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Studies on Cognitive Behavioral Therapy and Graded Exercise Therapy for ME/CFS are misleading

Tom Kindlon

Senior Member
Messages
1,734
I thought this was very good

Full text in English: https://goo.gl/wSMO7a
i.e.
https://www.researchgate.net/public...ded_Exercise_Therapy_for_MECFS_are_misleading

Studies on Cognitive Behavioral Therapy and Graded Exercise Therapy
for ME/CFS are misleading

Sten Helmfrid

Assoc. Prof. of Physics, Member of the Swedish ME Association

This is a translation of an article published in Socialmedicinsk tidskrift, Stockholm, Sweden, on September 28th, 2016. http://socialmedicinsktidskrift.se

Link to the original article in Swedish (vol. 93, issue 4, pp. 433–44):
https://goo.gl/bEkOlT
i.e.
http://socialmedicinsktidskrift.se/index.php/smt/article/view/1450/1255

Citation: Helmfrid S. Studier av kognitiv beteendeterapi och gradvis ökad träning vid ME/CFS är missvisande. Soc Med Tidskr. 2016;93(4):433–44.


Abstract

There have been a number of studies on Cognitive Behavioral Therapy (CBT) and Graded Exercise Therapy (GET) for ME/CFS based on a treatment model where the disease is perpetuated by cognitive processes. Although the studies are flawed and the model lacks scientific support, the treatments are described as evidence based. The studies are non-blinded and rely on subjective outcomes. There are no objective measures of adherence. The diagnostic criteria vary, and the participating patients often have one or several psychiatric diagnoses apart from suffering from chronic fatigue. The underlying model has no theoretical foundation and is at odds with physiological findings. Surveys suggest that the efficacy of CBT is no better than placebo and that GET is harmful. Therefore, cognitive behavioral therapy and graded exercise therapy for ME/CFS are not evidence based.

Full text in Swedish:
Keywords: myalgic encephalomyelitis, chronic fatigue syndrome, treatment, biopsychosocial, PACE

 

Tom Kindlon

Senior Member
Messages
1,734
Another problem is that post-infective fatigue only has been reported after a limited number of infections [49,50]. The hypotheses do not explain why some pathogens do not trigger ME/CFS. The same perpetuating cognitive factors should be present after any infection.

49. Kondo K. Post-Infectious Fatigue. Japan Med Assoc J. 2006;49(1):27–33.

50. Hickie I, Davenport T, Wakefield D, et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. Br Med J. 2006;333(7568):575.
 
Messages
2,158
Excellent article. I'd have liked to see mention that FINE and the PACE followup showed no between group differences, and the latest PACE data release, but we can't have everything! There's plenty here to completely demolish the biopsychosocial model. Now how do we get all doctors to read it!
 

Yogi

Senior Member
Messages
1,132
This is excellent. However will doctors pay attention to it as it not in "peer reviewed journal" and not by a medical doctor?

It should not really matter as it is the quality of the paper that counts rather than who wrote it and where. However the medical profession is very backward in its thinking and defers too much to authority.
 

Tom Kindlon

Senior Member
Messages
1,734
This is excellent. However will doctors pay attention to it as it not in "peer reviewed journal" and not by a medical doctor?

It should not really matter as it is the quality of the paper that counts rather than who wrote it and where. However the medical profession is very backward in its thinking and defers too much to authority.
http://socialmedicinsktidskrift.se/index.php/smt/pages/view/in_english
About the Journal
Socialmedicinsk Tidskrift (smt) – Journal of Social Medicine – is a multidisciplinary forum for research and policy and welcomes submissions from all fields of Social medicine, Public Health, Health Promotion and Health and Social Services. The scope of the journal includes Social Insurance Systems, Social and Health Policy, Social Services, Public Health, Drug Abuse, Co-operation between the Medical and Social sector providers, Ethics and Health Economy. Smt is its own publisher and printing is performed by Alfaprint AB, Stockholm.


Smt is published 6 times per year, mainly in Swedish with English abstracts to original contributions. Occasionally, papers in other Nordic languages and English are published. External reviewers assess all original papers. In addition to full research papers smt publishes book reviews, presentations of recently published thesis’s and debate articles. The readers are in general a mix of the public, private and public sector organisations and institutions, students, researchers and professionals in areas of Public health and Social medicine in Sweden and other Nordic countries. The structure of smt includes six issues yearly with a certain theme, and in addition to submitted, peer-reviewed contributions.


Since 1924 the main part of every issue of the Journal of Social Medicine contains a theme section, where research and practical experiences within a specific theme, area or field is presented and discussed by different authors. Examples of themes that have been published during the 21st century are Education in Public health, Stress medicine, Vulnerability, Empowerment, Violence in relationships, Elderly care and Distribution of resources within the Health Care. Every theme has its own theme editor/s, which is one or two persons that have extensive knowledge within the field and about which authors who could contribute with relevant manuscripts of current interest.


During the 21st century the Journal of Social medicine has gone through a slow renewal of the journals format and layout. As a part of this renewal smt got its own web site. In 2008 the board of smt decided to expand availability to reach new readers and authors. Until then the journal had only been available in print, but since potential new readers tended to read and download information of the Internet the board decided to make smt available online. A decision that lead to the creation of a new web site where readers could read and download articles and authors could submit their manuscript through the system embedded in the web site. Right now you are visiting this website.


If you are interested in submitting manuscripts, advertising, subscribing to the printed issue, the distribution of the journal or back issues please contact the Editorial office (redaktionen@socialmedicinsktidskrift.se)
 

Yogi

Senior Member
Messages
1,132
@tomkindlon thanks for that info as I did not click on the swedish links and did not see that.

Whilst I am responding here- thanks a lot for all your hard work on ME and with writing to journals etc that you have done over the years !!
 

RogerBlack

Senior Member
Messages
902
can papers like this be used as new research for NICE consideration ?
This is not research as such.
It is more an extended letter to the editor - the publication of these may be quite a low bar, and may not need to pass any peer review.
Any peer review that does happen is of the 'it's not clearly wrong' sort - and it catches the attention of the editor to be published.

This is not of itself evidence a properly conducted clinical review should use - it's one persons opinion, backed by a selection of previously published papers, and does not of itself add anything to the sum of knowledge on CFS/ME/SEID/'there's nothing bloody wrong with you, you're just faking it'.

It can contain arguments they should look at in weighing the existing evidence.

Evidence a clinical treatment guideline review is supposed to take into account varies from:
Clinical trials with adequate numbers of patients to robustly determine the effect of that treatment.
Evidence around if those trials are properly conducted.
Research into the way the disease changes the state of the human body.
Inferences that can be securely drawn from the first two into likely results of treatments and their costs and harms on the whole patient population involved.

Letters (even from powerful people) advocating one side or the other should be ignored other than as they may point to either evidence about clinical trials or research about the body. Simply adopting the viewpoint of a given letter like this is absolutely what a clinical treatment review must not do.

Quality unfortunately of reviews varies significantly often from a careful and rational unbiased assessment of all evidence around.