Cognitive behaviour therapy for distress in people with inflammatory bowel disease: A benchmarking study - Chalder , Jordan , Hayee

Sly Saint

Sly Saint

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Cognitive behaviour therapy for distress in people with inflammatory bowel disease: A benchmarking study

First published: 11 September 2018
https://doi.org/10.1002/cpp.2326

Abstract
Objective
Anxiety and depression are common in inflammatory bowel disease (IBD) and have been linked to clinical recurrence. Previous randomized controlled trials (RCT's) have found no evidence that psychological interventions enhance outcomes for people with IBD but have recruited patients without distress. This study investigates the clinical benefits of a nonrandomized uncontrolled study of clinic based cognitive behaviour therapy (CBT) for people with IBD who had moderate–severe levels of anxiety or low mood and compares the results with a previous RCT of CBT in this population.

Method
Assessments were completed at baseline and end of treatment and included measures of low mood, generalized anxiety, quality of life (QOL), and symptomatic disease activity. The patient health questionnaire and generalized anxiety disorder 7 measures were the primary outcomes. Results in the form of a standardized effect size of treatment were compared with a previous RCT to consider if CBT had greater benefits for those with distress.

Results
Thirty patients were deemed appropriate for CBT, and 28 accepted treatment. The results from this clinic based CBT intervention suggest statistically significant reductions in symptoms of anxiety (<0.001), low mood (<0.001), and disease activity (p < 0.01) and increases in QOL (p < 0.001). The uncontrolled effect sizes were large and superior to those found in published RCTs.

Conclusion
This nonrandomized uncontrolled trial of a clinic‐based CBT intervention suggests that CBT may have benefits for those with moderate–severe disturbances to mood and that effect sizes can be improved by targeting those with distress. RCTs are required to establish efficacy.
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https://onlinelibrary.wiley.com/doi/full/10.1002/cpp.2326

so it was tried before and it made no difference, but the patients we tried it on weren't distressed enough.........but this lot were and hey it worked(?)

eta: what's a benchmarking study?
 
The notion that a "distress" subgroup exists which is worthwhile studying and treating is questionable because if previous studies didn't obtain positive results it means that such a subgroup must be small or not all that distressed. If it even exists and isn't an artifact of poor methodology like most effects reported by these people.

Uncontrolled, nonrandomized, unblinded, subjective outcomes: can it get any worse? I hope they can at least resist telling participants that the therapy is highly effective and will bring large health benefits.
 
Previous randomized controlled trials (RCT's) have found no evidence that psychological interventions enhance outcomes for people with IBD but have recruited patients without distress.
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Bolding mine.

Have they? Did they specifically and deliberately exclude patients who suffered from distress caused by IBD? Can Trudie et al prove that?

Trudie doesn't seem to have been bothered by her co researchers claiming at various times they were studying ME when their entry criteria was designed to include patients without ME in PACE.
 
Has ‘research’ become just another box to tick? (Like when local govt does a ‘public consultation’ after they have already done all the work and made a plan set in stone?)

Yes, we ‘did the study’.
What? No, we didn’t ask for a good study, that would take time, effort and more resources. No need, we already know everything. We just need to ‘prove’ it.

Ga...
 
Subtropical Island said:
Has ‘research’ become just another box to tick?
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Yes because there’s a fashion for Evidence Based Medicine so if you want to do something you need to be able to point to significant results in a trial

There are so many of these CBT trials, can we think of one where almost no one would believe CBT makes much difference? That could be useful. In a disease which has a lot of public support and measurable biomedical issues if it can be shown that people are just trained to answer the questionnaire ‘better’ rather than actually getting better it could help us.
 
Jenny TipsforME said:
There are so many of these CBT trials, can we think of one where almost no one would believe CBT makes much difference? That could be useful. In a disease which has a lot of public support and measurable biomedical issues if it can be shown that people are just trained to answer the questionnaire ‘better’ rather than actually getting better it could help us.
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One could easily do a trial that is designed to demonstrate how CBT can produce false positive results. You would have to deceive therapists and patients which is unethical. On the other hand there is legitimate doubt that CBT really works as claimed and continuing to deliver CBT for this purpose while not knowing if it really works or not would also be unethical (and far more so).

Take asthma patients, tell them that asthma is influenced by nerve and immune function, then tell them they can learn to keep their mind in a calm positive state that will positively influence asthma through these pathways. Find therapists that are willing to believe this story and design a therapy that maximizes placebo effects (it might look a lot like LP). Use all the dirty tricks to further maximize false positives: select only patients that enthusiastically believe in this story, avoid follow up assessment of health, during the trial tell participants how wonderfully effective the treatment is, etc. But unlike the CBT/LP people, you'll also objectively measure breathing capacity and hide the results from therapists and patients until the end of therapy.

The control group will be treatment as usual.

The objective measurements will then tell the real story, while the subjective ones tell the story of how bad people are in remaining objective.

But do we really need such a study? We already know that objective measurements in ME/CFS don't change much if at all. There's got to be other condition where CBT is used and similar discrepancy between objective and subjective outcomes are seen. The data is already out there, it's just that few are paying attention.
 
strategist said:
Take asthma patients,
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The trouble is asthma is a condition where plenty of people believe it’s influenced by stress and hypochondria. We need one where people don’t think this.

And I’m thinking of finding an already published study, to get around the ethical dodgyness of it. CBT seems to have been used for almost everything, it shouldn’t be hard.

NB psychotherapists aren’t necessarily keen on CBT. I was at a meeting where several psychotherapists/psychologists were complaining about CBT. It is a short term, cheap intervention but they were complaining that a generation of people were only being trained to do this because of these pragmatic reasons. A repercussion could be that experience of more in depth psychotherapies could die out within a generation if CBT continues this way. With talking therapies people need supervision and so on, it’s not something you can learn from a book.
 
Jenny TipsforME said:
The trouble is asthma is a condition where plenty of people believe it’s influenced by stress and hypochondria. We need one where people don’t think this.
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That makes it a good candidate. We do not care about the possibility that somewhere out there is some psychogenic asthma under certain circumstances, but we care about showing that CBT for physical symptoms studies conducted in the usual manner produce false positive results. This means that any further claims of CBT helping need to demonstrate that it produces objectively measurable positive results.
 
I was reading something recently about asthma and patients' responses about feeling better. It showed that only those who thought they felt better AND had had an appropriate drug, rather than a placebo, were actually breathing better....

If i find it I'll reference it. Could well have been on here or PR or...
 
MEMarge said:
I was reading something recently about asthma and patients' responses about feeling better. It showed that only those who thought they felt better AND had had an appropriate drug, rather than a placebo, were actually breathing better....

If i find it I'll reference it. Could well have been on here or PR or...
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Found it:
https://www.nejm.org/doi/full/10.1056/NEJMoa1103319

Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma
  • Michael E. Wechsler, M.D., et al.
July 14, 2011
 
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