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Dutch ME/CVS Treatment Contrasts with International Consensus
In the Netherlands, children with ME/CVS are treated with Cognitive Behavioral Therapy (CBT), a method considered risky by many international experts due to the potential for worsening symptoms. This contrasts with the US and UK, where CBT has been removed from medical guidelines, highlighting a significant discrepancy in approach.
- What are the immediate consequences of using CBT to treat ME/CVS in children in the Netherlands, compared to the approaches used in the US and UK?
- In the Netherlands, children with ME/CVS, a chronic debilitating illness, are treated with Cognitive Behavioral Therapy (CBT), a method increasingly questioned internationally. CBT encourages ignoring physical limitations, potentially worsening symptoms and leading to reliance on wheelchairs. This contrasts with the US and UK, where CBT has been removed from medical guidelines due to risks.
- How does the Dutch medical establishment's approach to ME/CVS differ from international consensus, and what are the underlying reasons for this discrepancy?
- The Dutch approach to ME/CVS differs significantly from that of the US and UK. While the Netherlands emphasizes CBT, focusing on psychological factors, countries like the US and UK recognize neurological and immunological causes, highlighting post-exertional malaise (PEM) as a core symptom. Ignoring PEM through CBT, as practiced in the Netherlands, is considered risky in these countries.
- What systemic changes are needed in the Netherlands to address the ongoing issue of ME/CVS treatment, considering the latest scientific findings and the experience with long covid?
- The continued use of CBT for ME/CVS in the Netherlands despite international evidence suggesting its ineffectiveness and potential harm highlights a significant gap in medical understanding and practice. Increased bio-medical research on ME/CVS and long covid, coupled with experience in long covid clinics that avoid CBT, may gradually shift the Dutch approach, but separate guidelines for post-acute infection syndromes are needed for effective change.
Cognitive Concepts
Framing Bias
The article frames the issue by primarily highlighting the negative consequences of CBT for ME/CVS patients in the Netherlands, presenting numerous accounts of patients experiencing worsening symptoms. The headline and opening paragraphs immediately establish a critical tone, setting the stage for a largely negative portrayal of the current Dutch approach. The use of words like "betwijfeld" (doubted), "riskant" (risky), and "schrijnend" (heartbreaking) contributes to a strongly negative framing. This emphasis on negative consequences overshadows any potential positive aspects or subtleties related to CBT application or ongoing debate within the medical community.
Language Bias
The article uses loaded language that leans towards a negative portrayal of CBT. Terms like "betwijfeld" (doubted), "riskant" (risky), and descriptions of patients "fysiek instorten" (physically collapsing) and their condition "verslechterden" (worsened) evoke strong negative emotions. The repeated emphasis on the negative consequences of CBT reinforces this bias. More neutral alternatives could include phrases like "the effectiveness of CBT is debated," "CBT poses potential risks," or "some patients experienced a worsening of symptoms."
Bias by Omission
The article focuses heavily on the criticisms of Cognitive Behavioral Therapy (CBT) for ME/CVS in the Netherlands, but omits discussion of potential benefits or alternative viewpoints that might support the continued use of CBT in certain cases. It also doesn't explore the nuances of CBT implementation, acknowledging that the approach might vary significantly between practitioners. While mentioning the 2018 Gezondheidsraad report, it doesn't delve into the specifics of the report's recommendations beyond its general critical stance on CBT combined with graded exercise therapy. The article also lacks specific details about the success rate of alternative treatments proposed in other countries, thereby not providing a balanced picture of treatment efficacy.
False Dichotomy
The article presents a false dichotomy by portraying a stark contrast between the psychological approach used in the Netherlands and the biomedical approach favoured in the US and UK. The reality is likely more nuanced, with varying degrees of emphasis on psychological and physical factors depending on the individual patient and their response to treatment. The article simplifies the situation by suggesting that only one approach is correct, neglecting the potential value of integrated approaches that combine psychological and biomedical interventions.
Sustainable Development Goals
The article highlights the negative impact of using Cognitive Behavioral Therapy (CBT) to treat ME/CVS in children. CBT, which encourages ignoring fatigue signals, has led to physical deterioration and worsening of symptoms in some children, even resulting in wheelchair dependence. This contradicts the SDG target of ensuring healthy lives and promoting well-being for all at all ages. The current treatment approach in the Netherlands is criticized internationally and is considered by experts in the US and UK to be inappropriate and potentially harmful.