People with Inflammatory Bowel Disease Prefer Cognitive Behavioral Therapy for Fatigue Management: A Conjoint Analysis 2024 Emerson et al

[Andy]

Abstract

Background
Psychological interventions are a promising area for fatigue management in patients with inflammatory bowel disease (IBD). However, most interventions trialled to date have been pilots with limited direct input from patients about the type of intervention they want. Thus, this study aimed to explore patient preferences for a psychological IBD fatigue intervention.

Methods
An international online cross-sectional survey was conducted with adults with self-reported IBD. A conjoint analysis was employed to elicit, through a series of forced-choice scenarios, patient preferences for a fatigue intervention. For this study, the attributes manipulated across these forced-choice scenarios were type of intervention, modality of delivery, and duration of intervention.

Results
Overall, 834 people with IBD were included in analysis. Respondents ranked the type of psychological intervention as most important for overall preference (with cognitive-behavioral therapy (CBT) preferred over the other approaches), followed by modality of delivery, but placed very little importance on how long the intervention runs for. Patients with IBD appear to most strongly preference a short online CBT intervention for managing their IBD-related fatigue.

Conclusion
This study helps provide therapists and program developers clear direction on patient preferences when it comes to developing new psychological programs that address fatigue in IBD.

Open access, https://link.springer.com/article/10.1007/s10620-024-08468-9

 

[Eddie]

They probably liked the short online CBT intervention because it required the least effort out of these useless treatments.

 

[Hutan]

I haven't read the study. But the first point is the bias in the selection of respondents. 'International online' suggests a lot of self-selection.

The second point is that if I had to do this

A conjoint analysis was employed to elicit, through a series of forced-choice scenarios, patient preferences for a fatigue intervention.

and the options were
A. CBT or psychotherapy
B. Short or long
C. Online or in a clinic
I too would choose a short online CBT course, (the lesser of all evils) as these people did.

The result, however, would say nothing about the effectiveness of such an approach. As a respondent, I might not even know what CBT really is and what would be expected of me. I suspect that if the investigators had thrown in an option of a free voucher for groceries in category A, then 'free grocery voucher emailed each week for 8 weeks' might have come out the best.

 

[Eleanor]

The participants were asked to say which one they preferred out of pairs of short descriptions of unnamed therapies, e.g. 'A psychological therapy focused on finding solutions rather than focusing on the problem' or 'A psychological therapy focused on the links between our thought and how we behave'. They weren't actively choosing CBT or evaluating their own experiences of CBT or anything else.

So one might ask whether the researchers' descriptions of these therapies actually match up very well with people's experience. And the discussion section does raise a few questions like this (eg why don't people like the idea of mindfulness even though it has been shown effective in RCTs) but without coming to any clear conclusions.

 

[rvallee]

Psychological interventions are a promising area for fatigue management in patients with inflammatory bowel disease

They are not. Have never been. Hence the lack of citation. They're a product without a need, and here it's people interested in pushing the product who set the tone.

Despite the often psychological nature of fatigue, the potential value of adjunctive interventions to target psychological comorbidities has only been tested more recently.

Also with no citation, just a vibe from a long-held assertion without any basis. It comes from a lazy loop where no one cares about actual evidence and accept a default explanation out of ignorance. This cycle has been going on for decades, so hardly recent.

Growing interest in Acceptance and Commitment Therapy (ACT) and mindfulness may indicate new directions for exploration, as both are growing in popularity within chronic illness populations and different healthcare settings

Again just pushing what they want, rather than what's needed. There is no such popularity within chronic illness populations, this is asinine.

So yeah this is basically the equivalent of a food company doing a focus group with 4 jams, all theirs, which then boasts that jam 1 is the public's favorite, this analysis should be laughed at mercilessly. The "choices":

Cognitive behavior therapy
Acceptance and commitment therapy
Solution focused therapy
Mindfulness

Online
Face-to-face
Blended

4 weeks
6 weeks
8 weeks
10 weeks
12 weeks

How they were described:

Cognitive behavior therapy: ‘A psychological therapy focused on the links between our thoughts and how we behave’

Acceptance and commitment therapy: ‘A psychological therapy based on accepting what is out of your personal control, and committing action that improves and fulfills your life’

Solution focused therapy: ‘A psychological therapy focused on finding solutions rather than focusing on the problem’

Mindfulness: ‘A therapeutic practice focusing on one’s awareness in the present moment, while acknowledging and accepting one’s thoughts, feelings, and bodily sensations’

This is simply not a valid way of doing any of this, and the conclusion chosen here is a complete joke. It also has nothing at all to do with fatigue.

 

[rvallee]

"Do you like me?":

1. Yes
2. Oh, yes!
3. Not no
4. Yass!

Choose only one. You must choose one. QED.

 

[Eleanor]

Another nugget from the paper:

A systematic evaluated the efficacy of psychological interventions for IBD fatigue and established that while the evidence base is small, the findings are promising for CBT, as indicated by improvements in fatigue impact and severity scores [10]. However, fatigue impact worsened by 6 months and severity worsened by 12 months [11].

As Inigo Montoya might say: You keep using that word, "promising". I do not think it means what you think it means.

 

[Ash]

"Do you like me?":

1. Yes
2. Oh, yes!
3. Not no
4. Yass!

Choose only one. You must choose one. QED.

 

[Ash]

They are not. Have never been. Hence the lack of citation. They're a product without a need, and here it's people interested in pushing the product who set the tone.

Also with no citation, just a vibe from a long-held assertion without any basis. It comes from a lazy loop where no one cares about actual evidence and accept a default explanation out of ignorance. This cycle has been going on for decades, so hardly recent.

Again just pushing what they want, rather than what's needed. There is no such popularity within chronic illness populations, this is asinine.

So yeah this is basically the equivalent of a food company doing a focus group with 4 jams, all theirs, which then boasts that jam 1 is the public's favorite, this analysis should be laughed at mercilessly. The "choices":



How they were described:

This is simply not a valid way of doing any of this, and the conclusion chosen here is a complete joke. It also has nothing at all to do with fatigue.

 

[alktipping]

I see acceptance and commitment therapy as medical lingo to tell the patients we have nothing and will be of no use to you . or please bugger of i am busy ticking boxes that are more financially rewarding.

 

[Hutan]

Coming back to this, this morning, I'm still incredulous.

Very nice examples @rvallee. I loved the jam one.

So yeah this is basically the equivalent of a food company doing a focus group with 4 jams, all theirs, which then boasts that jam 1 is the public's favorite, this analysis should be laughed at mercilessly.

But what these people did is actually far worse. It's like the participants in the food company test don't actually get to see and taste and smell the jams. Instead they only get a very brief and vague description of each one.

And then, when I think about it a bit more, at least with jam, the participants probably have some experience with jams and the specific fruit to guide their choices. They might know that they generally prefer raspberry jam to marmalade, and so even a vague description can result in an educated guess. And, they can be fairly confident that each jam is going to be sweet, sit where it is put on the bread and add some taste to the toast. The jam might not be great, but it will be somewhat effective at doing a 'jam-like' job. But, here, there's no certainty that the therapies will do anything therapeutic at all. So, it's like asking participants to rate 4 "products" as jams when some or all of the products aren't anything like jams at all.

Sorry, clearly I have spent more time thinking about this paper than it warrants.

 

[bobbler]

Just sounds like something that in any other sector might be using what would be termed as mis -selling of treatment, facts etc

very dodgy using forced choices

And if their facts on outcome are incorrect then if it weren’t theoretical and not actual it would be a consent issue

anyway even if all of this BS wasn’t present then anyone who dies market research knows the least reliable thing you can ask anyone is what they think they might want to do if…

people just can’t predict behaviour.

all ithus surely reflects is the will of the investigator like one big constructed mirror.

 

[cassava7]

Some people may prefer homeopathic or other folk remedies, but why should preference matter if a treatment is not effective to begin with?

 

[Sean]

My preference is for treatments that actually, you know, work, and are safe and available.

 

[bobbler]

My preference is for treatments that actually, you know, work, and are safe and available.

precisely. there should be someone asking why someone would actually do a forced choice of treatments that don't in this kind of research?

there surely should be something of an ethics issue - either of them needing to be updated (if they hadn't anticipated someone would do something like this because it is so ingenuine) or need to be being implemented properly

even if someone isn't getting funding in the direct sense for this, but being 'funded' by their job, there is something to be said for an issue of why being only explained by 'intention to sell' on the basis of what is the equivalent of saying to people with eg terrible hayfever 'would you prefer being made to do a bleep test once remotely or three times in person at a dodgy gym'... there does come a point where if someone isn't doing the research to show up how you shouldn't use these mis-selling techniques then it's beyond any usefulness or 'good'?