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(2007) CBT improving self-reported, not objective tests of cognitive performance

Discussion in 'Latest ME/CFS Research' started by Esther12, Oct 29, 2011.

  1. Esther12

    Esther12 Senior Member

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    The effect of cognitive behaviour therapy for chronic fatigue syndrome on self-reported cognitive impairments and neuropsychological test performance
    Hans Knoop, Judith B Prins, Maja Stulemeijer, Jos W M van der Meer, and Gijs Bleijenberg

    http://www.ncbi.nlm.nih.gov/pubmed/20047707

    Abstract
    Background
    Patients with chronic fatigue syndrome (CFS) often have concentration and memory problems. Neuropsychological test performance is impaired in at least a subgroup of patients with CFS. Cognitive behavioural therapy (CBT) for CFS leads to a reduction in fatigue and disabilities.
    Aim
    To test the hypothesis that CBT results in a reduction of self?reported cognitive impairment and in an improved neuropsychological test performance.
    Methods
    Data of two previous randomised controlled trials were used. One study compared CBT for adult patients with CFS, with two control conditions. The second study compared CBT for adolescent patients with a waiting list condition. Self?reported cognitive impairment was assessed with questionnaires. Information speed was measured with simple and choice reaction time tasks. Adults also completed the symbol digit?modalities task, a measure of complex attentional function.
    Results
    In both studies, the level of self?reported cognitive impairment decreased significantly more after CBT than in the control conditions. Neuropsychological test performance did not improve.
    Conclusions
    CBT leads to a reduction in self?reported cognitive impairment, but not to improved neuropsychological test performance. The findings of this study support the idea that the distorted perception of cognitive processes is more central to CFS than actual cognitive performance.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077788/

    They don't actually give us the results from the tests though, to let us see how they compare to healthy controls. They talk as if 'CBT is great because these patients are too worried about neuropsychological problems', but don't address how serious those problems actually are, and how concerned about them it would be reasonable to be! (The paper isn't really worth reading - they've barely put any of the data from their study in to it - I hate it when researchers do that).

    These are the tests they use:

    Neuropsychological tests

    Reaction time task
    The reaction time task consisted of two subtests, simple and choice reaction time tasks. Both are described in detail elsewhere.8,15 In a previous study, the reaction times of patients with CFS were slower than that of healthy controls on both tasks.8

    Symbol digit modalities task

    The symbol digit modalities task (SDMT)16 was used in the adult study as a measure of complex attention. In previous studies, patients with CFS scored lower than a matched healthy control group.8,9


    It's another example of CBT being great at getting patients to answer questionnaires in a more 'healthy' manner, but not so good at actually reducing disability. I get the impression that for a lot of doctors, they mainly want CFS patients to complain less... that's their priority for any treatment!
    Dolphin likes this.
  2. Marco

    Marco Old blackguard

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    Hard to argue with your assessment Esther.
  3. Sean

    Sean Senior Member

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    Yes.

    All CBT is doing is just teaching patients to change their test taking behaviour for subjective self-report measures, independent of any improvement in their objective real world functioning.

    That is what the science really shows.

    And it ain't a pretty result.
  4. wdb

    wdb Admin

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    That conclusion is outrageous, all it proves is the CBT didn't achieve anything and that subjective self administered measurements are so prone to bias they are as good as useless.
    being likes this.
  5. Marco

    Marco Old blackguard

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    I was a little rushed when I replied yesterday.

    This is the key issue and interesting in the recent context of published papers apparently witholding data.

    If patients were reporting cognitive deficits that did not show up on objective tests and CBT reduced those subjective reports, that would strongly support the underlying hypothesis.

    As the authors didn't report this data one might assume that they did find objective cognitive impairment which would undermine their hypothesis and clearly illuminate the true effect of CBT.

    This data is fundamental to the interpretation of their findings.

    I'm 'baffled' as to why it wasn't included.
  6. Esther12

    Esther12 Senior Member

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    Yeah. I'm 'baffled' to. Surely if the data supported their hypothesis they would included it, and if not they would be remiss not to mention it. What could be going on here?!
  7. Dolphin

    Dolphin Senior Member

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    This research group had data from motion sensing devices for the Prins et al (2001) study that wasn't flattering for their theories - didn't get published till 2010.
  8. Snow Leopard

    Snow Leopard Senior Member

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    Also interesting is the fact that they neglected to mention in the original published studies that they conducted neuropsychological tests (with null results).

    edit - the main flaw with many of the neuropsychological testing is that they don't account for the decline in performance over time as subjects become mentally fatigued over time. Patients who participate in this sort of research tend to be only moderately fatigued and could easily cope with 15 minutes of testing but not, say 5 hours of testing which would show major declines compared to healthy (and baseline matched) controls.
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  9. Esther12

    Esther12 Senior Member

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    I hadn't noticed that it was the same studies as those they took actometer readings for.

    lol - they collected a pretty thorough amount of data - it was a well designed study. How unfortunate for them that all the objective assessments showed how useless their CBT was - how fortunate for them that no-one seems to care.

    They used the sort of objective assessments I thought PACE should have used.... a decade ago!! The way they gradually sneak the data out, trying to spin it to support their own prior assumptions, is just sickening to watch.

    Yeah - "All patients suffered the most disability for those cognitive functions which were tested last."

    I've got quite a thorough IQ test that was done at my uni's psychology department before I got ill (several pages of results). I've been trying to find it (without luck) in case it would allow for more meaningful assessment of any future neuropsychological testing.
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  10. Valentijn

    Valentijn Activity Level: 3

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    This is one of the first studies I read when my doctor wanted to send me to the "CFS" clinic in Nijmegen that produced that paper. I interpreted the summary as meaning CBT makes people feel better, but not function any better, and at that time I couldn't understand why they still advocate CBT at Nijmegen.

    Now that I know more about the twisted reasoning used to support psychological theories in general, it makes sense in the context of "CFS" researchers that hold those beliefs. That is, they either know it's BS and don't care because they want to stay in business, or they are so entrenched in their beliefs that they're not capable of seeing the world as it really is.

    I'm fortunate to be a patient at a CFS clinic where the senior specialist finds the research coming out of Nijmegen to be as ridiculous as I do.
  11. Hip

    Hip Senior Member

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    Does anyone know whether this self-reporting proceed has been used in all studies on CBT?

    If so, the whole CBT thing is even more of a farce.
  12. oceanblue

    oceanblue Senior Member

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    Is that a quote from the paper? It seems to me to be crucial, in line with Snow Leopard's comments.

    Another study had similar findings - Acute fatigue in chronic fatigue syndrome patients, (though it drew some odd conclusions):
  13. Esther12

    Esther12 Senior Member

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    Sorry - I was just joking: acting as if they had not realised that people with CFS might be more likely to get tired during testing.

    Sadly it's often difficult to detect which absurdities are parts of CFS papers, and which a jokes about them.
  14. oceanblue

    oceanblue Senior Member

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    I was taken in by your flawless academicese :)

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