Guardian: 'What is CBT for psychosis anyway?' Debate developing re: CBT and ME

[Firestormm]

What is CBT for psychosis anyway?

As the debate about the efficacy of CBT for psychosis continues, clinical psychologist Dr Lucy Maddox explains how it's used in practice

Read more: http://www.theguardian.com/science/...sychosis-cognitive-behavioural-therapy-voices

A thorough article, but check out the comments as it's developing into a debate around the 'sticking plaster' solution that is CBT for all conditions as prescribed by the NHS including for ME/CFS with regards suitability for all...

 

[A.B.]

When a treatment aims to change a patient's perception, and the efficacy of the treatment is measured by a change in perception, there will be no condition where said treatment fails to be helpful.

Besides CBT, there's another intervention known for mainly changing perceptions: placebos. It is considered unethical to use placebos as treatment for real physical illness.

 

[Esther12]

Ta Fire. Keith Laws was in the comments section:

http://discussion.theguardian.com/comment-permalink/35889916

1) As one of the authors of the meta analysis (Jauhar et al http://bjp.rcpsych.org/content/204/1/20), at which you say you want to "poke holes", I will make a few comments about the meta analyses discussed. It is CBT clinicians/researchers running the RCTs who select symptom-reduction as the outcome- not meta-analysts. Indeed, of more than a dozen published meta analyses in this area, all have reported on symptom reduction, including NICE

2) I am not aware of any meta analysis showing that CBT benefits 'levels of satisfaction' or anxiety in psychosis – perhaps the author could reference this (it certainly wasn’t Wykes et al). Further regarding Wykes et al, those authors did examine "levels of functioning, and levels of low mood" - And found no impact of CBT on these outcomes in studies that they defined as having 'acceptable levels of 'quality' (see http://schizophreniabulletin.oxfordjournals.org/content/34/3/523.long)


3) "The current evidence on CBT for psychosis being able to reduce positive symptoms is actually not as bad as some would have us believe, with comprehensive meta-analyses showing some reduction of positive symptoms (and those studies which informed the NICE guidelines)."

The 'comprehensive meta analysis' referred to here is Stafford et al http://www.bmj.com/content/346/bmj.f185 is not, in fact, a meta analysis of people ‘with’ psychosis, but one examining if CBT prevents people ever developing psychosis. It is also factually incorrect to claim that this meta analysis produced evidence for "reduction of positive symptoms". Stafford et al are unequivocal in stating " There were no significant effects of this treatment on quality of life, symptoms of psychosis (total, positive, or negative), depression, or mania."

Regarding “those studies that informed the NICE guidelines”, the NICE meta analysis is hardly now or was ever 'worth the paper it was written on'. The ‘update’, on those who have psychosis, was published in Feb 2014, but includes studies only published up until 2008 - ignoring 6 years of generally better controlled largely negative studies. Moreover, the 2009 NICE meta analysis is massively flawed - it contains 110 separate meta analyses and so, by chance will, of course, find (spurious false positive) effects. Many of their so-called ‘meta analyses’ were run on just 2 or even 1 study -this is cherry-picking as an artform!

4) The article concludes " In my mind when we pick apart what CBT for psychosis aims to do and what it looks like when it's being done, measures of distress, level of functioning, and patient satisfaction in relation to their individual goals for therapy are perhaps better rulers to select than whether or not someone is still hearing a voice."

These may be better outcomes, but who can say? ...little or no research has addressed these outcome! Although NICE might talk about distress as a target for CBT for psychosis, they present zero evidence on it. CBT for psychosis advocates, researchers and clinicians rarely measure such alternatives (and in a few instances where distress has been examined, it is not impacted by CBT). CBT was designed to address symptom reduction and so, its unsurprising that it has been promoted by advocates as a quasi-neuroleptic. If the evidence goes against their 'own' focus on symptom reduction, it is hardly surprising that CBT advocates might want to attribute the focus to others and consequently change their target outcomes

 

[manna]

i think the idea of cbt, mind/body, etc is to stop he mind ruminating on its general situation. the less you "think" the less cerebral odema you will experience. i would say that psychosis has, more than likely, a cerebral odema/inflammation counterpart. psychosis is also self generating once it has occurred, i.e. if you think it over it continues and to stop thinking will slow it down, by degree, but not much really. all the same insisting your mind stop thinking can help. thoughts are an energy form and can directly affect physical reality- but poor digestion mreans anxious thoughts.

the argument here, for me, is the extent to which it works and the fact that it denies the physical, for the most. ive always felt the psyche heads shoot themselves, and their therapies, in the foot by insisting it be mainly a psychological issue. they'd have far more folk using it if they agreed that diet and physical therapies, like acupuncture, work and are valid too.

personally, i think if you have psychosis, your first port o call is gluten free. paranoid schizophrenia is not a sympton of celiac without good reason. there are many quicker and easier ways than cbt to reduce cerebral odema, imo. but it doesn't hurt to have a look and take any good points. personally i use the "stop" idea. if i find myself excessively ruminating on the struggle of my illness i'll tell myself to stop. but thats more common sense than cbt etc but it took hearing it to do it. also they say replace that negative rumination with a positive thought form. i see no reason why that can't be slightly beneficial. when trying it i even feel a little better for it. but they take it out of perspective, i think, and overamplify its use and deny other, at least as valid, approaches. ive no interest in believing im well. my interest is to stop ruminating. living alone breeds that problem i think. much is exorcised from the head with chat but then much can be put in, in the way of stress, by chatting, too.

during "journeying" (deep medtative trance) ive, a few times, become aware of a brittle crystalline energy matrix/web formed around the head and how this web restricts the flow of energy from the head down into, for the purposes of regulation, the body. thoughts do exaccerbate this situation but it comes from both sides, and in me/cfs, id say its predominantly physical. i.e. poor digestion equals less seratonin equals stressed head and body. and the digestion can definitely be that bad that no amount of "stopping" thoughts will change much. i heard recently that 95% of seratonin is stored in the mucous membrane of the gut (if its healthy and intact)---the brain gut connection.