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Telephone-administered versus live group cognitive behavioral stress management for adults with CFS

Dolphin

Senior Member
Messages
17,567
It bears consideration that cognitive behavioral stress management is distinct from the prior CBT studies conducted in CFS in its focus on modifying stress responding (i.e., stress management). For instance, it neither focuses on modifying patients' interpretations of the genesis of their illness nor on potential fear/avoidance of physical activity.

Another approach, referred to as cognitive behavioral stressmanagement (CBSM) [9,25], which directly targets stress management by teaching cognitive re-restructuring, coping skills, interpersonal skills, relaxation, and other anxiety reduction techniques in a group format, was shown to improve quality of life and decrease perceived stress and symptoms among CFS patients [14].

For both the L-CBSM and T-CBSM interventions, each session consisted of a relaxation training exercise and a didactic portion focused on CBSM techniques. Trained clinicianswho held a graduate-level mental health degree led the sessions. Relaxation training exercises included diaphragmatic breathing, progressive muscle relaxation, and guided imagery. Cognitive behavioral techniques taught in session included cognitive restructuring, assertiveness training, anger management training, and the use of effective coping strategies.
 

Dolphin

Senior Member
Messages
17,567
Among treatments available for CFS, behavioral approaches have garnered much attention. Cognitive behavioral therapy (CBT) is among themostwidely studied and has shown mixed results for reducing illness burden and improving patients' mental and physical health [17–22]. CBT approaches designed to decrease avoidance of physical activity and to increase physical activity in a graded fashion in patients with chronic fatigue [21], have generated much current interest, though controversy remains concerning the sampling approach and outcome variables used in these studies [23,24]. Whether this form of CBT will ultimately show to be efficacious in patients diagnosed with CFS remains to be seen, though it should be pointed out that reviews of CBT-based interventions used to date in this population do not support increases in physical activity as the underlying mechanism of action. To the extent that stress processes, including neuroimmune regulation, may maintain or exacerbate the CFS symptomology [11,13,16], it is plausible that cognitive behavioral interventions that focus more directly on stressor processing and stress responses may also modulate CFS symptoms.

[23] S. Kirby, Methods and outcome reporting in the PACE trial, Lancet Psychiatry 2 (4) (2015) e10.
[24] S. McGrath, Omission of data weakens the case for causal mediation in the PACE trial, Lancet Psychiatry 2 (4) (2015) e7–e8.
@Simon
 

Dolphin

Senior Member
Messages
17,567
Basic logic failure: the study design doesn't allow drawing any conclusions about the effectiveness of these interventions. It can only tell you which of these is better at altering questionnaire responses, which reflects the sum of treatment effect plus a variety of human biases. For all we know the differences may be purely down to bias. Indeed, it seems unlikely that talking would produce changes in physical symptoms such as PEM, fever, chills, etc, and it is likely that it's easier to introduce bias with live CBT than with a telephone CBT.

Why is it so difficult for some researchers to grasp even the basics?

4.1. Putative mechanisms of action

Interestingly, controlling for session attendance did not alter the magnitude of the comparative and within-group effects examined. Given that session attendance did not account for the differential efficacy of L-CBSMversus T-CBSM, what other factors might explain the relatively greater effects from L-CBSM? One potential explanation is the opportunity for visual transactions among live groups and/or via a more intensive social support experience. While telephone-delivered individual therapies have demonstrated efficacy comparable to face-to-face individual therapy in a variety of patient populations [27,43,44], including ME/CFS [45], past research on the efficacy of telephone-delivered group psychotherapy has been mixed. Using an individual format in past telephone-delivered therapies may have maximized participants' communication with their therapist and uptake of CBT-related skills. In this study of T-CBSM, participants may have been less engaged during sessions than in L-CBSM, and the study therapist could easily miss this lack of engagement in the absence of visual feedback. If, for instance, a patient was not engaged in a relaxation demonstration, she or he may not have learned the skill or benefited from practicing relaxation, and the T-CBSM therapists were not able to see the patient to provide corrective feedback or further instruction. It is also possible that a significant portion of the relative L-CBSM versus TCBSM intervention benefit comes from having weekly social support, which may have been more salient for group members seeing each other face-to-face (i.e., in L-CBSM).
This is what they came up with. It seems quite plausible to me that the differences are due to response biases.
 

Dolphin

Senior Member
Messages
17,567
Finally, in addition to obtaining self-report measures, future research should examine comparative effects of behavioral (e.g., return to work full-time), diagnostic (e.g., clinician- confirmed remission of CFS symptoms), and biological outcomes between in-person and telehealth interventions for CFS.