Bob said:
It seems that they managed to change 'beliefs' about fatigue (hence the short-term improvements to the self-reported outcomes), but not actually improve the illness.
Is this not then a 'good thing' for them to admit? Do you perhaps think it is a 'good paper' I wonder because it reveals the true nature of improvement.
My point was that, considering the background of the authors, they probably belief that CFS/ME is 'perpetuated' by maladaptive cognition & behaviour. (i.e. the usual psycho-social model of illness.)
So they think that changing the patient's beliefs about their symptoms will cure the illness.
Well, it blatantly failed to make any difference to the actual illness in this study.
Instead, what it did was to change how patients filled in their questionnaires, temporarily.
This isn't surprising if you set out to brainwash a patient that they are not really ill, but they are misinterpreting their symptoms.
For a short while, a patient may change the way they report their symptoms, just as they have been trained to, but over the long-term, the patient will forget this mind-training, and will answer the questions honestly again.
This effect is demonstrated in the difference between self-reported fatigue questionnaires and objectively measured physical function.
This is the reason that psycho-social research rarely includes objective measures of disability, or if they do, they don't report the results.
It's known as 'response bias' whereby patients self-report their symptoms differently as a result of external influences.
A similar effect is seen for homoeopathy. It's the placebo effect. A patients' expectations are raised, and their interpretation of their symptoms subtly change as a result of altered expectations, as a result of external influence. They may feel better for a while, but the actual disease process remains.
However, in these psycho-social models of illness, the proponents are still claiming that they affect the course of the illness. (i.e. that they can cure ME, as in the PACE trial in which patients were reported to have 'recovered' when in fact there was no indication of recovery at all.)
Another mediator of response bias, is social pressure to please your therapists, who persistently tell you that you are behaving well if you report improved symptoms, and who might implicitly suggest that you've been a disappointment if you report worsening symptoms, and may even explicitly say that you are not behaving properly if you report worsening symptoms.
The best type of clinical trial will include a control group which offers the patients the same type of expectations as the treatment group, in terms of illness outcomes, and the same changes in perception. (i.e. a placebo control group.)
For example, a control group for a clinical trial based on psychological interventions could include a positive-thinking course alongside a course that is aimed specifically at ME patients that helps them in various ways to cope with symptoms, to cope with their lives, and to feel more positive about themselves.