On 2016 Dec 18, Suzy Chapman commented:

A misattribution still stands in the critique of Cognitive-behavioural group treatment for a range of functional somatic syndromes: randomised trial. at PLOS Blog Mind the Brain. On behalf of Prof Allen Frances MD and myself, we would be obliged if you will give this your attention.

On 2016 Dec 08, James C Coyne commented:

This RCT is an excellent example of a badly designed study gone wrong. That the authors switched scoring of outcomes after results of another trial were known is the final blow. The trial:

Was unblinded to patients, interventionists, and to the physicians continuing to provide routine care. Had a grossly unmatched, inadequate control/comparison group that leads to any benefit from nonspecific (placebo) factors in the trial counting toward the estimated efficacy of the intervention. Relied on subjective self-report measures for primary outcomes.

With 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.

The study showed an inexplicably high 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.

The study is focused on unvalidated psychiatric diagnoses being applied to patients with multiple somatic complaints, some of whom may not yet have a medical diagnosis, but most clearly had confirmed physical illnesses.

The “CBT” did not map well into international understandings of 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.

I provided a more extended and detailed critique at the PLOS blog Mind the Brain http://blogs.plos.org/mindthebrain/2016/12/07/danish-rct-of-cognitive-behavior-therapy-for-whatever-ails-your-physician-about-you/

On 2016 Dec 08, James C Coyne commented:

This RCT is an excellent example of a badly designed study gone wrong. That the authors switched scoring of outcomes after results of another trial were known is the final blow. The trial:

Was unblinded to patients, interventionists, and to the physicians continuing to provide routine care. Had a grossly unmatched, inadequate control/comparison group that leads to any benefit from nonspecific (placebo) factors in the trial counting toward the estimated efficacy of the intervention. Relied on subjective self-report measures for primary outcomes.

With 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.

The study showed an inexplicably high 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.

The study is focused on unvalidated psychiatric diagnoses being applied to patients with multiple somatic complaints, some of whom may not yet have a medical diagnosis, but most clearly had confirmed physical illnesses.

The “CBT” did not map well into international understandings of 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.

I provided a more extended and detailed critique at the PLOS blog Mind the Brain http://blogs.plos.org/mindthebrain/2016/12/07/danish-rct-of-cognitive-behavior-therapy-for-whatever-ails-your-physician-about-you/