Rethinking the treatment of CFS — a reanalysis and evaluation of findings from a recent major trial of GET and CBT (2018) Wilshire et al.

Arnie Pye said:
Whenever I read any kind of comment like this it always make me think of the Auchwitz entrance with its motto "Arbeit Macht Frei" (Work Sets You Free).
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Me too :) There is also something called Arbeitstherapie ("work therapy", i.e. increasing physical and mental well-being by working) - this is an official "therapy" in Germany. Of course, you don't get paid for the "work". Strictly, Arbeitstherapie goes back to the Euthanasia program by the Nazis. It's therefore a bit shocking that it still exists...but to be "fair", then, sick people who could still work weren't murdered (but had to work), today it's only a "therapy".
 
The review is here:
https://www.jwatch.org/na46472/2018/04/06/chronic-fatigue-treatment-redux-questioning-efficacy-cbt
The comment is very odd:
COMMENT
Both analyses actually yielded similar results; the only difference seems to be the “spin,” with the current authors suggesting caution and accusing the study investigators of overenthusiasm. Most experts seem to be cautious about CBT and graded exercise. However, these noncurative interventions are worth trying to lessen distress and dysfunction because options for these patients are so limited.

Making scientific data publicly available is likely to advance science. Although this analysis does not yield results substantially different than the original, it reminds us to look beyond the headlines and examine the details of any study.
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Either they didn't read the Wishire paper properly, or one of the PACE PI's wrote that comment.
 
The other thing about BMC Neurology is that the journal added an editorial note to the published protocol noting that investigators are supposed to stick to their protocols and that readers should contact the investigators if there is any deviation from the protocol. I cited this attached editorial note in my series.
 
I think it also should be appreciated that work does of course have its place in helping people recover from conditions where serious psychological factors are an issue, and there are no (remaining) physiological encumbrances. Occupational therapy is a form of this for people with depression etc, and is perfectly valid.

What these bl**dy people cannot get their heads around (maybe because they are stuck too far up somewhere) is that work is no sodding use at all as a therapy for an energy-depleting illness where physical and cognitive effort makes you more ill! I mean, how complicated is that?!
 
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Kalliope said:
Front news at the Norwegian site Forskningno (Research.no) who provides news on research and science for a general audience.

The article is mainly based on a radio segment from Sweden about the PACE-trial, the re-analysis and an interview with dr. Per Julin from the ME-ward at Stora Sköndal.

Terapi og trening hjelper ikke mot ME
google translation: Therapy and exercise does not help against ME
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Oooh, that's going to really upset a certain Norwegian pro-BPS advocate! Get ready for the latest twitter rant!
 
Barry said:
I think it also should be appreciated that work does of course have its place in helping people recover from conditions where serious psychological factors are an issue, and there are no (remaining) physiological encumbrances. Occupational therapy is a form of this for people with depression etc, and is perfectly valid.

What these bl**dy people cannot get their heads around (maybe because they are stuck too far up somewhere) is that work is no sodding use at all as a therapy for an energy-depleting illness where physical and cognitive effort makes you more ill! I mean, how complicated is that?!
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I'd add the caveat that 'work' is not the same as meaningful activity. Even in their studies that praise work there are warnings about the type of work involved. This is often ignored when put into policy. Sometimes it is the work environment that has made or majorly contributed to the illness in the first place. Now if we have the combination of meaningful activity along with income, that is a good combination.

I get annoyed by policy makers ignoring the distinction. I used to be involved with a group at an allotment that turned about 20 plots into a wildlife garden, with all the work being done by people with mental illness. It provided meaningful and enjoyable activity for patients, helped give a reason for leaving the home, social interaction, stress reduction for the mental health workers, reduced stigma, and received support from allotment tenants.

It used to be run all day on a Tuesday and on Friday mornings. Liked by all the professionals, including the head of the Mental Health Trust.

It got closed down by cuts due to austerity. Yet these idiots get vastly more sums of money for making sick people sicker.

Argh! :banghead:
 
Yes, and I don't think you can make a blanket statement that all work is good for your psychological wellbeing, its an empirical question whose answer will depend on the type of work and the person. Its pretty easy to think of types of work that might have a net negative impact on a person, such as working in a slaughterhouse, a poultry factory, a mine, or a sweatshop in Asia.
 
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