Guided versus unguided internet-administered emotional awareness and expression therapy (I-EAET) for patients with [PPS] 2026 Maroti et al

Andy

Andy

Senior Member (Voting rights)
Full title: Guided versus unguided internet-administered emotional awareness and expression therapy (I-EAET) for patients with persistent physical symptoms: A randomized trial

Highlights​

  • The added value of therapist guidance in asynchronous internet-administered psychodynamic interventions remains unclear.
  • RCT comparing guided vs unguided internet-administered I-EAET for PPS.
  • No significant between-group differences on continuous somatic symptom scores although effect sizes favored guided (d = −0.21).
  • A significantly higher proportion of participants achieved a clinically meaningful response in guided treatment (47% vs 30%).
  • Findings inform the role of therapist guidance in internet-administered psychodynamic interventions.

Abstract​

Persistent physical symptoms (PPS) are common, disabling, and associated with high health care use, yet effective and scalable psychological treatments remain limited. Internet-administrated self-help programs may improve access to care. Asynchronous Internet-administered Emotional Awareness and Expression Therapy (I-EAET) with therapist guidance has been shown to reduce somatic symptoms in PPS, but the added value of the of therapist is unclear.

Therefore, adults with PPS (N = 154) were randomized to guided (n = 76) or unguided (n = 78) I-EAET. Both formats comprised 10 self-help modules over 10 weeks, focusing on increasing emotional awareness, addressing unresolved conflicts, and fostering adaptive expression of avoided feelings. Guided participants received weekly written therapist feedback, whereas unguided participants had only technical support. Somatic symptom severity (PHQ-15) was assessed weekly and analyzed using linear mixed-effects models.

Results showed that both groups improved significantly over time, but the group × time interaction was not significant, indicating no clear advantage of therapist guidance. However, at post-treatment, guided I-EAET was associated with a small effect size benefit in PHQ-15 scores (d = −0.21) and a higher proportion of responders (47.2% vs. 29.6%) than unguided I-EAET. Secondary outcomes (PHQ-9, GAD-7, PCL-5, DERS-16) also showed small, mostly non-significant differences favoring guidance. These small group differences were attenuated at 10-week follow-up.

Taken together these findings indicate that guided and unguided I-EAET yield largely comparable outcomes for persistent physical symptoms. As the study was not powered to detect small between-group effects, these findings should be interpreted cautiously and require confirmation in adequately powered trials.

Open access
 
So the “therapist” contributed written notes marking the homework- given the propensity of these approaches to turn the whole process into sausage machine I assume there would be a good proportion of cut and paste content in the feedback. which in my experience is the antithesis of what I want from a therapist - flexible supportive personalised engagement in person/by phone focused on my specific situation and concerns.
 
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Persistent physical symptoms (PPS) are common, disabling, and associated with high health care use, yet effective and scalable psychological treatments remain limited.
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Why is this so surprising when (a) ill people tend to be the ones using healthcare, and (b) psychological treatments don't address the illness in any way?

It's as if the industry can't be completely sure that hitting thumbs with hammers has no beneficial effects, and thinks another few decades of research is justified due to the potential rewards.
 
In addition, all outcomes were based on self-report measures. However, assessments were collected through standardized automated procedures, with participants completing questionnaires independently online, which reduces the risk of assessor bias.
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Yet again the BPS ideologist demonstrate that they don’t understand basic research methodology.

They found negligible changes regardless of modality, which can be fully explained by bias alone.
 
The paper said:
Taken together these findings indicate that guided and unguided I-EAET yield largely comparable outcomes for persistent physical symptoms. As the study was not powered to detect small between-group effects, these findings should be interpreted cautiously and require confirmation in adequately powered trials.
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So, yet another useless 'pilot' trial where nothing of value can be concluded, and because it showed no benefit they didn't, but if it had, they would have emphasized how it's promising, but they still conclude that more of the exact same should be done, again, because reasons. Tails they win. Heads they win. No coin to toss they win. Coin toss is a draw they win. The house always wins.

Although it's funny that one thing it does strongly suggest, as is tradition, is that therapists add no value outside of slightly biasing responses, which is their entire role and function. Which has been known for decades, but the gravy trolley must keep looping around the track, otherwise it would be disrespectful to the millions of loops it has already performed.
The added value of therapist guidance in asynchronous internet-administered psychodynamic interventions remains unclear
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Also notable that the above is just the traditional "X but with distinction Y performed by people doing A but not B on days D but without E", none of which have a plausible reason to change outcomes, that are basically equivalent to random sports stats about some athlete having the most Xs on odd days following a full moon in a half-decadal timeframe since the league started counting Ys, except less significant and not even minimally fun or interesting.
 
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Yes, they understand it enough to rig it in their favour.

They are also quick to point out the methodological weaknesses in biomed studies, thus demonstrating that they know what they are doing.
 
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