Collection of evidence for the efficacy of CBT/GET

Discussion in 'Psychosomatic theories and treatments discussions' started by DMissa, May 7, 2025.

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  1. Utsikt

    Utsikt Senior Member (Voting Rights)

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    The BPS crowd believe that ME/CFS CBT stems from false beliefs in combination with deconditioning, so in their world, CBT is applicable.

    What we need is to show that regardless of the cause, CBT is not effective.
     
    Last edited: May 7, 2025
  2. DMissa

    DMissa Senior Member (Voting Rights)

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    Suffice it to say that were I drafting anything in particular I would be seeking close patient involvement. :)
     
  3. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Fair enough, although in a sense details are irrelevant. They re all open label studies with subjective outcomes so useless for providing a proof of efficacy. The more subtle thing is that they may nevertheless be adequate to provide proof of inefficacy!!
     
  4. Sean

    Sean Moderator Staff Member

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    Last edited: May 7, 2025
  5. ME/CFS Skeptic

    ME/CFS Skeptic Senior Member (Voting Rights)

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  6. Turtle

    Turtle Senior Member (Voting Rights)

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    CBT stems from false beliefs FULL STOP
     
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  7. Utsikt

    Utsikt Senior Member (Voting Rights)

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    I only noticed that typo now! I intended to write ME/CFS but my brainfog tricked me at some point. I’ve edited the original comment.
     
  8. Kitty

    Kitty Senior Member (Voting Rights)

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    Can anyone remember anything about the risks of CBT/GET? It's part of the original question, but I can't recall it being looked at (though with my memory, that doesn't mean much).

    If it hasn't been looked at, then given the number of complaints about harm it's quite telling.
     
  9. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    There was the survey done for the NICE ME/CFS Guidelines review, but I can never remember where it was published.
     
  10. Utsikt

    Utsikt Senior Member (Voting Rights)

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    The Norwegian ME Association has a survey that shows that GET was the intervention most strongly associated with deterioration by patients. Curative CBT was also towards the bottom.
     
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  11. Nightsong

    Nightsong Senior Member (Voting Rights)

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    https://meassociation.org.uk/wp-con...nd-GET-Final-Consolidated-Report-03.04.19.pdf
     
  12. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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  13. Nightsong

    Nightsong Senior Member (Voting Rights)

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    Last edited: May 8, 2025
  14. Robert 1973

    Robert 1973 Senior Member (Voting Rights)

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    I just want to highlight that the problem with the subjective outcomes in PACE etc. is that they are not corroborated by improvement in objective outcomes. I’m pretty sure Jonathan makes this point in his JHP paper and/or testimony to NICE. If improvements in subjective outcomes in unblinded trials were supported by corresponding improvements in objective outcomes, that would tell us something useful about efficacy.

    When there is improvement in subjective outcomes in unblinded trials but no significant improvement in objective measures (as in PACE etc) that is a good indication that reported subjective improvements may be due to bias and that the intervention may be ineffective.


    Maybe better to use the BMC Psychology link as that includes the illuminating correspondence between the authors of the 2 papers: https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0218-3
     
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  15. rvallee

    rvallee Senior Member (Voting Rights)

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    Has anyone actually asked the promoters of this mindset how that's any different from any other alternative medicine? How this is precisely one of the primary arguments for why alternative medicine can best be described as "medicine that does not work"?

    Health care isn't supposed to be about "making people feel a bit better", and yet all appearances in the recent decade suggest that this has become the primary goal for anything that isn't dealing with a specific disease process, and even then the woo is creeping everywhere.

    Which is exactly how the US ended up with an antivaccine fraud who thinks raw milk and weight lifting is all that's needed to be healthy, and a likely Surgeon-general who is a wellness influencer who failed medical school. The slippery slope has been greased up way too heavily, it's all related.

    Not that I expect a serious answer, but it's the freaking core argument for what differentiates alternative from scientific medicine, how every single health pseudoscience quack out there can make the exact same boasts, speak to their 'clinical' experience and have no trouble finding clients who will say exactly the same.

    Because it's only a matter of time before the line simply ceases to exist if they keep degrading the standards down to that. If we haven't already crossed that line, and it's just a matter of time before reality asserts itself. Which it may already have, it's not as if health care systems are built to notice something like it. If anything, they are intentionally blinded to it. Just like they've been completely blind to LC arriving, coming, and now having been memory-holed in the same trash dump they built for us.
     
  16. MSEsperanza

    MSEsperanza Senior Member (Voting Rights)

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    Thank you @DMissa for doing that and asking us.

    Also thank you to everyone who already helped.

    I don't have anything to add to that collection, just in case you aren't aware already of the many creative pseudo-rebuttals of forum members' assessment of the evidence / criticism of the unreliable trial methodology most commonly used in this field --
    there's a collection of some of the commonest pseudo-rebuttals and short arguments to reject these here.

    The pseudo-rebuttals include this gem (machine translation from German) :

    "The fact that many symptoms can only be recorded subjectively is also not a disadvantage because ultimately only the patient can evaluate the success of his or her own treatment. If a person learns to rate his or her own symptoms as less severe or threatening, then this can be seen as a genuine relief, since here too it is the subjective patient perspective alone that counts. Overall, therefore, no need for change to the methods paper is seen on this point." (*)

    (*) IQWiG, Documentation and evaluation of comments on the Draft of the General Methods 6.1 (in German), https://www.iqwig.de/methoden/allgemeine-methoden_dwa-entwurf-fuer-version-6-1_v1-0.pdf

    From the discussion thread on bias due to a lack of blinding here.


    Edited for clarity.
     
    Last edited: May 10, 2025
  17. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    see also tag 'harms' for many threads (not all are ME/CFS).
     

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