Illness “reversal” and behavioral intervention

The most fundamental concern we have is focused on the type of causal model that was linked to the CBT and GET conditions in this study.  The model, based on the application of cognitive-behavioral and physical conditioning principles, predicts that properly designed behavioral or exercise interventions will “reverse” the CFS illness.  Not improve symptoms/functioning or provide better management, but “reverse” the illness.  This term implies that the illness can be cured (or something close to it) with behavioral techniques.

If one assumes such a direct correspondence between behavioral treatment and curative outcomes, then the illness is by implication a psychiatric condition.  Once this assumption is made, then research efforts to assemble a biomedical model of CFS are more likely to be delegitimized.  And the public’s perception of the illness as simply being tired is again reinforced. Perhaps this is the most unfortunate aspect of the PACE trial:  The omission of any reference to the medical complexity of this illness.

Furthermore, when one compares the study goal of illness “reversal” to the reported outcomes, the support for such reversal is modest at best: 30% of GET and CBT patients achieved normative physical functioning—but the 30% figure was in comparison to 15% who achieved such normative function in the standard medical care control condition.

Thus a more accurate statement of this finding would be: An additional15% of patients in the CBT and GET conditions achieved normal functioning in comparison to standard medical care. The critical standard of clinical significance is that a therapy results in restoration of normal function.  But their own data do not support reversal outcomes above and beyond standard medical care for the vast majority of their subjects in the CBT and GET conditions.