Cognitive behavioral therapy

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Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that is used as a management technique for a wide range of life-altering events, including serious and/or chronic illness such as cancer and multiple sclerosis. In these contexts, it helps patients to adapt to their health condition.

CBT is often proposed as a primary treatment for ME/CFS,[1] this choice of treatment is justified using the unproven biopsychosocial hypothesis of ME/CFS, this hypothesis assumes that dysfunctional illness beliefs exist in patients with ME/CFS, and changing these beliefs will lead to recovery.[1][2][3] However, in this context, its goal is frequently to dissuade patients of illness beliefs that are also held by a number of scientists who remain in good health, one such belief typically challenged during CBT is the belief that ME/CFS is a physical or neurological illness, a "belief" shared by the World Health Organization.[4][5][6]

CBT is one of the therapies used in the controversial PACE trial.[7]

Cognitive Behavioral Therapy for ME/CFS: What's the issue? This is not an argument with psychiatry. Mental and physical illness are equally real and horrible. As with any long-term illness, some people with ME/CFS will develop comorbid depression and other mental health problems where CBT can be of help alongside good quality general management. The argument here is with a flawed model of causation assuming efficacy for CBT and GET while taking no significant account of varying clinical presentations and disease pathways. —Charles Shepherd, Journal of health psychology (2017)[8]
CBT for ME/CFS: What's the issue?[8]

United Kingdom[edit | edit source]

This video shows excerpts from a British training video. CBT is offered (free of charge) to patients by the British National Health Service (NHS).

Evidence[edit | edit source]

In a complex review of existing research Nijs et al. in 2008, all of who were proponents of the biopsychosocial model, only the PACE trial, and the Cochrane review that heavily relied upon it were cited as evidence of the effectiveness of CBT as a treatment for ME/CF.[9] Nijs et al. found that neither CBT nor pain physiology education nor "pacing activity self-management education" reduced the patients' supposed "fear of movement", and that "severe exacerbation of symptoms following physical activity" was characteristic of chronic fatigue syndrome.[9]

Systematic reviews conducted in 2019 and 2020 found that most trials of cognitive behavioral therapy were relatively low quality with prominent bias, and of 11 randomized controlled trials of CBT, only 5 showed measurable improvement.[10][11]

Harms of Cognitive Behavioural Therapy and Graded Exercise Therapy

As a physician bedridden with myalgic encephalomyelitis (ME) for more than a decade who is totally dependent on others, all thanks to a major relapse caused by GET, I am in a unique position to answer how harmful GET and cognitive behavioral therapy (CBT) really are. The basis of these therapies is false illness beliefs, meaning that it is all in the mind. These beliefs ignore all of the evidence that ME is a physical disease, such as intracellular immune dysfunctions, which not only restrict exercise capacity but also worsen with exercise (2). The main characteristic of ME is an abnormally delayed muscle recovery after doing trivial things, not chronic fatigue, and GET and CBT force you to ignore your symptoms to exercise your way back to full fitness. If you do that, you exceed your limit and cause a relapse, and the more you exceed your limit, the bigger the relapse and the less likely you are to recover from it. Many patients with this condition have become homebound and bedridden because of a major relapse caused by GET, and we will get our health and independence back only if we receive proper medication.

“
”
Dr Maik Speedy


Long term effects[edit | edit source]

Westen et al (2004) found that psychological therapies in general were ineffective in the long term, although they did not assess ME/CFS separately patients.[12]

Reports of harm[edit | edit source]

Surveys from patient organizations have found considerable rates of harm from CBT among the patients surveyed.[3][13] The largest UK patient charities, ME Association and Action for ME, have both called for the use of CBT to challenge "illness beliefs" to be withdrawn and for NHS staff to warn patients of the potential for harm.[14] The largest independent patient survey of patient experiences of CBT and GET in the UK was commissioned by NICE, and found that ME/CFS patients undergoing CBT for their illness were almost twice as likely to have their mental health deteriorate than improve as a result of the course. One in 5 developed new symptoms, physical health was also more likely at show no improvement or be negatively affected than to improve.[15]

Robin Brown, a British doctor with ME/CFS has created petition that many thousands have signed calling for GET and related CBT to be removed from the UK treatment guidelines immediately.[16][7]

Articles explaining CBT not appropriate for ME/CFS[edit | edit source]

CDC withdrawal of CBT treatment[edit | edit source]

July 3, 2017, The Centers for Disease Control and Prevention's (CDC) website Chronic Fatigue Syndrome page has been changed to "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)" and GET and CBT recommendations have been removed.[21][22]

Notable studies[edit | edit source]

  • 2017, Myalgic encephalomyelitis/chronic fatigue syndrome patients’ reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys[25] (Full text)
  • 2018, Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review[29]
  • 2018, Cognitive–behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe[30]
  • 2019, Assessment of the scientific rigour of randomized controlled trials on the effectiveness of cognitive behavioural therapy and graded exercise therapy for patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review[10]
  • 2020, Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)[11]

See also[edit | edit source]

Critics

Other important links

Learn more[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Twisk, Frank N.M.; Maes, Michael (2009). "A review on cognitive behavioral therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS". Neuro Endocrinology Letters. 30 (3): 284–299. ISSN 0172-780X. PMID 19855350.
  2. ↑ 2.0 2.1 Friedberg, Fred (July 2, 2016). "Cognitive-behavior therapy: why is it so vilified in the chronic fatigue syndrome community?". Fatigue: Biomedicine, Health & Behavior. 4 (3): 127–131. doi:10.1080/21641846.2016.1200884. ISSN 2164-1846.
  3. ↑ 3.0 3.1 3.2 Speedy, Maik (December 2015). "Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome" (PDF). Annals of Internal Medicine. 163 (11): 884–885. doi:10.7326/L15-5170. PMID 26618290. As a physician bedridden with myalgic encephalomyelitis (ME) for more than a decade who is totally dependent on others, all thanks to a major relapse caused by GET, I am in a unique position to answer how harmful GET and cognitive behavioral therapy (CBT) really are. The basis of these therapies is false illness beliefs, meaning that it is all in the mind. These beliefs ignore all of the evidence that ME is a physical disease, such as intracellular immune dysfunctions, which not only restrict exercise capacity but also worsen with exercise (2).
    The main characteristic of ME is an abnormally delayed muscle recovery after doing trivial things, not chronic fatigue, and GET and CBT force you to ignore your symptoms to exercise your way back to full fitness. If you do that, you exceed your limit and cause a relapse, and the more you exceed your limit, the bigger the relapse and the less likely you are to recover from it. Many patients with this condition have become homebound and bedridden because of a major relapse caused by GET, and we will get our health and independence back only if we receive proper medication.
  4. ↑ Chalder, Trudie; Goldsmith, Kimberley A; White, Peter D; Sharpe, Michael; Pickles, Andrew R (2015). "Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial". The Lancet Psychiatry. 2 (2): 141–152. doi:10.1016/S2215-0366(14)00069-8. ISSN 2215-0366.
  5. ↑ 5.0 5.1 5.2 5.3 Geraghty, Keith J; Blease, Charlotte (September 15, 2016). "Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent" (PDF). Journal of Health Psychology. 23 (1): 127–138. doi:10.1177/1359105316667798. ISSN 1359-1053.
  6. ↑ World Health Organization. "8E49 Postviral fatigue syndrome | ICD-11 - Mortality and Morbidity Statistics". icd.who.int. Retrieved November 2, 2018. 8E49 Postviral fatigue syndrome
    Other disorders of the nervous system
    Inclusions Benign myalgic encephalomyelitis
    chronic fatigue syndrome
  7. ↑ 7.0 7.1 "Our Illness Management Report calls for major changes to therapies offered for ME/CFS | 29 May 2015". The ME Association. Retrieved October 13, 2018.
  8. ↑ 8.0 8.1 Shepherd, Charles B (2017). "PACE trial claims for recovery in myalgic encephalomyelitis/chronic fatigue syndrome – true or false? It's time for an independent review of the methodology and results". Journal of Health Psychology. doi:10.1177/1359105317703786.
    This is not an argument with psychiatry. Mental and physical illness are equally real and horrible. As with any long-term illness, some people with ME/CFS will develop comorbid depression and other mental health problems where CBT can be of help alongside good quality general management. The argument here is with a flawed model of causation assuming efficacy for CBT and GET while taking no significant account of varying clinical presentations and disease pathways.
  9. ↑ 9.0 9.1 Nijs, Jo; Roussel, Nathalie; Van Oosterwijck, Jessica; De Kooning, Margot; Ickmans, Kelly; Struyf, Filip; Meeus, Mira; Lundberg, Mari (May 3, 2013). "Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice" (PDF). Clinical Rheumatology. 32 (8): 1121–1129. doi:10.1007/s10067-013-2277-4. ISSN 0770-3198.
  10. ↑ 10.0 10.1 Ahmed, SA; Mewes, JC; Vrijhoef, HJM (May 10, 2019). "Assessment of the scientific rigour of randomized controlled trials on the effectiveness of cognitive behavioural therapy and graded exercise therapy for patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review". Journal of Health Psychology. 25 (2): 240–255. doi:10.1177/1359105319847261. ISSN 1359-1053.
  11. ↑ 11.0 11.1 Kim, Do-Young; Lee, Jin-Seok; Park, Samuel-Young; Kim, Soo-Jin; Son, Chang-Gue (January 6, 2020). "Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)". Journal of Translational Medicine. 18 (1): 7. doi:10.1186/s12967-019-02196-9. ISSN 1479-5876. PMC 6943902. PMID 31906979.
  12. ↑ Westen, Drew; Novotny, Catherine M.; Thompson-Brenner, Heather (2004). "The Empirical Status of Empirically Supported Psychotherapies: Assumptions, Findings, and Reporting in Controlled Clinical Trials". Psychological Bulletin. 130 (4): 631–663. doi:10.1037/0033-2909.130.4.631. ISSN 1939-1455.
  13. ↑ 13.0 13.1 Kindlon, Tom (2011). "Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome" (PDF). Retrieved October 29, 2018.
  14. ↑ 14.0 14.1 "ME/CFS Illness Management Survey Results - "No decisions about me without me" Part 1" (PDF). ME Association. ME Association. May 2015.
  15. ↑ 15.0 15.1 Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS) (February 27, 2019). "Evaluation of a survey exploring the experiences of adults and children with ME/CFS who have participated in CBT and GET interventional programmes. FINAL REPORT" (PDF). Oxford Brookes University.
  16. ↑ Brown, Robin. "NICE stop harming ME/CFS patients - Take CBT and GET out of the CFS guidelines NOW! | Sign the Petition". Change.org. Retrieved November 13, 2018.
  17. ↑ Johnson, Cort (November 14, 2015). "The Chokehold Behavioral Treatments Have on Chronic Fatigue Syndrome". Health Rising.
  18. ↑ "ME/CFS Australia (SA) Inc: ME/CFS Research UK Slams Lancet Psychiatry Report Advocating Exercise For Chronic Fatigue Syndrome Sufferers". sacfs.asn.au. Retrieved October 13, 2018.
  19. ↑ Goudsmit, Ellen; Howes, Sandra (May 29, 2017). "Bias, misleading information and lack of respect for alternative views have distorted perceptions of myalgic encephalomyelitis/chronic fatigue syndrome and its treatment". SAGE Journals. doi:10.1177/1359105317707216. Retrieved December 23, 2018.
  20. ↑ Geraghty, Keith; Jason, Leonard; Sunnquist, Madison; Blease, Charlotte; Tuller, David; Adeniji, Charles (February 2019). "The 'Cognitive Behavioural Model' of Chronic Fatigue Syndrome: Critique of a Flawed Model". Journal of Health Psychology. 6 (1): 2055102919838907. PMID 31041108.
  21. ↑ Tuller, David (July 10, 2017). "Trial By Error: The CDC Drops CBT/GET". Virology Blog.
  22. ↑ "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". CDC. Retrieved July 10, 2017.
  23. ↑ Núñez, Montserrat; Fernández-Solà, Joaquim; Nuñez, Esther; Fernández-Huerta, José-Manuel; Godás-Sieso, Teresa; Gomez-Gil, Esther (March 2011). "Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up". Clinical Rheumatology. 30 (3): 381–389. doi:10.1007/s10067-010-1677-y. ISSN 1434-9949. PMID 21234629.
  24. ↑ Illegems, Jela; Moorkens, Greta; Van Den Eede, Filip (2016). "Group Cognitive Behaviour Therapy for Chronic Fatigue Syndrome". Psychotherapy and Psychosomatics. 85 (5): 308. doi:10.1159/000445166. ISSN 1423-0348. PMID 27513528.
  25. ↑ Geraghty, Keith; Hann, Mark; Kurtev, Stoyan (August 29, 2017). "Myalgic encephalomyelitis/chronic fatigue syndrome patients' reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys". Journal of Health Psychology. doi:10.1177/1359105317726152.
  26. ↑ McPhee, Graham (2017). "Cognitive behaviour therapy and objective assessments in chronic fatigue syndrome". Journal of Health Psychology. 22 (9): 1181–1186. doi:10.1177/1359105317707215. ISSN 1461-7277. PMID 28805529.
  27. ↑ Wilshire, Carolyn E.; Kindlon, Tom; Courtney, Robert; Matthees, Alem; Tuller, David; Geraghty, Keith; Levin, Bruce (March 22, 2018). "Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT". BMC Psychology. 6 (1). doi:10.1186/s40359-018-0218-3. ISSN 2050-7283. PMC 5863477. PMID 29562932.
  28. ↑ Spandler, Helen; Allen, Meg (August 16, 2017). "Contesting the psychiatric framing of ME/CFS" (PDF). Social Theory & Health. 16 (2): 127–141. doi:10.1057/s41285-017-0047-0. ISSN 1477-8211.
  29. ↑ Vink, Mark; Vink-Niese, Alexandra (October 8, 2018). "Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review". Health Psychology Open. 5 (2). doi:10.1177/2055102918805187. ISSN 2055-1029. PMID 30305916.
  30. ↑ Twisk, Frank; Corsius, Lou (August 2018). "Cognitive–behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe". The British Journal of Psychiatry. 213 (2): 500–501. doi:10.1192/bjp.2018.136. ISSN 0007-1250.
  31. ↑ Baschetti, Riccardo (April 2001). "Cognitive behaviour therapy and chronic fatigue syndrome" (PDF). British Journal of General Practice. 51 (465): 316. PMC 1313986.
  32. ↑ Chalder, Trudie (November 29, 2013). "Chronic Fatigue Syndrome". In Hofmann, Stefan G. (ed.). The Wiley Handbook of Cognitive Behavioral Therapy. 2. Chichester, West Sussex, UK: Wiley Blackwell. doi:10.1002/9781118528563.wbcbt23/abstract. ISBN 1118533208.
  33. ↑ Dalal, Farhad (May 2015). "Statistical Spin, Linguistic Obfuscation: The Art of Overselling the CBT Evidence Base". The Journal of Psychological Therapies in Primary Care (pdf). pp. 1–25. Retrieved February 20, 2019.
  34. ↑ "New study questions use of talking therapy as a treatment for schizophrenia". Medical Xpress. University of Hertfordshire. July 20, 2018. Retrieved October 13, 2018.
  35. ↑ Dalal, Farhad (September 2018). CBT: The Cognitive Behavioural Tsunami: Managerialism, Politics and the Corruptions of Science. doi:10.4324/9780429457814. ISBN 9780429457814. Retrieved February 20, 2019.
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