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Commentary: Heading for a therapeutic stalemate

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3774 (Published 22 June 2011) Cite this as: BMJ 2011;342:d3774

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Re:Cognitive behavioural therapy use does not imply a psychological cause for ME/CFS

Sinan Eccles does not understand the difference between the form of
CBT offered to other illness groups, and that offered to ME/CFS patients
and advocated as effective by the PACE trial paper and CFS/ME clinics. I
copy below an excerpt from the PACE results, describing the form of CBT
used. (1, page 3).

"Cognitive behaviour therapy (CBT)
CBT was done on the basis of the fear avoidance theory of chronic fatigue
syndrome. This theory regards chronic fatigue syndrome as being reversible
and that cognitive responses (fear of engaging in activity) and
behavioural responses (avoidance of activity) are linked and interact with
physiological processes to perpetuate fatigue. The aim of treatment was to
change the behavioural and cognitive factors assumed to be responsible for
perpetuation of the participant's symptoms and disability."

The irony is that the real life experience of people with the
neurological disease myalgic encephalomyelitis shows that ignoring their
symptoms and engaging in activity beyond their very limited capabilities
is the way to aggravate the disease. Many severe, bed-bound patients date
their decline into full-care status to taking part in Graded Exercise and
this form of CBT which challenges their "false illness beliefs".

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; The Lancet, Early Online Publication, 18 February
2011doi:10.1016/S0140-6736(11)60096-2

Competing interests: I'd like some effective treatment.

28 June 2011
Jane Clout
housebound advocate
For the truth about M.E.