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CBT treatment for a range of functional somatic syndromes: RCT (Schröder et al., 2012)

Discussion in 'Latest ME/CFS Research' started by Dolphin, May 24, 2012.

  1. Dolphin

    Dolphin Senior Member

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    Somebody from Denmark asked me to look over this for them. They said it has got positive media coverage there. Prof Fink wants the Ministry of health to make this the standard treatment for functional somatic syndromes in Denmark. However I remain busy with stuff (which has meant I have participated little in Phoenix Rising for many weeks now) so can't read it at the moment so I thought I would throw it out to people here. 56% of the participants had CFS. (Formatting went weird and too busy to spend any more time on it)
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  2. wdb

    wdb Admin

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    Looks like another study showing an intervention that aims to change perceptions of illness is moderately effective at changing perceptions of illness.

    I'm sure you could recruit 54 participants with brain tumours, give them 31.5 hours of therapy designed to make them believe the tumours were smaller, then using questionnaires show they now perceived the tumours to be smaller, and conclude the therapy was effective in shrinking the tumours.
    WillowJ, COACH, peggy-sue and 8 others like this.
  3. alex3619

    alex3619 Senior Member

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    Hi wdb, if it were not severely unethical to do so I think such a study would be a good idea - it would expose the poor science for what it is. I again wonder what "enhanced usual care" really means (sometimes they talk of standard medical care in for example the PACE trial) - what they call enhanced I might call pathetic. Bye, Alex
    peggy-sue likes this.
  4. oceanblue

    oceanblue Senior Member

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    Dolphin
    Your presence is being missed. I thought maybe you'd met someone and were otherwise engaged...

    Hard to say too much about the study itself (beyond wdb's point) without seeing the full text.
    The mean difference of 4.0 looks very small:
    • If for the three subcales combined (PF, Pain & Vitality) it's tiny.
    • If averaged for all 3 (ie each subscale moved 4.0 points) it's small. Even if these are norm-based scores where 10 points = 1SD, that's at best a 0.4SD change per scale - when even PACE called a 0.5SD the minimum 'Clinically Useful Difference'.
    • If using the traditional 0-100 scoring, the change is smaller still
    Can't see this being worthwhile even on the most optimistic reading of results.
    biophile likes this.
  5. user9876

    user9876 Senior Member

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    I think they need to justify that using an agregate score is ok. Looking at the theory behind likert scales they sum up the vaules from different questions based on the assumption that all the questions reflect on one partifular attitude that people may have.
    "The central idea of the scaling theory is that the unknown position of a person on a latent mental attribute (e.g.: a disposition, an attitude, an opinion, a notion, an impression, an intention, a view, a conception, a judgement), is estimated by his agreement or disagreement with statements that are relevant and valid for this latent attribute."

    Given this assumption it is ok to add up the scores. The problem with the 36 item short form health survey is ti represents a number of different factors. Depending on the balance of the questions and how they address different aspects a slight improvement in one area and a worsening in another may lead to an improvement in the overall score. That is the scale is not monotonic which is essential for good measurement. The balance of the questions will also reflect on how linear the scale is.

    I think to use such scales the results should be viewed as a vector of the different aspects and multi variate stats should be used. I've even read that responses from positive and negative questions should be kept separate as there are different psycological processes in getting that data and they can represent different attitiudes.

    Then there are issues with the scoring of each item. It is only correct to quote the mean and standard deviation where the scale is continious and covers the full range of answers (i.e. represents all extremes and everything in between evenly). A well constructed likert item will have a symmetric scale which is spread over a range of possible answers that can be approximated to a linear continious scale. I'm sure that the chandler fatigue scale doesn't meet these criteria but I believe that the SF-36 health survey is very adhoc in its scoring methods. I havn't found time to research the theory behind the need to have a continious scale for quoting means and standard deviations but various pieces of pragmatic advice on constricting surveys seem to refer to this and the use of the medium and quartiles if the scale does not approximate a continuous scale.

    There may be other theories behind the SF-36 scale that justifies its use. I've not seen them but then I've not really looked. Economists and psycologists I've worked with have talked of likert scaling as the correct way for doing surveys and getting responses from subjects.
  6. Calathea

    Calathea Darkness therapy

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    You do realise that "functional somatic syndromes" is code for "no physical illness present, they're causing their own symptoms and will improve if they put their mind to it", right?
  7. user9876

    user9876 Senior Member

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    I thought "functionan somatic syndromes" was code for no one quite knows the cause so if we kill research, ignore what evidence exists, form dodgy theories based on poor reasoning then we can claim we can treat the disease and make lots of money
  8. Calathea

    Calathea Darkness therapy

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    That too. They claim they treat the disease by carefully explaining the diagnosis (which itself is fraudulent) to the patient, who then magically recovers because they have been reassured.
  9. SOC

    SOC Moderator and Senior Member

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    For some reason Stockholm Syndrome comes to mind....
    Enid likes this.
  10. oceanblue

    oceanblue Senior Member

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    UPDATE I've now seen the full text and the increase is slightly larger than I'd thought.
    The findings with the aggregated scle findings (PF, pain and vitality) are probably too complicated to bother with so I'll focus on the SF36 Physical Function scores which were helpfully included for comparison with other trials (eg PACE). However, these are the 'norm-based' scores where 50= population mean and each 10 points from the mean = 1SD.

    What's a little odd is that the 'control' group SF36 PF score declined slightly over the 16 months of the study. So just looking at the intervention group, from baselines:

    Baseline= 32.5
    16 months= 38.7

    which gives a mean increase of 6.2points = 0.62 SD ie over the 0.5SD often used for 'minimally useful difference'.The increase relative to control was larger at 8.8 points, 0.88 SD.

    For comparison, PACE showed a 1.2SD gain from baseline, but 0.47SD gain relative to the control group, which improved a lot. Of course, all these gains are self-reported and in both cases the control group knew they were in the control group and not receiving the intervention being tested in the trial.
  11. SilverbladeTE

    SilverbladeTE Senior Member

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    Somewhere near Glasgow, Scotland
    no, it's more like the Eugenicists' ideology and "experiments"
    and I use IDEOLOGY with damn good, specific meaning.
  12. Enid

    Enid Senior Member

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    Any chance these fairylanders will get engaged with real science. ???. Oh and real medicine of course which for decades have passed them by and they will to preserve their ignorant reputations. I've 4 Docs in my own family - various specialists - Profs - who cannot agree with the mumbo jumbo/twat produced by these sort of pathetics.
  13. user9876

    user9876 Senior Member

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    I believe it is highly questionable whether you can use the mean and standard deviation for such scales. Basically to use a mean and a standard devation you need a linear scale that is having equal intervals between each choice. I know that psyciatrists tend to say that an there scales approximate an interval scale but I'm not sure that this is justified.

    There are very limited choices for each question within the scale and to make any approximation to an interval scale you need to show that people will understand them as even intervals (psyciatrists would argue that they just need to be of the same magnitude). If you get bunching at the ends, that is people are using the edges of the scale this would suggest that the end conditions have a big range hence the intervals are not even.

    Then there is a problem of how the values of each question are combined. Since they are unitless then simply adding them up you move further away from any approximation to an interval scale. Here you have an ordinal scale that is each time a measurement increases this represents an increase in what ever you are measuring but not necessarily an even increase. Here you can only use medians, modes and percentiles. Regression isn't valid on such scales.

    You can get away with adding questions that represent the same thing - for example physical function and claiming you have an ordinal scale. If you start to combine questions representing multiple aspects such as physical function and mental function then you create a non monotonic scale. That is an improvement in the items you are measuring will not necessarily lead to an improvement in the score you are assigning them. Here it doesn't make sense even to talk of medians and percentiles, just the mode (most common). To check this you should check that results from all the questions are highly correlated.

    In the PACE trial as they use the chandler fatigue scale which according to the original paper has two major infulancing factors (shown by the principle component analysis). So they cannot simply add up the values and then quote means, standard deviations or even medians and percentiles. There analysis is just mathematically incorrect.
    SOC likes this.
  14. SilverbladeTE

    SilverbladeTE Senior Member

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    Somewhere near Glasgow, Scotland
    Talking maths, proper use of statistics and science with these bigots, is utterly pointless, folks :/
    It's like trying to persude a zealot their idealogy is based on bullshit, lies, stupidity, make believe or bigotted foolishness: they cannot AND WILL NOT accept such, because the whole premise of their lives would be invalidated.

    So, you are coming about it the wrong way, you CANNOT persusde these people they are wrong by logic, all you can do is destroy their capacity to abuse or even kill folk by appealing to those above and beyond their sphere of professionally-zealotry-idealogical-lunatic support (ie they publish such volumes of twaddle to support their idealogy/selves, it's self-justification, not science)

    have them thrown out of their positions, remove their medical licences, arrested for false imprionment and torture, etc, by external authorities who work on logic and law.

    These bastards need JAILED. Sooner this is realized, sooner it occurs (with proper law/investigation), the better
    This is not some esoteric scientific debate without real consquences.
    Take your conculsions with evidence/support to those who can act on such, and warnings of consequences (ie, voter lashback) if any scumbag refuses to act on this.

    Of allevils, the deliberate twistign and abuse of our systems of law and justice to support these monsters is horrendous.
    Each person, especially child, held in asylums, prevented form getting BIOLOGICAL aid for a serious condition, dosed with posionous, damaging and contra-indicated drugs is a heinous crime.
    Any such death resulting from such is murder, not manslaughter.

    ACT UP, that works, trying to comprehend these assclowns' lunacy, does not ;)
    peggy-sue likes this.
  15. user9876

    user9876 Senior Member

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    I don't think we will ever change the minds of the psyciatrists. But I am disappointed that good medical journals don't pick up on obvious errors. It makes me wonder what errors are in papers in other medical fields. Personally I think the editor of the lancet should be sacked for publishing the PACE trial paper in the form it is in.
    peggy-sue and SOC like this.
  16. alex3619

    alex3619 Senior Member

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    I do not think we will change the minds of those at the core of the dysfunctional belief hypotheses. They are not the targets. They rely heavily on creating a supporting network who are not true believers - including other psychiatrists. These and their institutions are the real targets in my view. These are the ones who need to be reached. Change the minds of their supporters, both individual and institutional, and you remove their power. They will just be another group of failed researchers with a whacky unproven idea about disease. Only then can we even talk about the possibility of legal redress. Bye, Alex
    peggy-sue and Dolphin like this.
  17. Enid

    Enid Senior Member

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    Yes Silverblade but the heavy burden of the psychiatric (all in your thoughts is done now - they failed - and in the face of science will continue to fail as real science unravels). Who cares about about their pathetic stance !. Keep up with medical discoveries - you B..... idiots. If I could and did for the sake of those around me less able than me in Accident and Emergency I'm happy. Are they stark raving mad these people that on the one hand I was so worried about those around me around (elderly bemused by their situation) and a psychiatrist foisted on me by 4 juniour Docs whilst passing in and out of consciousness bringing a list of questions such of "what day is it" - they are not even human. Or have I missed something in my 75 years and Guru Wessely et al has all the answers to the good life ?. He just thinks he has - no way.
  18. Enid

    Enid Senior Member

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    Legal redress sounds good to me Alex. I'm falling - passing out - glands up and down - unable to think or stand and yet the numbos jumbos in medicine want to pass off as a mind problem - are they stupid. Of course SW and all his willful cronies. Stuff 'em alex this is no way forward for ME. They are wanting sufferers bonkers (well in the sense of imaging all). When you are ill and cannot name the day (the psychos list) and least of one's concerns is apparently wonko - they should try being very ill !!!. Not the first thing one thing one thinks about when the bathroom calls.
  19. Esther12

    Esther12 Senior Member

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    I don't think that anyone should expect any real accountability to occur over the problems that have surrounded CFS. No-one got fired over claims about Iraq's WMD... the dishonesty around CFS is relatively trivial in comparison. People in positions of power and authority are almost always able to get away with mistreating those in positions of weakness, and those with the power and authority needed to change this are not likely to do so.

    PS: I really struggle with some of the maths. Even when I understand what's been said I find that I can forget the first half of an argument before I've taken in the second. When I've got a bit more energy I should try to take some notes on it, and work through what's been said.
    peggy-sue likes this.
  20. Enid

    Enid Senior Member

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    There may be no accountability as long as this slippering sliding bunch retire to their gardens (watch out the flowers - hopefully prick 'em). But history is written - SW, Whites, Chalders et al. who couldn't keep their fingers out and delay real discoveries - that will be their end - mine will be reactives from ME (my Neuriologist) but I hope theirs will be much more uncomfortable. Dig themselves out - no way for these ignorant dabblers.

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