Chronic Fatigue Syndrome: Diagnosis and Management

Total Page:16

File Type:pdf, Size:1020Kb

Chronic Fatigue Syndrome: Diagnosis and Management National Institute for Health and Care Excellence Draft Myalgic encephalomyelitis (or encephalopathy) / chronic fatigue syndrome: diagnosis and management [C] Evidence reviews for accessing health and social care services NICE guideline <number> Evidence reviews underpinning recommendations and research recommendations in the NICE guideline November 2020 Draft for Consultation These evidence reviews were developed by the National Guideline Centre DRAFT FOR CONSULTATION Disclaimer The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties. NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn. Copyright © NICE 2021. All rights reserved. Subject to Notice of rights. ISBN: DRAFT FOR CONSULTATION Contents Contents .............................................................................................................................. 4 Barriers and facilitators to accessing health and social care services ........................... 6 1 Barriers and facilitators to the process of diagnosing of ME/CFS............................ 7 1.1 Summary of the protocol ....................................................................................... 7 1.2 Methods and process ............................................................................................ 7 1.3 Qualitative evidence .............................................................................................. 7 1.1.1 Included studies ......................................................................................... 7 1.1.2 Excluded studies ........................................................................................ 8 1.1.3 Summary of qualitative studies included in the evidence review ................ 9 1.1.4 Summary of the qualitative evidence ........................................................ 16 1.1.5 Narrative summary of review findings ...................................................... 18 1.4 Barriers and facilitators to the diagnosis of ME/CFS in young people .................. 25 1.1.6 Narrative summary of review findings ...................................................... 25 1.1.7 Economic evidence .................................................................................. 29 2 Barriers and facilitators to the care of people with ME/CFS.................................... 30 2.1 Summary of the protocol ..................................................................................... 30 2.2 Methods and process .......................................................................................... 30 2.3 Qualitative evidence ............................................................................................ 30 2.3.1 Included studies ....................................................................................... 30 2.3.2 Excluded studies ...................................................................................... 30 2.4 Summary of studies included in the qualitative evidence ..................................... 31 2.5 Summary of the qualitative evidence ................................................................... 41 2.5.1 Narrative summary of review findings for adults (severity mixed or unclear) .................................................................................................... 43 2.6 Summary of the qualitative evidence ................................................................... 52 2.6.1 Narrative summary of review findings for Children and young people (severity: mixed/ unclear .......................................................................... 54 2.6.2 Economic evidence .................................................................................. 64 3 The committee’s discussion and interpretation of the evidence ............................ 66 3.1 The quality of the evidence .................................................................................. 66 3.2 Findings identified in the evidence synthesis ....................................................... 67 3.3 Cost effectiveness and resource use ................................................................... 78 3.4 Other factors the committee took into account ..................................................... 79 Appendices ........................................................................................................................ 80 Appendix A – Review protocols ................................................................................ 80 Appendix B – Literature search strategies ............................................................... 95 B.1 Clinical search literature search strategy ................................................................. 95 Appendix C – Qualitative evidence study selection ............................................... 100 4 DRAFT FOR CONSULTATION Appendix D – Qualitative evidence ......................................................................... 102 Appendix E GRADE-CERQual tables ...................................................................... 171 Appendix F Excluded studies ................................................................................. 218 References ....................................................................................................................... 226 5 DRAFT FOR CONSULTATION Access to care 1 Barriers and facilitators to accessing 2 health and social care services 3 Review questions 4 1. What are the barriers and facilitators to the diagnosis of ME/CFS? 5 2. What are the barriers and facilitators to the care of people with ME/CFS? 6 Introduction 7 People with ME/CFS are underserved by health and social care services and commonly 8 report difficulties in accessing care. This starts at the beginning of the person’s journey with 9 difficulties in obtaining a diagnosis. There is often a protracted process resulting in feelings of 10 disbelief, lack of understanding and frustration on the part of the patient. This has a 11 significant impact on quality of life and delays are likely to alter the trajectory of care and 12 treatment received. 13 Medical professionals have often been hesitant in giving a diagnosis of ME/CFS; this may 14 relate to lack of knowledge and various misconceptions about the condition within the health 15 and social care professions. Delays in diagnosis has a significant negative impact on people 16 with ME/CFS, with misdiagnoses also presenting as a problem. Some patients have 17 reported having an ME/CFS diagnosis withheld, whilst others claim that the diagnosis is used 18 as a “waste-basket diagnosis” for all patients with unexplained fatigue. Generally, there 19 seems to be a poor understanding of ME/CFS amongst health and social care professionals. 20 Challenges may also arise with referral to specialist services; due to the disparate nature of 21 ME/CFS services; (dependent on location), the same person could be referred to neurology, 22 psychiatry, immunology, endocrinology, rheumatology and pain services. This lack of unified 23 approach impacts on the person’s understanding and ability to manage their condition and 24 will inevitably lead to different approaches to treatment depending on speciality. These 25 difficulties accessing care can continue. 26 The committee used both reviews to inform their recommendations on accessing a diagnosis 27 and care for people with or suspected ME/CFS. The evidence found for the review questions 28 outlined above is in sections 1.3 and 2.3. The committee discussion of the evidence and 29 interpretation is in section 3. 30 © NICE 2021. All rights reserved. Subject to Notice of rights. 6 DRAFT FOR CONSULTATION Access to care 1 1 Barriers and facilitators to the process of 2 diagnosing of ME/CFS 3 1.1 Summary of the protocol 4 For full details see the review protocol in appendix A. 5 Table 1: Characteristics of review question Objective To identify the barriers and facilitators in the process of diagnosing people with ME/CFS Population and Adults, children and young people who are diagnosed with ME/CFS, or who are setting suspected of having ME/CFS by their primary clinician. Clinicians caring for people with ME/CFS, or people suspected to have ME/CFS Stratification:
Recommended publications
  • Inquiry Into NHS Service Provision for ME/CFS
    All-Party Parliamentary Group on ME Inquiry into NHS Service Provision for ME/CFS March 2010 All-Party Parliamentary Group on ME Inquiry into NHS Service Provision for ME/CFS Contents Foreword 3 Introduction 4 Limitations of the Inquiry 4 Review of Current Treatments 4 Review of Adult Services 9 Review of Children’s Services 12 Training 14 Research 16 Disability and Benefits 16 Conclusion 17 Recommendations 18 Appendix 1: APPG Inquiry on NHS service provision for people with ME: Terms of reference 21 References 24 2 All-Party Parliamentary Group on ME Inquiry into NHS Service Provision for ME/CFS Foreword The All Party Parliamentary Group on M.E. (Myalgic Encephalomyelitis) strives to support the improvement of health and social care of all people with M.E. in the UK. The APPG accepts the WHO Classification of M.E. (ICD G93.3) as a neurological condition and welcomed the recognition by the Department of Health that M.E. is a long term neurological condition. Department of Health funding in 2004/05 and 2005/06 resulted in the establishment of 13 Clinical Network Coordinating Centres and some 50 Local Multidisciplinary Teams. However subsequent changes in NHS organisation and budget setting arrangements have since made it far more difficult to establish the level of investment into the care of these patients. It has also become apparent that some of these newly established secondary services are having to cope with significant reductions in funding. As a result, some have either closed or are under threat of closure. Patient group surveys and letters to MPs and members of the House of Lords continue to identify high levels of patient concern about the services which are being provided and further concerns about the way in which the recommendations contained in the 2007 guideline on ME/CFS from NICE could result in an inflexible approach to management.
    [Show full text]
  • The Rise and Fall of the Wessely School
    THE RISE AND FALL OF THE WESSELY SCHOOL David F Marks* Independent Researcher Arles, Bouches-du-Rhône, Provence-Alpes-Côte d'Azur, 13200, France *Address for correspondence: [email protected] Rise and Fall of the Wessely School THE RISE AND FALL OF THE WESSELY SCHOOL 2 Rise and Fall of the Wessely School ABSTRACT The Wessely School’s (WS) approach to medically unexplained symptoms, myalgic encephalomyelitis and chronic fatigue syndrome (MUS/MECFS) is critically reviewed using scientific criteria. Based on the ‘Biopsychosocial Model’, the WS proposes that patients’ dysfunctional beliefs, deconditioning and attentional biases cause illness, disrupt therapies, and lead to preventable deaths. The evidence reviewed here suggests that none of the WS hypotheses is empirically supported. The lack of robust supportive evidence, fallacious causal assumptions, inappropriate and harmful therapies, broken scientific principles, repeated methodological flaws and unwillingness to share data all give the appearance of cargo cult science. The WS approach needs to be replaced by an evidence-based, biologically-grounded, scientific approach to MUS/MECFS. 3 Rise and Fall of the Wessely School Sickness doesn’t terrify me and death doesn’t terrify me. What terrifies me is that you can disappear because someone is telling the wrong story about you. I feel like that’s what happened to all of us who are living this. And I remember thinking that nobody’s coming to look for me because no one even knows that I went missing. Jennifer Brea, Unrest, 20171. 1. INTRODUCTION This review concerns a story filled with drama, pathos and tragedy. It is relevant to millions of seriously ill people with conditions that have no known cause or cure.
    [Show full text]
  • ME Is Not a Functional Disorder
    ME Association Recipient: Sir Andrew Dillon Letter: Greetings, M.E. is not a functional disorder Comments Name Location Date Comment Carol Bryant Mottram, 2017-09-27 My daughter has ME and clearly this illness is NOT in her England, UK mind it is a physical illness Clare Crofts Rochdale, 2017-09-27 My daughter had Very Severe ME for the last 6years, was England, UK diagnosed as terminal 18 months ago and died in May this year. This disease is horrendous and needs the medical community to take it seriously Sheena young Prestatyn, 2017-09-27 M.E is not a functional disorder and should not be treated as Wales, UK such. Julie Holliday Shrewsbury, 2017-09-27 I have ME and have been treated appallingly by the NHS. England, UK Paul Winter Hailsham, 2017-09-27 I have ME. Some hospitals, such as the National England, UK Neurological Hospital in Queen Square, London, are already routinely ignoring the NICE guidelines and diagnosing people with ME as having FND. This is unacceptable given the mounting evidence that ME is a neuro-imune disease. Jane Iles Cheddar, 2017-09-27 This is too important. NICE need to look at the facts and England, UK listen to ME specialists and more importantly, the sufferers Kathie Cortese UK 2017-09-27 I have got M.E and I know it's not a " functional disorder" NICE need to use more recent up-to-date world studies, and consult with ME patients, and experts on ME Jayne Glover Warminster, 2017-09-27 I don't want other people to suffer the indignity and England, UK humiliation that I have endured for the last 15 years.
    [Show full text]
  • Growing Evidence of an Emerging Tick-Borne Disease That Causes A
    For Lyme Disease Awareness and Action Senate Inquiry Submission My Story • Name: Sara Franzoni • Age: 31 • • • • I want my story to be public About my journey • I acquired Lyme-like illness at: Allansford VIC 3277 • I have left Australia. • Type of Bite: no memory of the bite • I was sick for 17 years before I was diagnosed • I have a positive blood test from Igenix laboratory and a negative blood test from Melbourne Pathology • I tested positive for Borrelia Burgdorferi, Pyrrole Disorder, Glandular Fever. • I have seen approximately 50 doctors and medical practitioners in my journey. • I have been admitted to hospital twice for my illness. • I have also been diagnosed with CFS, Glandular Fever, IBS, Adrenal Fatigue, Bilateral Carpal Tunnel, Leaky Gut, Pyrrole Disorder, Depression, Anxiety, Q Fever, Rickettsia. My life • Prior to my illness, my life was unburdened, free and energetic. I was diagnosed at 14, so I was just a kid – but I still remember feeling different in my body prior to experiencing the illness. I would wake every morning excited and with so much energy for the day. I felt light, and I ‘buzzed’. I was naturally athletic and played a lot of sports. I grew up in the country in a dairy farming area. When I first started showing symptoms at age 14 (1998) most doctors in the area simply did not know how to treat me. I had blood tests (particularly for glandular fever) that showed nothing. At first I was told it was post- viral fatigue syndrome. Then when the symptoms continued for 6 months we finally saw another doctor in Warrnambool who diagnosed me with CFS.
    [Show full text]
  • Hay Fever and Allergies, a Homeopathic
    Harmony Centre News The perfect setting for healing, learning and development Spring 2008 No. 6 ith the New Year come some positive changes at the Harmony Centre. One most welcome development is that we now have receptionist cover full time at the centre, from Monday to Friday. Generally, our reception Wwill be manned from 9am to 1pm and 2pm to 6pm, five full days a week. If you call, someone will be there to help with your query. Also, if you would like to drop into the centre, it is open to welcome visitors. Our receptionists Lucietta, Tricia, Val and Janet are there to help with your queries. The centre has had a couple of additions to practitioners, see below for what sounds like some exciting new work on offer. The Harmony Room continues to host classes, meetings, workshops and courses. It is a spacious and inspiring room, so why not consider it for your next function. Finally, Thursday evening events are back! See the pull-out sheet inside for details of events up to Easter. Wishing you health and happiness in 2008. New light for ME and chronic fatigue ate Simpson and Steve Kate had ME for nearly five years and used the Lightning Fawdry have recently joined Process to get well. She also used it to recover from depres- Kthe Harmony Centre. They sion and anxiety caused by childhood traumas. Steve used the specialise in teaching the Lightning Process to clear the fatigue he had since having glandular fever Process which enables sufferers of as a teenager, and then went on to use it to recover from hay ME and other chronic conditions to fever and asthma too.
    [Show full text]
  • A Systematic Review of the Evidence Base for the Lightning Process
    A systematic review of the evidence base for the Lightning Process P Parker (a)*, J Aston (b), L de Rijk (b) a School of Psychology, London Metropolitan University, 166-220 Holloway Rd, N7 8DB b Kings College London Abstract Background The Lightning Process (LP), a mind-body training programme, has been applied to a range of health problems and disorders. Studies and surveys report a range of outcomes creating a lack of clarity about the efficacy of the intervention. Objective This systematic review evaluates the methodological quality of existing studies on the LP and collates and reviews its reported efficacy. Data sources Five databases, PsycINFO, PubMed, CINAHL, Embase, ERIC (to September 2018), and Google and Google Scholar were searched for relevant studies. Study Selection Studies of the LP in clinical populations published in peer-reviewed journals or in grey literature were selected. Reviews, editorial articles and studies/surveys with un-reported methodology were excluded. Data extraction Searches returned 568 records, 21 were retrieved in full text of which 14 fulfilled the inclusion criteria (ten quantitative studies/surveys and four qualitative studies). Data synthesis and Conclusions The review identified variance in the quality of studies across time; earlier studies demonstrated a lack of control groups, a lack of clarity of aspects of the methodology and potential sampling bias. Although it found a variance in reported patient outcomes, the review also identified an emerging body of evidence supporting the efficacy of the LP for many participants with fatigue, physical function, pain, anxiety and depression. It concludes that there is a need for more randomised controlled trials to evaluate if these positive outcomes can be replicated and generalised to larger populations.
    [Show full text]
  • CONTENTS Chairs Report April 2009 – April 2010 Chairman Report Page 1 Review of the Year & 2 It Has Been a Busy and Eventful Year
    Serving ME/CFS patients, carers and interested parties in Glamorgan May/June 2010 Issue 16 CONTENTS Chairs Report April 2009 – April 2010 Chairman Report Page 1 Review of the year & 2 It has been a busy and eventful year. The first event took place at the Thornhill centre on 6th April. We invited Kay Jen- AGM and Thera- Page 3 pies Day kins, from the Cardiff and Vale Coalition for Disabled People to give a talk on Direct Payments, how to get them and who is Membership Page 4 entitled etc. Money Due. Tea In The Park. 11th May; an event was held in conjunction with ME Aware- Xmas 09 Report ness week. The event entailed an excellent and informative Helping Hands. Page 5 talk by a GP on food allergy and intolerance, followed by a Book List. recorded interview between M.E sufferer Andreas Constanti- £164,000 For Re- Page 6 search Into Light- nou and Able Radio, the new internet radio station for people ning Process & with illness or disability. Dr Esther Crawley, who is a chil- Children With ME. dren‘s M.E specialist, was also interviewed about the condi- Recovery Story Page 7 tion. Recipe Page 8 Poem Page 9 1st June; Louise Tindal, a former M.E sufferer and member Severe ME info Page 10 Pack. attended a support group meeting and offered free taster ses- Private Dr Is Page 11 sions in holistic therapies. Lots of people had an Indian Head Given Drugs Ban massage. It was lovely to see people floating out afterwards, Benefit s & Work Page 12 stress free.
    [Show full text]
  • 2017 Authors Author Address Title Publication
    2017 Authors Author Title Publication Abstract address [No authors listed] RE: "MULTI-SITE CLINICAL Am J Epidemiol. 2017 ASSESSMENT OF MYALGIC Jul 1;186(1) :129. ENCEPHALOMYELITIS/CHRONIC FATIGUE SYNDROME (MCAM) : DESIGN AND IMPLEMENTATION OF A PROSPECTIVE/RETROSPECTIVE ROLLING COHORT STUDY". [No authors listed] Correction for Naviaux et al., Proc Natl Acad Sci U Erratum for Proc Natl Acad Sci U S A. 2016 Sep 13;113(37) :E5472- Metabolic features of chronic S A. 2017 May 80. fatigue syndrome. 2;114(18) :E3749. ABDULLA J(15) , Torpy Research Chronic Fatigue Syndrome. In: De Groot LJ(1) , et Chronic fatigue syndrome (CFS) is a common, enigmatic medical BDJ(16) . Professor, Cell al. editors. Endotext condition comprising mental and physical fatigue, diagnosed after and Molecular [Internet]. South exclusion of possible medical causes. The prominence of post- Biology, Dartmouth (MA) : exertional exacerbation of fatigue is highlighted by the recently College of the MDText.com, Inc.; suggested re-naming as Syndrome of Exertional Intolerance Disease Environment 2000-. 2017 Apr 20. (SEID) . Diagnosis is syndromic. No clinical test can confirm the and Life presence of CFS. Treatment is supportive with no specific therapy Sciences, shown to be reproducibly effective. There are several categories of University of hypotheses regarding CFS aetiology including infections, immune, Rhode Island, mitochondrial, neurobehavioural or stress system (HPA axis and Kingston, RI sympathetic nervous system) disorders. Recently, fatigue disorders have been popularly referred to as “adrenal fatigue.― Although CFS and the syndromically related fibromyalgia have been shown to have lower HPA axis function especially reduced cortisol, when analysed compared to controls in aggregate, and in some cases excessive sympathetic nervous system usually sympathoneural system responses, these findings overlap with controls and such testing is not diagnostic.
    [Show full text]
  • FREE||| an Introduction to the Lightning Process: The
    AN INTRODUCTION TO THE LIGHTNING PROCESS: THE FIRST STEPS TO GETTING WELL FREE DOWNLOAD Phil Parker | 280 pages | 24 Sep 2012 | Hay House UK Ltd | 9781781800577 | English | London, United Kingdom Getting Started with Salesforce: 3 Simple Steps for Beginners Alternative medicine Alternative veterinary medicine Quackery Health fraud History of alternative medicine An Introduction to the Lightning Process: The First Steps to Getting Well of modern medicine Pseudoscience Antiscience Skepticism Skeptical movement National Center for Complementary and Integrative Health Terminology of alternative medicine. Vasant Lad. Help Learn to edit Community portal Recent changes Upload file. Traditional medicine. October Following the initial email, you will be contacted by the shop to confirm that your item is available for collection. About the Author: Brad Smith. Retrieved 4 October Stock photo. Retrieved 12 February Please try again or alternatively you can contact your chosen shop on or send us an email at. Louise Hay. Your review has been submitted successfully. Manage In Explorer. The Lightning Process comprises three group sessions conducted on three consecutive days, lasting about 12 hours altogether, conducted by trained practitioners. Buy It Now. Your settings are good to go. Diagnoses Adrenal fatigue Aerotoxic syndrome Candida hypersensitivity Chronic Lyme disease Electromagnetic hypersensitivity Heavy legs Leaky gut syndrome Multiple chemical sensitivity Wilson's temperature syndrome. You will need to include the name of the opportunity, the account name, who on your team owns that opportunity, and the close date of the deal. Check it off. Namespaces Article Talk. And keep an eye on your analytics! Now, your opportunities will be organized by their current journey stage.
    [Show full text]
  • What Came First . . .? a Magazine and Website for Cranleigh and the Surrounding Areas CRANLEIGH MAGAZINE
    CRANLEIGH MAGAZINE NOV 2019 - FREE ISSUE 49 NOVEMBER What Came First . .? A magazine and website for Cranleigh and the surrounding areas www.cranleighmagazine.co.uk CRANLEIGH MAGAZINE CELEBRATING 25 YEARS WITH THE LAUNCH OF OUR NEW SHALFORD SHOWROOM IN GUILDFORD SHALFORD SHOWROOM RICHMOND SHOWROOM 7 KINGS ROAD 1-3 POPLAR COURT PARADE SHALFORD RICHMOND ROAD GUILDFORD GU4 8JU TW1 2DT TEL • 01483 277166 TEL • 01483 277166 [email protected] www.aspectkitchens.com Tel: 01403 751 873 Email: [email protected] Tel: 01403 751 873 Email: [email protected] 2 courses2 courses – £–2 £52.955.95 | 33 courses courses – £ 30– .95£30 .95 Tel: 01403 751 873 Email: [email protected] Blue Cheese, Celery & Pear Soup With No7 Blue Monday by Alex James, served with a fresh Jengers Mead Bakery Harvester slice Blue Cheese, Celery & Pear Soup With No7 Blue Monday by AlexHomemade James, served Chicken with Liver a& fresh Cognac Jengers Pate Mead Bakery Harvester slice served with sweet and sour onions & crostinis drizzled with homemade pesto Homemade Chicken Liver & Cognac Pate served with sweet and sourHome onions Cured & crostinisTrout Gravalax drizzled with homemade pesto local Chalk Stream Trout cured with Silent Pool Gin served with horseradish cream & crostinis Christmas Pudding served the way youWild like Mushrooms Homeit let that Cured be in with a Light Troutbrandy Cream Gravalaxsauce & orChive homemade sauce vanilla custard local Chalk Streamon a Jengers Trout Mead cured Harvester with Silent slice topped Pool withGin
    [Show full text]
  • Working with the Science Media Centre
    With thanks to our sponsors Contents Editor’s foreword Geoff Watts, science writer and broadcaster The following organisations have contributed to the costs of the Science Media Centre’s 10th anniversary: aybe I’m entirely the wrong person to have publication of their own research through to distant BIVDA, BP plc, British Pharmacological Society, EUK Consulting, GlaxoSmithKline, Imperial College London, Editor’s foreword 1 collated these reflections on the Science Media events of which they have the specialised knowledge or Maudsley Charity, MSD, National Grid, Society for Applied Microbiology, Society for General Microbiology, MCentre (SMC). A decade ago, when I first heard understanding required to offer authoritative comment. Springer Science+Business Media, Wellcome Trust Chief Executive’s introduction 2 of the proposal to set up another body to help science Many of the issues tackled by the SMC are important not journalists do their job properly (which was how I then only for the science involved, but because that science Climate of crisis 4 perceived it), I really couldn’t see the point. Didn’t we all has an impact on society. This is clearly so of the topics GM on trial 6 have our own contact lists? Hadn’t every university and chosen for this booklet. every research institute got a press office eager to alert GM on trial again 8 us to their latest findings? Didn’t science and medical As many of the authors of the following accounts are journalists already get enough press information from keen to emphasise, even those among them who were Media meltdown 10 enough organisations without another body clamouring initially apprehensive about meeting the media have found the experience unthreatening and even enjoyable.
    [Show full text]
  • Running Head: EVALUATING the REDISCOVERY PROCESS 1
    Running head: EVALUATING THE REDISCOVERY PROCESS 1 Evaluating The Rediscovery Process as a Treatment Programme for a Range of Substance Use Disorders. Phil Parker Id: php0059 A Thesis Submitted in Partial Fulfilment of the Requirements for the Degree, Doctor of Philosophy in the Psychology of Health London Metropolitan University Sept 2019 EVALUATING THE REDISCOVERY PROCESS 2 Abstract Poor outcomes for many of those in treatment for substance use disorders (SUD) has raised interest in recovery-based approaches, positive psychology and the importance of flourishing, a quality defined as functioning positively in all realms of life. However, there is little research into approaches that focus on flourishing in SUD. This study evaluates The Rediscovery Process (TRP), a brief, recovery focussed approach for SUD. It teaches self-coaching techniques designed to increase flourishing and recovery capital (psychological health, physical health, quality of life, days at work, college, volunteering and housing status) and to reduce impulsivity. A mixed-methods approach was used, comprising of three studies. First, to evaluate the effect of the TRP on substance use, flourishing, impulsivity and recovery capital, a preliminary pilot study using a randomised wait-list controlled structure was conducted. 72 participants who had been formally diagnosed with single and poly-drug use issues, including, alcohol, opiate, cocaine, crack, cannabis and amphetamine were assigned to either immediately receive the intervention or to wait for the treatment, providing a wait-list control arm. Validated measures of substance use, flourishing, impulsivity and recovery capital were assessed pre- and 1 month post- intervention. The results of the study showed that, compared to the wait-list control group, the TRP provided a significant decrease in alcohol use (the most commonly used substance in the study) and impulsivity, and an increase in flourishing and recovery capital.
    [Show full text]