Gabrielle Murphy

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Source:measussex.org.uk

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).[1][2]

NICE Guidelines Committee 2018-2020[edit | edit source]

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.[1][3][4][5] 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.[6]

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.[7]

Books[edit | edit source]

  • 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[2]

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.[8]

British Association for CFS/ME (BACME)[edit | edit source]

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.[9]

Sussex & Kent ME/CFS Society[edit | edit source]

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.[9]

PACE trial[edit | edit source]

Murphy is a co-author of the PACE trial, having referred patients from her clinic.[10]

Open letter in support of Wessely and the PACE trial[edit | edit source]

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."[11][12]

Notable studies[edit | edit source]

  • 2011, Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial[13]
  • 2016, Treatment outcome and metacognitive change in CBT and GET for Chronic Fatigue Syndrome[14]

Letters[edit | edit source]

Talks and interviews[edit | edit source]

Clinic location[edit | edit source]

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

Online presence[edit | edit source]

  • Facebook
  • Twitter
  • YouTube
  • Website/Blog

Learn more[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 NICE. "Committee member list | NICE CG53 CFS/ME guidance update". nice.org.uk. Retrieved November 8, 2018.
  2. ↑ 2.0 2.1 Fernie, Bruce; Murphy, Gabrielle (2009). Coping better with chronic fatigue syndrome/myalgic encephalomyelitis : cognitive behaviour therapy for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ ME). London: Karnac Books. ISBN 9781849408240. OCLC 729246215. We also recommend the consideration of other therapies such as Graded Exercise Therapy and Adaptive Pacing Therapy, both of which patients may find helpful, and sometimes preferable.
  3. ↑ Geraghty, Keith. "Dr Keith Geraghty on Twitter". Twitter. Retrieved November 8, 2018. So, NICE ME/CFS review panel, we have 1 dr. from PACE trial, 1 physio who is running Esther Crawley's FITNET & MAGENTA trials, 2 x from staunch Liverpool CBT-GET promotion centre, 1 dr GP who sees CFS as medically unexplained symptom CBT promoted - TOTAL CBT Promotion BIAS !
    ‏@keithgeraghty My focus is research - but this review panel is so biased I am just listing some of those biases; its up to patients and patient groups to take this information to NICE and ask for new members and a rethink.
  4. ↑ "CALL TO ACTION! NICE ARE BETRAYING US!". Phoenix Rising ME / CFS Forums. Retrieved November 8, 2018.
  5. ↑ "NICE Appoints Committee Rife with Bias - Take Action! - #MEAction". #MEAction. November 3, 2018. Retrieved November 9, 2018.
  6. ↑ "CFS/ME Clinical & Research Network & Collaborative (CCRNC) 2009 Conference". ME agenda. February 21, 2009. Retrieved November 8, 2018. An invitation has been sent for posters for the conference. The deadline has, now passed but please contact Gabrielle Murphy for any further information.
  7. ↑ Murphy, Gabrielle (May 2018). "Message from the Chair on ME Awareness Month". BACME. BACME. Retrieved November 8, 2018.
  8. ↑ {{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.<t>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.
  9. ↑ 9.0 9.1 "Medical Advisors - Sussex & Kent ME/CFS Society". Sussex & Kent ME/CFS Society. Retrieved November 8, 2018.
  10. ↑ White, PD; Goldsmith, KA; Johnson, AL; Potts, L; Walwyn, R; DeCesare, JC; Baber, HL; Burgess, M; Clark, LV; Cox, DL; Bavinton, J; Angus, BJ; Murphy, G; Murphy, M; O'Dowd, H; Wilks, D; McCrone, P; Chalder, T; Sharpe, M; on behalf of the PACE Trial Management Group (March 5, 2011), "Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial", The Lancet, 377 (9768): 823–836, doi:10.1016/S0140-6736(11)60096-2, PMID 21334061
  11. ↑ http://www.independent.co.uk/voices/letters/ios-letters-emails-online-postings-2-december-2012-8373777.html
  12. ↑ http://forums.phoenixrising.me/index.php?entries/simon-wessely-and-letters-condemning-me-cfs-patients-to-continued-illness-and-stigma.1324/&page=1#blogcomment-5657
  13. ↑ White, PeterD.; Sharpe, Michael C.; Chalder, Trudie; DeCesare, Julia C.; Walwyn, Rebecca; PACE trial group (March 8, 2007). "Protocol for the PACE trial: a randomised controlled trial of adaptive pacing, cognitive behaviour therapy, and graded exercise, as supplements to standardised specialist medical care versus standardised specialist medical care alone for patients with the chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy". BMC neurology. 7: 6. doi:10.1186/1471-2377-7-6. ISSN 1471-2377. PMC 2147058. PMID 17397525.
  14. ↑ Fernie, Bruce A.; Murphy, Gabrielle; Wells, Adrian; Nikčević, Ana V.; Spada, Marcantonio M. (July 2016). "Treatment Outcome and Metacognitive Change in CBT and GET for Chronic Fatigue Syndrome". Behavioural and Cognitive Psychotherapy. 44 (4): 397–409. doi:10.1017/S135246581500017X. ISSN 1469-1833. PMID 25895437.
  15. ↑ Russell, Alice; Hepgul, Nilay; Nikkheslat, Naghmeh; Borsini, Alessandra; Zajkowska, Zuzanna; Moll, Natalie; Forton, Daniel; Agarwal, Kosh; Chalder, Trudie; Mondelli, Valeria; Hotopf, Matthew; Cleare, Anthony; Murphy, Gabrielle; Wong, Terry; Foster, Graham; Schütze, Gregor A.; Schwarz, Markus J.; Harrison, Neil; Zunszain, Patricia; Pariante, Carmine (2018). "Persistent fatigue induced by interferon-alpha: a novel, inflammation-based, proxy model of chronic fatigue syndrome". Psychoneuroendocrinology. doi:10.1016/j.psyneuen.2018.11.032. ISSN 0306-4530.
  16. ↑ White, PD; Chalder, T; Sharpe, M; Angus, BJ; Baber, HL; Bavinton, J; Burgess, M; Clark, LV; Cox, DL; DeCesare, JC; Goldsmith, KA; Johnson, AL; McCrone, P; Murphy, G; Murphy, M; O'Dowd, H; Potts, L; Walwyn, R; Wilks, D (January 2017). "Response to the editorial by Dr Geraghty". Journal of Health Psychology. 22 (9): 1113–1117. doi:10.1177/1359105316688953.
  17. ↑ Katz, Ben Z; Collin, Simon M; Murphy, Gabrielle; Moss-Morris, Rona; Wyller, Vegard Bruun; Wensaas, Knut-Arne; Hautvast, Jeannine L.A.; Bleeker-Rovers, Chantal P; Vollmer-Conna, Uté; Buchwald, Dedra; Taylor, Renée; Little, Paul; Crawley, Esther; White, Peter D; Lloyd, Andrew (April 3, 2018). "The international collaborative on fatigue following infection (COFFI)". Fatigue: Biomedicine, Health & Behavior. 6 (2): 106–121. doi:10.1080/21641846.2018.1426086. ISSN 2164-1846. PMID 30666281.

graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

See Graded exercise therapy.

cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

See cognitive behavioral therapy.

NICE guidelines Clinical guidelines used in the UK.

PACE trial A controversial study which claimed that CBT and GET were effective in treating "CFS/ME", despite the fact that its own data did not support this conclusion. Its results and methodology were widely disputed by patients, scientists, and the peer-reviewed scientific literature.

See ME/CFS.

biopsychosocial model (BPS) - A school of thought, usually based in psychology, which claims illness and disease to be the result of the intermingling of biological, psychological and social causes. (Learn more: me-pedia.org)

NICE guidelines Clinical guidelines used in the UK.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

cognition Thought processes, including attention, reasoning, and memory.

stress Stress can by either physical or psychological, or both. Stress is either 1) a state of emotional or psychological strain or 2) the physical stress (pressure or tension) that a physical object such the human body is placed under, e.g., a stress test is a medical test that monitors the cardiovascular system during strenuous exercise.

cognition Thought processes, including attention, reasoning, and memory.

graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

pacing The practice of staying within one's "energy envelope" or personal limit by combining periods of activity with periods of rest or avoiding exerting beyond a certain level. ME/CFS patients use pacing to avoid or reduce post-exertional malaise (PEM). Some patients use a heart rate monitor to help with pacing.

bias Bias in research is "a systematic deviation of an observation from the true clinical state". (Learn more: me-pedia.org)

Concerning living organisms, such as cells or the human body.[1]  Physio logical (as in physio) is not to be confused with psych ological (emotional stress).

physiological Concerning living organisms, such as cells or the human body.  Physio logical (as in physio) is not to be confused with psych ological (emotional stress).

enterovirus A genus of RNA viruses which typically enter the body through the respiratory or gastrointestinal systems and sometimes spread to the central nervous system or other parts of the body, causing neurological, cardiac, and other damage. Since the first reports of myalgic encephalomyelitis (ME), enteroviruses have been suspected as a cause of ME. Enteroviruses have also been implicated as the cause of Type I diabetes, congestive heart failure, and other conditions. Enteroviruses include poliovirus, coxsackieviruses, and many others. New enteroviruses and new strains of existing enteroviruses are continuously being discovered. (Learn more: viralzone.expasy.org)

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