Arvo
Senior Member (Voting Rights)
eta:
"But that once the fatigue had been triggered, there were a number of factors which perpetuated it, but principally a fear of making symptoms worse and this all or nothing approach to activity which often leads to fear avoidance.
So the CBT was based on the actual model and included a structuring of the daily activities people had been struggling with a gradual return to normal activities over weeks and sometimes months.
And the idea was to stabilise their activities, have it more consistent, and then build up gradually so that their confidence was built. And then we addressed unhelpful beliefs related to their fears about making symptoms worse. I have to say at this point that we weren’t trying to change peoples attributions from physical ones to psychological ones."
"So what changed in our study. Well the thing that changed and seemed to be associated with a better outcome was the belief that exercise should be avoided and that doing less helped fatigue. That was the thing that changed. What didn’t change was their belief in the fact they had something physically wrong with them."
I can only speak for the earliest years (<1993), but while technically true it is not in two of her earliest papers about the therapy to explicitly explain thoughts like thinking you have ME b/c of symptoms as a "distortion of reality"*, I fail to see a big difference in effect between that and "cognitive work to break the association between increase in symptoms and stopping or avoiding the activity" by someone who firmly believes your illness is a neurosis, an "abnormal illness behaviour", who probably shows it, and who is specifically focused on wheter you think you have ME or not. Also, Chalder and Butler on the Wessely side of early beginnings (there were two currents coming together, Institute of Psychiatry and Oxford) were originally Behaviour Therapists, so it's not strange that initially the heaviest focus lied on that, the 'unwarranted behaviour' of avoidance of activities, with the cognitions as driver of that avoidance.
*I got this from the PACE trial CBT manual, which seems to be dated 19/6/2002, which seems early (so maybe a dossier number?). This is session 8-12. Session 1 starts with the instruction that the therapist should "acknowledge the reality of symptoms and the distress and handicap caused" while "conveying warmth and genuine interest" and that "the therapist should be open-minded about the cause of the symptoms". From that to the instruction of session 8-12, that's just plain purposeful abuse.
"So at the end of that sort of era, if you like, we found that there was some evidence for a cognitive behavioural model of fatigue syndromes, and it was CBT or a modified form of CBT was the effective treatment for adults and children with fatigue syndromes in a variety of settings.
The NICE guidelines took it on board and they recommend and they still recommend at the moment that CBT and Graded exercise therapy should be offered to people with mild to moderate CFS."
A. Does she mean the PACE trial as the end of that sort of era? B/c that was published 22 years after she started CBT for ME, quite a long time to set it loose on people while you're claiming still to be in the process of discovering if the model your approach is built on even applies.
And what does she mean with a "modified form of CBT"?
B. They're always so quiet about severe ME. In theory the "effect" of their therapy should be the same in severe ME (same model right?), and in practise it is deemed so. Have they ever explained why CBT is (pure theoretically) not offered to severe ME patients? (Their dutch branch are less cautious and have said that it's because severe ME patients don't want to while they could be helped.)