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(1996) Cognitive behaviour therapy for the chronic fatigue syndrome: a RCT (Sharpe et al., 1996)

Dolphin

Senior Member
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17,567
Free full text: http://www.bmj.com/content/312/7022/22

BMJ. 1996 Jan 6;312(7022):22-6.

Cognitive behaviour therapy for the chronic fatigue syndrome: a randomized controlled trial.

Sharpe M1, Hawton K, Simkin S, Surawy C, Hackmann A, Klimes I, Peto T, Warrell D, Seagroatt V.
Author information

Abstract
OBJECTIVE:
To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with thechronic fatigue syndrome.

DESIGN:

Randomised controlled trial with final assessment at 12 months.

SETTING:

An infectious diseases outpatient clinic.

SUBJECTS:

60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome.

INTERVENTIONS:

Medical care comprised assessment, advice, and follow up in general practice.

Patients who received cognitive behaviour therapy were offered 16 individual weekly sessions in addition to their medical care.

MAIN OUTCOME MEASURES:

The proportions of patients (a) who achieved normal daily functioning (Karnofsky score 80 or more) and (b) who achieved a clinically significant improvement in functioning (change in Karnofsky score 10 points or more) by 12 months after randomisation.

RESULTS:

Only two eligible patients refused to participate.

All randomised patients completed treatment. An intention to treat analysis showed that 73% (22/30) of recipients of cognitive behaviour therapy achieved a satisfactory outcome as compared with 27% (8/30) of patients who were given only medical care (difference 47 percentage points; 95% confidence interval 24 to 69).

Similar differences were observed in subsidiary outcome measures.

The improvement in disability among patients given cognitive behaviour therapy continued after completion of therapy.

Illness beliefs and coping behaviour previously associated with a poor outcome changed more with cognitive behaviour therapy than with medical care alone.

CONCLUSION:

Adding cognitive behaviour therapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in functional impairment.
 

Dolphin

Senior Member
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17,567
BMJ. 1996 Apr 27;312(7038):1096; author reply 1098.
Cognitive behaviour therapy for the chronic fatigue syndrome. Good general care may offer as much benefit ascognitive behaviour therapy.
Shepherd C.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350899/?page=1

Good general care may offer as much benefit as cognitive behaviour therapy

EDITOR,-Successful outcomes have been reported from controlled clinical trials of an eclectic range of treatments-from immunotherapy to magnesium supplementation-for the chronic fatigue syndrome.' Unpublished data suggest that equal success can be achieved with some forms of alternative therapy (for example, homoeopathy) when patients believe strongly in the approach. Most physicians, however, continue to view all such results with healthy scepticism. An equally cautious view needs to be taken when assessing Michael Sharpe and colleagues' study of cognitive behaviour therapy.2 In a disorder that is almost certainly heterogeneous in nature, two important questions need to be answered before we can conclude that cognitive behaviour therapy is of value.

Firstly, does cognitive behaviour therapy offer any more benefit than good general care, support, and use of drugs for symptomatic relief (particularly for alleviating insomnia, myalgia, and any coexistent depression), which is increasingly being provided by general practitioners and the primary health care team? The protocol used in a controlled study of cognitive behaviour therapy in Australia may help with the answer to this.? Control patients in Sharpe and colleagues' study, who failed to show any significant improvement after one year, received "no further specific explanation or advice" apart from being advised to increase their level of activity gradually. By comparison, the control group in the Australian study-whose improvement was similar to that of those receiving cognitive behaviour therapy-were given medical care by a unit with recognised skill in all aspects of managing the chronic fatigue syndrome.

Secondly, are patients who benefit from cognitive behaviour therapy a subgroup with appreciable coexistent psychiatric morbidity? Although Sharpe and colleagues' study contained a high proportion (67%) of patients with depression, anxiety, or somatisation disorder, no useful information is provided on whether these factors may have influenced outcome. Findings from an American controlled study of cognitive behaviour therapy suggest, however, that a subset of patients with the chronic fatigue syndrome, who have high levels of depressive symptoms and maladaptive thinking regarding their fatigue, are the ones who can really benefit from this type of behavioural intervention.4

The apparent success rates for pharmacological, psychological, and alternative treatments in the chronic fatigue syndrome indicate that assessment of each patient remains the most important determinant when approaches to management are being considered. Until more is known about the precise pathoaetiology of the syndrome this is likely to remain the case.

CHARLES SHEPHERD Honorary medical adviser ME Association, Stanford le Hope, Essex SS17 OHA

1 Shepherd C. Myalgic encephalomyelitis: post-viral fatigue syndrome. Guidelines for the care ofpatients. 2nd ed. Stanford le Hope: ME Association, 1995.

2 Sharpe M, Hawton K, Simkin S, Surawy C, Hackmann A, Klimes I, et al. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial. BMJ 1996;312:22-6. (6 January.)

3 Lloyd AR, Hickie I, Brockman A, Hickie C,Wilson A, Dwyer J, et al. Immunologic and psychologic therapy for patients with chronic fatigue syndrome: a double-blind, placebocontrolled trial. Am J Med 1993;94:197-203.

4 Friedberg F, Krupp LB. A comparison of cognitive behaviour treatment for chronic fatigue syndrome and primary depression. Clin Infect Dis 1994;18 (suppl): 105-9.
 

Dolphin

Senior Member
Messages
17,567
BMJ. 1996 Apr 27;312(7038):1096-7; author reply 1098.
Cognitive behaviour therapy for the chronic fatigue syndrome. Patients were not representative of all patients with the syndrome.
Gibbons R, Macintyre A, Richards C.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350876/pdf/bmj00539-0052c.pdf

Patients were not representative of all patients with the syndrome

EDITOR,-Michael Sharpe and colleagues conclude that cognitive behaviour therapy leads to a sustained reduction in functional impairment for patients with the chronic fatigue syndrome.1 The levels of disability of the 60 patients who took part in the study suggest, however, that these patients do not represent a comprehensive cross section of patients with the syndrome. The 60 patients scored 60-78 on the Karnofsky scale assessing disability and so represent a different population from the 143 patients reported on by Case History Research on ME (myalgic encephalomyelitis), who would have scored 30-60 (R Gibbons et al, first world congress on chronic fatigue syndrome and related disorders, Brussels, Nov 1995). Fifty nine of these 143 patients reported functional deterioration after sustained, incrementally increased physical exertion.

The authors did not assess other symptoms common in the chronic fatigue syndrome, such as pain, nausea, muscle weakness, or balance problems-a measure of the reduction of which was taken as a standard for "success" in an earlier trial.2 The lack of evidence of significant changes in other measures besides "the principal complaint of severe fatigue" in the authors' study tends to diminish the validity of their conclusions.

If functional capacity alone is to be assessed in a trial a validated instrument should be used. The Karnofsky scale is not sensitive enough to measure function since a value of 80 implies "normal activity with effort; some signs or symptoms of disease." But what does the phrase "normal activity" mean? Does it mean being able to get up, dress, and walk at a level sufficient to maintain (unemployed) independence or does it mean an ability to perform all these activities together with a return to full time employment and participation in sport?

Given the heterogenous nature of the chronic fatigue syndrome, we are concerned at the apparent enthusiasm for cognitive behaviour therapy, which may be helpful for patients who have factors such as depression or maladaptive behaviour (too much bed rest) but may in the long term be detrimental to a specific subgroup of patients. We note that in Sharpe and colleagues' trial the condition of four of the 30 patients given cognitive behaviour therapy had deteriorated after 12 months. Could these patients have a distinct type of the chronic fatigue syndrome, meeting the original clinical criteria for myalgic encephalomyelitis,3 and be at risk from cognitive behaviour therapy?
RAY GIBBONS Researcher
ANNE MACINTYRE Researcher
CHRIS RICHARDS Researcher Case History Research on ME (CHROME), 3 Britannia Road, London SW6 2HJ
 

Dolphin

Senior Member
Messages
17,567
BMJ. 1996 Apr 27;312(7038):1097; author reply 1098.
Cognitive behaviour therapy for the chronic fatigue syndrome. Cognitive behavior therapy should be compared with placebo treatments.
Pearce J.

Cognitive behaviour therapy should be compared with placebo treatments

EDITOR,-Lest Michael Sharpe and colleagues' paper lends respectability to the notion that the chronic fatigue syndrome is a diagnostic entity or suggests that cognitive behaviour therapy has any value specific to the condition,' I wish to make three points.

Firstly, the disorder that the authors treated is heterogeneous, the only defining criteria used being fatigue, impaired daily activities, and the absence of signs of physical disease or "severe depression." Claims for a specific effect in any diffuse symptom complex are dangerous. Quinine is effective in many cases of cramp, but neither the symptom nor the benefit is specific.

Secondly, cognitive behaviour therapy and any comparable substitute were denied the control patients, who were therefore matched only on pretreatment criteria regarding their clinical state and not controlled in respect of a comparable treatment. Despite the authors' claim for a "specificity of treatment effect" the benefits shown are consistent with the provision of much attention, encouragement, and a positive attitude to the nature of the illness and the strategies to counter it.'

Thirdly, Sharpe and colleagues did not compare cognitive therapy with other treatments or placebo, and the improvements (including persistence after the treatment had ended) are compatible with a placebo effect.3 The "return to normal functioning (albeit with continuing fatigue) in most cases" is typical of the outcome for many such patients managed by other means. Before this expensive and time consuming remedy is generally applied, a formal comparison of cognitive therapy with placebo treatments is needed.

JIM PEARCE Consultant neurologist
Anlaby, Hull HU10 7BG

1 Sharpe M, Hawton K, Simkin S, Surawy C, Hackmann A, Klimes I, et al. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial. BMJ 1996;312:22-6. (6 January.)

2 Woods TO, Goldberg DP. Psychiatric perspectives: an overview. Br Med Bull 1991;47:908-18.

3 Pearce JMS. The placebo enigma. QJMed 1995;88:215-20.
 

Dolphin

Senior Member
Messages
17,567
Essential elements of the treatment must be identified

EDITOR,-We have several practical and theoretical concerns about Michael Sharpe and colleagues' study of cognitive behaviour therapy in the chronic fatigue syndrome.' The authors managed to obtain almost 100% uptake of treatment and compliance among patients who were attending an infectious diseases clinic and were strongly convinced that their chronic fatigue had a physical cause. We would struggle to engage our patients similarly, even with two hours for an initial appointment, and we could not offer them anything approaching an hour of treatment a week for four months. The difference between what was provided in the study and what clinicians can routinely offer their patients makes it important to identify the essential elements of the treatment.

The package given included cognitive techniques such as "question[ing] a simple disease explanation," "strategies to reduce excessive perfectionism and self criticism," and a problem solving approach of "gradual and consistent increases in activity." The continuing improvement after the end of treatment is unusual for the cognitive psychotherapies and suggests that the behavioural component was most effective. We find it puzzling, therefore, that the authors attribute the beneficial effects of treatment to "a specific effect on illness perpetuating beliefs and coping behaviour," particularly as these attitudes did not change substantially. The patients would inevitably report less avoidance of exercise if they were complying with the study. After treatment at least half of the patients still believed that the illness was physical (from tables 2 and 5), and the vast majority still applied the damaging label of "myalgic encephalomyelitis"2 to their condition.

Although the authors rightly state that their results tell us little about aetiology, they will inevitably be taken (at least by some people) to mean that the condition is primarily psychological-particularly as the authors have stated elsewhere that the chronic fatigue syndrome "does not reflect a particular biological process, but rather specific psychologic and behavioural mechanisms."3 Notwithstanding an artificial distinction between biology and behaviour, such "psychologisation" of the illness ignores increasing evidence of specific neurobiological abnormalities.4

If, as we suspect, the behavioural component of the treatment proves to be the essential therapeutic element then this will provide more specific information for hypotheses on the causes of the chronic fatigue syndrome and allow the most efficient use of an effective but time consuming treatment.

STEPHEN M LAWRIE Lecturer Department of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH1O 5HF

ANTHONY J PELOSI Consultant psychiatrist Hairmyres Hospital, Glasgow G75 8RG

1 Sharpe M, Hawton K, Simkin S, Surawy C, Hackmann A, Klimes I, et al. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial. BMJ 1996;312:22-6. (6 January.)

2 Lawrie SM, Pelosi AJ. Chronic fatigue syndrome: prevalence and outcome. BMJ 1994;308:732-3.

3 Surawy C, Hackamann A, Hawton K, Sharpe M. Chronic fatigue syndrome: a cognitive approach. Behav Res Ther 1995;33:535-44.

4 Demitrack MA, Dale JK, Straus SE, Laue L, Listwak SJ, Kruesi MJP, et al. Evidence for impaired activation of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome. I Clin Endocrinol Metab 1991;73:1224- 34.

5 Beam JA, Allain T, Coskeran P, Munro N, Butler J, McGregor A, et al. Neuroendocrine responses to d-fenfluramine and insulin-induced hypoglycaemia in chronic fatigue syndrome. Biol Psychiatry 1995;37:245-52.
 

Dolphin

Senior Member
Messages
17,567
BMJ. 1996 Apr 27;312(7038):1097; author reply 1098.
Cognitive behaviour therapy for the chronic fatigue syndrome. Use an interdisciplinary approach.
Eaton KK.

Use an interdisciplinary approach

EDITOR,-From their randomised trial in the chronic fatigue syndrome Michael Sharpe and colleagues conclude that cognitive behaviour therapy is more effective than "medical care" in improving day to day function.' It is not clear that the data presented justify this conclusion.

Firstly, the authors do not compare like with like: the group given cognitive behaviour therapy received 16 hours of therapy while the "medical" group received no intervention. Secondly, the "medical" group of patients were "advised to increase their level of activity by as much as they felt able," which may have had adverse effects if the activity was unsupervised and inappropriate.2 This could have affected the results by making the group given cognitive behaviour therapy seem to improve by more than they did. Thirdly, all patients, and particularly those with the chronic fatigue syndrome, need detailed discussion of their problems. Many doctors will not have been aware that in providing such discussion-surely the duty of all doctors-they were in part providing cognitive behaviour therapy.

Perhaps it is inappropriate to complain that the authors did not address the physical problems of the chronic fatigue syndrome as this was not part of their remit. However, physical factors, including perfusion changes3 and erythrocyte rigidity, are present.4 Over 100 papers in the literature show that stress damages the immune system': cognitive behaviour therapy is likely to be helpful.

Surely the best way of treating this complex disorder is by using an interdisciplinary approach rather than the limited potential of any single modality. This study might have been more productive if the medical group had undergone a comparable and appropriate programme of physical management.

K K EATON Consultant allergist Princess Margaret Hospital, Windsor, Berkshire SL4 3SJ

1 Sharpe M, Hawton K, Simkin S, Surawy C, Hackmann A, Klimes I, et al. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial. BMJ 1996;312:22-6. (6 January.)

2 Lane RJM, Burgess RP, Flint J, Riccio M, Archard LC. Exercise responses and psychiatric disorder in chronic fatigue syndrome. BMJ 1995;311:544-5.

3 Costa DC, Brostoff J, Douli V, Ell PJ. Brain stem hypoperfusion in patients with myalgic encephalomyelitis syndrome. EurJ Nucl Med 1992;19:733.

4 Simpson LO. The role of non discocyte erythrocytes in the pathogenesis of myalgic encephalomyelitis/chronic fatigue syndrome. In: Hyde B, Godstein J, Levin P, eds. The clinical and scientific basis of myalgic encephalomyelitislchronic fatigue syndrome. Ottawa: Nightingale Research Association, 1992:597-605.

5 Irwin M, Daniels M, Bloom ET, Smith TL, Weiner H. Life events, depressive symptoms and immune function. Am J Psychiarry 1987;144:437-41.
 

Dolphin

Senior Member
Messages
17,567
BMJ. 1996 Apr 27;312(7038):1097-8.
Cognitive behaviour therapy for the chronic fatigue syndrome. Patients' beliefs about their illness were probably not a major factor.
Ho-Yen DO.

Patients' beliefs about their illness were probably not a major factor

EDITOR,-Michael Sharpe and colleagues' study confirms that the best medical advice for patients with the chronic fatigue syndrome is not "nothing can be done" or that "the disease will burn itself out."' The study produced improvement in 73% of the patients, which is comparable to the 80% improvement produced by my management techniques.2 3 Interestingly, my approach seems to be fundamentally different from that of Sharpe and colleagues.

Two previous studies of cognitive behaviour therapy in patients with the chronic fatigue syndrome showed no benefit over ordinary medical management.4" What is meant by cognitive behaviour therapy may go some way to explaining this apparent discrepancy between previous studies and that of Sharpe and colleagues. Most of us would agree that "inaccurate and unhelpful beliefs, ineffective coping behaviour, negative mood states, social problems, and pathophysiological processes all interact to perpetuate the illness."' I would also agree with Sharpe and colleagues' next statement that "treatment aims at helping patients to re-evaluate their understanding of the illness and to adopt more effective coping behaviours." Sharpe and colleagues conclude that patients gain benefit from cognitive behaviour therapy because it reduces their beliefs that illness is mainly physical, the cause is a virus, the illness is myalgic encephalomyelitis, and exercise should be avoided. My approach in the initial management aims to increase the patients' beliefs in these areas.3 So how could our results be similar?

Both my approach and that of Sharpe and colleagues recognise that negative mood states and social problems must be dealt with. Another common aspect of management is that emphasis is on a "collaborative rather than an-adversarial approach." A turning point is often when a patient develops confidence and starts to feel able to exert some control over the illness.3 At this stage energy levels are higher and activity also increases, but I do not recommend an emphasis on greater activity until a patient feels 80% normal.3

I believe that the patients' beliefs about the chronic fatigue syndrome-that it was mainly physical, was caused by a virus, or was myalgic encephalomyelitis-were not a major factor in the improvement of Sharpe and colleagues' patients. It was probably far more important that there was collaboration to deal with the patients' problems with a definite regimen, regular appointments, and clear objectives.

D 0 HO-YEN Consultant microbiologist Microbiology Department, Raigmore Hospital NHS Trust, Inverness IV2 3UJ

1 Sharpe M, Hawton K, Simkin S, Surawy C, Hackmann A, Klimes I, et al. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial. BMJ 1996;312:22-6. (6 January.)

2 Shanks MF, Ho-Yen DO. A clinical study of chronic fatigue syndrome. BrJ Psychiatry 1995;166:798-801.

3 Ho-Yen DO. Better recovery from viral illness. 3rd ed. Inverness: Dodona Books, 1993.

4 Friedberg F, Krupp LB. A comparison of cognitive behaviour treatinent for chronic fatigue syndrome and primary depression. Clin Infect Dis 1994;18(suppl): 105-9.

5 Lloyd AR, Hickie I, Brockman A, Hickie C,Wilson A, Duyer J, et al. Immunologic and psychological therapy for patients with chronic fatigue syndrome: a double-blind, placebocontrolled trial. Am I Med 1993;94:197-203.
 

Dolphin

Senior Member
Messages
17,567
BMJ. 1996 Apr 27;312(7038):1096; author reply 1098.
Cognitive behaviour therapy for the chronic fatigue syndrome. Evening primrose oil and magnesium have been shown to be effective.
Chilton SA.

Cognitive behaviour therapy for the chronic fatigue syndrome Evening primrose oil and magnesium have been shown to be effective

EDITOR,-In their paper on cognitive behaviour therapy for -the chronic fatigue syndrome Michael Sharpe and colleagues state that many pharmacological treatments have been suggested but none are of proved value.' Last year Lewith stated that the only two treatments that had been properly evaluated were evening primrose oil and magnesium by injection.2 Intramuscular magnesium supplements have been given to patients with low red cell magnesium in a double blind placebo controlled trial; myalgia and fatigue improved in about 70% of subjects.3 Evening primrose oil has been used to treat myalgic encephalomyelitis and is the only other treatment that has been adequately tested in a controlled trial. High doses in randomised controlled trials have been shown to have a significant effect in 70-80% of patients with myalgic encephalomyelitis or the chronic fatigue syndrome.4 I would be interested to hear Sharpe and colleagues' comments about these papers.

S A CHILTON General practitioner Martonside Medical Centre, Middlesbrough, Cleveland TS4 3BU

1 Sharpe M, Hawton K, Simkin S, Surawy C, Hackmann A, Klimes I, et al. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial. BM3 1996;312:22-6. (6 January.)

2 Lewith G. Chronic fatigue syndrome. Update 1995;50:765.

3 Cox IM, Campbell MJ, Dowson DI. Red blood cell magnesium levels and the chronic fatigue syndrome (ME); a case control study and a randomised controlled trial. Lancet 1990;337:757-60.

4 Behan PO, BehanWMH, Horrobin D. The effect of high doses of essential fatty acids in the post-viral fatigue syndrome. Acta Neurol Scand 1990;82:209-16.
 

Dolphin

Senior Member
Messages
17,567
Authors' reply

EDITOR,-We addressed a clinical question of practical importance to ourselves and our colleagues-namely, could we improve the disability and fatigue of patients referred to a hospital clinic with severe medically unexplained fatigue (the chronic fatigue syndrome)? The available evidence indicated that the prognosis for these patients was poor' and (contrary to S A Chilton's suggestion) that there were no treatments of proved and accepted effectiveness.2 3 We chose cognitive behaviour therapy because it is effective in related conditions4 and because (for reasons given in the paper) we did not agree with Charles Shepherd's suggestion that its application to the chronic fatigue syndrome has been adequately evaluated. We chose to compare this therapy with sympathetic medical care from physicians experienced in assessing the syndrome as this is the best care available to most patients referred to hospital. Our results clearly show that patients who received cognitive behaviour therapy improved substantially more than those who were given only medical care.

Many of the methodological points raised by the correspondents were addressed in our original paper. Several correspondents ask, however, whether a simpler or alternative intervention might not have produced a similar benefit when compared with simple medical care. We agree that both replication of our result and the evaluation of alternative approaches are needed. Some data are already available. Colleagues at King's College Hospital, London, recently compared a similar form of cognitive behaviour therapy with a relaxation treatment matched for time (A Deale et al, world congress of cognitive and behavioural therapies, Copenhagen, Denmark, Jul 1995). They found that the cognitive behaviour therapy was substantially more effective, which suggests that neither simple attention nor relaxation treatment is adequate for this condition. We agree with the correspondents who suggest that the next steps for research should include identification of the effective ingredients of cognitive behaviour therapy and the delineation of factors relating to the patient that predict a good response.

Shepherd, Ray Gibbons and colleagues, and K K Eaton all suggest that we neglected the biological component of our patients' illness. In fact (and contrary to Stephen M Lawrie's selective quotation), we take an explicitly biopsychosocial view of the chronic fatigue syndrome. We have been at pains to point out that the relative effectiveness of cognitive behaviour therapy does not mean that the illness is "all in the mind." While biological factors are likely to be important, however, their precise nature remains uncertain.

Many more questions still need answers: Gibbons and colleagues ask whether cognitive behaviour therapy is effective for extremely disabled patients, Shepherd suggests that homoeopathy can work as well, and D 0 Ho-Yen speculates that his treatment has a similar effectiveness. We hope that these questions will be addressed in randomised controlled trials as only in this way will it be possible to adopt an evidence based approach to treatment. For the time being, intensive and individually tailored cognitive behaviour therapy is one of the few approaches that has been found to help most patients attending hospital outpatient clinics with this chronic and disabling illness.

MICHAEL SHARPE Clinical tutor
KEITH HAWTON Senior clinical lecturer Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX
TIM PETO Consultant physician Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU

1 Sharpe M, Hawton KE, Seagroatt V, Pasvol G. Patients who present with fatigue: a follow up of referrals to an infectious diseases clinic. BMJ 1992;305:147-52.

2 Wilson A, Hickie I, Uloyd A, Wakefield D. The treatment of chronic fatigue syndrome: science and speculation. Am J Med 1994;96:544-50.

3 McCluskey DR. Pharmacological approaches to the therapy of chronic fatigue syndrome. In: Bock GR, Whelan J, eds. Chronic fatigue syndrome. Chichester: John Wiley, 1993:280-7. (Ciba Foundation symposium 173.)

4 Sharpe M. Cognitive behavioural therapies. In: Mayou R, Bass C, Sharpe M, eds. Treatment offsmctional somatic symptoms. Oxford: Oxford University Press, 1995:122-43.
 

jimells

Senior Member
Messages
2,009
Location
northern Maine
Sharpe et al said:
Shepherd suggests that homoeopathy can work as well,

Arggh! These people are horrible! Dr Shepherd most certainly did not endorse homeopathy! What he actually said was,

Dr Shepherd said:
Most physicians, however, continue to view all such results with healthy scepticism

Clearly Dr Shepherd is writing that CBT likely works no better than homeopathy and similar treatments. They have completely twisted his words.

I hope I never encounter Michael Sharpe and his pals. It would be very difficult to Keep Calm.
 
Messages
13,774
I don't really remember this Sharpe study, but it is a bit depressing how back then people were saying 'is it more effective than placebo/homeopathy?' and the response to that from biopsyosocial researchers over the last two decades seems to have been to just talk up the exciting benefits of placebo.
 

Snow Leopard

Hibernating
Messages
5,902
Location
South Australia
I don't really remember this Sharpe study, but it is a bit depressing how back then people were saying 'is it more effective than placebo/homeopathy?' and the response to that from biopsyosocial researchers over the last two decades seems to have been to just talk up the exciting benefits of placebo.

If these people were studying the physical sciences they'd never get anything done with the sort of faith they have in the placebo effect...
 

Sean

Senior Member
Messages
7,378
One of my fantasies is to let a few good scientists loose on the BPS malarkey. Physicists, chemists, biologists, math and stats, etc.

It would be a blood bath.
 

L'engle

moogle
Messages
3,196
Location
Canada
On one table let's arrange some components into a circuit design and connect them together with actual wires. On another table let's just pile a bunch of components up so that it looks all electronicsy-ish. Should get a good outcome either way, right? We can call it circuit behavioral theory and train the pile of components to overcome its false beliefs about electrical current.