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Cognitive behavioral therapy
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== 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.<ref name="Nijs2013">{{Cite journal | last = Nijs | first = Jo | authorlink = Jo Nijs | last2 = Roussel | first2 = Nathalie | author-link2 = Nathalie Roussel | last3 = Van Oosterwijck | first3 = Jessica | author-link3 = Jessica Van Oosterwijck | last4 = De Kooning | first4 = Margot | author-link4 = Margot De Kooning | last5 = Ickmans | first5 = Kelly | author-link5 = Kelly Ickmans | last6 = Struyf | first6 = Filip | last7 = Meeus | first7 = Mira | author-link8 = Mira Meeus | last8 = Lundberg | first8 = Mari | date = 2013-05-03 | title = Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice | url = https://www.researchgate.net/profile/Jessica_Van_Oosterwijck/publication/236614064_Fear_of_movement_and_avoidance_behaviour_toward_physical_activity_in_chronic-fatigue_syndrome_and_fibromyalgia_State_of_the_art_and_implications_for_clinical_practice/links/00b7d51f78a8f28745000000/Fear-of-movement-and-avoidance-behaviour-toward-physical-activity-in-chronic-fatigue-syndrome-and-fibromyalgia-State-of-the-art-and-implications-for-clinical-practice.pdf | journal=Clinical Rheumatology|language=en|volume=32 | issue = 8 | pages = 1121β1129|doi=10.1007/s10067-013-2277-4|issn=0770-3198|quote=|via=}}</ref> 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.<ref name="Nijs2013" /> 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.<ref name=":8">{{Cite journal | last = Ahmed | first = SA | last2 = Mewes | first2 = JC | last3 = Vrijhoef | first3 = HJM | date = 2019-05-10 | title = 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 | url = https://doi.org/10.1177/1359105319847261 | journal = Journal of Health Psychology|language=en-US|volume=25 | issue = 2 | pages = 240β255|doi=10.1177/1359105319847261|issn=1359-1053}}</ref><ref name=":9">{{Cite journal | last = Kim|first = Do-Young | last2 = Lee | first2 = Jin-Seok | last3 = Park | first3 = Samuel-Young | last4 = Kim | first4 = Soo-Jin | last5 = Son | first5 = Chang-Gue | date = 2020-01-06 | title = Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) | url = https://doi.org/10.1186/s12967-019-02196-9 | journal = Journal of Translational Medicine|volume=18 | issue = 1 | pages = 7|doi=10.1186/s12967-019-02196-9|issn=1479-5876|pmc=6943902|pmid=31906979}}</ref> {{Quote box|As a physician bedridden with myalgic encephalomyelitis (ME) for more than a decade who is totally dependent on others, all thanks to a major relapse caused by GET, I am in a unique position to answer how harmful GET and cognitive behavioral therapy (CBT) really are. The basis of these therapies is false illness beliefs, meaning that it is all in the mind. These beliefs ignore all of the evidence that ME is a physical disease, such as intracellular immune dysfunctions, which not only restrict exercise capacity but also worsen with exercise (2). The main characteristic of ME is an abnormally delayed muscle recovery after doing trivial things, not chronic fatigue, and GET and CBT force you to ignore your symptoms to exercise your way back to full fitness. If you do that, you exceed your limit and cause a relapse, and the more you exceed your limit, the bigger the relapse and the less likely you are to recover from it. Many patients with this condition have become homebound and bedridden because of a major relapse caused by GET, and we will get our health and independence back only if we receive proper medication. | title = Harms of Cognitive Behavioural Therapy and Graded Exercise Therapy|source=Dr Maik Speedy}}
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