Dr David Tuller: And Now–No Surprise–CBT for Post-Covid Fatigue


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Trial By Error: And Now–No Surprise–CBT for Post-Covid Fatigue

8 AUGUST 2020

By David Tuller, DrPH

Old habits die hard. So do bad ideas. Especially when these old habits and bad ideas have formed the basis for prominent academic and medical careers in the UK and the Netherlands.

In the UK, Professor Trudie Chalder of King’s College London has advised patients with prolonged fatigue after an acute bout of Covid-19 that they should get back to regular activities quickly and avoid resting too much. The effort from the UK National Health Service called “Your COVID Recovery” promotes a course of increasing exercise based on what appears to be a deconditioning model–despite lack of evidence that the exhaustion experienced by many post-Covid patients is mainly the result of deconditioning.

In the Netherlands, the Dutch health research agency ZonMw has proposed a welcome and long-overdue investment of almost $30 million (€25 million) over ten years in biomedical research into ME/CFS (more about that later). At the same time, the agency has also announced support for another effort by Professor Hans Knoop in his longstanding campaign to promote cognitive behavior therapy. His new study, highlighted along with dozens of others about Covid-19 on the ZonMw website, is called: ReCOVer: Can Cognitive Behavioral Therapy via the Internet prevent the fatigue symptoms of COVID-19 patients from becoming chronic? A controlled and randomized trial

Here we go again.

Professor Knoop, a psychologist at Amsterdam University, demonstrated his willingness to make preposterous claims with a co-authored commentary published alongside the 2011 PACE trial report in The Lancet. Professor Knoop and his co-author falsely claimed that 30 percent of those who received CBT or graded exercise therapy met a “strict criterion” for recovery. The commentary was disinformation–I documented its Trumpian misrepresentations and misstatements a few years ago. It remains an embarrassment to the medical literature, as does the PACE trial itself.
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I am vaguely hopeful that some countries will take the Covid-19 post virual condition seriously and ultimately end up funding research into ME/CFS, but it's not going to be the UK that wakes up to this condition. They still haven't changed the advice from CBT and GET and there is no evidence they intend to even with their review in April next year. They just put out a change removing pain meds from those with chronic conditions instead replacing that with CBT so its pretty clear what direction this is likely heading.