A Cochrane systematic review & meta-analysis published a few days ago shows abysmal effect sizes for CBT compared to standard care in the treatment of "somatoform disorders".
http://www.ncbi.nlm.nih.gov/pubmed/25362239
Their objective was:
You can bet many of these folks had CFS, FM, POTS etc., although they do say that they excluded people who had "only one specific functional syndrome":
Here's the list of quackish interventions studied:
They forgot to include blood letting and mercury salts.
Outcome measures were of course various self-report somatisation scales/questionnaires. Even so, the effect size was small and there were substantial methodological problems with the included studies:
The already poor effect was further reduced at one-year follow-up:
CBT had essentially no effect on functional disability and quality of life (mostly measured by the SF-36):
The only analysis approaching an objective outcome was healthcare use:
In other words, while the patients were being brainwashed by CBT, the number of doctor visits and medication use declined. CBT in the case of treatment of MUPS always involves convincing the patient to let go of searching for a medical explanation for their symptoms and to embrace a psychological aetiology. Sometimes the patients are explicitly told that they can only participate in therapy if they agree not to pursue medical investigations at the same time. This would explain the initial difference. However, at one-year follow-up, when the patient has had the chance to see how ineffective the psychological approach has been, the difference in doctor visits and medication use is zero between the CBT group and the control group.
Naturally, the review does not contain a whiff of objective outcomes like employment or receipt of disability benefits.
http://www.ncbi.nlm.nih.gov/pubmed/25362239
Their objective was:
To assess the effects of non-pharmacological interventions for somatoform disorders (specifically somatisation disorder, undifferentiated somatoform disorder, somatoform disorder unspecified, somatoform autonomic dysfunction, pain disorder, and alternative somatoform diagnoses proposed in the literature) and MUPS in adults in comparison with treatment as usual, waiting list controls, attention placebo, psychological placebo, enhanced or structured care, and other psychological or physical therapies.
You can bet many of these folks had CFS, FM, POTS etc., although they do say that they excluded people who had "only one specific functional syndrome":
As we aimed to summarise interventions for multiple symptoms, we excluded studies that examined participants diagnosed with only one specific functional syndrome or symptom (e.g. fibromyalgia or fatigue). Moreover, existing Cochrane reviews address specific syndromes and complaints (Bernardy 2013; Price 2008; Zijdenbos 2009).
Here's the list of quackish interventions studied:
Eligible studies included one or more of the following experimental interventions.
We excluded interventions based on complementary medicine from this review. In addition, pharmacological interventions and consultation letter interventions were beyond the scope of this review; they were evaluated in other Cochrane reviews (Hoedeman 2010; Kleinstäuber 2013).
- Psychological therapies:
- CBT (e.g. reattribution therapy and problem-solving therapy);
- behavioural therapy (e.g. classical CBT, biofeedback therapy, relaxation therapy, and psycho-education);
- third-wave CBT (e.g. mindfulness);
- psychodynamic therapies (e.g. group therapy);
- humanistic therapies (e.g. person-centred therapy);
- integrative therapies (e.g. cognitive analytical therapy).
- Physical therapies:
- physical activity training (e.g. graded activity training);
- other physical therapies (e.g. activation therapy or running therapy).
They forgot to include blood letting and mercury salts.
Outcome measures were of course various self-report somatisation scales/questionnaires. Even so, the effect size was small and there were substantial methodological problems with the included studies:
Combining all studies that compared some psychological therapy with usual care or waiting list, psychological therapies were significantly more effective at end of treatment, though the effect was small (SMD -0.34; 95% CI -0.53 to -0.16; 10 studies, 1081 analysed participants,Analysis 1.1). Heterogeneity was moderate (I2 = 49%), and the overall quality of the evidence was low (Summary of findings for the main comparison).
The already poor effect was further reduced at one-year follow-up:
At follow-up, measurements within one year of follow-up, the effect of psychological therapies remained significant (SMD -0.24; 95% CI -0.37 to -0.11; 7 studies, 950 participants; I2 = 0%).
CBT had essentially no effect on functional disability and quality of life (mostly measured by the SF-36):
Seven studies, of which four addressing CBT reported on functional disability and quality of life, using a variety of instruments. At the end of treatment, a statistically significant effect was found favouring the psychological therapies (SMD 0.17; 95% CI 0.03 to 0.32; 7 studies, 730 participants; I2 = 0%; Analysis 1.21). We judged the evidence to be moderate. At follow-up within one year after treatment, differences were similar but no longer significant (less than one year: SMD 0.16; 95% CI -0.01 to 0.33; 4 studies, 526 participants; I2 = 0%; Analysis 1.22). After one year, only one study provided data for functional disability and quality of life (Analysis 1.23).
Four studies compared CBT with usual care. At end of treatment, a non-significant difference was found favouring CBT (SMD 0.15; 95% CI -0.06 to 0.37; 4 studies, 341 participants; I2 = 0%; Analysis 1.21, subanalysis 1.21.1).
The only analysis approaching an objective outcome was healthcare use:
Six studies assessed healthcare use, operationalised in different ways, with moderate quality of evidence. During the treatment phase, two studies found a significant difference in the number of participant-initiated doctor visits and medication usage in favour of CBT (SMD -0.68; 95% CI -1.06 to -0.30; 117 participants; Analysis 1.24). In the period less than one year after treatment, perhaps a more relevant timeframe, four studies found no clear evidence of a difference (SMD -0.09; 95% CI -0.31 to 0.12; 532 participants; I2 = 20%; Analysis 1.25).
In other words, while the patients were being brainwashed by CBT, the number of doctor visits and medication use declined. CBT in the case of treatment of MUPS always involves convincing the patient to let go of searching for a medical explanation for their symptoms and to embrace a psychological aetiology. Sometimes the patients are explicitly told that they can only participate in therapy if they agree not to pursue medical investigations at the same time. This would explain the initial difference. However, at one-year follow-up, when the patient has had the chance to see how ineffective the psychological approach has been, the difference in doctor visits and medication use is zero between the CBT group and the control group.
Naturally, the review does not contain a whiff of objective outcomes like employment or receipt of disability benefits.
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