Re-visiting professional ethics in psychotherapy: Reflections on the use of talking therapies as a supportive adjunct for myalgic encephalomyelitis / chronic fatigue syndrome and ‘medically unexplained symptoms’

Abstract:

Following years of debate over the effectiveness of cognitive behavioural therapy for myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS), public health bodies in the UK and beyond have determined that no psychotherapy is clinically proven for this patient group.

In the field of ME/CFS and the wider arena of ‘medically unexplained symptoms’ (MUS), patient survey data and qualitative research capturing patient experiences and psychotherapist attitudes suggest that therapeutic practice may sometimes fall short of required ethical standards. This raises questions about how psychotherapists can safely support, as opposed to treat, people with these debilitating conditions.

We consider four ethical principles that feature throughout psychotherapists’ codes of practice, those of respect, competence, responsibility, and integrity, and discuss examples of good and poor practice in this arena as evinced by recent empirical literature.

Following this, we offer a variety of suggestions to help strengthen ethical psychotherapy practice among patients with ME/CFS and other MUS. In terms of practitioner education, we recommend greater emphasis on humility and reflexive practice, exploration of personal as well professional ethics, and integration of patient expertise-by-experience, accompanied with latest evidence, into foundational and on-going training.

In terms of practice, we suggest consideration of formalized patient-focused feedback systems and greater transparency visà-vis patient access to clinical notes. Finally, we underline the importance of elevating patients from mere subjects to co-producers of psychotherapy research.

Source: Joanne Hunt, Charlotte Blease. Re-visiting professional ethics in psychotherapy: Reflections on the use of talking therapies as a supportive adjunct for myalgic encephalomyelitis / chronic fatigue syndrome and ‘medically unexplained symptoms.’ OSF preprints. https://osf.io/2m9eb/ (Full text)

Interventions to support mental health in people with long COVID: a scoping review

Abstract:

Introduction: Long COVID (LC) is a multisystem disease with symptoms lasting weeks or months beyond the acute COVID-19 infection. Several manifestations are reported by people with LC, including effects on mental health, with varying degrees of psychological distress and disturbances to daily activities. Research conducted to identify effective interventions to support mental health among people with LC has been limited by the breadth and scope of studies.

Aim: This review aims to identify interventions being tested to support mental health of people with LC.

Methods: A scoping review was conducted by searching five databases for articles published between January 2020 and early October 2022 to identify research evaluating interventions focused on improving mental health symptoms associated with LC. Results from all sources were checked for eligibility by two reviewers, and agreements were resolved by discussion. Gray literature and reference list of included studies and relevant reviews were scrutinised to identify any additional studies. Data extraction was conducted by one reviewer and checked by another reviewer for accuracy.

Results: Of the 940 studies identified, 17 were included, the design of which varied but included mainly case studies (n = 6) and clinical trials (n = 5). Several interventions were described, ranging from single interventions (e.g., pharmacologic) to more holistic, comprehensive suites of services (pharmacologic and non-pharmacologic). Several mental health outcomes were measured, mostly anxiety and depression. All included studies were reported to be associated with improvements in participants’ mental health outcomes.

Conclusion: This scoping review identified studies reporting on a variety of interventions to support mental health among people with LC. Although positive changes were reported by all studies, some were case studies and thus their findings must be interpreted with caution. There is a need for more research to be conducted to identify the impact of interventions on mental health of people with LC.

Source: Al-Jabr H, Hawke LD, Thompson DR, Clifton A, Shenton M, Castle DJ, Ski CF. Interventions to support mental health in people with long COVID: a scoping review. BMC Public Health. 2023 Jun 20;23(1):1186. doi: 10.1186/s12889-023-16079-8. PMID: 37340400; PMCID: PMC10280822. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10280822/ (Full text)

Childhood trauma as a risk factor for a dysfunctional heart rate variability in patients with CFS/ME

Background: Myalgic encephalomyelitis, also called Chronic Fatigue Syndrome or ME/CFS, is a severe and complex multisystemic disease with a heterogenous combination of symptoms. Studies have shown decreased heart rate variability (HRV) in this population. Moreover, there is a growing body of evidence showing high levels of childhood trauma (CHT) among ME/CFS patients. Traumatic experiences in childhood are linked to a decreased HRV. Specially, emotional traumatization impacts HRV. The present study investigates HRV in the context of CHT in a ME/CFS population.

Methods 37 patients diagnosed with ME/CFS participated in this study. Demographic-, clinical data, the degree of disability, and RMSSD parameters of HRV were extracted from patient records. HRV data was gathered over 30 minutes whilst in supine position. CHT was administered using the Childhood Trauma Questionnaire-Short Form. Disability was assessed using the Bell Disability Scale. Multiple regression analyses were conducted using the CHT total scores and emotional abuse and emotional neglect subscales in relation to HRV.

Results Variables / Research Materials Data / Observations Results • Fig.5 HRV in the Monitoring compare the interaction between VNS Sympathic Frequency (LF 0.04-0.15) and Parasympathic Frequency (HF 0.15-0.50) in four stages: Orthostatic Schellong Test, start of the Monitoring in lying down position, Middle section after 15 Minutes and after 30 Minutes. • Box-Plot Data shows the most fluctuation of Sympathic in the middle section. The highest scores and fluctuation which appear of Parasympathic activity is in the beginning of the measurement.

Conclusion • In sum, the results of the study suggest that CHT is more prevalent in ME/CFS populations. However, an effect of childhood trauma on HRV function and disability could not be demonstrated in this sample. The findings indicate that the underlying pathophysiologic mechanism of CHT in ME/CFS are more complex and not expressed in HRV. Future studies should include additional aspects and examine the impact of childhood trauma by looking at other biological systems affected in ME/CFS.

Works Cited • Cohen, J. (1988) Statistical power analysis for the behavioral sciences, New York second edition.

Source: Ziaja, Christof, Young, Susanne, Sadre Chirazi – Stark, Michael.Childhood trauma as a risk factor for a dysfunctional heart rate variability in patients with CFS/ME. 2023/05/24 DOI:10.13140/RG.2.2.17700.65929 https://www.researchgate.net/publication/370987476_Childhood_trauma_as_a_risk_factor_for_a_dysfunctional_heart_rate_variability_in_patients_with_CFSME 

‘Welcome to my world’: a thematic analysis of the lived experiences of people with Myalgic Encephalomyelitis during the UK COVID-19 lockdown

Abstract:

Objectives: We explore the experiences of people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (pwME/CFS) during the first UK COVID-19 lockdown period. We specifically probe perceived commonalities and departures in experience between government- and health-imposed lockdowns, application of coping strategies for social isolation, and predictions for inclusion of the chronically ill in post-pandemic society.

Methods and measures: Thirty semi-structured interviews were conducted in pwME/CFS between June – July, 2020. Responses were qualitatively analysed using an experiential, thematic framework.

Results: While participants reported enhancements in digital accessibility during lockdown, they perceived this as an unintentional benefit from changes designed to cater universally. Similarly, their expectation was that the general population’s limited experience of restriction would not engender greater understanding for those who would continue to experience health-imposed lockdowns, post-pandemic. Participants described numerous strategies for coping with restriction and isolation, developed during prior health-imposed lockdowns and applied to this novel circumstance, highlighting the presence of acceptance and resilience in the sample.

Conclusions: Our findings suggest that future work may fruitfully examine whether our participant’s predictions for post-pandemic societal inclusion have been met, and how resilience and acceptance might be developed and nurtured in chronically ill populations through times of adversity.

Source:Portch E, Moseley RL, Wignall L, Turner-Cobb JM, Taylor Z, Gondelle M. ‘Welcome to my world’: a thematic analysis of the lived experiences of people with Myalgic Encephalomyelitis during the UK COVID-19 lockdown. Psychol Health. 2023 May 31:1-18. doi: 10.1080/08870446.2023.2220009. Epub ahead of print. PMID: 37259524. https://pubmed.ncbi.nlm.nih.gov/37259524/

Factors associated with psychiatric outcomes and coping in Long COVID

Abstract:

The relationship between Long COVID (LC) and psychiatric outcomes, as well as factors associated with presence and absence of these, has so far been insufficiently studied. Here we evaluated psychiatric symptoms and coping among patients with LC and patients recovered from COVID-19 who participated in a large international survey. Given increased rates of psychiatric illness with chronic medical conditions and known immune-inflammatory contributors to psychiatric disease, we hypothesized that a subset, but not the entirety, of LC respondents may have comorbid psychopathology.

A substantial minority of both groups experienced suicidality, depression and anxiety symptoms, with these symptoms being more common in the LC group. LC respondents used more adaptive coping styles. Psychiatric outcomes in LC were associated with younger age, greater reductions in overall health, higher symptom severity, limitations to physical capability, lower income, financial hardship, psychiatric history, employment impact, male sex, men and non-binary gender, and negative experiences with medical professionals, family, friends, partners and employers.

Source: Re’em, Y., Stelson, E.A., Davis, H.E. et al. Factors associated with psychiatric outcomes and coping in Long COVID. Nat. Mental Health 1, 361–372 (2023). https://doi.org/10.1038/s44220-023-00064-6 https://www.nature.com/articles/s44220-023-00064-6 (Full text)

Patient and clinician experiences of fibromyalgia, ME/CFS and medically unexplained symptoms: A meta-aggregative systematic review

Abstract:

Objectives: Fibromyalgia (FM), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and other syndromes with medically unexplained symptoms (MUS) pose significant healthcare challenges. We aimed to synthesize qualitative evidence regarding the experiences of persons with these conditions (PwC) and their healthcare professionals (HCPs).

Methods & Measures: Databases were searched using terms relating to FM/ME/CFS/MUS, Experience and Qualitative research. Studies published between 2001-2021 concerning adult PwC or HCP perspectives were included and synthesized using Meta-Aggregation, with confidence established following the ConQual approach.

Results: 143 studies were included, with 708 findings aggregated into 82 categories and 13 synthesized findings. PwC narratives reflected a range of themes concerning: The experience of symptoms; The patient journey; Identity loss and change; Managing chronic illness; Understanding and legitimacy; Support needs and experiences; Healthcare needs and experiences; and Managing the healthcare encounters. HCPs perspective themes included: Beliefs and attitudes towards patients; Sensemaking at the limits of medical knowledge; Consultation and management; The patient-clinician relationship; and Barriers and facilitators to care.

Conclusion: Sensemaking challenges are at the core of the patient and clinician experience of MUS, FM and ME/CFS. While gaps in biomedical knowledge are clear, this review highlights the need to address the patient-clinician dynamic in the context of uncertainty.

Source: Duda N, Maguire R, Gitonga I, Corrigan S. Patient and clinician experiences of fibromyalgia, ME/CFS and medically unexplained symptoms: A meta-aggregative systematic review. PsyArXiv [Preprint], 28 Apr 2023  https://psyarxiv.com/5ct4k/ (Full text)

Risk factors for psychiatric symptoms in patients with long COVID: A systematic review

Abstract:

Prolonged symptoms of COVID-19 have been found in many patients, often known as Long COVID. Psychiatric symptoms are commonly seen in Long COVID patients and could last for weeks, even months, after recovery. However, the symptoms and risk factors associated with it remain unclear.

In the current systematic review, we provide an overview of psychiatric symptoms in Long COVID patients and risk factors associated with the development of those symptoms. Articles were systematically searched on SCOPUS, PubMed, and EMBASE up to October 2021. Studies involving adults and geriatric participants with a confirmed previous COVID-19 diagnosis and reported psychiatric symptoms that persist for more than four weeks after the initial infection were included. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies. Prevalence rates and risk factors associated with psychiatric symptoms were collected. This present study was registered at PROSPERO (CRD42021240776). In total, 23 studies were included.

Several limitations in this review were the heterogeneity of studies’ outcomes and designs, studies limited to articles published in English, and the psychiatric symptoms mainly were assessed using self-report questionnaires. The most prevalent  reported psychiatric symptoms, from the most to the least reported, were anxiety, depression, post-traumatic stress disorder (PTSD), poor sleep qualities, somatic symptoms, and cognitive deficits. Being female and having previous psychiatric diagnoses were risk factors for the development of the reported symptoms.

Source: Zakia H, Pradana K, Iskandar S. Risk factors for psychiatric symptoms in patients with long COVID: A systematic review. PLoS One. 2023 Apr 7;18(4):e0284075. doi: 10.1371/journal.pone.0284075. PMID: 37027455; PMCID: PMC10081737. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10081737/ (Full text)

The Role of Psychotherapy in the Care of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Abstract:

Myalgic encephalomyelitis/chronic fatigue (ME/CFS) is a post-infectious, chronic disease that can lead to severe impairment and, even, total disability. Although the disease has been known for a long time, and has been coded in the ICD since 1969 (G93.3), medical research has not yet been able to reach a consensus regarding its physiological basis and how best to treat it. Against the background of these shortcomings, psychosomatic disease models have been developed and psychotherapeutic treatments have been derived from them, but their empirical testing has led to sobering results.
According to the current state of research, psychotherapy and psychosomatic rehabilitation have no curative effect in the treatment of ME/CFS. Nevertheless, we see numerous patients in practices and outpatient clinics who suffer severely as a result of their illness and whose mental well-being and coping strategies would benefit from psychotherapeutic help.
In this article, we outline a psychotherapeutic approach that serves this need, taking into account two basic characteristics of ME/CFS: firstly, the fact that ME/CFS is a physical illness and that curative treatment must therefore be physical; and secondly, the fact that post exertional malaise (PEM) is a cardinal symptom of ME/CFS and thus warrants tailored psychotherapeutic attention.
Source: Grande T, Grande B, Gerner P, Hammer S, Stingl M, Vink M, Hughes BM. The Role of Psychotherapy in the Care of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Medicina. 2023; 59(4):719. https://doi.org/10.3390/medicina59040719 (Full text)

Graded exercise therapy and cognitive behavior therapy do not improve employment outcomes in ME/CFS

1 Introduction:

In a 1989 article, Wessely et al. [1] proposed a model of the onset and perpetuation of chronic fatigue syndrome, the illness often called myalgic encephalomyelitis and now frequently referred to as ME/CFS. In this model, patients’ symptoms were attributed to the effects of deconditioning following an acute illness. The symptoms were said to be perpetuated by patients’ persistent but purportedly unwarranted conviction that they continued to suffer from a medical disease that was exacerbated by exertion. The proposed treatment strategy combined gradual increases in activity to reverse the presumed deconditioning with efforts to alter patients’ supposedly misguided perceptions about their ailment.

ME/CFS has long been associated with marked disability and long-term sickness absences [2], with estimated rates of unemployment among patients ranging from 35% to 69% [3]. From the start, the promotion of behavioral and psychological rehabilitation has been intertwined with questions about whether ME/CFS patients with limited capacity to work should be able to receive some form of income or disability support. In a section on “sickness benefits” in the 1989 paper [1], the authors argued that decisions about social welfare payments should be linked to patients’ willingness to undergo behavioral and psychological interventions. “It is reasonable to expect a patient to cooperate with treatment before being labelled as chronically disabled,” noted the authors, notwithstanding the theoretical and unproven status of their model.

This rehabilitative approach achieved dominance over the next couple of decades, not only in the UK but in the US and many other countries. Graded exercise therapy (GET) and an illness-specific form of cognitive behavior therapy (CBT) became the predominant and most heavily researched ME/CFS interventions and were enshrined in multiple clinical guidelines. A 2005 review of the natural history of the illness [4], which found that only 5% of patients fully recovered spontaneously, noted “increasing evidence” for GET and CBT and therefore advised that “medical retirement should be postponed until a trial of such treatment has been given.”

While many studies have included employment status as a demographic data point [2, 3], fewer have specifically examined the relationship between GET and CBT and employment-related outcomes. Nonetheless, the results from the latter group are consistent and clear: The interventions do not lead to improved outcomes in employment status [5–13].

This question has taken on renewed urgency given the overlaps between ME/CFS and the phenomenon known as long Covid, or more formally as post-acute sequelae of SARS CoV-2 (PASC). A significant proportion of patients with prolonged symptoms after a coronavirus infection appear to suffer from the same cluster of symptoms that characterize ME/CFS, including pronounced exhaustion, relapses after minimal exertion known as post-exertional malaise (PEM), cognitive impairments, and orthostatic intolerance, among others. Like ME/CFS patients, many of this new PASC cohort have found that they are unable to sustain their previous level of employment. While the similarities between the two conditions have been widely noted by clinicians and medical investigators, they have also led to efforts to promote the traditional ME/CFS rehabilitation paradigm for this large wave of post-viral patients.

2 Employment outcomes in the PACE trial

After gaining momentum during the 1990 s and 2000 s, the GET/CBT approach was significantly reinforced with the 2011 publication in the Lancet of the first results of the PACE trial, the largest study of the two interventions for ME/CFS [5]. Additional PACE results were published in 2012 and 2013 [6, 7]. The study was partially funded by the UK’s Department for Work and Pensions (DWP). Officials at the agency presumably believed or hoped that the trial would provide robust data to support the use of these two strategies.

The PACE investigators presumably hoped for that as well; key members of the team maintained strong links with disability insurance companies, advising them that GET and CBT were effective in helping this group of challenging patients recover. In a 2002 essay for a UNUMProvident report on trends in disability [14], Michael Sharpe, a lead PACE investigator, wrote that “symptoms and disability” in patients with unexplained conditions “are shaped by psychological factors,” and in particular by “patients’ beliefs and fears.” He suggested that the promotion of biological disease models by ME/CFS patient advocates could impact health outcomes among insurance claimants.

Commenting on how public messaging and related “social factors” influenced the course of illness for these patients, Sharpe wrote: “Relevant factors include the information patients receive about the symptoms and how to cope with them. This information may be helpful or may stress the chronicity of the illness and promote helplessness. Such unhelpful information is found in “self-help” (!) books and increasingly on the Internet (see for example www.meassociation.org.uk)…Other social factors that perpetuate illness are anger with the person or organisation the illness is attributed to, or toward the insurer for not believing them.” In the article, Sharpe further argued that receiving financial benefits ultimately discouraged such claimants from getting better.

However, the data from PACE did not provide evidence that GET and CBT were effective in helping ME/CFS patients in the employment domain [6]. With 641 participants, PACE was the largest treatment trial for ME/CFS [5]. The investigators themselves referred to it as the “definitive” test of the two interventions [15]. In touting it as a success, they reported that around 60% had improved and 22% had recovered after treatment with GET and CBT, much more than in the other groups [5, 7]. However, these positive findings were all from subjective, self-reported measures. When such measures are paired with unblinded treatments, as in the PACE trial, they are subject to an unknown amount of bias.

PACE also included an employment measure as one of four objective outcomes, along with whether or not the participant was receiving social welfare or disability benefits, a step-test to assess fitness, and a six-minute-walking test. The results were uniformly poor. The first three measures produced null findings across the board, with no advantages conferred by the interventions [6, 7]; in the six-minute walking test, the GET group showed a statistically significant but clinically insignificant improvement [5]. In terms of employment, the percentage of participants in the GET group reporting lost days of work increased from 83% at baseline to 86% at 12 months after randomization; in the CBT group, the percentage was 84% both before and after treatment. In all study arms, the percentage of participants receiving unemployment or disability benefits was higher after treatment [6].

In promoting GET and CBT as effective, the PACE authors downplayed the findings on employment, receipt of disability or unemployment support, and other objective results, suggesting these should be ignored when determining whether patients had improved and recovered. In correspondence, they challenged the reliability and even the objectivity of the measures they themselves had pre-designated as objective. As they wrote: “Recovery from illness is a health status, not an economic one, and plenty of working people are unwell, while well people do not necessarily work. Some of our participants were either past the age of retirement or were not in paid employment when they fell ill. In addition, follow-up at 6 months after the end of therapy may be too short a period to affect either benefits or employment.” [16].

It is indisputable that other factors besides health status play a role in employment outcomes. Nonetheless, if the PACE trial’s reported results of significant improvement and recovery were accurate, then a measurable benefit from GET and CBT in employment and in the receipt of financial support would have been expected. As has been well-documented, the investigators weakened key subjective outcome measures in ways that dramatically improved their reported results; published re-analyses of trial data have found that no one achieved “recovery” from either of the therapies, and rates of improvement were so marginal that they were likely due to bias and expectation effects [17, 18]. Given these findings, the similarly disappointing results for employment outcomes in PACE should not be surprising.

3 Other studies on CBT/GET and employment outcomes

In a review of treatment studies that included employment outcomes, Vink and Vink-Niese [8] found that the standard interventions did not have an overall positive effect on work status. Besides PACE, among the studies reviewed were two other randomized trials and five observational studies based on data from clinical services. The two other trials, one in the Netherlands with 278 participants and one in England with 153, both investigated CBT and reported no statistically significant differences in employment outcomes between the intervention and control groups [9, 10]. The largest observational study included 952 patients seeking care at specialty clinics in England, although a great many did not provide post-treatment outcomes; among a subgroup of 394, 18% reported having returned to work or increased work hours, while 30% reported having stopped work or reduced work hours [11]. According to a Belgian report, a review of 655 patients attending domestic clinics found that “employment status decreased” when assessed after treatment while the percentage of those “living from a sickness allowance” rose from 54% to 57% [12].

Other observational research had similarly unpromising findings. In the most recent study, Stevelink et al. [13], of 508 patients who attended clinical services between 2007 and 2014, only 316 provided information about post-treatment employment status, among other measures. Of those, 9% had returned to work after not having worked at baseline. On the other hand, 6% had stopped working after having been working at baseline, leaving a net return-to-work after treatment of just 3%–a handful of people. Moreover, that figure is likely to be overstated, given the high loss-to-follow-up from the initial sample of 508. The drop-outs were more seriously ill at baseline, so they might be expected to have worse employment outcomes than those who ended up providing data at the final time point.

According to the authors, “unhelpful beliefs such as fear of activity and exercise and concerns about causing damage, combined with all or nothing behaviour and behavioural avoidance, were associated with not working” [13]. This statement is problematic because “fear of activity,” “concerns about causing damage” and related indications of caution should be considered reasonable and prudent perspectives, not “unhelpful beliefs,” among patients with the core ME/CFS symptom of PEM. Beyond that, the study itself documented little or no change after treatment in the domains of “fear-avoidance,” “catastrophizing,” “embarrassment avoidance,” “symptom focusing,” “all-or-nothing behaviour,” and “avoidance/resting behaviour,” even though such factors were “specifically targeted in CBT and, to some extent, GET.”

Moreover, the authors reported no change in subjective fatigue scores, and only a marginal increase in subjective physical function scores, with participants remaining seriously disabled even after treatment. Thus, although the authors noted correctly that “meaningful occupation is important for well-being and psychosocial needs,” their study documented that their approach failed to impact factors presumed to be essential to helping participants achieve that important goal. (Since Stevelink et al’s senior author was one of the lead PACE investigators, it is unclear why the paper did not mention the null employment results from that “definitive” study.)

The theoretical illness model underlying all of these studies is essentially the one outlined by Wessely et al. more than three decades ago [1]. That illness model is at odds with the extensive physiological abnormalities that have been found in ME/CFS [17, 19]. Research findings have also undermined two core assumptions of the model–specifically, that ME/CFS patients are deconditioned and have an unwarranted fear of activity or exercise. [20–22]. In 2017, the US Centers for Disease Control and Prevention dropped its recommendations for GET and CBT as ME/CFS treatments. In 2021, the UK National Institute for Health and Care Excellence (NICE) reversed its earlier support for the interventions in new ME/CFS guidelines; in its analysis, NICE assessed the quality of the evidence supporting GET and CBT as either “very low” or merely “low” [23]. These developments are consistent with the failure of GET and CBT to lead to improved employment outcomes in PACE and other studies.

4 Conclusion

In a recent study of employment status among clinic attendees, Stevelink et al. [13] wrote that “work-related outcomes should be targeted” in treatment for ME/CFS. It is certain that people with ME/CFS experience disrupted occupational lives and that it would be desirable to identify treatments that could restore their full capacity for employment. However, the most common behavioral and psychological interventions— that is, GET and CBT–have already been tested sufficiently to reach a conclusive assessment that they do not lead overall to meaningful improvements in work status. These poor results are consistent across randomized trials, including the high-profile and “definitive” PACE study, as well as observational studies of patients seeking clinical services for their illness.

Some investigators and medical experts continue to promote GET and CBT as treatments for ME/CFS patients based on subjective findings from flawed studies. They also seek to extend these recommendations to patients with long Covid, or PASC, many of whom are receiving ME/CFS diagnoses and facing employment challenges. It is time to state the obvious: The objective data on work outcomes indicate that GET and CBT do not lead to readily apparent benefits in this domain. In consequence, they should no longer be recommended to ME/CFS patients as a strategy for achieving occupational rehabilitation and related benefits.

Source: Tuller D, Vink M. Graded exercise therapy and cognitive behavior therapy do not improve employment outcomes in ME/CFS. Work. 2023 Mar 10. doi: 10.3233/WOR-220569. Epub ahead of print. PMID: 36911962. https://content.iospress.com/articles/work/wor220569 (Full text)

Characteristics associated with physical functioning and fatigue in patients with chronic fatigue syndrome (CFS): secondary analyses of a randomized controlled trial

Abstract

Objective: This study aimed to explore associations at the group level between patient characteristics at baseline and the outcomes of physical functioning and fatigue in patients with chronic fatigue syndrome (CFS) participating in a randomized controlled trial on cognitive behavioural therapy (CBT).

Methods/design: Consecutively, 236 adult participants fulfilling the Centres for Disease Control and Prevention (CDC) 1994 criteria for CFS were randomly allocated to either 16 weeks of standard CBT, 8 weeks of Interpersonal CBT or a treatment as usual control group. In secondary analyses we investigated how gender, age, pain, anxiety, depression, memory and VO2max at baseline were associated with physical function and fatigue before and after treatment, controlling for the CBT-interventions and the baseline levels of the outcome measures.

For the two groups receiving CBT, a 1-year follow-up analysis was also done. Bivariate and multivariable linear regression was used to explore the targeted associations.

Results: At baseline, less pain (p < .001) and higher VO2max (p = 0.014) were associated with better physical function, while better memory (p = 0.001) and fewer depressive symptoms (p = 0.017) were associated with less fatigue. Better memory and physical function at baseline (p = 0.015 and p < .001, respectively) and male gender (p = 0.003) were associated with higher physical function post-intervention.

Male gender (p = 0.010) was associated with higher physical function at 1-year follow-up. Fatigue severity at baseline was the only variable associated with follow up scores for fatigue (p < .001).

Conclusion: Our findings show that fatigue and physical function were associated with different types of characteristics at baseline, indicating a heterogeneity among CFS patients.

Source: Merethe Eide Gotaas, Tormod Landmark, Anne S. Helvik & Egil A. Fors (2023) Characteristics associated with physical functioning and fatigue in patients with chronic fatigue syndrome (CFS): secondary analyses of a randomized controlled trial, Fatigue: Biomedicine, Health & Behavior, DOI: 10.1080/21641846.2023.2175521 https://www.tandfonline.com/doi/full/10.1080/21641846.2023.2175521 (Full text)