Graded Exercise Therapy, at least in the UK, comes with the advice that 'Boom & Bust' cycles of activity are an obstacle to the rehabilitation of the MECFS patient. After a week of Vøgt retweets in my twitter feed, I thought it would be productive to explore an idea from psychiatry that might be considerably wanting for evidence and demonstrate how there's not exactly a dearth of skepticism to be found on this side of the fence. Assumedly, the first place you might look to develop the idea that Boom & Bust is a hinderence to recovery, is by looking at the rehabilation process patients suffering injuries and other diseases have gone through. In the cases of succesful rehabilitation, what overall effect did Boom & Bust behaviour have on the speed of recovery? Did the patient persist with Boom & Bust behavior despite it's hindering effects? If the patient is able to achieve results, despite inefficiences, what effect does this have on the claim that Boom & Bust is responsible for the failure of a treatment like GET? It might well be argued from the psychiatric perspective that, the psychological cost of failure after a Boom & Bust cycle of activity is unique to the 'Oxford CFS' patient. While this might be argued, how exactly can it be proven? After a Boom & Bust cycle of activity, patients experience 'relapses' where symptom severity is increased and new or uncommon symptoms may present at the same time. When it comes to data on relapse, such as 2 day exercise testing, there is actually substantial data that supports the idea of impaired recovery from exertion when compared to healthy controls. It is perhaps most notable that such studies do not seem to enjoy the level of replication in the UK as they do in the US. The next hurdle is, how do you measure and attribute anxiety after a relapse? Anxiety due to poor health is reasonable behaviour. It would be extremely difficult to specifically prove that the anxiety following a Boom & Bust cycle is contributing to a behavioral pattern that re-enforces a sickness role in the absence of a persistent disease process. Given that medical science, while amazing, has much still to learn, how can you logically & ethically make the leap that the patient's described experience is unreliable and a diagnosis of abherrent behavior is appropriate and evidence based? I'll leave it there for now, but I'm really interested to hear others thoughts on this and learn of any research that is relevent to these points.