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All the trials outside the UK suggest that this therapy is useful only for those with a phobic anxiety about activity and/or clinical depression (see also Jason et al). The studies conducted in the UK do not contradict this. For instance, in the Sharpe trial, about seventy per cent of the subjects had a psychiatric diagnosis. A description of the sample (Surawy et al) also indicate that most had poor coping strategies. We have no evidence that the trial included patients who were sensible and were coping well.
Regarding the severity of their complaints, no one in the Sharpe trial had a Karnofsky score below 60. The means were 71-72 and the maximum was 78. A successful outcome was noted when patients reached a score of 80 (regarded as normal) or they improved by 10 points. Measures other than the Karnofsky score did not reveal significant differences between the groups assessed. Those who have asked him personally have been told by Dr. Sharpe that the patients with PVFS/ME did not respond as favourably as the others. (Information about subgroups is generally not included in reports since UK researchers don't believe that the differences between subgroups are of importance. Indeed, few are following the 1994 recommendations (Fukuda et al) to study subsets).
Incidentally, an earlier trial by Stokes et al (BMJ) also reported positive results with graded exercise though I learned from the subjects that all those with ME had relapsed. They wrote a letter to the editor of the BMJ but the information was not passed on to the readership. The ME patients who took part in the first trial conducted by Prof. Wessely also reported relapses but again, this information was not included in the report.
Other UK trials have also selected patients with poor coping strategies, personality disorders and/or psychiatric illnesses. We have no details of any trial using more strictly selected patients who did not have additional problems.
Remember that other controlled trials have shown that alternative approaches used in orthodox medicine (programmes comprising supportive counselling, advice re-balancing rest and activity etc.) work as well as CBT in patients with more strictly defined CFS. This information has been published in peer review journals and a university thesis. Unfortunately, American authorities tend not to invite British ME specialists to speak at conferences. (NB. ME and CFS are not the same, by definition).
Copyright EM. Goudsmit 1998.
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