Guardian: Long Covid is very far from ‘all in the mind’ – but psychology can still help us treat it - by Carmine M Pariante, April 2021

Kalliope

Kalliope

Senior Member (Voting Rights)
The Guardian: Long Covid is very far from 'all in the mind' - but psychology can still help us treat it by Carmine M Pariante

- Carmine M Pariante is professor of biological psychiatry at King’s College London and editor of the blog platform Inspire the Mind


Quote:
This point is particularly important in the context of CFS/ME and, more recently, long Covid. Offering lifestyle changes or psychotherapeutic approaches to these patients does not mean that their symptoms are “not real”. Medics routinely help cancer patients with these approaches every day, yet I never hear anyone accusing doctors of suggesting cancer is all in the mind.

There is also good evidence that all types of symptoms can be influenced by anticipation and beliefs, as has been demonstrated many times with the powerful placebo and “nocebo” effects. Being offered something believed to be positive (for example, an empty capsule that we believe to contain a medication) or negative (an empty capsule we believe to contain a toxin) will make our symptoms better (placebo) or, respectively, worse (nocebo). This is not snake oil for the gullible: these are biological effects based on measurable changes in the brain and the body, and can occur in everybody. This is why the standard evaluation of a novel treatment for any disorder – including the very real Covid infection – requires a comparison with a dummy treatment, so that our expectations, positive or negative, do not influence the results. This concept is particularly relevant in the context of the recent controversy around a Guardian article on this topic, and the response it has received.
 
Kalliope said:
The Guardian: Long Covid is very far from 'all in the mind' - but psychology can still help us treat it by Carmine M Pariante

- Carmine M Pariante is professor of biological psychiatry at King’s College London and editor of the blog platform Inspire the Mind


Quote:
This point is particularly important in the context of CFS/ME and, more recently, long Covid. Offering lifestyle changes or psychotherapeutic approaches to these patients does not mean that their symptoms are “not real”. Medics routinely help cancer patients with these approaches every day, yet I never hear anyone accusing doctors of suggesting cancer is all in the mind.

There is also good evidence that all types of symptoms can be influenced by anticipation and beliefs, as has been demonstrated many times with the powerful placebo and “nocebo” effects. Being offered something believed to be positive (for example, an empty capsule that we believe to contain a medication) or negative (an empty capsule we believe to contain a toxin) will make our symptoms better (placebo) or, respectively, worse (nocebo). This is not snake oil for the gullible: these are biological effects based on measurable changes in the brain and the body, and can occur in everybody. This is why the standard evaluation of a novel treatment for any disorder – including the very real Covid infection – requires a comparison with a dummy treatment, so that our expectations, positive or negative, do not influence the results. This concept is particularly relevant in the context of the recent controversy around a Guardian article on this topic, and the response it has received.
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Prof. Pariante has shared a link on Twitter. Research director dr. Signe Flottorp from the Norwegian Institute of Public Health liked it.
There's a comment from dr. Nisreen Alwan:
Thank you. This is an interesting article but in my opinion misses the point that it's not the patients who're seperating the "physical" & the "mental", it's the labelling, which in turn creates stigma and determines the resources invested in investigation, treatment & support...
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Kalliope said:
This point is particularly important in the context of CFS/ME and, more recently, long Covid. Offering lifestyle changes or psychotherapeutic approaches to these patients does not mean that their symptoms are “not real”. Medics routinely help cancer patients with these approaches every day, yet I never hear anyone accusing doctors of suggesting cancer is all in the mind.
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Disingenuous, I'm sure he's intelligent enough to know exactly what the differance is. Cancer folks are not having their cancer treated with physchotheraputic approaches, they're having surgery and chemotherapy. M.e. folks are denied any treatments under the dogma that cbt, graded exercise will cure them. Furthermore the symptoms of M.E. and Long Covid mean these approaches can cause harm in these patients.
 
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Kalliope said:
This point is particularly important in the context of CFS/ME and, more recently, long Covid. Offering lifestyle changes or psychotherapeutic approaches to these patients does not mean that their symptoms are “not real”. Medics routinely help cancer patients with these approaches every day, yet I never hear anyone accusing doctors of suggesting cancer is all in the mind.
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Misrepresenting why we object to useless 'treatments' does not suddenly make those useless 'treatments' work.
 
Medics routinely help cancer patients with these approaches every day, yet I never hear anyone accusing doctors of suggesting cancer is all in the mind.
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This point is made over and over again and whoever expresses it is always being dishonest, in my opinion. The whole notion just glides right past the issue that patients with ME, IBS, fibromyalgia have - that people with cancer get treated for their symptoms with physical resources, i.e. surgery, chemo, pain relief, and probably a few other things that I am unaware of. I wonder how many people with ME or fibromyalgia or IBS are tested for things like nutrient deficiencies or anaemia, or various forms of arthritis or lupus, or cancer? There is nothing to stop a person with ME from developing rheumatoid arthritis or lupus or cancer or hypothyroidism or hyperthyroidism. But how many ever get these conditions diagnosed and treated promptly?
 
Kalliope said:
The Guardian: Long Covid is very far from 'all in the mind' - but psychology can still help us treat it by Carmine M Pariante

- Carmine M Pariante is professor of biological psychiatry at King’s College London and editor of the blog platform Inspire the Mind


Quote:
This point is particularly important in the context of CFS/ME and, more recently, long Covid. Offering lifestyle changes or psychotherapeutic approaches to these patients does not mean that their symptoms are “not real”. Medics routinely help cancer patients with these approaches every day, yet I never hear anyone accusing doctors of suggesting cancer is all in the mind.

There is also good evidence that all types of symptoms can be influenced by anticipation and beliefs, as has been demonstrated many times with the powerful placebo and “nocebo” effects. Being offered something believed to be positive (for example, an empty capsule that we believe to contain a medication) or negative (an empty capsule we believe to contain a toxin) will make our symptoms better (placebo) or, respectively, worse (nocebo). This is not snake oil for the gullible: these are biological effects based on measurable changes in the brain and the body, and can occur in everybody. This is why the standard evaluation of a novel treatment for any disorder – including the very real Covid infection – requires a comparison with a dummy treatment, so that our expectations, positive or negative, do not influence the results. This concept is particularly relevant in the context of the recent controversy around a Guardian article on this topic, and the response it has received.
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Might be worth people sending in a letter. Remember shorter letters have a much better chance of getting published.
 
Seems to me a lot of self justifying waffle. Just because psychological therapy can help cancer patients cope doesn't mean they are treating the cancer. He's deliberately missing the point. There is not evidence that psychological therapies can treat ME/CFS itself, any more than that it can treat cancer.
 
Disingenuous manipulative snake oil. That they have to misrepresent the fact to make their point does not concern them is such a big part of the problem. They see nothing wrong with lying, and that's what makes everything they do wrong.

This is basically an advertisement for a jobs program that trades lives for mediocre careers. The hubris here is staggering, as is the reckless indifference for the consequences they create. But they never have to face them, so on they go destroying lives.
 
Conversely, changes in lifestyle and behaviour, and psychological therapies (which work by challenging unhelpful ways we think about ourselves and world around us), have been shown to help patients with physical disorders including cancer, irritable bowel syndrome, diabetes, multiple sclerosis and stroke, to name just a few.

This point is particularly important in the context of CFS/ME and, more recently, long Covid. Offering lifestyle changes or psychotherapeutic approaches to these patients does not mean that their symptoms are “not real”. Medics routinely help cancer patients with these approaches every day, yet I never hear anyone accusing doctors of suggesting cancer is all in the mind.

There is also good evidence that all types of symptoms can be influenced by anticipation and beliefs, as has been demonstrated many times with the powerful placebo and “nocebo” effects. Being offered something believed to be positive (for example, an empty capsule that we believe to contain a medication) or negative (an empty capsule we believe to contain a toxin) will make our symptoms better (placebo) or, respectively, worse (nocebo). This is not snake oil for the gullible: these are biological effects based on measurable changes in the brain and the body, and can occur in everybody. This is why the standard evaluation of a novel treatment for any disorder – including the very real Covid infection – requires a comparison with a dummy treatment, so that our expectations, positive or negative, do not influence the results. This concept is particularly relevant in the context of the recent controversy around a Guardian article on this topic, and the response it has received.

Patients being told their symptoms are in their mind is completely unacceptable to every doctor I know, and such attitudes have no place in modern medicine. But this dismissive approach has nothing to do with the important clinical understanding that psychological factors and approaches can influence these conditions, as they do any other illness. Those who reject the notion that psychological approaches can help us better understand and treat physical symptoms are themselves falling, perhaps inadvertently, into the trap of differentiating and stigmatising mental illness.

We need every tool in the box to treat long Covid – and it must be hoped that the new focus and funding on this condition may also provide us with new and useful insights into treating CFS/ME patients.
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There is something wrong with this argument.

I thought the point of placebo effects was that they aren't real biological changes, but are just people thinking they are better - as with the asthma experiment where the patients given sham acupuncture or dummy inhalers thought their breathing had improved, but testing showed only the group who were given inhalers containing the real drug actually improved when their breathing was tested.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154208/

Similarly with other diseases - like debunked claims that positive thinking therapies had helped cancer patients live longer.

I am prepared to believe that psychological therapies may lead to some measurable biological changes, such as reduced (or probably in some cases increased) stress responses, but there doesn't seem to be any evidence that they have any effect on the disease being treated.

Is he shooting himself in the foot by claiming that psych therapies for ME/CFS and long Covid are as 'real' as placebo effect? If that's all they are equivalent to, why not stop messing with our minds and just give us dummy pills?
 
Trish said:
There is something wrong with this argument.

I thought the point of placebo effects was that they aren't real biological changes, but are just people thinking they are better - as with the asthma experiment where the patients given sham acupuncture or dummy inhalers thought their breathing had improved, but testing showed only the group who were given inhalers containing the real drug actually improved when their breathing was tested.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154208/

Similarly with other diseases - like debunked claims that positive thinking therapies had helped cancer patients live longer.

I am prepared to believe that psychological therapies may lead to some measurable biological changes, such as reduced (or probably in some cases increased) stress responses, but there doesn't seem to be any evidence that they have any effect on the disease being treated.

Is he shooting himself in the foot by claiming that psych therapies for ME/CFS and long Covid are as 'real' as placebo effect? If that's all they are equivalent to, why not stop messing with our minds and just give us dummy pills?
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This would be an excellent posted retort in my opinion. All though I don't even think there is any evidence of psychological therapies ever leading to some measurable changes(yet)?
 
Not that I'm capable of writing a letter but having read a few responses to this sort of nonsense I find the best responses incorporate answers to anticipated further responses while addressing what has been said. Wording needs to anticipate leaving no room for wriggling around again with their slippery language.

Also, I'd like to point out -- again -- that when the BPS throw out the suggestion that we are erroneously thinking they are using therapies that are 'for the mind' and therefore it is us who are treating disease as a dualist concept (mind illness and body illness) . . .

They should remember that none of them have ever once raised the issue with insurance or government that "mind illness' or mental health as it's known should have parity in terms of the social assistance that is given to 'purely physical illness'. One might be inclined to ask why that is? If as they now keep repeating (and the patient community has never denied) physical and mental health / illness are all one and the same.

Yet despite even their best most (manipulated) robust figures for the efficacy of CBT they have NEVER shown 100% of people improve. So what of all those who do not?

Well the CBT cabal has worked hard to ensure that they are variously blamed for not benefiting, ignored by the medical establishment or gas-lighted for being mean to therapists who are just trying to help.
 
Well, if BPS people like Pariente feel the need to respond to Monbiot by reiterating muddled arguments about placebos being good because you have to have placebo controls in trials then hopefully Monbiot will be encouraged to believe that the story sold him by the patient activists was spot on. Nothing like 'protesting too much' to blow your own cover chaps (when it comes to someone who can actually think).
 
Is there really hope in trying to reason with these people?

In my experience as a nurse, yes stress tended to worsen any chronic illness in the short term for some people. So did Christmas holidays and drinking a lot caused an increase in hospital admissions.

For me, the problem with the 'psychology is helpful' argument is that the help (%) is very over-estimated, over blown.
 
The irony is that Pariente is really repeating Knoop and White when they said that CBT is really working as a placebo. The problem with that for White was that he claimed that placebos had no effect on ME, but that cannot right if PACE showed CBT effective and it is a placebo.

But the key thing is that the definition of a placebo is that it makes people say they are better but for reasons that have nothing to do with any mechanism that is specific to the modality of treatment. In other words if CBT is a placebo then it doesn't need to be CBT. A blue pill would do, or jumping on a piece of paper or cold baths.
 
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