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Lancet Psychiatry: Per Fink and Sharpe recommends more intensive CBT for the severely ill

Discussion in 'General ME/CFS News' started by Countrygirl, Jul 4, 2015.

  1. Countrygirl

    Countrygirl Senior Member

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    In this new Lancet article, our favourite duo, Sharpe and Per Fink recommend more intensive CBT for the severely ill.


    http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00233-3/fulltext?elsca1=etoc&elsca2=email&elsca3=2215-0366_201507_2_7_&elsca4=Forensic and Legal Medicine|Lancet|Neuropsychiatry|Psychiatry/Addiction Medicine




    .
     
    Last edited: Jul 4, 2015
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  2. Effi

    Effi Senior Member

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    This is highly disturbing.
     
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  3. adreno

    adreno PR activist

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    So it doesn't work for severely ill patients, therefore give them more?
     
  4. adreno

    adreno PR activist

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    [​IMG]

    Looking at the figure, all disorders show ES lower than 0.5, which isn't even moderate. Why even bother? From this, CBT seems utterly ineffective for these disorders, far lower than ES for depression, for example.
     
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  5. aimossy

    aimossy Senior Member

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    Just my opinion but I think these guys are now crossing ethical lines too openly and too far!
     
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  6. A.B.

    A.B. Senior Member

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    They should design some trials first that can distinguish between placebo and treatment effects. As far as I'm concerned, it still hasn't been proven that any of these psychological interventions is more than training people to give the "right" questionnaire answers.
     
    Last edited: Jul 4, 2015
  7. alex3619

    alex3619 Senior Member

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    Well, isn't that a lay definition of insanity? Repeatedly doing what does not work?
     
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  8. alex3619

    alex3619 Senior Member

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    Yes, I think this is one of the huge issues I have been discussing elsewhere. OBJECTIVE improvement must substantiate subjective claims that are vulnerable to extreme bias using questionnaires.

    Edit: this is a comment I earlier posted to FB:

    Given that outcome measures are typically subjective, and CBT might well alter how many patients fill in questionnaires, this might be a shift back toward its true effectiveness rate (which might be worse than zero) as people see through the gloss and babble. I do think CBT can help some to some degree, but its overhyped, oversold, etc. Who those some are, and to what degree, is still not being properly studied. It may even be nobody.

    Psychiatry will not advance as a science until objective measures are used. Even then entire methodological systems have to be abandoned, and psychiatry evolve to modern use of the scientific method. Until then much, if not most, of psychiatry, and probably all of psychogenic medicine, will remain dubious alternative medicine that has wormed its way into medical doctrine.

    More and more patients and prospective patients are better and better informed. Psychiatry has not only lost its gloss, its becoming visibly more and more tarnished. Fixing this will require a shift of the basic paradigms used in psychiatric practice and research. It will require a shift from dogma to rational practice.
     
    Last edited: Jul 4, 2015
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  9. Sidereal

    Sidereal Senior Member

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    It's worked out so well for his patient Ms Hansen.
     
  10. Sidereal

    Sidereal Senior Member

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    Not to mention that the confidence interval crosses 0 for CFS, IBS, hyperventilation and "most severely ill patients" indicating no significant effect for CBT for those conditions. It's amazing how their own data show that this treatment doesn't work yet that doesn't stop them from promoting even more of it.
     
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  11. Sean

    Sean Senior Member

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    They are not making this forgiveness thing easy. :rolleyes:
     
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  12. worldbackwards

    worldbackwards A unique snowflake

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    Isn't this just how fundamentalism works? The more doubts you have, you more you double down on certainty.
     
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  13. Simon

    Simon

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    Thanks. What amazes me is that comparison with depression. A recent meta-analysis found the effect size for depression had fallen since the 1970s from about 2.4 (miracle cure) to 1.2. But an effect size of 1.2 is still pretty-impressive. This compares with an effect size of under 0.5 for CFS in the benchmark study (PACE), even before allowing for issues of placebo effect/response bias in an unblinded trial with subjective outcomes.

    You might think that with such a small effect size the proponents of CBT/GET would pause to think: 'if we can only make such a modest difference with our best shot, maybe our model is wrong?'. PACE, of course, explicityly based its therapy on a model that the illness is perpetuated by patients' flawed beliefs/behaviours.
     
    Last edited: Jul 5, 2015
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  14. Gijs

    Gijs Senior Member

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    I call it gaslighting... mental abuse! Before my illness i didn't know that scientists, docters, psychiatrists and the medical community where such stupid and simplistisch people! They need serious CBT to correct there disfunctional minds... They are the real grazy ones but the don't know it....
     
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  15. Sidereal

    Sidereal Senior Member

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    The recent P2P meta-analysis showed the same thing happening in the CFS field. The initial study by Wessely's group showed a huge and highly improbable, never-to-be-replicated effect size, as so often happens in medicine. Subsequent studies show a return to planet Earth (regression to the mean).

    I suspect if PACE were repeated by other investigators who didn't have an allegiance bias to CBT, used blinded raters and non-absurd inclusion and recovery criteria, we'd see an effect size approaching 0.
     
  16. adreno

    adreno PR activist

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    And to imagine that Fink & co. keep a girl locked up, on the basis of a 0.35 ES intervention.
     
  17. A.B.

    A.B. Senior Member

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    There was a CBT and GET study done by Spanish researchers associated with a rheumatology clinic, and they found the intervention worsened physical functioning and pain scores.
    Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up
     
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  18. Sidereal

    Sidereal Senior Member

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  19. alex3619

    alex3619 Senior Member

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    You are too kind to them. I suspect we would see a modest effect size ... a modest worsening of the situation, not an improvement. Other studies using objective measures show things get worse.
     
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  20. Sidereal

    Sidereal Senior Member

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    I was allowing for use of subjective measures such as SF-36 which would probably still show some small residual effect of CBT "happy positive healing thoughts" brainwashing on questionnaire-taking behaviour. :lol:
     
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