(old) Brief CBT from non-specialists ineffective (from a 2002 JoCFS study)

[Dolphin]

(I was going to challenge this on the CAA thread but that has over 1000 posts so I think a lot of people might never see it.)

Teejkay highlighted the following:

http://cme.medscape.com/viewarticle/581527_5

5. Consider cognitive behavioral therapy (CBT). The goal of CBT in the management of CFS is to help patients cope with their illness, change behaviors that can contribute to symptom expression, and develop an individualized activity plan to avoid postexertional malaise on one extreme and deconditioning on the other. While CBT is frequently prescribed as a coping strategy, it can also improve function and activity levels.

Some patients are resistant to this therapy because they mistakenly believe health practitioners who prescribe CBT think CFS is purely a psychological illness. Educating patients about the role CBT can play in helping them learn to manage activity levels, stress, and symptoms may help overcome this reluctance.

Because cognitive behavioral therapists who are knowledgeable about CFS are not available in many communities, clinicians may find it useful to practice an informal kind of CBT in their own practices when referral to a therapist isn't possible. Educating patients about pacing their activities, avoiding or reducing known stressors whenever possible, building their coping skills, and accepting the limitations of their illness can be achieved by a clinician in a primary care setting. (See the section on CBT in Managing Activity for more information.)

As I’ve mentioned before, CBT isn’t a coping strategy.

(From the Canadian ME/CFS Guidelines Overview)

SELF-HELP STRATEGIES (SHS)
A hypothesis underlying the use of Cognitive Behaviour Therapy (CBT) for ME/CFS is based
on the premise that the patient’s impairments are learned due to wrong thinking and
“considers the pathophysiology of CFS to be entirely reversible and perpetuated only by the
interaction of cognition, behaviour, and emotional processes. The patient merely has to
change their thinking and their symptoms will be gone. According to this model, CBT should
not only improve the quality of the patient’s life, but could be potentially curative”46.
Supporters suggest that “ideally general practitioners should diagnose CFS and refer patients
to psychotherapists for CBT without detours to medical specialists as in other functional
somatic syndromes”47. Proponents ignore the documented pathophysiology of ME/CFS,
disregard the reality of the patients’ symptoms, blame them for their illness, and withhold
medical treatment. Their studies have often included patients who have chronic fatigue but
excluded more severe cases as well as those who have other symptoms that are part of the
clinical criteria of ME/CFS. Further, their studies fail to cure or improve physiological
impairments such as OI, sore throat, IBS, etc. Dr. A. Komaroff48, a Harvard based world
authority, stated that the evidence of biological process “is inconsistent with the hypothesis
that (the syndrome) involves symptoms that are only imagined or amplified because of
underlying psychiatric distress. It is time to put that hypothesis to rest”. Some physicians,
who are cognizant of the biological pathophysiology of ME/CFS, teach patients coping skills
but call them “CBT”. We urge such doctors to use the term “Self-Help Strategies” and avoid
using the terms “Cognitive Behaviour Therapy” and “Cognitive Retraining Therapy”.

Anyway, one reason CBT can be mentioned in educational material is because it’s seen as “evidence-based”.

However, CBT given by family physicians/general practitioners isn’t “evidence-based” (i.e. even those who are into CBT for CFS don’t claim CBT from a family physicians/general practitioner is “evidence-based”).

Here is a study on the issue (it may get forgotten about sometimes as it isn't in PubMed):

http://www.informaworld.com/smpp/content~content=a903592583&db=all

Can General Practitioners Manage Chronic Fatigue Syndrome?
A Controlled Trial

Authors: Lisa Whitehead a;Peter Campion a

Affiliation: a The Health and Community Care Research Unit, University of Liverpool,

DOI: 10.1300/J092v10n01_05

Published in: Journal Of Chronic Fatigue Syndrome, Volume 10, Issue 1 January 2002 , pages 55 - 64


Abstract
Background: Chronic Fatigue Syndrome/Myalgic En-cephalomyeltis (CFS/ME) is now recognised as a condition that results in substantial disability with a prevalence of around 0.6%.

Aim: The study aimed to test the hypotheses that general practitioners could (a) diagnose and (b) treat patients with the Chronic Fatigue Syndrome (CFS).

Method: All practices in two health authorities were contacted with a 35% uptake. Fifty percent of practices then entered a patient into the study. Practices were randomised to either intervention or control groups, and were encouraged to recruit patients. It was intended that the intervention practices would introduce a form of brief cognitive behavioural therapy. Control practices were invited to manage their patients as usual, which often included referral to secondary care.

Results: The study suffered from both poor recruitment and high drop out. However, we were able to show that this intervention had no effect on the illness of the patients enrolled, and that patients with CFS remained highly disabled over the 12 month study period, whatever their treatment.

Conclusion: The study suggests that general practitioners in this study were unable to effectively treat the condition. This accords with the Royal Colleges' report (1996), that the only evidence for effective treatment thus far has come from specialist units. The study suggests that general practitioners are unable to provide a management programme of this nature, and possibly effective treatment programmes for CFS in primary care.

Keywords: Chronic Fatigue Syndrome; primary care; management

 

[V99]

Thanks TOMK

Also, even if it were a coping stategy, why would they assume that everyone would need to be taught how to manage activity levels, stress, etc. Many will do this already.