UK: Workshop - CBTReach - CBT for Persistent Physical Symptoms, Chalder - 9 May 2023

ABSTRACT
Cognitive behaviour therapy for persistent physical symptoms: what to do and how it works?

Professor Trudie Chalder


Overlapping, common, persistent physical symptoms, not associated with significant pathology, are associated with profound distress, sleep disturbance and disability. Patients with these symptoms attract a range of different labels including irritable bowel syndrome, , chronic fatigue, cough hypersensitivity, fibromyalgia, and dissociative seizures. Around 50% of patients in secondary care have symptoms such as these. Evidence has accumulated for the efficacy of cognitive behaviour therapy. Some studies focus on one syndrome such as irritable bowel syndrome while others take a transdiagnostic approach.


The aim of the workshop is to,

(1) describe specific and transdiagnostic models and treatment approaches for persistent physical symptoms, and

(2) describe evidence of efficacy and mechanisms of change.


This workshop will be useful for qualified cognitive behaviour therapists and clinical psychologists working in primary or secondary care, occupational therapists, psychiatrists, and primary care physicians.


In this workshop you will develop an understanding of why physical symptoms persist within a cognitive behavioural framework, the extent to which they can be changed and how they can be changed. Building on your existing skills you will expand your repertoire of skills and techniques that will translate into effective change for your clients and patients. A range of self-report scales will be described as well as self help materials for patients.



References


Chalder T, Willis C. ‘Lumping’ and ‘splitting’ medically unexplained symptoms: is there a role for a transdiagnostic approach? J Ment Health. 2017 Jun;26(3):187–191. doi.org/10.1080/09638237.2017.1322187


Chalder T, Patel M, Hotopf M, Moss-Morris R, Ashworth M, Watts K, David AS, McCrone P, Husain M, Garrood T, James K, Landau S. Efficacy of therapist delivered transdiagnostic CBT for patients with persistent physical symptoms in secondary care: a randomised control trial. Psychol Med. 2021 May 31. doi.org/10.1017/S0033291721001793 [Epub]


Husain M, Chalder T. Medically unexplained symptoms: assessment and management. Clin Med (Lond). 2021 Jan;21(1):13-18. doi.org/10.7861/clinmed.2020-0947


Windgassen S, Moss-Morris R, Goldsmith K, Chilcot J, Sibelli A, Chalder T. The journey between brain and gut: a systematic review of psychological mechanisms of treatment effect in irritable bowel syndrome. Br J Health Psychol. 2017 Nov;22(4):701–736. doi.org/10.1111/bjhp.12250


https://www.cbtreach.org/about

 

Using the terminology “chronic fatigue” seems so disingenuous. Can anybody attest to Chalder’s reputation amongst physicians and academics? It seems she’s highly regarded, and it’s utterly bewildering why.

 

Interesting choice of references (reference material) for the workshop.

 

She cares so much about the people this treats it is now 'transdiagnostic'? - 'let's not diagnose anymore because it only wastes my time listening to what you think you have when the treatment will be the same anyway'. Just so happens that without having to diagnose any condition I can sell my cure based on my own personal form selling merely 'they'll fill this form out differently at the end'.

"What did they have?".... "lower scores on average for my forms than before they did the session" .... "oh, so what shall we fund it under.. low/high score syndrome?" should surely be the discussion? How is this getting away with 'all diseases' instead of 'no illnesses' it has been proven to work for being the assumption of this?

That 'should people be allowed to do useless bad research' thread is really important here. Morally obviously not, as well as many other obvious reasons. They do it for many reasons and the impacts.....


operationalising the 'it's in yer head just try focusing on not doing ill and distracting yourself to not focus on it' bigotry to pretend it's 'science' based on the fallacy 'really bad, biased research set-up merely as a vehicle to carry your opinion-based narrative and fait-a-compli claims is better than the 'no research' you claim is the alternative - when even if that were the case basic logic, decency and respectful clinical approach would surely be that?

 

I can't find the link to it but on one of the various sites (might be one of the FND ones where she is a medical advisor) it says that TC was the first Professor of CBT.

 

It's on the page you linked to : https://www.cbtreach.org/about - next to her oversized photo

Trudie Chalder PhD

Professor of Cognitive Behaviour Therapy

Department of Psychological Medicine

IOPPN

Kings College

University of London.

Trudie is the first Professor of CBT in the UK and President of BABCP 2012-2014

 

Yes very strange that your only references are your own studies!

 

There was the survey done at the request of NICE early on in the ME/CFS guidelines rewrite process, that asked both about GET and CBT, though I can’t remember where it was published and whether it had any detail.

 

I fully agree that the harm caused by this dodgy ‘CBT’ needs to start being unbundled and defined. Like that everybody’s welcome (is that the right name?) page.

too many who shove others off into it believe they brochure ‘it will help people cope’ and think they don’t need to interrogate if that’s nonsense, about what, and won’t open their mind to the idea it can be psychologically and physically harmful as a treatment.

one reason I suspect is simply because of the tendency for certain individuals to throw ‘anti mental health’ at anyone who rightly - as they should for anyone led overall safety - asks whether something has risks and could actually be harmful even if it is technically under ‘psychological retraining’ because after all that term doesn’t include only things that retrain in ways that are helpful and don’t harm.

So it needs blatant defined harm to stop them suggesting they are the victim of someone saying their treatment is bad by spelling out they aren’t, the ones it hurt - in this way - are the ones who can be heard, tell their story and not be accused of anything other than reporting safety info.

I think cfs-CBT is perhaps worse than GET as it’s more persistent in its gaslighting residue lurking for years, it’s those courses that deliberately stay up online to influence support networks to not support disabled people (goodness knows what it does to many relationships), and it’s tentacled into the practice of physios, OTs, nurses

the worry is it’s been trained as if it’s a good technique without them realising it’s just bullying invalidationand lack of empathy under a pretence of ‘therapeutic technique’ when you step back - and that these are fundamentally terrible things in any profession but really bad in medicine and where there is a power imbalance. And that the ‘embedded stuff’ won’t get unpicked like the courses might unless someone spells it out as a wake up call.

how do we get this dirty underbelly out from ‘embedding’ everything without blowing up the myth that ‘bad is good’ [as long as you claim good intentions with no proof you put much effort into checking those intentions matched consequences of said actions] and saying no it’s just bad and look what it actually does on the ground when it infiltrates access to everything service or support wise …. Without holding up a mirror to the consequences of what it does?

 

There have also been cases where cognitive behavioral therapy has been a cure. I would not write off this type of treatment. Let it evolve like all other therapies.
In general, the topic of psychosomatics is very interesting. People like to make things up They can even make up a disease for themselves Quite real ones! And they can do it both consciously and unconsciously.

 

There is an evidentiary double standard in psychosomatic land though. Those suggesting these post-infectious conditions are driven by organic pathological processes are required to produce consistent, replicated, and objective anomalies that could explain clinical presentations.

Psychosomatics traffic in the amorphous. I think your line, “people like to make things up,” perfectly illustrates this point. As far as CBT, the issue is perpetual underperformance in clinical trials. There are anecdotes supporting an eclectic array of interventions for the constellation of symptoms falling under the auspices of CFS. That doesn’t make them universally applicable.