From "The Big Issue in the North’, 14-20 April 2008 (writer: Martin Guttridge-Hewitt)
(NB: "Royal Medical School" should read "Royal Society of Medicine")
The use of cognitive behavioural in the treatment of chronic fatigue syndrome has come under renewed fire ahead of a Royal Medical School conference at the end of this month.
Cognitive Behavioural Therapy (CBT), currently promoted as a treatment for a range of mental conditions, it is also recommended by the National Institute for Clinical Excellence (NICE) for chronic fatigue syndrome, also known as ME which
is thought to affect some 250,000 UK residents.
CBT teaches patients to recognise their thoughts and behaviour and to take steps to change them. Unlike other talking therapies, it focuses on the here and now rather than seeking to find the root cause of the problems. But some health professionals including members of the British Psychological Society believe that advocating CBRT for chronic fatigue syndrome implies that it has a psychological origin, whereas the World Health Organisation (WHO) classifies the condition as a neurological disease, a category which includes multiple sclerosis and epilepsy.
British Psychological Society members also brand CBT as impractical, uneconomical and inflexible . And the absence of critics of CBT in the Royal Medical Schools conference is further evidence of bias, they say. “NICE’s guidelines do not accept any alternative”, said Dr Ellen Goudsmit of the BPS.
“They’re not just promoting the treatment, they are actively hyping it up and ignoring evidence that shows alternatives may be more suitable”. They are alsothe most expensive treatments available.”
A UK adaptation of WHO guidelines reclassified the condition as a mental disorder. But in 2006, a coroner attributed the death of Sophie Mirza, 32, of Brighton, to acute renal failure resulting from chronic fatigue syndrome – a verdict campaigners believe shows the condition is a physical one.
Dr Charles Shepherd, medical advisor to the ME Association (MEA), said. “The MEA does not accept the conclusion that ME and chronic fatigue syndrome is largely or wholly maintained by unhelpful beliefs and behaviours. Consequently, we would
not endorse any form of behaviour or treatment that is purely based on the idea.” A Chief Medical Officer report gives weight to this view. It found that only 7 percent of patients treated with CBT had noticed an improvement in their condition.
Commenting on the absence of BPS members from the RMS conference, Goudsmit said: “It is strange for independent psychologists to see all evidence that challenges CBT and the preferred treatment of ME and chronic fatigue being ignored by thedominant bodies in medicine”. Some health professional say the best way to treat chronic fatigue patients is with tailor-made programmes combining different medical components.