Cochrane Database Syst Review - Psychosocial interventions for conversion and dissociative disorders in adults (2020) Ganslv et al.

Cheshire

Cheshire

Senior Member (Voting Rights)
The abstract is very long (see below) so I will highlight the conclusion:
The results of the meta-analysis and reporting of single studies suggest there is lack of evidence regarding the effects of any psychosocial intervention on conversion and dissociative disorders in adults. It is not possible to draw any conclusions about potential benefits or harms from the included studies.
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Abstract
Background: Conversion and dissociative disorders are conditions where people experience unusual neurological symptoms or changes in awareness or identity. However, symptoms and clinical signs cannot be explained by a neurological disease or other medical condition. Instead, a psychological stressor or trauma is often present. The symptoms are real and can cause significant distress or problems with functioning in everyday life for the people experiencing them.

Objectives: To assess the beneficial and harmful effects of psychosocial interventions of conversion and dissociative disorders in adults.

Search methods: We conducted database searches between 16 July and 16 August 2019. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and eight other databases, together with reference checking, citation searching and contact with study authors to identify additional studies.

SELECTION CRITERIA: We included all randomised controlled trials that compared psychosocial interventions for conversion and dissociative disorders with standard care, wait list or other interventions (pharmaceutical, somatic or psychosocial).

DATA COLLECTION AND ANALYSIS: We selected, quality assessed and extracted data from the identified studies. Two review authors independently performed all tasks. We used standard Cochrane methodology. For continuous data, we calculated mean differences (MD) and standardised mean differences (SMD) with 95% confidence interval (CI). For dichotomous outcomes, we calculated risk ratio (RR) with 95% CI. We assessed and downgraded the evidence according to the GRADE system for risk of bias, imprecision, indirectness, inconsistency and publication bias.

Main results: We included 17 studies (16 with parallel-group designs and one with a cross-over design), with 894 participants aged 18 to 80 years (female:male ratio 3:1). The data were separated into 12 comparisons based on the different interventions and comparators. Studies were pooled into the same comparison when identical interventions and comparisons were evaluated.

The certainty of the evidence was downgraded as a consequence of potential risk of bias, as many of the studies had unclear or inadequate allocation concealment. Further downgrading was performed due to imprecision, few participants and inconsistency.

There were 12 comparisons for the primary outcome of reduction in physical signs.

Inpatient paradoxical intention therapy compared with outpatient diazepam: inpatient paradoxical intention therapy did not reduce conversive symptoms compared with outpatient diazepam at the end of treatment (RR 1.44, 95% CI 0.91 to 2.28; 1 study, 30 participants; P = 0.12; very low-quality evidence).

Inpatient treatment programme plus hypnosis compared with inpatient treatment programme: inpatient treatment programme plus hypnosis did not reduce severity of impairment compared with inpatient treatment programme at the end of treatment (MD -0.49 (negative value better), 95% CI -1.28 to 0.30; 1 study, 45 participants; P = 0.23; very low-quality evidence).

Outpatient hypnosis compared with wait list: outpatient hypnosis might reduce severity of impairment compared with wait list at the end of treatment (MD 2.10 (higher value better), 95% CI 1.34 to 2.86; 1 study, 49 participants; P < 0.00001; low-quality evidence).

Behavioural therapy plus routine clinical care compared with routine clinical care: behavioural therapy plus routine clinical care might reduce the number of weekly seizures compared with routine clinical care alone at the end of treatment (MD -21.40 (negative value better), 95% CI -27.88 to -14.92; 1 study, 18 participants; P < 0.00001; very low-quality evidence).

Cognitive behavioural therapy (CBT) compared with standard medical care: CBT did not reduce monthly seizure frequency compared to standard medical care at end of treatment (RR 1.56, 95% CI 0.39 to 6.19; 1 study, 16 participants; P = 0.53; very low-quality evidence). CBT did not reduce physical signs compared to standard medical care at the end of treatment (MD -4.75 (negative value better), 95% CI -18.73 to 9.23; 1 study, 61 participants; P = 0.51; low-quality evidence). CBT did not reduce seizure freedom compared to standard medical care at end of treatment (RR 2.33, 95% CI 0.30 to 17.88; 1 trial, 16 participants; P = 0.41; very low-quality evidence).

Psychoeducational follow-up programmes compared with treatment as usual (TAU): no study measured reduction in physical signs at end of treatment.

Specialised CBT-based physiotherapy inpatient programme compared with wait list: no study measured reduction in physical signs at end of treatment. Specialised CBT-based physiotherapy outpatient intervention compared with TAU: no study measured reduction in physical signs at end of treatment.

Brief psychotherapeutic intervention (psychodynamic interpersonal treatment approach) compared with standard care: brief psychotherapeutic interventions did not reduce conversion symptoms compared to standard care at end of treatment (RR 0.12, 95% CI 0.01 to 2.00; 1 study, 19 participants; P = 0.14; very low-quality evidence).

CBT plus adjunctive physical activity (APA) compared with CBT alone: CBT plus APA did not reduce overall physical impacts compared to CBT alone at end of treatment (MD 5.60 (negative value better), 95% CI -15.48 to 26.68; 1 study, 21 participants; P = 0.60; very low-quality evidence).

Hypnosis compared to diazepam: hypnosis did not reduce symptoms compared to diazepam at end of treatment (RR 0.69, 95% CI 0.39 to 1.24; 1 study, 40 participants; P = 0.22; very low-quality evidence).

Outpatient motivational interviewing (MI) and mindfulness-based psychotherapy compared with psychotherapy alone: psychotherapy preceded by MI might decrease seizure frequency compared with psychotherapy alone at end of treatment (MD 41.40 (negative value better), 95% CI 4.92 to 77.88; 1 study, 54 participants; P = 0.03; very low-quality evidence). The effect on the secondary outcomes was reported in 16/17 studies. None of the studies reported results on adverse effects. In the studies reporting on level of functioning and quality of life at end of treatment the effects ranged from small to no effect.

Authors' conclusions: The results of the meta-analysis and reporting of single studies suggest there is lack of evidence regarding the effects of any psychosocial intervention on conversion and dissociative disorders in adults. It is not possible to draw any conclusions about potential benefits or harms from the included studies.
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https://pubmed.ncbi.nlm.nih.gov/32681745/

Am I wrong, or are scandinavian psychologists more and more critical of the doxa?

Edit: paragraph breaks are mine.
 
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InitialConditions said:
A psychological stressor or trauma is present in most people's lives if you consider their whole history since birth/childhood. You can always find something if you are looking for it. Why do some develop so-called conversion disorder?
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I can feel a presence. I think it's a man, older. Maybe someone with an M, or a P. Is there a Michael or maybe a Peter? Does anyone have a relative maybe with an M in their name, anywhere in their name? Maybe someone from the distant past? No? Anyone? Bueller?

This junk is indistinguishable from psychics and mentalists. They just take super vague things that people latch on to and worm their way trying to manipulate.

This soon after CODES was published, the largest experiment of its kind on whatever "dissociative" means. Maybe people are getting tired of defending indefensible quackery? The very concepts should have been retired decades ago, an aberration in modern medicine that would be equivalent to NASA having a billion-dollar astrology department. Grow up, people, this is barbaric nonsense.
 
Trial By Error by David Tuller - No Evidence for CBT and Other "Conversion Disorder" Therapies

The new review is an update of a 2005 version. Its stated objective was “to assess the beneficial and harmful effects” of the psychosocial interventions in question, several of which were forms of CBT. The review included 17 studies published up until last year, with a total of 894 participants. The 2010 pilot study for CODES was included, although CODES itself was published too late. The Cochrane review found that the studies were generally of poor quality and produced little or no evidence of benefits from a range of psychosocial interventions.
 
Conversion and dissociative disorders are conditions where people experience unusual neurological symptoms or changes in awareness or identity. However, symptoms and clinical signs cannot be explained by a neurological disease or other medical condition.
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Can they be more vague? I don't think so. That's exactly the same thing as all the other things other than not being an acronym, for a change. Just the latest rebranding in a long line of psychosocial, biopsychosocial, psychogenic, conversion, affective, functional, medically unexplained. They all mean the exact same damn thing and these charlatans pretend otherwise. All style no substance.
Instead, a psychological stressor or trauma is often present.
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No idea how something like that passes peer review. Cochrane is such a disaster. This is an opinion presented as fact. There is no evidence whatsoever to support that other than being the arbitrary definition of this fictitious category.

Evidence-based medicine, where facts don't matter and everything is made-up. Let's just throw all the books and go with our guts! YEEEHAAA!!
 
Is this the first Cochrane review of psychological treatments that specifies as its primary outcome measure: reduction in physical signs? In other words it foregrounds objective measures that can be recorded by clinicians, such as reduction in frequency of seizures - 'signs' rather than patients' subjective reports of symptoms.

Does this set a precedent for the new Cochrane review of exercise for ME? Can it be insisted that this should also give primary outcome status to objective measures?
 
Sly Saint said:
TC talks briefly about the CODES trial (but couldn't recall what CODES stood for) and said that the therapy improved Quality of Life for the patients.
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bullshit. The study had three questionnaires measuring health related quality of life. They had results on one but null results on the other two. So they're claiming benefits in health-related quality of life. it's all gibberish.
 
dave30th said:
bullshit. The study had three questionnaires measuring health related quality of life. They had results on one but null results on the other two. So they're claiming benefits in health-related quality of life. it's all gibberish.
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Make the patients fill endless questionnaires, statistically, you'll get some positive results.

Ladies and gentlemen *Science*
 
TC talks briefly about the CODES trial (but couldn't recall what CODES stood for)
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Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial
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Totally normal to forget what the acronym of your own large trial actually means. The competence on display and attention to details are mesmerizing.
 
rvallee said:
Totally normal to forget what the acronym of your own large trial actually means. The competence on display and attention to details are mesmerizing.
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Yet more evidence it truly is a template model of ‘research’ if you churn out ‘study’ after ‘study’ and there’s barely any difference not surprising you can’t even remember the titles - they all blur and you can’t tell them apart. In practice you’re just making the same points whatever the ostensible subject is.
 
Sean said:
I am starting to warm to the idea of banning acronyms for trial names.
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I wonder if the use of these acronyms reflect an underlying process that is not aimed [at] advancing understanding or knowledge but rather at developing marketable products. So many of these trials take the superficial form of experimental science, but are in reality PR and marketing exercises.

Science ideally consists of a clearly specified theory that generates concrete hypotheses that are then tested experimentally, whereas these studies seem to start from a mutable assertion that these symptom groupings are somehow psychogenic and a researcher belief that psychological/behavioural interventions (ie CBT) are wonderful, then ‘research’ is designed not to test falsifiable hypotheses, but to ideally confirm the wonderfulness of the intervention(s).

[edits]
 
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