Danish RCT of Cognitive Behavior Therapy for Whatever Bothers Your Physician About You, 2023, James Coyne, Substack blog

Trish · Jul 31, 2023

https://jimcoyneakacoyneoftherealm.substack.com/p/danish-rct-of-cognitive-behavior?

Danish RCT of Cognitive Behavior Therapy for Whatever Bothers Your Physician About You

The flawed RCT was actually an advertisement for Per Fink's clinic providing psychiatric diagnoses to chronically physically ill patients whom other physicians had difficulty diagnosing and managing.

2023 Introduction: Persons with chronic fatigue syndrome or long Covid beware.
An earlier version of this Substack article, Danish RCT of cognitive behavior therapy for whatever ails your physician about you, was originally posted as PLOS Blogs Mind the Brain December 7, 2016. PLOS Blogs subsequently shut down all psychology posts. The original version was stored in a damaged archives, with all comments lost.

My warning from the 2016 article is especially important today.

In 2023, the obvious addition would patients with Long Covid.

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More at link

Trish · Jul 31, 2023

The article is mainly a copy of a now deleted blog post by Coyne from 2016

It's his analysis of what's wrong with this published research:

Schröder A, Rehfeld E, Ørnbøl E, Sharpe M, Licht RW, Fink P. (2012). Cognitive–behavioural group treatment for a range of functional somatic syndromes: randomised trial. The British Journal of Psychiatry. 200(6), 499-507

Coyne lists at the beginning a summary of his key findings from examining this research:

A summary overview of what I found:
The RCT:

Was unblinded to patients, interventionists, and to the physicians continuing to provide routine care.

Had a grossly unmatched, inadequate control/comparison group that leads to any benefit from nonspecific (placebo) factors in the trial counting toward the estimated efficacy of the intervention.

Relied on subjective self-report measures for primary outcomes.

With such a familiar trio of design flaws, even an inert homeopathic treatment would be found effective, if it were provided with the same positive expectations and support as the CBT in this RCT. [This may seem a flippant comment that reflects on my credibility, not the study. But please keep reading to my detailed analysis where I back it up.]

The study showed an inexplicably high rate of deterioration in both treatment and control groups. The apparent improvement in the treatment group might only reflect less deterioration than in the control group.

The study is focused on unvalidated psychiatric diagnoses being applied to patients with multiple somatic complaints, some of whom may not yet have a medical diagnosis, but most clearly had confirmed physical illnesses.

But wait, there is more!

It’s not CBT that was evaluated, but a complex multicomponent intervention in which what was called CBT is embedded in a way that its contribution cannot be evaluated.

The “CBT” did not map well on international understandings of the assumptions and delivery of CBT. The complex intervention included weeks of indoctrination of the patient with an understanding of their physical problems that incorporated simplistic pseudoscience before any CBT was delivered. We focused on goals imposed by a psychiatrist that didn’t necessarily fit with patients’ sense of their most pressing problems and the solutions.

And the kicker.
OMG!

The authors switched primary outcomes – reconfiguring the scoring of their subjective self-report measures years into the trial, based on peeking at the results with the original scoring.

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There follows his detailed analysis of what he found wrong with the research.

Amw66 · Jul 31, 2023

If there is a more suitable thread feel free to move it mods

https://twitter.com/user/status/1686134925022355456

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Danish RCT of Cognitive Behavior Therapy for Whatever Bothers Your Physician About You, 2023, James Coyne, Substack blog

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Danish RCT of Cognitive Behavior Therapy for Whatever Bothers Your Physician About You, 2023, James Coyne, Substack blog

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