Laws/Huda - The harms of psychotherapy: are BME and LGBT communities more at risk?

[worldbackwards]

This is an article on harms caused to patients with anxiety and depression, but I think there are some wider resonances here.

...we need qualitative research to identify the different types of harms experienced as a result of psychotherapy and to try and understand the processes leading to it. We then need the development of research methods such as ways of measuring the frequency and severity of these different types of harm identified by qualitative research. We can then move onto properly assessing the extent of harm caused by psychotherapy and how long it persists.

That this has not happened already is puzzling. Psychotherapists try and minimise harm to their clients by therapy through improving their skills by training and discussing cases in supervision. Yet this has not seemed a priority for researchers. Their focus seems to be on proving the effectiveness of therapy and the processes underpinning this.

This reflects a focus on the interests of psychotherapy and psychotherapists but not that of their clients. Clients clearly benefit from evidence of effectiveness but they also benefit from research on harms, which allows them to make informed choices and it helps the therapist minimise further the risk of harms. I can think of few types of treatments outside alternative medicine where there is such poor systematic collection of harmful effects caused by the intervention during research studies, barring details of self-harm and sometimes symptom ratings.

Obviously, they type of harms in administering CBT for ME would be different than in psychiatric illnesses, but it does make an interesting point, that psychiatric research is already set up to avoid these questions: harms simply don't enter the discussion.

http://www.nationalelfservice.net/t...py-are-bme-and-lgbt-communities-more-at-risk/

 

[Invisible Woman]

This is something I have often wondered about in relation to ME patients. We have all heard about those who just get to the point where they cannot cope anymore. In all the rush for funding for mental health interventions for just about anything these days, why not research the harms that can be done?

I'm thinking particularly in regard to:

1 - those with ME who underwent CBT designed to address abnormal illness beliefs. Did any find that this was the straw that broke the camel's back for them in terms of their mental health? Did any of them later avoid mental health professionals although they could have used the support?

2 - those who just avoided mental health professional altogether - even though the support might have helped them - because they were afraid of inappropriate interventions (such as our old friend: abnormal illness beliefs)?

I think it would be valuable to know how many people either died or had their quality of life significantly reduced by either of the above.

Is it the case for some that, instead of being an additional means of available support, mental health is just another brick in the wall of our suffering and isolation?

 

[Tom Kindlon]

I thought I would take the opportunity to plug my open access paper:

Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Bulletin of the IACFS/ME. 2011;19(2): 59-111

Tom Kindlon

Information Officer (voluntary position), Irish ME/CFS Association PO Box 3075, Dublin 2, Rep. of Ireland


Abstract*
Across different medical fields, authors have placed a greater emphasis on the reporting of efficacy measures than harms in randomised controlled trials (RCTs), particularly of nonpharmacologic interventions.

To rectify this situation, the Consolidated Standards of Reporting Trials (CONSORT) group and other researchers have issued guidance to improve the reporting of harms.

Graded Exercise Therapy (GET) and Cognitive Behavioural Therapy (CBT) based on increasing activity levels are often recommended for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).

However, exercise-related physiological abnormalities have been documented in recent studies and high rates of adverse reactions to exercise have been recorded in a number of patient surveys.

Fifty-one percent of survey respondents (range 28-82%, n=4338, 8 surveys) reported that GET worsened their health while 20% of respondents (range 7-38%, n=1808, 5 surveys) reported similar results for CBT.

Using the CONSORT guidelines as a starting point, this paper identifies problems with the reporting of harms in previous RCTs and suggests potential strategies for improvement in the future.

Issues involving the heterogeneity of subjects and interventions, tracking of adverse events, trial participants’ compliance to therapies, and measurement of harms using patientoriented and objective outcome measures are discussed.

The recently published PACE (Pacing, graded activity, and cognitive behaviour therapy: a randomised evaluation) trial which explicitly aimed to assess “safety”, as well as effectiveness, is also analysed in detail.

Healthcare professionals, researchers and patients need high quality data on harms to appropriately assess the risks versus benefits of CBT and GET.

* I gave each sentence in the Abstract its own paragraph, to make it easier to read

http://iacfsme.org/PDFS/Reporting-of-Harms-Associated-with-GET-and-CBT-in.aspx

 

[GreyOwl]

@Tom Kindlon maybe your paper deserves its own thread?

ETA: I started a new thread here.

 

[Esther12]

It wouldn't surprise me if the greater the difference in beliefs & cultural values there is, the more likely it is that harm is done.

In the case of ME/CFS, lots of therapists are actively trained to hold beliefs about the illness which are not supported by the evidence, or widely shared by patients. It's difficult to believe that is a good idea.

 

[Invisible Woman]

I had a rather lively discussion with a doctor about exercise and GET etc. a few years back. He didn't believe that GET was particularly helpful nor did he think that any ME/CFS patients he saw had a primary psych disorder. Our area of disagreement was around whether GET could actually cause harm. I maintained it could and he reckoned there was simply no evidence to support this.

I went away and printed off a copy of @Tom Kindlon's paper and sent it to him. He was intrigued and found it very informative.

So, a belated thank you, Tom!

 

[Dolphin]

The current lack of attention to harms resulting from psychological interventions means that patients are not able to make informed decisions about treatment.

 

[Invisible Woman]

...and that is what they are counting on. Even if your doc is ambivalent towards the PACE-type CBT and GET model they may push patients towards it as it's "the only game in town". I don't believe that the NICE guidelines give advice about the risks - please feel free to correct me if I am wrong about that.

So the doc may not be aware of the true risk of harm. The patient (who may know no better) will not be fully informed of the risks. If the patient is reluctant to try CBT/GET they may well be told that if they really wanted to get better they would try anything/everything. This reluctance to try treatments may then become a barrier to gaining the benefits or support they need & so they become the "undeserving sick".

What a stitch up!