I too am aware of studies showing that certain immune markers=2C such as sp=
ecific cytokines=2C are increased as a response to stress. Treatments like =
CBT can also normalise cortisol levels=2C and perhaps the whole HPA axis (=
Roberts et al=2C Psychological Medicine=2C in press). However=2C if one f=
ocuses on CFS and ME=2C we don't have the evidence from trials to support t=
he use of CBT where there is evidence of ongoing infection but no comorbid=
psychopathology=2C as the relevant studies have not been done. As for immu=
ne functioning=2C one study found that certain abnormalities were related t=
o poor outcome following non-pharmacological interventions (Jason et al=2C =
2008). In other words=2C the immunologically healthier individuals showed g=
reater improvement. It may eventually be found that CBT is helpful and cost=
-effective even where there is no anxiety=2C stress and other concurrent ps=
ychological illness=2C but at the time of writing=2C we can only speculate =
about the potential benefits in such cases=2C based on research on other di=
sorders. So we have theory and practice. I was concerned with clinical prac=
tice only but welcome further studies to assess the efficacy of CBT in post=
-infectious CFS and which includes measures of immune status etc.=20
=20
It is my opinion that=2C based on what we currently know about ME and CFS=
=2C a general recommendation re CBT can only be justified where there is co=
-morbid anxiety=2C depression=2C stress and other psychological problems. I=
n the UK=2C the waiting list for CBT for depression is around 14 months in=
certain areas. The NHS has to prioritise. To advocate CBT for CFS and ME=
where there is no actual evidence for the view that it may help the illnes=
s as a whole=2C especially when there are such limited resources=2C is not =
something I am prepared to do. Should evidence emerge that CBT does have a=
clinically significant impact on the illness severity or the progression o=
f the syndrome independent of psychopathology=2C I will review this advice.=
=20
=20
I've always noted the importance of limiting stress because of its negative=
effect on the body as well as mind. My post should not be used to debate C=
artesian dualism. My advice was based on a detailed knowledge of the litera=
ture. (I acknowledge that there is a lot of inadequate information on CBT=
=2C hence my post=2C and I know that a few people who are offered a psycho=
logical treatment will interpret this as a sign that the doctor believes th=
at the illness is largely psychological. But that's a minority and it diver=
ts attention away from the fact that professionals should be encouraged to =
base treatment decisions on best evidence. With hospitals in the UK having =
huge debts=2C it may be argued that we cannot afford to experiment with CBT=
on the NHS.)
=20
CFS is complex and I believe that most doctors have an open mind regarding=
aetiology. They may suggest CBT as a treatment solely because it is being =
promoted (hyped) in the BMJ and other British journals. I submit that the u=
nfortunate attitudes re CBT expressed here and elsewhere have more to do w=
ith the exaggeration of outcomes and the lack of interest in the methodolog=
ical flaws in published trials. There are issues concerning the versions=2C=
especially one which implies that CBT is effective as a treatment for the =
illness as a whole. I am also reluctant to recommend CBT for every patient =
because of the lack of published protocols=2C and the knowledge that the di=
fferent trials often used a different manual. However=2C I agree that CBT m=
ay be helpful for some patients=2C as well as enjoyable. (The latter depend=
s on the quality of the therapeutic alliance). If offered=2C I certainly wo=
uldn't advise anyone to turn it down. The therapist may be very knowledgeab=
le and discussing the difficulties associated with an illness like CFS may =
well make one feel better. That's not a contradiction. I'm differentiatin=
g between general advice and policy on the one hand and circumstances affe=
cting an individual on the other.=20
=20
In light of the widespread misunderstanding regarding CBT=2C reliable infor=
mation as to rationale and efficacy is important. With this in mind=2C it i=
s helpful to distinguish between what we know about CFS and what might work=
in light of research on other disorders. Finally=2C there are several stud=
ies supporting the use of multidisciplinary=2C multi-component intervention=
s for CFS=2C which is a further reason to question the claims made with reg=
ard to CBT=2C especially its alleged 'superiority'.=20
=20
=20
Jason LA=2C Torres-Harding S=2C Brown M=2C Sorenson M=2C Donalek J=2C Corra=
di K=2C et al. Predictors of change following participation in non-pharmaco=
logic interventions for CFS. Trop Med Health. 2008=3B 36(1):23-32.
----------------------------------------------------------------------=20
Dr. Ellen M. Goudsmit C.Psychol. FBPsS (Trained in clinical as well as hea=
lth psychology).=20
This account was one of many hotmail addresses stolen in August 2009. Hotma=
il are not helping those affected. You may receive emails from 'me'. Only =
the ones noting the FBPsS are genuine.
=20
Available via Skype: ellen.goudsmit
=20
For information on ME and CFS=2C see:=20
http://freespace.virgin.net/david.axford/melist.htm=20
*** This e-mail and any attachments are confidential and solely for the inf=
ormation of the addressee. Any copying or disclosure to a third party is un=
authorised and the sender is not responsible for any matter resulting from =
changes to the text made by a third party.=20
=20
=
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