Interventions
SMC: children and their families are offered a
variety of treatment options that are recommended
in NICE guidelines [2]. Typically this is centred
around graded activity and involves a follow-up
phone call at two weeks followed by family based
rehabilitation consultations lasting one hour at
approximately six weeks, three months, and four
and a half months. The number and timing of the
sessions are agreed with the child and family and
varies depending on the needs and goals of the
child. Children who have high levels of anxiety are
offered three individual sessions of CBT every two
weeks over a six week period. Other interventions
such as graded exercise therapy (GET) [16]are
available for children and young people if needed.
The clinical team providing SMC are not informed
by the research team to which trial arm a participant
has been allocated.
SMC plus the LP: in addition to the SMC detailed
above, young people and their parents will be asked
to read the information about the LP on the website
[
http://www.lightningprocess.com] or using
information sheets. If the young person is well
enough, they will be asked to read a book about the
LP, given to them from the LP team, or listen to an
audio book if preferable. Children/young people and
their parents will be asked to complete an
assessment form (which will take about ten minutes)
where they are asked to identify their goals and
describe what they learnt from reading the book.
After this they will have a telephone call with a LP
practitioner (usually approximately 20 minutes).
This is used to check that the young person and
their parents are happy about attending the
course, checks the goals identified by the young
person and is an opportunity for the young person
and their parents to ask further questions. If the
young person and their family are happy to
continue, the young person will be given a date to
attend a course.
The course is three sessions on three consecutive
days. Each session is three hours and forty-five minutes
long. Group sessions will include three to five young
people between 12 and 18 years of age who live within
the region covered by the CFS/ME service. During the
group, children and young people will receive a theory
session and a practical session. The course is free to
those participating in the trial.
1. The theory session will include taught elements
on the stress response, how the mind-body inter-
acts and how thought processes can be both help-
ful and negative. The language used by young
people will be discussed and in some cases chal-
lenged. Young people will be encouraged to think
about what they may be able to take responsibility
for and change. The taught sessions are followed
by a group discussion.
2. The practical session is used to put some of the
skills learnt into practice. Young people identify a
goal they wish to achieve (such as standing for
longer) and are then given alternative ways to
think about and prepare for this. This involves
using different cognitive (thinking) strategies
before and during the period in which achieving
the goal is attempted. Young people are also
asked to identify a goal wherein they can practise
the strategies in the afternoon or evening. This
goal will usually be short but could be an activity
that is up to 30 minutes long.
3. The LP practitioner will then arrange two follow-
up phone calls with the young person and parents
within two weeks of the course and then
approximately six to eight weeks later.