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Publication bias has inflated efficacy claims of psychotherapy incl CBT 4 depression

Discussion in 'Other Health News and Research' started by Dolphin, Oct 21, 2011.

  1. Dolphin

    Dolphin Senior Member

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    I wonder how much of an issue this is in the ME/CFS field?

    Free full text at: http://bjp.rcpsych.org/content/196/3/173.long or http://bjp.rcpsych.org/content/196/3/173.full.pdf

     
    wdb likes this.
  2. anciendaze

    anciendaze Senior Member

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    One of the side-effects of the mental illness that struck George III and precipitated the regency crisis of 1788 was a reexamination of the effectiveness of methods of treatment. You can see a depiction of those treatments in the movie, "The Madness of George III".

    A skeptical doctor (whose name escapes me at the moment) made a study of admissions to madhouses. He concluded that 1/3 of those admitted later returned to their previous lives, 1/3 improved, but remained confined, and 1/3 remained unchanged.

    Taking this as the null hypothesis for treatment of mental illness you might conclude that 33% would recover regardless of treatment.
     
  3. Enid

    Enid Senior Member

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    It's about time the psychology/psychiatric fraternity took a hard look at their so-called scientific findings.
     
  4. Sean

    Sean Senior Member

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    As I recall, one of the claims made by the psych school of ME/CFS is that the results of their use of CBT etc are comparable to other disorders that these therapies are used for. This is supposed to help prove that they are effective for ME/CFS, and even that this supports their long standing claim that ME/CFS is a primarily mental disorder. But which I have always thought really just proves how ineffective they are, for both ME/CFS and the other disorders they are used for.

    In other words, this whole branch of medicine is riddled with problems of over reliance on subjective assessment, and publication bias. This may help explain why they are so reluctant to bring the ME/CFS psychs to heel, as it will expose the deeper generic methodological problems cutting across all of psychiatry/psychology.
     
    Sidereal likes this.
  5. biophile

    biophile Places I'd rather be.

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    Good find. An interesting reminder from the discussion section:

    [30] = "Size of treatment effects and their importance to clinical research and practice." | Kraemer HC, Kupfer DJ. | Biol Psychiatry. 2006 Jun 1;59(11):990-6. Epub 2005 Dec 20. | http://www.ncbi.nlm.nih.gov/pubmed/16368078

    So a NNT of 7-8 for CBT/GET in PACE would therefore be roughly about d=0.3? Perhaps I should take a look at the Lancet paper again and try to calculate d more directly.

    I have noticed a trend that when meta-analyses tackle the issue of psychological factors in illness/disease, the results usually end up sobering the hype. The symbol for much of the biopsychosocial CFS research and commentary should be the gyroscope, the rapid persistent spinning is what keeps holding up an otherwise unstable device due to the angular momentum! Although the biological research hasn't been perfect either.

    I don't remember all the details now but I looked into that claim once before and (unsurprisingly) found that in general CBT for CFS is not as effective as CBT for depression (maybe about 50-60% as effective at face value?). So just another CFS assfact? At best without methodological considerations, the former has generally a small to moderate effect and the latter has generally a moderate to large effect. There are rare outliers in both examples reporting much greater success. Except now of course, according to the above mentioned Cuijpers et al 2010 paper posted by Dolphin, when factoring in indications of publication bias, CBT for depression generally does not have large effect but a moderate one. IIRC, systematic reviews into CBT for CFS have also noted possible publication bias, but there aren't as many studies to review and the issue hasn't been thoroughly investigated.
     
  6. anciendaze

    anciendaze Senior Member

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    During the period when I felt my problem must have a psychological basis I talked to a number of people who had recovered from serious psychological problems. Many credited a particular therapist for their recovery. Others were less enthusiastic about the therapist, but mentioned a friend who had remained in communication when others avoided them. Later, questioning still others who gave their therapist credit, I discovered that virtually all those who recovered had such a reliable friend. This stuck in my mind because I was astonished at the range of treatment strategies, including contradictory techniques, offered as psychological therapies.

    This raised a question in my mind which I have been unable to answer. One control you are unlikely to see in research on psychological therapy is the involvement of people with empathy, but without any professional training. This might expose the true value of that professional training.
     
  7. Sean

    Sean Senior Member

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    Pretty sure something like this has actually been done with CBT (not for ME/CFS specifically), and the results were not good for the highly trained professional experts, the amateurs did almost as well. So you will not be hearing much about this result from the pros.

    Far as I can recall the literature, the only consistent factor in psycho-therapeutic response is the quality of the relationship between therapist and patient, not something that can be taught or subject to formulas or methodologies. The particular mode of therapy is virtually irrelevant. CBT just happens to be the flavour of the decade. It only has the "most evidence" because it has the most studies done. It all gets a bit circular after that.
     
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  8. Esther12

    Esther12 Senior Member

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    While the downsides of the over-promotion of CBT for things like depression are less worrying, I think that there are a lot of similarities to the problems found with CFS. There's also no need to deal with the 'they just don't like psychology' side of things.
     
  9. Esther12

    Esther12 Senior Member

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    Looks like the same group with a new paper and a similar finding.

    Open access: http://www.ncbi.nlm.nih.gov/pubmed/25062429

     
    Sean, Sidereal, Valentijn and 2 others like this.

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