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"CBT and GET are effective"

Discussion in 'Latest ME/CFS Research' started by Denise, Apr 22, 2015.

  1. Denise

    Denise Senior Member

    The first author is at (Institute of Psychiatry) King's College London. (Article is behind a paywall, so I have not been able to read it.)

    Behav Cogn Psychother. 2015 Apr 21:1-13. [Epub ahead of print]

    Treatment Outcome and Metacognitive Change in CBT and GET for Chronic Fatigue Syndrome.
    Fernie BA1, Murphy G2, 3, Nikčević AV4, Spada MM5.

    Author information:

    • 1King's College London,Institute of Psychiatry,Psychology and Neuroscience, and Cascaid,South London and Maudsley NHS Foundation Trust,UK.
    • 2Royal Free Hampstead NHS Foundation Trust,London,UK.
    • 3University of Manchester,UK.
    • 4Kingston University,Kingston upon Thames,UK.
    • 5London South Bank University,UK.
    Studies have reported that Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) are effective treatments for Chronic Fatigue Syndrome (CFS).

    One hundred and seventy-one patients undertook a course of either CBT (n = 116) or GET (n = 55) and were assessed on a variety of self-report measures at pre- and posttreatment and follow-up.

    In this paper we present analyses on treatment outcomes for CBT and GET in routine clinical practice and evaluate whether changes on subscales of the Metacognitions Questionnaire-30 (MCQ-30) predict fatigue severity independently of changes in other covariates, and across the two treatment modalities.

    Both CBT and GET were equally effective at decreasing fatigue, anxiety, and depression, and at increasing physical functioning. Changes on the subscales of the MCQ-30 were also found to have a significant effect on fatigue severity independently of changes in other covariates and across treatment modalities.

    The findings from the current study suggest that CFS treatment protocols for CBT and GET, based on those from the PACE trial, achieve similar to poorer outcomes in routine clinical practice as in a RCT.

    PMID: 25895437 [PubMed - as supplied by publisher]
    Last edited: Apr 22, 2015
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  2. alex3619

    alex3619 Senior Member

    Logan, Queensland, Australia
    Still no objective measures? I wonder why?
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  3. WillowJ

    WillowJ คภภเє ɠรค๓թєl

    WA, USA
    funny, no measures of effect, significance, etc., are reported in the abstract.
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  4. SilverbladeTE

    SilverbladeTE Senior Member

    Somewhere near Glasgow, Scotland
    And what exactly do they think is a "good outcome"?

    Emperor Wessely goes Water Skiing!

    Denise likes this.
  5. lazzlazz


    In Lucinda Bateman's talk at the link below, at about the 51:00 minute mark, she talks about "subgroups" of "chronic fatigue" (not necessarily CFS) patients that she has observed in her clinic. Based on her experience (specifically, slide at about 51:25), she thinks exercise is "helpful" for gradual onset, but "impossible" for sudden onset, devastating CFS (she seems to think her "gradual onset" category (for which she says "often pain predominant") is really FM; it's not clear from this discussion why she thinks that; she also has another category called "definite but not sudden onset" which she thinks can be either CFS or FM). In this part of the talk, she's making some interesting comments about the similarities between CFS & FM; these reflect her opinions and aren't part of the IOM report.

    Ultimately, the answer to whether exercise is helpful is probably quite complicated. It probably depends on many factors: severity of CFS, the person's ability to pace oneself, how many other demands are on the patient and the degree to which they "exert" the patient. In other words, each patient can handle X amount of exertion, and going beyond that leads to relapse/negative effects.
    The real problem is when exercise is presented as a cure-all for everyone, and especially when physicians view patients as "not wanting to get better" because they don't comply with exercise regimes. There's plenty of evidence that exercise is not a cure-all for everyone, and as we all know, when you have CFS and over-exert yourself (via exercise or other activities that exert you), you can pay for it for many days (some weeks) as you relapse.

    I have relatively mild CFS and I like to exercise, but I exercise at a fairly low intensity (especially compared to my pre-CFS days) - mostly walking or LifeCycle recumbent bike, watching a video (not at a high intensity - I'm not trying to get my heart rate up to max levels). I also have learned to not exercise when I have too many other demands, because too much total exertion has negative effects. Interestingly, I would have put myself in Bateman's "gradual onset" category (for me, pain is not prominent although it occurs very occasionally, 1-2 x month). (I'm fairly confident my CFS diagnosis is correct as I was diagnosed by a practitioner at a clinic that's recognized as having strong expertise in this area).
    Last edited: Apr 22, 2015
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  6. IreneF

    IreneF Senior Member

    San Francisco
    Still need to know how the patients were diagnosed.

    Anxiety and depression are not symptoms of CFS, so improvement doesn't tell you anything about the efficacy of CBT or GET in treating CFS. So according to the abstract, these modalities were effective to some extent in treating fatigue, depression, and anxiety.
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  7. Snow Leopard

    Snow Leopard Hibernating

    South Australia
    It is slippery language. "equally effective" doesn't mean much when there is no placebo control. "Equally effective" could mean that neither work.
  8. Sean

    Sean Senior Member

    "Equally effective" could mean equally ineffective.
  9. DaiWelsh


    Makes me wonder - I do not recall the exact results of the pace trial but were they not similar for CBT and GET?

    Is it reasonable to expect two completely different (on the surface) treatments to get the same moderate increases? Does it in fact provide more supporting evidence for the theory that this represents an increase in self-report results after any treatment from positive, encouraging practitioners?

    In other words my guess would be that any treatment applied by enthusiastic practitioners would yield similar self-report changes. Crystals, meditation, reiki, homeopathy, lighting process, smile therapy - provided the practitioner convinced the patient it was a legitimate treatment that had a good chance of helping them and then asked them these questions themselves...? Of course I have no evidence to support this theory, how very unscientific of me, but I wanted to fit in ;)

    Just to be clear I am not talking about placebo effect, no actual improvement, merely an effect on self-report.

    Of course it is possible both have the same effect by coincidence, but I would have more faith in their results if one came out clearly ahead (without them having "picked a horse" in order to achieve this end).

    A cynic might say that if they did pick a horse they would lose half their invested believers.
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  10. Bob


    England (south coast)
    So, overall, worse outcomes were seen in this study compared to PACE. But it's not explained in the abstract which specific outcomes were 'poorer'. The National Outcomes Database (NOD) study, by Esther Crawley et al., found that CBT/GET in clinical settings had similar effects for fatigue as the PACE trial, but no useful effects for physical function.
    Last edited: Oct 23, 2015
  11. user9876

    user9876 Senior Member

    They still have techniques that tell people to think about symptoms and then ask them 'are you thinking about your symptoms differently' and they get an answer of well maybe a little bit. They need to justify that this links to an actual improvement but I suspect they don't.

    The Metacognitions Questionnaire-30 (MCQ-30) seems like a bit of a joke particularly to see it as a continuous linear scale which I suspect they do to calculate stats on it.
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  12. user9876

    user9876 Senior Member

    Perhaps all this type of paper proves is how poor peer review is.
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  13. Sidereal

    Sidereal Senior Member

    They admit in the paper that all the measures were non-normally distributed but then go on to do parametric statistics for all the efficacy analyses. o_O
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  14. SOC

    SOC Senior Member

    Yup. Even the most primitive intelligent review by someone with basic knowledge of statistics (which any decent scientific researcher has) should have caught that and booted the paper back to the authors for a rewrite. It doesn't even take any knowledge of the field to know that this paper fails.

    My daughter came home from university today with an assignment to find a bad paper and review it, explaining what makes it unacceptable. It was not even required that the paper be in their own small field because any decent researcher can spot bad experimental design and statistical analysis. College students can do this but psychiatry researcher/reviewers can't?

    Maybe I should drop the class a hint to take a look into psychiatry journals. ;)
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  15. user9876

    user9876 Senior Member

    You could suggest the original PACE paper although I think the PACE recovery paper is a more extreme example especially if she could get the ONS data that they use to justify protocol changes
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  16. msf

    msf Senior Member

    Jesus, I think the UK will be the last redoubt of CBT/GET for ME. The only question is which will go first, CBT/GET, or the NHS?
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  17. Dolphin

    Dolphin Senior Member

    Another psychological model to contend with. :(

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  18. Esther12

    Esther12 Senior Member

    There was some discussion of the Moss-Morriss attentional bias stuff here:


    It all looked very weak.

    My summary (may not work if the attachment doesn't copy over):

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  19. Dolphin

    Dolphin Senior Member

    This is the comparison they make with PACE Trial:

    "Clinical change data" refers to an improvement of 8 or more on SF-36 physical functioning and 2 or more on Chalder fatigue questionnaire.

    The positive change % ("very much better" or "much better") in this were
    (at follow-up):
    CBT: 50.5%
    GET: 51.2%

    PACE Trial:
    CBT: 41%
    GET: 41%
    Last edited: Apr 29, 2015
  20. Dolphin

    Dolphin Senior Member

    Main results.
    Note these results are less impressive when one realises that patients can improve over time when diagnosed and given basic care e.g. the SMC-only group in the PACE Trial (who didn't receive CBT, GET or APT) also improved a bit on such measures.

    Fernie et al 2015 Table 1.png
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