Cognitive-behavorial and graded exercise therapies for chronic fatigue (syndrome) are associated with lower levels of work/school attendance, by Frank N M Twisk in J Behav Med [Published online 28 March 2019]

Psychological and demographic factors associated with fatigue and social adjustment in young people with severe chronic fatigue syndrome/myalgic encephalomyelitis: a preliminary mixed-methods study, Sheila Ali, Lucy Adamczyk, Mary Burgess, Trudie Chalder in Journal of Behavioral Medicine pp 1–13 [First Online: 25 January 2019]

Twisk comments on the recent study by Ali and colleagues which reported that stronger fear avoidance beliefs at baseline were associated with higher fatigue approximately 5 months later (T2) and worse social adjustment at T1 and T2, and female gender and treatment were associated with lower work/school attendance at T1 and T2.

Ali et al. conclude: ‘‘Fearful beliefs about activity could be targeted using cognitive-behavioural interventions’’.

Twisk makes 3 challenges to the study results:

  1. the patients investigated cannot be qualified as CFS patients, let alone ME patients – the discredited Oxford criteria was used for selection
  2. The results do not support the claim that CBT & GET are effective rehabilitative treatments as in most cases (25/41) treatment was associated with lower work/school attendance at baseline and after 5 months.
  3. In spite of claiming their study ‘‘did not allow for causal inferences to be made’ they conclude that fearful beliefs could have ‘‘developed as a result of being so severely ill’’

Twisk believes the study actually shows that there is a need for accurate diagnosis (ME, CFS or CF) and that CBT and GET are neither effective nor safe.

Read the full article

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