Jonathan Edwards
Senior Member (Voting Rights)
If patients clearly know beforehand that exercise is bad for them, why are there so many reports of patients trying GET and getting worse? I'm thinking about surveys here, not merely anecdotes. I think what's happening is that patients are willing to try GET and don't necessarily have strong opinions on it until it harms them.
In a certain sense that patients are willing to believe in GET makes the poor results of PACE more credible. It doesn't work even if patients believe in it.
I have been thinking this over recently. The BPS model that informs Chalder's CBT does not so much imply that patients know before hand exercise is bad for them. It is very clearly based on the line of argument (in Wessely, Chalder et al 1989) that the problems that patients BELIEVE that exercise is bad for them (falsely) and that this belief is sufficiently strong that it wilt be altered simply by a leaflet or advice but only by a specific thought-changing therapy that uses 'cognitive strategies' i.e. brainwashing techniques.
Now if we take this requirement for the disease model seriously then pretty much by definition anyone with a belief this deep when looking at the information sheet for patients at the time of recruitment BEFORE being exposed to brainwashing will refuse to take part. It is pretty much a requirement of the false belief needing CBT theory that people with such beliefs will not have taken part in PACE.
That leaves plenty of room for other people who thought maybe exercise was bad trying PACE because they were desperate.However, these people by definition do not come under the theory that says that there is an irrational BELIEF too deep touching with a friendly patient information sheet!