Illness beliefs

The illness beliefs hypothesis posits that specific beliefs relating to ME/CFS are found in patients, and that these beliefs are maintaining factors which prevent recovery, and may even increase the severity of the illness. These illness beliefs have been described as "negative thoughts", "dysfunctional" or "unhelpful" beliefs which, according to this hypothesis, result in "maladaptive" behaviors that prevent people recovering from ME/CFS.

The illness beliefs hypothesis is part of the biopsychosocial model (BPS) and is used to justify the use of cognitive behavioral therapy (CBT) as a primary treatment for ME and CFS, rather than its use as a treatment only for patients with depression, anxiety or emotional problems resulting from Chronic Fatigue Syndrome. For example in the PACE trial CBT was tested to determine whether it helped people could "recover" from ME/CFS, with improvements in depression or anxiety considered to be secondary outcomes. The same illness beliefs hypothesis was used with severely ill patients in the similar FINE trial.

Theory
Patients are expected to identify their own dysfunctional illness beliefs, but those referred to be proponents of this hypothesis include:
 * The belief that ME/CFS symptoms are the result of a physical illness
 * The belief that ME/CFS needs medical treatment (physical treatment only)
 * activity has "harmful effects"

Treatment
Cognitive behavioral therapy (CBT) is proposed to encourage the person to challenge and alter their illness beliefs, and any behaviors that result from these beliefs. The illness beliefs may be referred to as "unhelpful thoughts", which the person should work to identify, and then look at evidence for or against each belief, then re-evaluate these beliefs. CBT involves finding actions (behaviors) that result from the unhelpful thoughts (illness beliefs) and deciding which behaviors to change. The CBT model also states that changing behaviors related to the illness can change the thoughts linked to those behaviors.

The CBT used for ME/CFS is specific to the illness, and has components not found in CBT that has been used with patients who have cancer, Multiple sclerosis (MS) or other chronic illnesses.

Learn more

 * Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent
 * PACE trial Cognitive Behavioral Therapy manual for participants