Cognitive Behavioral Therapy Improves Physical Function & Fatigue in Mild & Moderate CFS: A Consecutive RCT, 2021, Gotaas et al

https://twitter.com/user/status/1386783829143269382

 

https://twitter.com/user/status/1386784480329932811

 

https://twitter.com/user/status/1386785540054335493

 

https://twitter.com/user/status/1386994111689994241

 

https://twitter.com/user/status/1386994654206480386

 

(Not a recommendation.) Swedish BPS blogger Jörgen Malmquist writes about the study:

https://web.archive.org/web/2021050...oda-verkningar-av-kbt-rapporteras-fran-norge/

 

x*0=0

X can be anything. Optimize for x all you want, it can even be both huge and magical. Still

x*0=0

Always and forever.

 

At least dr. Fors seems happy about the study, so that's nice.

Here's a google translated tweet from today about the study where he tags the university (NTNU) where the planned Lightning Process study will take place as well as the Ministry of Health and Care Services and the Norwegian Directorate of Health. Research director of the National Institute of Public Health, Flottorp, has liked and retweeted.

Tweet:
New RCT shows that cognitive therapy and gradual increase in activity in a rehabilitation paradigm have an effect on mild and moderate CFS / ME without mental comorbidity https://ncbi.nlm.nih.gov/pmc/articles/PMC8071989/pdf/fpsyt-12-580924.pdf…
@NTNUhelse
@helse_og_omsorg
@Helsedir

 

This is just an exercise in getting patients to change their questionnaire taking behaviour, I think the authors need to understand response bias. They should have used actigraphy and trialed sham CBT.

 

There is a risk with that in that the sham CBT could actually "perform" better, given the evaluation is also mostly a sham. I really doubt anyone tries that, the risk is too great and the bubble too fragile.

 

I suppose there could be a trial with two CBT conditions, with one based on ‘BPS’ false beliefs model and one based on supporting people to adapt to a real disabling biomedical condition, though I doubt any of the BPS advocates would go along with this because of their own false beliefs and their seeking only confirmation.

 

I should be able to remember but they do so many strange things and advance such a variety of creative arguments to misinterpret their results that it is hard for me to keep it all together in my head without checking. That particular outcome was not included in the conclusions, even though it was the primary outcome. Both groups had reduced step count, but the intervention group had a greater drop.

 

Really does highlight that "conclusions" by definition are simply the output of one or more people drawing those conclusions - an interpretation of findings at best. If no bias, and no ambiguity, then you might expect there to be only one possible conclusion available to be drawn. There is always the potential for ambiguity combined with human error, but one would hope that with rigorous scientific process and peer review it would be a minor problem. But once we have bias in play, especially when borne of deceitful intent, then all manner of possible conclusions are available to be drawn.

My only knowledge of the scientific process for a clinical trial is from this forum, so is very limited. But it is clear there are many stages, and the validity of any one stage is only as good as the validity of its preceding stages, and that any errors along the way will be cumulative. Even with the very best scientists and support team, there will be plenty of scope for things going wrong, hence the need for a rigorous scientific process being followed to minimize that. But once you have scientists prepared to exploit those weaknesses to their own scientific - and often personal - ends, then the scope for corruption of scientific truth is major, especially if they are also skilled at social engineering, self-serving networking and propaganda, etc.

 

Would that Dr also be happy if big Pharma designed a non-blinded study where participants got 16 weeks of medication, 8 weeks of internet medication and a control group that got nothing. No objective outcomes were used because that might spoil the party.

Best place for studies like that is the bin. It should have never been funded;
waste of research money

 

The Norwegian newspaper Dagbladet has an article today about the study with enthusiastic comments from Ingrid Helland from the National Competence Service for CFS/ME and Henrik Vogt.

The article is paywalled, but here are a few google translated quotes:


According to the study, there is no evidence that cognitive behavioral therapy contributes to the worsening of the condition in patients with mild to moderate CFS / ME.

- CFS / ME is a disease with a fluctuating course, and it cannot be ruled out that a possible deterioration reflects a natural variation in the course of the disease. However, it is important to be aware that treatment that is not well enough adapted can lead to worsening, and patients with CFS / ME are particularly vulnerable to this, says Eide Gotaas.

...


- We used the so-called Fukuda criteria, because they have been developed specifically with research in mind. Some time into the project, we also began to evaluate patients against the Canada criteria, says Eide Gotaas.

The Canada criteria have been developed for clinical use and describe specific symptoms, to a greater extent than the Fukuda criteria and are also considered to be stricter. The researchers wanted to use two sets of criteria, to investigate whether there could be differences between patients diagnosed based on the Fukuda criteria and the Canada criteria.

- We found no differences between the patients who met only the Fukuda criteria and patients who met both sets of criteria, says Eide Gotaas.

...

This is how the treatments went

The two treatments that were investigated in the study at NTNU are both forms of cognitive behavioral therapy. The difference is the number of treatment hours. Standard / long CBT takes place over 16 treatment hours, while short / I-CBT takes place over eight treatment hours.

Standard / long CBT: The treatment was developed in collaboration with Professor Trudie Chalder at Kings College London. The treatment is based on a biopsychosocial CBT model. It involves a planned and graded approach to activity based on the patient's prerequisites, which is especially important for patients with ME. A biopsychosocial model assumes that one sees the body as a whole, where emotions, thoughts, biology and environment influence each other. The biopsychosocial approach is common and accepted in most disciplines in medicine where relevant.

Short I-CBT: The treatment was developed by professor of psychology, Tore Charles Stiles. As standard CBT in several studies has shown limited effect, he developed a shorter interpersonally oriented CBT. Interpersonal therapy is a treatment method, which aims to help patients cope with interpersonal difficulties. This treatment is also based on a biopsychosocial model. The purpose of designing a shorter course of therapy was also to make the treatment more accessible and affordable for a group of patients with a low level of function. In this treatment, graded activity increase is not an element. The goal is still to resume activity.

Source: Merethe Eide Gotaas

 

It's already well-established, from dozens of experiments, that there is no actual difference between short and long forms of CBT, or any therapy for that matter, because they all have no impact on outcomes. So the comparison here is entirely pointless, as is the whole study. Technically it's just yet another CBT vs GET where both are assumed to be "effective" (just don't ask for evidence).

So this exact experiment has been done dozens of times already. But because this is simply not a serious field of study, more identical experiments could happen for the next half-century and no one involved would see any fault in that. What a sick joke.

It's also fundamentally bizarre that such a pointless study should get gushing news coverage, or any at all. It shows that this is entirely a marketing effort, there is no actual research happening and the conclusions can be written in advance. The point is to sell this ideology and medical authorities are actually complicit in behaving unethically and far outside the limits of what is acceptable for their responsibilities.

 

You must be psychic!
The article continues with:

- Common to several of the research environments is that there is a hypothesis that there may be subgroups of ME patients. Eide Gotaas and her colleagues at NTNU are therefore in the process of investigating whether it is possible to identify the subgroups, which will have particularly use of cognitive behavioral therapy.