this theory are contrasted with those from two other possible mechanisms of healing: (1) psychologic processes and (2) mechanisms involving electromagnetic influence between people (biofield/energy medicine). Topics for empirical study include a hyperfast communication system, the phenomenology of entanglement, predictors of outcome in naturally occurring clinical settings, and the importance of therapist and patient characteristics to outcome.