Discussion in 'Other Health News and Research' started by Firestormm, Oct 22, 2013.
First commented upon here.
Was suggested it had it's own thread
Only 10-20% of hospital patients worry "obsessively" about their health? I would guess that most people who find themselves in a hospital would be pretty worried. That seems like a rational response to me.
Now I'm going to feel obliged to find the paper and press release!
A while back I started a thread on an RCT for psychosomatic/functional/hysterical/whatever symptoms, and that had really poor results too. It seems like loads of 'evidence based' psych therapies are no better than homeopathy at leading to minor improvements in subjective self-report measures in non-blinded trials. I've seen a number comparisons between CBT and minimal control interventions (someone with minimal training being nice to the patientin an RCT) which produce equal results - it seems to me than we should be using the least intrusive (and cheapest) form of therapy when results are similar. Claiming expertise over how another human being should think and behave should only be done cautiously, and when there is clear evidence that this will help the individual. I'm not sure that CBT reaches that standard for anything (however much it does appeal to my own prejudices), and certainly not for the range of conditions it is currently being promoted.
Edit: having said all that, it is possible that this is a good and study and understated results... it just has the smell of spin and hype.
Esther12 you can always request the paper on the forum and see if someone else can help get the thing if it's not available; but I know what you mean. All these psycho-papers are too distracting a read from one's daily allowance of activity. One kind of falls into a trap - if you see what I mean
It always feels more relaxing to look at stuff not related so directly to oneself. (Even if it is a bit of a waste of time - we all need our fun and games):
The trial's protocol is open access here:
They used the Health Anxiety Inventory as their primary outcome.
Some details on this measure here: http://webcache.googleusercontent.com/search?q=cache:E3B5D9f53ZwJ:serene.me.uk/tests/hai.pdf &cd=1&hl=en&ct=clnk&gl=uk&client=firefox-a
Anyone know if 2·98 points seen as a clinically significant difference?
From the above document, it seems that it's lower than the typical SD for these groups (PACE guestimated clinically useful differences in the end by using 0.5 of sd for patients who had been defined by having certain scores):
Typical Mean Scores and Standard Deviations
Just found the paper and comment for free here: http://press.thelancet.com/healthanxiety.pdf
CBT ~ a treatment therapy obsessively looking for an illness.
Here's the press release: http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_18-10-2013-12-51-57
The study tried to be single blind. I'm not sure how well this could have overcome problems with response bias, considering the nature of the condition being treated, but kudos for trying imo.
Looks like reported differences diminished over-time, with standard care result improving, while +CBT results got worse. At 24 months, the difference is reduced to 2.24.
For their 'normal' anxiety outcome measure, I'm not sure if this means that there was not a significant difference at 24 months (their final time period). They do no explicitly say, and I've not got the appendix:
For the outcome measure they had regarded as their second most important, the use of medical resources, they excluded the patient who used the most resources from the CBT group, as an outlier.
In their protocol, they said:
In the BBC article one of the researchers said:
This is from their discussion:
Also, their patients were those keenest on CBT:
Given their results, I'm not sure they have that much reason to be concerned about patients thinking that psychiatry has little to offer them. One of the authors of this paper already has a book out: 'Tackling Health Anxiety: A CBT Handbook'. Seems like a bit of a fumble to me.
Some sharp comments in the commentary:
Sounds like their answer is more lumping, including those with 'medically unexplained symptoms', alcohol problems, poor treatment adherence, etc.
Also, they say things like this:
Personally, I don't care what the recommended first step is, I care about what the evidence shows. So long as the NHS is still recommending homoeopathy as a treatment to patients, I don't really care much about their recommendations.
My summary: CBT for health anxiety is, even for those patients keenest on this intervention, of little use. No significant impact on QOL or health care use, and at 24 months was only associated with a HAI score 2.24 lower than those who had only received standard medical care (from baselines of 24·9 (4·2) and 25·1 (4·5) ). It could well be worthwhile for some patients, but it really doesn't warrant cheery headlines, or tut-tutting over patients disinterest in the effective psychological treatments available to them. This from the press release seems totally unwarranted: "The findings are good news for the 10 to 20 per cent of hospital patients who excessively worry that they have a serious, undiagnosed illness." The idea that these results would justify providing CBT to 10 to 20 per cent of hospital patients is just madness.
Really, I'm shocked by how ineffective this intervention was, considering the way in which those with hypochondria are often talked of in the medical literature. I had assumed that CBT was massively more effective than it seems to be, and based on this study, I'm not sure that we have any reason to think it would be preferable to 'befriending' or some other minimal intervention that avoids making claims of expertise.
The hype was nowhere near as bad as what we saw with PACE though, and I don't think that the way they presented their results was that bad. I wish researchers would be more willing to say: 'Oh dear, our treatment isn't very good. We'd expected it would do better than this.'
ah, good old "Womb madness" for the 21st century, keeping useless fekwits in jobs and patients in crap for two centuries!
I can just see the same faces of these folks, on bearded, moustachioed "Empire types" in about 1880, explaining how excessive masturbation causes Tuberculosis.
Few thousand years earlier, them examining the entrails of goats to prophesy good fortune for Caesar
And 200 years from now, same faces in the "fraud and bullshit to avoid" section of medical college neural downloads.
Thing is, many cases of "hypochondria" are the DOCTOR'S INTERPRETATION, not the bloody facts of the case. Every day somewhere several someones will die because doctors claimed they were hypochondriacs, rather than admit they simply don't know, that the patient, being the person who's lived inside their own body, does actually know what is "normal"
Maybe about 9 or 10 years ago, there was a petition organised by counsellors from all types of therapy other than CBT, asking that their types of counselling not be sidestepped in favour of CBT, because even then, there was a concerted move in Psychiatry to use CBT over any other kind of counselling/therapy.
It's cheap. It can be spun well because of it refusing to look at the reasons for the problem, or to do proper follow up.
yu, MONEY TALKS
look at way it was hyped in the NHS, and also, like statins have been pushed as a "wonder drug" despite the risks
You can also try a Google Site Search
Separate names with a comma.