CBT combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a feasibility study, 2020, Wyller et al

Trial by Error by David Tuller: Nudge for BMJ About Music Therapy, Letter to "Health Anxiety" Expert

I have written two more letters and have posted them below.

The first letter is a nudge to BMJ’s research integrity department, which missed a deadline this week for providing me with an update on the status of that music therapy study from Norway. You know, the one that started off as a fully powered trial but failed on multiple metrics and ended up being published as a feasibility study seeking data to support the need for a fully powered trial, as I recently documented. I sent the letter this morning.

The second letter, sent yesterday, is to the lead investigator of the study on “health anxiety” and CFS/ME that I critiqued earlier this week. Like the PACE authors and so many other CBT proponents, she appears to interpret equivocal findings in ways that suit her narrative but strain or even violate common sense. At my own academic institution, PACE has already been distributed in epidemiology seminars as an excellent case study of poor research; perhaps the health anxiety study or others from this cohort of investigators can be put to similarly good use.
https://www.virology.ws/2020/07/03/...-xcPV-Ord5N78oxAlp2u0e-OjRvnBclWHOP0mqkdRCdLs
ETA: Link with the letters is also posted on the thread about the study on CFS/ME and co-morbid health anxiety here
 
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I found a sister paper in "Music and Medicine"
Music Therapy for Chronic Fatigue Following Epstein-Barr Virus Infection in Adolescents
Gro Trondalen, Julie Mangersnes, Lars Ole Bonde, Sadaf Malik, Tarjei Tørre Asprusten, Linn Rødevand, Maria Pedersen, Vegard Bruun Bratholm Wyller

Abstract

This research study, which was a part of arandomized controlled trial, explored music therapy as a part of an individually tailored mental training programfor Chronic Fatigue(CF) following Epstein-Barr virus (EBV) infection in adolescents. This article presents the qualitative data stemming from the interviews, which focused on music therapy. The interviews were performed after completion of the program. The mental training program consisted of 10 sessions distributed between a family session (1), individual sessions with music therapy (4), and individual cognitive behavioral therapy (6). Music therapy included music listening, improvisation, song writing, instrument training, in addition to suggested homework. The analysis was informed through the procedure of Interpretative Phenomenological Analysis (IPA). Results indicated three main themes: i) personal capacity to act through music, ii) subjective understanding of the link between body and mind, and iii) inhabiting the music space. We suggest future music therapy program to be resource- and user oriented, improvisational, and offer training on an instrument. A vital component should be active music listening, comprising verbal communication, relaxation techniques and joint verbal reflection, to foster mentalization. The therapist and the client select music together, while playlists are negotiated, and invited homework included.
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http://mmd.iammonline.com/index.php/musmed/article/view/679/0

Full text only available to subscribers.

Edit: Please note that this study was part of a randomized controlled trial ;)
 
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Nina E. Steinkopf with new blog post where she shares an e-response she submitted about this study to BMJ. Her response was rejected because of its length and because it overlapped with other responses already online. BMJ also informed her: “we are currently reviewing the original article in light of the concerns expressed in the published e-response. The decision was made by the Editor in Chief of the journal.”

Her blogpost is both in Norwegian: Blir musikkterapistudien trukket tilbake?
and in English: Is BMJ retracting the Music Therapy study?
 
Kalliope said:
Nina E. Steinkopf with new blog post where she shares an e-response she submitted about this study to BMJ. Her response was rejected because of its length and because it overlapped with other responses already online. BMJ also informed her: “we are currently reviewing the original article in light of the concerns expressed in the published e-response. The decision was made by the Editor in Chief of the journal.”
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This is excellent news. They have no way to get out of this box they've made for themselves. They cannot defend the reviewing, since one reviewer didn't read it. Any re-review would have to reveal the errors that have been exposed. I think retraction is the only way out. But they are Houdinis and could likely think of some justification for republishing it.
 
Trial By Error by David Tuller: Another Letter About BMJ's Music Therapy Study

I am still waiting for answers from BMJ about the Norwegian study of cognitive behavior therapy plus music therapy for treatment of chronic fatigue in adolescents after mononucleosis. The study was published in BMJ Paediatrics Open. I have written about it here.

This morning I sent the following letter to the BMJ research integrity coordinator who had responded to the initial letter from me as well as four colleagues–Jonathan Edwards from University College London, Vincent Racaniello and Mady Hornig from Columbia, and John Swartzberg from Berkeley. These colleagues have been cc’d on my exchange with the research integrity coordinator, along with the journal’s editor-in-chief, BMJ’s editorial director, and a Norwegian journalist who has written about the study
 
What's even more baffling than BMJ's intransigence here is that almost no one outside of our small circle seems to be bothered by this. It shows a complete breakdown of the peer review and quality control process at one of the most important medical journals in the world and... nothing.

Hello? Is this mic on? Anyone concerned with research integrity and quality? Not when it concerns "those patients"? Oh, OK. That doesn't seem right at all but OK. Not even the "professional skeptics"? Same response, not a concern when it comes to "those patients"?

SIRI: what are moral quandaries?
 
The primary outcome was average steps per day, objectively measured. Both groups performed worse on this measure after the trial than they did at baseline, with the decline even greater among those who received the intervention.
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I think that quite apart from BMJs lapses in adhering to its own standards, one of the main issues is that neither the journals nor the authors of these trials will contemplate the notion that any of these therapies could be harmful or make patients worse.

The DWP has a similar attitude and will cite 'customer satisfaction' surveys as proof that they are doing a good job.
 
Years ago this guy published a study testing his persistent arousal hypothesis of CF using clonidine. If I recall correctly, in that study activity levels also declined in the intervention group. I don't recall if it was statistically significant but the graph was rather startling. Undeterred by reality, he has continued to promote this hypothesis despite the massive self-own.

Now we have this CBT music study in which the intervention also made activity levels worse. What's useful about this study is that it shows that people will tick boxes on questionnaires that say they are feeling better over time on repeated administrations of the same questionnaire (in both intervention and treatment-as-usual groups) irrespective of what is actually happening to them in reality as evidenced by the step count.

This guy's studies have refuted many aspects of BPS but for whatever reason he offers totally illogical interpretations that are contrary to the results and they are eagerly accepted by govt authorities. Why is he doing this?

Being an ME patient is like being stuck in some unfathomable Kafkaesque nightmare. When I tell ppl about the kinds of stuff medical journals publish these days no one believes me.
 
A long blog post by Toto NeuroImmunologisk Kurativ Behandling going through many aspects of the study.

This research publication by Malik et al. is encumbered with an extreme number of types of bias and which is documented in this review. It is nevertheless with great surprise that this research team both willingly and intentionally wants to risk its entire research ethical - and academic integrity. This at the same time as the research project, at least on this website, was aware that a full-scale RCT was to be carried out. It goes without saying that when Malik et al are presented and disseminated as a "feasibility" study , it provides a basis for follow-up. The discrepancies are extensive and pervasive , and of such a nature that it is problematic to get a full overview of actual findings. Some "factual information" is a direct lie, there are major errors and omissions in tables and figures, there is also a lack of information such as exclusion criteria specific to the treatment intervention itself, characterization of participants and information to document claims and more.

Norsk ME-forskning: Vegard Bruun Bratholm Wyller med tvilsom og kritikkverdig forskningspraksis
google translation: Norwegian ME research: Vegard Bruun Bratholm Wyller with dubious and questionable research practice
 
dave30th said:
Yeah, three months now.
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If there's more follow up posts on this, they have published results separately on the music therapy part, where it is stated that the music therapy was part of a randomized controlled trial (my bold).

Abstract said:
This research study, which was a part of arandomized controlled trial, explored music therapy as a part of an individually tailored mental training programfor Chronic Fatigue(CF) following Epstein-Barr virus (EBV) infection in adolescents. This article presents the qualitative data stemming from the interviews, which focused on music therapy. The interviews were performed after completion of the program. The mental training program consisted of 10 sessions distributed between a family session (1), individual sessions with music therapy (4), and individual cognitive behavioral therapy (6). Music therapy included music listening, improvisation, song writing, instrument training, in addition to suggested homework. The analysis was informed through the procedure of Interpretative Phenomenological Analysis (IPA). Results indicated three main themes: i) personal capacity to act through music, ii) subjective understanding of the link between body and mind, and iii) inhabiting the music space. We suggest future music therapy program to be resource- and user oriented, improvisational, and offer training on an instrument. A vital component should be active music listening, comprising verbal communication, relaxation techniques and joint verbal reflection, to foster mentalization. The therapist and the client select music together, while playlists are negotiated, and invited homework include.
Click to expand...

http://mmd.iammonline.com/index.php/musmed/article/view/679
 
Esther12 said:
Thanks. No luck with sci hub for that.
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Annoyingly I can't get it through my university either. As with the CBT part, here they've changed the study from being on adolescents with CFS to adolescents with CF in the abstract (the music therapy partner has an article on their webpage about the study a few years back where it says they will study adolescents with cfs/me, which is in line with the study protocol for the CBT study where it says participants would be those adolescents that "had developed" cfs.)
 
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