CBT for CFS Should Target “Problematic Worry,” Says New Study from Professor Chalder

By David Tuller, DrPH

Apparently, after 30+ years of promoting cognitive behavior therapy for chronic fatigue syndrome (so-called), Professor Trudie Chalder has discovered something new: Patients worry a lot! And those with worse symptoms tend to have higher worry levels! She believes CBT for CFS can be tweaked to make a difference. She presents this information in a new study, published in the journal Behavior Therapy–yet another in which she and her colleagues disavow the possibility of inferring causality but use causal language anyway.

The article, posted a few days ago, is called “Generalised worry in patients with Chronic Fatigue Syndrome following Cognitive Behavioural Therapy–a prospective cohort study in secondary care.” Sten Helmfrid made me laugh with this tweet about it: “Professor Chalder concludes that patients with #ME/CFS worry a lot and suggests that CBT should focus on the issue. One of the reasons that patients worry is the large number of substandard CBT papers that are pumped out. I don’t think CBT is the solution!”

The study involved a cohort of 470 people with CFS [I am using this name in this post because the study uses it] attending a specialty care clinic between 2007 and 2014 and receiving CBT. Participants completed self-report measures, including a measure of “generalised worry,” at baseline, discharge from treatment, and follow-up at three months and six months. More than 70% met the study’s criteria for “generalised worry” at baseline.

After CBT, the average worry score marginally improved, although there was a huge participant drop-off at six-month follow-up–less than half returned questionnaires. Not surprisingly, higher worry scores were associated with worse scores for fatigue, anxiety, and work and social adjustment. The authors recommend that CBT for CFS should specifically target “generalised worry” alongside whatever else it is supposed to be doing.

The article is based on the questionable notion that it is possible to tease out excessive or abnormal levels of “generalised worry” from people’s experience of having a chronic disabling disease–especially one that is routinely misinterpreted by people like Professor Chalder as psychologically and behaviorally driven. To measure the core construct, Professor Chalder and her colleagues used an instrument called the Penn State Worry Questionnaire (PSWQ), which asks respondents to consider 16 statements characterizing their level of worrying.

Here are some examples: “Many situations make me worry,” “I am always worrying about something,” and “I worry all the time.”

It stands to reason that having CFS or any major illness or disability would impact people’s responses to many if not all of these questions about how much they worry. To address concerns about the appropriateness of the instrument for this study population, the authors note that “the PSWQ is considered a valid and reliable measure of problematic worry for patients with CFS.”

First, what does that mean? For CFS patients specifically, what would be defined as “problematic worry” as opposed to appropriate or non-problematic worry, and on what grounds? And no citation or reference is provided for the assertion. Who is it that considers the PSWQ to be a “valid and reliable measure” of this construct for this patient group, and based on what data?

A search of PubMed for the PSWQ plus “chronic fatigue syndrome” or “myalgic encephalomyelitis” yields no results. Yet an ingenious sleuth in this field alerted me to one such study“Hyperventilation in patients with chronic fatigue syndrome: The role of coping strategies.” Was this 2007 paper in Behaviour Research and Therapy what Professor Chalder and her colleagues had in mind?

Given that the authors of this 15-year-old article included the PSWQ among their multiple outcomes, I suppose one could argue they considered it to be “a valid and reliable measure” in this context. But they did not discuss why they considered the PSWQ to be appropriate for this particular population, they did not mention the construct of “problematic worry,” and they only briefly mentioned the results for this scale. It would therefore not be accurate to suggest that they validated the scale for use with a CFS sample.

Beyond that issue, the new study has no comparison arm and is not designed to allow for causal inferences. In the limitations section, the authors acknowledge this: “There was no control group and we did not randomize our sample, therefore it is not possible to draw conclusions about the effectiveness of CBT for CFS, or generalised worry.

Yet the paper includes language implying causation. The discussion includes this: “This prospective cohort study aimed to explore the prevalence of generalised worry in people with CFS and examined whether worry changed as a result of CBT specifically tailored to target fatigue and social functioning.”

If the study design does not allow for conclusions to be drawn about the effectiveness of CBT for CFS or “generalised worry,” as the paper argues, then how could the research assess whether “worry changed as a result of CBT”? It cannot. It is measuring associations only, not whether one thing changed “as a result of” another.

In a 2020 paper also on clinical outcomes of CBT, Professor Chalder, Professor Sir Simon Wessely, and colleagues engaged in similar linguistic slippage—noting the inability to make causal assumptions while simultaneously making causal assumptions. That published was published by the Journal of the Royal Society of Medicine, whose editor has since been named to head BMJ. Psychology professor Brian Hughes and I published a rebuttal to that paper in the Journal of Health Psychology after the JRSM rejected it.

As in that paper, the authors are contradicting themselves on the question of causality. Either they didn’t notice, or they didn’t care. Apparently this little detail also slipped by the journal’s peer reviewers and editors. These lapses are troubling–but par for the course with this cabal.





8 responses to “CBT for CFS Should Target “Problematic Worry,” Says New Study from Professor Chalder”

  1. Lou Avatar

    We do worry that no amount of debunking her theories and her very low quality research will stop Professor Chalders parasitical behavior. It’s Deeply Worrying to be the target of the woman’s obsessions. She apparently cannot envision life without us. Would she benefit from some form of extensive therapy? Freudian? Jungian? Preferably for years.

  2. CT Avatar

    Do the authors state in the paper how ‘worry’ and ‘anxiety’ differ? Are they perhaps using the word ‘worry’ here because they’re using a questionnaire with ‘worry’ in its title or because it sounds a little less serious/ more trivial than ‘anxiety’? Will they be suggesting worry beads as a treatment next, I wonder?

  3. Lady Shambles Avatar
    Lady Shambles

    One of the joyous aspects of having ME-related cognitive problems that veer toward what one might call a sort of intermittent dyslexia is discovering ‘meanings’ which, whilst not intended, seem to make more sense. Thus I read “.. (so-called), Professor Trudie Chalder…” as “(so-called) Professor, Trudie Chalder…”. Where I misread the placement of that comma made all the difference! 😉

    Interesting use of the ‘CFS’ initialism rather than their usual muddle of the conjoined ‘CFS/ME’ (whatever that is supposed to be! ). Given NICE has chosen to use the ‘ME/CFS’ appellation (with which I don’t personally agree, ‘ME’ will suffice as nicely as any unwanted disease or its associated nomenclature might do) might we argue that the use of ‘CFS’ alone is intended to distract the uninitiated from the ignominy of NICE’s mic drop wrt the BPS ‘evidence base’ being of ‘low’ or ‘very low’ quality? If so then they, Chalder amongst them, are making the error of thinking that everyone else is quite as stupid as they themselves appear to be. The one good thing about this paper is that it’s so ludicrously crap that it will achieve its aim because we’ll forget all about our supposed ‘worries’, bent double in laughter at Chalder’s utter delusional gibberish. Come on love, you’re making a complete fool of yourself. Give it up!

    Apologies. I have arrived at the point where I have neither energy nor will to make detailed or methodical observations about the continued overspill from the cesspit of BPS very low quality drivel. I’m so glad others like David and Brian et al have the stamina to do this because it *is* essential work. Thank you! All I can manage is sarcasm. Yes I’m aware it’s the lowest form of wit, but I feel it nicely matches these examples of the lowest form of … whatever tf it is. Certainly not ‘science’!

  4. LB Avatar

    As we now know, CBT is not recommended for treat of the condition M.E anymore.

    I see this as a desperate attempt to keep her claws in the M.E field. It keeps her in a job and getting funding for more crappy research studies.

    Her research never mentions which came first illness then worry or worry then illness. Normally, Chalder and her ilk are quick to point out negative illness beliefs driving the illness.

    I refer back to my 2nd paragraph, these people are desperate to stay in m.e research and this feels like a softening of hypothesis to fit within the supportive treatment role and keep her job.

  5. Shelley Waller Avatar
    Shelley Waller

    The reality is that ppl with ME have so much more to worry about. Most cannot access a medical expert who specialises in their treatment. Most know if they don’t do the research themselves, they’ll never receive a correct diagnosis nor any treatment of related co-morbidities like POTS/MCAS/EDS etc. Most will struggle to get support/understanding from their usual emotional network or their employers. Most will be trivialised and invalidated and feel powerless to navigate the disability support system when most are unable to maintain financial independence. Most will be stuck indoors and bedbound, left alone with their thoughts. Ppl with ME can’t just get up and go for a run to blow out the cobwebs. Most direct their energies into advocacy bc it’s the one thing they can do to help themselves. Or follow the research to maintain a flagging sense of hope for the future – the very things the BPS brigade criticise the most! These experts in the field of psychology seem to have found a rather unhealthy way to maintain their bias in the face of the blinding obvious…similar to the way doctors reacted when confronted with germ theory…the Semmelweiss Reflex.

  6. jimells Avatar

    Like CT, I too wonder what is the definition of “generalized worry”. Does it have a diagnostic code? Does anyone recognize this illness label besides Chalder and gang?

    A sensible person might conclude that such obvious rubbish research can not stand, until they remember that even Freud the Fraud is still revered by the psychobabblers and psychiatry in general. The BPS gang are such good con artists that they make Ponzi and even Bernie Madoff look like pikers.

    What worries me is that the New Dark Ages may last as long as the original Dark Ages.

  7. Lisa Avatar

    We will have to wait for a biomarker. Or some kind of microbiome-altering drugs. Or at least an animal model. Until then, we will have to keep putting up with BS.

  8. J. Avatar

    l didn’t think they could come up with anything more stupid to present as ‘scientific evidence’ for the CBT aimed yet again for CFS !
    So myself as a person who has had M.E for over 45 yrs, who lost a Career, who lost her family and friends, who has been disbelieved by doctors, even ridiculed , who battles with constant pain 24 hrs a day,(and my list goes on and on ) .. forgive me , but perhaps iv had reason to ‘worry’.
    But i’m curious , why they direct this as ‘ new finding ‘ as evidence for treatment CFS patients?. Are they desperate !!
    So to make it clear to them ,from someone who has M.E (or CFS ) as they like to call it, who has tried CBT… it does nothing ! Absolutely nothing !
    l am so angry..when will they stop this nonsense. l have 6 siblings who, two have Cancer, one has heart disease, one has Parkinson and two have Diabetes. Not one on them have had to endure the CBT pushed at them the way CFS/ME patients have, which does absolutely nothing for their CFS/M.E Disease. All my siblings have had so much help in having proper treatment that they can and have, carried on normal lives and not one of them is bedbound. After over 45 years, l never have and still do not have , that ‘ luxury’ !