Dr David Tuller: Quartet of Trials Reveals Limitations of CBT for “Medically Unexplained Symptoms”


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This must be a particularly good blog by David as Facebook has just put me in Facebook jail for trying to post it in an ME group. It is a threat to national security, perhaps?? :D


Trial By Error: Quartet of Trials Reveals Limitations of CBT for “Medically Unexplained Symptoms”
3 July 2021 by David Tuller 1 Comment

By David Tuller, DrPH
A year ago, I wrote a post about how the biopsychosocial ideological brigades had completed a trifecta of major studies that investigated cognitive behavior therapy for a variety of so-called “medically unexplained symptoms” (MUS). As a group, the studies demonstrated the overall ineffectiveness of CBT as a treatment for this category of disorders—despite herculean efforts to spin the results the other way. MUS is usually defined to include chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, functional neurological disorders, and other conditions for which pathophysiological mechanisms have not been identified.

These three trials were: the PACE trial for chronic fatigue syndrome, which also tested graded exercise therapy; the ACTIB trial for irritable bowel syndrome; and the CODES trial for psychogenic non-epileptic seizures, a form of functional neurological disorder also called dissociative seizures. Now a fourth major trial can be added to the group. PRINCE Secondary is a recently published study of CBT to treat so-called “persistent physical symptoms” (PPS), another term for MUS. I blogged last month about how the investigators tried to present the trial as a success despite null results for the primary outcome.