CBT is a short-term form of psychotherapy aimed at changing the way you think, act and communicate in order to change your emotions about things, such as your health. It's commonly used to treat problems such as depression, addiction and eating disorders.
A study designed to see how big an impact CBT has had on people's lives looked into whether it helps people continue working, get and education or job training, take part in sports, keep their social lives and perform household tasks. Here's what people reported:
- Complete recovery - 2%
- Some improvement - 30%
- No change - 30%
- Poor outcome, including deterioration - 38%
Notice that the largest group reported negative effects on their health and life. Of real significance is that CBT actually appears to have had the worst outcome in people who were either working or in school, and did not help people keep their jobs. It did, however, lead some people to take up athletic activity. The study concludes that the effectiveness of CBT in scientific publications has been overstated and is misleading.
Have you had CBT, or do you know anyone who has? Have you been told you should have CBT? Does this study give you hope that doctors will stop pushing psychological treatments for ME/CFS? Leave a comment here or in About.com's Fibromyalgia & ME/CFS Forum.
Please do not infer from my comments that I believe CBT is the answer to CFS. T
The statistical relevance of the study in question seems to be somewhat doubtful given the summary I read. Why? Because people who have a negative experience of something are more likely to pick up an online survey and vent. People who had a successful experience with CBT are less likely to me trolling the internet for CFS information anyway. Thus the study is probably to those who have negative experiences to report.
Its probably true that that negative experiences of CBT are under reported and the positive effects are overstated – see the latest Jason study which only found modest effects – but this ’study’ seems unlikely to tell us much about that. Instead this is a study that calls for another, more rigorously controlled study.
My impression is that the CFS/FM initially appeared to be a physical problem, but over time with little objective evidence to prove a physcial basis the psychological basis came into play more. There is much anxiety, stress intolerance and depression associated with the illness. I tend to side with the idea that many people will feel worse after CBT treatment, because the illness can express itself in so many ways over a 24 hour period. How long does someone providing CBT actually observe the patient? Well, they only do for maybe less than an hour. We want to get well and be the good soldier, and there is always the placebo effect. Certainly behaviour changes are absolutely necessary or to continue to deal with what might becomeor is a chronic ilness. CBT could be very beneficial for those in the early stages? The likelyhood of CFS/FM being recognized early on, is less than 99% today, given what the general medical community understands and beleives. We don’t have a medical system than readily sends a person with the early signs of the illness to a CFS/FM specialist. And as many of you know there are not very many specialists. I tend to beleive that if symptoms are recognized early on behaviour modifications could be beneficial, but there still is allot we don’t know about the genetics or baisi of this condition. Also, if you have been able to function adequately for the fisrt half of your life, there is a certain amount of resistance toward getting treatment via CBT, since you would not have the capacity to see what is coming (too hard to beleive that your health could get into such a state). That is why objective diagnostic tests are so important and for doctors to have the ability to get the tests done as soon as possible. The earlier the better. CBT is frustrating to those who are very ill, cannot drive, cannot sleep, or cannot dress themsleves on a regular basis, etc… and still SSDI looks to this as a solution for there condition. Shame on SSDI.
FM is a not a psychological condition…we do have evidence of that now.
My feelings about CBT are: Everyone can benefit from recognizing behaviors and stressors that set them into a flare. By becoming aware of negative effects in reaction to day-to-day events, it can only do good. When one feels good psychologically; it helps physically. Though it’s not a cure-all, it sure doesn’t hurt.
I participated in a 10 week CBT study at a university in NY. This was 10 years ago. I found that while I attended the sessions, I felt “somewhat” better on a psychological level and I attributed that to the social support of other members in the group. After the sessions ended there was no lasting effect from the cognitive behavior therapy. CBT teaches you how to look at things from a different perspective. It teaches how to challenge your automatic thoughts, specifically your negative thoughts. I do not believe that it is “the answer” to CFS. It might help a little sometimes to help you deal with the mental stress but it has no significant impact on the physical symptoms.
I think there is a chicken or egg component. I personally find that any psychological aspects are after the fact – they happen BECAUSE of the illness instead of being the cause.
To take up Cort’s point about the study in question being an internet questionnaire.
It’s not just internet questionnaires which have found such negative results: in large offline postal questionnaires by UK ME support organisations, results have been at best very modest and at worst lead to exacerbation (especially in severely affected). (Perhaps the thinking behind doing this study using the internet was to maybe reach more housebound patients?)
CBT research for CFS in general is prone to selection biases e.g. people who are less sure of a serious biological basis for their illness are more likely to take up CBT (which can’t be blinded in trials), which may also explain why no severely affected patients are studied, a bizarre situation by any standard. Poor results are less likely to get published and encourage modest results to be “talked up”. The statistics are often faulty, the diagnoostic definition altered, the measures incomplete or subjective, medical explanations ignored and various other methodological flaws.
Another of the problems with CBT is that it’s now become a woolly umbrella term for various approaches. Carruthers et al advise that patient-centered supportive therapy shouldn’t be termed CBT. The UK and Dutch CBT model is invariably the one where the patient has faulty beliefs and “fear avoidance” or “symptom focussing” with the therapist paying lip service to biology in the form of deconditioning, despite muscle wastage being a rare finding in ME/CFS.