{"id":11123,"date":"2016-12-10T09:17:24","date_gmt":"2016-12-10T09:17:24","guid":{"rendered":"http:\/\/wames.org.uk\/cms-english\/?p=11123"},"modified":"2017-08-14T05:24:15","modified_gmt":"2017-08-14T05:24:15","slug":"danish-rct-of-cognitive-behavior-therapy-for-whatever-ails-your-physician-about-you","status":"publish","type":"post","link":"https:\/\/wames.org.uk\/cms-english\/danish-rct-of-cognitive-behavior-therapy-for-whatever-ails-your-physician-about-you\/","title":{"rendered":"Danish RCT of cognitive behavior therapy for whatever ails your physician about you"},"content":{"rendered":"<h3><strong>PLOS blog<\/strong> post by James Coyne PhD, 7 December 2016: <a href=\"http:\/\/blogs.plos.org\/mindthebrain\/2016\/12\/07\/danish-rct-of-cognitive-behavior-therapy-for-whatever-ails-your-physician-about-you\/\" target=\"_blank\" rel=\"noopener\">Danish RCT of cognitive behavior therapy for whatever ails your physician about you<\/a><\/h3>\n<p>I was asked by a Danish journalist to examine a randomized controlled trial (RCT) of cognitive behavior therapy (CBT) for functional somatic symptoms. I had not previously given the study a close look.<\/p>\n<p>I was dismayed by how highly problematic the study was in so many ways.<\/p>\n<p>I doubted that the results of the study showed any benefits to the patients or have any relevance to healthcare.<\/p>\n<p>I then searched and found the website for the senior author\u2019s clinical offerings. \u00a0I suspected that the study was a mere\u00a0experimercial\u00a0or marketing effort of the services he offered.<\/p>\n<p>Overall, I think what I found hiding in plain sight has broader relevance to scrutinizing other studies claiming to evaluate the efficacy of CBT for what are primarily physical illnesses, not psychiatric disorders. Look at the other RCTs. I am confident you will find similar problems. But then there is the bigger picture\u2026<\/p>\n<p>[A controversial assessment ahead? You can stop here and read\u00a0the full text of the RCT\u00a0\u00a0of the study and its\u00a0trial registration\u00a0before continuing with my analysis.]<\/p>\n<p>Schr\u00f6der A, Rehfeld E, \u00d8rnb\u00f8l E, Sharpe M, Licht RW, Fink P.\u00a0<a href=\"http:\/\/bjp.rcpsych.org\/content\/200\/6\/499.long\" target=\"_blank\" rel=\"noopener\">Cognitive\u2013behavioural group treatment for a range of functional somatic syndromes: randomised trial<\/a>.\u00a0The British Journal of Psychiatry.\u00a02012 Apr 13:bjp-p.<\/p>\n<p>A summary overview of what I found:<br \/>\nThe RCT:<\/p>\n<ul>\n<li>Was\u00a0unblinded\u00a0to patients, interventionists, and to the physicians continuing to provide routine care.<\/li>\n<li>Had a grossly unmatched,\u00a0inadequate control\/comparison group\u00a0that leads to any benefit from nonspecific (placebo) factors in the trial counting toward the estimated efficacy of the intervention.<\/li>\n<li>Relied on\u00a0subjective self-report measures for primary outcomes.<br \/>\nWith such a familiar trio of design flaws, even an inert homeopathic treatment would be found effective, if it were provided with the same positive expectations and support as the CBT in this RCT.\u00a0[This may seem a flippant comment that reflects on my credibility, not the study. But please keep reading to my detailed analysis where I back it up.]<\/li>\n<li>The study showed an inexplicably\u00a0high rate of deterioration in both treatment and control group. Apparent improvement in the treatment group might only reflect less deterioration than in the control group.<\/li>\n<\/ul>\n<p>The study is focused on\u00a0unvalidated psychiatric diagnoses\u00a0being applied to patients with multiple somatic complaints, some of whom may not yet have a medical diagnosis, but most clearly had confirmed physical illnesses.<br \/>\nBut wait, there is more!<\/p>\n<p>It\u2019s\u00a0not CBT\u00a0that was evaluated, but a\u00a0complex multicomponent intervention in which what was called CBT is embedded in a way that its contribution cannot be evaluated.<br \/>\nThe\u00a0\u201cCBT\u201d did not map well on international understandings\u00a0of the assumptions and delivery of CBT. The complex intervention included weeks of indoctrination of the patient with an understanding of their physical problems that incorporated simplistic pseudoscience before any CBT was delivered. We focused on goals imposed by a psychiatrist that didn\u2019t necessarily fit with patients\u2019 sense of their most pressing problems and the solutions.<\/p>\n<p>And the kicker.<\/p>\n<p>The authors\u00a0switched primary outcomes\u00a0\u2013 reconfiguring the scoring of their subjective self-report measures years into the trial, based on a peeking at the results with the original scoring.<\/p>\n<p>Investigators have a website which is marketing services. Rather than a quality contribution to the literature, this study can be seen as an\u00a0experimercial\u00a0doomed to bad science and questionable results from before the first patient was enrolled. An undeclared conflict of interest in play? There is another serious undeclared conflict of interest for one of the authors.<\/p>\n<p>For the uninformed and gullible, the study handsomely succeeds as an advertisement for the investigators\u2019 services to professionals and patients.<\/p>\n<p>Personally, I would be indignant if a primary care physician tried to refer me or friend or family member to this trial. In the absence of overwhelming evidence to the contrary, I assume that people around me who complain of physical symptoms have legitimate physical concerns. If they do not yet have a confirmed diagnosis, it serves little purpose to stop the probing and refer them to psychiatrists. This trial operates with an anachronistic Victorian definition of psychosomatic condition.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>PLOS blog post by James Coyne PhD, 7 December 2016: Danish RCT of cognitive behavior therapy for whatever ails your physician about you I was asked by a Danish journalist to examine a randomized controlled trial (RCT) of cognitive behavior &hellip; <a href=\"https:\/\/wames.org.uk\/cms-english\/danish-rct-of-cognitive-behavior-therapy-for-whatever-ails-your-physician-about-you\/\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[1908,11,426,1909,2272,2150],"class_list":["post-11123","post","type-post","status-publish","format-standard","hentry","category-news","tag-andreas-schroder","tag-cbt","tag-cognitive-behavioural-therapy","tag-per-fink","tag-prof-james-c-coyne","tag-prof-michael-sharpe"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p5qkYK-2Tp","_links":{"self":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/11123","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/comments?post=11123"}],"version-history":[{"count":2,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/11123\/revisions"}],"predecessor-version":[{"id":14014,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/11123\/revisions\/14014"}],"wp:attachment":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/media?parent=11123"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/categories?post=11123"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/tags?post=11123"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}