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CBT ineffective for somatoform disorders and medically unexplained physical symptoms (MUPS)

Sidereal

Senior Member
Messages
4,856
A Cochrane systematic review & meta-analysis published a few days ago shows abysmal effect sizes for CBT compared to standard care in the treatment of "somatoform disorders".

http://www.ncbi.nlm.nih.gov/pubmed/25362239

Their objective was:

To assess the effects of non-pharmacological interventions for somatoform disorders (specifically somatisation disorder, undifferentiated somatoform disorder, somatoform disorder unspecified, somatoform autonomic dysfunction, pain disorder, and alternative somatoform diagnoses proposed in the literature) and MUPS in adults in comparison with treatment as usual, waiting list controls, attention placebo, psychological placebo, enhanced or structured care, and other psychological or physical therapies.

You can bet many of these folks had CFS, FM, POTS etc., although they do say that they excluded people who had "only one specific functional syndrome":

As we aimed to summarise interventions for multiple symptoms, we excluded studies that examined participants diagnosed with only one specific functional syndrome or symptom (e.g. fibromyalgia or fatigue). Moreover, existing Cochrane reviews address specific syndromes and complaints (Bernardy 2013; Price 2008; Zijdenbos 2009).

Here's the list of quackish interventions studied:

Eligible studies included one or more of the following experimental interventions.
  1. Psychological therapies:
      1. CBT (e.g. reattribution therapy and problem-solving therapy);
      2. behavioural therapy (e.g. classical CBT, biofeedback therapy, relaxation therapy, and psycho-education);
      3. third-wave CBT (e.g. mindfulness);
      4. psychodynamic therapies (e.g. group therapy);
      5. humanistic therapies (e.g. person-centred therapy);
      6. integrative therapies (e.g. cognitive analytical therapy).
  2. Physical therapies:
      1. physical activity training (e.g. graded activity training);
      2. other physical therapies (e.g. activation therapy or running therapy).
We excluded interventions based on complementary medicine from this review. In addition, pharmacological interventions and consultation letter interventions were beyond the scope of this review; they were evaluated in other Cochrane reviews (Hoedeman 2010; Kleinstäuber 2013).

They forgot to include blood letting and mercury salts.

Outcome measures were of course various self-report somatisation scales/questionnaires. Even so, the effect size was small and there were substantial methodological problems with the included studies:

Combining all studies that compared some psychological therapy with usual care or waiting list, psychological therapies were significantly more effective at end of treatment, though the effect was small (SMD -0.34; 95% CI -0.53 to -0.16; 10 studies, 1081 analysed participants,Analysis 1.1). Heterogeneity was moderate (I2 = 49%), and the overall quality of the evidence was low (Summary of findings for the main comparison).

The already poor effect was further reduced at one-year follow-up:

At follow-up, measurements within one year of follow-up, the effect of psychological therapies remained significant (SMD -0.24; 95% CI -0.37 to -0.11; 7 studies, 950 participants; I2 = 0%).

CBT had essentially no effect on functional disability and quality of life (mostly measured by the SF-36):

Seven studies, of which four addressing CBT reported on functional disability and quality of life, using a variety of instruments. At the end of treatment, a statistically significant effect was found favouring the psychological therapies (SMD 0.17; 95% CI 0.03 to 0.32; 7 studies, 730 participants; I2 = 0%; Analysis 1.21). We judged the evidence to be moderate. At follow-up within one year after treatment, differences were similar but no longer significant (less than one year: SMD 0.16; 95% CI -0.01 to 0.33; 4 studies, 526 participants; I2 = 0%; Analysis 1.22). After one year, only one study provided data for functional disability and quality of life (Analysis 1.23).

Four studies compared CBT with usual care. At end of treatment, a non-significant difference was found favouring CBT (SMD 0.15; 95% CI -0.06 to 0.37; 4 studies, 341 participants; I2 = 0%; Analysis 1.21, subanalysis 1.21.1).

The only analysis approaching an objective outcome was healthcare use:

Six studies assessed healthcare use, operationalised in different ways, with moderate quality of evidence. During the treatment phase, two studies found a significant difference in the number of participant-initiated doctor visits and medication usage in favour of CBT (SMD -0.68; 95% CI -1.06 to -0.30; 117 participants; Analysis 1.24). In the period less than one year after treatment, perhaps a more relevant timeframe, four studies found no clear evidence of a difference (SMD -0.09; 95% CI -0.31 to 0.12; 532 participants; I2 = 20%; Analysis 1.25).

In other words, while the patients were being brainwashed by CBT, the number of doctor visits and medication use declined. CBT in the case of treatment of MUPS always involves convincing the patient to let go of searching for a medical explanation for their symptoms and to embrace a psychological aetiology. Sometimes the patients are explicitly told that they can only participate in therapy if they agree not to pursue medical investigations at the same time. This would explain the initial difference. However, at one-year follow-up, when the patient has had the chance to see how ineffective the psychological approach has been, the difference in doctor visits and medication use is zero between the CBT group and the control group.

Naturally, the review does not contain a whiff of objective outcomes like employment or receipt of disability benefits.
 
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A.B.

Senior Member
Messages
3,780
An important issue was that all studies in this review included participants who were willing to receive psychological treatment. In daily practice, there is also a substantial proportion of participants not willing to accept psychological treatments for somatoform disorders or MUPS.

Even when the patients want it, it doesn't work.
 

chipmunk1

Senior Member
Messages
765
we already knew that b*haviourism doesn't work that well for somatoform disorders. Fr*udianism (Psychodynamics) doesn't work either. It does work for keeping the patients away from doctors. maybe that's what they want to achieve?

CBT in the case of treatment of MUPS always involves convincing the patient to let go of searching for a medical explanation for their symptoms and to embrace a psychological aetiology

Embracing a psychological aetiology, means accepting that it is my fault that i feel sick and that i should feel guilty for bothering others with my personal problems.
 

JAM

Jill
Messages
421
Summary:
"Mumbly-wank by psych smegheads achieves bugger all change in people who are terribly ill and thus wasted their time and shortening lives on this bovine excrement!
CBT we must therefore assume is Complete Bloody Twaddle!"
In that context. Who ever decided to promote this as a cure to any physical disease must have been possessed by evil incarnate. But as intended (as a way to cope with harmful emotional stimuli) it is effective. I really hope we can not throw the baby out with the bathwater. It is very helpful when used properly.
 

adreno

PR activist
Messages
4,841
Embracing a psychological aetiology, means accepting that it is my fault that i feel sick and that i should feel guilty for bothering others with my personal problems.
I don't see why this would be the case, anymore than it is for physiological etiologies.
 

Sidereal

Senior Member
Messages
4,856
we already knew that b*haviourism doesn't work that well for somatoform disorders. Fr*udianism (Psychodynamics) doesn't work either. It does work for keeping the patients away from doctors. maybe that's what they want to achieve?

CBT in the case of treatment of MUPS always involves convincing the patient to let go of searching for a medical explanation for their symptoms and to embrace a psychological aetiology

Embracing a psychological aetiology, means accepting that it is my fault that i feel sick and that i should feel guilty for bothering others with my personal problems.

Right. The purpose of these "therapies" is to reduce healthcare spending. They provide justification for refusing people referrals to specialists, tests, treatments. After all, as SW said, "unnecessary investigations" may lead to "hypothesis generation" about what else may be wrong with the patient, other than their defective personality.
 

chipmunk1

Senior Member
Messages
765
I don't see why this would be the case, anymore than it is for physiological etiologies.

for somatoform disorders it is very often the case.

diabetes, cancer:

poor sick person you deserve all available medical treatments.

fibro, cfs:

you need to learn....
it is not good if we let you access medical treatment xy...
we count your visits to healthcare providers. almost always you frequent them too much...
you should see us less...
You are not aware that you ...
you have the following character flaws...
you could improve this...
we don't like cases like you...
 

SilverbladeTE

Senior Member
Messages
3,043
Location
Somewhere near Glasgow, Scotland
In that context. Who ever decided to promote this as a cure to any physical disease must have been possessed by evil incarnate. But as intended (as a way to cope with harmful emotional stimuli) it is effective. I really hope we can not throw the baby out with the bathwater. It is very helpful when used properly.

The psychs are "Evil Incarnate"
Modern day Cult of The Invisible Sky God pretending to be Science wrapped up in very twisted egotistical personalities with very little empathy or compassion, using their power to single out, belittle, abuse and destroy people, not with bonfires and branding irons or beheading, no, but destroying them as people. people who are so sick they cannot fight back.
Typical attitude of cowardly little bullies.

Too many psychs seem to be sociopaths or bordering on such behaviour, ala The Milgram Experiment.
Gives them full fledged excuse, only in their heads, to do ANYTHING.
Up to and including dragging children form their families, torturing children, and causing such extreme torture by exacerbation of medical conditions and misuse of potent drugs that patients die in one of the most horrific ways there is to be murdered, or they have taken part in a deliberate policy of dehumanization for social exclusion and inevitable thousands of deaths that causes and IS causing.
 

JAM

Jill
Messages
421
The psychs are "Evil Incarnate"
Modern day Cult of The Invisible Sky God pretending to be Science wrapped up in very twisted egotistical personalities with very little empathy or compassion, using their power to single out, belittle, abuse and destroy people, not with bonfires and branding irons or beheading, no, but destroying them as people. people who are so sick they cannot fight back.
Typical attitude of cowardly little bullies.

Too many psychs seem to be sociopaths or bordering on such behaviour, ala The Milgram Experiment.
Gives them full fledged excuse, only in their heads, to do ANYTHING.
Up to and including dragging children form their families, torturing children, and causing such extreme torture by exacerbation of medical conditions and misuse of potent drugs that patients die in one of the most horrific ways there is to be murdered, or they have taken part in a deliberate policy of dehumanization for social exclusion and inevitable thousands of deaths that causes and IS causing.
Wow. I that doesn't describe any of the professionals I have worked with. When used properly I have gained great benefit from working with them. You seem to have quite a large chip on your shoulder.
 
Messages
15,786
I don't see why this would be the case, anymore than it is for physiological etiologies.
There's a distinct classification and special contempt for patients accused of having physical symptoms caused only by psychological factors. The vast majority of medical professionals sensibly wouldn't expect someone to think their way out of major depressive disorder or schizophrenia, yet it's demanded that we do it, and we are blamed when we don't.
 

chipmunk1

Senior Member
Messages
765
Wow. I that doesn't describe any of the professionals I have worked with. When used properly I have gained great benefit from working with them. You seem to have quite a large chip on your shoulder.

[satire]well if you manage find a gentle and emphatic ECT practitioner things are probably not that bad. ;)
 

adreno

PR activist
Messages
4,841
The psychs are "Evil Incarnate"
Modern day Cult of The Invisible Sky God pretending to be Science wrapped up in very twisted egotistical personalities with very little empathy or compassion, using their power to single out, belittle, abuse and destroy people, not with bonfires and branding irons or beheading, no, but destroying them as people. people who are so sick they cannot fight back.
Typical attitude of cowardly little bullies.

Too many psychs seem to be sociopaths or bordering on such behaviour, ala The Milgram Experiment.
Gives them full fledged excuse, only in their heads, to do ANYTHING.
Up to and including dragging children form their families, torturing children, and causing such extreme torture by exacerbation of medical conditions and misuse of potent drugs that patients die in one of the most horrific ways there is to be murdered, or they have taken part in a deliberate policy of dehumanization for social exclusion and inevitable thousands of deaths that causes and IS causing.
You have a seriously twisted view of reality.
 

JAM

Jill
Messages
421
[satire]well if you manage find a gentle and emphatic ECT practitioner things are probably not that bad. ;)
ECT? I'm not saying that they are all perfect, just that they are not all evil incarnate. I worked closely with several CBT practitioners while getting my graduate certificate in Disability Policy and Practice, granted a special segment of the profession is drawn to that kind of work, so may not be the norm, but to suggest that all practitioners in the field are evil is ridiculous. We need to speak out against those that are, but will not be taken seriously if we try to paint a whole profession with the same brush.
 

Cheshire

Senior Member
Messages
1,129
The psychs are "Evil Incarnate"
Modern day Cult of The Invisible Sky God pretending to be Science wrapped up in very twisted egotistical personalities with very little empathy or compassion, using their power to single out, belittle, abuse and destroy people, not with bonfires and branding irons or beheading, no, but destroying them as people. people who are so sick they cannot fight back.
Typical attitude of cowardly little bullies.

Too many psychs seem to be sociopaths or bordering on such behaviour, ala The Milgram Experiment.
Gives them full fledged excuse, only in their heads, to do ANYTHING.
Up to and including dragging children form their families, torturing children, and causing such extreme torture by exacerbation of medical conditions and misuse of potent drugs that patients die in one of the most horrific ways there is to be murdered, or they have taken part in a deliberate policy of dehumanization for social exclusion and inevitable thousands of deaths that causes and IS causing.

Psychs are evil. Wowww, what an overgeneralization.

I don't think the problem is with psychs per se.

The problem is with health care practitioners that support the view that physical symptoms without explanation MUST be the consequences of psychiatric disturbances.


In my own journey, psychiatrists and psychologists have been very helpful because they all acknowledged that I don't have any psychiatric issue and that I have a medical problem that medicine don't understand. On the other hand, all the meds I met but my actual GP, all said I have a psychiatric disorder, despite the psychiatric assessments I underwent...


There certainly are pervert psychiatrists (IMO P White is a good candidate), because all professions in which one takes care of others are attractive to such people (teachers, priests are good example of jobs attracting paedophiles), and they can be very very dangerous. But that doens't mean they all are!!

We are struggling against the clichés used by Whyte and co. We shouldn't use them, and look for acuracy and truth.
 

ahmo

Senior Member
Messages
4,805
Location
Northcoast NSW, Australia
Received this post yesterday.


PSYCHIATRY SUCKS

C. Norman Shealy, M.D., Ph.D.

Most of you know what I think of 99% of psychiatry. And I's not even certain about the other 1%. The following is just a bit of the sickness of the system:

Here is a sobering video exposing psychiatry's shameful pseudoscientific history and the duping of the medical industry - and the public - by Big Pharma. This is a must watch.

http://www.cchr.org/videos.html
 
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Cheshire

Senior Member
Messages
1,129
Received this post yesterday.

PSYCHIATRY SUCKS


C. Norman Shealy, M.D., Ph.D.


Most of you know what I think of 99% of psychiatry. And I's not even certain about the other 1%. The following is just a bit of the sickness of the system:


Here is a sobering video exposing psychiatry's shameful pseudoscientific history and the duping of the medical industry - and the public - by Big Pharma. This is a must watch.

http://www.cchr.org/videos.html

cchr is the church of scientology... No more scientific than Chalder or Crawley's prose :eek: