Outpatient CBT for Motor Functional Neurological Disorder and Other Neuropsychiatric Conditions: A Retrospective Case Comparison (2019) O’Connell

[Sly Saint]

Nicola O’Connell, M.Sc., Ph.D.,Gillian Watson, B.N., P.G.Dip.CBT,Clare Grey, M.Sc., P.G.Dip.CBT,
Rosa Pastena, D.Clin.Psych.,Kenneth McKeown, B.Sc.

Abstract
Objective:
No gold-standard treatment exists for motor functional neurological disorder (mFND), and limited evidence has been found for the effectiveness of cognitive-behavioral therapy (CBT) in treating the disorder. This study examined sociodemographic and clinical characteristics, treatment outcomes, and treatment dropout among patients with and without mFND who received CBT in a neuropsychiatric outpatient clinic in the United Kingdom.

Methods:
Data from a large anonymized psychiatric register were used to identify patients who received outpatient CBT in a neuropsychiatry clinic between 2006 and 2016 and who had either mFND (N=98) or other neuropsychiatric conditions (ONP) (N=76, control group). The study examined sociodemographic characteristics, physical symptom improvement, and changes in clinical outcome and scores on three instruments measuring psychological distress, psychiatric sequelae of brain injury, and depression.

Results:
The most common mFND symptoms were weakness, pain, and tremors. A logistic regression analysis found no sociodemographic differences between patients with mFND who dropped out early and those who completed CBT. Pre- and post-CBT scores on the three instruments were available for only a small subset of patients; both mFND and ONP patients showed significant improvements in overall scores. A logistic regression analysis found only a single predictor of symptom improvement in the mFND group: acceptance of a psychological explanation of symptoms prior to treatment.

Conclusions:
Improvements in physical and psychological functioning were similar for patients with mFND and patients with ONP who were treated in a specialist CBT clinic. This study provides evidence that CBT is feasible and effective for some patients with mFND.

https://neuro.psychiatryonline.org/doi/abs/10.1176/appi.neuropsych.19030067?journalCode=jnp



"This study provides evidence that CBT is feasible and effective for some patients with mFND."
suspect that this will be another instance where the evidence is weak and improvement minimal.
eta: scihub http://sci-hub.tw/https://neuro.psy...1176/appi.neuropsych.19030067?journalCode=jnp

 

[Hoopoe]

A logistic regression analysis found only a single predictor of symptom improvement in the mFND group: acceptance of a psychological explanation of symptoms prior to treatment.

That seems to be equally consistent with the positive effect being merely due to bias (expectation that the treatment will work or could work).

 

[Sly Saint]

scihub link now in OP

That seems to be equally consistent with the positive effect being merely due to bias (expectation that the treatment will work or could work).

their explanation

Although pre-CBT acceptance of psychological explana-
tions predicted patient improvement, three patients with
mFND did not accept this explanation after receipt of CBT
but nonetheless experienced symptomatic improvements.
Saifee et al. (39) argued that psychological attributions could
be used as a criterion to select patients for CBT. Our
findings suggest that improvement may be possible regardless of at-
tribution, albeit in a small proportion of patients. Although
symptom reattribution is an important part of CBT, other
techniques, such as mindfulness, establishing a sleep routine,
and helping solve obstacles to recovery, may be as effective.

That only half the mFND group experienced physical
symptom improvements might appear low, but previous
literature indicates that FND prognosis is poor. A systematic
review found that 39% of patients with mFND had the same
or worse symptoms at follow-up, and only 20% had complete
remission (40). An RCT testing CBT for patients with
medically unexplained symptoms (N=79) reported that 51%
of patients maintained improvement at 12-month follow-up,
a finding comparable to our own (17)

they do always seem to have an answer to everything.

 

[large donner]

Our findings suggest that improvement may be possible regardless of at-
tribution, albeit in a small proportion of patients.

That's an automatic fail then idiots.

 

[Hoopoe]

Expectation isn't the only factor driving biased responses.

 

[rvallee]

That seems to be equally consistent with the positive effect being merely due to bias (expectation that the treatment will work or could work).

This sentence could be rewritten this way and not lose any meaning or value:

A logistic regression analysis found only a single predictor of symptom improvement in the astrology group: acceptance of an astrological explanation of symptoms prior to treatment.​

Obviously people who believe in astrology will report more benefits from... is there such a thing as astrological treatments? I guess the LP somehow counts.

Anyway, this shows how utterly useless this is. Substitute for scientology, homeopathy, healing crystals or anything else and you'd get the same outcome. Hell, a huge number of people are drinking their aged urine and reporting... things, of some kind.

With the rise of woo all over medicine, I think there should be strong considerations to adding quack treatment controls in addition to placebo controls. So compare the active treatment with no treatment and an unambiguous make-believe treatment. I absolutely do not trust the people promoting this nonsense to do honest comparisons, they would likely sabotage the quack treatments the same way PACE sabotaged pacing, but over time I think a clear picture would emerge and things like CBT would actually underperform compared to most other quack pseudoscience.

 

[rvallee]

Expectation isn't the only factor driving biased responses.

Expectations. Researcher bias in psychosomatics is essentially maximized and influences all decisions, including which questionnaires are more likely to give what answers, as well as in cherry-picking and selective reporting.

Researcher bias is often what will lead to leverage and maximize participant bias, something that is now normalized because of trials like PACE that directly and explicitly tried to influence the outcome by creating expectations in the participants, then performing data analysis based on the researchers' expectations (and that of their sponsors, of course).

Looking more and more like we are in the age placebo, bias is now of no concern, in fact it is encouraged specifically to achieve outcomes and the scientific method is for suckers.