Psychosocial Interventions and Immune System Function

The conclusions drawn from psychosocial studies always read as if robustly positive.

While a meta analysis can't pull out information that isn't there I can't help but note that while they claim better immune functioning at the end of CBT there is no mention of whether the people in the trial felt any relief of symptoms / improved functioning.

There were no less than 6 study limitation mentioned I'll quote 4 through 6:

Fourth, the control groups in the studies examined varied considerably, and it can be difficult to blind participants to their condition assignment in a psychotherapy RCT. Therefore, placebo and expectancy effects are possible. Fifth, although random assignment should equate intervention and control group participants on factors such as comedication and cotreatment, some study groups could have differed in the extent to which participants took some forms of medication or received other forms of treatment. Sixth, some effect sizes estimated in the moderator analyses may have been nonsignificant because of low statistical power. This is especially true for the analyses involving intervention type and disease state or reason for seeking treatment. Finally, although these data indicate that psychosocial interventions are associated with enhanced immune system function, they do not elucidate the mechanisms underlying these associations. It has been suggested that reductions in stress-related neural or psychological processes may help explain such associations,3-6,106
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In the fifth limitation they point out that some interventions may have included medication of participants -- it's not clear how many studies may have been affected by that.

Also, when you read the discussion they are claiming their therapy approach as an adjunct to other therapy (medication is implied). So the capacity of CBT to effect change is not seen as a solution on it's own for improving immune function. The benefit of including CBT for all your health needs being it's cost effectiveness.
 
I thought some CBT for CFS studies also tested immune markers with null results such as the study by Lloyd et al. 1993 and the one by Jason et al. 2007. I don't see these included.

One explanation might be that the data of null results aren't displayed in the paper: the authors simply say 'null results, not interesting' and do not provide the data so that the authors of this review couldn't use it in their meta-analysis. [EDIT- or perhaps the CFS studies simply didn't use the immune markers used in this study]

The scope of this review and the number of included studies is so big that it is really difficult to check if they included all studies or check if the included studies are of decent quality. I hope the reviewers were able to check. Can anyone find the supplementary material?
 
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Recent estimates suggest that more than 50% of all deaths worldwide are currently attributable to inflammation-related diseases. Psychosocial interventions may represent a potentially useful strategy for addressing this global public health problem, but which types of interventions reliably improve immune system function, under what conditions, and for whom are unknown.
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I'm sorry but this reads exactly like detoxing or optimizing the immune system or other junk pseudoscience. How does someone make the mental leaps from inflammation to CBT? And if we are talking about the possibility of half of all mortality, it really sounds like efforts should be somewhere between 1,000 and 100,000,000 more serious than "hey, maybe CBT could do something or whatever".

What even is "enhanced immune system function"? Is that even a valid notion or just some arbitrary benchmark? It is defined as:
indexed by lower proinflammatory cytokine or marker levels (t17.1 = 3.68; P = .002), higher immune cell counts (t9.9 = 2.96; P = .01), higher natural killer cell activity (t2.1 = 4.48; P = .04), and improved other immune outcomes (eg, blastogenesis, number of postoperative infectious diseases
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Given the standard of research in psychiatry, especially where psychosocial stuff is considered, it's hard to trust in the reliability of the underlying work.

Psychiatry is officially a joke discipline.
 
Michiel Tack said:
Don't think psychiatry is the problem. I suspect that for people with something like schizophrenia or severe depression psychiatrists can be useful.
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There is definitely a problem when people from multiple countries very consistently produce junk science and react with hostility to criticism.

It's hard to precisely define the boundaries of this problem within research and disciplines. While it's true that the core group of these junk scientists seems small, a lot of psychiatrists believe in things like functional somatic syndromes, in factitious or fabricated illness by proxy and so on which can easily cause a nightmare scenario for patients. These problematic labels also often lack a scientific basis. It's unclear if these are real phenomena or just a narrative applied to certain situations.
 
Michiel Tack said:
Don't think psychiatry is the problem. I suspect that for people with something like schizophrenia or severe depression psychiatrists can be useful.
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It sure can but a discipline is evaluated on its whole performance, this is the difference between professionals and amateurs. And it would fare so much better in areas they can actually help if they let go of this kind of nonsense, in a way they are impeding their own progress by holding on to grandfathered myths built on magical thinking.

You won't find an astrology lab anywhere in any NASA lab or office. Because they are serious disciplines that may have fringe people but not entire fringe movements like this.
 
this is why I do not trust meta analysis of anything people cannot be trusted to go through all these papers and there highly suspect methodology using computers to isolate particular words phrases and graphs tells us nothing about quality .A profession that mass produces copy paste papers will always get positive results from idiots who are to lazy to do the hard work of looking at each paper and its methodologies before even attempting to sift through the data to find anything that is statistically meaningful .
 
Coyne said:
Many studies were early, grossly underpowered studies with whole battery of immune measures assessed, but only positive findings emphasized in original papers.
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I don't think we have to look much further for an explanation than this - cherry-picking random results. We've seen too many rubbish CBT studies to think that a meta-analysis of them is going to reveal some important truth.
 
Interesting to see that the authors define RCT as 'randomised clinical trial' rather than 'randomised controlled trial':
To address these issues, we conducted what we believe is the first systematic review and meta-analysis of randomized clinical trials (RCTs) that have examined the effects of a psy- chosocial intervention on immune system outcomes.
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They do seem to have required control treatments of sorts though:
To be included, studies had to have randomized par- ticipants to a psychosocial intervention condition or a con- trol condition (ie, any condition lacking a psychosocial intervention component, such as a treatment as usual or wait- list control condition).
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Coyne said:
Almost all studies have control/comparison groups that are not matched in nonspecific factors.
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Yes, of course, a wait-list or TAU control means that those participants probably did not receive the benefit of the group interaction that was part of many of the psychosocial treatments. It's pretty easy to imagine patients chatting amongst themselves, hearing of more effective medicines and management techniques to actually improve their illness (e.g. HIV) or condition. I guess it's possible that the social interaction helped too - maybe people dealing with a bereavement might have better immune function if they have a chat with others going through the same thing once a week. But improvement in a group treatment relative to a wait-list or TAU control is not evidence that e.g. CBT is better than a patient support group.

Edited to add:
As shown in Table 1, the most reliable intervention-based associations were found for individuals receiving treatment for HIV, auto- immune disorders, cancer, and insomnia.
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These are all conditions where patients could probably pick up information on medicines and management from other patients that made a real difference to their health.
 
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More on the group treatment effect:
For all interventions there was a higher improvement in treatments with group sessions (0.38 vs 0.20 for no group sessions).
Screen Shot 2020-06-05 at 11.03.47 PM.png

Just for CBT, there was also a higher improvement in treatments with group sessions (0.36 vs 0.28 for no group sessions) although the paper reports that the statistics don't support the difference being significant (that's the P value of 0.53).

Screen Shot 2020-06-05 at 11.06.01 PM.png
 
One last comment:
This comprehensive review of 6 RCTs revealed that psychosocial interventions were significantly associated with enhanced immune system function, as indexed most consistently by intervention-related decreases in levels of proinflammatory cytokines or markers (eg, interleukin-6, C-reactive protein) and, secondarily, by increases in immune cell counts (eg, CD 6, CD4) over time.
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Is an increase in immune cell counts always a good thing?
A study on obesity thought not:
Increasing body weight is associated with higher CD4, CD8, total lymphocyte, and WBC counts in women. ...The increased number of immune cells associated with obesity may be the result of a chronic inflammatory state due to increased cytokine production by adipose tissue.
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:confused:
 
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