Opinion The long wait for a breakthrough in chronic fatigue syndrome, Lloyd and van der Meer, BMJ, 2015

You expected better from Lloyd and van der Meer?

 

Agreed, though I thought their made up theories about why CBT and GET work were quite enlightening in terms of how their minds work when confronted with evidence that patients aren't deconditioned, and that after CBT/GET, fitness levels don't improve.

So they dismiss the deconditioning theory much beloved of Wessely, and instead make up a strange explanation about the treatments desensitising an exaggerated nervous system response to signals related to exercise.

They say this exaggerated physiological response leads to symptoms after exercise that then leads to fear of exercise, that then perpetuates symptoms. So CBT breaking that pattern of faulty thinking and/or starting to exercise more somehow reverses the faulty physiological response, but they don't know how. And anyway they admit a lot of pwME don't have fear avoidance but instead to boom and bust. They don't seem to explain how their theories cope with that. So they hastily change the subject to sleep and blame patients for sleeping too much or too little.

Basically it seems that we need individualised treatment to persuade us that whichever activity or sleep pattern we are doing, whether too much or too little of either, we are doing it wrong, and if we do GET or CBT instead we will learn to behave ourselves and believe ourselves better. Or something.

Or as InitialConditions puts it much more succinctly, it's a pile of shite.