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Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial, 2019, Everitt et al

Discussion in 'Health News and Research unrelated to ME/CFS' started by Andy, Sep 18, 2019.

  1. Andy

    Andy Committee Member (& Outreach when energy allows)

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    Authors also include McCrone, Chalder and Moss-Morris.
    Open access, https://www.thelancet.com/journals/langas/article/PIIS2468-1253(19)30243-2/fulltext
     
    rvallee, DokaGirl, Simone and 3 others like this.
  2. Amw66

    Amw66 Senior Member (Voting Rights)

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    Does anyone from IBS community critically analyse these in the way we do for SMILE etc?
    It may be enlightening
     
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  3. strategist

    strategist Senior Member (Voting Rights)

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    Buy our product.
     
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  4. Cheshire

    Cheshire Moderator Staff Member

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    Where's the control group?
     
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  5. Hutan

    Hutan Moderator Staff Member

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    I think the biggest issue is that the control (Treatment as Usual) isn't good enough. Treatment as Usual could easily have been 'very little care'. In contrast, the 'CBT' treatments weren't just the hand-wavy brain-gut axis and addressing unhelpful thoughts. There was solid stuff like working on good diet. The regular followup probably helped people stay motivated about taking medication and fibre products.

    So, there may well be some limited benefit in having a coach who helps you follow what good advice there may be for managing IBS. But does it need to have the magic of CBT added? We still don't know. Is it better than having IBS patients attend support groups or participate in online forums?

    The other issues I've seen so far are
    • the very high loss to follow-up,
    • and, related to that, a lot of imputation of missing data being done. Having seen the mess Crawley et al created with imputation in one of their papers, I think it would be worth poking into that.
    • subjective outcomes
     
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  6. Hutan

    Hutan Moderator Staff Member

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    Just by the way:
    So, in the year after the trial was over, only 10 out of 187 participants in the Treatment as Usual group felt that it was worth even accessing the online CBT course. And that's just accessing it, having a look at it, not completing it.

    You'd think if this was something fairly effective, word would have got around and the controls would have been lining up for the treatment.
     
  7. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    Again subjective outcomes in an open label trial, without any adequate control.

    No wonder this larger group of researchers are so defensive of such as PACE and of this methodology for evaluating CBT. So much research and so many reputations rely on it.

    What happened to a general acceptance forty years ago that if you have methodological problems in particular research approaches, often an issue in clinical research, the best way forward is to seek confirming evidence from different and varied experimental designs and sources, not double down on the one problematic approach?
     
  8. Mithriel

    Mithriel Senior Member (Voting Rights)

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    This is one of the issues I have with FND. They treat it with physio and CBT to persuade patients that there is no actual disease.

    There seems no reason to think that the psychological treatments add anything. Personally I would not class therapeutic massage as a complementary treatment. They treat frozen shoulder by manipulation under anaesthetic and I found that massage helped my body remember where it should be by moving it in ways I could not manage myself.
     
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  9. rvallee

    rvallee Senior Member (Voting Rights)

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    Don't even need to read further than this. Dropout rates of this order make the results impossible to interpret.

    Ah, there it is. Obviously. But it would be too complex to properly account for difference in eating habits. How many participants who improved had a horrible diet to begin with? There are far too many factors involved to ascribe any benefits to therapy itself when it includes modifying eating habits, which are obviously a primary aspect of reducing, though not treating, IBS. A control arm with nutritional advice (and possibly some financial support to sustain since eating healthy is more expensive) would have been necessary, without one nothing can be concluded.

    Typical garbage from the usual CBT brigade.
     
  10. rvallee

    rvallee Senior Member (Voting Rights)

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    "The bastards don't want to get better"

    Or something like this.

    Why don't people like our treatments? Clearly they are wrong because we are obviously right.
     
  11. DokaGirl

    DokaGirl Senior Member (Voting Rights)

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    CBT, TM, and yoga never helped my IBS. I will say again...probiotics help my IBS. We have seen a number of studies that show disordered gut bacteria appears to play a significant role in IBS. The following are just 2 such studies:


    "Gut dysbiosis and irritable bowel syndrome: The potential role of probiotics."


    RESULTS:
    IBS is a common disease for which no resolutive therapy is presently available. In recent years, strong evidence of a possible relationship between modifications of the gut microbiota composition and development of IBS has been collected. Moreover, the evidence showed that attempts to treat acute infectious and post-antibiotic gastroenteritis with some probiotics were significantly effective in a great number of patients, leading many experts to suggest the use of probiotics to address all of the clinical problems associated with IBS.

    CONCLUSION:
    The available data are promising, but presently, a precise definition of which probiotic or which mixture of probiotics is effective cannot be made. Moreover, the dose and duration of treatment has not been established. Finally, we do not know whether probiotic treatment should be different according to the type of IBS. Further studies are needed before probiotics can be considered a reliable treatment for IBS.


    https://www.ncbi.nlm.nih.gov/pubmed/29291933



    "The gut microbiome and irritable bowel syndrome


    Abstract
    Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders encountered in clinical practice. It is a heterogeneous disorder with a multifactorial pathogenesis. Recent studies have demonstrated that an imbalance in gut bacterial communities, or “dysbiosis”, may be a contributor to the pathophysiology of IBS. There is evidence to suggest that gut dysbiosis may lead to activation of the gut immune system with downstream effects on a variety of other factors of potential relevance to the pathophysiology of IBS. This review will highlight the data addressing the emerging role of the gut microbiome in the pathogenesis of IBS and review the evidence for current and future microbiome based treatments"

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039952/
     
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  12. Michelle

    Michelle Senior Member (Voting Rights)

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    And avoiding FODMAPs. Several years ago I saw a piece at Medscape titled "Why telling your IBS patients to just eat more fiber may be bad advice." I immediately clicked because I had long since noticed that certain foods that were high fiber, i.e. apples, were painful to eat. Finally someone had figured it out--at least in my case. Avoiding FODMAPs eliminated most of my IBS symptoms, combined with a couple of probiotics (added years later when I began having increased loose-stools). My gastroenterologist has been using it with many of her patients for years now. See oldish paper explaining it here.

    One of the big problems with IBS is that it may well be multiple diseases/conditions that are being lumped together (thanks, in part, to people like Chalder et. al.). There is a clear subgroup that responds well to a lower-FODMAP diet but not all IBS patients do. At the end of the day, we define this disorder based on symptoms, not any biomarker. How do we know those symptoms are all describing the same condition? Given the prevalence of the condition -- 10-20% of the general population -- I find it hard to believe it would be the same thing in all of those people.

    The kicker, in my case, is a couple of weeks ago I woke up constipated for the first time in years. After a few days of it not resolving and increasing my FODMAP intake, I finally went and picked an apple from one of the columnar apple trees I have on my balcony (bought around the time I was just learning about FODMAPs). Have been eating apples now just about every day since. Gonna try some milk this week. Go figure. My best crazy speculation at what might be happening is something hormonal as I've probably been in peri-menopause for about a year now. A friend of mine noted that she was suddenly able to eat things she'd not been able to eat for years after menopause. But note, it's just that: crazy speculation. The reality is, who the hell knows why?
     
  13. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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  14. rvallee

    rvallee Senior Member (Voting Rights)

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    This is disastrous and completely disqualifies the trial of any conclusions. When nearly half of participants are so disappointed in what they saw that they don't bother responding, that's a sign that you screwed up.

    It's seriously remarkable that you can find in the same paragraph that CBT is a recommended treatment but that there is no evidence for its efficacy. This is not even close to be OK, yet so typical of BPS, selling the treatment for years before putting it to the test and then simply using the fact that it had been used for years as a good enough reason to continue despite evidence showing it is useless.

    The whole edifice of EBM needs to be torn down, it is so heavily abused it puts the entire field of medicine at risk. Well, actually it's the patients that are put at risk but then if you never ask the question you can claim otherwise, typical BPS BS.

    Edit: apparently I repeat myself. Whatever.
     
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