Cognitive Behaviour Therapy Complemented with Emotion Regulation Training for Patients with Persistent Physical Symptoms... Kleinstäuber et al (2019)

Woolie

Woolie

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Author list: Maria Kleinstäuber Christine Allwang Josef Bailer Matthias Berking Christian Brünahl Maja Erkic Harald Gitzen Mario Gollwitzer Japhia-Marie Gottschalk Jens Heider Andrea Hermann Claas Lahmann Bernd Löwe Alexandra Martin Jörn Rauk Annette Schröder Johannes Schwabe Jeanine Schwar Rudolf Stark Frauke Dorothe Weiss Winfried Rief

abstract:
Introduction: Persistent medically unexplained symptoms (MUS) are a major burden for health care. Cognitive behaviour therapy (CBT) is efficacious for patients with MUS, with small to medium effects. The current study investigates whether therapy outcomes of a CBT for MUS patients can be improved by complementing it with emotion regulation training. Methods: In a multicentre trial 255 patients with at least three persisting MUS were randomised to 20 sessions of either conventional CBT (n = 128) or CBT complemented with emotion regulation training (ENCERT; n = 127). Somatic symptom severity and secondary outcomes were assessed at pre-treatment, therapy session 8, end of therapy, and 6-month follow-up. Results: Linear mixed-effect models revealed medium to large effects in both study arms for almost all outcomes at the end of therapy and 6-month follow-up. ENCERT and CBT did not differ in their effect on the primary outcome (d = 0.20, 95% CI: –0.04 to 0.44). Significant time × group cross-level interactions suggested ENCERT to be of more benefit than conventional CBT for a few secondary outcomes. Moderator analyses revealed higher effects of ENCERT in patients with co-morbid mental disorders. Discussion/Conclusions: Current findings are based on a representative sample. Results demonstrate that both CBT and ENCERT can achieve strong effects on primary and secondary outcomes in MUS patients. Our results do not indicate that adding a training in emotion regulation skills generally improves the effect of CBT across all patients with MUS. Large effect sizes of both treatments and potential specific benefits of ENCERT for patients with co-morbid mental disorders are discussed.
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Just parking this here, will read it fully and add some quotes and comments tomorrow. This first author is trained in Germany, but now New Zealand based, she has been mentioned in the NZ/South Pacific thread before.
 
This has been tried hundreds of times already. No, it does not change anything to add more junk to the junk. It's still the exact same as any other behavioral treatment, the substance is entirely superfluous. With a fake mustache. Playing country music. On a full moon. Walking backwards. All useless distinctions that make no difference.

This is negligent mismanagement of public resources. To do the same thing hundreds of times until you can simply point to the sheer volume of attempts as evidence that it should be used is malpractice, full stop.

There is no crisis of replicability in psychology, when junk like this gets replicated hundreds of times over with the same results. There is a crisis of validity and basic oversight. If the people who make the decisions can't exercise judgment they should be replaced. All of them. They are clearly not capable of doing proper oversight if they can't see that hundreds of identical experiments are effectively identical for all intents and purposes.
 
The current study investigates whether therapy outcomes of a CBT for MUS patients can be improved by complementing it with emotion regulation training.
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If people are given anti-depressants their emotions get flattened. Is that what they want?

I find it very annoying when I'm told, either in person or in articles, that my emotions are "wrong" or "inappropriate" or "excessive". I accept that people need help if they can't control their tempers and they lash out at others. But so many emotions appear to be disapproved of. Are we supposed to be happy, happy, happy all the time? Makes me think of the Stepford Wives.
 
Okay, this trial was designed to see if adding an emotion regulation training to standard CBT improved outcomes (cf. standard CBT) for a group defined as having MUS by the latest acronym. The definition encompassed people with MECFS.

There isn't much point in discussing what the emotional regulation training actually involved, because it didn't produce better results than standard CBT.

There was a protocol for the trial available here. The primary outcomes were:

1. Number of symptoms rated as at least moderately severe on the SOMS-7T: person has to rate the severity of 53 physical symptoms on a 5-point Likert scale. The person rates only those symptoms that cannot be sufficiently explained medically.

2. Severity index (mean value of all symptom ratings) on the SOMS-7T .​

They assessed these two measures prior to the therapy, immediately after and at six months follow-up.

The only objective outcome was health care utilisation. Showed no effects (trends slightly toward more utilisation for the emotion regulation group after treatment)

Outcome 1 did not differ significantly between the two groups immediately after treatment or at six months post treatment. I didn't see any mention of Outcome 2 anywhere in the study.

Dropouts: About 1 sixth of participants who entered the trial did not complete the post-treatment assessment, and about twice that number did not complete six month follow up. However, they did do an intention-to-treat analysis, where drops outs are counted as failures.

Spin: The fact that the main hypotheses were not confirmed is hardly mentioned in the paper. Instead, there's a lot of focus on the fact that both groups self-reported on all sorts of things more positively at the end of the trial than at the beginning (obviously, not what the trial was set up to investigate, and very probably a spontaneous remission effect). This focus on different timepoints was one of the elements of "spin" in psychotherapy trials that was recently mentioned in that metanalysis of trials for depression by Stoll et al (here).

There was also a lot of discussion of secondary outcome measures that differed between the groups after treatment. By the end of the paper, you would be forgiven for thinking the trial was a roaring success.

(edited for typos)
 
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NelliePledge said:
Emotion regulation training sounds very dodgy but I’m not surprised by anything from the Muppets.


Ah it’s a new flavour of the month from California https://www.emotionregulationtherapy.com/
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This is quite a hoot, @NelliePledge.

I think the description makes it all crystal clear ;):
Emotion Regulation Therapy (ERT) is a manualized treatment that integrates components of cognitive-behavioral, acceptance, dialectical, mindfulness-based, and experiential, emotion-focused, treatments using a mechanistic framework drawn from basic and translational findings in affect science.
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You know you're dealing with REAL SCIENCE when there are so many big words!!

I like this too:
Decrease use of emotional avoidance strategies (such as worry, rumination and self criticism);
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Newsflash here, apparently, worrying/ruminating/criticising yourself can help you to avoid your negative emotions! SO much cheaper than drugs or alcohol. Instead of all that expensive drinking, all you have to do to avoid those nasty negative emotions is to worry more and keep reminding yourself how shit you are!
 
Outcomes
Primary and Secondary Outcomes
Symptom severity over the past 7 days was assessed with the so-matisation severity index of the Screening of Somatoform Disor-ders-7T (SOMS-7T; [37]). Number of somatic symptoms over the past 7 days, symptom disability, and the psychological B-criteria of SSD were assessed with the MUS interview as secondary outcomes [34]. The PHQ-15 [33] was applied as a secondary economic self-rating scale to assess symptom severity. As further secondary out-comes we assessed symptom disability with the mPDI [32], health-relatedquality of life with the sum score of the five items of the EuroQuol-5D (EQ-5D; [38]), health anxiety with the modified Short Health Anxiety Inventory (mSHAI; [39]), cognitive and be-havioural symptom coping as well as symptom distress with a mod-ified version of the Pain Coping Questionnaire (mPCQ; [40]), de-pressive symptoms with the Beck Depression Inventory-II (BDI-II; [41]), general psychopathology with the Global Severity Index (GSI) of the Symptom Checklist-90-Revised (SCL-90-R; [42]), and a question which assessed the number of GP visits during the past 12 months. Emotion regulation skills were measured with the Emo-tion Regulation Skills Questionnaire (ERSQ, [43])
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So the entirety of the outcomes consist of ten questionnaires and asking 'how often did you visit the doctor'.
 
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I think if I were faced with 10 questionnaires to fill in all at once including intrusive and irrelevant questions about my emotional state I would be ticking any box at random by the end, or just choosing all the boxes saying I'm fine in order to get away from the whole sorry mess. I very much doubt they would learn anything 'real' about me or my health.
 
Emotion Regulation Therapy (ERT) is a manualized treatment that integrates components of cognitive-behavioral, acceptance, dialectical, mindfulness-based, and experiential, emotion-focused, treatments using a mechanistic framework drawn from basic and translational findings in affect science.

Do I laugh or cry?
 
Sean said:
Emotion Regulation Therapy (ERT) is a manualized treatment that integrates components of cognitive-behavioral, acceptance, dialectical, mindfulness-based, and experiential, emotion-focused, treatments using a mechanistic framework drawn from basic and translational findings in affect science.

Do I laugh or cry?
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With properly regulated emotions, neither obviously.. ;)
 
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