• Welcome to Phoenix Rising!

    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of and finding treatments for complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

    To become a member, simply click the Register button at the top right.

The Lancet Psychiatry Article "Casts Doubt Over The Validity of The PACE Hypothesis"

Never Give Up

Collecting improvements, until there's a cure.
Messages
971
The link works for me. Try copying and pasting it into your URL bar/field.

"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
  1. 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
  2. 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).)
  3. 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
  4. 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).)
  5. 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).)
 

joshualevy

Senior Member
Messages
156
That's a letter to the editor, not an article. See the "Correspondence" right over the title. If you look at the current issue, you can see the Articles section long after the Correspondence section.

Joshua
 

SOC

Senior Member
Messages
7,849
That's a letter to the editor, not an article. See the "Correspondence" right over the title. If you look at the current issue, you can see the Articles section long after the Correspondence section.

Joshua
Ah, they fooled me. I saw the Previous Article and Next Article buttons and assumed this piece in between was also an article. Silly me.

Good letter anyway. Well written and concise.

I'm still astonished that The Lancet, of all journals, published this letter instead of trashing it the moment they got it. I consider this progress.
 

Never Give Up

Collecting improvements, until there's a cure.
Messages
971
Ah, they fooled me. I saw the Previous Article and Next Article buttons and assumed this piece in between was also an article. Silly me.

Good letter anyway. Well written and concise.

I'm still astonished that The Lancet, of all journals, published this letter instead of trashing it the moment they got it. I consider this progress.
Me, too!
 

Sean

Senior Member
Messages
7,378
I'm still astonished that The Lancet, of all journals, published this letter instead of trashing it the moment they got it. I consider this progress.
Credit where due. A number of letters from patients have been formally published by various journals, including The Lancet for the original PACE paper (2011).

Begrudgingly at times, sure, but they did publish them.
 

sarah darwins

Senior Member
Messages
2,508
Location
Cornwall, UK

sarah darwins

Senior Member
Messages
2,508
Location
Cornwall, UK
They always respond to anything that threatens their narrative, just with more incestuous papers praising the effectiveness of CBT and GET.

I've realised I shouldn't have used the word "campaigning" with regard to Robert Courtney (my apologies).

As I recall, the surmised existence of "a campaign" was successfully used as grounds for the denial of a Freedom of Information request re PACE.

I should have said that Robert Courtney has previously raised valid questions about the PACE trial and the conclusions drawn from it. Which he has.
 

Effi

Senior Member
Messages
1,496
Location
Europe
Most correspondents make criticisms of the trial as a whole, which we have already addressed in detail, and which might reflect the apparent campaign to bring the robust findings of the trial into question. (...)
We intend to further explore multiple mediator effects and the potential effects of outcomes on mediators in future papers. Some correspondents suggest that objective outcomes are more important than self-report measures. In view of the subjective nature of fatigue and the overriding importance of the patients own judgement of their functioning, we believe that self-rated outcomes remain the most important ones. Although it is entirely understandable that some patients with chronic fatigue syndrome are cautious about engaging in activity and exercise, increasing those activities gradually offers both improved functioning and reduced fatigue in some patients. Our findings also suggest that better targeting of fearful beliefs in treatment may result in better outcomes.
Seems like the BPS bunker is gonna stick with their faulty illness beliefs for a while longer... Letting go is hard, I get that. Nothing that a lil' CBT couldn't fix though! Just gra-dual-ly let go... :rolleyes:
 

SilverbladeTE

Senior Member
Messages
3,043
Location
Somewhere near Glasgow, Scotland

Anonymous_-_Prise_de_la_Bastille.jpg





nuremberg_defendants.jpg
 

Dolphin

Senior Member
Messages
17,567
(In case anyone missed it)
The journalist, David Tuller DrPH, has today posted a substantial piece on the PACE Trial:

TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study
http://www.virology.ws/2015/10/21/trial-by-error-i/

There's an introduction and summary at the start if you don't want to take on the whole thing.

It's being discussed in this PR thread:
http://forums.phoenixrising.me/inde...he-pace-chronic-fatigue-syndrome-study.40664/

ME Network have also posted their own summary piece:
http://www.meaction.net/2015/10/21/david-tuller-tears-apart-pace-trial/