One of the ME Association’s recent research initiatives was to critically examine the theoretical basis and clinical application of the use of Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) in ME/CFS.
We felt that a closer examination of these therapies was vital, particularly now that evidence is needed to better inform decisions relating to the revision of the NICE clinical guideline on the treatment of ME/CFS. And who better to do this work than Dr Keith Geraghty?
Passion for good research
Dr Geraghty is an Honorary Research Fellow at the Centre for Primary Care within the Division of Population Health, Health Services Research & Primary Care at University of Manchester, where much of his work focuses on ME/CFS.
He is a nationally recognised expert on the disease having published several scientific papers on the efficacy of treatments for ME/CFS; the doctor-patient relationship; and harms associated with the biopsychosocial model.
He is also associate editor for several medical journals and an expert peer reviewer for leading health care organisations, including the National Institute for Health Research (NIHR) and Cochrane.
But what makes Dr Geraghty a force to be reckoned with is his passion for good research. He came into this field after personal experience with ME/CFS: he was a typical, healthy, active adult when he was struck down with an infection that left him unwell for years.
At the time, he was a medical student undertaking graduate-entry medicine at the University of Leicester. Prior to starting his medical degree course, he had worked as a research scientist at Imperial College London; had undertaken three degrees to PhD level at Cardiff University and moved into research after his doctorate. However, he left his prestigious post at one of the UK’s top Universities in order to become clinically qualified – his goal was to combine clinical practice with research.
Outside of doing multiple degrees, Dr Geraghty rowed for Cardiff University, undertook army officer training and enjoyed travel and a full social life. Everything in his life was going to plan – up to the point where he suffered a mystery infection that changed everything.
“My early symptoms were a sore throat that just never went away, even after rounds of antibiotics. I just never felt right, like I wasn’t myself anymore. I struggled on for a few years, feeling weak all the time.” He told me.
“I used to come home from the hospital, flop on my bed, fully dressed, with my stethoscope around my neck and I’d just wake up the next morning in the same position. I recall my neck and thyroid gland swelling up and I remember asking a consultant trainer at the Leicester Royal Infirmary (where I was doing rounds), to take a look at me.”
“He sent me down stairs to have an urgent CT and ultrasound scan of my neck. The results came back that I did indeed have a swollen thyroid gland. An infectious disease consultant reviewed by case and diagnosed ‘post-viral fatigue syndrome’.”
Dr Geraghty struggled on but eventually decided to take time away from medicine. He hoped he would return, but never did.
“I found myself at home resting. I had a belief that this was just some type of glandular fever and that I was one of the unlucky ones who got a bad dose and that with enough rest – I’d make a full recovery.”
Unfortunately, he did not return to his former good health, instead he spent years unwell, mostly confined to home. It was at this time he began to fall back on his research skills to investigate his own condition. It took him almost five years to get a diagnosis of ME/CFS.
“Ironically, I had never heard of ME/CFS. They don’t teach medical students about ME/CFS, so it took me a year or two just to read papers on the illness.”
An open mind
Dr Geraghty spent a few years familiarising himself with the literature – he even contacted leading scientists in the UK and abroad to pick their brains about the likely causes of ME/CFS and possible treatments.
He kept an open mind – his main intention was just to understand the history, the literature and latest developments in the field. He was particularly perplexed to find that the only treatment offered by the NHS was cognitive behavioural therapy – psychotherapy for a post-viral infectious illness.
Some years ago, he moved from reviewing the science to contributing his own research. His health had begun to slowly improve, although he says he has never fully recovered, but his cognitive abilities remained intact and he now feels he has the energy and continuing commitment to add to the understanding of ME/CFS aetiology (the causes of the illness), and pathogenesis (how the illness develops).
Dr Geraghty took his Masters in Public Health at the University of Manchester and his work on ME/CFS attracted the attention of Prof. Aneez Esmail, a professor of General Practice and a working GP. Prof. Esmail offered him an honorary position to formalise his standing as a research fellow within the Centre for Primary Care.
Poor evidence for the biopsychosocial model
He quickly found that the illness ‘M.E.’ is hugely neglected compared with other similar conditions and GPs often have little training in how to diagnose or manage patients.
He also discovered that the current treatment model, a biopsychosocial model, appeared problematic and had the potential to cause significant distress or harm.
He analysed data from UK patient surveys (focusing on the 2015 ME Association survey evidence for CBT, GET and Pacing), and he compared them with international survey evidence.
His work showed a consistent pattern:
- Most patients with ME/CFS did not report benefits from using CBT or GET;
- A large percentage reported deterioration following GET;
- The vast majority preferred the Pacing approach;
- Pacing had the most positive impact on symptoms.
Following this, Dr. Geraghty looked at data from the controversial PACE trial and concluded that it lacked scientific rigour and robustness. In 2016, he wrote a thought-provoking editorial in the Journal of Health Psychology entitled “PACE-GATE” to outline major flaws in the PACE trial methods and the interpretation of its’ findings.
This publication sparked a response from the PACE authors and subsequently led in 2017 to a special edition in the same journal by the editor. It revealed that even more experts had concerns about the PACE trial and use of CBT and exercise therapy treatments for ME/CFS.
- Dr Charles Shepherd from the ME Association saw his own concerns published in the Journal, and called for an independent review of the PACE trial.
In 2017, the ME Association awarded Dr. Geraghty a grant to continue his work reviewing the theoretical basis of CBT and GET treatments and the impact on patients with ME/CFS. He has already published important papers from this work (below) and has several more with significant findings ready to be submitted.
- ME/CFS patients’ reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys (2017)
- ME/CFS and the biopsychosocial model: a review of patient harm and distress in the medical encounter (2017)
Dr Geraghty’s work has put him on the map. He began collaborating with the UK ME/CFS Biobank team in 2018 and co-authored papers on the ethical dimensions of ME/CFS treatment with Dr. Blease at Harvard University.
He is also increasingly being asked by journalists to give his expert opinion on developments in ME/CFS and is very active on Twitter;
“I like interacting with patients and other interested parties. You can learn a lot from them on social media and it’s always nice to keep people up-to-date with what you are doing. But it’s not always possible to respond to everyone.”
Dr Geraghty aims to establish himself as a leading ME/CFS researcher and hopes to encourage other scientists to come into this exciting field. He is passionate about educating doctors and works tirelessly behind the scenes to encourage them to have a better understanding of the disease and its’ impact on patients, their families and on wider society.
The ME Association Christmas Appeal
The Christmas Appeal provides a good opportunity for you to help us raise even more funds to invest with researchers like Dr Geraghty in 2019. Our best hope to find answers to this disease lies with good quality research.
We want to understand how best to manage ME/CFS. We want to discover diagnostic tests, effective treatments and ultimately a cure. We need to know what is driving the disease and we believe that biomedical research will find the necessary answers.
If you would like to support our Christmas Appeal, then please:
- Visit our JustGiving page to start fundraising or to make an online donation,
- Send a cheque payable to The ME Association (with a note saying that it is for the Christmas Appeal) to ME Association, 7 Apollo Office Court, Radclive Road, Gawcott, Buckinghamshire, MK18 4DF.
- Make a donation by card over the phone to head office (01280 818964).
For more information, visit the Christmas Appeal page of our website. Thank you.