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Exercise does not help Depression, CBT/GET for ME is *DEAD!*

Discussion in 'Other Health News and Research' started by SilverbladeTE, Jun 6, 2012.

  1. SilverbladeTE

    SilverbladeTE Senior Member

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    Somewhere near Glasgow, Scotland
    http://www.bbc.co.uk/news/health-18335173

    UP YOUR ARSES, PSYCHOBABBLERS! :alien:
    Yer bullshit is dead in the water :p


    What was curious about the case of the dog that barked in the night?
    The dog didn't bark at all!


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  2. Marco

    Marco Old blackguard

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    Imagine that - bummer!
  3. oceanblue

    oceanblue Senior Member

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    Free full text:
    Facilitated physical activity as a treatment for depressed adults: randomised controlled trial | BMJ

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  4. biophile

    biophile Places I'd rather be.

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    Interesting SilverbladeTE. Here is the full text from BMJ: http://www.bmj.com/content/344/bmj.e2758 . Of course, some people are claming exercise has wonderful short term benefits for depression (http://www.sciencedaily.com/releases/2010/04/100405122311.htm).

    I did a search on the issue. A 2011 systematic review came to the conclusion of a small to moderate effect in the short term for depression but no or little evidence for long term benefit (http://www.ncbi.nlm.nih.gov/pubmed/21034688). Others suggest there may be some benefit for patients of chronic illness and comorbid but mild-moderate depression (http://www.ncbi.nlm.nih.gov/pubmed/22271118), cancer survivors in general (http://www.ncbi.nlm.nih.gov/pubmed/22068286) and cancer survivors with depression (http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030955). A 2010 systematic review reports small benefits across multiple domains for fibromyalgia (http://www.ncbi.nlm.nih.gov/pubmed/20459730). Interestingly for healthy people, exercising outdoors may be better than indoors (http://www.ncbi.nlm.nih.gov/pubmed/21291246).

    However, I haven't had a closer look at these papers, and if CFS is any indication, it would be very wise to be extremely skeptical about taking any claims at face value. CFS research on the issue of graded exercise therapy, where mediocre results for a proportion of broadly defined patients in self-reported measures only, is riddled with spin and flaws that have somehow managed to hoodwink a generation of health care professionals into believing that exercise is the cure for us despite post-exertional symptomatology being at the heart of ME/CFS. Some of these problems may also exist in other fields of research?

    GET for CFS probably isn't an outright "scam" as such but appears to be a house of cards based more on ideology and wishful thinking than concrete evidence. Fads come and go, gaining prominence due to influential proponents or gullible audience and a hollow evidence-base, but then fall as reason and better evidence exposes them in better context. The history of psychology and psychiatry is not a stranger to such fads, but each generation thinks they are smarter than the previous one and immune to being seduced by the next fad.
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  5. alex3619

    alex3619 Senior Member

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    I agree with oceanblue, its a house of cards based on medical ideology. Idealologically driven policy in anything is dangerous. Look at the current campaign against the disabled in the UK - that is ideologically not factually driven.

    I have wondered quite often why the PACE study did not get at least moderate results - or indeed any other CBT/GET study. They misdiagnose anxiety and depression as CFS almost routinely, I think there is ample evidence to show that. Since, it was claimed, GET is good for depression, they should have gotten moderate results. They didn't. This is secondary but not strong evidence that CBT does not work - one of the reasons its not strong is that they are not using standard CBT. Its so highly modified that I think its impossible to compare CBT used to treat CFS with CBT for other disorders.

    There is appears to be no evidence regarding CBT in this study. I think its a failure as a treatment of the cause of CFS, but its not clear from this study that this is an accurate interpretation for depression. I would like to point out this though. Most of the problems come from studies that have small effect sizes within the expected range from bias; subjective measures like surveys as outcomes, and unsubstantiated or untestable theories like the dysfunctional belief model of CFS (or almost any psychosomatic model). If you can't test it, its not science.

    If anyone has an interest in debunking CBT I would suggest reading widely in the CBT literature. This would be easier for individuals who have access to articles behind paywalls. I would certainly be interested to read what they could find.

    I am interested in debunking CBT (and GET) with respect to the versions used for CFS and ME. There is evidence that ME is a sufficiently special case that a strong argument can be made against the use of either. On the other hand I think traditional CBT could be useful, if carefully and rationally used for patients who need psychological guidance - not for everyone, and not forced on them. Exercise is also a good idea if it fits patient needs - this isn't about fitting researcher or doctor needs, or medical ideology. However, I prefer to take my exercise information from researching exercise physiologists who are aware of the biological problems post-exercise in ME and CFS. For now that is a very short list, all in the USA.

    Bye, Alex
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  6. Esther12

    Esther12 Senior Member

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    I think that doctors need to give less advice. Just leave it to people to decide for themselves how they want to live their lives, as the evidence that so much advice is based upon seems tenuous or misleading. Unfortunately doctors (or their representatives) seem rather keen to be paid to manage every aspect, the biopsychosocial, or their patients lives.

    I don't think it should be thought this study definitively shows that exercise is not helpful for 'depression' - but it is an other reminder of how little we know about so many conditions. There also seems to be a willingness to embrace cognitive or behavioural interventions with even relatively low standards of supporting evidence... perhaps becuase this shifts the burden on to patients? Perhaps cost reasons? Perhaps out of a desire to blame the sick (which seems to be a common theme throughout humanity's history)?
    barbc56 likes this.
  7. biophile

    biophile Places I'd rather be.

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    I haven't read a textbook on CBT in a long time and there are research papers I still intend to read, but IIRC there is no fundamental difference between CBT for mental health vs CBT for CFS, the variation is just in the examples of thoughts-feelings-behaviours which are identified as "unhelpful". For major depressive disorder, examples include thoughts of "I don't deserve happiness", feelings of guilt, and behaviours such as excessive drinking to cope with emotional pain. For CFS, examples include thoughts like "I have a physical illness and activity is harmful", feelings such as fear and anxiety towards symptoms or activity, and behaviours of avoiding activity or napping during the day and joining a patient organisation for support (or being a member of this forum!).

    The PACE CBT therapist manual also states that in this model "the symptoms and disability of CFS/ME are perpetuated predominantly by unhelpful illness beliefs (fears) and coping behaviours (avoidance)" which "interact with the participant’s emotional and physiological state and interpersonal situation to form self-perpetuating vicious circles of fatigue and disability". Compared to general CBT, the application of CBT to CFS also has additional consideration for the supposed functional physiological aspects of CFS (deconditioning and autonomic arousal etc). Remember the notorious Liverpool CF/CFS clinic handout? PACE actually acknowledges this document in their manuals!

    However, this isn't wholly unique to CBT for CFS either, as the 5 area assessment used on general CBT websites like [The Royal College of Psychiatrists' "Let Wisdom Guide" (http://www.rcpsych.ac.uk/mentalhealthinfoforall/treatments/cbt/5areas.aspx)] already incorporates "altered physical feelings/symptoms" in the model (the PACE CBT participant manual provides an almost exact diagram on p56 under the section about tackling unhelpful thoughts). PACE and other CBT/GET proponents just take it one step further by speculating more about the particular vicious circle between initial symptoms (CFS triggered by social and physical and emotional stressors) and patients then resting to help recover, leading to deconditioning and the consequent post-exertional symptoms, leading to boom bust cycles and outright fear-avoidance of additional symptoms in a downwards spiral (see diagrams on p21 of the CBT participant manual and p21+p54 of the CBT therapist manual, and the diagram at http://www.kcl.ac.uk/innovation/groups/projects/cfs/patients/understanding.aspx).

    CBT is a pragmatic approach which deals with solutions in the here and now rather than what happened in the past. This is one reason why proponents of CBT for CFS don't seem to care about what causes CFS. The notion of breaking the "vicious circle" is also classic CBT. CBT/GET proponents claim that these therapies aren't being applied to CFS on the basis that CFS is a mental disorder and the (supposed) "success" of these therapies for CFS does not imply the illness is "psychiatric". These claims may be technically correct but are still disingenuous and appear to be said to increase acceptability of therapy ...

    The cognitive behavioural model of CFS, including the one mentioned in the 2011 Lancet paper on the PACE Trial, assumes it to be a functional illness without disease pathology and primarily perpetuated by cognitive and behavioural factors. There is no denying that CBT for CFS is generally aimed at reversing the condition by changing these supposed factors. Furthermore, examples of conditions relevant for CBT (in the above cited website and others like http://www.overcoming.co.uk) are generally mental health issues or problems with management. Although "chronic fatigue" and "chronic pain" can be relevant for a wide range of medical conditions, these symptoms are listed among an ocean of mental health problems. In the UK, the Royal College of General Practitioners even classifies fatigue within its mental health curriculum. Similarly, some people view chronic pain as a biopsychosocial issue too.

    So CBT by default implies mental health issues or problems with illness management. People don't get diagnosed with heart disease or diabetes and then goaded into a routine course of CBT, as proponents of CBT for CFS either want us to believe happens or want for us to do when diagnised with CFS. alex3619 mentions that CBT can still be helpful for other issues, such as coping. Sure, and it would have been interesting if PACE had an arm of the trial where CBT was applied to CFS on a general basis for coping with illness rather than reversing the illness, as there may be benefits to CBT which have nothing to do with the pet theories of CBT/GET proponents such as White et al.
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  8. Bob

    Bob

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    I'm really quite annoyed after hearing about this research. We've been told that exercise 'treats' depression for decades now. It was one of those things where if you had depression, it felt like you were being accused of leading a sedentary lifestyle, so it was all your own fault. (Same as ME!) I used to suffer from chronic fluctuating levels depression quite badly when I was in my teens. But I was pro-active with my lifestyle and did everything I could to help myself. Despite the ongoing depression, I used to love exercising, including running, swimming and cycling. On one occasion, I ran my furthest distance which was 10 miles. By the end of the run, I had become bored and probably a bit tired, and as I finished the run, I had that very familiar feeling of depression. I was really frustrated about this, because I had been consistently told that depression responds to exercise. So I thought, if a 10 mile run doesn't help me, then my attempts to alleviate my own depression are defeated. I never ran such a long distance again.

    And now they tell us that it was all lies. So 'science' has been misrepresenting the facts for 20 years or more. It's a shame that the 'bad science' people don't actually take an interest in the 'bad science'. (I've recently been having discussions on Twitter about GM, and it's really irritating when pro-GM people accuse others of being anti-science, or of not understanding the science, when concerns are expressed that science is unable to police itself. Just as with ME, a lot of people arrogantly, and ignorantly, misuse, and misunderstand, the science to propagate their own bias.)

    Getting back to the depression study, I heard one of the authors being interviewed on the radio this morning and he said that none of the past studies were large enough (i.e. did not have large enough sample sizes) to get accurate results.

    In the radio interview, he also acknowledged that some people might experience a temporary increase in endorphins when exercising, but that this categorically does not reduce or treat depression. He was absolutely clear that exercise has zero impact on depression.

    The interview also confirms some of the points that biophile highlighted in his first post.

    Here's the radio interview:
    http://news.bbc.co.uk/today/hi/today/newsid_9726000/9726228.stm

    (Thanks for posting the article, Silverblade.)
  9. barbc56

    barbc56 Senior Member

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    It's a catch22. When I am feeling better, THAT is when I can increase my activity. Same with depression. It may be more of an indication of how someone feels.

    Barb C.:>)
  10. Tito

    Tito Senior Member

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    Let's not forget about the whole industry behind the "exercice is good for you" message. Very similar to the "5 portions a day" message by the Californian grocers that became a medical 'truth'. Very similar to the vitamin supplements. Very similar to the "drink 2liters of water a day", etc. End of the seventies, there was no one carrying a bottle of water, there were no vitamin supplements in supermarkets, no gym every 100 yards, no veggie brigade,... Was the depression rate really higher than now?
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  11. Enid

    Enid Senior Member

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    Yeah well any idiot knows a walk or whatever produces seratonin - shortly acting and no cure for illnesess. The pathetic psychobabblers are exposed.
  12. alex3619

    alex3619 Senior Member

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    Going back to CBT, the technology is the same in CFS as in other disorders like depression, but the targets are different. Those differences in targets (the thoughts and behaviours they want to reprogram) may make a huge difference in outcome. If they have relevance there might be some impact, if they are groundless then the impact will be zero or harmful. Since we don't understand most psychiatric disorders, and the psychiatrists seem very out of touch with the biomedical science on ME, there are more likely to do harm than good - this would be the case even if we didn't have as much evidence that they are doing harm as we do.

    It does not mean however that we can generalize CBT impact - CBT is not really a standardized methodology - its a whole school of therapy and two different studies might use very different techniques on balance. That is a big reason why metastudies might be highly flawed as well - how can you do meta-analysis on different though similar techniques? This of course goes to the heart of evidence based medicine as a justification for psychiatric intervention like CBT. If studies are not comparable, what does that do to the evidence base?

    White is on record as saying that exercise is a fine example of BPS intervention or something to that effect. This is from Biopsychosocial Medicine. He also claimed he can improve fitness in CFS with exercise - but as we know there is no credible evidence of this.

    I still find it very interesting that psychiatrists think they understand neurology, immunology and exercise physiology, yet don't give credence to views of proven exercise physiology researchers who have repeatedly debunked the exercise claims about CFS since the 1990s.

    Bye, Alex
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  13. Enid

    Enid Senior Member

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    They have a convenient way of ignoring neurology, immumunology, virology, bacteriology etc findings - you name it - all to the "good" for these mumbo jumbos and their necessarily ignorant pies in the sky.
  14. Bob

    Bob

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    I could have debunked the exercise claims about depression as well, from a personal point of view, but I didn't know so much about how science works in those days, so I took it at face value.

    I've never thought that CBT could have helped my type of depression either, because I've always been convinced that my depression was based on inflammation, or the autoimmune system, or genetics, rather than maladaptive cognitive processes. And now I'm certain that I'm right, considering everything I now know, and my experiences with ME.

    I've never checked it out but I wonder exactly how successful CBT is at treating depression. I bet it's not half as effective as I've always been led to believe.

    I don't mind science getting it wrong sometimes, but what I do mind is the arrogance that says that if you disagree with selected scientific outcomes, or the current scientific consensus, then you are ignorant or unscientific.

    Rant over :mad:
  15. Esther12

    Esther12 Senior Member

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    There does seem to be an overlap between the exaggerated claims made about cognitive and behavioural treatments for depression and CFS. In both cases, they end up lumping together groups of patients and treating them pragmatically on unproven models of the illness which end up promoting prejudices about these patient groups. It seems as if lower standards of care are seen as acceptable when patients are being treated as having a mental health disorder. With cancer, a patient wouldn't be given drugs with lots of side-effects unless there was good positive evidence that this individual patient had a tumour... in the same way, patients shouldn't be treated as if they are suffering from a specific cognitive distortion unless there is good evidence that they, as an individual, are.

    It seems like CBT is a useful intervention for lots of anxiety problems, but for almost everything else it's a bit of a sham.

    Now I need to go back and re-read a lot of this thread, as I haven't really taken in some of the longer posts.
  16. oceanblue

    oceanblue Senior Member

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    I agree with most of what you say, but wasn't aware there was much evidence re fitness of CFS patients changing after exercise either way. The PACE 6MWT for GET would be the closest, but I've been reading a lot about fitness/conditioning recently and haven't come across anything else. Any links would be appreciated. Thanks
  17. SilverbladeTE

    SilverbladeTE Senior Member

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    Bob
    Gm crops are largley being pushed by Monsanto, one of the most evil entities the world has ever seen, a "war criminal" organization, who covered up the truth about it's vile poison, that was killing US service people as well as millions of vietnamese...and got away with it.
    And folk trust them with "frankensteining" our vital crops?!

    And no, that's not hyperbole, because the eventual outcome *IS* unknown, and screwing with the crops that keep our entire civilization going should be a CAPITAL crime.
    People simply have no idea of how stupidly dangerous that meddling is.
    To put it simply, see the Potato Famines of the 1800s.
    Yes I know the research is supposedly to help stop such horrors, but if they screw up, they could easily make major food crops toxic or ruined etc, leading to world wide famines.
    It's like experimenting with the only waterhole you've got in a desert!
    it is completely insane, and really just to give that vile company more ways to screw farmers out of money, see how they treat seeds as some bizarre "Intellectual Property", make the plants sterile so farmers can never replant (oh how WONDERFUL that will be if we ever have some global crisis, eh?).
    etc.

    The "Conventional Wisdom", the "System", as applies ot GM crops or ME, shows how pathetically stupid, greedy and short sighted our society is :(
    only ever learns after catastrophy, see nuclear industry for example, then backslides into the SAME wrong doing (again see nuclear industry, US citizens should be hopping mad that their safety is being compromised to satisfy the industry/government scumbags, undoing extremely good safety regulations so some illegitimate primate-relatives-of-Homo-Sapiens fellators can get some more $$$ :rolleyes: )
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  18. Esther12

    Esther12 Senior Member

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    Why would anyone have ever thought otherwise?!
  19. SilverbladeTE

    SilverbladeTE Senior Member

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    Many people simply don't get the risk, have been bamboozled by the PR crap from "MonSatan" :p
    And of course, many many fine politicians I am sure, have taken very very big bribes, er, I mean, lawful campaign contributions, free lunches etc! :D

    We've already seen that despite their bullshit, there has been cross pollination. Absolutely insane, it's like watching a re-run of the nuclear arms race...which resulted in the Mayak, Sellafield and Chernobyl disasters, amongst others
  20. Esther12

    Esther12 Senior Member

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    re GM crops: I have very little faith in our regulatory or scientific processes to ensure that these new technologies are only used in a way that does not risk harming the public, or ensures that an risk is borne by those hoping to profit from them... but I've also read a lot of not very good criticism of these new technologies from environmental groups. I really don't trust either side. If biotech companies were required to get insurance which would cover all potential costs to society of their work, I'd be happy to let them get on with it... but I don't really trust their claims that they are certain that no problems will be caused. I don't know why I'm writing about this in this thread!

    Back to this topic... there are already a couple of critical rapid responses on the BMJ. I don't think that we should start assuming that the claims of these researchers are necessarily true. It's so difficult to measure outcomes with something like depression too... I think it's best to be cautious about all this stuff:

    http://www.bmj.com/content/344/bmj.e2758?tab=responses

    One of the rapid responses mentioned his twitter feed, which is here in case you wanted to read: https://twitter.com/#!/dnunan79

    I just see this as further evidence that we really have no idea what's going on with a whole range of things, and that we need to stop spending so much money on expert therapists who give advice to patients.
    oceanblue likes this.

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