MAGICAL MEDICINE: HOW TO MAKE AN ILLNESS ... - Invest in ME

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Sessions 5 – 7 are based on “cognitive work” in which the participant’s “thoughts, feelings and behaviour…illness
attributions (and) self esteem” will be discussed. “Participants will be taught how to identify thinking errors” ‐‐ this
assumes that participants do have “thinking errors” ‐‐ and therapists are to tell participants that “A common
problem is a difficulty in identifying unhelpful thoughts”. Consequently, the participant, who may not have
thinking errors, is instructed to re‐interpret in a negative (ie. “unhelpful”) light thoughts that may not be
unhelpful.
In Sessions 8 – 11 therapists are to “discuss potential blocks to recovery”, one of which is a participant “being in
receipt of benefits or income protection (IP)”.
“Evidence from research trials has indicated that patients who are in receipt of benefits or permanent health insurance
do less well than those who are not in receipt of them. In reality, benefits and IP can help patients financially in the
short term but prove an obstacle to getting better in the long term”: that patients who are in receipt of financial
support may be more seriously ill ‐‐ and therefore do less well ‐‐ than those who are not in receipt of it is
not considered.
Income protection is once again addressed, at considerable length, and in a way that seems highly unusual
in a clinical trial. Therapists are directed that: “it is helpful for you to offer to write to employers, insurance
companies, be involved with their occupational health department or whatever is necessary to help the participant to
meet work‐related goals”.
Is it the job of a non‐medical “therapist” in a clinical trial to encourage a participant ‐‐ who may be seriously
ill ‐‐ back to work?
Other blocks to recovery are said to be a fear of social situations, being responsible for running the home,
work, paying bills etc.
Also in these sessions, “the content of their thought diaries should be reviewed”; “suggestions to increase their
awareness of thinking errors should be discussed”; and “The role of unhelpful thoughts in recovery should be
discussed”.
In Sessions 12 – 14 (“Preparing for the future”) participants are to be informed that: “the follow‐up period is when
many clients make the majority of their improvement and that the end of treatment should therefore not be seen as the
end of recovery”.
Clearly, then, it is only after 14 sessions of CBT have finished that most people are said to make the majority
of their improvement.
This does not accord with what Peter White – to whom acknowledgement is made by Mary Burgess and
Trudie Chalder – said in the St Bartholomew’s submission to the NICE Guideline Development Group: “If a
therapy is not helping within a few months, either the therapy or the diagnosis or both should be reviewed and changes
considered”.
Perhaps this is just one more illustration of the many ambiguities and contradictions that pervade the PACE
Trial Manuals.
This CBT Manual for Therapists provides evidence of a central flaw in the MRC PACE Trial: on page 7
Burgess and Chalder state: “No specific cause for CFS/ME has been identified” (ie. the Investigators concede
that they do not know what causes “CFS/ME”), but on page 28 the authors state that CBT does not work
from a pathological assumption (ie. although the cause of “CFS/ME” is unknown, participants are assumed
to have no physical disease).