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

[Luther Blissett]

For some kind of comparison of effect sizes in CBT, I point readers to

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263389/

Cognitive behavioural therapy in anxiety disorders: current state of the evidence.

Five studies examined the efficacy of CBT in panic disorder in a randomized placebo-controlled design.6 The effect size was 0.35 (95% CI 0.04-0.65), indicating a small to medium effect ((Figure 1).How important it is to take into account the type of effect size when appraising the magnitude of effect can be seen from a different meta-analysis that calculated uncontrolled pre- to post-treatment effect sizes.9. That meta-analysis reported an effect size of 1.53 for CBT in panic disorder.

Efficacy
The controlled effect size for CBT in generalized anxiety disorder was 0.51 (95% CI 0.05-0.97), indicating a medium effect (Figure 1) although only two studies using a randomized controlled design to examine CBT treatment in patients with generalized anxiety disorder were available. Nevertheless, these results were recently corroborated by a Cochrane meta-analysis examining psychological treatments of generalized anxiety disorder.14 Based on thirteen studies, the authors concluded that psychological therapies, all using a CBT approach, were more effective than treatment as usual or wait list control in achieving clinical response at post-treatment (RR 0.64, 95% CI 0.55-0.74). However, those studies examining CBT against supportive therapy (nondirective therapy and attention-placebo conditions) did not find a significant difference in clinical response between CBT and supportive therapy at post-treatment (RR 0.86, 95%CI 0.70 to 1.06).

Again, the meta-analysis calculating uncontrolled pre- to post-treatment effect sizes found much a larger overall effect size of 1.80. 9

Efficacy
In seven randomized placebo-controlled treatment studies, the effect of CBT in social anxiety disorder was 0.62 (95% CI 0.39-0.86, Figure 1) indicating a medium effect. In a separate meta-analysis, the uncontrolled pre- to post-treatment acute treatment effect size was 1.27.9



Effectiveness
In eleven effectiveness studies, the uncontrolled pre- to post-treatment effect size was 1.04 (95% 0.79-1.29).5

Efficacy
In six randomized placebo-controlled efficacy trials of CBT in PTSD, the controlled effect size was 0.62 (95% CI 0.28-0.96), indicating a medium effect. A recent Cochrane analysis of psychological treatment in PTSD15 supported these findings and found that trauma-focused CBT was more effective than treatment as usual or wait list control. The uncontrolled effect size derived from a separate meta-analysis was 1.86. 9



Effectiveness
Six studies examined the effectiveness of CBT in the treatment of PTSD5 and found an uncontrolled pre- to post-treatment effect size of 2.59 (95% CI 2.06-3.13).

Not surprisingly therefore, in the meta-analysis of randomized, placebo-controlled trials, pooled analyses using data from ITT samples yielded much smaller effect sizes than those derived from completer samples. In the completer sample, the overall Hedges' g for anxiety disorder severity was 0.73 (95% CI: 0.56-0.90 and the pooled odds ratio for treatment response was 4.06 (95% CI: 2.78-5.92). However, in ITT analyses that were only provided for the minority of included studies, the Hedges' g for anxiety disorder severity was 0.33 (95% CI: 0.110.54), and the odds ratio for treatment response was 1.84 (95% CI: 1.17-2.91). The authors of the meta-analysis6 concluded the following:

Given the status of CBT as the gold-standard psychosocial intervention for treating anxiety disorders, it is very surprising and concerning that after more than 20 years of CBT treatment research, we were only able to identify 6 high-quality randomized placebo controlled CBT trials that provided ITT analyses for continuous measures and only 8 trials for ITT response rate analyses. In our opinion, this is an unacceptable situation that will have to change for psychosocial intervention to become a viable alternative to pharmacotherapy in the medical community.

 

[Woolie]

Don't think I said anything about CI's actually!

Oh, sorry, don't know where I sprang that from. Maybe I should think a it more before I write!

 

[Jonathan Edwards]

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.

Judging by what people are quoting in other posts it does seem to me true. It seems that sympathetic professors do just as well as 'trained' CBT therapists' and that 'supportive measures' do as well as CBT. It may not be the blue cardigans but from what I can see it may well just be talking to someone who listens and then saying you are better because you don;t want to seem ungrateful. That is what almost certainly happens in rheumatology drug trials in the placebo arms where patients get quite a lot better.

 

[Snow Leopard]

Thank you, that made me chuckle.

Is this the new naturist forum?

Also, the Emperor has no clothes!

 

[Large Donner]

It seems that sympathetic professors do just as well as 'trained' CBT therapists' and that 'supportive measures' do as well as CBT. It may not be the blue cardigans

Please will you make up your mind I have just ordered 5 blue cardigans from Jacamo. Freddy Flintoff wears them you know!!

Its TV blue aswell, you know that mesmorizing blue that only gets worn on Sky News female newscasters etc who look like they are dressed to go out to a nightclub rather than present the news.

I'm sure it has some memorizing quality that makes us believe everything that comes out of their mouths, afteral if you just listened to the content you might realise its a talking head in front of a corporate script on a green screen surrounded by "live news events".

Its blue its all about blue. Blue is true!!! Blue is true!!!! Blue is true.......

 

[SilverbladeTE]

So what about the ones wearing red shirts?

 

[CFS_for_19_years]

Its blue its all about blue. Blue is true!!! Blue is true!!!! Blue is true.......

And love is love is love is love is love is love...... no matter who is doing the talking, the CBT therapist, or the warm-hearted professor.

 

[Snow Leopard]

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

I like it. Just a pity its such a crap journal.

 

[barbc56]

My favorite therapist. RIP Mr. Rogers!.

 

[IreneF]

Judging by what people are quoting in other posts it does seem to me true. It seems that sympathetic professors do just as well as 'trained' CBT therapists' and that 'supportive measures' do as well as CBT. It may not be the blue cardigans but from what I can see it may well just be talking to someone who listens and then saying you are better because you don;t want to seem ungrateful. That is what almost certainly happens in rheumatology drug trials in the placebo arms where patients get quite a lot better.

The study about sympathetic listeners vs the trained therapists dates to 1979. I don't know much more about it. It seems to be a case of regression to the mean on top of lots of Hawthorne effect (just being in a study causes improvement).

Classic CBT challenges maladaptive thinking styles. It works only for people who have maladaptive thinking styles (duh). It does not work for people with biologically based depression (yours truly). It probably doesn't work too well for people who have generally crappy lives.

Let's assume that there's a group of people who have chronic fatigue, and we say it's chronic fatigue syndrome or ME, or whatever you want to call it. No one can figure why these people are about as energetic as empty space, so we say it must be that they are actually depressed, and they are depressed because of maladaptive thinking. We prescribe CBT. However, I don't see any attempt to distinguish among people who could be treated by antidepressants, people who have truly crappy lives, and people who have truly unexplained fatigue.

Sorry if this doesn't quite make sense, I'm rather foggy today.

 

[panckage]

I always considered CBT a fancy word for education

 

[Jonathan Edwards]

Classic CBT challenges maladaptive thinking styles. It works only for people who have maladaptive thinking styles (duh). It does not work for people with biologically based depression (yours truly). It probably doesn't work too well for people who have generally crappy lives.

I understand the theory and that there seems little justification in ME, but I am struggling to find evidence that we know it actually works in any situation and particularly that it does anything more than could be got from reading a helpful book, perhaps together with someone to give encouragement. As far as I can see there is no defined technique that requires special technical training that has been validated by trials. The trial on this thread seems to indicate that if there is then UK therapists aren't much good at it anyway!

 

[Woolie]

I am struggling to find evidence that we know it actually works in any situation

Probably phobias. Graded exposure (a CBT technique) seems to have measurable impact on people's physiological response to the trigger stimulus (e.g., spider) , even a long time after treatment. Its a nice demo, because does not rely on self-report.

One-session treatment of specific phobias in youths: A randomized clinical trial.
Öst, Lars-Göran; Svensson, Lisa; Hellström, Kerstin; Lindwall, Robert
Journal of Consulting and Clinical Psychology, Vol 69(5), Oct 2001, 814-824.

Haven't looked closely at it, though.

 

[A.B.]

Probably phobias.

Chalder and colleagues have argued that CFS is exercise phobia. As usual their statements are vague but they do seem to think that it's at least a big component.

'Fear of exercise' is biggest barrier to chronic fatigue syndrome recovery
http://www.medicalnewstoday.com/articles/287972.php

Side question: can CBT cure phobia of reading biomedical literature? Or is that less phobia and more willful ignorance?

 

[lansbergen]

Side question: can CBT cure phobia of reading biomedical literature? Or is that less phobia and more willful ignorance?

 

[Chrisb]

'Fear of exercise' is biggest barrier to chronic fatigue syndrome recovery

I recently came across a saying, "if the facts disprove the hypothesis, "tant pis pour les faits"". This appeared in a book written in the 1890's. The original saying must have been much earlier to have made the transition from French to English.

One might have hoped that an awareness of the problems associated with this sort of thinking might have permeated the inner enclaves of some psychiatry departments before now.

 

[Cheshire]

This exercice phobia theory is just the stupidest and most illogical element of their theory. Trudie Chalder keeps telling how she has to first help people reduce their activity to reach a baseline upon which to built up stamina, ie people are doing too much.

In which phobia disorder do you have to first reduce the exposure to the feared element? This is just insane how such poorly designed theories make it in the medical field.

 

[Snow Leopard]

Chalder and colleagues have argued that CFS is exercise phobia. As usual their statements are vague but they do seem to think that it's at least a big component.

What a freakin load of shit. I have a phobia - of needles. It causes extreme distress, sometimes fainting afterwards - or a need to 'escape' - to exit the area as quickly as possible and relax elsewhere. This is very very different to the reasons why anyone I have ever known chooses not to exercise.

 

[msf]

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...

View attachment 16060

Is that a Muppet version of Fear and Loathing in Las Vegas?

´We were somewhere around Barstow on the edge of the desert when the CBT began to take hold.´

 

[eastcoast12]

´We were somewhere around Barstow on the edge of the desert when the CBT began to take hold.´

There goes one of gods own prototype CBT. Never intended for humans. To weird to live but even too weirder to die