Dr David Tuller: With Trump Out, Can GET/CBT Be Next?

[Countrygirl]

https://www.virology.ws/2020/11/09/...lgxF3EPrDUY0fcoH9M4ztYltXYwmvdtjmbNpZWnzBWgtY

Trial By Error: With Trump Out, Can GET/CBT Be Next?
9 NOVEMBER 2020
By David Tuller, DrPH

As the GET/CBT paradigm continues its slow collapse, members of the biopsychosocial ideological brigades have been busy repositioning themselves. The British Association for CFS/ME recently issued a muddled statement that seemed to rebut its own previous positions on GET and CBT—without explanation for the changes. Sir Simon recently suggested on twitter that these interventions were not based on the notion of getting more fit—a 1984-ish effort to un-say what he and his colleagues have asserted for years about the role of deconditioning in the illness. Going forward, I think we can expect more of these verbal pyrotechnics from people who know they got it wrong.

Tomorrow, we will learn a bit more about whether the international reevaluation and repudiation of the GET/CBT paradigm in recent years has had much impact in the UK. NICE is a major arm of the domestic medical-industrial complex, and its clinical guidelines are used extensively in British medical practice. Moreover, NICE’s influence extends far beyond domestic consumption. NICE guidelines are routinely cited and followed by health officials and clinicians around the world.

Here’s what I recently predicted about two main points of the draft NICE guidance to be released tomorrow:

 

[Diwi9]

Fingers crossed, I hope David is correct.

 

[BrightCandle]

I think he is wrong and they will just rename GET to graded activity and still use CBT for coping strategies. They will position it away from deconditioning and into multiple systemic conditions instead and nothing else will change, there will be no symptom relief recommendations.

I hope I am wrong, I really hope this is a turning point. But I don't have his confidence given the people who are coming up with the guidelines.

 

[lauluce]

sorry, what's happening tomorrow?

 

[Diwi9]

sorry, what's happening tomorrow?

I believe it is the draft NICE Guidelines.

 

[anni66]

Link to draft guideline and consultation docs
https://www.nice.org.uk/guidance/indevelopment/gid-ng10091/documents

 

[Diwi9]

Am I dreaming?

Physical activity
21 1.11.15 Do not advise people with ME/CFS to undertake unstructured exercise that is not part of a supervised programme, such as telling them to go to the gym or exercise more, because this may worsen their symptoms.

24 1.11.16 Do not offer people with ME/CFS:
• any therapy based on physical activity or exercise as a treatment or cure for ME/CFS
• generalised physical activity or exercise programmes – this includes programmes developed for healthy people or people with other illnesses
• any programme based on fixed incremental increases in physical activity or exercise, for example graded exercise therapy
• structured activity or exercise programmes that are based on deconditioning as the cause of ME/CFS
• therapies derived from osteopathy, life coaching and neurolinguistic programming (for example the Lightning Process).

 

[Diwi9]

Psychological support: cognitive behavioural therapy

2 1.11.43 Only offer cognitive behavioural therapy (CBT) to people with ME/CFS who would like to use it to support them in managing their symptoms of ME/CFS and to reduce the psychological distress associated with having a chronic illness. Do not offer CBT as a treatment or cure for ME/CFS.

6 1.11.44 CBT should be only delivered by a healthcare professional with appropriate training and experience in CBT for ME/CFS, and under the 8 clinical supervision of someone with expertise in CBT for ME/CFS.

9 1.11.45 Discuss with the person the principles of CBT, its role in supporting them 10 to adapt to and manage the impact of symptoms of ME/CFS and the potential benefits and risks. Explain that CBT for people with ME/CFS:
• is not curative
• is designed to improve wellbeing and quality of life
• aims to improve functioning and reduce the psychological distress associated with having a chronic illness
• does not assume people have ‘abnormal’ illness beliefs and behaviours as an underlying cause of their ME/CFS, but recognises that thoughts, feelings, behaviours and physiology interact with each other
• takes a non-judgemental, supportive approach to the person's experience of their symptoms and the challenges these present

 

[Imse]

Let's hope all caretakers reads this:

DRAFT FOR CONSULTATION
Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: NICE guideline
DRAFT (November 2020) 34 of 72
1 Psychological support: cognitive behavioural therapy
2 1.11.43 Only offer cognitive behavioural therapy (CBT) to people with ME/CFS
3 who would like to use it to support them in managing their symptoms of
4 ME/CFS and to reduce the psychological distress associated with having
5 a chronic illness. Do not offer CBT as a treatment or cure for ME/CFS.