Shared Individual Formulation Therapy (SIFT): an open-label trial of a new therapy accommodating patient heterogeneity in [FND], 2021, Gutkin et al

Full title: Shared Individual Formulation Therapy (SIFT): an open-label trial of a new therapy accommodating patient heterogeneity in functional neurological disorder

Background

Functional Neurological Disorder (FND) is a complex neuropsychiatric condition with a multifactorial aetiology. The heterogeneity of patients with FND is rarely considered in psychotherapy trials, which may contribute to variable outcomes. Shared Individual Formulation Therapy (SIFT) is a new, brief (four session) psychotherapy that aims to accommodate heterogeneity by providing a personalised, trans-theoretical formulation of the person’s difficulties and accompanying management plan.

Methods
An open-label, prospective trial of outpatient SIFT for adults with FND was conducted, using health-related quality of life (SF-12) as the principal outcome measure, with secondary measures of mental health, dissociation, health care use and attitude to the FND diagnosis. Measures were collected at baseline, end of treatment and 6- and 12-month follow-ups.

Results
Twenty-nine participants with various FND symptoms enrolled. Twenty-four completed all four sessions and 25 completed follow-up measures at 12 months. SF-12 scores improved significantly at end of treatment and were sustained throughout follow-up with moderate effect sizes (0.39–0.47; all p < 0.001). Most secondary outcomes also improved significantly at all time points. The intervention was highly acceptable and tolerable to patients and perceived as beneficial.

Conclusion
This trial provides preliminary evidence for initial and sustained benefit from SIFT for adults with FND. Further study is needed to validate these findings.

Paywall, https://link.springer.com/article/10.1007/s00415-021-10797-y

 

In clinical pharmacology it takes tens of thousands of scientists decades to develop treatments, 95%+ of which fall at one hurdle or another, to get a few effective treatments.

In clinical psychology all you need to do is ask the patient some gossipy questions about themselves and dream up a theory and a treatment on the spur of the moment. You can be pretty guaranteed that they will improve and say the treatment was acceptable and tolerable.

Where is the catch?

 

This is basically the "anyway, here's (a remake of) Wonderwall" of cover band musicians. They just keep creating models and "treatments" for those models in an endless loop, all clearly derived from the same idea, all so nearly identical it is essentially the same thing the way a remake of a song is still mostly the same song.

And as Jonathan said, somehow, it always "works". Every damn thing they try just happens to "work", even with the most minimal effort of a copy-paste formula. It can't ever be defined what it "works" at, but it somehow always does "work".

And yet, somehow, despite every thing they try always working, for decades on end, they are still at the original stage of trying a bunch of stuff that never goes anywhere, because the only thing that matters in all this is this simple nugget of time loop: more research is needed. Always more, always the same, never going anywhere. But they NEED it.

 

And apparently you don't need to compare it to anything, either. Even without a comparison group, you can make claims of effectiveness, as these people do, and as Chalder recently did in her study of GET results from the clinic.

 

This is not an experimental trial, at best it is a feasibility study as to whether it would be practicable to conduct such a trial.

Though given it is an open label trial with subjective outcomes, they would have been far more productive putting the effort into developing objective outcome measures.

 

The trick is in how you define 'works'. For psychology/psychiatry, you just choose some unquantifiable targets and choose your questions to give your desired results.

 

This is crucial. However they fail when they do this. So far their research relies on subjective outcomes in which therapy essentially coaches patients on how to fill in the questionnairre.

 

Actually funny that in the BPS article I shared in another thread with an interview with Jo Daniels, CBT 'works' is quoted in the article. They know that it's only valid to say it 'works' as long as you don't define work as meaning the same thing it actually does.

They know it can't be argued that it works, only that it 'works'. Which doesn't stop many people from saying so, but always dependent on the target audience. This was meant for other psychologists and so they have to be more precise, they simply remove the quotes in other settings because the very nature of a con is simply to express confidence that it 'works'.

 

And draw a model with arrows when you're really serious about it. You can't have a proper model of your fabricated illness mechanism without arrows. Arrows are fancy.

 

Just to point out that this Gutkin is the same lead author who last year published a systematic review hyping the purported evidence that psychological therapies are effective interventions for functional neurological disorders. He announced that as his first published paper. i guess we're unlucky enough to be discussing the second one.

 

And here he is.

https://twitter.com/user/status/1440655275074023444

 

Really seems like he nailed it at "Spontaneous remission explains B+A vs RCT diffs" and could have stopped there. It really does explain it all, the numbers showing benefits fall far below the known natural remission threshold.

It's the exact same process behind why people recover from the flu or a common cold by putting a potato in their sock. They would have anyway.

But this is just illustrative? OK, then. Why not? It's just people's lives, no big deal.

 

It's easier than you think.

For example Symptoms Hidden from Inventory Therapy.