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Cognitive–behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe

  • Frank Twisk (a1) and Lou Corsius (a2)
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References
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1Janse, A, Worm-Smeitink, M, Bleijenberg, G, Donders, R, Knoop, H. Efficacy of web-based cognitive-behavioural therapy for chronic fatigue syndrome: randomised controlled trial. Br J Psychiatry 2018; 212: 112–8.
2Twisk, FNM, Corsius, LAMM. 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 encephalomyelitis. Gen Med Open 2017; 1: 113.
3Sunnquist, M, Jason, LA, Nehrke, P, Goudsmit, EM. A comparison of case definitions for myalgic encephalomyelitis and chronic fatigue syndrome. J Chronic Dis Manag 2017; 2: pii:1013.
4Cheshire, A, Ridge, D, Clark, L, White, P. Why patients with chronic fatigue syndrome/myalgic encephalomyelitis improve or deteriorate with graded exercise therapy. J Psychosom Res 2016; 85: 59.
5Twisk, F. Studies and surveys implicate potential iatrogenic harm of cognitive behavioral therapy and graded exercise therapy for myalgic encephalomyelitis and chronic fatigue syndrome patients. Res Chronic Dis 2017; 1: 13–4.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Cognitive–behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe

  • Frank Twisk (a1) and Lou Corsius (a2)
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eLetters

Response to Twisk and Corsius letter: “Cognitive behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe”

Damien Ridge, Professor of Health Studies, University of Westminster, London
Anna Cheshire, Research Fellow, University of Westminster, London
Peter White, Emeritus Professor of Psychological Medicine, Queen Mary University, London
Lucy Clark, Research Fellow, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, London
13 December 2018

We were surprised that the above named letter was published by the journal because of the errors contained within it. (1) Janse and colleagues may themselves respond to the letter, providing as it does a most partial critique of their trial of web-based CBT for chronic fatigue syndrome (CFS). We wish to draw readers’ attention to some of the errors, in which Twisk and Corsius misrepresent one of our own studies. They quote a conference abstract, describing our qualitative study of participant experiences of graded exercise therapy (GET), following involvement in a trial of guided graded exercise self-help, claiming that: “Several large-scale patient surveys and studies, for example Cheshire et al. (4), indicate that CBT, especially when combined with GET, can cause iatrogenic harm and is not safe” (1). Firstly, ours was a small-scale qualitative study. Secondly, it did not involve CBT. Finally, we did not find any evidence of iatrogenic harm or lack of safety. Instead, Twisk and Corsius may have meant to cite the main paper from the GETSET trial. However, this larger study also did not involve CBT, and it additionally revealed no evidence of harm or lack of safety, with no significant differences found in eight safety outcomes between graded exercise self-help and the control intervention of specialist medical care, once missing data were considered (2). A Cochrane systematic review of exercise therapies for chronic fatigue syndrome similarly concluded that: “Patients with CFS may generally benefit and feel less fatigued following exercise therapy, and no evidence suggests that exercise therapy may worsen outcomes” (3).

Our qualitative study, which is currently in press (5), suggests that patients found GET to be challenging. However, GET was reportedly most helpful when patients were well motivated and supported, not suffering from a comorbid condition, and when their illness had a shorter duration (4, 5). When so few successful treatments exist for such a chronic and disabling condition as CFS, it is critical that any criticisms of research suggesting that behavioural interventions may help, are accurate and do not misinterpret the evidence.

1. Twisk F, Corsius L. Cognitive behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe. Br J Psychiatry 2018; 213: 500-1.

2. Clark LV, Pesola F, Thomas JM, Vergara-Williamson M, Beynon M, White PD. Graded exercise therapy guided self-help versus specialist medical care for chronic fatigue syndrome (GETSET): a randomised controlled trial. Lancet 2017; 390: 363-73.

3. Larun, L., Brurberg, K., Odgaard-Jensen, J., & Price, J. Exercise therapy for chronic fatigue syndrome. BJPsych Advances 2017; 23: 144.

4. Cheshire A, Ridge D, Clark L, White P. Why patients with chronic fatigue syndrome/myalgic encephalomyelitis improve or deteriorate with graded exercise therapy. J Psychosom Res 2016; 85: 59.

5. Cheshire A, Ridge D, Clark L, White P. Guided graded Exercise Self-help for chronic fatigue syndrome: patient experiences and perceptions. Disabil Rehabil 2018; doi: 10.1080/09638288.2018.1499822.

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Conflict of interest: PW reports funding from the NIHR Research for Patient Benefit programme during the conduct of this study; is a member of the Independent Medical Experts Group (a non-departmental public body, which advises the UK Ministry of Defence regarding the Armed Forces Compensation Scheme); has provided unpaid advice to the UK Department for Work and Pensions regarding mental health issues; and does paid consultancy for a re-insurance company. The other authors declare no conflict of interest.

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