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Psychosocial Interventions and Immune System Function

Discussion in 'Other psychosomatic news and research' started by Grigor, Jun 4, 2020.

  1. Grigor

    Grigor Senior Member (Voting Rights)

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    New review & meta-analysis of 56 RCTs in JAMA Psychiatry showing that psychotherapy in general, and especially CBT, reduces
    inflammation & improves ImmuneSystem function!

    Online article: https://t.co/xlS3n9OoLg

    PDF: https://t.co/xtOjKbcJEv

    Doesn't the placebo response also temporarily improves certain functions?
     
  2. Grigor

    Grigor Senior Member (Voting Rights)

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  3. Snowdrop

    Snowdrop Senior Member (Voting Rights)

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    The conclusions drawn from psychosocial studies always read as if robustly positive.

    While a meta analysis can't pull out information that isn't there I can't help but note that while they claim better immune functioning at the end of CBT there is no mention of whether the people in the trial felt any relief of symptoms / improved functioning.

    There were no less than 6 study limitation mentioned I'll quote 4 through 6:

    In the fifth limitation they point out that some interventions may have included medication of participants -- it's not clear how many studies may have been affected by that.

    Also, when you read the discussion they are claiming their therapy approach as an adjunct to other therapy (medication is implied). So the capacity of CBT to effect change is not seen as a solution on it's own for improving immune function. The benefit of including CBT for all your health needs being it's cost effectiveness.
     
  4. ME/CFS Skeptic

    ME/CFS Skeptic Senior Member (Voting Rights)

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    I thought some CBT for CFS studies also tested immune markers with null results such as the study by Lloyd et al. 1993 and the one by Jason et al. 2007. I don't see these included.

    One explanation might be that the data of null results aren't displayed in the paper: the authors simply say 'null results, not interesting' and do not provide the data so that the authors of this review couldn't use it in their meta-analysis. [EDIT- or perhaps the CFS studies simply didn't use the immune markers used in this study]

    The scope of this review and the number of included studies is so big that it is really difficult to check if they included all studies or check if the included studies are of decent quality. I hope the reviewers were able to check. Can anyone find the supplementary material?
     
    Last edited: Jun 4, 2020
  5. rvallee

    rvallee Senior Member (Voting Rights)

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    I'm sorry but this reads exactly like detoxing or optimizing the immune system or other junk pseudoscience. How does someone make the mental leaps from inflammation to CBT? And if we are talking about the possibility of half of all mortality, it really sounds like efforts should be somewhere between 1,000 and 100,000,000 more serious than "hey, maybe CBT could do something or whatever".

    What even is "enhanced immune system function"? Is that even a valid notion or just some arbitrary benchmark? It is defined as:
    Given the standard of research in psychiatry, especially where psychosocial stuff is considered, it's hard to trust in the reliability of the underlying work.

    Psychiatry is officially a joke discipline.
     
  6. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    They talk about 'beneficial immune system functions' and 'harmful immune system functions' apparently without realising that these are nonsense terms.
     
  7. ME/CFS Skeptic

    ME/CFS Skeptic Senior Member (Voting Rights)

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    Don't think psychiatry is the problem. I suspect that for people with something like schizophrenia or severe depression psychiatrists can be useful.
     
  8. Snowdrop

    Snowdrop Senior Member (Voting Rights)

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    The distinction may be in the difference between psychiatry proper and Consultation-Liaison Psychiatry which is proving itself to be pretty fast and loose with data / facts.
     
  9. Grigor

    Grigor Senior Member (Voting Rights)

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  10. strategist

    strategist Senior Member (Voting Rights)

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    There is definitely a problem when people from multiple countries very consistently produce junk science and react with hostility to criticism.

    It's hard to precisely define the boundaries of this problem within research and disciplines. While it's true that the core group of these junk scientists seems small, a lot of psychiatrists believe in things like functional somatic syndromes, in factitious or fabricated illness by proxy and so on which can easily cause a nightmare scenario for patients. These problematic labels also often lack a scientific basis. It's unclear if these are real phenomena or just a narrative applied to certain situations.
     
  11. rvallee

    rvallee Senior Member (Voting Rights)

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    It sure can but a discipline is evaluated on its whole performance, this is the difference between professionals and amateurs. And it would fare so much better in areas they can actually help if they let go of this kind of nonsense, in a way they are impeding their own progress by holding on to grandfathered myths built on magical thinking.

    You won't find an astrology lab anywhere in any NASA lab or office. Because they are serious disciplines that may have fringe people but not entire fringe movements like this.
     
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  12. alktipping

    alktipping Senior Member (Voting Rights)

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    this is why I do not trust meta analysis of anything people cannot be trusted to go through all these papers and there highly suspect methodology using computers to isolate particular words phrases and graphs tells us nothing about quality .A profession that mass produces copy paste papers will always get positive results from idiots who are to lazy to do the hard work of looking at each paper and its methodologies before even attempting to sift through the data to find anything that is statistically meaningful .
     
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  13. Andy

    Andy Committee Member

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  14. Hutan

    Hutan Moderator Staff Member

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    I don't think we have to look much further for an explanation than this - cherry-picking random results. We've seen too many rubbish CBT studies to think that a meta-analysis of them is going to reveal some important truth.
     
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  15. Hutan

    Hutan Moderator Staff Member

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    Interesting to see that the authors define RCT as 'randomised clinical trial' rather than 'randomised controlled trial':
    They do seem to have required control treatments of sorts though:
    Yes, of course, a wait-list or TAU control means that those participants probably did not receive the benefit of the group interaction that was part of many of the psychosocial treatments. It's pretty easy to imagine patients chatting amongst themselves, hearing of more effective medicines and management techniques to actually improve their illness (e.g. HIV) or condition. I guess it's possible that the social interaction helped too - maybe people dealing with a bereavement might have better immune function if they have a chat with others going through the same thing once a week. But improvement in a group treatment relative to a wait-list or TAU control is not evidence that e.g. CBT is better than a patient support group.

    Edited to add:
    These are all conditions where patients could probably pick up information on medicines and management from other patients that made a real difference to their health.
     
    Last edited: Jun 5, 2020
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  16. Hutan

    Hutan Moderator Staff Member

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    More on the group treatment effect:
    For all interventions there was a higher improvement in treatments with group sessions (0.38 vs 0.20 for no group sessions).
    Screen Shot 2020-06-05 at 11.03.47 PM.png

    Just for CBT, there was also a higher improvement in treatments with group sessions (0.36 vs 0.28 for no group sessions) although the paper reports that the statistics don't support the difference being significant (that's the P value of 0.53).

    Screen Shot 2020-06-05 at 11.06.01 PM.png
     
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  17. Hutan

    Hutan Moderator Staff Member

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    One last comment:
    Is an increase in immune cell counts always a good thing?
    A study on obesity thought not:
    :confused:
     
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