Gabrielle Murphy

Dr. Gabrielle Murphy is a specialist physician working in the Department of Immunity and Inflammation at the Royal Free Hospital in London. She is the Clinical Lead of the Fatigue Service at The Royal Free Hampstead NHS Trust, North London, United Kingdom, (which primarily delivers Graded exercise therapy (GET) and Cognitive behavioral therapy (CBT).

NICE Guidelines Committee 2018-2020
Murphy was appointed to the NICE guidelines review committee for ME/CFS in November 2018, a controversial appointment given her work on the PACE trial, and opposing the release of the PACE data to patients and scientists, along with the other members of PACE trial management group. In 2009, Murphy was also involved a CFS/ME conference which included health insurance Unum Provident's Mansel Ayward as Keynote speaker; Esther Crawley was another speaker at the event.

Murphy is the current chair of BACME, which promotes only the biopsychosocial theory of ME and CFS, with cognitive behavioural therapy and graded exercise therapy being the treatments they recommend; no other organization's chair, president or chief executive is serving on the NICE guidelines review committee panel.

Books

 * 2009, Coping Better With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: Cognitive Behaviour Therapy for CFS/ME.
 * Contents include: - Critical incidents, vulnerability factors and maintaining factors - Goal setting - Thoughts and feelings - Sleep - Activity - Energy capsules - Impact crosses - Challenging unhelpful patterns of thinking - Stress and anxiety - Core beliefs - Symptom mapping - Planning for setbacks - Medical perspective

This book states that graded exercise therapy and adaptive pacing therapy may also be helpful or even preferable to patients. Adaptive pacing therapy was used in the PACE trial, which she was working on when the book was published. The theoretical basis described within the book have been criticized by a Health Psychologist with ME as being inconsistent with what CBT can do. {{Cite web|url=https://www.amazon.co.uk/gp/customer-reviews/R1FS8A9PMG2UK3/ref=cm_cr_arp_d_rvw_ttl?ie=UTF8&ASIN=1855755378|title=Is this for patients with CFS or people suffering from stress?|last=DrEMF|first=|date=|quote=I am a Health Psychologist who has specialised in CFS and ME for over 15 years. I abstract every scientific publication on both disorders for the Melvin Ramsay Archive, and completed a PhD on ME and post-viral syndrome. I am a Fellow of the British Psychological Society (i.e. quite senior). As a clinically trained psychologist, I know about CBT; what it can do and what it can't. I personally believe that CBT is a very helpful way of dealing with anxiety, fear, depression and other emotional problems associated with having a medical disorder. I have no problems recommending CBT when appropriate, but it has to be based on a sound understanding of the conditions, an up-to-date knowledge of the research and above all, respect for the patient. This book shows respect for the patient but little understanding of the research (hence physiological changes are linked solely to emotions, not evidence of viral activity or metabolic abnormalities), and the authors refer to deconditioning, shown quite a long time ago as playing no significant role in CFS. The theory underpinning this version of CBT is a mix of the CBT model ('CFS is largely a result of maladaptive beliefs, a lack of activity and the physiological results of stress') and something new which can be found on pages 129 and 134. For example, the authors state "the brain and body may have become primed to have the same maladaptive response to any stressor and that maladaptive response has become a conditioned (learned) response." It's this which interested me as a psychologist. The idea, as far as I understand it, is that we, or our brains, learn to associate stress (e.g. divorce) and the symptoms of CFS. Other stressors would then be able elicit 'CFS' through generalization. Except, it doesn't work that way. Although similar stressors to the original one can elicit a lesser response, at least in dogs, the stimulus has to be presented at certain intervals, otherwise the response will extinguish. In real life, many patients relapse and remit, or get worse. So point 1 is that CFS is not a lesser response and this requires an explanation. Then there is point 2; the issue of discrimination. The authors suggest any stressor can trigger 'CFS'. The following is a classic study in psychology. Rats given a sweet solution and X-ray felt sick, associating the sweetness with the nausea. They did not show distress when later tested with a strong light or noise. And there are other studies which demonstrate that one can learn an association between X and Y, but that exposure to Z won't have an effect. The stimuli (stressors) have to be similar to the original conditioned one, so with respect to CFS, the stressor would have to be significant, e.g. after a divorce, one would lose one's job, experience the death of a loved one, be beaten up etc, all within a period of 3-6 months. One can imagine these as capable of producing severe distress and ill-health. Missing the bus or the fridge breaking down should not elicit a conditioned response. We do not expect these 'hassles' to lead to severe symptoms. (If there were a lot of them, occurring one after the other for many months, then meditation, and a version of CBT with a different emphasis would be more appropriate). I think CFS specialists might have noticed if the majority of patients have a history of major negative life events preceding and subsequent to onset. Instead, the psychological literature has focused on unhelpful beliefs and inactivity. But beliefs and inactivity do not cause enteroviral infections (Chia and Chia 2008), intolerance to alcohol or swollen glands. In my view, the book isn't really about CFS but about chronic stress. The case histories give a clue. A man caught a bug and went back to work too quickly, hence a discussion about perfectionistic personality and stress. I consider that reasonable but would I diagnose that as CFS? No. A lady had a messy divorce which is very stressful, and reports fatigue, aches and pains, and tender glands. Again, is that CFS or chronic stress? Will CBT help them? Yes, it probably would. Will this version of CBt help genuine CFS? I doubt it. The research has shown only modest effects and that's only really for fatigue. Who might benefit from this book? A 12 year old with CFS.Adults with anxiety and stress due to overload. Yes, stress can cause fatigue and all the other symptoms described in the book. Conversely, this is not a guide for people with acute onset, post-viral ME, with neurological symptoms, nausea and muscle weakness, all closely related to minimal exertion and other factors such as the menstrual cycle, changes in the weather etc. A much better intro to CBT is the guide edited by Sue Pemberton. The chapter on sleep is fine, the section on energy capsules describes pacing well, and the advice on dealing with worrying is sound. But the activity diary is poor without a space for symptoms so one can see connections. As for everyone getting deconditioned due to prolonged bed rest, isn't that an urban myth? There's some unintentional humour. Having obviously seen a few individuals who need very basic, thought-by-thought advice, the book provides a list of activities to wind down. It goes like this (p. 43): Record worries in worry book; Read; Wash and clean teeth; Relaxation/meditation; Switch off lights; Go to bed. 24 hours later, I wondered if the authors would include this in a book for patients with cancer or MS? The above illustrates my main issue. There are touches of basic, sensible advice intertwined with an overly simplistic view of the illness-as-lived. To conclude: there's good news and bad news. The good news is that the book is very short (135 pages). The bad news is that it isn't the best guide about coping with classic CFS and ME. There are better books. Yes, CBT is useful for some with ME and CFS. But I'm not sure this version is one I'd personally recommend. Conflict of Interest: I have ME myself.

British Association for CFS/ME (BACME)
Dr. Murphy is an executive member of the British Association for CFS/ME (BACME), an organization that supported and advocated for GET and CBT in the treatment of ME/CFS. Her involvement with BACME included hosting the 2003 and 2005 Conferences, and being its Chair for 2004-2005, and in 2018.

Sussex & Kent ME/CFS Society
Dr. Murphy is a patron of the Sussex & Kent ME/CFS Society, a registered charity that informs, supports and represents those affected by Myalgic Encephalomyelitis (ME) or Chronic Fatigue Syndrome (CFS) across Sussex and Kent.

PACE trial
Murphy is a co-author of the PACE trial, having referred patients from her clinic.

Open letter in support of Wessely and the PACE trial
In Dec 2012, in response to criticism about the PACE trial and Sir Simon Wessely's psychological paradigm of ME/CFS, a letter of support for Wessely was published in several newspapers. Murphy was one of the signatories. The letter construed legitimate questions about the PACE trial as a personal attack, claiming "researchers in the field have been the target of a campaign to undermine their work and professional credibility."

Notable studies

 * 2011, Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial


 * 2016, Treatment outcome and metacognitive change in CBT and GET for Chronic Fatigue Syndrome


 * 2019, Persistent fatigue induced by interferon-alpha: a novel, inflammation-based, proxy model of chronic fatigue syndrome (Full text)

Letters

 * 2017, Response to the editorial by Dr Geraghty (Full text)


 * 2018, The International Collaborative on Fatigue Following Infection (COFFI) (Full text)

Talks and interviews

 * 2014, Dr Gabrielle Murphy - M.E. Research and Practice

Clinic location

 * Clinic Address: The Fatigue Service, Royal Free Hospital, Pond St, Hampstead, London NW3 2QG, United Kingdom


 * Email: rfh-tr.fatigueservice@nhs.net

Online presence

 * Facebook
 * Twitter
 * YouTube
 * Website/Blog

Learn more

 * 2011, Patient's report of visit with Dr. Murphy
 * 2007, Coercion as Cure Response