"Answer to IBS is in the mind" - media coverage of new Chalder/Moss-Morris trial

I have awful IBS. I did an NHS CBT for IBS course about 4 or 5 years ago. I am not sure it helped any of us on the course.

I saw a dietician (privately) two years ago and started the low FODMAP diet - currently a recommended treatment for IBS - and it made an enormous difference. Can't recommend it highly enough. The CBT? not so much.

This "CBT for everything" makes me so angry. It can and does help when used appropriately, for certain conditions, or so I understand, but it isn't panacea the BPS folks want us to believe.
 
Adrian said:
It seems to have the same issues as PACE in terms of subjective outcomes. Not only do they not learn that such approaches don't give reliable results but the NIHR who fund the trials equally don't seem to get the point (or allow reviewers to be chosen who run equally poor trials).

As academics they are somewhat stuck in that they run CBT for anything trials because that is all they can do.
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They have certainly found the formula for persuading and compelling people to answer questionnaires favorably, and have been churning out 'successes' since.

This is why I think the lightning process paper is so important. CBT is intuitively sensible and respectable to normal people. Lighting process is blatantly absurd. But they produce the same results. This should allow people to see that perhaps the CBT results are not as they seem.

Although, to be honest, the idea of tele-CBT being wildly effective for a condition should seem somewhat absurd to the casual observer.
 
Lucibee said:
OK - they did look at this:

"Ninety-nine of 136 (72.8%) participants had a clinically significant change in IBS-SSS (≧50 points) from baseline to 12 months in TCBT compared with 82/124 (66.1%) in WCBT and 58/131 (44.3%) in TAU."

But my point about possible 'outcome training' is still relevant here.
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The questions really matter here as well in terms of knowing what people were asked and how much they measure perception rather than actual things.
 
Here are the IBS-SSS questions [pdf]:
IBS Severity Scoring System [out of 500]

1. a) Do you currently suffer from abdominal (tummy) pain? Yes/No
b) If yes, how severe is your abdominal pain? [score 0-100 from ‘no pain’ to ‘very severe’]
c) Please enter the number of days that you get the pain in every 10 days [score nx10]

2. a) Do you currently suffer from abdominal distension (bloating, swollen or tight tummy)? Yes/No
b) If yes, how severe is your abdominal distension/tightness [score 0-100 from ‘no distension’ to ‘very severe’]

3. How satisfied are you with your bowel habit? [score 0-100 from ‘very happy’ to ‘very unhappy’]

4. How much does your IBS affect or interfere with your life in general? [score 0-100 from ‘not at all’ to ‘completely’]
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As a clinical guide, it's fine. But as soon as you start coaching patients on how to complete it (even if not explicitly), you will interfere with its usefulness.

eta: The test validation itself acknowledges that there will be a fair amount of intrapatient variability. It's interesting in the validation paper that those with moderate scores at baseline had the most variability. The problem when using these things as repeated measures is always that there is a tendency to present the worst picture at baseline, whatever your symptoms on the day happen to be.
 
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strategist said:
Apparently an example of unhelpful behaviour and thoughts is people with diarrhea immediately rushing to the toilet when they felt the urge.
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That is probably a perception that can be easily corrected, by not rushing to the toilet, when needed, whilst in the presence of the person making stupid judgements as to what is an unhelpful belief.

After a few hundred patients do this they may change their opinion on what is 'unhelpful'.
 
obeat said:
They say that diabetes will bankrupt the NHS but I think mass CBT (for everything) might do it sooner.
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Chronic illnesses will bankrupt the NHS, but it's their choice (the governments) to keep giving out treatments that simply improve medtrics temporarily rather than research and develop treatments/support that cures/helps people.

The reasons why.......who knows, most sound like conspiracy theories, but I suspect it's just because people are in charge, and people, are people.
 
I wonder if the best way to expose the worthlessness of these studies would be to do a CBT study on a condition which can be measured objectively, with two protocols: one using Chalder methodology and one using adequate controls, objective outcome measures and strict adherence to the pre-registered protocol. If the Chalder protocol produced a positive result for the effectiveness of CBT and the other produced a null result it would be clear evidence that Chalder methodology produces false positive results.

For most of us such a study would be unnecessary. We already have the evidence from the SMILE trial that this type of methodology produces positive results for bogus treatments like the Lightning Process. We also have the data from the Rituximab phase II and phrase III trials which show how unblinded trials which rely on subjective outcome measures can produce false positive results. And we have the data from PACE and the Dutch studies which show that improvements in subjective outcome measures are not matched by improvements in objective outcome measures. But it seems that for some, and particularly those funding Chalder et al, such evidence and sound the logical arguments (to which the CBT ideologues have no response) are not enough. It may be that we need our equivalent of Eddington’s eclipse experiment to demonstrate beyond all doubt the worthlessness of so much research with therapist-based interventions. (With apologies to Newton for the analogy.)

[edit - typos]
 
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Esther12 said:
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https://www.telegraph.co.uk/science...bowel-syndrome-psychological-new-study-shows/

https://www.dailymail.co.uk/health/...rapy-cure-IBS-better-drugs-study-reveals.html

https://www.chroniclelive.co.uk/news/uk-news/talking-therapy-better-drugs-irritable-16108042

Press release with a link to the paper for when embargo has lifted (it seems it hasn't yet). Note the use of selected anecdotes from trial participants - this way they get to choose the voice of patients: https://www.eurekalert.org/pub_releases/2019-04/uos-ccp041019.php

This is the trial: https://www.southampton.ac.uk/psychology/research/projects/actib.page

ISRCTN registraion only mentions self-report questionnaires as outcomes: http://www.isrctn.com/ISRCTN44427879?q=&filters=recruitmentCountry:United Kingdom,conditionCategory:Digestive System&sort=&offset=89&totalResults=319&page=1&pageSize=100&searchType=basic-search

Given the media coverage, Science Meida Centre spin wouldn't surprise me, but no sign of it yet.

Edited additions:

Science Media Centre: http://www.sciencemediacentre.org/c...therapy-cbt-for-irritable-bowel-syndrome-ibs/

BBC: https://www.bbc.co.uk/news/health-47884038

And Guardian: https://www.theguardian.com/society/2019/apr/11/therapy-phone-online-help-people-ibs-study



Are we now going to get some pained articles about "all we did was conduct a trial likely to exaggerate any benefits of psychological therapies and then promote our results to the media with anecdotes about how life-changing our treatment was... how could that have led to appalling headlines about how the answer to IBS is 'in the mind'?!"
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This was the study that was mentioned by TC at her ''MUS" talk a few weeks ago at UCL. She asked those attending not to leak it until its release. It was excised from my recording.
 
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https://gut.bmj.com/content/early/2019/03/26/gutjnl-2018-317805

Assessing telephone-delivered cognitive–behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial


  1. Hazel Anne Everitt1,
  2. Sabine Landau2,
  3. Gilly O’Reilly1,
  4. Alice Sibelli3,
  5. Stephanie Hughes1,
  6. Sula Windgassen3,
  7. Rachel Holland2,
  8. Paul Little1,
  9. Paul McCrone4,
  10. Felicity Bishop5,
  11. Kimberley Goldsmith2,
  12. Nicholas Coleman6,
  13. Robert Logan7,
  14. Trudie Chalder8,
  15. Rona Moss-Morris3
Some of the usual suspects, Trudie Chalder, Rona Moss Morris & Paul McCrone. Plus Kimberley Morris to do the stats.
 
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