1. Patients launch $1.27 million crowdfunding campaign for ME/CFS gut microbiome study.
    Check out the website, Facebook and Twitter. Join in donate and spread the word!
AVIVA Semi-Finals: National ME/FM Action Network is competing for $100,000
The National ME/FM Action Network in Canada is competing for $100,000 for biomedical research of ME and FM in the Aviva Community Fund contest. With thanks to all who helped, they made it through the first round of voting into the Semi-Finals.
Discuss the article on the Forums.

Psychological Treatments That Cause Harm

Discussion in 'Other Health News and Research' started by Esther12, Sep 21, 2013.

  1. Esther12

    Esther12 Senior Member

    Messages:
    5,384
    Likes:
    5,891

    Open access: http://users.ipfw.edu/young/350-Abnormal/assignments/Psych-treatments-that-cause-harm.pdf

    I only had a browse of this, and decided it was one of the many interesting papers I was going to have to put to one side, but thought that it could be of interest to someone else here (feel free to summarise for us!) so am posting it up.

    Some bits remind me of Dolphin 's comments comparing safety procedures for drugs and psychological treatments:

    It didn't look killer interesting, or to be making really startling new points with references to data that was important, but I may have missed stuff, and I didn't work to understand anything with unfamiliar terminology. Overall, it seemed pretty complacent, considering the topic, and the recognition of the importance of 'do no harm' in medicine.

     
    Valentijn, Roy S and Dolphin like this.
  2. A.B.

    A.B. Senior Member

    Messages:
    764
    Likes:
    2,255
    What I find puzzling is that all psychotherapies are equally "effective". That is exactly what one would see if they were merely a placebo.
     
    Snowdrop, taniaaust1, PennyIA and 5 others like this.
  3. Esther12

    Esther12 Senior Member

    Messages:
    5,384
    Likes:
    5,891
    It does seem that some are trying to claim that expertly provided psych therapies should be respected because they harness the magical power of placebo.

    Alternatively, those 'expert' homeopathy quacks should be treated with disdain, because their treatments are no more effective than placebo.
     
  4. lansbergen

    lansbergen Senior Member

    Messages:
    1,154
    Likes:
    582
    :D:D:D:D:D
     
  5. A.B.

    A.B. Senior Member

    Messages:
    764
    Likes:
    2,255
    There are studies which claim to show that psychotherapy is more effective than placebo.

    However, one should not forget that not all placebos are created equal: sham surgery is a stronger placebo than a sugar pill.

    Comparing psychotherapy with a sugar pill could merely be, for all we know, a comparison between two different placebos.

    A better comparison would be real psychotherapy with sham psychotherapy with social interaction.
     
    Valentijn and Bob like this.
  6. peggy-sue

    peggy-sue

    Messages:
    2,494
    Likes:
    2,876
    Scotland
    I find the whole idea very interesting.
    I have a particular "downer" on CBT which I had long before I got ill - because of a course of CBT I had for OCD.
    I was such a resounding success story that my therapist used my case for her PhD.:thumbsup:

    I was not any sort of success story at all. She did not follow me up, she did not address the reason I had developed OCD in the first place.

    She had decided my reward for cutting down the number of times I washed things, or washed my hands should be an alcoholic drink.
    She clearly had not read OU lecturer Fred Toate's excellent book on OCD, which specifically warns against folk with OCD using alcohol to self-medicate.

    I carried on after I had been "cured", with my new problem of abusing alcohol to hide from and cope with the real reason for my problems, which was bullying and mental abuse from my ex.

    The entire case had been a waste of time.
    A sticky plaster over a cancer.

    But my therapist put a lovely spin on it.
     
    leela, Roy S, taniaaust1 and 5 others like this.
  7. user9876

    user9876 Senior Member

    Messages:
    794
    Likes:
    1,950

    I think there is a research group looking at whether the placebo effect can be used to treat people. I think they are the ones who carried out an asthma study and come from a acupuncture background.

    My feeling is that the placebo effect is about changing how people feel about illness and interpret things rather than having any underlying effect. Hence it seems to be effective with pain, it doesn't reduce pain just helps how people interpret or report their pain levels.

    The dangers of such an approach is that people will ignore symptoms or do stuff that will harm their body. I've heard people say that homeopathy doesn't do any harm as long as people still follow conventional medical advice. However, I don't believe that this is the case where the placebo effect in homeopathy could cause symptom and pain level reports to be down played.
     
    Valentijn, Bob, Svenja and 1 other person like this.
  8. Roy S

    Roy S former DC ME/CFS lobbyist

    Messages:
    447
    Likes:
    472
    Illinois, USA
    I would very much like to see good research studies on the harms done to ME/CFS patients by bad psychotherapy.
     
    Griffin, jimells, taniaaust1 and 4 others like this.
  9. peggy-sue

    peggy-sue

    Messages:
    2,494
    Likes:
    2,876
    Scotland
    I would prefer to see the harms caused to all therapy clients, (given what happened to me), not just ME ones.

    CBT is promoted over all other forms of psychotherapy because it is the cheapest and quickest.
    It deliberately does not try to address the reasons for problems, it just fixes the immediate symptoms. The therapists stop at the point where they can say the behaviours are gone/ abated. That is deemed a cure.

    But as far as I am concerned, if the reasons for the problems have not been addressed, they will just manifest in another way. In my case, it was alcoholism, encouraged with the blessing of a "therapist".
     
  10. Bob

    Bob

    Messages:
    8,861
    Likes:
    12,456
    South of England
    Wow, that sounds totally unethical!
     
    leela, PennyIA, Shell and 2 others like this.
  11. peggy-sue

    peggy-sue

    Messages:
    2,494
    Likes:
    2,876
    Scotland
    It was. But that's CBT for you.
    Does not give a damn about any harm it might cause and deliberately does not look for any, just in case it finds it.

    :zippit: The miracle of CBT cannot be questioned.:zippit:
     
    alex3619 and Roy S like this.
  12. Valentijn

    Valentijn Activity Level: 3

    Messages:
    6,692
    Likes:
    10,146
    Amersfoort, Netherlands
    My case study would show that the Dutch version of CBT for ME/CFS made me feel seriously suicidal for a day or two.

    The practitioner (psychologist) was trying to convince me that only I could "heal" myself, which I already knew was total bullshit. She insisted I imagine my symptoms failing to improve, and that doctors could not help me. So basically she repeatedly (like 5 or 6 times) had me visualize that in one session, which had me sobbing for most of the appointment.

    It was incredibly painful. To imagine that nothing could be done about ANY of my symptoms, unless I could force myself to somehow make them disappear. I would also be in a lot of pain, very disabled, unable to sleep, constipated, brain-fogged, etc, etc, etc.

    Her abuse was triggered by me wanting to talk about a very bad appointment with a neurologist in the process of getting my neurally mediated hypotension diagnosed. So instead of getting to vent about that abuse, I got more abuse and complete rejection of my experiences.

    Fortunately I had my fiance with me, and he was very supportive. And immediately after the psychologist I had an appointment with the physiotherapist at the same clinic, who was a pretty nice guy. He could see how upset I was, and immediately went to have a talk with the psychologist, looking somewhat pissed off.

    After a day or two, I was able to switch from being seriously suicidal to being seriously pissed off. I researched Dutch CBT-for-ME/CFS a bit, and realized where her abuse originated from. I also found out that they're strongly opposed to patients using any assistant devices, so my fiance and I kept going to appointments just to discuss mobility scooters as much as possible, and eventually give her credit for our decision to purchase one to follow her instructions to "get out more".

    But without the support of my fiance and the physiotherapist, and the knowledge of how stupid and ill-informed she was, things might have turned out very differently. And I can easily imagine how it might turn out differently for someone with less support and self-confidence.

    So now I just hate her and hope she suffers as much as we do. And I don't feel guilty about that at all.
     
    Griffin, leela, helen1 and 6 others like this.
  13. peggy-sue

    peggy-sue

    Messages:
    2,494
    Likes:
    2,876
    Scotland
    Yet I read, just recently, on an official thingy from NICE recommendations about mobility scooters for "CFS/ME" - which said that these should NOT be given to sufferers because "they encourage laziness".
    Same for Blue Badges for cars. Not to be given to PWME.

    Edited to add:-

    :D For this post, my 1,000th, I got awarded "Addicted" status here. Quite appropriate for me in this thread.

    Valentijn, I'm so sorry to hear of what happened to you and very glad you had somebody with you at the time.
    You do raise a very important point though, which has been noticed by Dolphin too
    - about the psychological damage that can be created
    by the situation of having a person in authority,
    somebody on whose goodwill you depend upon for help,
    sitting there telling you that you are doing this all to yourself on purpose, that you are not really ill at all, and refusing to recognise your reality as valid.
     
    taniaaust1, alex3619 and Valentijn like this.
  14. Dolphin

    Dolphin Senior Member

    Messages:
    6,870
    Likes:
    6,161
    Very sorry to hear of your experiences, Valentijn.
    Although I've looked into the physical problems that graded activity-oriented CBT/GET can cause, I haven't really looked in to psychological harms.
    Also, it frustrates me when people say that CBT will help with coping. If it's graded activity-oriented CBT, some parts might, and some parts might have the opposite effect. :(
     
    peggy-sue, Valentijn and Bob like this.
  15. Esther12

    Esther12 Senior Member

    Messages:
    5,384
    Likes:
    5,891
    It's really hard to control for 'worthless placebo' with talking therapies, as therapists can claim that the 'real' efficacy of their treatments stems from the aspects of treatment also likely to lead to response bias.

    Without having done anything to improve patients health, it's easy to image being able to manipulate patients into reporting less symptoms by:

    1) Presenting oneself as an authority figure with real power who is working to help improve symptoms
    2) Being likeable, caring, and giving the impression of really trying to help
    3) Encouraging the patient to believe that they have some control over their symptoms, and that patients who do as they're told will report improvement in symptoms (this could be aided by giving them a somewhat challenging task intended to aid improvement)
    4) Encouraging patients to believe that thinking more 'positively' about symptoms is the correct thing to do, and will help them.
    5) You get the drill, etc, etc.

    Yet CBT promoters can claim that a 'placebo' intervention which included these things could be genuinely effective. (Sorry - really tired... going to stop this post rather bluntly - bleurgh).
     
  16. Dolphin

    Dolphin Senior Member

    Messages:
    6,870
    Likes:
    6,161
    It's probably important to distinguish in discussions about psychotherapy between mainly biological conditions and mainly psychological conditions: if your mood for example is the main problem, an intervention like psychotherapy could in theory improve that and that could be sufficient.
     
  17. Little Bluestem

    Little Bluestem Senescent on the Illinois prairie, USA

    Messages:
    2,684
    Likes:
    2,016
    Midwest, USA
    If you were drunk enough, I suppose you would not notice your symptoms, unless your neurological symptoms or weakness made it physically impossible to keep drinking. :confused:
     
    peggy-sue and vamah like this.
  18. A.B.

    A.B. Senior Member

    Messages:
    764
    Likes:
    2,255
    The idea that we can distinguish between psychological and biological conditions is an illusion.
     
    peggy-sue and Lala like this.
  19. Dolphin

    Dolphin Senior Member

    Messages:
    6,870
    Likes:
    6,161
    That's one way of looking at it. I still think sometimes a useful distinction can be made in practice.

    If a therapy is supposed to improve depression or anxiety, it can be hard to find biological measures to objectively assess such an intervention. One tends to be forced to use questionnaires.

    I wrote what I did partly in replying to your vague statement:
    Questionnaires could be sufficient to validate this claim with mood disorders (I'm guessing it is this sort of evidence the claim is based on). I don't find them sufficient with ME/CFS just as I wouldn't with multiple sclerosis/cancer/cystic fibrosis/motor neuron disease.

    Eventually we might have objective measures for everything incl. anxiety, depressive, complusive hand washing, agoraphobia, etc. At the moment, I think it's much more reasonable to accept the use of questionnaires as outcome measures for some conditions rather than others. Maybe a purist can find it unfair.

    Related to this: I find it much more plausible that depression/anxiety/compulsive hand washing/agoraphobia could be effectively treated by a talking therapy than multiple sclerosis/cancer/cystic fibrosis/motor neuron disease. Some people, e.g. Louise Hay, may not.
     
    aimossy likes this.
  20. Esther12

    Esther12 Senior Member

    Messages:
    5,384
    Likes:
    5,891
    It does seem that a lot of people with problems un-amenable to talking therapies get given diagnoses like anxiety/OCD/etc.

    I think that a lot of these conditions could have similar political problems to those that surround CFS: lots of people with different problems being lumped in together, exaggerated claims being made about the efficacy of psychological treatments, a tolerance for managing patients with misleadingly positive claims about their control over symptoms, public views of these disorders being shaped by those with less serious problems who are more likely to recovery, etc, etc.

    I wonder how much of the increased animosity around CFS as opposed to those other conditions is a result of those with traditional mental health diagnosis feeling that they and their minds are less worthy of respect, so are more accepting of quackery? Also, conditions like OCD, anxiety, etc, can leave patients feeling as if they cannot really control their thoughts, and that they want to have their minds medicalised, which is not the case for most with CFS. At the same time, it also seems that a lot of people with depression, anxiety, OCD, etc think that the health care they get is shit (this is just my impression from comments posted on-line on forums, medical sites, etc - also there was that paper showing psych professionals got the lowest ratings from their patients).

    There is probably a danger that those who are able to spend a lot of time researching this stuff, are also those who make their money from claiming to be mental health experts. It will rather bias things in favour of the interests of those who want to claim to be mental health experts.

    (I was tempted to delete this post, as it's such a complicated topic, I've only read around the topic a little, I'm not at all sure what I think about a lot of these things, and am feeling too tired to really explain myself. It's also a bit OT).
     
    aimossy and vamah like this.

See more popular forum discussions.

Share This Page