Recent CBT, GET, PACE study published in Lancet
Last week, a study on chronic fatigue syndrome was published. It has resulted in a lot of
comments, controversy and media attention. We would like to bring it to your attention
because the headlines in the media do not tell the whole story and we urge you to
interpret them carefully. For example, the study did not conclude, as, for example, the
CBC stated (18 Feb): "Taking it easy is not the best treatment for chronic fatigue
syndrome, rather exercise and behavior therapy are, a large study finds."
The objective of the study was to compare specialist medical care alone, to specialist
medical care with adaptive pacing therapy, to specialist medical care alone with cognitive
behavioral therapy, to specialist medical care alone with graded exercise therapy. The
study was well conducted using a large sample. All patients met the Oxford criteria for
chronic fatigue syndrome and were recruited from six secondary-care clinics in the UK.
Specialist medical care included advice about chronic fatigue syndrome, including
avoidance of activity extremes, and rest and self-help strategies.
The authors concluded that cognitive behavioral therapy and graded exercise can safely be
added to standard medical care to moderately improve outcomes for chronic fatigue
syndrome. Important to note, and similar to what the authors pointed out, a positive
effect of cognitive therapy does not translate to the fact that these illnesses are
psychological in nature.
To understand what “moderate gains” actually means requires a careful review of the
grading systems developed for this study - but on the surface it appears as if these were
quite minor improvements in some symptoms.
Furthermore, the positive effects of Adaptive Pacing should not be discounted. Adaptive
Pacing was developed for this study so it is not yet clear how that lines up with what
most of us in Ontario consider PACING. Its is also unclear how a person with ME -
especially as defined under Canadian Consensus i.e. including Post Exertion Malaise -
would volunteer to participate in a study involving regular exercise, unless they were
already quite skilled at pacing their energy. There is a need for clarification and more
research.
MEAO will continue to monitor the study and the reaction to it and will provide a more
detailed analysis in an upcoming Reaching Out. In the meantime, if you have questions or
concerns, please contact us at info(a)meao.ca
Editor’s note: If you have opinions on CBC’s coverage, its possible to send them on-line
feedback.
www.cbc.ca/contact/
Lydia
Lydia E. Neilson, M.S.M. , Founder
Chief Executive Officer
NATIONAL ME/FM ACTION NETWORK
512 - 33 Banner Road
Nepean, ON K2H 8V7 Canada
Tel. 613.829.6667
Fax 613.829.8518
Email: mefmaction(a)ncf.ca
www.mefmaction.net
NATIONAL ME/FM ACTION NETWORK - HOST OF THE IACFS/ME INTERNATIONAL RESEARCH & CLINICAL
CONFERENCE - OTTAWA, CANADA
SEPTEMBER 22 - 25, 2011
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