Psychological therapy as a treatment for ME

November 19, 2007

The Daily Telegraph published a letter by Professor Peter Littlejohns, clinical and public health director at the National Insttitute for Health and Clinical Excellence, in which he refutes the claim that NICE considers ME a psychological disorder.

Dr Charles Shepherd, medical adviser to The ME Association, has also submitted a letter to the Daily Telegraph in response to the comments made today about the NICE Guideline and cognitive behaviour therapy by their medical columnist, Dr James Le Fanu.

Both letters appear below:

Professor Littlejohns' letter

Sir – The National Institute for Health and Clinical Excellence (Nice) has never classified chronic fatigue syndrome, or ME, as a psychological disorder (report, November 16).

The use of psychological therapy as part of a collaborative approach in treating ME does not imply that symptoms are made up or "in the patient's head".

Cognitive behavioural therapy is an evidence-based psychological therapy used in many health settings, including cardiac rehabilitation and cancer management. When it is used in treating ME, the aim is to reduce the levels of symptoms, disability and distress associated with the condition.

Our guidelines make it clear that it is one option that people with mild or moderate chronic fatigue syndrome should be offered to manage their condition.

We have not been notified of any application made to the court for judicial review of the guidelines, and leave for a review has not been granted. We will, of course, respond to any application appropriately.

Professor Peter Littlejohns, Clinical and Public Health Director, NICE, London WC1

Dr Shepherd's letter

Sir – NICE (the National Institute for Health and Clinical Excellence) clearly have a difficult job to do but as Dr James le Fanu correctly points out they are making a complete mess of trying to help people with ME/CFS.

The problem lies with the way in which a misguided medical profession decided to rename and redefine ME (myalgic encephalomyelitis) as CFS (chronic fatigue syndrome). In doing so they have created a spectrum of illnesses ranging from those who have a recognised neurological condition to those who have a type of chronic fatigue that is indistinguishable from a psychiatric illness.

For NICE to then conclude that everyone under the umbrella of ME/CFS should be automatically offered cognitive behavioural therapy and/or graded exercise therapy – treatments which patients often report are ineffective, or may even make them feel worse – makes no practical or economic sense at all.

No wonder NICE is once again being challenged in the courts and in parliament.

Dr Charles Shepherd, Hon Medical Adviser, ME Association

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