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

The cognitive behavioral model

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

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

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

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

The PACE trial

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

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

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

  • 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)

Books

Talks and interviews

Learn more

See also

References

  1. "Trudie Chalder - Research Portal, King's College, London". kclpure.kcl.ac.uk. Retrieved Aug 6, 2019. 
  2. "King's College London - Prof Trudie Chalder nominated President-Elect of BABCP". www.kcl.ac.uk. Retrieved Aug 6, 2019. 
  3. "Trudie Chalder | PhD | King's College London, London | KCL | Department of Psychological Medicine | ResearchGate". ResearchGate. Retrieved Aug 6, 2019. 
  4. "King's College London - Who's who". www.kcl.ac.uk. Retrieved Aug 6, 2019. 
  5. "Past Presidents and Elected Officers". www.babcp.com. Retrieved Aug 6, 2019. 
  6. 6.06.16.2 Butler, S; Chalder, T; Ron, M; Wessely, S (Feb 1991). "Cognitive behaviour therapy in chronic fatigue syndrome". Journal of Neurology, Neurosurgery, and Psychiatry. 54 (2): 153–158. ISSN 0022-3050. PMC 1014351Freely accessible. PMID 2019842. 
  7. 7.07.1 Kennedy, Tom; Jones, Roger; Darnley, Simon; Seed, Paul; Wessely, Simon; Chalder, Trudie (Aug 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 1188111Freely accessible. PMID 16093252. 
  8. 8.08.1 van Kessel, Kirsten; Moss-Morris, Rona; Willoughby, Ernest; Chalder, Trudie; Johnson, Malcolm H.; Robinson, Elizabeth (Feb 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. 10.010.1 Tack, Michiel (Jun 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. 11.011.111.2 Wilshire, Carolyn E.; Kindlon, Tom; Courtney, Robert; Matthees, Alem; Tuller, David; Geraghty, Keith; Levin, Bruce (Mar 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 5863477Freely accessible. PMID 29562932. 
  12. 12.012.1 Wessely, S; David, A; Butler, S; Chalder, T (Jan 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 1711569Freely accessible. PMID 2553945. 
  13. Stahl, D.; Rimes, K. A.; Chalder, T. (Aug 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. 14.014.114.2 "The Wiley Handbook of Cognitive Behavioral Therapy, 3 Volume Set". Wiley.com. Retrieved Aug 6, 2019. 
  15. Deale, A.; Chalder, T.; Marks, I.; Wessely, S. (Mar 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. 16.016.116.2 Sharpe, M.; Chalder, T.; McCrone, P.; Wilks, D.; O'Dowd, H.; Murphy, M.; Murphy, G.; Angus, B. J.; Bavinton, J. (Mar 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 (Sep 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. (Aug 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. (Feb 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 Aug 6, 2019. 
  21. Chalder, Trudie; Andiappan, Manoharan; Burgess, Mary (Mar 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 (Sep 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 (Jun 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 (Dec 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. 25.025.1 Burgess, Mary; Lievesley, Kate; Ali, Sheila; Chalder, Trudie (Jan 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 (Jan 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 6498783Freely accessible. PMID 31080632. 
  28. Sharpe, Michael; Chalder, Trudie; Stone, Jon (Jan 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 (Jan 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 (Feb–Mar 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 (Mar 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 (Sep 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 (Apr 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 (Jan 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 4730538Freely accessible. PMID 26805863. 
  36. Cho, Hyong Jin; Costa, Erico; Menezes, Paulo Rossi; Chalder, Trudie; Bhugra, Dinesh; Wessely, Simon (Mar 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 (Aug 6, 2019). "Data on the level of maximal scoring (on the 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 1175848Freely accessible. 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 Aug 6, 2019. 
  40. Creswell, C.; Chalder, T. (Oct 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. 42.042.1 Deary, Vincent; Chalder, Trudie (Apr 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 (Aug 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 (Sep 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 (Dec 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. (Apr 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 (Sep 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. (Aug 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 Aug 6, 2019. 
  50. Moss-Morris, Rona; Dennison, Laura; Landau, Sabine; Yardley, Lucy; Silber, Eli; Chalder, Trudie (Apr 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 (Oct 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 (Jun 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. (Jul 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 (Sep 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 (Mar 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. (Oct 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. (Jun 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 2905892Freely accessible. PMID 20548043. 
  58. Everitt, Hazel Anne; Landau, Sabine; O'Reilly, Gilly; Sibelli, Alice; Hughes, Stephanie; Windgassen, Sula; Holland, Rachel; Little, Paul; McCrone, Paul (Apr 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. (Feb 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. 
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Cognitive behavioral therapy[citation needed]

"Bias in research is "a systematic deviation of an observation from the true clinical state" (Sackett et al., 1986).[1]

Myalgic encephalomyelitis or chronic fatigue syndrome, often used when both illnesses are considered the same.

Graded Exercise Therapy, a gradual increase in exercise or activity, according to a pre-defined plan.<ref name="pace2011a">{{Cite journal

Myalgic encephalomyelitis or M.E. has different diagnostic criteria to chronic fatigue syndrome; neurological symptoms are required but fatigue is an optional symptom.<ref name="ICP2011primer">{{Citation

The information provided at this site is not intended to diagnose or treat any illness.
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