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.

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charities, ME Association and Action for ME, have both called for the use of CBT to challenge "illness beliefs" to be withdrawn and for NHS staff to warn patients of the potential for harm.

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

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)
 * 2016, Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent (Full)
 * 2016, Group Cognitive Behaviour Therapy for Chronic Fatigue Syndrome
 * 2017, Cognitive Behavioural Therapy and Objective Assessments in Chronic Fatigue Syndrome
 * 2018, Rethinking the treatment of Chronic Fatigue Syndrome
 * 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

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
 * 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