Effect of exposure-based vs traditional cognitive behavior therapy for [FM]: a two-site single-blind randomized controlled trial 2023 Hedman-Lagerlöf

[Sly Saint]

Fibromyalgia is a debilitating pain condition for which treatment effects are typically modest. The most evaluated psychological treatment is traditional cognitive behavior therapy (T-CBT), but promising effects have recently been seen in exposure-based cognitive behavior therapy (Exp-CBT).

We investigated whether Exp-CBT was superior to T-CBT in a randomized controlled trial. Self-referred participants with fibromyalgia (N = 274) were randomized (1:1) to 10 weeks of Exp-CBT or T-CBT. Treatments were delivered online and presented as “CBT for fibromyalgia.”

Participants were assessed at baseline, weekly during treatment, posttreatment, and at 6- and 12-month follow-up. Primary outcome was the difference in reduction in fibromyalgia severity as measured using the Fibromyalgia Impact Questionnaire (FIQ) over 11 assessment points from baseline to posttreatment, modelled within an intention-to-treat framework using linear mixed effects models fitted on multiple imputed data.

Approximately 91% of weekly FIQ scores were collected over the main phase. There was no significant difference between Exp-CBT and T-CBT in the mean reduction of fibromyalgia severity from pretreatment to posttreatment (b = 1.3, 95% CI −3.0 to 5.7, P = 0.544, d = −0.10).

Minimal clinically important improvement was seen 60% in Exp-CBT vs 59% in T-CBT. Effects were sustained up to 12 months posttreatment. This well-powered randomized trial indicated that Exp-CBT was not superior to T-CBT for fibromyalgia. Both treatments were associated with a marked reduction in fibromyalgia severity, and the online treatment format might be of high clinical utility. T-CBT can still be regarded a reference standard treatment that remains clinically relevant when compared to novel treatment approaches.

Effect of exposure-based vs traditional cognitive behavior t... : PAIN (lww.com)

 

[Sly Saint]

article on the paper

There does not appear to be any profound differences between so-called exposure-based CBT and traditional CBT in the treatment of fibromyalgia, according to a study led by researchers at Karolinska Institutet. Both forms of treatment produced a significant reduction in symptoms in people affected by the disease. The study is one of the largest to date to compare different treatment options for fibromyalgia and is published in the journal PAIN.

About 200,000 people in Sweden currently live with fibromyalgia, a long-term pain syndrome that causes great suffering for patients through widespread pain, fatigue, and stiffness in the body. There is no cure for fibromyalgia. Existing drugs often have insufficient effect, raising the need for more effective treatment methods. Cognitive behavioral therapy (CBT) has shown some effect, but there is a lack of trained CBT practitioners. There is also a lack of knowledge about which form of CBT is most effective.

The study compared two different forms of internet-delivered cognitive behavioral therapy in terms of how well they reduce the symptoms and functional impact of fibromyalgia.

In brief, exposure-based CBT involves the participant systematically and repeatedly approaching situations, activities, and stimuli that the patient has previously avoided because the experiences are associated with pain, psychological discomfort, or symptoms such as fatigue and cognitive problems.

Study: Traditional CBT as effective as exposure therapy for fibromyalgia (msn.com)

 

[NelliePledge]

Missing two letters from the world effective
In….

 

[rvallee]

So just like the FITNET Crawley paper, they compare 2 useless treatments, found them to be equally ineffective, but conclude that they are both effective, since the trials are biased to produce an effect. They effectively do basic arithmetic where A=0, B=0, therefore A and B = 100%, since this is the way this treatment model works, they take any BS number and assert that it should work on everyone.

This is insane. There is no other way to describe this ideology. No matter what they do, they just write it down as successful, and no one seems to care outside of a small number of people.

This is a phobia-focused approach:

The full 10 weeks were therefore heavily focused on exposure, meaning that participants were encouraged to repeatedly and systematically engage in activities that gave rise to pain and pain-related distress (exposure) while refraining from behaviors intended to reduce pain and pain-related distress in the short term (response prevention). Although the fear of pain was the focus of some exposure exercises, this was not the sole target of exposure in this protocol.

And it amounts to abuse to subject people without phobias to this, it more or less amounts to CBT + GET. They can call that exposure if they want, this is absurd. This ideology is textbook banality of evil, but the only way they could ever understand this is if they themselves experienced it, and if that happened, they'd basically be out of the profession and never listened to.

 

[Wonko]

Possibly a different insane treatment modality should be tried - OTH (Other People Hopping).

Maybe trying OTH for 4 hours vs 23 hours and then giving the patient a questionnaire to record the effect of seeing other people hopping had on their symptoms.

Or maybe OTH vs OPL (Other People Leapfrogging)

Something's got to work dammit!!!

 

[Creekside]

Is exposure-based CBT exercising nude?

 

[Sean]

Primary outcome was the difference in reduction in fibromyalgia severity as measured using the Fibromyalgia Impact Questionnaire (FIQ)

Stopped there.

 

[Andy]

More patient blaming nonsense from the same team here, Shared and distinct effect mediators in exposure-based and traditional cognitive behavior therapy for FM: Secondary analysis... 2024 Hedman-Lagerlöf