The dangers of unmoderated internet pain communities.

1. Bentall,R.P.,etal. (2002). "Predictorsof response totreatmentforchronicfatigue syndrome."BrJ
Psychiatry181: 248-252.
BACKGROUND:Controlledtrialshave shownthatpsychological interventionsdesignedto
encourage gradedexercisecanfacilitate recoveryfromchronicfatigue syndrome.AIMS:Toidentify
predictorsof response topsychologicaltreatmentforchronicfatigue syndrome.METHOD:Of 114
patientsassignedtoequallyeffective treatmentconditionsinarandomised,controlledtrial,95
completedfollow-upassessments.Relationshipsbetweenvariablesmeasuredpriortorandomisation
and changesinphysical functioningandsubjective handicapat1 yearwere evaluatedbymultiple
regression.RESULTS: Poor outcome was predictedby membershipofa self-helpgroup,beinginreceipt
of sicknessbenefitatthe start of treatment,anddysphoriaasmeasuredbythe Hospital Anxietyand
Depressionscale.Severityof symptomsanddurationof illnesswere notpredictorsof response.
CONCLUSIONS:Pooroutcome inthe psychological treatmentof chronicfatigue syndrome ispredicted
by variablesthatindicate resistance toaccepting the therapeuticrationale,poormotivationto
treatmentadherence orsecondarygainsfromillness.
Thieme,K.,etal.(2006). "Psychological paintreatmentinfibromyalgiasyndrome:efficacyof operant
behavioural andcognitivebehavioural treatments."ArthritisResTher8(4):R121.
The presentstudyfocusedonthe evaluationof the effectsof operantbehavioural (OBT) and
cognitive behavioural(CBT) treatmentsforfibromyalgiasyndrome (FMS).One hundredandtwenty-five
patientswhofulfilledthe AmericanCollegeof RheumatologycriteriaforFMS were randomlyassignedto
OBT (n = 43), CBT (n= 42), or an attention-placebo(AP) treatment(n= 40) that consistedof discussions
of FMS-relatedproblems.Assessmentsof physical functioning,pain,affectivedistress,andcognitive and
behavioural variableswere performedpre-treatmentandpost-treatmentaswell as6 and 12 months
post-treatment.Patientsreceivingthe OBTor CBT reporteda significantreductioninpainintensitypost-
treatment(all Fs> 3.89, all Ps < 0.01). In addition,the CBTgroupreportedstatisticallysignificant
improvementsincognitive(all Fs>7.95, all P < 0.01) and affective variables(allFs> 2.99, all Ps < 0.02),
and the OBT group demonstratedstatisticallysignificantimprovementsinphysical functioningand
behavioural variables(all Fs> 5.99, all Ps< 0.001) comparedwithAP.The AP groupreportedno
significantimprovementbutactuallydeteriorationinthe outcome variables.The post-treatmenteffects
for the OBT and CBT groupswere maintainedatboththe 6- and 12-monthfollow-ups.These results
suggestthatboth OBT and CBT are effective intreatingpatientswithFMSwithsome differencesinthe
outcome measuresspecificallytargetedbythe individualtreatmentscomparedwithanunstructured
discussiongroup. The APgroup showedthat unstructured discussionof FMS-relatedproblemsmaybe
detrimental.