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Cognitive behaviour therapy and objective assessments in chronic fatigue syndrome

Cognitive behaviour therapy and objective assessments in chronic fatigue syndrome

Graham McPhee
First Published June 19, 2017

Abstract
Most evaluations of cognitive behavioural therapy to treat people with chronic fatigue syndrome/myalgic encephalomyelitis rely exclusively on subjective self-report outcomes to evaluate whether treatment is effective. Few studies have used measures appropriate to assessing whether cognitive behavioural therapy changes in more objective measures. A review of studies incorporating objective measures suggests that there is a lack of evidence that cognitive behavioural therapy produces any improvement in a patient’s physical capabilities or other objective measures such as return to work. Future studies of chronic fatigue syndrome/myalgic encephalomyelitis should include some objective assessments as primary outcomes. If this is to include activity monitors, we first need a sound baseline dataset.
http://journals.sagepub.com/doi/abs/10.1177/1359105317707215?journalCode=hpqa

Paywall at this moment in time but I've seen it said that this will be changed to open access, as with all the recent commentaries.
 

Alvin2

The good news is patients don't die the bad news..
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2,997
Personally i think its a waste of money to research if CBT will improve ME/CFS, its in the same category of will CBT improve allergies or arthritis or hypothyroidism [facepalm]
 
Thanks for the PDF @slysaint

Personally i think its a waste of money to research if CBT will improve ME/CFS, its in the same category of will CBT improve allergies or arthritis or hypothyroidism [facepalm]
I don't disagree with you but the intention of this paper is to look at the objective results from the PACE trial and to see if they support the claims made by the PACE trial authors. We obviously know the answer to that but it's good to get it explicitly put into a published paper.

@Graham finishes by saying
but there is still no evidence that CBT has any real effect upon CFS/ME itself, nor is there any evidence to support the persistent beliefs that continuing symptoms are simply the results of fear and deconditioning. I believe that any form of CBT that is based on those beliefs is unsubstantiated and, based on the available evidence, is unable to improve physical capacity.
 
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Excellent article, thank you Graham McPhee (@Graham is this you?).

I've read the full article on Sci hub and it is very clearly written and brings out all the points I would have wanted to. I'm glad this disparity between slight improvement on questionnaire and none on objective tests has been so clearly spelled out and published.

It reinforces @Jonathan Edwards paper that explained why unblinded trials should not rely solely on subjective outcome measures.

I'm glad it is also spelled out that they had actometers in their original plan but ditched them part way through the trial - I think this is inexcusable, and part of the reason I think the trial can be called fraudulent - by the time they were actually running the trial they will have seen the smaller studies that showed that actometers did not support so called evidence of improvement found subjectively.
 

Jonathan Edwards

"Gibberish"
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5,256
Nice article. It seems there is now at least one reliable channel for getting sense published on CBT. Having the detailed facts out there in citable form is a major step forward.

It is interesting that Horton's position is now very different from theWakefield case.Then he could be seen as being open to 'original' science. In the case of PACE it is clear now that he is just propping up an establishment clique of people who do not know how to do science at all.
 

Graham

Senior Moment
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5,188
Location
Sussex, UK
Thanks for the kind comments. It's something that had bugged me for some time. The article is in the Journal of Health Psychology, and they intend to put all the PACE/ME articles online: they asked me to make a video to link to it (even though I gave them a link to the sort of videos I make!), so that will come out when the article goes online.

I had some good teachers and lots of helpful advice!
 

Seven7

Seven
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3,444
Location
USA
Great! also, I think would be nice an analysis of the aftermath. How many institutionalized, and ignored patients (like the result of applying CBT ) has been in the community.
 

Alvin2

The good news is patients don't die the bad news..
Messages
2,997
I don't disagree with you but the intention of this paper is to look at the objective results from the PACE trial and to see if they support the claims made by the PACE trial authors. We obviously know the answer to that but it's good to get it explicitly put into a published paper.
Ok, i didn't know it was an article referencing PACE. However this is more maddening, money was wasted on PACE that could have done much better following reality, and more money, time and resources are wasted fighting it :bang-head:
That said this is a strategy, and i don't know if its the best one, publishing articles that say the opposite won't do much to convince those who choose to believe lies, they are more interested in pretending lies are true then in looking for the truth. IMO we will need a disease mechanism and/or a test for ME/CFS to smash PACE with, making it untenable.
There is precedent for this, narcolepsy was believed to be caused by emotional trauma and the preferred "treatment" was dream analysis to go along with the stimulants (since REM sleep intrudes onto regular sleep and daily functioning). The success rate for this treatment was zero but until Orexin was discovered and linked to narcolepsy the cause was psychosomatic and now its generally accepted to be autoimmune.
 
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publishing articles that say the opposite won't do much to convince those who choose to believe lies,
It will do a lot to convince people who otherwise wouldn't have questioned the PACE paper.

A lot of the issue is around people assuming PACE must be good because it was published in the lancet. This helps to debunk that.
 
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Alvin2

The good news is patients don't die the bad news..
Messages
2,997
It will to a lot to convince people who otherwise wouldn't have questioned the PACE paper.

A lot of the issue is around people assuming PACE must be good because it was published in the lancet. This helps to debunk that.
I would be ecstatic if publishing this would get PACE retracted. I hope i am wrong but i doubt it will be retracted because of this. IMO a lot of litigation and fighting will be required at this rate becasue the Lancet believes in the PACE lies or they can't admit fault or both. Neither will be changed by facts, otherwise this fight would already be over.
However a disease mechanism will force change because right now denial is easy, no tests, no mechanism and a culture of victim blaming is easy to accept, a measurable test or proven mechanism will make the lies untenable. As i said narcolepsy is one case history in this.
Again i hope i am wrong, an easy retraction and smothering of the CBT/GET lies would be very good for all of us.
 

Jonathan Edwards

"Gibberish"
Messages
5,256
It will to a lot to convince people who otherwise wouldn't have questioned the PACE paper.

A lot of the issue is around people assuming PACE must be good because it was published in the lancet. This helps to debunk that.

I agree, and I think it does more. I think there are reasons to believe that now that there are several well reasoned publications demonstrating the problems with the trial the authors and colleagues are seriously worried about the collapse of their credibility. The criticism of the recent spate of lectures about malicious activists has also generated interest outside of medicine, let alone psychiatry.