I can tell from the title having 'brief' as the first word that there is your issue with the method/switch-and-bait
PEM is basically saying: if you exert then you get worse
afterwards and if you don't take that time (which it imposes due to horrible loss of function and symptoms, and yet many of us like having the worst flu and forcing yourself into work before you are 'ready' soldier through) to recover and are forced to do this continually.... well it is down the line with
huge debilitation from a long-term deterioration (they insist on calling it 'relapse' to misdirect of course because you are getting worse than you have been, and this makes it sound like being ill was temporary and you recover then get wors again, and it also sounds like mental health with their labels).
In the interim we are all so conscientous and keen that the lie it isn't a serious illness and we won't be harmed by this makes us all harm ourselves whilst thinking we are doing good, along of course with the putting words in people's mouths by coercion brainwashing techniques forcing 'more positive answers' out of people. It seems from below to also then perceive things getting worse and symptoms not as symptoms but as 'moderate stress that may promote thriving' and that perceiving these as symptoms would be 'maladaptive'. Before they then fill out all the questionnaires ie training in answering the questions differently despite having the same or worse symptoms or debility by brainwashing them to think that's merely them being 'maladaptive' and 'stressing themselves in order to promote thriving'?
Altering these expectancies is thus the purpose of the intervention.
Hence, the first stage provided cognitive reassurance that bodily symptoms do not necessarily indicate a disease but rather a disorder that is temporary and amendable.
prompting patients to infer that recovery would require an active pursuit of physical and mental tasks, thereby fostering positive stimuli expectancies. The therapists also questioned patients’ perceived benefit of symptom surveillance and explained why conscious awareness of the relationship between activities and symptoms may perpetuate the latter.
The latter always included an explanation of normal responses to stressful situations, emphasizing that moderate stress may promote thriving, and how certain infections (eg, COVID-19) could trigger maladaptive responses and diverse, unpredictable, and bothersome symptoms (eg, fatigue, dyspnea, and brain fog).
OH yeah, and using the drop-out rate by making a treatment the illest can't complete and then excluding those results so hey presto the group who does finish is then a group with the iller ones with PEM filtered out.
A total of 473 patients with mild to moderate PCC were assessed for eligibility (n = 364 physician referred; n = 109 self-referred); 314 were included (225 females [72%]; mean [SD] age, 43 [12] years) and 231 completed the primary end point evaluation.
A really horrible con.
And these people are well aware. They know full well and were told by the Nice analysis that they needed to be looking at 12, 24, 26 months down the line as the primary outcome. And any normal trial would be required to do this to check harm. You know like if a drug made someone think they felt better a month in but wrecked another body-part long term. But it seems their reaction to that has been a focus on ensuring they 1. rewrite what PEM is, and 2. ensure that studies are even more filled with all the obvious problematic flaws other studies in other areas wouldn't be allowed to have due to the huge bias of unblinded subjective studies along with ensuring measures are short-term and no long term follow-up or independent monitoring of harm/getting worse (again you'd need good controls for that too).
It's the most cruel thing when anyone who isn't callous puts a bit of time into thinking about it because they can put themselves in the ill people's shoes when they did everything they were told and then were left destroyed and on a scrapheap as if 'it should work so the fact you were broken by it means you are to blame' so not even any acknowedgement or accountability but then being disappeared with cruelty encouraging people to not show their face for being iller.