Therapy could be offered to women suffering menopause symptoms | Menopause | The Guardian
I'd be careful about Mr Ferriss's overconfident generalisation of his own experience, his dismissal of journaling, and his scare quotes around "problem" — he's a sample of 1.
There's no silver bullet. Sometimes you need to work on cognition (e.g. journaling), sometimes on behaviour, sometimes on mindfulness, sometimes on exposure to anxiety triggers, sometimes you need medication, and often some combination of those. Everyone is different.
By David Tuller, DrPH
*This is a crowdfunding month at UC Berkeley for my Trial by Error project. If you appreciate my work and would like to help support it, here’s the link for this November’s campaign.
As I pointed out last month when I reviewed a ridiculous study of “psychosomatic therapy” for “persistent somatic symptoms,” the Dutch psychologizers can’t seem to stop churning out poor-quality research purporting to support claims that their interventions are effective. Before the psychosomatic therapy study was the one investigating cognitive behavior therapy (CBT) for fatigue associated with long Covid, in which the authors declared success but failed to disclose that they had null results for their one objective measure—how far participants moved, as assessed by actigraphy.
Now we have another study of this ilk, this time a meta-analysis of individual patient data from a batch of studies of CBT for ME/CFS: “Does the effect of cognitive behavior therapy for chronic fatigue syndrome (ME/CFS) vary by patient characteristics? A systematic review and individual patient data meta-analysis.” The lead and senior authors are the same as for the recent study of CBT for long Covid –Dr Tanja Kuut and Professor Hans Knoop, both from the University of Amsterdam.
The new meta-analysis was published by Psychological Medicine, a journal that is essentially an in-house publication for the stream of shoddy papers emerging from members of the CBT/GET ideological brigades. (The Journal of Psychosomatic Research performs a similar function.) To make it more of an inside job, all eight studies included in the meta-analysis were done by investigators from the same group of researchers that includes Dr Kuut and Professor Knoop.
Given the background of both the authors and the journal, low expectations for this meta-analysis would be warranted. And such low expectations are rewarded. The authors seem to think that by slicing and dicing old data in new ways they will come up with refurbished findings that bolster their case. But this notion is a delusion.
Here is a quote from Professor Knoop in a press release about the study: “These results give a clear picture that CBT can be beneficial for a substantial number of patients.” But Professor Knoop and his colleagues still fail to grasp or acknowledge an essential problem–studies that are unblinded and rely solely on subjective outcomes for their claims of success are prone to an unknown amount of bias. The results are therefore hard if not impossible to interpret. All eight studies included in this meta-analysis featured this design. Meta-analyzing data fraught with bias does nothing to improve the quality of the data or minimize the bias.
To justify this reliance on subjective outcomes, the paper includes the following statement: “All case definitions of ME/CFS rely on reports of patients of subjectively experienced symptoms. Therefore the efficacy of interventions aimed at symptoms of ME/CFS can only be determined with patient-reported outcome measures.”
This is simply untrue. The efficacy can also be assessed by objective indicators of actual functioning—such as actigraphy, which measures physical movement. The investigators themselves know this, since they have used actigraphy in previous research. Other possible indicators include employment status, social benefits status, and assessments of physical fitness and walking ability. None are perfect. But they are certainly relevant to determining the efficacy of “interventions aimed at symptoms of ME/CFS.”
In previous research of CBT for ME/CFS from members of the Dutch group of investigators, the actigraphy results have been poor, in contrast to the positive subjective reports. Those findings were left out of the original trial reports—as they are left out of this meta-analysis. Ignoring null objective findings while touting positive subjective ones is the epitome of what would be called cherry-picking. This self-serving decision is unacceptable and raises questions about the integrity of the authors as well as of the meta-analysis itself.
The eight studies included a total of 1298 participants. The primary outcome was fatigue severity; the secondary outcomes were functional impairment and physical functioning. The studies confirmed the basic principle that unblinded trials testing therapeutic interventions and relying on subjective outcomes will tend to yield positive results. No surprises there! According to the meta-analysis of moderating factors, the effects of CBT varied with age, functional impairment status, and whether participants’ activity levels were what the investigators called “fluctuating.” The meta-analysis found no differences in outcomes according to whether or not participants reported having post-exertional malaise (PEM).
The article is one of a number recently that tried to push back against the 2021 ME/CFS guidelines issued by the National Institute for Health and Care Excellence (NICE). These guidelines reversed NICE’s previous recommendations for CBT and GET as curative treatments, although they allow for CBT as a supportive intervention. As part of its decision-making process, NICE placed greater weight on studies that required the presence of PEM. The authors of the new meta-analysis make it clear they believe that decision to be unjustified, asserting that “our findings do not support the decision of NICE to downgrade evidence from studies not mandating the presence of PEM in their updated guideline.” In reality, their findings are neither here nor there regarding this matter. The authors claim that most of the participants in the combined sample experienced PEM, but it is unclear how or how carefully this trait was assessed in each of the included studies.
The meta-analysis also notes this: “In the Cochrane risk of bias tool studies are penalized if the outcome assessor (the patient) was aware of the intervention received. However, this limitation is inherent to the evaluation of behavioral/psychotherapeutic interventions using a subjective outcome measure.”
It is true that this limitation is inherent to the study design mentioned—an unblinded trial relying on subjective outcomes. But that recognition doesn’t mitigate the bias generated by this combination of factors. These authors have themselves chosen not to include objective measures of functioning. Given that choice, they don’t then get to exempt their work from being penalized for this obvious deficiency. Like other offerings from Professor Knoop and his minions, this methodologically defective paper is a piece of crap. The reported benefits for CBT cannot be taken at face value.
(Originally posted on Virology Blog.)
I'm actually going to read a bit about the intersection between Buddhist psychology and cognitive-behavioral therapy. The core of Buddhism is the curing of suffering, and I need to become my own therapist if I want to consistently contribute to everyone else.
Roca Inc. is a program in #Massachusetts & #Baltimore that trains #shooters to refrain from shooting by literally changing their minds through #CBT. Learn how the programme helps interrupt the cycle of #violence.
All I did was read the first hit and I immediately realized it was just stupid. The thinking, not the worksheet.
I just sort of laughed with relief and the thinking melted away for hours. I should probably pursue this more...
One of many very similar worksheets:
"... Sir Simon Wessely, one of the most powerful figures in the British medical establishment.
"A man whose bad science, ego and ideology have for decades set back research into myalgic encephalomyelitis/chronic fatigue syndrome and treatments for the disease. ...
"Countless people were harmed... by following these junk cures."
David F Marks (an eminent academic psychologist)
Professionals have let down patients by not alerting everyone to this issue
Please also see the full paper here too: https://www.cambridge.org/core/journals/the-cognitive-behaviour-therapist/article/cognitive-therapy-for-ptsd-following-birth-trauma-and-baby-loss-clinical-considerations/B16190E8FA6C537D6E7F7B7F7C59D459
BCP New paper: Cognitive change before sudden gains in cognitive behavioural therapy for panic disorder
Fill free text at https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/cognitive-change-before-sudden-gains-in-cognitive-behavioural-therapy-for-panic-disorder/A64726A503EBD9E76F057ED6EF25B0F4
It's nice to be learning to live *with* my anxiety disorders harmoniously.
Rather than trying to stamp it out and push back on it indefinitely.
Funnily enough, my anxiety has improved because of it! Thanks for nothing, CBT.
We are going to meet in a 5 star skyscraper hotel with a nice view on Frankfurt's skyline.
This Sunday could be much worse 😎
"Despite Resistance, Policy Makers Push The Paradigm On ME/CFS And Long COVID"
by Prof Brian Hughes ( @b_m_hughes ), Prof Steven Lubet & David Tuller DrPH
#MyalgicEncephalomyelitis #ChronicFatigueSyndrome #MEcfs #CFS #PwME @longcovid
#LongCovid #PwLC #postcovid #postcovid19 #LC #Covidlonghaulers #PostCovidSyndrome #longhaulers
#GradedExerciseTherapy #GET #cognitivebehaviouraltherapy #CBT
#askingautistics I did some exams and it confirm my lack of deep sleep 😴
I just have a bunch of naps all night.
Does any #actuallyAutistic here have done Cognitive Behavioral Therapy for that kind of trouble ?
There is this French website that the doctor recommended me https://www.therasomnia.com but I am a bit skeptical…
It’s amazing what kind of clarity and introspection #CBT can give you. My session today was pretty eye-opening. Even if those eyes became Niagara Falls.
"They didn’t understand PEM. I was told if I didn’t try GET it meant I didn’t really want to get better. I was told it was impossible for exercise to harm. They told me how GET helped patients much sicker than me with MS, stroke & Parkinsons. If they could do it, why couldn’t you."
Response to this on the bird site:
"The head psych I had to see at my local hospital for CBT & GET had never ever read any scientific papers about ME outside the field of psychology. I found this out as I was asking how his statements fitted with the science I had read. GET ended up disabling me permanently (contd.)"
My friend and fellow erotica writer Scarlett Thomas Wolfe's new novel The French Domme's Diary, is out. If you love hardcore femdom, I'm certain you will love this book. It explores a variety of femdon-related kinks in intimate and explicit detail. Not for the faint of heart.
It seems pretty popular to hate on #CBT (therapy) lately and while I have some harsh critiques of it myself, it did help me quite a bit for many years. It’s worth giving a try with some caveats. (Like try not to use it as denial of actual ongoing trauma.)
#cbt just seems like:
Patient: “everyone hates me”
Therapist: “everyone? All 7 billion people on earth?”
Patient, if the patient was at all honest: “no you raving loon, you fucking banana, you complete imbecile, I was using what your middle school English teacher called a hyperbole, it is a form of exaggeration for effect, the effect being that I am upset. Have you never heard of these or any type of figurative language whatsoever? How did you manage to get those fancy degrees when you’re this stupid?”
Actually, because the patient is afraid of being punished by the therapist for being honest: “I guess not.”
For the first time, #PwME have our own infhografic thanks to the collaboration between Spanish Patients Association #PEM @/AsociacionPEM and #phisicians of #Spanish #PrimaryCare Sociaty @/SEMG_ES (feel free to tell me wrong concepts).
NO graded exercise therapy (#GET) nor cognitive-behavioral therapy (#CBT).
#MEawarenessHour #MEcfs #Inphografic #MyalgicEncephalomyelitis #disabled #dependence #health #exarcise #psychology #AltText4ME
Cognitive behavioral therapy (#CBT) helps with severe #fatigue associated with #LongCOVID. The CBT addressed disrupted sleep/wake patterns, unhelpful beliefs about fatigue, low/uneven activity level, perceived lack of social support, psychological processing of COVID, fears and worries about COVID, and coping with pain.
Oops, almost missed these 2 😂
I had this on, IIRC called the "Ball Buster", and this is where I got the ring on. Looser when I'm not so hard 😂
None of these toys actually tell you how they're meant to be worn, this seems to be it, though? I've masturbated with this on a few times, but it's not my favorite
(edit: forgot the alt text, sorry, I'm tired. Black leather CBT device with snaps in the front of the balls, and flaps that snap around the cock!)
Next up is this ball separator thing. I don't think red is really my color 😂but it feels pretty good!
You can see I've got the ring on now, and even fairly hard, it's got a bit of a gap. It's not so loose it will fall off, but it also doesn't do much for me. I think it would be more fun if it were a little tighter!
Hi friends! I'm back with some more pictures from yesterday!
Here's the toy I said might be too big. Let's investigate! Also, my #balls got some more attention. We're not done with them yet!
IIRC this ball stretcher thing is deer leather. 1.5" maybe? It's pretty good, but it doesn't quite fit right
Guess I mixed up my pictures there a bit, I'm fucking exhausted. Don't think I slept well 🥱
I'm messing up my schtick 😂
So, I think it's not tight in the first one, looks pretty tight to me in the last 3
I did tighten it down until it hurt just a little. I couldn't take it for too long 😣
So I tightened it a little 😈😫
That may have lasted 30 seconds? For some reason I wasn't keeping track of time well 😂
Hi friends, here it is! Just jumped right in to it here, but it's not like you haven't seen it!
I just barely fit through the holes, as you can see from the cock ring like effect 😂
It's not so tight it hurts and I'm not so hard it hurts, but that's a massive erection!
It does hurt to stroke (in a bad way), holes are too small 😂
The "scrotum clamp ball crusher" (edit) is screwed down on my #balls in the last 3!
I tried to fit all these in my profile but they just won’t. So let’s try it this way!
I IDENTIFY AS
INTERESTS AND FETISHES
#piss #WS #watersports #urinal #sounding #CBT #gangbang #GroupSex #orgy #bareback #ImpactPlay #spanking #whip #cane #ENM #bestiality #beastiality #beast #gag #jood #bondage #collar #leash #HookPull #ThePath #spirituality #NeedlePlay #bodymod #cockmod #meatotomy #subincision #UrethraPlay #UrethralInsertion #UrethralStretching #spit #degradation #PublicSex #RoughSex #CNC #ServiceStraightCock #incest #FatherSon #DadSon #BootLicking #FootWorship #underwear #bulge #biting #OpenFamily #TitTorture
For today Patreon update, I can give you some insides of my relationship with Petra...
Yeah, she enjoys that too... (but not like me, ehehe)
I don't know if you know, but supposedly one can follow hashtags. I can't, but I think that's an app specific issue I have.
I'd be happy to talk with you about #RecoveryInc #RecoveryInternational and the books by Dr. Abraham Low. I attend zoom meetings on and off. I've been through #CBT and #DBT and #acceptance therapy (and various uncategorized 'therapy') and they all gave me lots of good info, but nothing helped as over all or long term as #RI
It's 6-year anniversary of this paper of mine. It could be useful if somebody feels coerced into doing graded activity or exercise programmes; also to counter claims that the #PACEtrial showed graded activity programs are safe.
Proud Boss to a hard working Bull. Ex British guy in Australia.
Other than that, just ask I guess 👍
"Treatment Harms to Patients with #MyalgicEncephalomyelitis/#ChronicFatigueSyndrome" by Dr David Marks (an eminent academic psychologist)
Great to see this published
Professionals have let down patients by not alerting everyone to this issue
My breakdown at work that led to me taking sick-leave and eventually, last year, taking early retirement, was not my first. When I was 20 I struggled with panic attacks and became severely agoraphobic. With Cognitive Behavioral Therapy (#CBT) I recovered, began a new degree and that led me into a career as a researcher. But the #anxiety never subsided to the point that I was comfortable. And I would often feel depressed.
Walking the Plank: You may never shake the fear, but you might change how you feel about it.
[On a side note, I'm not a big fan of their negative attitude towards #medication as a real way to find hope and perhaps healing. I recommend Dr. Peter Kramer's Against #Depression for a pro-medication argument.]
Your #thought|s can be your strongest tool or your biggest burden.
How do you know if this is true?
Where do you see people react very differently in the same situation, facing the same activating event?
How can that be?
#Ruminating is like a self-built cage. You constantly ponder over the same questions:
Thanks to @aphyr for setting up this instance, and what seems to be the great community of folks here on woof.group. Looking forward to getting to know some of you.
The NIH is making its RECOVER trials for #LongCovid test therapies that are actively harmful for these patients and have long been debunked: graded exercise therapy and cognitive behavioral therapy. (Therapy's great to manage feels about this disease, not a way to cure this.)
Add your name to this petition to tell them to redirect energy into things that we don't already know will do harm:
I highly recommend Jessica Dore’s weekly offerings newsletter. Today’s is especially great. I’ll give one person here a free month, first come first served, just pm me. https://jessicadore.substack.com/p/offering-december-18-2022?utm_medium=email #tarot #cbt #dbt #advice #pemachodron #therapy #grief #fear
Simple questions can result in meaningful, impacting discoveries. That's mostly how my coaching often works.
One of my favorites is:
Whose affairs are you dealing with?
1. Your own
3. "God's" or to your liking "Universe's"
It's very obvious that only in the first area you have room for influence and improvement.
If you deal with other affairs, you suffer.
our little film (queer porn) c/ore was shot almost completely with my phone in an abandoned chromium mine in Turkey. features bondage, skipped frames, unforgiving DIY mood, a beautiful green light and our own music.
we are happy to have it hosted on pink label, a feminist porn platform with very high ethical standards and practices.
if you use the affiliate link, we earn a small commission (could pay the batteries and memory card) :
🏳️🌈 OLA DE CALOR 🔞
Tras la ruptura con su mujer, Liam necesita hacer horas extras por el temor a los gastos del divorcio. Sin dinero, emprende la ruta 69, pero no ha podido reparar el aire acondicionado de su gran camión. En pleno julio y con una ola de calor sofocante, sufre el riesgo de una deshidratación peligrosa, por lo que se ve obligado a conducir sin ropa. Un enorme sheriff se cruza en su camino y Liam deberá hacer todo lo posible para evitar un arresto por conducir desnudo.
🔁 ¿Me retooteas, por favor? Con ello me ayudas a sobrevivir. ¡Gracias! 🙂
#relatoerótico #relatoseróticos #Gay #CockFucking #AssPlay #Oral #Fisting #Leather #Exhibitionist #Neoprene #Gear #GayBears #cbt #GayFetish #Butt #AssPlay #Nudist #GayEs18 #NSFW #Nude #Nudity #ArtisticNude #NudeMale #Explicit #BDSM #Lesbian #Pussy #Porn #OnlyFans #GayPorn #Penis #GayMuscle #HairyMan #Daddy #Bondage #Horny #Sexy #Cum #Dick #Bear #Bulge #GayBulge #porno #PornoCanal #PornoDuro #Pornografia #CamionerosGays #AitorAbadés #Ruta69 #OlaDeCalor
Points raised are still very relevant now; if graded exercise/activity approaches are seen as safe, it's quite possible pressure could be put on some patients to undertake them.
A clinical trial is underway testing a mobile #app designed to help people with a serious #lung disorder manage #anxiety that often accompanies the disease. https://sciencebusiness.technewslit.com/?p=44184 #Science #Business #ClinicalTrial #MentalHealth #PulmonaryFibrosis #Smartphone #Collaboration #CBT #Sweden
My problem with CBT is the fact that you're being instructed to learn how not to think about - rather than helped to process, and in doing so move on from - the shit that's spoiling your life. Analogy - if my house is on fire, I'd prefer instruction on how to leave the building, rather than suggestions as to how I might stop thinking about the heat and destruction.
What is a #brainelevator?
Example: You see a dog. You feel #fear, you might freak out. Because you believe it might harm you.
If everyone seeing a dog would have the same belief, they all would be scared. No one would love dogs or work with them.
So, in #CBT we question your conditioned...
#Mentalhealth is my main favorite subject that I'll be tooting about.
Modern, integrated cognitive behavioral trainig (iCBT) combines the best approaches of conscious and unconscious mental processes.
Many guys look at me and assume I'm a Dom Top Daddy. My role changes based on activity:
Hitting me, humiliation/degradation
The pic represents me being a good hole for Dad on a hike
Finally time for an #introduction!
Intro: I’m based in Dublin, but as Significant Other works in England, we travel back and forth frequently. Was a single parent for a large part of my life, ditto being a #cbt therapist. Am very glad to have a job I’ve loved, & continue to love. I’ve also been active when possible in trying to help social justice as this has such an impact on #mentalhealth. When I retire, I intend to take up #mosaic & #stainedglass. Oh yes, ex #rowing - always the bow! #Mastodaoine