BMJ 1996;312:1097 (27 April)

Letters

Cognitive behaviour therapy should be compared with placebo treatments

EDITOR,--Lest Michael Sharpe and colleagues' paper lends respectability to the notion that the chronic fatigue syndrome is a diagnostic entity or suggests that cognitive behaviour therapy has any value specific to the condition,1 I wish to make three points.

Firstly, the disorder that the authors treated is heterogeneous, the only defining criteria used being fatigue, impaired daily activities, and the absence of signs of physical disease or "severe depression." Claims for a specific effect in any diffuse symptom complex are dangerous. Quinine is effective in many cases of cramp, but neither the symptom nor the benefit is specific.

Secondly, cognitive behaviour therapy and any comparable substitute were denied the control patients, who were therefore matched only on pretreatment criteria regarding their clinical state and not controlled in respect of a comparable treatment. Despite the authors' claim for a "specificity of treatment effect" the benefits shown are consistent with the provision . . . [Full text of this article]


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Relevant Article

Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial
Michael Sharpe, Keith Hawton, Sue Simkin, Christina Surawy, Ann Hackmann, Ivana Klimes, Tim Peto, David Warrell, and Valerie Seagroatt
BMJ 1996 312: 22-26. [Abstract] [Full Text]

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