Sean B.M. Kirby
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterest Forms.do?msNum=L15-0446.
Kirby SB. Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Ann Intern Med. 2015;163:885-886. doi: 10.7326/L15-5172
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Published: Ann Intern Med. 2015;163(11):885-886.
TO THE EDITOR:
I read Smith and colleagues' review (1) with interest and would like to make 2 points in response to White and associates' comment. First, counseling, with its more modest, noncurative goal of helping patients adapt to limitations imposed by chronic disease and disability, does not posit a primary causative role for cognitive behavioral factors. However, the cognitive behavioral model for CFS does posit such a role and hence claims curative potential by modifying those factors through CBT (2).
No clinical trials are available that directly compare counseling and CBT for CFS, but 2 trials do so for chronic fatigue, a defining symptom of this condition. In 2001, Ridsdale and coworkers (3) reported “equivalent” therapeutic outcomes for counseling and CBT and suggested that the choice between these approaches depends on nontherapeutic factors, such as cost and accessibility. In 2012, Ridsdale and coworkers (4) found no difference among counseling, GET, and usual care plus a CBT booklet. Smith and colleagues (1) were also unable to distinguish between counseling and CBT for efficacy. These results, the low-moderate effect sizes of CBT and GET for CFS, the predominantly subjective self-report basis of those effects and their general discordance with the more objective outcome measures (particularly for CBT), and the principle of parsimony all question the value of assuming a primary causative role for cognitive behavioral factors in CFS (1, 2).
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