Feasibility of group-based acceptance & commitment therapy for adolescents (AHEAD) w/multiple functional somatic syndromes, 2020,Hansen Kallesøe et al

Andy

Andy

Retired committee member
Full title: Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: a pilot study
Background
Recurrent and impairing functional somatic syndromes (FSS) are common in adolescents. Despite a high need for care, empirically supported treatments are lacking for youth. The aim of this uncontrolled pilot study was to assess feasibility and treatment potential of a new intervention with group-based Acceptance and Commitment Therapy (ACT) in a generic treatment approach for adolescents with multiple FSS.

Methods
Twenty-one patients received ‘ACT for Health in Adolescents’ (AHEAD) (30 h), specifically developed for adolescents (aged 15–19 years) with moderate to severe FSS. Close relatives attended an information meeting to facilitate support of the patients throughout treatment. Treatment satisfaction was evaluated by means of self-report and relatives’ impressions. Self-reported physical health at 3 months follow-up (FU) after end of treatment was the primary outcome whereas secondary outcomes included symptom burden, limitation due to symptoms, illness worry, emotional distress and physical and emotional symptoms. Treatment targets were assessed by measures on illness behaviour, illness perception and psychological inflexibility.

Results
Nineteen patients (90.5%) completed the treatment with a high overall attendance rate of 93%. All would recommend the treatment to a friend with similar problems. Close relatives rated it valuable to participate in an information meeting. Patients’ physical health improved significantly from assessment to FU with a clinically relevant mean change of 8.9 points (95% CI [5.4; 12.4]; SRM 0.91 [0.26;1.57]). Improvement was also seen on all secondary outcome measures, from assessment to FU. Maladaptive illness behaviours and perceptions as well as psychological inflexibility showed a significant decline from assessment to FU.

Conclusion
AHEAD was feasible and potentially efficacious and warrants testing in a larger clinical trial.
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Open access, https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02862-z
 
Insurance companies:

Okay, so we've given the patients something cheap yet also worse than nothing in the form of CBT. But how do we further reduce the payout to these awfully sick patients?

Psychiatrists:

Okay, imagine CBT.... but... in A GROUP SETTING!!

Insurance companies:

Shut-Up-And-Take-My-Money-Fry.jpg
 
I have concerns as to a bigger picture of where this might lead with regards to programming young people. As psych experiments go I think in time this will be a Frankenstein.

From the paper:

Opening up was addressed using metaphors and exercises aimed at improving the ability to allow for the unpleasant bodily sensations without taking actions to avoid it (i.e. acceptance), in the service of remaining present in the moment. This also includes the capability of observing your thoughts, and seeing them as merely thoughts, rather than acting on them as if they represent the truth (i.e. defusion).
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Do these people get a discount for every 100 identical trials they run? There have literally been hundreds of identical trials of this. The substance is entirely irrelevant and this methodology would show the same results no matter what goes in there, the details of which are, of course, never provided. This kind of "treatment" is commonly used, has been for years. Why is there a need for a "feasibility" trial for something that is commonly used in practice and has been touted as effective for decades despite it being known that there is no evidence for it, hence the endless cycle of doing the same pilot trials over and over again? How does no one find that completely absurd?

Again, there is no crisis of replicability in clinical psychology or in evidence-based medicine. In fact there is too much replication, hundreds of identical experiments, always with the same methods and substance, always with the same outcomes. None of them are valid. It is a crisis of validity, of pseudoscience so thoroughly dominating the field that the incentive system is over poorly replicating things endlessly, always within the same bounds of mixing up a handful of concepts with the tiniest variations.

This is a jobs program for people who can't science. Why is that even a thing?
 
This is quite concerning.

It seems that the intervention consisted of psychoeducation for adolescents to teach them about central sensitization and peripherally increased bodily stress response as an overall explanation of the development and maintenance of what the authors call 'Bodily Distress Syndrome' (BDS).

BDS is not a diagnosis used by researchers in other countries and there is simply insufficient evidence for central sensitization or increased bodily stress response in these patients. I'm usually cautious in my criticism but this really looks like pseudoscience. I'm not sure if the authors realize what impact it can have if someone with medical authority proclaims these theories. Not only the patient but also their relatives might believe them to be true.

So it looks like the authors are spreading dubious illness beliefs, which is remarkable because they write about 'maladaptive illness behaviours and perceptions' as if they know what behaviors and perceptions are good or bad for patients. They write:
Known maintaining factors include negative illness perceptions (e.g. single cause attribution of symptom, no sense of control and long expectancy of symptoms) [14–16] and maladaptive illness behaviours (e.g. avoidance, control and ‘all-or-nothing’ behaviour) [17]. Furthermore, parental overprotective behaviour can increase distress and disability in the young [18–21],
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Haven't read all these references but it looks like these are merely association studies that didn't come close to proving the things the authors claim.

The therapy itself consists of things that remind me of bogus commercial health programs such as promoting self compassion and kindness to your self, connecting with an inner sweet spot, writing a kind letter to yourself etc.
 
Michiel Tack said:
This is quite concerning.

It seems that the intervention consisted of psychoeducation for adolescents to teach them about central sensitization and peripherally increased bodily stress response as an overall explanation of the development and maintenance of what the authors call 'Bodily Distress Syndrome' (BDS).

BDS is not a diagnosis used by researchers in other countries and there is simply insufficient evidence for central sensitization or increased bodily stress response in these patients. I'm usually cautious in my criticism but this really looks like pseudoscience. I'm not sure if the authors realize what impact it can have if someone with medical authority proclaims these theories. Not only the patient but also their relatives might believe them to be true.

So it looks like the authors are spreading dubious illness beliefs, which is remarkable because they write about 'maladaptive illness behaviours and perceptions' as if they know what behaviors and perceptions are good or bad for patients.
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What we have is essentially an attempt to propagate a fantasy.

They can't really come out and say it - maybe many can't actually see it - but the pseudoscience is so thin that it can only be seen a haphazard and permutable cover.
 
Sadly ACT is the new buzzword.
Add to ACES and adolescence has got even less going for it.
There never seems to be understanding of asymmetrical power balances / influence of peers/ impact of being held responsible for your illness.

Coming to a therapist near you.
 
Nina E. Steinkopf has looked further into this research project and found several things not adding up:

A million dollar industry of wasted

Quote:https://melivet.com/2024/03/17/a-million-dollar-industry-of-wasted-research/
By claiming that stress is a disease factor despite the fact that they didn’t find that, the researchers strengthen the perception of psychosomatics as a cause. Insurance companies can then refer to these research articles when they reject claims for compensation.https://melivet.com/2024/03/17/a-million-dollar-industry-of-wasted-research/
 
Similar excuse as QMUL's BS answer that they don't have the resources to get the PACE data. Misbehavior going unpunished leads to more misbehavior. Funny how that works.

It's going to be very hard to justify there not being giant lawsuits for all of this. It's even more nakedly corrupt than what the tobacco industry did, but only because once the tobacco industry's cover up was exposed it could no longer be maintained because people care about all the deaths it was causing. All it takes for evil to flourish is for good people to do nothing about it. They are, in effect, condoning and nurturing it, giving aid and comfort to institutional violence.
 
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