Reports from participants in GET and CBT trials

There is something called exercise-induced anaphylaxis.

I experienced that a few times immediately after a race: my throat (and tongue?) would swell up and then dissipate after about 10 minutes. After the first time, I would go and hang with the paramedics in case it got worse and they needed to epi-pen me.


This manual shows they have no knowledge about sports medicine and how to train correctly. An athlete is NEVER told to ignore physical signs that seem uncommon

Exactly. Ignorance is dangerous.
 
Yes, that is why I said 'indication' - a pointer towards, but indeed, I am being charitable.

I'd be very careful of being charitable on this point. I think it was Trudie Chalder who essentially said that ME consists of feeling tired (because there are no objective, definitive tests) and so if people report that they don't feel tired any more, that's job done.

Astonishingly, I don't recall any acknowledgement from any of these psychiatrists that patients might be influenced in their reporting of fatigue by any other factor than how fatigued they feel - such as social pressure to appear to be well. This is undergraduate stuff. Just jaw-dropping to me.
 
Yet another thing that needs changing in medicine.

Is anyone campaigning for it?

If not, maybe this is a campaign that our community could begin.

It seems to me that ME is at the centre of a perfect storm of medical crap - the rush to assume that poorly understood illnesses are 'all in the mind', the low quality of psychiatric trials, the irresponsibility of institutions when faced with bad trials, the absence of anyone to take charge of dealing with 'new' diseases, and this - no system for dealing with harms from psychosocial interventions.

Nail meet head.
 
What the PACE CBT therapist manual says about setbacks https://www.qmul.ac.uk/wolfson/media/wolfson/current-projects/3.cbt-therapist-manual.pdf

1. No acknowledgement that increased activity is probably the most common trigger for aggravation of symptoms.
2. The insistence that setbacks are not an indicator that CBT is problematic.
3. The insistence that patients are recovering despite setbacks.

What the PACE GET therapist manual says https://www.qmul.ac.uk/wolfson/media/wolfson/current-projects/5.get-therapist-manual.pdf

There you have it, setbacks are a normal part of a GET program.
So what, in their bizzaro version of science, does count as evidence for a failed therapy?

Where is the possibility for falsification?

Sometimes I think they are just taking the piss.
 
This:
It seems to me that ME is at the centre of a perfect storm of medical crap - the rush to assume that poorly understood illnesses are 'all in the mind', the low quality of psychiatric trials, the irresponsibility of institutions when faced with bad trials, the absence of anyone to take charge of dealing with 'new' diseases, and this - no system for dealing with harms from psychosocial interventions.
Perfectly summarised. Its huge.
 
I've found one of the PACE participant accounts on Virology Blog: http://www.virology.ws/2015/10/30/p...to-david-tuller/comment-page-1/#comment-41476

Participant in the PACE trial Paul Everett (who is personally known to me) publically spoke yesterday about what happened to him. Participants in the OWN WORDS say more than the summary of the parts – which has shown to be very dubious. Read Angela Kennedy’s previous responses to the PACE trial for clarity too.

Paul’s experience in the trial: I was on the PACE trial after having ME for 20+ years and I was desperate to finally be given some hope !! I was told CBT would be best
for myself but was not available for a year – BUT if you help us with our PACE trial we will dangle a carrot of hope in front of you and you may be randomly selected to receive CBT… Happy Days … well not so happy days as my selection was nothing, just monitoring once in a while. I had to travel home on my own in floods of tears and massive confusion.

So I was now on the PACE trial … so much paperwork to do …so many interviews where I poured my heart out and highlighted drugs that may help and what was good or bad for our condition ( after all we are the experts ) – it all seemed to fall on death ears as there was already a bias to it being a mental disorder as this was my Professors field. I
invited my Professor to come and spend a day with me so he could really understand the struggle we live with in our environment – he declined my kind invitation and I realised from then on that no one was actually listening to me – I could go on but I think this was a common issue with patients on the trial. Anyhow the whole process set me back years, I did get CBT after the year as promised and my adviser was fantastic and really caring but had little experience with ME – I remember her saying it would be a good idea to take my computer out of my bedroom – I agreed and was looking forward to doing just that on my long train journey home – that plan of action must have been spoken about 10 years ago and guess what my computer is still in the flipping bedroom – help !!!

Anyhow I send love and light out to all my fellow sufferers and survivors and there will be real help for us one day, keep positive, keep laughing at the crazy pain and comatose state we find ourselves in but please don’t go near the gym xxxxx

I shall keep looking for others...
 
And another: http://www.virology.ws/2015/10/30/p...to-david-tuller/comment-page-1/#comment-41500

Another participant’s experience in their own words:

“I took part in this study, and was randomised to the GET group, and I’d be very sceptical about its results.

My initial blood tests showed some signs of infection and inflammation so I was sent for another set which apparently didn’t, so I could be accepted into the trial.* The assessment/criteria forms which had to be filled out at the before and during the trial, did not mention symptoms after exertion or delayed onset fatigue, there was very little attention paid to pain and cognitive/mental issues were very blurred.

At the start of the trial, I had to wear an accelerometor thing for a week, presumably to measure activity levels. But at the end of the trial, this wasn’t repeated. The fitness tests measured the number of steps I could do in a set amount of time, but paid no attention to the fact that I usually couldn’t walk for 2 days after these assessments.

The ‘handbook’ I was given contained an incredibly flawed model, which GET is based on, which basically goes ‘felt a bit ill – led to resting too much – led to deconditioning – led to the ME/CFS symptoms’. This completely ignores the fact that the vast majority of people don’t rest early on and carry on pushing themselves despite severe pain and
fatigue.

I would suggest that the criteria were so vague and the assessment so poor that a majority of the people who recovered using GET never had ME/CFS in the first place.”

permalink http://www.guardian.co.uk/discussion/comment-permalink/9627125 (since the Guardian changed it’s website, you now need to scroll down just over half way).

*The Oxford Criteria, used to filter applicants, does not accept people with neurological or immune system abnormalities. This on its own devalues any outcome.
 
http://www.virology.ws/2015/10/30/p...to-david-tuller/comment-page-1/#comment-41540

I have a good friend who took part in the PACE trial – she has been diagnosed with ME/CFS BUT also has PBC which has many similar symptoms – she was accepted on the trial despite the potential for this to muddy the results. She also met two others taking part, one of whom had depression and another who had cycled to the trial in his lunch break from work!! I do not know of anyone with ME or CFS who could do that without severe relapse afterwards! It is clear to her and to me that the trial was very flawed.
 
Anyhow the whole process set me back years, I did get CBT after the year as promised and my adviser was fantastic and really caring but had little experience with ME – I remember her saying it would be a good idea to take my computer out of my bedroom – I agreed and was looking forward to doing just that on my long train journey home – that plan of action must have been spoken about 10 years ago and guess what my computer is still in the flipping bedroom – help !!!
I understand this is a personal testimony - but I don't understand how a therapist can be "fantastic" and "caring" when they didn't help and didn't care enough to find out about ME.
 
Re: GET - useful or risky?
by goblinff on Wed Aug 14, 2013 11:21 am

I was on the PACE trial at Kings, on CBT. But it didn't really work for me, so per the Trial terms, they offered me Pacing instead, but didn't have the staff, so we talked about GET but I was too scared to try it.
They did send me a booklet on Graded Exercise, published by the NHS and written partly by a greek named lady, but I can't find it.
Do you know if there's a copy online? or where I could get one from?
Because the AFME has a booklet on Pacing but no-one seems to have one on GET, and I know it exists/ existed?

https://www.talkhealthpartnership.com/forum/viewtopic.php?f=490&t=4557#p12993
 
I understand this is a personal testimony - but I don't understand how a therapist can be "fantastic" and "caring" when they didn't help and didn't care enough to find out about ME.

It's the being "grateful for crumbs" response. Some patients have no one who cares how they are or will listen in detail. Maybe they don't have day to day problems on obtaining care or an income or housing or food. They need someone to listen to them.

The therapist says that apart from CBT. GE etc there is nothing else that can be done anyway so for this patient it's better than nothing.
 
From another thread...

Not found exactly what I was looking for, but something fairly close.

http://www.virology.ws/2018/01/15/trial-by-error-my-six-month-review/

David Tuller said:
On my recent trip, I interviewed one participant at length. He made a particularly salient point: Although during the trial he appeared to increase how much he walked, he did so at the expense of engaging in other activities. In other words, even those who increased their walking distance in the PACE trial might have done so by compensating for that extra exertion elsewhere their lives. So as this participant explained, he didn’t in the end engage in more activity overall—just more walking.

So far we have too many second-hand accounts. Why are people not coming forward?
 
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