Comment on: Cognitive behaviour therapy for the chronic fatigue syndrome: a randomized controlled trial. [BMJ. 1996]
EDITOR,-We have several practical and theoretical concerns about Michael Sharpe and colleagues’ study of cognitive behaviour therapy in the chronic fatigue syndrome.’ The authors managed to obtain almost 100% uptake of treatment and compliance among patients who were attending an infectious diseases clinic and were strongly convinced that their chronic fatigue had a physical cause. We would struggle to engage our patients similarly, even with two hours for an initial appointment, and we could not offer them anything approaching an hour of treatment a week for four months. The difference between what was provided in the study and what clinicians can routinely offer their patients makes it important to identify the essential elements of the treatment.
The package given included cognitive techniques such as “question[ing] a simple disease explanation,” “strategies to reduce excessive perfectionism and self criticism,” and a problem solving approach of “gradual and consistent increases in activity.” The continuing improvement after the end oftreatment is unusual for the cognitive psychotherapies and suggests that the behavioural component was most effective. We find it puzzling, therefore, that the authors attribute the beneficial effects of treatment to “a specific effect on illness perpetuating beliefs and coping behaviour,” particularly as these attitudes did not change substantially. The patients would inevitably report less avoidance of exercise if they were complying with the study. After treatment at least half of the patients still believed that the illness was physical (from tables 2 and 5), and the vast majority still applied the damaging label of “myalgic encephalomyelitis”2 to their condition.
You can read the full comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350875/pdf/bmj00539-0053b.pdf
Source: Lawrie SM. Cognitive behaviour therapy for the chronic fatigue syndrome. Cognitive behavior therapy. Essential elements of the treatment must be identified. BMJ. 1996 Apr 27;312(7038):1097; author reply 1098. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350875/