Cognitive behavioral therapy

Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that is used as a management technique for a wide range of life-altering events, including serious and/or chronic illness such as cancer and multiple sclerosis. In these contexts, it helps patients to adapt to their health condition.

CBT is often proposed as a primary treatment for ME/CFS, this choice of treatment is justified using the unproven biopsychosocial hypothesis of ME/CFS, this hypothesis assumes that dysfunctional illness beliefs exist in patients with ME/CFS, and changing these beliefs will lead to recovery. However, in this context, its goal is frequently to dissuade patients of illness beliefs that are also held by a number of scientists who remain in good health, one such belief typically challenged during CBT is the belief that ME/CFS is a physical or neurological illness, a "belief" shared by the World Health Organization.

CBT is one of the therapies used in the controversial PACE trial.

United Kingdom
This video shows excerpts from a British training video. CBT is offered (free of charge) to patients by the British National Health Service (NHS).

Evidence
In a complex review of existing research Nijs et al. in 2008, all of who were proponents of the biopsychosocial model, only the PACE trial, and the Cochrane review that heavily relied upon it were cited as evidence of the effectiveness of CBT as a treatment for ME/CF. Nijs et al. found that neither CBT nor pain physiology education nor "pacing activity self-management education" reduced the patients' supposed "fear of movement", and that "severe exacerbation of symptoms following physical activity" was characteristic of chronic fatigue syndrome.

Systematic reviews conducted in 2019 and 2020 found that most trials of cognitive behavioral therapy were relatively low quality with prominent bias, and of 11 randomized controlled trials of CBT, only 5 showed measurable improvement.

Long term effects
Westen et al (2004) found that psychological therapies in general were ineffective in the long term, although they did not assess ME/CFS separately patients.

Reports of harm
Surveys from patient organizations have found considerable rates of harm from CBT among the patients surveyed. The largest UK patient charities, ME Association and Action for ME, have both called for the use of CBT to challenge "illness beliefs" to be withdrawn and for NHS staff to warn patients of the potential for harm. The largest independent patient survey of patient experiences of CBT and GET in the UK was commissioned by NICE, and found that ME/CFS patients undergoing CBT for their illness were almost twice as likely to have their mental health deteriorate than improve as a result of the course. One in 5 developed new symptoms, physical health was also more likely at show no improvement or be negatively affected than to improve.

Robin Brown, a British doctor with ME/CFS has created petition that many thousands have signed calling for GET and related CBT to be removed from the UK treatment guidelines immediately.

Articles explaining CBT not appropriate for ME/CFS

 * 2009, A review on cognitive behavioral therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS
 * 2011, Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
 * 2015, The Chokehold Behavioral Treatments Have on Chronic Fatigue Syndrome


 * 2015, No decisions about ME without me


 * 2015, ME Research UK Slams Lancet Psychiatry Report Advocating Exercise For Chronic Fatigue Syndrome Sufferers
 * 2017, Bias, misleading information and lack of respect for alternative views have distorted perceptions of myalgic encephalomyelitis/chronic fatigue syndrome and its treatment (Full Text)
 * 2017, Cognitive behavioral therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent
 * 2019, Evaluation of a survey exploring the experiences of adults and children with ME/CFS who have participated in CBT and GET interventional programmes. FINAL REPORT (Full text)
 * 2019, Why Graded Exercise Therapy and Cognitive Behaviour Therapy are Controversial in Chronic Fatigue Syndrome
 * 2019, The 'Cognitive Behavioural Model' of Chronic Fatigue Syndrome: Critique of a Flawed Model - (Full text)

CDC withdrawal of CBT treatment
July 3, 2017, The Centers for Disease Control and Prevention's (CDC) website Chronic Fatigue Syndrome page has been changed to "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)" and GET and CBT recommendations have been removed.

Notable studies

 * 2009, A review on cognitive behavioral therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS
 * 2011, Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
 * 2011, Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up (Full Text)
 * 2016, Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent (Full Text)
 * 2016, Group Cognitive Behaviour Therapy for Chronic Fatigue Syndrome


 * 2017, Myalgic encephalomyelitis/chronic fatigue syndrome patients’ reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys (Full text)


 * 2017, Cognitive Behavioural Therapy and Objective Assessments in Chronic Fatigue Syndrome
 * 2018, Rethinking the treatment of Chronic Fatigue Syndrome


 * 2017, Contesting the psychiatric framing of ME/CFS (Full text)


 * 2018, Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review
 * 2018, Cognitive–behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe
 * 2019, Assessment of the scientific rigour of randomized controlled trials on the effectiveness of cognitive behavioural therapy and graded exercise therapy for patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review
 * 2020, Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)

Learn more

 * 2001, Cognitive behaviour therapy and chronic fatigue syndrome
 * 2011, Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
 * 2013, Wiley - Chronic Fatigue Syndrome Part Two. Specific Disorders
 * 2015, Statistical Spin, Linguistic Obfuscation: The Art of Overselling the CBT Evidence Base
 * 2016, Editorial: Cognitive-behavior therapy: why is it so vilified in the chronic fatigue syndrome community?
 * 2018, New study questions use of talking therapy as a treatment for schizophrenia
 * 2017, Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent
 * 2018, CBT: The Cognitive Behavioural Tsunami: Managerialism, Politics and the Corruptions of Science (Research Abstract)