Cognitive and emotional variables predicting treatment outcome of CBT for patients with medically unexplained symptoms.., 2021, Sarter et al

Andy

Andy

Retired committee member
Full title: Cognitive and emotional variables predicting treatment outcome of cognitive behavior therapies for patients with medically unexplained symptoms: A meta-analysis

Highlights

• A meta-analysis of cognitive-emotional predictors of the outcome of CBT for MUS.
• Comorbid mood and anxiety disorders predict less favorable CBT outcome.
• Catastrophizing and somatosensory amplification predict less favorable CBT outcome.
• Symptom acceptance and self-efficacy predict favorable CBT outcome.
• Predictor-outcome association pronounced in patients with CFS and IBS.

Abstract

Objective
Cognitive behavior therapy (CBT) is the best-evaluated psychological approach to treat patients with medically unexplained symptoms (MUS). We still need a better understanding of what characterizes patients with MUS who benefit more or less from CBT. This systematic review aimed to identify patients' cognitive-emotional characteristics predicting the outcome of CBT for MUS.

Methods
A systematic literature search (PubMed, PsycINFO, Web of Science) revealed 37 eligible studies, 23 of these provided data for meta-analyses. Mean correlation coefficients between predictor variables and the outcomes (symptom intensity, physical or social-emotional functioning) were calculated using a random-effects model. Differences between syndromes of MUS were investigated with moderator analyses.

Results
Meta-analyses showed that patients with a comorbid mood disorder (r = 0.32, p < .01) or anxiety disorder (r = 0.18, p < .01), symptom catastrophizing and worries (r = 0.34, p < .01), tendencies of somatosensory amplification (r = 0.46, p = .04), and low symptom acceptance or self-efficacy (r = 0.25, p < .01) have a less favorable CBT outcome. Moderator analyses revealed that these associations between predictors and treatment outcome are pronounced in patients with chronic fatigue syndrome and irritable bowel syndrome.

Conclusions
Our results show that pre-treatment differences in patients' cognitive-emotional characteristics predict patients' outcome in CBT. Patient-tailored CBT could be a promising approach to address MUS patients' widely varying needs more effectively.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0022399921001318
 
NelliePledge said:
German researchers on the MUS bandwagon, one is based in New Zealand
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It doesn't only make for easy PhDs, makes for easy whole careers. Endless funding and zero effort necessary, can simply copy-paste known formula and do a bit of interpretation, even if it's been done dozens of times before. Compared to real science, this is like a work vacation.

I'm not saying it's actually a jobs program for people who want an easy ride playing doctor but if it were, it wouldn't look any different at all. They even get awards for not doing any work. Hard to resist the lure, all that is needed is not to care beyond the paycheck.
 
I have a hard time with "catastrophizing"--the assumption is that the more you worry, the more screwed up you are. but if you have an unidentified organic illness, of course you'll worry but you'll be categorized as "catastrophizing." Catastrophizing only makes sense for something known 100% to be completely benign
 
Translation
the paper said:
Objective
Cognitive behavior therapy (CBT) is the best-evaluated psychological approach to treat patients with medically unexplained symptoms (MUS).
Click to expand...
CBT as a treatment for MUS has been extensively studied. (Subtext: But the studies don't actually prove that CBT works in treating MUS, so we'll make a sentence that has the words 'best' and 'treat' in it, and hope that readers read this as saying that CBT is good for MUS.)

the paper said:
We still need a better understanding of what characterizes patients with MUS who benefit more or less from CBT. This systematic review aimed to identify patients' cognitive-emotional characteristics predicting the outcome of CBT for MUS.
Click to expand...
We're sure that if we look hard enough, we will find a subset of MUS patients that we can fix. (and/or, the funders keep funding us to keep looking, so, why not?)

the paper said:
Methods
A systematic literature search (PubMed, PsycINFO, Web of Science) revealed 37 eligible studies, 23 of these provided data for meta-analyses.
Click to expand...
We found some studies on the diverse array of illnesses we lump together as MUS. We used some of them for this analysis. But you have to get past the paywall to find out if the reasons for leaving out 14 studies have a good basis. Yes, we know that CBT studies all tend to have the same problems and therefore are typically rated as low quality evidence, but we believe that by putting the poor quality data into one big pile, we can produce something useful. (Subtext: useful in justifying more research for us, at least).

the paper said:
Results
Meta-analyses showed that patients with a comorbid mood disorder (r = 0.32, p < .01) or anxiety disorder (r = 0.18, p < .01), symptom catastrophizing and worries (r = 0.34, p < .01), tendencies of somatosensory amplification (r = 0.46, p = .04), and low symptom acceptance or self-efficacy (r = 0.25, p < .01) have a less favorable CBT outcome. Moderator analyses revealed that these associations between predictors and treatment outcome are pronounced in patients with chronic fatigue syndrome and irritable bowel syndrome.
Click to expand...
The patients who are most upset or most worried about things, and who report the worst symptoms and the least willingness to keep accepting the symptoms, and who have already tried all the usual fixes like eating better and feel least able to fix themselves, are the ones most likely to stay sick.

the paper said:
Conclusions
Our results show that pre-treatment differences in patients' cognitive-emotional characteristics predict patients' outcome in CBT. Patient-tailored CBT could be a promising approach to address MUS patients' widely varying needs more effectively.
Click to expand...
It's those whiny ones, the ones who say that they are sick and are worried about staying sick that we have trouble fixing. The ones who report not being very sick to start with and who can modify their life to accommodate their illness fairly easily are much easier to convince that they have recovered. 'Patient-tailored CBT' isn't 'cookie-cutter CBT' - it needs experts and special training courses, and it's extremely hard to evaluate, cos, you know, everyone is different. So, that's what we will be applying for funding for next.
 
"Cognitive behavior therapy (CBT) is the best-evaluated psychological approach to treat patients with medically unexplained symptoms (MUS)."

ER what? No evidence of this whatsoever. A few poor quality trials have shown nothing of the sort. Fantasy.

Using the word 'treat' implies ability to cure by most reasonable patients understanding.

MUS as a concept is scientifically illiterate. Apples, pears, bananas all spliced up together in one big medical fruit salad.

Since there is a lack of underlying mechanisms underpinning all of the differing conditions lumped together under the MUS banner how can anyone claim anything is being "treated"? Bonkers

"We still need a better understanding of what characterizes patients with MUS who benefit more or less from CBT."

Perhaps if they had stopped at "We still need a better understanding......" therefore best tred carefully and with humility. So, suggesting CBT might be an answer is jumping the gun big time. It's so demeaning to themselves let alone the patients to take this in any way seriously. It's as if it lands from Mars - the CBT can treat x and y bit. 'We don't really know, it's all a bit muddy and muddled and unclear so we'll pop all this stuff ' together in one place and suggest CBT will be helpful' It's so bizarre it's off the scale. It's magical thinking on steroids - about the conditions - and about what CBT is and isn't and its uses and limitations. It's as if they truely believe CBT is the answer to everything. It's unhinged.

"This systematic review aimed to identify patients' cognitive-emotional characteristics predicting the outcome of CBT for MUS."

One has to have conclusive, objective evidence that pts 'Cognitive-emotional characteristics' whatever that mumbo jumbo might mean (shudder) is in any way related to the symptoms and real world reality of living with one of their so-called MUSs. How on earth any of this can predict anything at all is baffling.

The more I read the more extreme and unhinged this gets.

It is the extreme denial and trivialisation of the existence of differing disabling medical conditions. It's offensive and harmful.
 
It's as if they truly believe CBT is the answer to everything. It's unhinged.
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Reading the FND website, it has a long (over a page) list of the conditions that are actually FND and apparently, they can all be treated by CBT. It's not just that you could read that into what they say, it is actually stated as a fact.

I can't understand why peer reviewers and journal editors don't see it. You do not have to know about ME or even be aware of the methodological problems with the studies to be suspicious of one treatment curing forty or more different diseases.
 
Joan Crawford said:
"Cognitive behavior therapy (CBT) is the best-evaluated psychological approach to treat patients with medically unexplained symptoms (MUS)."

ER what? No evidence of this whatsoever. A few poor quality trials have shown nothing of the sort. Fantasy.
Click to expand...
Best appears to mean "most" here. Which is true, it's the most-studied. Over-studied, even. And in this field, as we know, quantity is all that matters, so the most-studied is the same as "best", because quality is entirely irrelevant. Which is another own goal too subtle for biased people suffering from false attribution syndrome.
 
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