CBT for ME/CFS study questioned
22nd March 2018 – A new analysis about the effectiveness of exercise and psychological therapy for people with chronic fatigue syndrome suggests that the technique for combating the condition shows only modest results.
Chronic fatigue syndrome (CFS) is widely known as ME, which stands for myalgic encephalomyelitis, and the condition is sometimes referred to as CFS/ME.
It is a long-term condition characterised by severe and persistent fatigue. Normal activities like walking, showering or even talking can leave people exhausted for days or weeks.
It affects around 250,000 people in the UK.
The PACE trial
One controversial strategy to cope with the condition is graded exercise therapy (GET), in which exercise is started very slowly and gradually increased over time. This is combined with cognitive behavioural therapy ( CBT).
A government-funded study known as the PACE trial found this treatment combination was moderately effective at helping people with CFS, leading to recovery in around a fifth of patients.
However, PACE has since faced intense criticism from patients and charities, including from the ME Association, which helped fund the latest review, over how the results were obtained, analysed and presented.
The original authors of the PACE trial say they stand by their findings.
According to researchers involved in the latest study, the results were unreliable because original rules for how the trial would be carried out were not followed.
To re-evaluate, they used data obtained under a Freedom of Information request to recalculate the PACE results. Researchers found that the groups who received CBT or GET did not significantly outperform those who got normal care. Also, their recovery rates were consistently low and not significantly different.
Recovery rates never exceeded 8% in any treatment group, according to the study in BMC Psychology.
Commenting in a statement, Dr Charles Shepherd, honorary medical adviser to the ME Association, says: "The message is clear – CBT and GET are not effective ways of treating a serious neuroimmune disease.
"The sooner this message gets across to health professionals the better."
Three authors of the original PACE trial – Professor Michael Sharpe from the University of Oxford, and Professor Trudie Chalder and Kimberley Goldsmith from King’s College London – say that "we find little of substance in this critique and stand by our original reports".
They continue: "The PACE trial found that CBT and graded exercise therapy are safe and moderately effective treatments; a positive message for people who suffer from this otherwise long-term debilitating illness."