When Does Psychological Therapy Count As A Success?

always, if you lower the methodological bar low enough. The just published study by Chalder et al (2021), is an exemplar,  focussing on cognitive behaviour therapy for people with persistent physical complaints (PPS) https://doi.org/10.1017/S0033291721001793:

  • that there was no significant difference in outcome on the primary outcome measure, the self-report Work and Social Adjustment Scale
  • the authors of their report were evaluating their own protocol for PPS [hitherto known as Medically Unexplained Symptoms (MUS)]
  • there was no independent clinical assessment of outcome
  • the control group received ‘standard medical care’, there was no control for attention (the treatment group received 8,  1 hour sessions) 
  • there was no evaluation of effectiveness in a non research setting

Tolin et al ( 2015) https://doi.org/10.1111/cpsp.12122 have presented a clearly defined methodological bar as to what constitutes an Empirically Supported Treatment (EST), that has been adopted by  the American Psychological Association. Far from clearing this bar Chalder et al (2021) protocol  failed on each of the 5 criteria above. In addition Chalder et al (2021) fail to mention that total reliance on self-report measures, this makes the study especially prey to demand characteristics, in that those given attention are likely to want to please the therapists and not to feel they have wasted their own time by indicating a better response than otherwise.

Chalder et al (2021) fail to reference any work that challenges the very concept of MUS e.g Geraghty and Scott (2020) https://doi.org/10.1186/s40359-020-0380-2. The theoretical basis for Chalder et al’s CBT (2021) is that ‘Patients with PPS can develop unhelpful cognitions and behaviour which can consequently lead to a reduction in daily functioning, reduced quality of life, and an increased susceptibility towards developing depression and anxiety’. These authors inform the reader that all those in the study met criteria for fibromyalgia, but by Chalder et al’s (2021) rationale all with a persistent physical symptom require psychological therapy, this would just about swallow up all mental health resources in primary and secondary care. 

 In their statement of Conflict of Interest the authors Chalder et al (2021) indicate their background in the training of IAPT staff, unfortunately it is likely that the treatment protocol will find its way into the organisations ministrations, before any independent evaluation, despite the authors call for further research .  

 

References

Chalder T et al (2021). Efficacy of therapist-delivered transdiagnostic CBT for patients with persistent physical symptoms in secondary care: a randomised controlled trial. Psychological Medicine 1–11. https://doi.org/10.1017/S0033291721001793

Geraghty, K., & Scott, M. J. (2020). Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified. BMC psychology, 8(1), 13. https://doi.org/10.1186/s40359-020-0380-2

Tolin, D. F., Mckay, D., Forman, E. M., Klonsky, E. D., & Thombs, B. D. (2015). Empirically supported treatment: Recommendations for a new model. Clinical Psychology: Science and Practice, 22(4), 317–338. https://doi.org/10.1111/cpsp.12122

One thought to “When Does Psychological Therapy Count As A Success?”

  1. Thank you for highlighting yet another waste of precious research funding.

    These published papers always show success because they are marketing, not research. No one is expected to actually read the paper, or even the abstract. No one is supposed to read past the headlines, which seldom reflect the actual content.

    The UK psychobabble brigade churns out an amazing volume of rubbish research. Every day they add more noise to the scientific knowledge base. I speculate the recent increase in volume is intended to influence the pending NICE review of myalgic encephalomyelitis.

    Unfortunately for Chalder and associates, actual scientific investigators are starting to examine this work. Their personal attacks against patient advocates (“Dangerous ME Militants are criticizing us from their beds!”) and even researchers such as Dr Geraghty and Dr David Tuller, are no longer working. We are not intimidated. We are not going away.

    At this point the BPS crowd don’t know what to do so they do what they know: churn out more and more useless garbage at an ever-increasing rate.

Leave a Reply