A peer reviewed health psychology publication has accepted a
shortened, updated version of the pacing paper currently available
online (url below). This will be the first academic article on this
technique to be published.
The paper includes a definition (so that researchers will be able to
study the exact, same strategy) plus clinical guidelines and a review
of the relevant scientific evidence. It also covers Adaptive Pacing
Therapy (APT), which is a combination of pacing (based on the 50%
solution) and GET.
The paper concludes that based on the evidence, pacing should not be
promoted as a therapy (to be used on its own). Indeed, I now
recommend that it should become an additional component of a
multi-dimensional programme which also offers medical care,
information, coping skills training plus advice on diet and stress
reduction. Such programmes are similar to those based on Lazarus's
theory of stress and coping which are commonly used in the management
of patients with medical disorders e.g. cancer, MS and spinal cord injuries.
Space did not permit me to cover the 50% solution, where patients
rest even though they are not particularly tired, or pacing
themselves as part of their efforts to keep within their daily
limits. The literature and clinical experience suggest that
operating well below one's capacity may lead to isolation,
frustration and depression, as well as increasing one's risk
of osteoporosis, deconditioning, and bowel dysfunction. I have seen
no evidence of clinical gains associated with this version of pacing.
The paper was submitted before the results of the recent article by
Jason et al were published. Their study found that a programme
including coping skills training and pacing was as good as CBT/GET.
It is hoped that having formally defined the concept, colleagues will
be able to re-assess pacing in clinical practice and conduct
meaningful research (e.g. compare and contrast pacing with APT or GET
in different subsets). The RCT by Wallman et al was confusing as the
title of the paper referred to graded exercise though the text
confirmed that the programme was based on the principle of pacing,
i.e. activity was determined by the body's response to exertion
rather than a schedule.
I should like to thank the ME Association, and in particular, Drs.
Shepherd and Macintyre, for listening to my ideas on pacing all
those years ago, and for their support for the technique since. I
also wish to thank Prof. Jason and all the patients who responded to
all my articles in newsletters, which 'encouraged' me to amend and
improve the concept.
I hope that people will find the paper interesting and helpful.
----------------------------------------------------------------------
Ellen M. Goudsmit PhD AFBPsS
For information on ME and CFS, see:
http://freespace.virgin.net/david.axford/melist.htm
CONGRATULATIONS, ELLEN!
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