Why they advocate CBT and GET
And now for the moment we’ve all been waiting for…the cure!
Because they think we don’t have an organic physical condition, but think we are suffering basically from psychological and behavioural problems, they advocate Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) (the CBT is often partly to get patients to do graded exercise). So the CBT (according to them) is not to help people deal better with their physical condition, it is to help them change their (alleged!) abnormal cognitions and behaviours.
One of the big problems with this approach is that they do not recognise that there might be a limit to the activities the patient can perform, and they don't see that patients cannot just "Graded Exercise" their way out of ME/CFS. (Of course if the patient is getting better anyway then they can increase activity).
For people who have not come across it, this is a brief summary of what CBT is, from the British Association of Behavioural and Cognitive Psychotherapies.
“Cognitive Behaviour Therapy (CBT) is a talking therapy. It can help people who are experiencing a wide range of mental health difficulties. What people think can affect how they feel and how they behave. This is the basis of CBT.
During times of mental distress, people think differently about themselves and what happens to them. Thoughts can become extreme and unhelpful. This can worsen how a person feels. They may then behave in a way that prolongs their distress.
CBT practitioners help each person identify and change their extreme thinking and unhelpful behaviour. In doing this, the result is often a major improvement in how a person feels and lives.”
I studied psychology for a year in university and we were thought that CBT was for things like depression, anxiety, and phobias.
So if you look at the previous comments from the psychiatrists (in my other posts) you can see that the extreme and unhelpful thoughts and behaviours they think we have is our attitude to activity, our beliefs that we have an organic illness etc. So this is what the target of their CBT therapy is.
Anyway these are some relevant quotes:
“At present treatment should address psychological disorder, misunderstandings about the nature of the condition, avoidance of activity, exercise intolerance and sleep disorder.”
Royal Colleges Report UK, 1996.
“Could the observed psychological disorder simply be a reaction to a physical illness? This explanation is the least convincing
.” Royal Colleges Report 1996.
“beliefs are…probable illness-maintaining factors and targets for therapeutic intervention”
"The most important starting point is to promote a consistent pattern of activity, rest, and sleep,followed by a gradual return to normal activity; ongoing review of any ‘catastrophic’ misinterpretation of symptoms"
Chronic fatigue syndrome: a practical guide to assessment and management
Sharpe M Chalder T Wessely S et al, General Hospital Psychiatry 1997:19:3:185-199 http://www.kcl.ac.uk/content/1/c6/01/47/68/27Sharpe1997.pdf
"When symptoms are found not to result from "genuine physical illness" they are often believed to be insignificant or attributed to mental illness...In fact there is scant provision in either medical or psychiatric services for the patient with somatic complaints who has neither physical disease nor severe mental illness.
We now know that we could do better. Evidence for the superiority of new ways of thinking about and managing such patients is growing....These new treatments, often referred to as cognitive behavioural therapies, take an explicitly integrative approach to patients' complaints—an approach in keeping with the evidence that the perpetuation of unexplained somatic symptoms is best understood in terms of an interaction between physiological processes, psychological factors, and social context.
This integrative approach also provides a logical basis for management. The first step is acknowledging the reality of the patient's problem. The second is systematically identifying and listing the principal factors that perpetuate illness, including disordered physiology, misinterpretation of associated bodily sensations, abnormalities of mood, unhelpful coping behaviour, and social stressors. The third step is making a management plan that targets the most important of these factors for each patient. For example, a patient with chronic fatigue may benefit from information to combat unfounded fears about the illness, guidance and encouragement in returning to normal activity, and help with employment and other problems.
.... Innovative service developments such as joint medical-psychiatric clinics and dedicated liaison psychiatry and psychology services will provide for patients who require more intensive treatment. Finally, the small but conspicuous group of patients who present with recurrent and multiple physical symptoms will be given proactive and coordinated care aimed at limiting unnecessary medical intervention and preventing iatrogenic harm.
BMJ 1997;315:561-562 (6 September), Richard Mayou, and Michael Sharpe.
Editorias: Treating medically unexplained physical symptoms Effective interventions are available
Note: Not all CBT therapists agree with these extreme views about ME/CFS patients. These views might be more prevalent in the UK, where it’s main promoters live, and now these extreme views are basically official NHS policy. Doctors or therapists elsewhere, unfortunately, could be influenced by these thinkers if they read their papers, and if they don’t know about the evidence countering these views.
Some patients here may find they have gone to a CBT therapist who might try to encourage them to pace more - the opposite of what the psychiatrists above try to do. Also CBT therapists (or other types of counsellors or psychologists) not influenced by the above extreme views, might see their role more as helping the patient come to terms with their limitations, rather than trying to pretend these limitations don’t exist. The Canadian Overview document has an interesting comment on this issue which I will post below.
Unlike what the psychiatrists above argue, there is evidence of an underlying disease in ME/CFS (so it is not our imagination), and people with ME/CFS do genuinely have a problem with exercise.