Review Efficacy of internet-based cognitive behavioral therapy on somatic symptom disorder and common related functional disorders:... 2026 Liu et al

Andy

Andy

Senior Member (Voting rights)

Highlights​

  • ICBT improves somatic symptoms and health anxiety with benefits lasting 12 months.
  • ICBT has no significant difference versus other psychotherapies, is higher to waitlist, and similar or slightly higher versus TAU.
  • ICBT exerts moderate effects on improving anxiety, depression, and functioning, small effect on sleep.
  • The adverse event rate of iCBT is 27%, with no serious adverse events reported.

Abstract​

Introduction​

Cognitive behavioral therapy (CBT) is recommended for somatic symptom disorder (SSD) and functional somatic syndromes. Face-to-face CBT is limited by accessibility barriers. Internet-based CBT (iCBT) addresses the aforementioned limitations. This study aimed to evaluate the efficacy of iCBT in SSD and common functional somatic syndromes.

Methods​

A meta-analysis was conducted, following the PRISMA statement for study screening. Databases including PubMed, Embase, and CENTRAL. The primary outcomes included somatic symptoms and health anxiety. Secondary outcomes included mood-related outcomes, functioning, and sleep.

Results​

A total of 23 studies were included (1746 iCBT-group vs 1553 control-group patients). Post-treatment, iCBT showed no significant effect difference vs. other psychotherapies (Hedges'g [95% CI]: general symptoms = 0.09 [−0.11; 0.28]; health anxiety: = 0.18 [−0.17; 0.52]), but outperformed waitlisting across most symptoms (Hedges'g [95% CI]: general symptoms = 0.30 [0.12; 0.48]; gastrointestinal = 0.62 [0.35; 0.88]; fatigue = 0.47 [0.25; 0.68]; health anxiety = 0.71 [0.26; 1.16]). The effect of iCBT was not significantly different or slightly higher than treatment as usual after treatment (Hedges'g [95% CI]: gastrointestinal = 0.41 [0.23; 0.58]; fatigue = 0.65 [−0.51; 1.82]; fibromyalgia = 0.27 [0.00; 0.55]). The pooled adverse event rate in the iCBT group was 27%, with no serious adverse events reported.

Discussion​

The iCBT is an effective intervention for SSD and common functional somatic syndromes. However, heterogeneity still exists among subtypes, and personalized plans need to be formulated.

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if all of the interventions perform the same, someone should maybe ask if that’s because they are all equally ineffective.

I haven’t seen the assessment of the quality of the trails, and because it isn’t mentioned in the abstract I’m going to assume it was not very good or they found a way to botch the assessment.
 
The revised Cochrane risk-of-bias tool for randomized trials (RoB2) was used to assess the risk of bias in the individual original studies [29]. Risk of bias assessment was also completed independently by two researchers (SL and ZH) back-to-back and cross-checked. Disagreements were discussed by discussion and in conjunction with other researchers. In view of the particularity of psychological intervention, which is difficult to achieve blinding, in this study, the overall rating of RoB2 had not considered blinding. If all the other four dimensions except the measurement of outcome were low risk, the overall rating was low risk. If there were uncertain risks but no high risks, the overall rating was uncertain risk. If one or more of them were high risk, the total rating was high risk.
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In view of the particularity of psychological intervention, which is difficult to achieve blinding, in this study, the overall rating of RoB2 had not considered blinding.

So there is no attempt to connect with the real world, where reliability is a matter of fact, not choice.
There must be a technical term for wearing your incompetence on your sleeve.
 
In view of the particularity of psychological intervention, which is difficult to achieve blinding, in this study, the overall rating of RoB2 had not considered blinding.
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How nice that we can just pretend that something doesn’t exist if we don’t want to deal with it. The fact that they don’t even try to hide it is telling us a lot: they either don’t understand why they are wrong, or they know it won’t have any consequences.
 
Utsikt said:
How nice that we can just pretend that something doesn’t exist if we don’t want to deal with it. The fact that they don’t even try to hide it is telling us a lot: they either don’t understand why they are wrong, or they know it won’t have any consequences.
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They did it wrong, the trick in nutrition is to first claim it's fine to have problematic studies as long as at least two large ones have the same direction on the results. Then you just have to say you've followed the field's "best practice" and not go into further detail.
 
If rubbish is the input, it takes a lot of effort to not produce more rubbish. Looks like this team took the easy route and produced more rubbish.

I'd use the analogy of not spinning straw into gold, but in fact I think that's what the whole psychosomatic industry does. They take studies that are basically worthless and use them to support a lucrative industry.

This paper is from a Chengdu team (China), so it has consequences for a huge number of people. I hate to think how many people will be harmed by treatments supported by this paper. We need to keep working on getting our fact sheets translated and finding Chinese patient support groups.

I wonder how this team came to decide to do this study? The senior and corresponding author is Jinmei Li, a neurology professor of West China Hospital, Sichuan University. They have co-authored 3 papers already this year and 21 papers last year. There are other papers from West China Hospital, from the paediatrics department e.g.
Analysis of clinical characteristics and prognosis of childhood functional neurological disorder: Identifying key factors of prognosis and optimizing clinical management in the Journal of Psychosomatic Research.

I think a common factor might be a Brazilian neurologist who is a Professor at University College London, Ley Sander. He's on the Editorial Advisory Board of the Lancet Neurology. He's also a professor at the West China Hospital, Sichuan University. He's noted as a top co-author for Jinmei Li. Although his primary focus is epilepsy, he has published on functional seizures. e.g.
Epileptologists can improve outcomes through follow‐up and coordination of care for patients with functional seizures. Epileptic and functional seizures share some mechanistic overlap involving interoceptive, emotional, and stress dysregulation, and disorders of agency and perception... A holistic, biopsychosocial approach benefits all seizure patients and reflects modern models of epilepsy care.
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The links really highlights the need for an international approach to advocacy. What happens in University College London affects what happens to people in western China.
 
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Continuing the through line - both Ley Sander and Suzanne O'Sullivan are consultants at the UCLH Epilepsy service. Suzanne O'Sullivan features in the psychosomatic section of this forum. Penguin books says this about her:
Dr Suzanne O’Sullivan has been a consultant in neurology since 2004, first working at The Royal London Hospital and now as a consultant in clinical neurophysiology and neurology at The National Hospital for Neurology and Neurosurgery, and for a specialist unit based at the Epilepsy Society. She specialises in the investigation of complex epilepsy and also has an active interest in psychogenic disorders. Suzanne’s book about psychosomatic illness, It's All in Your Head, won both the Wellcome Book Prize and the Royal Society of Biology Book Prize.
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