Monday, July 21, 2008

Cochrane Review of CBT shows: it is useless …



"Cognitive behaviour therapy for chronic fatigue syndrome in adults (Review)"
By: Price JR et al, Department of Psychiatry, University of Oxford,Oxford, UK. jonathan.price@psych.ox.ac.uk

“Chronic fatigue syndrome (CFS) is a very common and disabling condition, in which people suffer from persistent symptoms of fatigue that are unexplained.”

“This review aimed to find out whether CBT is effective for CBT, both as a standalone treatment and in combination with other treatments, and whether it is more effective than other treatments used for CFS.”

“The review included 15 studies, with a total of 1043 CFS participants. The review showed that people attending for CBT were more likely to have reduced fatigue symptoms at the end of treatment than people who received usual care or were on a waiting list for therapy, with 40% of people in the CBT group showing clinical improvement, in contrast with 26% in usual care.

At follow-up, 1-7 months after treatment ended, people who had completed their course of CBT continued to have lower fatigue levels, but when including people who had dropped out of treatment, there was no difference between CBT and usual care.”

“CFS has had many names in recent decades. These include Royal Free disease, Iceland disease, neurasthenia, myalgic encephalomyelitis (’ME’), and post-viral fatigue syndrome.

All these appear to describe groups of patients with a similar problem, that is, persistent medically unexplained fatigue which causes disability and distress. The term CFS has been adopted and clearly defined in order to foster research on this common problem.

Opinions regarding the cause have tended to focus on either mainly physical or mainly psychological explanations."

So This study shows a few things:

1. As we have said many times before the CBT gang selects people with fatigue, not with Chronic Fatigue Syndrome or ME.

2. As people with ME do NOT suffer from fatigue this has clearly shown that all these CBT studies are basically creative storytelling articles from professor CBT and his friends.

3. And even for FATIGUE, CBT is completely useless !!!!

4. Because usual care for fatigue means a HOSTILE doctor who doesn’t believe a word you say and treats you accordingly, so if CBT is as effective as that than the psychiatrists are doing an even lousier job than we have been saying and we are simply pouring millions of pounds down the CBT drain. But again, we have been saying that for years.

5. Neurasthenia and hysteria were terms used for MS, which is now a proper disease, so are MS and ME the same than?

I certainly don’t think so, but it also implies that both are neurological illnesses, which we know anyway but this fact is IGNORED all the time by the CBT gang.

Furthermore, Neurasthenia is a pschiatric disorder and ME and CFS are neurological disorders. ME since 1969, CFS since 1992. So absolutely right, just a minority detail.

6. CFS has been “clearly defined”. Now on what planet do these CBT guys live??

CFS has been clearly defined to include as MANY patients with psychiatric based tiredness and (ALMOST) all patients with physical signs and symptoms have been EXCLUDED. Wakey wakey guys.

And Dr Ramsay, what is the "sheet anchor" of diagnosing Myalgic Encephalomyelitis (ME):

“Muscle fatiguability. Even after a minor degree of physical excercise, 3 or more days may elapse before full muscle power is restored. This feature is unique and is the "sheet anchor" of diagnosis.”

This feature however doesn’t feature AT ALL in all the psycho criteria and their so called CFS or ME as defined by the CBT gang.

So they actually talk and write about Chronic Fatigue and not the Syndrome or ME all the time. Again, just a minority detail …..

If you want to read the whole review, then you can download that HERE …………

And in case you want to Drive a Millionaire? Than just have a look at the following picture of a Swedish supercar, more details are available here……

A heck of a lot better than silly CBT. Thanks guys.



3 comments:

TerryE said...

I went through your quoted reference and what stood out is that it was a study of studies about CBT mostly comparing CBT to other psychiatric and behavioural treatments though some were against "usual care" (which in the UK means "go away an try to do a little more each day"). Guess what? "CBT is statistically more effective that the alternatives in these studies."

However, this approach intrinsically flawed because introduces a bias by restricting itself to studies which compare CBT to treatment X. This is because most self-respecting researchers and studies in this field regard CBT as irrelevant and don’t compare their treatment to it. The authors might as well aggregate studies about the effectiveness of leeches and bloodletting as a treatment for ME, because if there are any out there, guess what: in general they’ll be positive.

Compare this to the US CDC’s position (see http://www.youtube.com/watch?v=SYaCAcXD6ls) and I’ll pick one extremely relevant quote: "The bad news is that we don't know what causes it or how to treat it successfully, but the good news is that there are over 4,000 published studies that show underlying biological abnormalities with this illness. It's not an illness that people can simply imagine that they have, and it's not a psychological illness. In my view that debate, which has raged for twenty years, should now be over."

Now I know that you are sensitive to ME being lumped in with CFS and I agree that the focus in ME is on neurological dysfunction rather than metabolic dysfunction, but both have underlying biological / medical causes. Comparisons of psychological treatment are simply irrelevant.

Anonymous said...

thank you Lord for Dr Speedy.

this is how all doctors should behave as far as im concerned. the others are just totally medieval. i for one want to cheer on this blog, long may you life ...

cbt anonymous

TheSeldomSeenMan said...

One of the problems that is seldom mentioned,is that there a lot of people out there who are diagnosed with ME/CFS, (including quite a few who believe they have recovered from ME/CFS), who simply have no symptoms you would describe as:

“Muscle fatiguability. Even after a minor degree of physical excercise, 3 or more days may elapse before full muscle power is restored. This feature is unique and is the "sheet anchor" of diagnosis.”

In fact, as in my case, having these 'anchor' symptoms, (and not tiredness), can lead certain consultants to not diagnose ME/CFS.

Comments are made insteasd along the lines of: "well it can't be CFS, because you are not tired. I'm afraid we simply don't know what is causing all the limb pain, tremor, etc, when/after you exert."

On my travels before becoming bed/house bound after GET, I met or talked to numerous people who claimed to have been diagnosed with ME/CFS.

Often they would then go on to tell me how they had pretty much been cured with: food intolerance treatment, thyroid treatment, changing their diet from crap to healthy, by getting more sun, exercising, etc, etc.Often seeming to assume that everyone with a ME/CFS diagnosis, had a crap diet, didn't exercise, had no tan, etc, etc, before becoming ill.

The root of all this is of course the lack of objective testing,( which is one of the reasons why biomed research is needed), and then from this the development of the nebulous Oxford/Fukuda criteria.

The resultant media spin together with these factors, has allowed all manner of people to get put into the ME/CFS box through a mythical criteria that is a mix of the media spin and nebulous criteria.

The result is that GP's,etc genuinely think (why wouldn't they) that ME/CFS is mainly about feeling tiredness (or malaised/ depressed/ phobic/ a bit fluy or achy/ hypochondriac. And not a condition, (once outlined as akin to polio), that is disabling due to a strange muscle fatigability.

It also seems obvious to me that it is people who are diagnosed on the basis of this "MedOxkuda" critera nonsense, who are being put into (if not targeted for)ME/CFS GET/CBT trials.

Furthermore, I would suggest that those perosn only meeting the "Medoxkuda" criteria are not the ones who are dropping out of the trial. The drop outs are perhaps those who actually have the 'Sheet Anchor' symptom'. Being people who can perhaps relate without question to why myalgia is a part of their diagnosis. (Sadly, such people may also only learn too late how GET can take you from mild/moderate to severe ME).

Whatever the case, who exactly is being put in the trials is highly debatable, and I don't believe anyone can really now what has been assessed.

Therefore, I think all the research carried out on the Ox/Fuk criteria is essentally rubbish. No matter who does it or pays for it. It certainly won't in the case of the ME/CFS centres be the severe ME/CFS sufferers, because they are far too ill to get there.

When someone can be told or believe they have a neurological illness, called ME, when they have no muscle pain, no post exertional pain, and no suggestion of any neuro involvement at the start or ongoing there is something wrong (or corrupt) going on. And when those who actually do have the 'anchor' symptoms struggle to get that label, then more so.

But as long as GP's are told and hear from the media that anyone under the weather can be diagnosed with ME/CFS this mess will be the result.

Sadly the resultant large CFS/ME population such confusion makes is to the benefit of all sides. NHS, Insurers, Pharma's, Charaties, etc. More people = more money.

The problem in the future is also likely I think to be one of bad precedent. How many GP/consultants have effectively ruined the life of people they have diagnosed with ME/CFS. It would be a big thing for them to change their minds on the reality of ME/CFS, and admit what they have perhaps done in the past.

I also retain concern, about the medoxkuda crowd, roaming the ME/CFS boards and web sites, telling the newly diagnosed, how to push on and how recovery can be easily affected, with some positive spirit and action, but thats for another rant.

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