Cognitive behavioural therapy for ME/chronic fatigue syndrome is not effective. Re-analysis of a Cochrane review, 2019, Vink & Vink-Niese

Now might be a bad time to do that, for technical reasons. I am normally happy for whatever I post to be copied.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1834992/pdf/bmj00310-0013.pdf

 

Thanks Sarah!

 

Ok no problem. Thank you!

 

Thanks @Michiel Tack and @Sarah. I tracked down an earlier use by SW in Cognitive Behaviour Management of PVFS by Simon Wessely, Sue Butler, Trudie Chalder and Anthony David in Post viral Fatigue Syndrome Eds Jenkins and Mowbray

As regards practical advice the mainstay of treatment remains rest and to wait either for remission or a medical cure. This has been appropriately described as "therapeutic nihilism" (Bayliss 1988)

It is strange that the term used by Bayliss to justify treatment with antidepressants and monoamine oxidase inhibitors should also have been used to justify CBT. It seems clear that this was the world view that gave rise to the treatment.

Dawson's report contains this tantalising snippet

There were, however, some helpful psychiatric insights into the influence of personality, particularly introversion and neuroticism, on the response to disease and the length of convalescence.

If only we knew who was at the meeting to provide such insights. One has to wonder at the coyness.

 

And yet, I can't think of anything more nihilistic than "this treatment is bullshit but we'll sell it anyway".

He doesn't believe that, though. He knows the "treatment" is bullshit, it's just that it doesn't matter to him because he "knows" we're not actually sick so it's all good anyway. He's especially nihilistic in having no interest whatsoever in figuring out the disease, he's in the business of bullshit "rehabilitation" and motivated strictly by self-interest.

 

List of attendees can be found here:
https://onlinelibrary.wiley.com/doi/book/10.1002/9780470514382

 

Thank you very interesting

"Thirty microbiologists, psychiatrists, neurologists, and immunologists met informally at the Ciba Foundation recently" (written in November 1988).

They noted that "its hallmark" is "the muscle (and mental) fatigue" Yet they want to change that to "the symptom of fatigue must central rather than a sign of muscle weakness" because they say there is scant evidence of muscle weakness. So they changed the hallmark from something specific to something vague.

The other thing they also noted is "consistent problems with studies of the postviral fatigue syndrome - that selection criteria for patients vary from study to study and that controls are inappropriate or missing." And 30 years later we still have the same problems and we all know why.

 

Thanks for that but unfortunately it seems to be the 1993 symposium-unless there is something else there that I have not spotted. The 1988 one seems much more obscure.

 

Is that more vague? It seems to me more specific - because it pins the fatigue down to a central mechanism rather than being unspecified (central or peripheral).

 

Yes because they changed it from muscle fatigue to just fatigue in general

 

But you had said muscle (and mental) fatigue! That seems pretty nonspecific. Are there other sorts of fatigue? - I am not sure.

 

Thing is, we don't know what physicians mean by fatigue because it's used interchangeably to mean anything from light sleepiness to the perception of tiredness to moodiness. Obviously it's because they stretch the definition for convenience but because of this the word has basically been stripped of all useful meaning in the context of ME. The same happens in chronic fatigue research, the word is doing a lot of work that only has a loose association with how patients mean it, or how much it applies.

We are still stuck at phase 0, where the language used to describe the problem isn't even agreed upon and the ambiguity is aggressively exploited to add further confusion and squish ideological square pegs into round holes.

This problem is technically solvable, but human nature makes it nearly impossible without something to measure. Too many opinions being pushed, prejudices to counter. The same thing with chronic pain. Until something can be measured, it's too susceptible to opinions, ideology and motivated self-interest. It's not anything unique to this disease, it's a generic problem and unfortunately ME almost has every single one of those generic problems.

Are there other sorts of fatigue? Depends on the meaning of fatigue.

 

Interestingly, Phil "Lightning Process" Parker has shared a link to this re-analysis on Facebook with the comment "Interesting findings on cbt in me/cfs from a Cochrane review"

 

I fear that if CBT 'goes down' that LP will go with it.