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"CBT and GET were based on a hypothetical model of chronic fatigue syndrome whereby symptoms and disability are assumed to be primarily perpetuated by a fear of symptoms and activity, avoidance of activity, and associated deconditioning (lack of fitness). CBT and GET were intended to address these assumed perpetuating factors and to “reverse”2 the illness, leading to “an increase in activity capacity” and ultimately a recovery. CBT mainly focused on addressing fear and avoidance, and GET on reversing deconditioning. The trial's manual for therapists explains the model of illness for GET: “Participants are encouraged to see symptoms as temporary and reversible, as a result of their current physical weakness, and not as signs of progressive pathology”.1, 2
In the latest analysis of the PACE trial in
The Lancet Psychiatry (February, 2015),3 Trudie Chalder and colleagues explain that CBT and GET did not improve the assumed lack of fitness, as assessed via a step test, and that “fitness measures do not appear to mediate the effects of either treatment”. Chalder and colleagues acknowledge that the trial outcomes do not support the hypothetical deconditioning model of GET for chronic fatigue syndrome."
"The PACE trial is to our knowledge the largest investigation of CBT and GET for chronic fatigue syndrome to date. The deconditioning hypothesis was not supported, and the fear-avoidance hypothesis was not supported by the trial's objective outcomes. These factors, along with the disappointing self-report clinical response rates for CBT and GET in an open-label trial, cast substantial doubt over the validity of the fear-avoidance and deconditioning hypothesis for chronic fatigue syndrome."
I find the references section particularly interesting.
References
- White, PD, Goldsmith, KA, Johnson, AL et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011; 377: 823–836
- Bavinton, J, Darbishire, L, and White, PD. PACE manual for therapists; graded exercise therapy for CFS/ME. http://www.pacetrial.org/docs/get-therapist-manual.pdf; 2004. ((accessed Jan 16, 2015).)
- Chalder, T, Goldsmith, KA, White, PD, Sharpe, M, and Pickles, AR. Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial. Lancet Psychiatry. 2015;2: 141–152
- Kindlon, TP. Objective measures found a lack of improvement for CBT & GET in the PACE Trial: subjective improvements may simply represent response biases or placebo effects in this non-blinded trial. BMJ Rapid Response. 2015; http://www.bmj.com/content/350/bmj.h227/rr-10. ((accessed Jan 21, 2015).)
- Wilshire, CE. Re: Tackling fears about exercise is important for ME treatment, analysis indicates. BMJ Rapid Response. 2015; http://www.bmj.com/content/350/bmj.h227/rr-7. ((accessed Jan 21, 2015).)