Cognitive behaviour therapy for chronic fatigue syndrome: Differences in treatment outcome between a

[Keith Geraghty]

my problem is the control - eg usual care, 10 minutes appointments with GPs who do little compared with CBT 12 sessions of a sympathetic therapist who gives a host of advice and talk counselling - hardly a fair comparator, - the bias is in the design, not the data analysis

 

[Snow Leopard]

Bare with me, but... If this data was to be reported correctly, how would it be done? Any effect would be measured directly as UK vs NL right? So any Cohen's D would be determined directly comparing the post-intervention data of the UK clinics to NL clinics, controlling for any baseline differences?

 

[Large Donner]

I think this emphasises the fact that nobody actually knows what CBT is. Is it just talking to somebody, or talking to somebody with a nice blue cardigan, or talking to somebody you wouldn't want to upset so you say you are better to keep them happy or talking to someone with something useful to say that you could not read in a book (and if so what the heck is it?). It would be useful to know because it it's just nice blue cardigans then it would save a lot of expensive 'psychology training'.

Who has to be wearing the blue cardigan for CBT to work. Is it the patient or the therapist? What if they are both wearing a blue cardigan does that double the effect of neutralise it?

What happens if one person takes their cardy off during a session do they lose their power like the ring from the Lord of the Rings being thrown in the pit of Mount Doom, or do they just feel a bit chilly.

I so wish I had all the answers like the medieval priests of CBT.

 

[Scarecrow]

Bare with me, but...

Thank you, that made me chuckle.

Is this the new naturist forum?

 

[Snow Leopard]

Thank you, that made me chuckle.

Is this the new naturist forum?

Data, it wants to be free! (And naked!)

 

[Snowdrop]

Hey, how about the pink background on the Journal of Psychosomatic Research? I think that really adds credibility, no?

I think that every time I open go to a study on that site.

What we need is some kind of trial of false CBT - this might be tricky to set up.

Privately funded money? With a control that meets to have symptoms validated and mutual support as to what works for them (much like what happens here on PR)

Lecturing to patients that "you aren't sick, you are misinterpreting the signals from your body" doesn't really fit with the original description of CBT.

Perhaps not but in their mind it is an error on our part and therefore valid and in need of correction.

 

[chipmunk1]

Finding patients willing to believe that CBT could help with asthma might be difficult.

Why? Just recruit from KCL

 

[A.B.]

Why? Just recruit from KCL

From the staff or the patients?

 

[chipmunk1]

From the staff or the patients?

Staff

 

[Jonathan Edwards]

Who has to be wearing the blue cardigan for CBT to work. Is it the patient or the therapist? What if they are both wearing a blue cardigan does that double the effect of neutralise it?

What happens if one person takes their cardy off during a session do they lose their power like the ring from the Lord of the Rings being thrown in the pit of Mount Doom, or do they just feel a bit chilly.

I so wish I had all the answers like the medieval priests of CBT.

It would be the therapist wearing it. And it would have to be a nice blue cardigan, probably cashmere and certainly with no pilling from the washing machine. What was originally called un Cardigan Bleu Therapeutique by the French psychologists. Recent studies have shown that if you play a tape of crunching noises while people are eating cereal they find it tastier. These sensory context things can be very important. Maybe one could do a trial with therapists randomly changing from blue cashmere cardigans to lumpy brown cable-knits of the sort students wore in the mid 1960s. For all we know the reason why the Dutch therapists seem to be embarrassingly better at CBT than those at King's is simply that the Dutch have learnt not to wear those fawn jumpers with random coloured diamonds on them one used to see in Amsterdam. And of course if this is a psychosocial effect one cannot discount such things for a moment.

 

[SilverbladeTE]

Science laughs at "subjective measurements"
Alas "subjective" is needed for the complexity of human illness and the experience of it, but, if you cannot objectively measure it, it's all HEARSAY!

Show objective measurement, or admit it's just hearsay
if they won't admit that, then it's "snake oil medicine".
If it's hearsay you treat it VERY cautiously and admit such, still maybe useful when nothing else is of help, but you don't "beat the drum" and pronounce it a "cure/treatment"

You cannot treat horrible diseases with bloody hearsay and get away with it, except with psychiatry/psychology, because any other are the doctor would get stuck off or even jailed.
That's it in a nut shell.

using psychology to help a patient deal with a health problem is perfectly valid and humane
But the CBT/biosocial lot, are ideologically driven, NOT driven by the genuine welfare of the patient

it is therefor unsurprising there are differences because it is NOT objective and no way to admit or quantify the different approaches etc has on the patient's psychology
Team A maybe arrogant boors
Team B maybe humane and empathic
etc

more "Nero fiddles while Rome burns", that's what this is :/

 

[SilverbladeTE]

a thought struck me...
Holland, where weed is legalized.
yes, I can imagine some circumstances where such a study may well result in a spliffed, blissed out M.E. patient chilling with the Universe...

 

[Living Dead]

Perhaps not but in their mind it is an error on our part and therefore valid and in need of correction.

I realize that, but CBT should be about the patient correcting their own thoughts, not the therapist correcting them. The therapist should teach the methods to examine the truth value of a claim, not the truth value of a claim. There's a subtle difference.

 

[panckage]

Thank you, that made me chuckle.

Is this the new naturist forum?

Well on my crash days I usually don't bother to put on any clothes so

 

[BurnA]

Ive written two articles that speak about how subjective outcomes in CBT may come from a combination of therapy effect (someone listening), advice on stress management and sleep, and placebo --- rather than cognitive restructuring. I would really like to take my ideas forward with some kind of study to look more closely at what CBT actually involves and to ask patients about what it did for them. I am working on a proposal but think it would be hard to get funded, given the overwhelming populaity of CBT by NIHR (NHS) and so on.

What we need is some kind of trial of false CBT - this might be tricky to set up.

Jr of Psychosomatic Research does seem to be the 'go-to' journal for the PACE team.

Not quite CBT but this might be of interest from 1979.

Specific vs Nonspecific Factors in Psychotherapy A Controlled Study of Outcome

This study explored the relative contribution of the therapist's technical skills and the qualities inherent in any good human relationship to outcome in time-limited individual psychotherapy. Highly experienced psychotherapists treated 15 patients drawn from a relatively homogeneous patient population (male college students, selected primarily on the basis of elevations on the depression, anxiety, and social introversion scales of the Minnesota Multiphasic Personality Inventory). By traditional diagnostic categories, they would be classified as neurotic depression or anxiety reactions. Obsessional trends and borderline personalities were common. A comparable patient group was treated by college professors chosen for their ability to form understanding relationships. Patients treated by professors showed, on the average, as much improvement as patients treated by professional therapists. Treated groups slightly exceeded the controls. Group means, however, obscured considerable individual variability.

 

[IreneF]

I think this emphasises the fact that nobody actually knows what CBT is. Is it just talking to somebody, or talking to somebody with a nice blue cardigan, or talking to somebody you wouldn't want to upset so you say you are better to keep them happy or talking to someone with something useful to say that you could not read in a book (and if so what the heck is it?). It would be useful to know because it it's just nice blue cardigans then it would save a lot of expensive 'psychology training'.

That's not really true. At its best, CBT helps people who tend to catastrophize or think they are helpless. It's a sort of reality check. If you aren't stuck in a thinking style that CBT can address, then it's not going to help.

 

[IreneF]

@A.B.'s idea is nice. Another variation on this theme is to include an "organic" control (e.g. MS, lupus). If its CBT for CFS, the control group will probably exhibit similar improvements to the target group.

Trouble is, many CBT proponents will claim this as a win, because "every illness has a psychological component".

For some ideas for some good control conditions for CBT, see Lynch D, Laws KR and McKenna PJ. Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials. Psychological Medicine 2010; 40: 9-24.

Like CFS/ME, MS and lupus both wax and wane on their own.

Another paper by our favorite miracle workers:

Cognitive behaviour therapy for chronic fatigue syndrome: Differences in treatment outcome between a tertiary treatment centre in the United Kingdom and the Netherlands

• Treatment outcome of cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) was compared in two tertiary treatment centres in the Netherlands and the U.K.
• Effect sizes on fatigue severity and impairment differed between centres.
• Differences in patient characteristics could not explain variations in outcome.
• Differences in treatment protocols may be responsible for outcome differences.
• More attention should be paid to variation in treatment protocols in relation to outcome, to further develop and improve CBT for CFS.

http://www.jpsychores.com/article/S0022-3999(16)30328-2/abstract

Who cares?

 

[Woolie]

Bare with me, but... If this data was to be reported correctly, how would it be done? Any effect would be measured directly as UK vs NL right? So any Cohen's D would be determined directly comparing the post-intervention data of the UK clinics to NL clinics, controlling for any baseline differences?

Remember, effect sizes aren't statistical tests. They just a way of calculating the size of the difference between two means, taking into account the overall scale and how much variation there is in the data.

So if you wanted to actually test a hypothesis about UK/NL differences, then you would need to do inferential stats. t-tests, or ANOVA or the like. This is a stupid design (no control condition), but putting that aside for a moment, you could do an ANOVA that included both cohort (NL vs. UK) and both time points (pre vs. post treatment) then try to show an interaction (bigger influence of treatment on one group than another).

But all that would be silly, because this isn't a controlled experiment, and so the UK and NL groups aren't really directly comparable.

 

[Woolie]

Recent studies have shown that if you play a tape of crunching noises while people are eating cereal they find it tastier.

I'm afraid these sorts of findings are about as robust as CBT for CFS.

 

[JaimeS]

Something like this maybe? Different interventions for asthma. The first graph shows self rated breathing, the second shows objectively measured breathing. Finding patients willing to believe that CBT could help with asthma might be difficult.

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http://www.nejm.org/doi/full/10.1056/NEJMoa1103319#t=article

This is really cool; it points to how screwy self-reported measures can be! (Provided it in and of itself was a well-designed study...