{"id":10197,"date":"2016-10-19T06:28:27","date_gmt":"2016-10-19T06:28:27","guid":{"rendered":"http:\/\/wames.org.uk\/cms-english\/?p=10197"},"modified":"2016-10-19T06:28:27","modified_gmt":"2016-10-19T06:28:27","slug":"prof-hooper-challenges-value-of-cbt-for-me","status":"publish","type":"post","link":"https:\/\/wames.org.uk\/cms-english\/prof-hooper-challenges-value-of-cbt-for-me\/","title":{"rendered":"Prof Hooper challenges value of CBT for ME"},"content":{"rendered":"

Article<\/strong> by Prof Malcolm Hooper<\/a>, 15 October 2016: A response to Professor Fred Friedberg\u2019s editorial about CBT<\/a><\/p>\n

\"hooper\"Professor Fred Friedberg<\/a> asks why cognitive behavioural therapy (CBT) is so vilified in the chronic\u00a0fatigue syndrome community.<\/p>\n

He opens his Editorial by stating:<\/p>\n

\u201cCognitive behaviour therapy (CBT) is a well-established\u00a0psychosocial intervention for psychiatric disorders, pain management and stress related to medical\u00a0 conditions\u201d<\/p>\n

(Editorial: Cognitive-behavior therapy: why is it so vilified in the chronic fatigue\u00a0 syndrome community<\/a>? Fatigue, Biomedicine, Health & Behavior 2016:vol 4: no:3:127-131) but\u00a0 ME\/CFS is not, and never has been, a psychiatric disorder and CBT has no more role in its\u00a0 management than in the management of multiple sclerosis, MND, Parkinson\u2019s Disease, malignancies\u00a0 or other autoimmune disorders such as lupus or RA.
\nCBT is not mandated as the primary management approach in those other disorders, so why in\u00a0 ME\/CFS?<\/p>\n

Patients with ME\/CFS do not summarily reject any intervention that would help them: what they\u00a0reject is a psychosocial intervention that is used with the intention of changing their correct\u00a0 perception that they are very sick with an organic disease, not with a behavioural disorder that is\u00a0curable by \u201ccognitive re-structuring\u201d if they would only co-operate.<\/p>\n

Friedberg appears to assume that, where there is stress related to a medical disorder, CBT supports\u00a0patients to help them cope better with their disease.<\/p>\n

However, a key consideration which he fails to mention is the significant difference between\u00a0supportive CBT and directive CBT.<\/p>\n

In relation to ME\/CFS, in the UK PACE trial CBT was not supportive but directive: Professor Sir Simon\u00a0Wessely, currently President of the Royal College of Psychiatrists, has publicly stated: \u201cCBT is\u00a0directive \u2013 it is not enough to be kind or supportive<\/strong>\u201d (New Statesman, 1st May 2008).<\/p>\n

No amount of directive \u201ccognitive re-structuring\u201d can result in \u201crecovery\u201d from such a multi-system\u00a0inflammatory disease process as has been demonstrated in ME\/CFS.
\nThe Centres for Disease Control (CDC) has archived its toolkit that recommended CBT and GET as\u00a0interventions for ME\/CFS (http:\/\/www.cdc.gov\/cfs\/toolkit\/archived.html<\/a>) and the National Institutes\u00a0for Health (NIH) has produced a report which acknowledges the harm done to patients\u00a0(http:\/\/annals.org\/article.aspx?articleid=2322804<\/a>); their conclusions were based on comprehensive\u00a0reviews of over 9000 peer-reviewed research papers and testimony from expert researchers and\u00a0clinicians.<\/p>\n

Does this not provide the answer to Friedberg\u2019s question as to why CBT is so vilified in the ME\/CFS\u00a0 community?<\/p>\n

Diverting scarce resources from biomedical research by funding psychosocial interventions that have\u00a0been conclusively proven to be ineffective can only harm patients further.<\/p>\n

Money must now urgently be made available by institutions such as the MRC<\/a> for research that is\u00a0 relevant to the disorder; for example, Professor Faisal Khan (recently appointed to the Chair of\u00a0Cardiovascular Sciences, Division of Molecular and Clinical Medicine at the University of Dundee) is\u00a0working on NRF2 (nuclear receptor factor 2) in ME\/CFS patients and his work ties in with the study\u00a0by Japanese researchers who looked at index markers in ME\/CFS patients with dysfunction of TCA\u00a0(the tricarboxylic acid cycle, also known as the Krebs cycle, which is the biochemical pathway used to\u00a0generate energy) and urea cycles (http:\/\/www.nature.com\/articles\/srep34990<\/a> ).<\/p>\n

Behavioural researchers who for over 30 years have shown disregard for the scientific process\u00a0should have no influence on future research.<\/p>\n

Patients with ME\/CFS do not need \u201cbehavioural\u201d guidance from a profession which has visited such\u00a0harm upon them.<\/p>\n

To spell it out<\/strong>: directive CBT does not work for patients with ME\/CFS and it is time that those\u00a0psychologists and psychiatrists who insist that it does returned to reality<\/strong>.<\/p>\n

Professor Malcolm Hooper
\n15th October 2016<\/p>\n","protected":false},"excerpt":{"rendered":"

Article by Prof Malcolm Hooper, 15 October 2016: A response to Professor Fred Friedberg\u2019s editorial about CBT Professor Fred Friedberg asks why cognitive behavioural therapy (CBT) is so vilified in the chronic\u00a0fatigue syndrome community. He opens his Editorial by stating: … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[11,426,2347,42,2248,322],"class_list":["post-10197","post","type-post","status-publish","format-standard","hentry","category-news","tag-cbt","tag-cognitive-behavioural-therapy","tag-dr-fred-friedberg","tag-mrc","tag-prof-malcolm-hooper","tag-prof-simon-wessely"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p5qkYK-2Et","_links":{"self":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/10197","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/comments?post=10197"}],"version-history":[{"count":4,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/10197\/revisions"}],"predecessor-version":[{"id":10276,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/10197\/revisions\/10276"}],"wp:attachment":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/media?parent=10197"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/categories?post=10197"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/tags?post=10197"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}