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[funny] Cancer-related fatigue, CBT & Actometers. Bleijenberg, etc.

Discussion in 'Other Health News and Research' started by Esther12, Aug 20, 2013.

  1. Esther12

    Esther12 Senior Member

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    Maybe not Tig Notaro cancer-funny, but pretty good for an academic paper.

    Results are the same as for CFS, with CBT leading to improvements in questionnaire scores, but not objective measures of illness. They're more open about this being a problem than they were with their CFS results, but still try very hard to avoid mentioning even the possibility that their questionnaires are not reliable measures of outcome for cognitive or behavioural interventions (and succeed!).

    Full paper: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3360858/

    I picked some bits out, but it's quite a short paper, so people might prefer to just read it themselves.

    Couple of bits making it clear that, if CBT were working as intended, activity levels would increase:

    Nice they can be certain of this:

    Looks like the control was waiting list only, so lots of room for response bias.

    Again they decide to assume that perpetuating factors are entirely reversible and cognitive/behavioural, based on.... wish thinking? (pragmatism):

    Worth noting that 'top-up' sessions were available in the second six months:

    For those of you really interested in mediation analyses, there's a fair bit of it, and I'm too tired to dig into that right now (someone explained bootstrapping to me... I understood it for a bit!).

    No significant relationship between changes in physical function, and changes in fatigue questionnaire scores:

    I'm going to post all of their discussion, because it's a bit funny to me that they explore so many possibilities, without ever considering whether their highly effective cognitive-behavioural treatment might just be inducing response bias when compared to a waiting list control. We have no evidence that fatigue questionnaires are reliable ways of assessing cognitive and behavioural interventions.

    Also, they keep trying to come up with ways in which patients could have increased their activity... but that just didn't show up.

    I thought this might be of interest.

    PS: Best wishes to all those struggling with cancer or post-cancer fatigue. I ended up on a forum for cancer sufferers who were discussing some research once, and they seemed really pissed off by the way in which their cognitions and behaviours were being medicalised too. For them it was like: 'I've got Cancer! I don't want to have to deal with this shit too! Let me be myself.'
     
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  2. SOC

    SOC Senior Member

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    Some day the world is going to be laughing at these "think away your symptoms" CBT therapists. Let's hope it's soon.
     
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  3. biophile

    biophile Places I'd rather be.

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    Does it seem unusual to anyone that CBT for post-cancer fatigue and MS is more effective than for CFS? Yes, it would be ironic if after all their consideration for various mediators, they left out multiple forms of reactivity bias. The effects of CBT on fatigue in CFS and possibly other conditions may (largely) be a "laboratory artifact" as XMRV reportedly turned out to be, but unfortunately for us there has been a much longer period of "discovery and de-discovery".
     
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  4. taniaaust1

    taniaaust1

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    What's the bet they will be saying the above for us too when they are forced into admiting that CBT doesnt increase our physical activity level at all. They will still be saying it is "highly effective".
    I think this shows we will be fighting the idea of CBT being helpful for most of us for a very long time.
     
  5. biophile

    biophile Places I'd rather be.

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    This has already happened with slightly different wording. The above mentioned paper is an uncanny reflection of several of this group's papers on CBT for CFS, including the same speculation that increases in activity really did occur afterall but just was not measured. Some of it reminds me of what has been labelled as "tooth fairy science":

    http://www.skepdic.com/toothfairyscience.html

     
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  6. alex3619

    alex3619 Senior Member

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    Tooth fairy science ... like the whole of psychogenic medicine?
     
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  7. Sean

    Sean Senior Member

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    It didn't produce any measurable change in physical behaviour, but a few patients said it helped a bit, therefore it worked very well.

    You're shitting me.
     
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  8. Valentijn

    Valentijn Activity Level: 3

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    You haven't seen this same group's gems about CFS? Exactly the same results and BS conclusions, except that they hid the actometer results in the initial three studies. Better questionnaire responses, no improvement in actual activity levels via actometer, conclusion that "increasing activity doesn't mediate the (presumed) reduction in fatigue".

    Aside from the insane conclusions, which imply that questionnaires matter more than actual disability, their papers have been great for us. They prove that CBT/GET do not increase activity levels, even when that is the specific goal of the therapy. Excellent for citing when responding to the PACE crap.

    Incidentally, getting the same results in patients with post-cancer fatigue makes me wonder how much else we have in common.
     
  9. Esther12

    Esther12 Senior Member

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    Yeah - I'm interested in the large improvements in fatigue questionnaires following CBT we've seen elsewhere. The MS study had patients reporting feeling better than healthy controls!

    It's also interesting that in these areas, CBT promoters are often a bit more open about the problems with their research. The Chalder MS study talked about response bias. This study is way more open and honest than their CFS one (although still ridiculously evasive).

    Even after all the dodgy CFS research I've seen, I think that there's a part of me that still has an instinctive faith that these treatments cannot be total quackery... surely someone would have noticed before now! The more I look at the evidence though, the more it looks like they are just manipulating the way patients answer questionnaires.
     
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  10. Simon

    Simon

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    Much as it's good to see negative results being published as opposed to being buried, I can't figure out why they even ran the analysis.

    One of the first step in any mediation analysis is to "Show that the mediator affects the outcome variable"*. In this study, the proposed mediator, increased activity levels, doesn't affect the outcome: fatigue. GAME OVER.

    *see mediation guidelines website by Kenny (as in "The mediation hypothesis was tested according to guidelines of Baron and Kenny").
     
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  11. taniaaust1

    taniaaust1

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    I have to remember that example of things.
     
  12. Valentijn

    Valentijn Activity Level: 3

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    Their goal is to show that CBT "works" for cancer (and previously ME/CFS, etc). When the actometers show that the CBT isn't working, they then spin the results. In this case the spin is that they pretend questionnaire responses are the most important outcome measure, and that the actometers are only relevant in showing how CBT "works".

    My guess is that this group of researchers is required to use actometers and/or publish results, hence their willingness to go to absurd lengths to show that CBT practitioners are needed to cure fatigue. They will never ever state that "CBT doesn't increase activity levels" - they will twist it to say "Activity levels aren't responsible for decreasing fatigue after CBT."
     
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