Trudie Chalder

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Trudie Chalder, R.M.N., M.Sc., (born March 1960) is a Professor of cognitive behavioural psychotherapy at the Institute of Psychiatry, King's College London.[1] She has worked as director of the South London and Maudsley NHS Foundation Trust’s Chronic Fatigue Service[2][3] and is currently director of the Persistent Physical Symptoms Research and Treatment Unit at Kings College London.[4] From 2012 to 2014 Chalder was president of the British Association for Behavioural and Cognitive Psychotherapies.[5]

Chalders’ research focuses on psychosocial and behavioral aspects of persistent physical symptoms. She has helped develop cognitive behavioral interventions for chronic fatigue syndrome[6], irritable bowel syndrome[7], multiple sclerosis[8], and psychogenic nonepileptic seizures[9], often based on the fear-avoidance model. Her research, however, has been criticized for overemphasizing psychological factors and characterizing patients’ symptoms as unhelpful cognitive responses.[10] As one of the principal investigators of the PACE trial, Chalder was criticized for misrepresenting the study’s findings in favor of cognitive behavioral therapy and graded exercise therapy.[11]

Research[edit | edit source]

The cognitive behavioral model[edit | edit source]

In collaboration with colleagues such as Simon Wessely, Chalder helped develop the cognitive behavioral model (CBM) of chronic fatigue syndrome (CFS).[12][6] This model supposes that “unhelpful catastrophic interpretations of symptoms and excessive focus on symptoms are central in driving disability and symptom severity.”[13] With cognitive behavioral therapy (CBT) patients are encouraged to take on more optimistic interpretations of symptoms[14] and to gradually increase their activity levels without responding to symptom flares with resting behavior.[12][6]

Chalder has conducted several randomized trials which reported that CBT improves fatigue and physical function in patients with CFS.[15][16][17] She has studied the effectiveness of a family-focused version of CBT[18][19] for patients with CFS and shorter telephone[20][21] -and guided self-help versions[22] to reduce costs of the intervention. According to Chalder, the evidence indicates that CBT is an effective treatment for CFS[14] and “the idea that nothing can be done to help people with CFS must surely be challenged.”[23] Chalder has claimed that CFS patients can fully recover with CBT[24], even that even severe and homebound CFS patients improve with a family focused rehabilitation treatment.[25]

The methodology of trials of CBT for CFS, however, has been questioned[26] and some reviews have concluded that the lack of improvement on objective outcomes demonstrate that CBT is not effective in CFS.[27] Chalder has criticized articles that “underestimate” the benefits of CBT for CFS[28] and has claimed that “therapeutic nihilism, the idea that nothing can be done, may act as a self- fulfilling prophecy…”[25]

Development of Questionnaires[edit | edit source]

During her career, Chalder helped develop or validate various questionnaires to evaluate psychosocial factors suspected to perpetuate disability in chronic illnesses. She has studied the work and social adjustment scale[29], the cognitive behavioural responses questionnaire,[30] and the beliefs about emotions scale[31] and helped develop the irritable bowel syndrome-behavioral responses questionnaire[32], the behavioural responses to illness questionnaire[33] and the Chalder fatigue scale (CFQ).[34] The latter is a brief questionnaire assessing symptoms of fatigue which has been frequently used in research into CFS and has been translated into multiple languages.[35][36] The CFQ, however, has been criticized for having ceiling effects[37][38] and other operational flaws.[39]

Psychosocial factors[edit | edit source]

Chalders research has focused on the psychosocial factors which, according to the cognitive behavioral model, perpetuate the symptoms of CFS. These include defensive coping styles[40], somatic attributions[41], unhealthy perfectionism[42], high expectations[43], low self-esteem[44], lack of acceptance[45] and personality measures such as neuroticism[42]. According to Chalder’s research, CFS participants show significant attentional bias for fatigue-related words and are “more likely to interpret ambiguous information in a somatic way."[46] Other studies of Chalders team claimed that CFS patients have lower emotional expression[47], which the authors thought to be a learned response to unsympathetic response towards expression of negative emotions in early life.[48] Another prominent element in the CBM for CFS is fear avoidance.[49] Chalder has stated that while “avoidant coping strategies may help in the short term, the long-term consequences are potentially extremely unhelpful”[14] and may lead to deconditioning.  Others have questioned Chalders assessment of avoidant behavior in ME/CFS as it uses descriptions such as ‘physical activity makes my symptoms worse’, that overlap with post-exertional malaise, a core symptom of the illness.[10]

Research in other illnesses[edit | edit source]

Chalder has developed cognitive-behavioral interventions - often based on the fear-avoidance model - to treat fatigue in other conditions such as multiple sclerosis[8][50], low back pain[51], rheumatoid arthritis[52][53] and fatigue following cancer[54] or a stroke.[55] She has developed a cognitive behavioral model for medically unexplained symptoms[56] and has conducted randomized trials of CBT for irritable bowel syndrome[7] and dissociative non-epileptic seizures.[57] Chalder was for example coauthor of ACTIB, a large study which reported that web-based and telephone-delivered CBT are more effective in treating irritable bowel syndrome than treatment as usual.[58] She has also studied psychological factors in patients with a diabetic foot ulcer[59][60], muscle disease[61], and ADHD[62]. Chalder helped develop a web-based stress management intervention for occupational support workers[63] and The Practitioner Health Programme (PHP), a service set up to help doctors with mental health problems.[64]

Controversy[edit | edit source]

The PACE trial[edit | edit source]

Trudie Chalder was one of the principal investigators of the PACE trial, a 5 million pound study that investigated the effectiveness of cognitive behavioral therapy (CBT), graded exercise therapy (GET) and adaptive pacing therapy (APT) in a sample of more than 600 CFS patients.[16] While the reported findings indicated that CBT and GET were effective treatments for CFS, the authors have been criticized for misrepresenting the trials’ results.[65][66]

At the press conference for the 2011 Lancet paper that reported the main results of the PACE trial, Chalder said that twice as many people in the CBT and GET groups as in the other groups “got back to normal”[66], a conclusion that was not supported by the data presented but was taken over by news outlets.[67]

The PACE authors have been criticized for deviating from the methods specified in their protocol, without explaining these changes in full in their publications or how the changes impacted the reported findings.[65][66][11] Following inconsistencies in the economic analysis of the PACE trial, Professor James Coyne filed a request to the journal PLOS ONE to access the data of the trial, a request that was dismissed as vexatious by Kings College London.[68] PLOS ONE has since issued an expression of concern about the publications in question.[69]

The PACE authors have refused to share the trial's data for independent reanalysis due to concerns that “patients might be personally identified by releasing their data.”[70] During a 2015 first tribunal hearing on the release of the PACE trial data, expert witness Professor Ross Anderson defended the PACE authors’ decision by making "wild speculations" about "young men, borderline sociopathic or psychopathic" being attached to criticism of the PACE trial.[71] The tribunal considered these claims to be unfounded: it found no evidence of "direct threats", and only evidence of harassment provided was Prof. Chalder's testimony that she was once hackled in a seminar.[71][72] The tribunal rejected the appeal by the PACE investigators and ordered the release of some of the anonymised data of the trial.[71] An independent reanalysis showed that the PACE authors had inflated improvement and recovery rates threefold.[11] Three PACE authors, including Chalder, responded that they preferred their revised version of recovery over the one specified in the protocol, as it gives "absolute rates more consistent both with the literature and with our clinical experience."[73] An open letter signed by more than 100 prominent ME/CFS experts including researchers, clinicians, and MPs has called for “an independent re-analysis of the individual-level trial data, with appropriate sensitivity analyses.”[74]

The role of the parents[edit | edit source]

Chalder has written a self-help guide for young people struggling with chronic fatigue syndrome[75], although she has made some strong statements about this subject. She has written that “emotional involvement with the child’s problem might have the unintended result of placing an excessive emphasis on physical symptoms and rewarding their continuation.”[76] Elsewhere Chalder has stated that in her clinical experience “mothers fear of symptoms and the consequences of them lead them to encourage their children to reduce activities, thereby inadvertently reinforcing the vicious circle of symptoms and disability.”[77] According to Chalder parents can be helpful by encouraging their ill children “to continue with their activity programme despite their symptoms.”[78]

Patient surveys have indicated that a significant portion of participants report having worsened following a graded activity program.[79] In a review on treatments for CFS, however, Chalder emphasizes that “it is normal to experience a temporary increase in symptoms[80] that this doesn’t mean patients are have caused harm or will relapse, and “the symptoms will pass as they get fitter.”[80] According to Chalder, “parents should be reassured about the safety of the approach and should be given support in encouraging their child to engage in rehabilitation.”[81]

Conflicts of interest[edit | edit source]

In her publications, Chalder declared conflicts of interest which include consultancy work for insurance companies[16], payments for workshops and speeches on “evidence-based treatments for persistent physical symptoms” and royalties for the self-help books on chronic fatigue syndrome she has published.[82][83]

From 2003 to 2019 Chalder was a director of WESTSIDE PROPERTY (MANAGEMENT) LIMITED (02067823).[84] She was also an officer of OneHealth (Company number 04364122) from 2002 to 15 June 2010.[85] Co-author of the PACE-trial, Peter Denton White was also an officer of Onehealth.[85] Onehealth was dissolved on 15 June 2010. The memorandum of association stated that the purpose is to promote the biopsychosocial model of illness.[86] These conflicts of interest have not been declared in her publications.

Prominent Studies[edit | edit source]

  • 2019, The PACE trial of treatments for chronic fatigue syndrome: a response to WILSHIRE et al[106] - (Full text)
  • 2019, Cognitive and behavioural responses to symptoms in adolescents with chronic fatigue syndrome: A case-control study nested within a cohort[107] - (Abstract)
  • 2019, Perfectionism and beliefs about emotions in adolescents with chronic fatigue syndrome and their parents: a preliminary investigation in a case control study nested within a cohort[108] - (Abstract)
  • 2020, Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: outcomes from a specialist clinic in the UK[109] - (Full text)

Books[edit | edit source]

Talks and interviews[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. ↑ "Trudie Chalder - Research Portal, King's College, London". kclpure.kcl.ac.uk. Retrieved August 6, 2019.
  2. ↑ "King's College London - Prof Trudie Chalder nominated President-Elect of BABCP". kcl.ac.uk. Retrieved August 6, 2019.
  3. ↑ "Trudie Chalder | PhD | King's College London, London | KCL | Department of Psychological Medicine | ResearchGate". ResearchGate. Retrieved August 6, 2019.
  4. ↑ "King's College London - Who's who". kcl.ac.uk. Retrieved August 6, 2019.
  5. ↑ "Past Presidents and Elected Officers". babcp.com. Retrieved August 6, 2019.
  6. ↑ 6.0 6.1 6.2 Butler, S; Chalder, T; Ron, M; Wessely, S (February 1991). "Cognitive behaviour therapy in chronic fatigue syndrome". Journal of Neurology, Neurosurgery, and Psychiatry. 54 (2): 153–158. ISSN 0022-3050. PMC 1014351. PMID 2019842.
  7. ↑ 7.0 7.1 Kennedy, Tom; Jones, Roger; Darnley, Simon; Seed, Paul; Wessely, Simon; Chalder, Trudie (August 20, 2005). "Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial". BMJ (Clinical research ed.). 331 (7514): 435. doi:10.1136/bmj.38545.505764.06. ISSN 1756-1833. PMC 1188111. PMID 16093252.
  8. ↑ 8.0 8.1 van Kessel, Kirsten; Moss-Morris, Rona; Willoughby, Ernest; Chalder, Trudie; Johnson, Malcolm H.; Robinson, Elizabeth (February 2008). "A randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue". Psychosomatic Medicine. 70 (2): 205–213. doi:10.1097/PSY.0b013e3181643065. ISSN 1534-7796. PMID 18256342.
  9. ↑ Chalder, Trudie (1996). "Non-Epileptic attacks: A Cognitive Behavioural Approach in a Single Case with a Four-Year Follow-up". Clinical Psychology & Psychotherapy. 3 (4): 291–297. doi:10.1002/(SICI)1099-0879(199612)3:43.0.CO;2-H. ISSN 1099-0879.
  10. ↑ 10.0 10.1 Tack, Michiel (June 18, 2019). "The risk of labelling CFS symptoms as unhelpful cognitive responses". Clinical Child Psychology and Psychiatry: 1359104519853849. doi:10.1177/1359104519853849. ISSN 1359-1045.
  11. ↑ 11.0 11.1 11.2 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): 6. doi:10.1186/s40359-018-0218-3. ISSN 2050-7283. PMC 5863477. PMID 29562932.
  12. ↑ 12.0 12.1 Wessely, S; David, A; Butler, S; Chalder, T (January 1989). "Management of chronic (post-viral) fatigue syndrome". The Journal of the Royal College of General Practitioners. 39 (318): 26–29. ISSN 0035-8797. PMC 1711569. PMID 2553945.
  13. ↑ Stahl, D.; Rimes, K.A.; Chalder, T. (August 2014). "Mechanisms of change underlying the efficacy of cognitive behaviour therapy for chronic fatigue syndrome in a specialist clinic: a mediation analysis". Psychological Medicine. 44 (6): 1331–1344. doi:10.1017/S0033291713002006. ISSN 1469-8978. PMID 23931831.
  14. ↑ 14.0 14.1 14.2 "The Wiley Handbook of Cognitive Behavioral Therapy, 3 Volume Set". Wiley.com. Retrieved August 6, 2019.
  15. ↑ Deale, A.; Chalder, T.; Marks, I.; Wessely, S. (March 1997). "Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial". The American Journal of Psychiatry. 154 (3): 408–414. doi:10.1176/ajp.154.3.408. ISSN 0002-953X. PMID 9054791.
  16. ↑ 16.0 16.1 16.2 Sharpe, M.; Chalder, T.; McCrone, P.; Wilks, D.; O'Dowd, H.; Murphy, M.; Murphy, G.; Angus, B.J.; Bavinton, J. (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. ISSN 0140-6736. PMID 21334061.
  17. ↑ Ali, Sheila; Goldsmith, Kimberley; Burgess, Mary; Chalder, Trudie (September 2017). "Guided Self-Help for Patients with Chronic Fatigue Syndrome Prior to Starting Cognitive Behavioural Therapy: a Cohort Study". Behavioural and Cognitive Psychotherapy. 45 (5): 448–466. doi:10.1017/S135246581700025X. ISSN 1469-1833. PMID 28473005.
  18. ↑ Chalder, T.; Deary, V.; Husain, K.; Walwyn, R. (August 2010). "Family-focused cognitive behaviour therapy versus psycho-education for chronic fatigue syndrome in 11- to 18-year-olds: a randomized controlled treatment trial". Psychological Medicine. 40 (8): 1269–1279. doi:10.1017/S003329170999153X. ISSN 1469-8978. PMID 19891804.
  19. ↑ Deary, V.; Tong, J.; Chalder, T. (February 1, 2002). "Family cognitive behaviour therapy for chronic fatigue syndrome: an uncontrolled study". Archives of Disease in Childhood. 86 (2): 95–97. doi:10.1136/adc.86.2.95. ISSN 0003-9888. PMID 11827901.
  20. ↑ "(PDF) Telephone cognitive behaviour therapy for chronic fatigue syndrome in secondary care: A case series". ResearchGate. Retrieved August 6, 2019.
  21. ↑ Chalder, Trudie; Andiappan, Manoharan; Burgess, Mary (March 2012). "Cognitive Behaviour Therapy for Chronic Fatigue Syndrome in Adults: Face to Face versus Telephone Treatment - A Randomized Controlled Trial". Behavioural and Cognitive Psychotherapy. 40 (2): 175–191. doi:10.1017/S1352465811000543. ISSN 1469-1833.
  22. ↑ Ali, Sheila; Goldsmith, Kimberley; Burgess, Mary; Chalder, Trudie (September 2017). "Guided Self-Help for Patients with Chronic Fatigue Syndrome Prior to Starting Cognitive Behavioural Therapy: a Cohort Study". Behavioural and Cognitive Psychotherapy. 45 (5): 448–466. doi:10.1017/S135246581700025X. ISSN 1469-1833. PMID 28473005.
  23. ↑ Chalder, Trudie; Ali, Sheila; Burgess, Mary; Adamczyk, Lucy (June 1, 2019). "However CFS is operationalised young people's perspectives are important". Journal of Behavioral Medicine. 42 (3): 578–579. doi:10.1007/s10865-019-00034-3. ISSN 1573-3521.
  24. ↑ Flo, Elisabeth; Chalder, Trudie (December 1, 2014). "Prevalence and predictors of recovery from chronic fatigue syndrome in a routine clinical practice". Behaviour Research and Therapy. 63: 1–8. doi:10.1016/j.brat.2014.08.013. ISSN 0005-7967.
  25. ↑ 25.0 25.1 Burgess, Mary; Lievesley, Kate; Ali, Sheila; Chalder, Trudie (January 1, 2019). "Home-based family focused rehabilitation for adolescents with severe Chronic Fatigue Syndrome". Clinical Child Psychology and Psychiatry. 24 (1): 19–28. doi:10.1177/1359104518794764. ISSN 1359-1045.
  26. ↑ Ahmed, S. A.; Mewes, J.C.; 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: 1359105319847261. doi:10.1177/1359105319847261. ISSN 1461-7277. PMID 31072121.
  27. ↑ Vink, Mark; Vink-Niese, Alexandra (January 2019). "Cognitive behavioural therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective. Re-analysis of a Cochrane review". Health Psychology Open. 6 (1): 2055102919840614. doi:10.1177/2055102919840614. ISSN 2055-1029. PMC 6498783. PMID 31080632.
  28. ↑ Sharpe, Michael; Chalder, Trudie; Stone, Jon (January 31, 2018). "Don't reject evidence from CFS therapies". Nature. 554: 31–31. doi:10.1038/d41586-018-01285-x.
  29. ↑ Thandi, Gursimran; Fear, Nicola T.; Chalder, Trudie (January 2017). "A comparison of the Work and Social Adjustment Scale (WSAS) across different patient populations using Rasch analysis and exploratory factor analysis". Journal of Psychosomatic Research. 92: 45–48. doi:10.1016/j.jpsychores.2016.11.009. ISSN 1879-1360. PMID 27998511.
  30. ↑ Ryan, Elizabeth G.; Vitoratou, Silia; Goldsmith, Kimberley A.; Chalder, Trudie (February–March 2018). "Psychometric Properties and Factor Structure of a Long and Shortened Version of the Cognitive and Behavioural Responses Questionnaire". Psychosomatic Medicine. 80 (2): 230–237. doi:10.1097/PSY.0000000000000536. ISSN 1534-7796. PMID 29023262.
  31. ↑ Rimes, Katharine A.; Chalder, Trudie (March 2010). "The Beliefs about Emotions Scale: validity, reliability and sensitivity to change". Journal of Psychosomatic Research. 68 (3): 285–292. doi:10.1016/j.jpsychores.2009.09.014. ISSN 1879-1360. PMID 20159215.
  32. ↑ Reme, Silje E.; Darnley, Simon; Kennedy, Tom; Chalder, Trudie (September 2010). "The development of the irritable bowel syndrome-behavioral responses questionnaire". Journal of Psychosomatic Research. 69 (3): 319–325. doi:10.1016/j.jpsychores.2010.01.025. ISSN 1879-1360. PMID 20708455.
  33. ↑ Spence, Meagan; Moss-Morris, Rona; Chalder, Trudie (April 2005). "The Behavioural Responses to Illness Questionnaire (BRIQ): a new predictive measure of medically unexplained symptoms following acute infection". Psychological Medicine. 35 (4): 583–593. ISSN 0033-2917. PMID 15856728.
  34. ↑ Chalder, T.; Berelowitz, G.; Pawlikowska, T.; Watts, L.; Wessely, S.; Wright, D.; Wallace, E.P. (1993). "Development of a fatigue scale". Journal of Psychosomatic Research. 37 (2): 147–153. ISSN 0022-3999. PMID 8463991.
  35. ↑ Jing, Meng-Juan; Lin, Wei-Quan; Wang, Qiang; Wang, Jia-Ji; Tang, Jie; Jiang, En-She; Lei, Yi-Xiong; Wang, Pei-Xi (January 2016). "Reliability and Construct Validity of Two Versions of Chalder Fatigue Scale among the General Population in Mainland China". International Journal of Environmental Research and Public Health. 13 (1). doi:10.3390/ijerph13010147. ISSN 1661-7827. PMC 4730538. PMID 26805863.
  36. ↑ Cho, Hyong Jin; Costa, Erico; Menezes, Paulo Rossi; Chalder, Trudie; Bhugra, Dinesh; Wessely, Simon (March 2007). "Cross-cultural validation of the Chalder Fatigue Questionnaire in Brazilian primary care". Journal of Psychosomatic Research. 62 (3): 301–304. doi:10.1016/j.jpsychores.2006.10.018. ISSN 0022-3999. PMID 17324680.
  37. ↑ Kindlon, Tom (August 6, 2019). "Data on the level of maximal scoring (on the Chalder Fatigue Scale) would be useful". The BMJurl=https://www.bmj.com/rapid-response/2011/11/02/data-level-maximal-scoring-chalder-fatigue-scale-would-be-useful.
  38. ↑ Stouten, Bart (May 13, 2005). "Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution". BMC health services research. 5: 37. doi:10.1186/1472-6963-5-37. ISSN 1472-6963. PMC 1175848. PMID 15892882.
  39. ↑ "S4ME: Submission to the public review on common data elements for ME/CFS: Problems with the Chalder Fatigue Questionnaire". Science for ME. Retrieved August 6, 2019.
  40. ↑ Creswell, C.; Chalder, T. (October 2001). "Defensive coping styles in chronic fatigue syndrome". Journal of Psychosomatic Research. 51 (4): 607–610. ISSN 0022-3999. PMID 11595249.
  41. ↑ Creswell, Cathy; Chalder, Trudie (2003). "The relationship between illness attributions and attributional style in Chronic Fatigue Syndrome". British Journal of Clinical Psychology. 42 (1): 101–104. doi:10.1348/014466503762842057. ISSN 2044-8260.
  42. ↑ 42.0 42.1 Deary, Vincent; Chalder, Trudie (April 2010). "Personality and perfectionism in chronic fatigue syndrome: a closer look". Psychology & Health. 25 (4): 465–475. doi:10.1080/08870440802403863. ISSN 1476-8321. PMID 20204923.
  43. ↑ Godfrey, Emma; Cleare, Anthony; Coddington, Alice; Roberts, Amanda; Weinman, John; Chalder, Trudie (August 1, 2009). "Chronic fatigue syndrome in adolescents: Do parental expectations of their child's intellectual ability match the child's ability?". Journal of Psychosomatic Research. 67 (2): 165–168. doi:10.1016/j.jpsychores.2009.02.004. ISSN 0022-3999.
  44. ↑ Creswell, Cathy; Chalder, Trudie (September 2002). "Underlying self-esteem in chronic fatigue syndrome". Journal of Psychosomatic Research. 53 (3): 755–761. ISSN 0022-3999. PMID 12217449.
  45. ↑ Brooks, Samantha K.; Rimes, Katharine A.; Chalder, Trudie (December 2011). "The role of acceptance in chronic fatigue syndrome". Journal of Psychosomatic Research. 71 (6): 411–415. doi:10.1016/j.jpsychores.2011.08.001. ISSN 1879-1360. PMID 22118384.
  46. ↑ Hughes, A.M.; Chalder, T.; Hirsch, C.R.; Moss-Morris, R. (April 2017). "An attention and interpretation bias for illness-specific information in chronic fatigue syndrome". Psychological Medicine. 47 (5): 853–865. doi:10.1017/S0033291716002890. ISSN 1469-8978. PMID 27894380.
  47. ↑ Rimes, Katharine A.; Ashcroft, Joanna; Bryan, Lauren; Chalder, Trudie (September 2016). "Emotional suppression in chronic fatigue syndrome: Experimental study". Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association. 35 (9): 979–986. doi:10.1037/hea0000341. ISSN 1930-7810. PMID 27183308.
  48. ↑ Oldershaw, A.; Hambrook, D.; Rimes, K.A.; Tchanturia, K.; Treasure, J.; Richards, S.; Schmidt, U.; Chalder, T. (August 2011). "Emotion recognition and emotional theory of mind in chronic fatigue syndrome". Psychology & Health. 26 (8): 989–1005. doi:10.1080/08870446.2010.519769. ISSN 1476-8321. PMID 21598185.
  49. ↑ "Reducing fear avoidance beliefs key to improving symptoms and reducing disability in chronic fatigue syndrome". ScienceDaily. Retrieved August 6, 2019.
  50. ↑ Moss-Morris, Rona; Dennison, Laura; Landau, Sabine; Yardley, Lucy; Silber, Eli; Chalder, Trudie (April 2013). "A randomized controlled trial of cognitive behavioral therapy (CBT) for adjusting to multiple sclerosis (the saMS trial): does CBT work and for whom does it work?". Journal of Consulting and Clinical Psychology. 81 (2): 251–262. doi:10.1037/a0029132. ISSN 1939-2117. PMID 22730954.
  51. ↑ Reme, Silje E.; Tveito, Torill H.; Harris, Anette; Lie, Stein Atle; Grasdal, Astrid; Indahl, Aage; Brox, Jens Ivar; Tangen, Tone; Hagen, Eli Molde (October 15, 2016). "Cognitive Interventions and Nutritional Supplements (The CINS Trial): A Randomized Controlled, Multicenter Trial Comparing a Brief Intervention With Additional Cognitive Behavioral Therapy, Seal Oil, and Soy Oil for Sick-Listed Low Back Pain Patients". Spine. 41 (20): 1557–1564. doi:10.1097/BRS.0000000000001596. ISSN 1528-1159. PMID 27760062.
  52. ↑ Hewlett, Sarah; Chalder, Trudie; Choy, Ernest; Cramp, Fiona; Davis, Bev; Dures, Emma; Nicholls, Claire; Kirwan, John (June 2011). "Fatigue in rheumatoid arthritis: time for a conceptual model". Rheumatology (Oxford, England). 50 (6): 1004–1006. doi:10.1093/rheumatology/keq282. ISSN 1462-0332. PMID 20819797.
  53. ↑ Matcham, F.; Ali, S.; Hotopf, M.; Chalder, T. (July 2015). "Psychological correlates of fatigue in rheumatoid arthritis: a systematic review". Clinical Psychology Review. 39: 16–29. doi:10.1016/j.cpr.2015.03.004. ISSN 1873-7811. PMID 25912978.
  54. ↑ Armes, Jo; Chalder, Trudie; Addington-Hall, Julia; Richardson, Alison; Hotopf, Matthew (September 15, 2007). "A randomized controlled trial to evaluate the effectiveness of a brief, behaviorally oriented intervention for cancer-related fatigue". Cancer. 110 (6): 1385–1395. doi:10.1002/cncr.22923. ISSN 0008-543X. PMID 17661342.
  55. ↑ Wu, Simiao; Mead, Gillian; Macleod, Malcolm; Chalder, Trudie (March 2015). "Model of understanding fatigue after stroke". Stroke. 46 (3): 893–898. doi:10.1161/STROKEAHA.114.006647. ISSN 1524-4628. PMID 25649798.
  56. ↑ Deary, V.; Chalder, T.; Sharpe, M. (October 2007). "The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review". Clinical Psychology Review. 27 (7): 781–797. doi:10.1016/j.cpr.2007.07.002. ISSN 0272-7358. PMID 17822818.
  57. ↑ Goldstein, L. H.; Chalder, T.; Chigwedere, C.; Khondoker, M.R.; Moriarty, J.; Toone, B.K.; Mellers, J. D.C. (June 15, 2010). "Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT". Neurology. 74 (24): 1986–1994. doi:10.1212/WNL.0b013e3181e39658. ISSN 1526-632X. PMC 2905892. PMID 20548043.
  58. ↑ Everitt, Hazel Anne; Landau, Sabine; O'Reilly, Gilly; Sibelli, Alice; Hughes, Stephanie; Windgassen, Sula; Holland, Rachel; Little, Paul; McCrone, Paul (April 10, 2019). "Assessing telephone-delivered cognitive-behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial". Gut. doi:10.1136/gutjnl-2018-317805. ISSN 1468-3288. PMID 30971419.
  59. ↑ Vedhara, K.; Beattie, A.; Metcalfe, C.; Roche, S.; Weinman, J.; Cullum, N.; Price, P.; Dayan, C.; Cooper, A.R. (May 2012). "Development and preliminary evaluation of a psychosocial intervention for modifying psychosocial risk factors associated with foot re-ulceration in diabetes". Behaviour Research and Therapy. 50 (5): 323–332. doi:10.1016/j.brat.2012.02.013. ISSN 1873-622X. PMID 22459731.
  60. ↑ Winkley, K.; Sallis, H.; Kariyawasam, D.; Leelarathna, L.H.; Chalder, T.; Edmonds, M.E.; Stahl, D.; Ismail, K. (February 2012). "Five-year follow-up of a cohort of people with their first diabetic foot ulcer: the persistent effect of depression on mortality". Diabetologia. 55 (2): 303–310. doi:10.1007/s00125-011-2359-2. ISSN 1432-0428. PMID 22057196.
  61. ↑ Graham, Christopher D.; Weinman, John; Sadjadi, Reza; Chalder, Trudie; Petty, Richard; Hanna, Mike G.; Turner, Chris; Parton, Matt; Maddison, Paul (May 2014). "A multicentre postal survey investigating the contribution of illness perceptions, coping and optimism to quality of life and mood in adults with muscle disease". Clinical Rehabilitation. 28 (5): 508–519. doi:10.1177/0269215513511340. ISSN 1477-0873. PMID 24240060.
  62. ↑ Rogers, Denise C.; Dittner, Antonia J.; Rimes, Katharine A.; Chalder, Trudie (March 2017). "Fatigue in an adult attention deficit hyperactivity disorder population: A trans-diagnostic approach". The British Journal of Clinical Psychology. 56 (1): 33–52. doi:10.1111/bjc.12119. ISSN 0144-6657. PMID 27918087.
  63. ↑ Ridge, Mary; Wells, John; Denny, Margaret; Cunningham, Jennifer; Chalder, Trudie (April 2011). "Developing a web-based stress management intervention for occupational support workers". Journal of Mental Health (Abingdon, England). 20 (2): 185–197. doi:10.3109/09638237.2011.556162. ISSN 1360-0567. PMID 21406020.
  64. ↑ Brooks, Samantha K.; Chalder, Trudie; Gerada, Clare (April 2011). "Doctors vulnerable to psychological distress and addictions: treatment from the Practitioner Health Programme". Journal of Mental Health (Abingdon, England). 20 (2): 157–164. doi:10.3109/09638237.2011.556168. ISSN 1360-0567. PMID 21542716.
  65. ↑ 65.0 65.1 Geraghty, Keith J. (August 2017). "'PACE-Gate': When clinical trial evidence meets open data access". Journal of Health Psychology. 22 (9): 1106–1112. doi:10.1177/1359105316675213. ISSN 1461-7277. PMID 27807258.
  66. ↑ 66.0 66.1 66.2 "TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study". Virology blog. Retrieved August 6, 2019.
  67. ↑ Boseley, Sarah (February 18, 2011). "Study finds therapy and exercise best for ME". The Guardian. ISSN 0261-3077. Retrieved August 6, 2019.
  68. ↑ "Request for information under the Freedom of Information Act 2000 ("the Act")" (PDF). Wayback Machine. March 14, 2016. Retrieved August 6, 2019.
  69. ↑ White, Peter D.; Goldsmith, Kimberley A.; Johnson, Anthony L.; Knapp, Martin; Chalder, Trudie; Sharpe, Michael; McCrone, Paul (August 1, 2012). "Adaptive Pacing, Cognitive Behaviour Therapy, Graded Exercise, and Specialist Medical Care for Chronic Fatigue Syndrome: A Cost-Effectiveness Analysis". PLOS ONE. 7 (8): e40808. doi:10.1371/journal.pone.0040808. ISSN 1932-6203. PMC 3411573. PMID 22870204.
  70. ↑ White, Peter D; Chalder, Trudie; Sharpe, Michael; Angus, Brian J; Baber, Hannah L; Bavinton, Jessica; Burgess, Mary; Clark, Lucy V; Cox, Diane L (January 24, 2017). "Response to the editorial by Dr Geraghty". Journal of Health Psychology. 22 (9): 1113–1117. doi:10.1177/1359105316688953. ISSN 1359-1053.
  71. ↑ 71.0 71.1 71.2 "Tribunal orders release of PACE data". #MEAction. August 16, 2016. Retrieved August 6, 2019.
  72. ↑ Office of the Information Rights Commissioner (August 12, 2016). "Information Rights Tribunal Queen Mary University of London" (PDF). pp. 30–37.
  73. ↑ Chalder, T; K, Goldsmith; M, Sharpe (March 12, 2019). "The PACE trial of treatments for chronic fatigue syndrome: a response to WILSHIRE et al". BMC Psychol. 7: 15.
  74. ↑ "Trial By Error: Open Letter to The Lancet, version 3.0". Virology blog. Retrieved August 6, 2019.
  75. ↑ Chalder, Trudie; Hussain, Kaneez (2002). Self Help for Chronic Fatigue Syndrome: A Guide for Young People. Blue Stallion Publications. ISBN 9781904127017.
  76. ↑ Garralda, M. Elena; Chalder, Trudie (2005). "Practitioner Review: Chronic fatigue syndrome in childhood". Journal of Child Psychology and Psychiatry. 46 (11): 1143–1151. doi:10.1111/j.1469-7610.2005.01424.x. ISSN 1469-7610.
  77. ↑ Fisher, Linda; Chalder, Trudie (May 2003). "Childhood experiences of illness and parenting in adults with chronic fatigue syndrome". Journal of Psychosomatic Research. 54 (5): 439–443. ISSN 0022-3999. PMID 12726900.
  78. ↑ Rimes, Katharine; Chalder, Trudie (July 3, 2015). Overcoming Chronic Fatigue in Young People: A cognitive-behavioural self-help guide. Routledge. ISBN 9781317605379.
  79. ↑ "(PDF) Harms of Cognitive Behaviour Therapy Designed to Increase Activity Levels in Chronic Fatigue Syndrome: Questions Remain". ResearchGate. Retrieved August 6, 2019.
  80. ↑ 80.0 80.1 Rimes, K.A.; Chalder, T. (January 2005). "Treatments for chronic fatigue syndrome". Occupational Medicine (Oxford, England). 55 (1): 32–39. doi:10.1093/occmed/kqi015. ISSN 0962-7480. PMID 15699088.
  81. ↑ "Chronic Fatigue Syndrome | Tess Browne | Request PDF". ResearchGate. Retrieved August 6, 2019.
  82. ↑ Chalder, Trudie; Landau, Sabine; David, Anthony; Hotopf, Matthew; McCrone, Paul; Mosweu, Iris; Ferreira, Nicola; Frank, Philipp; Ashworth, Mark (July 1, 2019). "Persistent physical symptoms reduction intervention: a system change and evaluation (PRINCE)—integrated GP care for persistent physical symptoms: protocol for a feasibility and cluster randomised waiting list, controlled trial". BMJ Open. 9 (7): e025513. doi:10.1136/bmjopen-2018-025513. ISSN 2044-6055. PMID 31340956.
  83. ↑ Chalder, Trudie; Sharpe, Michael C; White, Peter D (February 18, 2012), "PACE trial clarification", The Lancet, 379 (9816): 616, doi:10.1016/S0140-6736(12)60267-0
  84. ↑ "Trudie CHALDER - Personal Appointments (free information from Companies House)". beta.companieshouse.gov.uk. Retrieved August 6, 2019.
  85. ↑ 85.0 85.1 London, Companies. "One Health". Companies London. Retrieved August 6, 2019.
  86. ↑ ltd, company check. "ONE HEALTH. Free business summary taken from official companies house information. Free alerts. Registered as 04364122". Company Check. Retrieved August 6, 2019.
  87. ↑ Chalder, T; Berelowitz, G; Pawlikowska, T; Watts, L; Wessely, S; Wright, D; Wallace, EP (1993), "Development of a fatigue scale", J Psychosom Res, 37: 147-153, PMID 8463991
  88. ↑ Sharpe, M; Chalder, T; Palmer, I; Wessely, S (1997), "Chronic fatigue syndrome. A practical guide to assessment and management" (PDF), Gen Hosp Psychiatry, 19 (3): 185-99, doi:10.1016/S0163-8343(97)80315-5, PMID 9218987
  89. ↑ Burgess, M.; Chalder, T. (May 10, 2011). "Adolescents with severe chronic fatigue syndrome can make a full recovery". Case Reports (may08 1): bcr0120113716–bcr0120113716. doi:10.1136/bcr.01.2011.3716. ISSN 1757-790X. PMC 3091076. PMID 22696706.
  90. ↑ Reme, Silje Endresen; Archer, Nicola; Chalder, Trudie (September 1, 2013), "Experiences of young people who have undergone the Lightning Process to treat chronic fatigue syndrome/myalgic encephalomyelitis – a qualitative study", British Journal of Health Psychology, 18 (3): 508–525, doi:10.1111/j.2044-8287.2012.02093.x, ISSN 2044-8287, retrieved December 12, 2016
  91. ↑ Borsini, A.; Hepgul, N.; Mondelli, V.; Chalder, T.; Pariante, C. (September 2013). "74. Recent stressful events contribute to the development of fatigue and depression in patients receiving Interferon-α treatment". Brain, Behavior, and Immunity. 32: e21–e22. doi:10.1016/j.bbi.2013.07.086.
  92. ↑ Sharpe, Michael; Chalder, Trudie; White, Peter D. (February 2015). "The planning, implementation and publication of a complex intervention trial for chronic fatigue syndrome: the PACE trial". BJPsych Bulletin. 39 (1): 24–27. doi:10.1192/pb.bp.113.045005. ISSN 2056-4694.
  93. ↑ Borsini, A.; Hepgul, N.; Mondelli, V.; Chalder, T.; Pariante, C.M. (July 2014). "Childhood stressors in the development of fatigue syndromes: a review of the past 20 years of research". Psychological Medicine. 44 (9): 1809–1823. doi:10.1017/S0033291713002468. ISSN 0033-2917.
  94. ↑ Hughes, A.M.; Chalder, T.; Hirsch, C.R.; Moss-Morris, R. (2016), "An attention and interpretation bias for illness-specific information in chronic fatigue syndrome", Psychological Medicine: 1–13, doi:10.1017/S0033291716002890
  95. ↑ Worm-Smeitink, M.; Nikolaus, S.; Goldsmith, K.; Wiborg, J.; Ali, S.; Knoop, H.; Chalder, T. (August 2016), "Cognitive behaviour therapy for chronic fatigue syndrome: Differences in treatment outcome between a tertiary treatment centre in the United Kingdom and the Netherlands", Journal of Psychosomatic Research, 87: 43–49, doi:10.1016/j.jpsychores.2016.06.006, ISSN 1879-1360, PMID 27411751
  96. ↑ Lewith, G.; Stuart, B.; Chalder, T.; McDermott, C.; White, P. D. (August 2016), "Complementary and alternative healthcare use by participants in the PACE trial of treatments for chronic fatigue syndrome", Journal of Psychosomatic Research, 87: 37–42, doi:10.1016/j.jpsychores.2016.06.005, ISSN 1879-1360, PMID 27411750
  97. ↑ Roberts, Emmert; Wessely, Simon; Chalder, Trudie; Chang, Chin-Kuo; Hotopf, Matthew (April 22, 2016), "Mortality of people with chronic fatigue syndrome: a retrospective cohort study in England and Wales from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) Register", The Lancet, 387 (10028): 1638–1643, doi:10.1016/S0140-6736(15)01223-4, ISSN 0140-6736, retrieved December 12, 2016
  98. ↑ Bad stats, non sequitur conclusions in Lancet chronic fatigue syndrome/suicide study
  99. ↑ Maria Elizabeth Loades, Katharine A Rimes, Sheila Ali, Kate Lievesley, Trudie Chalder. The presence of co-morbid mental health problems in a cohort of adolescents with chronic fatigue syndrome. Clinical Child Psychology and Psychiatry. 2017. doi:10.1177/1359104517736357
  100. ↑ Sharpe, M; Chalder, T; Johnson, AL; Goldsmith, KA; White, PD (2017), "Response to: Do more people recover from chronic fatigue syndrome with cognitive behaviour therapy or graded exercise therapy than with other treatments?", Fatigue: Biomedicine, Health & Behavior, 5 (1): 57-61, doi:10.1080/21641846.2017.1288629
  101. ↑ Loades, ME; Rimes, KA; Lievesley, K; Ali, S; Chalder, T (August 17, 2018). "Illness beliefs of adolescents with CFS and their parents: the perceived causes of illness and beliefs about recovery". Int J Adolesc Med Health. doi:10.1515/ijamh-2017-0197. PMID 30118437.
  102. ↑ Burgess, Mary; Lievesley, Kate; Ali, Sheila; Chalder, Trudie (August 16, 2018). "Home-based family focused rehabilitation for adolescents with severe Chronic Fatigue Syndrome". Clinical Child Psychology and Psychiatry: 135910451879476. doi:10.1177/1359104518794764. ISSN 1359-1045.
  103. ↑ Loades, Maria E.; Rimes, Katharine A.; Ali, Sheila; Lievesley, Kate; Chalder, Trudie (November 8, 2018). "Does fatigue and distress in a clinical cohort of adolescents with chronic fatigue syndrome correlate with fatigue and distress in their parents?". Child: Care, Health and Development. doi:10.1111/cch.12626. ISSN 0305-1862.
  104. ↑ Russell, Alice; Hepgul, Nilay; Nikkheslat, Naghmeh; Borsini, Alessandra; Zajkowska, Zuzanna; Moll, Natalie; Forton, Daniel; Agarwal, Kosh; Chalder, Trudie; Mondelli, Valeria; Hotopf, Matthew; Anthony, Cleare; 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. Retrieved December 18, 2018.
  105. ↑ Ali, Sheila; Adamczyk, Lucy; Burgess, Mary; Chalder, Trudie (January 25, 2019). "Psychological and demographic factors associated with fatigue and social adjustment in young people with severe chronic fatigue syndrome/myalgic encephalomyelitis: a preliminary mixed-methods study". Journal of Behavioral Medicine. doi:10.1007/s10865-019-00010-x. ISSN 0160-7715.
  106. ↑ Sharpe, Michael; Goldsmith, Kim; Chalder, Trudie (March 12, 2019). "The PACE trial of treatments for chronic fatigue syndrome: a response to WILSHIRE et al". BMC Psychology. 7 (1): 15. doi:10.1186/s40359-019-0288-x. ISSN 2050-7283.
  107. ↑ Loades, Maria Elizabeth; Rimes, Katharine; Lievesley, Kate; Ali, Sheila; Chalder, Trudie (March 15, 2019). "Cognitive and behavioural responses to symptoms in adolescents with chronic fatigue syndrome: A case-control study nested within a cohort". Clinical Child Psychology and Psychiatry: 135910451983558. doi:10.1177/1359104519835583. ISSN 1359-1045.
  108. ↑ Loades, Maria E.; Rimes, Katharine A.; Lievesley, Kate; Ali, Sheila; Chalder, Trudie (March 2019). "Perfectionism and beliefs about emotions in adolescents with chronic fatigue syndrome and their parents: a preliminary investigation in a case control study nested within a cohort". Psychology & Health: 1–17. doi:10.1080/08870446.2019.1579331. ISSN 0887-0446.
  109. ↑ Adamson, James; Ali, Sheila; Santhouse, Alastair; Wessely, Simon; Chalder, Trudie (October 2020). "Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: outcomes from a specialist clinic in the UK". Journal of the Royal Society of Medicine. 113 (10): 394–402. doi:10.1177/0141076820951545. ISSN 0141-0768.

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

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

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

medically unexplained physical symptoms (MUPS) - Technically, this term means that no cause or explanation for the patient's symptoms has yet been found. However, patients diagnosed with "MUPS" are generally lumped into a psychosomatic, or psychologically-caused category by those in the medical profession, without any scientific basis for doing so.

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.

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.

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.

flare-up A symptoms flare in ME/CFS is a temporary increase in symptoms, alternatively known as experiencing post-exertional malaise. May be referred to as a "crash" or "collapse".

objective outcome An outcome of a clinical trial that is independent of the judgement of opinion of the assessor/clinician, e.g. distance walked in 6 minutes. Patient-reported outcomes like questionnaires are not objectives.

chronic illness any long-term illness, regardless of the severity. Chronic illnesses are typically incurable, requiring long-term management.

An adjective relating to the physical body or physical symptoms. It is often contrasted with the adjective "psychological", which refers to the human mind or mental symptoms. In biology, "somatic cells" refer to all the cells of the body, except those which form an egg or sperm.

somatic An adjective relating to the physical body or physical symptoms. It is often contrasted with the adjective "psychological", which refers to the human mind or mental symptoms. In biology, "somatic cells" refer to all the cells of the body, except those which form an egg or sperm.

Bias in research is "a systematic deviation of an observation from the true clinical state".[1] (Learn more: me-pedia.org)

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

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM may be referred to as a "crash" or "collapse" and can last for days or weeks. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others.

See medically unexplained physical symptoms.

medically unexplained physical symptoms (MUPS) - Technically, this term means that no cause or explanation for the patient's symptoms has yet been found. However, patients diagnosed with "MUPS" are generally lumped into a psychosomatic, or psychologically-caused category by those in the medical profession, without any scientific basis for doing so.

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.

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)

α / Α. Greek letter alpha or alfa (a symbol used in science), equivalent to "a".

α α / Α. Greek letter alpha or alfa (a symbol used in science), equivalent to "a".

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.

The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

BMJ The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

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.

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.

β β / Β. Greek letter beta (a symbol used in science), equivalent to "b".

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