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Which countries have ditched the BPS approach or removed CBT/GET from their guidelines?

Discussion in 'Psychosomatic theories and treatments discussions' started by Wyva, Jun 19, 2021.

  1. Wyva

    Wyva Senior Member (Voting Rights)

    Budapest, Hungary
    Apart from the US and the UK, of course. I'm looking for any other countries, even if they just quietly removed the CBT/GET recommendations, so that I can give more examples to my GP to show him that a shift is happening. (This is in connection with the possible ME/CFS clinic he has in mind.)
    sebaaa, Joh, Invisible Woman and 12 others like this.
  2. cassava7

    cassava7 Senior Member (Voting Rights)

    The recommendations of GET and CBT were abandoned in the Dutch and Belgian guidelines (respectively 2018 and October 2020). The former caution that patients who refuse to undergo GET or CBT should not be penalized in receiving healthcare. The latter fully endorse the BPS and MUS approaches, however they indicate that CBT should not be systematically offered, without contra-indicating it, and recommend against strict GET (favoring instead techniques similar to "adaptative pacing" as in the PACE trial).

    NHS / Healthcare Improvement Scotland, independently of NICE, issued a caution notice on GET in August 2020:

    A Cochrane systematic review and a NICE Guideline are currently being revised and updated and caution should be noted on the use of GET for CFS/ME until the updates are published.
    ETA: given that two South Korean groups had systematic reviews on the prevalence of ME/CFS and the 2-day CPET as a diagnostic tool published recently, it would be interesting to know whether South Korean health authorities have official guidelines on ME/CFS or are in the process of establishing them.
    Last edited: Jun 19, 2021
    sebaaa, Hutan, Louie41 and 15 others like this.
  3. MatthiasRiem

    MatthiasRiem Established Member

    The statement about the Dutch guidelines is not quite right. What was published in 2018 was the Dutch Health Council advice for the Dutch parliament, not a guideline.
    The statements about GET and CBT in the document have lots of nuances.
    The Health Council saw 'no reason' to recommend GET.
    Regarding CBT, it states that there is no evidence for its efficacy in house- or bedbound patients. Still, a majority of the Health Council committee believes that a subgroup of non-housebound patients can benefit from CBT. The committee believes that reports of adverse effects from CBT can be explained by the fact that ME/CFS has a variable course, combined with the fact that CBT is not always effective - this could lead patients to attribute a deterioration during CBT to CBT, in the absence of a causal relationship.
    The Health Council accepts the possibility, in individual cases, of 'damage' from CBT. It advises health professionals to be alert to this and to advise the patient to stop increasing their physical activity 'if this happens'. (Several Dutch patient advocates have noted that this advice is completely at odds with - and can hardly be implemented in the context of - the Dutch treatment protocol 'CBT for CFS' by Knoop and Bleijenberg, which would instead encourage the therapist to offer alternative interpretations/cognitions regarding the increase in symptoms.)

    The passage regarding 'not penalizing' patients for refusing GET or CBT or both is about assessment of patients by insurance doctors. Dutch law requires employees to cooperate with 'treatments that are considered adequate according to general medical standards'. The Health Council advice states that neither GET nor CBT should be seen as adequate treatments for ME/CFS in this sense.
    This conclusion was embraced by the leadership of UWV (the Dutch DWP), but not by the Dutch Association for Insurance Medicine (NVVG) - which in effect means that insurance doctors at UWV still force employers into CBT.

    New treatment guidelines are currently being written. They will be based on the new NICE guidelines. Since the creation of the new Dutch guidelines is underway, it seems they will be based on the NICE draft. I do not know what influence the revised guideline text that will be published by NICE in august might still have on the Dutch guidelines.
    There are separate guidelines for insurance doctors, though. I am not aware of plans to replace those as well.

    Long story short: so far, the Netherlands have not ditched the BPS approach or CBT from any of their guidelines, though to be consistent with the Health Council advice of 2018, the new guidelines would certainly need to ditch GET. They would also need to ditch CBT at least for those house- or bedbound. But hey, let's hope the new guidelines will follow the NICE draft and go much further than that.
    Last edited: Jun 20, 2021
    Michelle, Sean, sebaaa and 9 others like this.
  4. Kirsten

    Kirsten Established Member (Voting Rights)

    I would say the situation in Scotland is fairly mixed, although the statement certainly helped. And hopefully the new NICE guidline will as well even if we don't always strictly follow NICE, it's still fairly influential.

    In my experience it seems if the healthcare professional knows someone personally who has ME then they tend to treat you better and with respect and do what they can to try and treat symptoms.

    But if they don't know anyone personally its the same old BPS nonsense. With some following blindly and not really understanding any of the issues, and often not caring. They're just doing what they're told by the system... And others viemently following BPS in a fairly sadistic way, full of thinly veiled anger and resentment towards patients...

    So, mixed, but not really "removed".

    Edited to add: But following this thread as i really hope there are some places who have managed to leave BPS in the past.
    Michelle, Sean, Amw66 and 4 others like this.

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