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CBT for bipolar: Keith Laws challenges NICE and inadequate meta-analyses

Discussion in 'Other Health News and Research' started by Bob, Feb 5, 2016.

  1. Bob

    Bob

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    England (south coast)
    NICE guidelines for psychological therapy - overstepping the evidence?
    NICE claim that they provide ‘evidence based’ healthcare guidance, but Keith Laws believes this isn’t the case when it comes to psychological therapies like CBT
    Keith Laws
    5 February 2016
    https://www.theguardian.com/science...ychological-therapy-cbt-overstepping-evidence
    Read on:
    https://www.theguardian.com/science...ychological-therapy-cbt-overstepping-evidence


     
  2. Invisible Woman

    Invisible Woman Senior Member

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    Or as I was taught as a teen (a long, long time ago) in my first into to computers - GIGO = Garbage In Garbage Out
     
  3. ahmo

    ahmo Senior Member

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    Northcoast NSW, Australia
     
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  4. Snowdrop

    Snowdrop Rebel without a biscuit

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    There have been a few interesting articles from the guardian of late. None speak directly to PACE and ME but the issues they address do apply.
     
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  5. Invisible Woman

    Invisible Woman Senior Member

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    Yes - we seem to be becoming part of a much larger argument re scientific & research standards, methods and transparency. This can only be a good thing I think.
     
  6. barbc56

    barbc56 Senior Member

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    @ahmo

    I was just going to post the same paragraph. Telling, isn't it!

    What I want to know with no disrespect to people with bipolar, there are a few in my family. I am genuinely asking this. Is the treatment for the manic phase different for the depressive stage? You are not manic you just think you are and then you are not depressed you are just thinking you're depressed. Do the two cancel each other out and wouldn't that be confusing to the patient?

    Maybe they address the whole illness? It's beyond me atm to see how this works.

    Oh wait, it doesn't work so maybe my question is moot?

    Thanks for the article @Bob. I have bookmarked it!

    Barb
     
  7. Esther12

    Esther12 Senior Member

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    I was amazed something that good got in the Guardian. Have I been missing other good bits?

    Would like to see a response to this. Seems like Keith Laws is getting on a roll going through different conditions and pointing out these sorts of problems. Great PACE has caught his attention.
     
  8. Keith Laws

    Keith Laws

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    Thanks. I would also very much like to see a 'response' ...
    If interested, next Wednesday, we have a 'Mental Elf' live webinar debate with various experts on the NICE bipolar guide http://www.nationalelfservice.net/campfire/psychotherapies-for-bipolar-disorder/
    ...And I agree, it would almost certainly be worth somebody looking through the NICE evidence on ME/CFS
     
  9. A.B.

    A.B. Senior Member

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    So it seems there is a situation of CBT being promoted aggressively for many conditions, even when it has little if any effect. There must be some systemic error if the same mistakes are being made over and over again. Curious minds want to know what that systemic error is.
     
  10. luludji

    luludji

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    I think the main error may be the inclusion bias.
    Only people who share the beliefs with the researchers and who are not too ill will go forward with this therapies.
    And will of course report benefit.
    Those who are too ill or too critical will not take part in this kind of studies.
    You can apply CBT to every ailment, by thus choosing the group who fits your expectations.
     
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  11. Invisible Woman

    Invisible Woman Senior Member

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    Assuming cheap = effective ?
     
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  12. chipmunk1

    chipmunk1 Senior Member

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    I would like to know this too.

    (Auto)suggestion is powerful if you believe in it but the effect doesn't last.

    https://en.wikipedia.org/wiki/Émile_Coué

     
    Last edited: Feb 6, 2016
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  13. barbc56

    barbc56 Senior Member

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    @Keith Laws

    Just realized you are the author. Thanks for the article!

    Barb
     
  14. alex3619

    alex3619 Senior Member

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    I paraphrased this a while back. BIBO. Babble in, babble out.
     
  15. Snowdrop

    Snowdrop Rebel without a biscuit

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    And that's how we get a substantial minority of sick 16 yo's. Here is a group that is vulnerable to the idea that CBT will work.
    They are a group rife with teenage angst. And CBT is not at all complicated or time consuming. A simple fix.
    And before you know it--poof--it's a fad. Roll out the clinics.
     
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  16. chipmunk1

    chipmunk1 Senior Member

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    http://www.blackdoginstitute.org.au...psychologicaltreatmentsforbipolardisorder.cfm

    This sounds more like a management strategy than a treatment. Has it ever been marketed as a treatment/cure?
     
  17. Esther12

    Esther12 Senior Member

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    Mental Elf discussion on this:



    I didn't find it that interesting tbh. It was decided to not discuss the specifics much, so instead they took turns affirming how they just want what's best for patients and don't think anyone wins from extremes views over whether drugs or talking therapies are better. There was someone who was involved in the NICE guidelines on but he'd only had a day to prepare, which is a fair reason for not being able to respond to a lot of the detailed points raised, but it would have been better if they'd delayed things for a week so that he would have been able to.

    Lots of similar concerns about psych trials generally to those we've mentioned in CFS CBT/GET trials here, but interesting how the discussion there (as opposed to here among patients) seemed built upon an assumption that patients will want their care and treatment (or some sort), even while they acknowledge how poor the evidence base for a lot of it is. [Unrestrained speculation ahead]: I feel like the culture of MH research has been a bit distorted by the fact that they tend to see patients as an other asking for help, rather than as people who are quite likely to prefer no treatment to treatment that has a weak evidence base. I think this is especially true for talking therapies, where so much is based on the relationship between therapist and patient: it's a bit of a personal rejection to think that your patients would rather be watching Netflix than spending time with you, and would be better off for it too.
     
    Last edited: Feb 14, 2016
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