Qualitative study of the acceptability and feasibility of acceptance and commitment therapy for adolescents with [CFS], 2021, Crawley et al

Discussion in 'Psychosomatic research - ME/CFS and Long Covid' started by Sly Saint, Apr 25, 2021.

  1. Hutan

    Hutan Moderator Staff Member

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    @Ravn, you expressed the feelings I share about ACT for ME/CFS very well. And @Robert 1973's letter is great.

    I think this study is a reaction to the realisation, expressed in the draft NICE guidelines, that CBT is not a treatment for ME/CFS. So here is this new thing that can be rolled out by all of the existing infrastructure. It is promoted as a treatment, not just psychological support, and yet at the same time it's suggested that it isn't going to change symptoms.

    Within that fuzziness is an awful lot of room for misrepresentation, and for therapists themselves to get confused about what they actually can achieve. We can see that happening here.

    From the paper:
    @adambeyoncelowe, @Keela Too , it's worth reading this paper to get a sense of what clinic staff might be offering and thinking about. Crawley et al appear to be wrestling with how they will deliver all of CBT, GET, Activity Management and now ACT to exhausted children who, as part of these therapies are being told to do more, and change their values so that they be all that they can be. If ACT is the next new thing, it may need to be covered in reasonable detail in the NICE guidelines, acknowledging that it is not a treatment, and giving some guidance on how to deliver it safely.


    This is the paper:
    Jonsjö M, Wicksell R, Holmström L, et al. Acceptance & Commitment Therapy for ME/CFS (Chronic Fatigue Syndrome) – A feasibility study. J Contextual Behav Sci. 2019;12:89–97 doi: 10.1016/j.jcbs.2019.02.008
    It's discussed here by @Michiel Tack:
    Discussing acceptance and commitment therapy in ME/CFS.

    From Michiel's letter to the editors and their reply defending ACT, it looks like, in the wrong hands, there is a lot of scope for harm. Coming from a chronic pain paradigm, it looks as though it can be used to encourage people to accept higher levels of pain, in order to increase functionality. That, of course, is only sustainable to a point with any health condition, and is particularly unsuited to the reality of ME/CFS.

     
    Last edited: Apr 26, 2021
  2. Trish

    Trish Moderator Staff Member

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    There is absolutely no evidence that any psychological therapy is an effective treatment for ME/CFS. So if the NICE guidelines committee do decide to name ACT, it should be on the list of unevidenced therapies that shouldn't be offered as treatments.

    Personally I find the idea of a healthy therapist instructing me on accepting my symptoms and disability demeaning, insulting and more like some of the aspects of religion I find most unacceptable, than health care.

    Sure, any named therapy in the hands of an empathic and skilled therapist may help some people who want them to cope with various distressing situations, but they should not be first line treatments for physical diseases.
     
  3. mango

    mango Senior Member (Voting Rights)

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    Jonsjö's supervisor Gunnar Olsson talked about ACT for ME in a webinar recently, mentioned briefly that they have realised along the way that their usual ACT model isn't suitable for pwME(!):

    https://www.s4me.info/threads/swede...-act-for-me-hosted-by-bragée-me-center.20149/

    My impression of what Olsson said in the webinar is that the ACT for ME model they are using today is very different from the one described in their study protocols (see threads linked in the webinar post for more details about them).
     
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  4. Adrian

    Adrian Administrator Staff Member

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    I suspect if you promote a potential treatment to patients where there are none you will get a relatively positive result from many. Hence I was wondering if you really want to know if patients find a potential therapy acceptable how you describe it is critical but also you could do a comparison with other made up or alternative therapies and this may help show the underlying thing of people will try anything or anything that seems remotely feasible.
     
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  5. FMMM1

    FMMM1 Senior Member (Voting Rights)

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    I think this is @Jonathan Edwards comment - the (dud) meal ticket lovingly polished -- how much money have they got certainly £millions - £10 million in total? Plus that provides the Government with an excuse/response - funded £xmillion -- children --- all the usual buzz words.

    I wonder if we could link the outcome of the NICE review, which considered the evidence to be poor, and the fact that this research is publicly funded - I'm in te UK and I for 1 object.

    @Trish maybe worth writing to the public accounts committee outlining that NICE have labelled these studies as poor and asking is this just jobs for the boys (in-folks getting public money). Also, have a go at the sponsoring body [anyone know who this is?] MRC or Government Departments are likely the funders.

    An MP has offered to write a question so may try to link all of this to the wider public perception of sleaze (in-folks getting public money for poor quality studies) - in my view at least it is.
     
    Last edited by a moderator: Apr 26, 2021
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  6. It's M.E. Linda

    It's M.E. Linda Senior Member (Voting Rights)

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    From memory, I think 3 MPs in the Committee for Science and Technology in the last Parliament tried something when discussing ‘Research Integrity’. (Supportive MPs were Norman Lamb (Chair), Carol Monaghan & Darren Jones)


    Also from memory, Meg Hillier, Chair of the Public Accounts Committee was sympathetic when GET was previously raised at Committee level, but was hampered by lack of evidence?

    Something could gain more traction now that NICE can be quoted that the studies were ‘poor or very poor’.
     
  7. It's M.E. Linda

    It's M.E. Linda Senior Member (Voting Rights)

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    Oral Evidence 8 May 2018

    Questions raised by Carol Monaghan with Sir Patrick Vallance about the release of data on the PACE trial

    http://data.parliament.uk/writtenev...-committee/research-integrity/oral/82537.html

    Then, another member of the Committee asks (my bolding):

    “ Vicky Ford: Again, this is just an observation. When Dr Goldacre was here, he was very focused on the point that all trials needed to report their results —not necessarily the raw, granular data, but the results—especially if trials had not shown positive benefits from treatments, so that that was known. I want to hear from the Minister whether he is backing the campaign to make sure that all trialresults become known. The suggestion was that, at a minimum, people who routinely do not publish their trial results should find it more challenging to receive public funding for future trials.”
     
  8. Robert 1973

    Robert 1973 Senior Member (Voting Rights)

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    I managed to edit my comment which has now been published below the preprint: https://www.medrxiv.org/content/10.1101/2021.04.20.21255804v1
    I’m minded to submit something similar to the journal when the final paper is published, assuming it’s much the same. If someone could tag me when it’s published that would be helpful in case I miss it.
     
  9. Andy

    Andy Committee Member

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    Just checked, no public response from the authors so far.
     
  10. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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  11. NelliePledge

    NelliePledge Moderator Staff Member

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    Is it time? No it is NOT.
     
  12. Denise

    Denise Senior Member (Voting Rights)

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    And it never (!) will be!
     
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  13. dave30th

    dave30th Senior Member (Voting Rights)

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    We will see many papers in progress that will be immediately out-of-date the minute they're published because of their references to "evidence-based" treatments (ie GET and CBT). Peer reviewers should immediately flag this issue, although most of them won't because they all mostly believe the exact same thing as the authors of these nonsensical papers. (Added): What will be most interesting to see is if anything changes assuming NICE publishes the guideline--will this bullshit still receive funding from UK agencies?
     
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  14. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

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    Reading the abstract, it seems randomisation would be a problem because children didn't want to be randomised.

    So, once again, that suggests people are a) either desperate for any treatment or b) desperate for the treatment that is currently being hyped because it's being hyped.
     
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  15. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    ACT always sounds to me like "suck it up and go away" therapy.
     
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  16. rvallee

    rvallee Senior Member (Voting Rights)

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    Better do this 28x more times just to be sure, how can we really know if something commonly used is feasible? After all, this exact study has only been done many dozens of times so far.

    What we really need to find out, though, is whether it is feasible for participants to drink a glass of water and evaluate how fresh it is. Maybe it's unfeasible and this would revolutionize our understanding of the relationship between the body and water. Better try it no less than 44 times.

    In my working days I worked a lot on BS marketing stuff, websites built specifically for a campaign that just gets thrown away once the date has passed. And it felt pointless, unproductive, but compared to this, I was basically doing something massively productive and rewarding.
     
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  17. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Has anyone any idea what this sentence is supposed to mean and how an intelligent professor can allow their name to be put on a paper that includes it?

    I cannot think of any particular issues around randomisation, other than needing a randomised set of allocations. And what has it to do with the actual treatment?
     
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  18. rvallee

    rvallee Senior Member (Voting Rights)

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    I usually defer to the famous Watergate quote, it fully applies: "the truth is, these guys are not very bright guys and things got out of hand". So far it works 100% of the time.

    I don't think memorizing textbooks fully qualifies as intelligence, though it can mimic it convincingly. It takes especially dull minds to mindlessly repeat the same nonsense for decades, anyone actually smart would be bored to death right away. That's the giveaway, that they aren't even bored of this yet.
     
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  19. dave30th

    dave30th Senior Member (Voting Rights)

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    When i asked questions about Professor Crawley's questionable work, the Bristol University vice chancellor filed multiple complaints with Berkeley's chancellor about my "behaviour." So ask questions about her work at your peril!
     
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  20. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    They know about my behaviour at UCL.
    And Crawley was once one of our trainees!
    But I realise that two premises don't necessarily make a syllogism.
     
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