Understandably GET is being highlighted as being generally detrimental as a treatment for ME/CFS. But the message on the version of CBT as used in the PACE trial being almost as bad and harmful does not appear to be getting through. @Emsho s testimony at the Scottish Parliament about the CBT she had been subjected to clearly surprised/shocked those who heard it. So I thought it might be useful to add to this thread any references to this tailor-made version of CBT which is no doubt still being used and still considered perfectly acceptable. I'll start with excerpts from the PACE trial therapists manual on CBT (pdf has been uploaded on another thread). " The essence of CBT is helping the participant to change their interpretation of symptoms and associated fear, symptom focussing and avoidance. Participants are encouraged to see symptoms as temporary and reversible and not as signs of harm or evidence of fixed disease pathology. In this way it is anticipated that they will gain more control of their lives, as they, and not their symptoms, dictate what they do." " Theoretical Model The model emphasises the importance of the participant’s understanding of their illness and their interpretation of symptoms. For example they may interpret symptoms as a warning sign to reduce activity. Fear of symptoms and consequent avoidance of activity [© Trial Management Group: CBT Therapists Manual Page 13 of 162 MREC version 2.1 – 08 December 2004 ISRCTN54285094] associated with symptoms is central. This model also acknowledges that the participant’s beliefs and behaviours are influenced by available information and attitudes of families and friends and that these may also need to be addressed. The model assumes that physiological (fatigue), cognitive (fear of engaging in activity) and behavioural responses (avoidance of activity), are linked. Therefore by modifying one response it is anticipated that changes occur in the other responses. For example, increasing activity (behaviour) may gradually reduce the fear (cognitions) that activity leads to worsening of symptoms." " CBT also actively addresses the participant’s understanding of their illness which may involve challenging unhelpful beliefs, e.g., about symptoms or activity that may be preventing recovery." " Planned increases in activity with challenging of understanding of symptoms" " Cognitive strategies These strategies aim to address unhelpful thoughts and beliefs and may involve agreeing specific behavioural experiments to test out the validity of the participants’ existing beliefs." " Taping of therapy sessions This is a necessary part of the trial and participants have all consented to taping of sessions. At the beginning of each session it would be useful to remind them that you will be taping the session. If participants are unclear of the reasons, you can remind them that you are doing this for the purposes of supervision, assessment of competence, assessment of therapy differences and other research purposes." I know there is no way that these would be made available but it would be very interesting if someone were to listen to them (maybe if there were an inquiry?). On page 28: DISTINGUISHING BETWEEN APT, CBT AND GET For CBT model: Works from a deconditioning assumption Aims for an improvement in function to occur Consider increase symptoms as natural response to increased activity. Establish a baseline Set graded goals" In fact having looked down the list the only one's that appears under GET and not CBT (ie all the others are the same) is "Demonstrate / practice exercise". and conversely under CBT and not GET "Explore unhelpful thoughts, Learn to challenge unhelpful thoughts". " You will be demonstrating a collaborative style at your first meeting when you individualise the CBT model to their illness. By this we mean drawing a model together, examining factors they think have been responsible for triggering as well as maintaining the illness. Agreeing an agenda for each treatment session, asking for their input in making suggestions for their activity programme and evaluating previous sessions will help participants to feel valued and included in the treatment process." There may be more references but I can't read any more of it at the moment.