New study questions use of talking therapy as a treatment for schizophrenia

Indigophoton · Jul 20, 2018

Another nail in the coffin for CBT.

The findings of the first meta-analysis examining the effectiveness of Cognitive Behavioural Therapy for psychosis (CBTp) on improving the quality of life and functioning and reducing distress of people diagnosed with schizophrenia have, today, been published in the peer-reviewed journal BMC Psychology.

The study, led by Keith Laws, Professor of Cognitive Neuropsychology at the University of Hertfordshire, found that CBTp showed no benefit for improving quality of life and reducing distress and only a small, temporary improvement in functioning for individuals diagnosed with schizophrenia.
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https://medicalxpress.com/news/2018-07-therapy-treatment-schizophrenia.amp

Hutan · Jul 20, 2018

Professor Laws said: "With an effect size that was close to zero, we found no suggestion that CBTp improves quality of life for people diagnosed with schizophrenia.

"Our findings have important implications for service users diagnosed with schizophrenia, the clinicians who work with them and also decision-making government agencies such as NICE, who might use such findings to update their guidelines and recommendations and thus improve the treatment advice for people diagnosed with schizophrenia."
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Keith Laws has had plenty of thoughts on CBT for CFS too. Among other things, he published in the Journal of Health Psychology:

http://journals.sagepub.com/doi/full/10.1177/1359105317710246

Reducing the psychological distress associated with chronic fatigue syndrome/myalgic encephalomyelitis is seen as a key aim of cognitive behavioural therapy. Although cognitive behavioural therapy is promoted precisely in this manner by the National Institute of Clinical Excellence, the evidence base on distress reduction from randomised controlled trials is limited, equivocal and poor quality.
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and made a comment in The Mental Elf
https://www.nationalelfservice.net/...itorial-without-perspectives/#comment-1043538 (edit: thanks Esther12, link fixed)

So, wherever we look – the majority of analyses, outcomes and effect sizes reported by Price et al do not obviously or clearly (in my view) point to CBT being supportive in CFS
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Some other threads here on S4ME with a Keith Laws link
https://www.s4me.info/threads/nice-...2016-jauhar-mckenna-and-laws.3582/#post-63746
On talking therapies for Bipolar disorder
https://www.s4me.info/threads/antip...ty-study-morrison-et-al-2018.3269/#post-58228

Keith Laws joined PR as a member. It would be great if he joined us here.

Sasha · Jul 20, 2018

Keith Laws also co-authored (with James Coyne) a letter entitled 'Results of the PACE follow-up study are uninterpretable' that appeared in Lancet Psychiatry, about the PACE long-term follow-up paper:

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00551-9/abstract

Esther12 · Jul 20, 2018

Hutan said: ↑

made a comment in The Mental Elf
https://www.nationalelfservice.net/...itorial-without-perspectives/#comment-1043538
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Thanks for the links - that one broke though. Here's the working one: https://www.nationalelfservice.net/...itorial-without-perspectives/#comment-1043538

edit: Although I'd question the value of CBT for cancer related fatigue and MS (on the evidence I've seen anyway), this response from Laws is quite funny too:

Finally, Dr Brurberg raises the following interesting point
“It is worth noting that the effects of CBT and GET in CFS/ME are similar to those seen among patients with other serious diseases where fatigue is a prominent symptom, e.g. cancer (Furmaniak et al, 2016) and multiple sclerosis (Heine et al, 2015; van den Akker et al, 2016). The benefit of CBT and GET does not imply that we can conclude that cancer, multiple sclerosis or CFS/ME occur for psychological reasons. It is difficult to understand why the benefit of CBT and exercise in patients with cancer and multiple sclerosis seems widely accepted, whereas the usefulness of CBT and GET for patients with CFS/ME remains controversial.”

It seems quite commonplace amongst CBT advocates to make such a argument – it centres on what I would call ‘nominal analogy’ assumption
if CBT impacts symptom X (fatigue) in disorder A (Cancer), then it will also impact symptom X (fatigue) in disorder B (CFS/ME). This argument is based on the assumption that identifying symptom X in both ‘disorders’ means they are identifying the same ‘thing’ … the symptom is abstracted and decontextualised …and hence it often follows, that the same treatment is applicable and possibly equally efficacious

It only takes a moments reflection to see that argument holds no (logical) water….….For example, CBT may reduce the symptoms of depression in those diagnosed with depression; however, other evidence shows that CBT does not reduce the symptoms of depression in Bipolar Depression (see Jauhar, McKenna & Laws 2016). If we turn back to the current case – Dr Brurberg cites the Cochrane review as evidence of CBT efficacy- even here it fails to show that CBT reduces depressive symptoms in CFS/ME… calling something a dog does not make it bark
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Alvin · Jul 20, 2018

Telling people to ignore the problem will not work for any condition. It may do a bit of symptom control depending on the specific issue but it fixes nothing.

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New study questions use of talking therapy as a treatment for schizophrenia

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