Research by the proponents of the CBT theory provide further evidence of its inadequacy.

More nails in the coffin

Research by the proponents of the CBT theory provide further evidence of its inadequacy.

Here’s a selection of findings by members of the CBT school which undermines their own theory. Details of the other studies can be found elsewhere.

1. Evidence against the hypothesis that causal attributions and beliefs perpetuate fatigue. Lawrie et al challenge the suggested relationship between attributions and outcome. Deale et al show that irrational views like "I should avoid physical activity" and "exercise is harmful" are neither universal nor strongly associated with disability. If only a proportion of patients have unhelpful, inaccurate views about exercise and they’re not highly correlated with prolonged illness, these cannot be major influences on CFS in general, only contributory factors in a subgroup.
Lawrie, SM., Manders, DN., Geddes, JR and Pelosi, AJ. A population-based incidence study of chronic fatigue. Psychological Medicine, 1997, 27, 343-353.
Deale, A., Chalder, T and Wessely, S. Illness beliefs and treatment outcome in chronic fatigue syndrome. Journal of Psychosomatic Research, 1998, 45, 1, 77-83.

2. Evidence challenging the assumption that patients with CFS tend to be prejudiced against all things psychiatric and therefore likely to reject psychological intervention. Both the trials below had low drop out rates, indicating that many patients accepted psychiatric treatment when offered. In fact, there’s not a single study which shows that people with CFS are more prejudiced than the population in general.

Deale, A., Chalder, T., Marks, I and Wessely, S. Cognitive behaviour therapy for chronic fatigue syndrome: a randomised controlled trial. American Journal of Psychiatry, 1997, 154, 3, 408-414.
Fulcher, KY and White, PD. Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. British Medical Journal 1997, 314, 1647-1652.

3. Evidence that graded exercise isn’t effective for everyone with CFS. The disappointing results in the study below may be related to the selection of patients. Were these more typical CFS sufferers, rather than the individuals with the seriously irrational beliefs included in previous studies (Kings/Oxford)? There are three other studies on CFS which also conflict with the glowing reports about CBT/graded exercise.

Wearden, AJ., Morriss, RK., Mullis, R., Strickland, PL., Pearson, DJ., Appleby, L., Campbell, IT and Morriss, JA. Randomised, double-blind, placebo-controlled treatment trial of fluoxetine and graded exercise for chronic fatigue syndrome. British Journal of Psychiatry, 1998, 172, 485-490.

4. Evidence against the hypothesis that depression is strongly linked with CFS/prolonged fatigue. Cleare et al’s study supports previous research showing that CFS is different from depression. Van der Linden et al found evidence of a prolonged fatigue state which is independent of both depression and anxiety. Indeed, there isn’t a single study which supports the view that post-infectious fatigue is a result or atypical form of psychiatric illness.

Cleare, AJ., Bearn, J., Allain. T., McGregor. A., Wessely, S., Murray, RM and O’Keane, V. Contrasting neuroendocrine responses in depression and chronic fatigue syndrome. Journal of Affective Disorders, 1995, 35, 283-289.
Van der Linden, G., Chalder, T., Hickie, I., Koschera, A., Sham, P and Wessely, S. Fatigue and psychiatric disorder: different or the same? Psychological Medicine, 1999, 29, 4, 863-868.

Epilogue

Some psychiatrists now accept that the CBT model is deeply flawed. As a result, they have come up with a new suggestion, namely, that CFS should be classified as a functional somatic syndrome. For more information on these disorders, see Barsky and Borus (Annals of Internal Medicine, 1999, 130, 910-921), or Wessely et al (Lancet, 1999, 354, 936-939)

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