Research abstract:

Myalgic encephalomyelitis/chronic fatigue syndrome patients’ reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys, by Keith Geraghty, Mark Hann, Stoyan Kurtev in Journal of Health Psychology, 29 August 2017 [Preprint]

Cognitive behavioural therapy and graded exercise therapy are promoted as evidence-based treatments for myalgic encephalomyelitis/chronic fatigue syndrome.

This article explores patients’ symptom responses following these treatments versus pacing therapy, an approach favoured by many sufferers. We analyse data from a large cross-sectional patient survey (n = 1428) and compare our findings with those from comparable patient surveys (n = 16,665), using a mix of descriptive statistics and regression analysis modelling.

Findings from analysis of primary and secondary surveys suggest that cognitive behavioural therapy is of benefit to a small percentage of patients (8%-35%), graded exercise therapy brings about large negative responses in patients (54%-74%), while pacing is the most favoured treatment with the lowest negative response rate and the highest reported benefit (44%-82%).

Article Conclusion:

This article presents results pertaining to ME/CFS patient reports of symptom changes following CBT, GET or PT. While a small percentage of patients report some benefit from either CBT or GET, the majority experience no benefit.

In contrast, pacing brings about the greatest positive impact with the least negative reactions. GET brings about a substantive deterioration in symptoms for almost half of patients and it is the least favoured treatment, compared with pacing, which is most favoured by patients. Adding GET in combination with other treatments worsens outcomes and contributes to increases in illness severity, whereas adding pacing in combination improves outcomes.

These findings conflict with evidence from clinical trials that report CBT and GET to be superior treatments, but are consistent with findings from multiple patient surveys that span 15 years and multiple countries.

Therapists’ views have an impact on patient outcomes, with views of ME/CFS being a physical illness associated with better outcomes than views of ME/CFS being psychological illness. Further research is needed to validate these findings and to investigate if pacing is a viable alternative treatment approach in ME/CFS.