Subjective Measures Are Insufficient – Lessons from CBT for ME/CFS

The  results of the PACE trial of CBT plus graded exercise for CFS have just been confirmed by a review of 5 Dutch studies

https://www.researchgate.net/publication/322956569_An_analysis_of_Dutch_hallmark_studies_confirms_the_outcome_of_the_PACE_trial_cognitive_behaviour_therapy_with_a_graded_activity_protocol_is_not_effective_for_chronic_fatigue_syndrome_and_Myalgic_Encep , the author’s concluded ‘ Improvements on subjective measures (self-report questionnaires), which are sensitive to placebo effects, response bias, buy-in effects and other psychological effects , isn’t reflected by an improvement in objective measures’. This was illustrated by the finding that 32% of the patients in the non-intervention group reported clinically significant improvement afterwards.

IAPT justifies itself wholly in terms of changes on psychometric tests, alleging a 50% recovery. However there has been no independent examination to determine the proportion totally free of symptoms by the end of treatment. My own work in fact suggests just a 10% recovery,https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0 . In mid July the Journal of Health Psychology is publishing an Open Access Special Issue ‘IAPT Under the Microscope’ in which these issues are explored further, with 4 contributors, including myself and a missive from the Editor, Dr David Marks.

Dr Mike Scott