Originally posted by Peter on Co-Cure:
Importance of Objective Measures of Therapy
In the PACE Trial Protocol White et al remark that (http://www.biomedcentral.com/1471-2377/7/6):
Some CFS/ME charity members have reported that they feel worse after exercise therapy, and to a lesser extent CBT [13,14], whereas the trial evidence suggests minimal or no risk with these treatments.
I am not sure that all the research trials of GET and CBT show minimal risk with these treatments. Drop-outs are sometimes quite high and reasons are not always provided. Furthermore there is a difference between monitoring participants and patients receiving a treatment.
Firstly, researchers know the difficulty of recruiting and retaining participants, especially in lengthy trials. It is only natural that participants receive favorable and considerate treatment in such circumstances. Losing one participant can represent the loss of a great deal of work. This might be avoided by showing consideration to participants that patients in regular medical care might not receive.
Secondly, the consideration shown to participants is going to be an aspect of the therapeutic relationship. In psychological therapy this relationship is considered so important that it is frequently the subject of research and text books. Yet it is this very relationship that can make any measurement of change difficult with subjective measures.
When a therapy client is asked, did you find therapy helpful, their reply can relate to several things other than how therapy actually helped them or not. These other factors can be highly significant and include things like; how much the client believes they can trust the therapist, how much they like the therapist (and believe the therapist likes them); how much loyalty they believe they owe to the therapist etc.
A client that works with a therapist they think is wonderful, is much less likely to simply say, therapy did not help me at all; as opposed to a client that worked with a therapist they are indifferent to. This distortion could easily be reflected in questionnaires (i.e. SF-32).
It is therefore essential to use objective measures wherever possible in all types of therapy.
Peter Kemp