The CBT myth

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Gerwyn

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After looking at the CBT data in depression only 22% of patients experienced remission and less than half that were in remission after a year---some therapy Kellar et al NEJM May 2000-----there is still no data showing that CBT is more effective than a chat and a cup of tea I dont know if there is a CBT thread in existence if so sorry.CBT has never been shown to improve any objectively measurable parameter of any kind all studies that report any benefit use self assessment questionaires which are unblinded and highly contraversial
 
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thefreeprisoner

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Yes if you tell people enough times (and get them to tell themselves enough times) that they are feeling good, and then you give them a questionnaire to ask whether they are feeling good - what do you get? Oh yes of course, they're feeling good.

*facepalm*

Rachel xx
 

Quilp

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Why not hypnotism ? One doesn't hear much about that in relation to M.E but i have always wondered why CBT is promulgated but hypnotism isn't. I'm not suggesting either are effective in treating M.E because i know they are not, but why CBT ? The bottom line perhaps ? Dare i say vested interests who head research and clinics into CBT ( and GET ) are at play here ? Perhaps i'm just cynical; perhaps i'm just right.

Kind regards Mark
 

Dolphin

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After looking at the CBT data in depression only 22% of patients experienced remission and less than half that were in remission after a year---some therapy Kellar et al NEJM May 2000-----there is still no data showing that CBT is more effective than a chat and a cup of tea I dont know if there is a CBT thread in existence if so sorry.CBT has never been shown to improve any objectively measurable parameter of any kind all studies that report any benefit use self assessment questionaires which are unblinded and highly contraversial
There is a study that found counselling is as good as CBT in chronic fatigue and in the subgroups with "Chronic Fatigue Syndrome".

Br J Gen Pract. 2001 Jan;51(462):19-24.

Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial.
Ridsdale L, Godfrey E, Chalder T, Seed P, King M, Wallace P, Wessely S; Fatigue Trialists' Group.

Department of General Practice, Guy's, King's and St Thomas's School of Medicine, King's College, 5 Lambeth Walk, London SE11 6SP. L.Ridsdale@iop.kcl.ac.uk

BACKGROUND: Fatigue is a common symptom for which patients consult their doctors in primary care. With usual medical management the majority of patients report that their symptoms persist and become chronic. There is little evidence for the effectiveness of any fatigue management in primary care.

AIM: To compare the effectiveness of cognitive behaviour therapy (CBT) with counselling for patients with chronic fatigue and to describe satisfaction with care.

DESIGN OF STUDY: Randomised trial with parallel group design. SETTING: Ten general practices located in London and the South Thames region of the United Kingdom recruited patients to the trial between 1996 and 1998. Patients came from a wide range of socioeconomic backgrounds and lived in urban, suburban, and rural areas.

METHOD: Data were collected before randomisation, after treatment, and six months later. Patients were offered six sessions of up to one hour each of either CBT or counselling. Outcomes include: self-report of fatigue symptoms six months later, anxiety and depression, symptom attributions, social adjustment and patients' satisfaction with care.

RESULTS: One hundred and sixty patients with chronic fatigue entered the trial, 45 (28%) met research criteria for chronic fatigue syndrome; 129 completed follow-up. All patients met Chalder et al's standard criteria for fatigue. Mean fatigue scores were 23 on entry (at baseline) and 15 at six months' follow-up. Sixty-one (47%) patients no longer met standard criteria for fatigue after six months. There was no significant difference in effect between the two therapies on fatigue (1.04 [95% CI = -1.7 to 3.7]), anxiety and depression or social adjustment outcomes for all patients and for the subgroup with chronic fatigue syndrome. Use of antidepressants and consultations with the doctor decreased after therapy but there were no differences between groups.

CONCLUSION: Counselling and CBT were equivalent in effect for patients with chronic fatigue in primary care. The choice between therapies can therefore depend on other considerations, such as cost and accessibility.
A subgroup analysis was done on the patients with CFS.

One can see the results in Tables 4a and 4b in the full article, available for free at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313894/pdf/11271868.pdf.

Here's an extract from the text:
Patients with chronic fatigue syndrome
In our study 45 (28%) patients conformed to CDC criteria for
CFS.12 The mean duration of fatigue symptoms at baseline
was 55.8 months, and their mean fatigue score 27.5. At six
months follow-up the mean fatigue score was 18.6 (SD =
8.4) in the counselling group and 20.8 (SD = 9.7) in the CBT
group (Table 4a). Scores in the counselling group were used
for comparison and the scores of the CBT group were subtracted;
the difference being 1.9 (95% CI = -3.8 to 7.6), a
non-significant trend in favour of counselling (Table 4b).
This finding tends to be ignored.
 
G

Gerwyn

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There is a study that found counselling is as good as CBT in chronic fatigue and in the subgroups with "Chronic Fatigue Syndrome".



A subgroup analysis was done on the patients with CFS.

One can see the results in Tables 4a and 4b in the full article, available for free at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313894/pdf/11271868.pdf.

Here's an extract from the text:


This finding tends to be ignored.
looking at the data the confidence intervals make any subgroup analysis meaningless and even though the authors claim the participants no longer met the(subjective) criterea for fatigue the absolute differences before and after "treatment" are negligable ..They have qoted the sd,s after treatment but not before and they dont look statistically or clinically significant
 
G

Gerwyn

Guest
There is a study that found counselling is as good as CBT in chronic fatigue and in the subgroups with "Chronic Fatigue Syndrome".



A subgroup analysis was done on the patients with CFS.

One can see the results in Tables 4a and 4b in the full article, available for free at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313894/pdf/11271868.pdf.

Here's an extract from the text:


This finding tends to be ignored.
looking at the data the confidence intervals make any subgroup analysis meaningless and even though the authors claim the participants no longer met the(subjective) criterea for fatigue the absolute differences before and after "treatment" are negligable in absolute terms.They have qoted the sd,s after treatment but not before and they dont look statistically or clinically significant
 

Dolphin

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looking at the data the confidence intervals make any subgroup analysis meaningless and even though the authors claim the participants no longer met the(subjective) criterea for fatigue the absolute differences before and after "treatment" are negligable in absolute terms.They have qoted the sd,s after treatment but not before and they dont look statistically or clinically significant
Not that I particularly think CBT or Counselling is the answer but just to point out that the Chalder fatigue scale is an 11 question scale scored 0-33 where one scores 1 if one says same as usual. One can work out the average values before treatment using the change scores of course. The point isn't so much that CBT or counselling is the answer but that they had similar effects. I'm not sure I understand your point about subgroup analysis.
 
G

Gerwyn

Guest
Not that I particularly think CBT or Counselling is the answer but just to point out that the Chalder fatigue scale is an 11 question scale scored 0-33 where one scores 1 if one says same as usual. One can work out the average values before treatment using the change scores of course. The point isn't so much that CBT or counselling is the answer but that they had similar effects. I'm not sure I understand your point about subgroup analysis.
there is a "scatter" in the fatigue scores at follow up in both groups why isn,t the scatter quoted at the start it should be according to scientific convention- but here they have only quoted the mean.If the scatter bars for before and after overlap then neither treatment worked or they were as bad as each other.The confidence intervals are a measure of something called the powering of the study and the ability to generalise from it.In an adequately powered study the CI,s should only vary about5% from the mean so this study was never designed to look at a subgroup analysis.Without meaning any disrespect the fatigue scale in itself is subjective and open to abuse in the wrong hands!
 
G

Gerwyn

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Yes, indeed Gerwyn, there's one of the two rubs. I just looked at your profile, and with your background you can see this, as I can - and I am a mathematical psychologist (meaning mostly that I got an M.Sc. in it mostly on stuff relating to mathematics, as I'd decided most of psychology is hardly a real science) and a philosopher of science.

Anyway, here are the two rubs with many papers about ME, and especially those by psychologists:

1. The writers don't really understand the statistics they are using. (They can use it because there are these days all manner of statistical packages, that will deliver p values, z scores and what have you on demand, in 1/100th of a second also). Much that I have seen of applied statistics in psychology - not only as regards ME - is gobblydegook or window dressing.

2. Especially with ME there are major methodological problems that are rarely addressed in a good way.

So... what you often get is n supposed people "with ME/CS", where it is virtually completely unclear how these have come to be selected, followed by something that purports to be a statistical analysis that ends in some claimed "Evidence Based" conclusions, where often the statistics is inappropriate, ill-reported or unmotivated, and the methodology merely a faith-based affair.

In brief, and regardless of the conclusions and the so called scientific journal it has been published in: Superficially, it looks like science, and maybe it is sincerely meant to be real science, but when you look closer the methodology used must be taken on faith, while the statistics are questionable at the very least.

It is mainly for these reasons that personally, although or because I am a psychologist, I am not much interested in what psychologists say about it, especially if the publications are about some claimed group of "patients with ME/CFS" and involve "statistics".

Another reason is that some of it is mock science. Thus in Holland I have, in the last half year, been invited two or three times to participate in "scientific studies" ("statistical") with the explicit aim - so far as I can see: because even the proponents of CBT and GET cannot produce decent evidence it works in any way as they claimed - to establish that a COMBINATION of CBT and some "physical help" is "most effective".

And as Rachel suggested earlier in this thread, this is done by suggesting what manner of answers proper patients should give to the "scientific questionnaire" they answer.

It is for these and similar reasons that I am since 30 years far more interested in the findings of real scientists - biochemists, neuro-scientists etc. - concerning ME than in what psychologists publish about it.
Hi I agree with every word--some so called scientific studies involving stats make me want to cry!
 
G

Gerwyn

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Hi Gerwyn, thanks, indeed - or laugh, scream, or start throwing one's statistical library in their general direction. (Kendall & Stuart (*) have high impact, in the full edition.) None of this will help any, unfortunately.

As a side note: I think this forum is still inventing itself, but already remarkably successful, and should allow - eventually - several Good Things, such as a coordinated group of people with some knowledge of science while having ME.

And incidentally, as I saw in another thread this interests you: I have myself invented the mitochrondial hypothesis for ME - or rather: the symptoms that ailed me, for I learned of ME only in 1989 - in 1986 or 1987, based on my own symptoms and those of my ex-wife, who has it also, and on my findings with B-vitamins, C and E, and a dive into biochemistry (that never was a major interest of mine). I have also written it out at the time, and have given it to several medical doctors, without receiving anything but faint praise in answer.

But there are quite a few scientifically qualified people with ME on the forum, and I think a gathering of minds and some making of plans may be a good idea. (Also in other respects - by which I mean this forum should give its members a means to set up coordinated groups of patients with ME, who try to realize some specific end, whether publicity, advocacy, or organizations of findings about treatments, medicines, supplements, diets etc. that may work (some, for some). This also should involve some prior brainstorming, and not get overly mixed up with the forum as an electronic talking place.)

As to science and ME: While I do not know whether Sir William Osler is always right that listening to the patients will provide the clues for successful treatment, it may be of help for good and healthy scientific researchers of ME to be able to communicate with a coordinated group of scientifically qualified persons with ME, if only because the latter know and understand most or a good part of the science the former presuppose, and know the disease and its symptoms first hand.

And maybe we can also hammer out some ideas of our own, or suggest what manner of research is likely most useful for patients. O, and get some sort of hold on research funding, as persons who are both directly concerned with good scientiic research into ME and are capable of judging at least part of the real and moclk scientific research that does take place.

Maarten.

(*) "The Advanced Theory or Statistics", in 3 volumes, of venerable age, but still very good, and quite hefty also, in my clothbound edition of 1960.
Hi Maarten-----I looked at the biochem of mito dysfunction and realised the implications for overall bodily functions particularily neuroendocrine homeostatic control and neurolgical dysfunction I then realised that a whole range of otherwise wholly disparate symptoms could flow from such a "simple" core defect----------My mito's are quite severely damaged and i need daily corrective measures to maintain my current level of physical and cognitive functioning----sorry for my n=1 trial!The symptoms are so similar to known mito disorder that this theory would seem plausible and parsimonious------I agree with your entire post by the way Gerwyn
 
T

thefreeprisoner

Guest
Hi Maarten and Gerwyn,

We are so lucky to have you both on this forum!
I'm about as good at statistics as I am at my Romberg Test, so it's great to know that we have two statistically astute fellows who can help critique any junk science that gets thrown at us.

Might you perhaps be interested in helping _kim_ with the wonderful survey that she's building? We definitely need somebody who knows what they are doing to analyse the results to help us figure out which conclusions (if any) we might be able to draw with some degree of mathematical confidence (if that makes any sense).

And finally...

or laugh, scream, or start throwing one's statistical library in their general direction. (Kendall & Stuart (*) have high impact, in the full edition.)

(*) "The Advanced Theory or Statistics", in 3 volumes, of venerable age, but still very good, and quite hefty also, in my clothbound edition of 1960.
I do love your dry sense of humour, Maarten... this made me laugh.

Rachel xx