The evidence for CBT in any condition, population or context... A meta-review... and panoramic meta-analysis, 2021, Fordham et al.

because there are no pro's to make believe ideology that harms every patient that ever comes into contact with an idiot who thinks they can see into the thoughts of people and attribute their illness to those thoughts . is it really stupidity or a desire to negate their responsibility to the patients who after all are also their employer . i truly wish that a better system for weeding out the useless members of the medical profession existed .

 

"a type of review that goes beyond the common approach of looking at a specific patient population (indication) and instead examines the effects of a given treatment across different indications."

"There are as yet no indexed terms in electronic databases for multiple-indication reviews. Different names such as “agenda-wide review” [11], “umbrella review” [2], and “panoramic meta-analysis” [6], [12] have been used in the literature to describe multiple-indication reviews."

https://www.sciencedirect.com/science/article/pii/S0895435614003394

 

They did a systematic review of systematic reviews without reviewing the actual trials. (This wasn't intended as a joke, it's actually what they have done).

The effect size across these reviews seems to be quite small not modest (0.23 standard deviation). If they looked at studies that used an active comparator the effect was no longer statistically significant and almost reduced to zero (standard mean difference: 0.09 (95% CI −0.01 to 0.19)).

 

https://twitter.com/user/status/1352373068304445442

 

Yes oops. Thanks for noting. Corrected it:

https://twitter.com/user/status/1352381486050267140

 

Don't know if I've mentioned this before, but until a year or two ago I had a lifelong paralysing fear of spiders, and if no-one was in the house to rescue me when I screamed I'd have to go and get the neighbours. I knew that there was an effective therapy but never went or kept putting it off.

Then I recently found a couple of apps. One of them started off with cartoon pictures, then moved on to tiny real spiders, gradually getting bigger and more scary. I had to erase them from the screen by running my finger over them. The other app had virtual reality spiders which moved very realistically.

One of the apps also had a CBT diary part, which was apparently essential, where I had to write down how I felt, note on a 1-10 scale how scared I was, analyse what I associated my fear of spiders with etc etc. "Bollocks to that nonsense" I thought, "I'll just do the pictures". So I did over a period of weeks, and it worked. I am now the house spider remover, and when a large one appeared in my office I left it there and considered it a pet for 3 weeks, saying "Good morning Incy Wincy" every day when I walked in. I even watched a few documentaries about spiders. Fascinating creatures.

The point is, gradually acclimatising myself to looking at spiders over a period of weeks did the trick. The CBT psycho diary feelings bit was tagged on, unquestionably considered an essential component, and would be given the credit for any success. If it hadn't worked for me it would have been my fault for not engaging with the method properly and opening up about my feelings. I decided that was a pile of shite I could do without, and I achieved a very successful outcome without it. And I really cannot emphasise enough how scared of spiders I had been for 50 years before doing it.

I wonder how often CBT is tagged on to something that already works, then advertised as the main feature and given the credit.

 

My memory of research on treating phobias, albeit forty years out of date, was that the key thing was sufficient exposure to the object of the phobia, at least where there was a specific concrete object such as spiders. Dressing up that exposure in different ways did not make a lot of difference to effectiveness, though different approaches may be more or less palatable to those experiencing them.

One thing that had previously struck me was that there was some parallels between the PACE approach to CBT/GET and approaches to treating phobias.

 

A while ago I looked through the CBT Festschrift for Gelder and came away with the distinct impression that CBT started as a plausible treatment for anxiety and phobia and then extended into more and more implausible conditions. It always seemed that the fear of exercise had to be introduced into CFS to give some allegedly legitimate point to the treatment.

 

My grandson had undiagnosed autism and became severely anxious about mixing with people. CBT did help him quite a lot.

He was disgusted with himself that something that was so easy for everyone else was hard for him and he knew the distress he was causing to the people he loved so he was becoming suicidal and deeply depressed.

The psychologist helped him to see that he had an illness that was nothing to do with moral failings and to give him a sense of self confidence by taking emotion out of the situation and making it a set of small problems he could either solve or or leave aside to concentrate on something else.

Being diagnosed with autism has helped, of course, as he now knows his symptoms are common enough with that and not of his own making.

It was the opposite of the LP where children are forced to believe everything is their own fault and they could become normal if they only worked hard enough.

 

One of the authors of this meta-review is Paul Stallard :

https://me-pedia.org/wiki/FITNET_trial

From his university's website: https://researchportal.bath.ac.uk/en/persons/paul-stallard :

"Paul Stallard is the author of 'Think Good Feel Good: A cognitive behaviour therapy workbook for children and young people' and Editor of the book series 'Cognitive Behaviour Therapy with children, adolescents and families'.

"He is an active researcher and has led large multi-site randomised controlled trials evaluating the effectiveness of school based CBT programmes on depression (PROMISE) and anxiety (PACES).

"He is interested in the use of techology to deliver interventions to children and young people has developed a computerised CBT programme (Think, Feel, Do), an app for adolescents who self-harm (BlueIce), and is part of a project exploring the use of a computerised CBT programme for children with chronic fatigue."