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'''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.
'''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]],<ref name="Twisk2009" /> this choice of treatment is justified using the unproven [[Biopsychosocial model|biopsychosocial]] hypothesis of ME/CFS, this hypothesis assumes that [[Illness beliefs|dysfunctional illness beliefs]] exist in patients with ME/CFS, and changing these beliefs will lead to recovery.<ref name="Twisk2009" /><ref name="Friedberg2016" /><ref name="Speedy2015">{{Cite journal|last=Speedy|first=Maik|author-link=Maik Speedy|date=Dec 2015|title=Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=http://www.annals.org/data/journals/aim/934718/aime201512010-l155178.pdf|journal=Annals of Internal Medicine|volume=163|issue=11|pages=884-885|quote=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).<br />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.|via=|doi=10.7326/L15-5170|pmid=26618290}}</ref> 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.<ref>{{Cite journal|last=Chalder|first=Trudie|author-link=Trudie Chalder|last2=Goldsmith|first2=Kimberley A|author-link2=Kimberley Goldsmith|last3=White|first3=Peter D|author-link3=Peter White|last4=Sharpe|first4=Michael|author-link4=Michael Sharpe|last5=Pickles|first5=Andrew R|author-link6=|date=2015|title=Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial|url=http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00069-8/abstract|journal=The Lancet Psychiatry|language=English|volume=2|issue=2|pages=141–152|doi=10.1016/S2215-0366(14)00069-8|issn=2215-0366|via=|quote=|author-link5=Andrew Pickles}}</ref><ref name="keith">{{Cite journal|last=Geraghty|first=Keith J|author-link=Keith Geraghty|last2=Blease|first2=Charlotte|author-link2=Charlotte Blease|date=2016-09-15|title=Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent|url=https://www.researchgate.net/profile/Keith_Geraghty/publication/308181085_Cognitive_behavioural_therapy_in_the_treatment_of_chronic_fatigue_syndrome_A_narrative_review_on_efficacy_and_informed_consent/links/5a15a37e4585153b546ca7c7/Cognitive-behavioural-therapy-in-the-treatment-of-chronic-fatigue-syndrome-A-narrative-review-on-efficacy-and-informed-consent.pdf|journal=Journal of Health Psychology|volume=23|issue=1|pages=127–138|doi=10.1177/1359105316667798|issn=1359-1053|via=}}</ref><ref>{{Cite web|url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/569175314|title=8E49 Postviral fatigue syndrome {{!}} ICD-11 - Mortality and Morbidity Statistics|last=World Health Organization|first=|authorlink=World Health Organization|date=|website=icd.who.int|language=en|archive-url=|archive-date=|access-date=2018-11-02|quote='''8E49 Postviral fatigue syndrome'''<br />Other disorders of the nervous system<br />Inclusions Benign myalgic encephalomyelitis<br />chronic fatigue syndrome}}</ref>
CBT is often proposed as a primary treatment for [[ME/CFS]],<ref name="Twisk2009" /> this choice of treatment is justified using the unproven [[Biopsychosocial model|biopsychosocial]] hypothesis of ME/CFS, this hypothesis assumes that [[Illness beliefs|dysfunctional illness beliefs]] exist in patients with ME/CFS, and changing these beliefs will lead to recovery.<ref name="Twisk2009" /><ref name="Friedberg2016" /><ref name="Speedy2015">{{Cite journal | last = Speedy|first = Maik | authorlink = Maik Speedy | date = Dec 2015 | title = Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | url = http://www.annals.org/data/journals/aim/934718/aime201512010-l155178.pdf | journal=Annals of Internal Medicine|volume=163 | issue = 11 | pages = 884-885|quote=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).<br />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.|via=|doi=10.7326/L15-5170|pmid=26618290}}</ref> 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.<ref>{{Cite journal | last = Chalder | first = Trudie | authorlink = Trudie Chalder | last2 = Goldsmith | first2 = Kimberley A | author-link2 = Kimberley Goldsmith | last3 = White | first3 = Peter D | author-link3 = Peter White | last4 = Sharpe | first4 = Michael | author-link4 = Michael Sharpe | last5 = Pickles | first5 = Andrew R | author-link6 = | date = 2015 | title=Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial | url = http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00069-8/abstract | journal = The Lancet Psychiatry|language=English|volume=2 | issue = 2 | pages = 141–152|doi=10.1016/S2215-0366(14)00069-8|issn=2215-0366|via=|quote= | author-link5 = Andrew Pickles}}</ref><ref name="keith">{{Cite journal | last = Geraghty|first = Keith J | authorlink = Keith Geraghty | last2 = Blease | first2 = Charlotte | author-link2 = Charlotte Blease | date = 2016-09-15 | title = Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent | url = https://www.researchgate.net/profile/Keith_Geraghty/publication/308181085_Cognitive_behavioural_therapy_in_the_treatment_of_chronic_fatigue_syndrome_A_narrative_review_on_efficacy_and_informed_consent/links/5a15a37e4585153b546ca7c7/Cognitive-behavioural-therapy-in-the-treatment-of-chronic-fatigue-syndrome-A-narrative-review-on-efficacy-and-informed-consent.pdf | journal=Journal of Health Psychology|volume=23 | issue = 1 | pages = 127–138|doi=10.1177/1359105316667798|issn=1359-1053|via=}}</ref><ref>{{Cite web | url = https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/569175314 | title = 8E49 Postviral fatigue syndrome {{!}} ICD-11 - Mortality and Morbidity Statistics | last = World Health Organization | first = | authorlink = World Health Organization | date = | website = icd.who.int|language=en|archive-url=|archive-date=|access-date=2018-11-02|quote='''8E49 Postviral fatigue syndrome'''<br />Other disorders of the nervous system<br />Inclusions Benign myalgic encephalomyelitis<br />chronic fatigue syndrome}}</ref>


CBT is one of the therapies used in the controversial [[PACE trial]].<ref name=":4">{{Cite web|url=https://www.meassociation.org.uk/2015/05/23959/|title=Our Illness Management Report calls for major changes to therapies offered for ME/CFS {{!}} 29 May 2015|website=[[The ME Association]]|language=en-US|access-date=2018-10-13}}</ref>
CBT is one of the therapies used in the controversial [[PACE trial]].<ref name=":4">{{Cite web | url = https://www.meassociation.org.uk/2015/05/23959/ | title = Our Illness Management Report calls for major changes to therapies offered for ME/CFS {{!}} 29 May 2015 | website = [[The ME Association]]|language=en-US|access-date=2018-10-13}}</ref>
[[File:CognitiveBehavioralTherapy-ME-ChronicFatigueSyndrome-BPS.jpg|thumb|450x450px|CBT for ME/CFS: What's the issue?<ref name="Shepherd2017" />|alt=Cognitive Behavioral Therapy for ME/CFS: What's the issue? This is not an argument with psychiatry. Mental and physical illness are equally real and horrible. As with any long-term illness, some people with ME/CFS will develop comorbid depression and other mental health problems where CBT can be of help alongside good quality general management. The argument here is with a flawed model of causation assuming efficacy for CBT and GET while taking no significant account of varying clinical presentations and disease pathways. —Charles Shepherd, Journal of health psychology (2017)<ref name="Shepherd2017">{{cite journal|last=Shepherd|first=Charles B|author-link=Charles Shepherd|date=2017|title=PACE trial claims for recovery in myalgic encephalomyelitis/chronic fatigue syndrome – true or false? It’s time for an independent review of the methodology and results.|journal=Journal of Health Psychology|doi=10.1177/1359105317703786|quote=<br>This is not an argument with psychiatry. Mental and physical illness are equally real and horrible. As with any long-term illness, some people with ME/CFS will develop comorbid depression and other mental health problems where CBT can be of help alongside good quality general management.  The argument here is with a flawed model of causation assuming efficacy for CBT and GET while taking no significant account of varying clinical presentations and disease pathways.}}</ref>]]
[[File:CognitiveBehavioralTherapy-ME-ChronicFatigueSyndrome-BPS.jpg|thumb|450x450px|CBT for ME/CFS: What's the issue?<ref name="Shepherd2017" />|alt=Cognitive Behavioral Therapy for ME/CFS: What's the issue? This is not an argument with psychiatry. Mental and physical illness are equally real and horrible. As with any long-term illness, some people with ME/CFS will develop comorbid depression and other mental health problems where CBT can be of help alongside good quality general management. The argument here is with a flawed model of causation assuming efficacy for CBT and GET while taking no significant account of varying clinical presentations and disease pathways. —Charles Shepherd, Journal of health psychology (2017)<ref name="Shepherd2017">{{cite journal | last = Shepherd | first = Charles B | authorlink = Charles Shepherd | date = 2017 | title=PACE trial claims for recovery in myalgic encephalomyelitis/chronic fatigue syndrome – true or false? It’s time for an independent review of the methodology and results. | journal = Journal of Health Psychology|doi=10.1177/1359105317703786|quote=<br>This is not an argument with psychiatry. Mental and physical illness are equally real and horrible. As with any long-term illness, some people with ME/CFS will develop comorbid depression and other mental health problems where CBT can be of help alongside good quality general management.  The argument here is with a flawed model of causation assuming efficacy for CBT and GET while taking no significant account of varying clinical presentations and disease pathways.}}</ref>]]


==United Kingdom==
==United Kingdom==
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== Evidence ==
== 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|author-link=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-link7=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=1121–1129|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" />
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 = 1121–1129|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=240–255|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>
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 = 240–255|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).
{{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}}
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}}


== Long term effects ==
== 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.<ref>{{Cite journal|last=Westen|first=Drew|author-link=|last2=Novotny|first2=Catherine M.|author-link2=|last3=Thompson-Brenner|first3=Heather|author-link3=|date=2004|title=The Empirical Status of Empirically Supported Psychotherapies: Assumptions, Findings, and Reporting in Controlled Clinical Trials.|url=https://dx.org/10.1037/0033-2909.130.4.631|journal=Psychological Bulletin|language=en|volume=130|issue=4|pages=631–663|doi=10.1037/0033-2909.130.4.631|issn=1939-1455|pmc=|pmid=|access-date=|quote=|via=}}</ref>
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.<ref>{{Cite journal | last = Westen | first = Drew | authorlink = | last2 = Novotny | first2 = Catherine M. | author-link2 = | last3 = Thompson-Brenner | first3 = Heather | author-link3 = | date = 2004 | title = The Empirical Status of Empirically Supported Psychotherapies: Assumptions, Findings, and Reporting in Controlled Clinical Trials. | url = https://dx.org/10.1037/0033-2909.130.4.631 | journal = Psychological Bulletin|language=en|volume=130 | issue = 4 | pages = 631–663|doi=10.1037/0033-2909.130.4.631|issn=1939-1455|pmc=|pmid=|access-date=|quote=|via=}}</ref>


===Reports of harm===
===Reports of harm===
Surveys from patient organizations have found considerable rates of harm from CBT among the patients surveyed.<ref name="Speedy2015" /><ref name="Kindlon2011" /> 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.<ref name=":7" />  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.<ref name="OxfordBrookesSurvey" />
Surveys from patient organizations have found considerable rates of harm from CBT among the patients surveyed.<ref name="Speedy2015" /><ref name="Kindlon2011" /> 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.<ref name=":7" />  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.<ref name="OxfordBrookesSurvey" />


[[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.<ref>{{Cite web|url=https://www.change.org/p/nice-stop-harming-me-cfs-patients-take-cbt-get-out-of-me-cfs-guidelines-now|title=NICE stop harming ME/CFS patients - Take CBT and GET out of the CFS guidelines NOW! {{!}} Sign the Petition|last=Brown|first=Robin|authorlink=Robin Brown|date=|website=Change.org|language=en-GB|archive-url=|archive-date=|access-date=2018-11-13}}</ref><ref name=":4" />
[[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.<ref>{{Cite web | url = https://www.change.org/p/nice-stop-harming-me-cfs-patients-take-cbt-get-out-of-me-cfs-guidelines-now | title = NICE stop harming ME/CFS patients - Take CBT and GET out of the CFS guidelines NOW! {{!}} Sign the Petition | last = Brown | first = Robin | authorlink = Robin Brown | date = | website = Change.org|language=en-GB|archive-url=|archive-date=|access-date=2018-11-13}}</ref><ref name=":4" />


== Articles explaining CBT not appropriate for ME/CFS ==
== Articles explaining CBT not appropriate for ME/CFS ==
*2009, [https://www.ncbi.nlm.nih.gov/m/pubmed/19855350/ 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]<ref name="Twisk2009" />
*2009, [https://www.ncbi.nlm.nih.gov/m/pubmed/19855350/ 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]<ref name="Twisk2009" />
*2011, [http://www.annals.org/data/journals/aim/934718/aime201512010-l155178.pdf Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]<ref name="Speedy2015" />  
*2011, [http://www.annals.org/data/journals/aim/934718/aime201512010-l155178.pdf Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]<ref name="Speedy2015" />  
*2015, [https://www.healthrising.org/blog/2015/11/11/chokehold-behavioral-treatments-chronic-fatigue-syndrome/ The Chokehold Behavioral Treatments Have on Chronic Fatigue Syndrome]<ref>{{Cite web|url=https://www.healthrising.org/blog/2015/11/11/chokehold-behavioral-treatments-chronic-fatigue-syndrome/|title=The Chokehold Behavioral Treatments Have on Chronic Fatigue Syndrome|last=Johnson|first=Cort|date=Nov 14, 2015|website=[[Health Rising]]|archive-url=|archive-date=|access-date=|authorlink=Cort Johnson}}</ref>
*2015, [https://www.healthrising.org/blog/2015/11/11/chokehold-behavioral-treatments-chronic-fatigue-syndrome/ The Chokehold Behavioral Treatments Have on Chronic Fatigue Syndrome]<ref>{{Cite web | url = https://www.healthrising.org/blog/2015/11/11/chokehold-behavioral-treatments-chronic-fatigue-syndrome/ | title = The Chokehold Behavioral Treatments Have on Chronic Fatigue Syndrome | last = Johnson | first = Cort | date = Nov 14, 2015 | website = [[Health Rising]]|archive-url=|archive-date=|access-date= | authorlink = Cort Johnson}}</ref>


*2015, [http://www.meassociation.org.uk/wp-content/uploads/2015-ME-Association-Illness-Management-Report-No-decisions-about-me-without-me-30.05.15.pdf No decisions about ME without me]<ref name=":7">{{Cite web|url=http://www.meassociation.org.uk/wp-content/uploads/2015-ME-Association-Illness-Management-Report-No-decisions-about-me-without-me-30.05.15.pdf|title=ME/CFS Illness Management Survey Results - “No decisions about me without me” Part 1|last=|first=|date=May 2015|website=[[ME Association]]|publisher=ME Association|archive-url=|archive-date=|access-date=}}</ref>
*2015, [http://www.meassociation.org.uk/wp-content/uploads/2015-ME-Association-Illness-Management-Report-No-decisions-about-me-without-me-30.05.15.pdf No decisions about ME without me]<ref name=":7">{{Cite web | url = http://www.meassociation.org.uk/wp-content/uploads/2015-ME-Association-Illness-Management-Report-No-decisions-about-me-without-me-30.05.15.pdf | title=ME/CFS Illness Management Survey Results - “No decisions about me without me” Part 1 | last = | first = | date = May 2015 | website = [[ME Association]]| publisher = ME Association|archive-url=|archive-date=|access-date=}}</ref>


*2015, [http://sacfs.asn.au/news/2015/01/01_18_mecfs_research_uk_slams_lancet_psychiatry_report_advocating_exercise_for_cfs_sufferers.htm ME Research UK Slams Lancet Psychiatry Report Advocating Exercise For Chronic Fatigue Syndrome Sufferers]<ref>{{Cite web|url=http://sacfs.asn.au/news/2015/01/01_18_mecfs_research_uk_slams_lancet_psychiatry_report_advocating_exercise_for_cfs_sufferers.htm|title=ME/CFS Australia (SA) Inc: ME/CFS Research UK Slams Lancet Psychiatry Report Advocating Exercise For Chronic Fatigue Syndrome Sufferers|website=sacfs.asn.au|access-date=2018-10-13}}</ref>
*2015, [http://sacfs.asn.au/news/2015/01/01_18_mecfs_research_uk_slams_lancet_psychiatry_report_advocating_exercise_for_cfs_sufferers.htm ME Research UK Slams Lancet Psychiatry Report Advocating Exercise For Chronic Fatigue Syndrome Sufferers]<ref>{{Cite web | url = http://sacfs.asn.au/news/2015/01/01_18_mecfs_research_uk_slams_lancet_psychiatry_report_advocating_exercise_for_cfs_sufferers.htm | title = ME/CFS Australia (SA) Inc: ME/CFS Research UK Slams Lancet Psychiatry Report Advocating Exercise For Chronic Fatigue Syndrome Sufferers | website = sacfs.asn.au|access-date=2018-10-13}}</ref>
*2017, Bias, misleading information and lack of respect for alternative views have distorted perceptions of [[ME/CFS|myalgic encephalomyelitis/chronic fatigue syndrome]] and its treatment<ref>{{Cite web|url=https://doi.dx.org/10.1177/1359105317707216|title=Bias, misleading information and lack of respect for alternative views have distorted perceptions of myalgic encephalomyelitis/chronic fatigue syndrome and its treatment|last=Goudsmit|first=Ellen|authorlink=Ellen Goudsmit|last2=Howes|first2=Sandra|authorlink2=Sandra Howes|date=May 29, 2017|website=SAGE Journals|language=en|doi=10.1177/1359105317707216|archive-url=|archive-date=|access-date=2018-12-23}}</ref> [http://journals.sagepub.com/doi/full/10.1177/1359105317707216 (Full Text)]
*2017, Bias, misleading information and lack of respect for alternative views have distorted perceptions of [[ME/CFS|myalgic encephalomyelitis/chronic fatigue syndrome]] and its treatment<ref>{{Cite web | url = https://doi.dx.org/10.1177/1359105317707216 | title = Bias, misleading information and lack of respect for alternative views have distorted perceptions of myalgic encephalomyelitis/chronic fatigue syndrome and its treatment | last = Goudsmit | first = Ellen | authorlink = Ellen Goudsmit | last2 = Howes | first2 = Sandra | author-link2 = Sandra Howes | date = May 29, 2017 | website = SAGE Journals|language=en|doi=10.1177/1359105317707216|archive-url=|archive-date=|access-date=2018-12-23}}</ref> [http://journals.sagepub.com/doi/full/10.1177/1359105317707216 (Full Text)]
* 2017, [https://www.researchgate.net/profile/Keith_Geraghty/publication/308181085_Cognitive_behavioural_therapy_in_the_treatment_of_chronic_fatigue_syndrome_A_narrative_review_on_efficacy_and_informed_consent/links/5a15a37e4585153b546ca7c7/Cognitive-behavioural-therapy-in-the-treatment-of-chronic-fatigue-syndrome-A-narrative-review-on-efficacy-and-informed-consent.pdf Cognitive behavioral therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent]<ref name="keith" />
* 2017, [https://www.researchgate.net/profile/Keith_Geraghty/publication/308181085_Cognitive_behavioural_therapy_in_the_treatment_of_chronic_fatigue_syndrome_A_narrative_review_on_efficacy_and_informed_consent/links/5a15a37e4585153b546ca7c7/Cognitive-behavioural-therapy-in-the-treatment-of-chronic-fatigue-syndrome-A-narrative-review-on-efficacy-and-informed-consent.pdf Cognitive behavioral therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent]<ref name="keith" />
* 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<ref name="OxfordBrookesSurvey">{{Cite web|url =https://www.meassociation.org.uk/wp-content/uploads/NICE-Patient-Survey-Outcomes-CBT-and-GET-Final-Consolidated-Report-03.04.19.pdf|title =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 |last=Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS)|location=Oxford Brookes University|date=Feb 27, 2019}}</ref> [https://www.meassociation.org.uk/wp-content/uploads/NICE-Patient-Survey-Outcomes-CBT-and-GET-Final-Consolidated-Report-03.04.19.pdf (Full text)]
* 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<ref name="OxfordBrookesSurvey">{{Cite web | url = https://www.meassociation.org.uk/wp-content/uploads/NICE-Patient-Survey-Outcomes-CBT-and-GET-Final-Consolidated-Report-03.04.19.pdf | title =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 | last = Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS)|location=Oxford Brookes University | date = Feb 27, 2019}}</ref> [https://www.meassociation.org.uk/wp-content/uploads/NICE-Patient-Survey-Outcomes-CBT-and-GET-Final-Consolidated-Report-03.04.19.pdf (Full text)]
* 2019, [https://blogs.bmj.com/medical-humanities/2019/07/04/why-graded-exercise-therapy-and-cognitive-behaviour-therapy-are-controversial-in-chronic-fatigue-syndrome/ Why Graded Exercise Therapy and Cognitive Behaviour Therapy are Controversial in Chronic Fatigue Syndrome]<ref name="Tack2019">{{Cite web|url=https://blogs.bmj.com/medical-humanities/2019/07/04/why-graded-exercise-therapy-and-cognitive-behaviour-therapy-are-controversial-in-chronic-fatigue-syndrome/|title=Why Graded Exercise Therapy and Cognitive Behaviour Therapy are Controversial in Chronic Fatigue Syndrome|last=Michiel|first=Tack|authorlink=Michiel Tack|date=Jul 4, 2019|website=BMJ Medical Humanities Blog|language=en-US|archive-url=|archive-date=|access-date=2019-07-09}}</ref>
*2019, The 'Cognitive Behavioural Model' of Chronic Fatigue Syndrome: Critique of a Flawed Model<ref name="Geraghty2019CBM">{{Cite journal | last = Geraghty|first = Keith | authorlink = Keith Geraghty | last2 = Jason | first2 = Leonard | author-link2 = Leonard Jason | last3 = Sunnquist | first3 = Madison | author-link3 = Madison Sunnquist | last4 = Blease | first4 = Charlotte | author-link4 = Charlotte Blease | last5 = Tuller | first5 = David | author-link5 = David Tuller | last6 = Adeniji | first6 = Charles | author-link6 = | date = Feb 2019 | title = The 'Cognitive Behavioural Model' of Chronic Fatigue Syndrome: Critique of a Flawed Model. | url = https://www.researchgate.net/publication/330901648_The_'Cognitive_Behavioural_Model'_of_Chronic_Fatigue_Syndrome_Critique_of_a_Flawed_Model | journal = Journal of Health Psychology|volume=6 | issue = 1|pmid=31041108 | pages = 2055102919838907|quote=|via=}}</ref> - [https://www.researchgate.net/publication/330901648_The_'Cognitive_Behavioural_Model'_of_Chronic_Fatigue_Syndrome_Critique_of_a_Flawed_Model (Full text)]
*2019, The 'Cognitive Behavioural Model' of Chronic Fatigue Syndrome: Critique of a Flawed Model<ref name="Geraghty2019CBM">{{Cite journal|last=Geraghty|first=Keith|author-link=Keith Geraghty|last2=Jason|first2=Leonard|author-link2=Leonard Jason|last3=Sunnquist|first3=Madison|author-link3=Madison Sunnquist|last4=Blease|first4=Charlotte|author-link4=Charlotte Blease|last5=Tuller|first5=David|author-link5=David Tuller|last6=Adeniji|first6=Charles|author-link6=|date=Feb 2019|title=The 'Cognitive Behavioural Model' of Chronic Fatigue Syndrome: Critique of a Flawed Model.|url=https://www.researchgate.net/publication/330901648_The_'Cognitive_Behavioural_Model'_of_Chronic_Fatigue_Syndrome_Critique_of_a_Flawed_Model|journal=Journal of Health Psychology|volume=6|issue=1|pmid=31041108|pages=2055102919838907|quote=|via=}}</ref> - [https://www.researchgate.net/publication/330901648_The_'Cognitive_Behavioural_Model'_of_Chronic_Fatigue_Syndrome_Critique_of_a_Flawed_Model (Abstract)]


== CDC withdrawal of CBT treatment ==
== 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 "[[ME/CFS|Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]] (ME/CFS)" and GET and CBT recommendations have been removed.<ref name="CDC-drops-GET">{{Cite web |url =http://www.virology.ws/2017/07/10/trial-by-error-the-cdc-drops-cbtget/|title=Trial By Error: The CDC Drops CBT/GET|website=[[Virology Blog]]|date=2017-07-10|last=Tuller|first=David|author-link=David Tuller}}</ref><ref>{{Cite web |url =https://www.cdc.gov/me-cfs/index.html|title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|website = CDC|access-date=2017-07-10}}</ref>
July 3, 2017, The [[Centers for Disease Control and Prevention]]'s (CDC) website Chronic Fatigue Syndrome page has been changed to "[[ME/CFS|Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]] (ME/CFS)" and GET and CBT recommendations have been removed.<ref name="CDC-drops-GET">{{Cite web |url = http://www.virology.ws/2017/07/10/trial-by-error-the-cdc-drops-cbtget/ | title = Trial By Error: The CDC Drops CBT/GET | website = [[Virology Blog]] | date = 2017-07-10 | last = Tuller | first = David | authorlink = David Tuller}}</ref><ref>{{Cite web |url = https://www.cdc.gov/me-cfs/index.html | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|website = CDC|access-date=2017-07-10}}</ref>


==Notable studies==
==Notable studies==
*2009, [https://www.ncbi.nlm.nih.gov/m/pubmed/19855350/ 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]<ref name="Twisk2009">{{Cite journal|last=Twisk|first=Frank N. M.|last2=Maes|first2=Michael|date=2009|title=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|url=https://www.ncbi.nlm.nih.gov/m/pubmed/19855350/|journal=Neuro Endocrinology Letters|volume=30|issue=3|pages=284–299|issn=0172-780X|pmid=19855350|quote=|author-link=Frank Twisk|author-link2=Michael Maes}}</ref>
*2009, [https://www.ncbi.nlm.nih.gov/m/pubmed/19855350/ 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]<ref name="Twisk2009">{{Cite journal | last = Twisk|first = Frank N.M. | last2 = Maes | first2 = Michael | date = 2009 | title = 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 | url = https://www.ncbi.nlm.nih.gov/m/pubmed/19855350/ | journal = Neuro Endocrinology Letters|volume=30 | issue = 3 | pages = 284–299|issn=0172-780X|pmid=19855350|quote= | authorlink = Frank Twisk | author-link2 = Michael Maes}}</ref>
*2011, [https://pdfs.semanticscholar.org/e464/4b1ccceb7e10b0f1 Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]  
*2011, [https://pdfs.semanticscholar.org/e464/4b1ccceb7e10b0f1 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<ref>{{Cite journal|last=Núñez|first=Montserrat|author-link=Montqserrat Núñez|last2=Fernández-Solà|first2=Joaquim|author-link2=Joaquim Fernández-Solà|last3=Nuñez|first3=Esther|author-link3=Esther Nuñez|last4=Fernández-Huerta|first4=José-Manuel|author-link4=José-Manuel Fernández-Huerta|last5=Godás-Sieso|first5=Teresa|author-link5=Teresa Godás-Sieso|last6=Gomez-Gil|first6=Esther|author-link6=Esther Gomez-Gil|date=Mar 2011|title=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|url=http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467.4965&rep=rep1&type=pdf|journal=Clinical Rheumatology|volume=30|issue=3|pages=381–389|doi=10.1007/s10067-010-1677-y|issn=1434-9949|pmid=21234629|quote=|via=}}</ref> [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467.4965&rep=rep1&type=pdf (Full Text)]
*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<ref>{{Cite journal | last = Núñez|first = Montserrat | authorlink = Montqserrat Núñez | last2 = Fernández-Solà| first2 = Joaquim | author-link2 = Joaquim Fernández-Solà | last3 = Nuñez | first3 = Esther | author-link3 = Esther Nuñez | last4 = Fernández-Huerta | first4 = José-Manuel | author-link4 = José-Manuel Fernández-Huerta | last5 = Godás-Sieso | first5 = Teresa | author-link5 = Teresa Godás-Sieso | last6 = Gomez-Gil | first6 = Esther | author-link6 = Esther Gomez-Gil | date = Mar 2011 | title = 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 | url =http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467.4965&rep=rep1&type=pdf | journal = Clinical Rheumatology|volume=30 | issue = 3 | pages = 381–389|doi=10.1007/s10067-010-1677-y|issn=1434-9949|pmid=21234629|quote=|via=}}</ref> [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467.4965&rep=rep1&type=pdf (Full Text)]
*2016, Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent<ref name="keith" /> [https://www.researchgate.net/profile/Keith_Geraghty/publication/308181085_Cognitive_behavioural_therapy_in_the_treatment_of_chronic_fatigue_syndrome_A_narrative_review_on_efficacy_and_informed_consent/links/5a15a37e4585153b546ca7c7/Cognitive-behavioural-therapy-in-the-treatment-of-chronic-fatigue-syndrome-A-narrative-review-on-efficacy-and-informed-consent.pdf (Full Text)]
*2016, Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent<ref name="keith" /> [https://www.researchgate.net/profile/Keith_Geraghty/publication/308181085_Cognitive_behavioural_therapy_in_the_treatment_of_chronic_fatigue_syndrome_A_narrative_review_on_efficacy_and_informed_consent/links/5a15a37e4585153b546ca7c7/Cognitive-behavioural-therapy-in-the-treatment-of-chronic-fatigue-syndrome-A-narrative-review-on-efficacy-and-informed-consent.pdf (Full Text)]
*2016, [https://www.ncbi.nlm.nih.gov/pubmed/27513528?dopt=Abstract Group Cognitive Behaviour Therapy for Chronic Fatigue Syndrome]<ref>{{Cite journal|last=Illegems|first=Jela|last2=Moorkens|first2=Greta|last3=Van Den Eede|first3=Filip|date=2016|title=Group Cognitive Behaviour Therapy for Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/27513528?dopt=Abstract|journal=Psychotherapy and Psychosomatics|volume=85|issue=5|pages=308|doi=10.1159/000445166|issn=1423-0348|pmid=27513528}}</ref>
*2016, [https://www.ncbi.nlm.nih.gov/pubmed/27513528?dopt=Abstract Group Cognitive Behaviour Therapy for Chronic Fatigue Syndrome]<ref>{{Cite journal | last = Illegems | first = Jela | last2 = Moorkens | first2 = Greta | last3 = Van Den Eede | first3 = Filip | date = 2016 | title=Group Cognitive Behaviour Therapy for Chronic Fatigue Syndrome | url = https://www.ncbi.nlm.nih.gov/pubmed/27513528?dopt=Abstract | journal = Psychotherapy and Psychosomatics|volume=85 | issue = 5 | pages = 308|doi=10.1159/000445166|issn=1423-0348|pmid=27513528}}</ref>


* 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<ref name="GeraghtyHannKurtev2017">{{Cite journal|last1= Geraghty|first1 = Keith|authorlink1 = Keith Geraghty|last2 = Hann |first2 = Mark|authorlink2 = Mark Hann |last3 = Kurtev |first3 = Stoyan|authorlink3 = Stoyan Kurtev| title = 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|journal = Journal of Health Psychology |volume = |issue = |page = | date = Aug 29, 2017|pmid= |doi= 10.1177/1359105317726152|url= https://doi.org/10.1177/1359105317726152}}</ref> [https://doi.org/10.1177/1359105317726152 (Full text)]
* 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<ref name="GeraghtyHannKurtev2017">{{Cite journal | last1 = Geraghty | first1 = Keith | author-link1 = Keith Geraghty | last2 = Hann | first2 = Mark | author-link2 = Mark Hann | last3 = Kurtev | first3 = Stoyan | author-link3 = Stoyan Kurtev| title = 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|journal = Journal of Health Psychology |volume = |issue = | page = | date = Aug 29, 2017|pmid= |doi= 10.1177/1359105317726152|url= https://doi.org/10.1177/1359105317726152}}</ref> [https://doi.org/10.1177/1359105317726152 (Full text)]


*2017, [https://journals.sagepub.com/doi/pdf/10.1177/1359105317707215 Cognitive Behavioural Therapy and Objective Assessments in Chronic Fatigue Syndrome]<ref>{{Cite journal|last=McPhee|first=Graham|author-link=Graham McPhee|date=2017|title=Cognitive behaviour therapy and objective assessments in chronic fatigue syndrome|url=https://journals.sagepub.com/doi/pdf/10.1177/1359105317707215|journal=Journal of Health Psychology|volume=22|issue=9|pages=1181–1186|doi=10.1177/1359105317707215|issn=1461-7277|pmid=28805529|via=}}</ref>
*2017, [https://journals.sagepub.com/doi/pdf/10.1177/1359105317707215 Cognitive Behavioural Therapy and Objective Assessments in Chronic Fatigue Syndrome]<ref>{{Cite journal | last = McPhee | first = Graham | authorlink = Graham McPhee | date = 2017 | title=Cognitive behaviour therapy and objective assessments in chronic fatigue syndrome | url = https://journals.sagepub.com/doi/pdf/10.1177/1359105317707215 | journal = Journal of Health Psychology|volume=22 | issue = 9 | pages = 1181–1186|doi=10.1177/1359105317707215|issn=1461-7277|pmid=28805529|via=}}</ref>
*2018, Rethinking the treatment of Chronic Fatigue Syndrome<ref>{{Cite journal|last=Wilshire|first=Carolyn E.|author-link=Carolyn Wilshire|last2=Kindlon|first2=Tom|author-link2=Tom Kindlon|last3=Courtney|first3=Robert|author-link3=Robert Courtney|last4=Matthees|first4=Alem|author-link4=Alem Matthees|last5=Tuller|first5=David|author-link5=David Tuller|last6=Geraghty|first6=Keith|author-link6=Keith Geraghty|last7=Levin|first7=Bruce|author-link7=Bruce Levin|date=2018-03-22|title=Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT|url=https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0218-3|journal=BMC Psychology|language=en|volume=6|issue=1|pages=|doi=10.1186/s40359-018-0218-3|issn=2050-7283|pmc=5863477|pmid=29562932|quote=|via=}}</ref>  
*2018, Rethinking the treatment of Chronic Fatigue Syndrome<ref>{{Cite journal | last = Wilshire | first = Carolyn E. | authorlink = Carolyn Wilshire | last2 = Kindlon | first2 = Tom | author-link2 = Tom Kindlon | last3 = Courtney | first3 = Robert | author-link3 = Robert Courtney | last4 = Matthees | first4 = Alem | author-link4 = Alem Matthees | last5 = Tuller | first5 = David | author-link5 = David Tuller | last6 = Geraghty | first6 = Keith | author-link6 = Keith Geraghty | last7 = Levin | first7 = Bruce | author-link8 = Bruce Levin | date = 2018-03-22 | title = Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT | url = https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0218-3 | journal = BMC Psychology|language=en|volume=6 | issue = 1| pages=|doi=10.1186/s40359-018-0218-3|issn=2050-7283|pmc=5863477|pmid=29562932|quote=|via=}}</ref>  


*2017, Contesting the psychiatric framing of ME/CFS<ref name="Spandler2017">{{Cite journal|last=Spandler|first=Helen|author-link=Helen Spandler|last2=Allen|first2=Meg|author-link2=Meg Allen|date=Aug 16, 2017|title=Contesting the psychiatric framing of ME/CFS|url=https://www.researchgate.net/profile/Helen_Spandler/publication/319157873_Contesting_the_psychiatric_framing_of_MECFS/links/599b082545851574f4ac5ba0/Contesting-the-psychiatric-framing-of-ME-CFS.pdf|journal=Social Theory & Health|language=en|volume=16|issue=2|pages=127–141|doi=10.1057/s41285-017-0047-0|issn=1477-8211|quote=|via=}}</ref> [https://www.researchgate.net/profile/Helen_Spandler/publication/319157873_Contesting_the_psychiatric_framing_of_MECFS/links/599b082545851574f4ac5ba0/Contesting-the-psychiatric-framing-of-ME-CFS.pdf (Full text)]
*2017, Contesting the psychiatric framing of ME/CFS<ref name="Spandler2017">{{Cite journal | last = Spandler | first = Helen | authorlink = Helen Spandler | last2 = Allen | first2 = Meg | author-link2 = Meg Allen | date = Aug 16, 2017 | title = Contesting the psychiatric framing of ME/CFS | url = https://www.researchgate.net/profile/Helen_Spandler/publication/319157873_Contesting_the_psychiatric_framing_of_MECFS/links/599b082545851574f4ac5ba0/Contesting-the-psychiatric-framing-of-ME-CFS.pdf | journal=Social Theory & Health|language=en|volume=16 | issue = 2 | pages = 127–141|doi=10.1057/s41285-017-0047-0|issn=1477-8211|quote=|via=}}</ref> [https://www.researchgate.net/profile/Helen_Spandler/publication/319157873_Contesting_the_psychiatric_framing_of_MECFS/links/599b082545851574f4ac5ba0/Contesting-the-psychiatric-framing-of-ME-CFS.pdf (Full text)]


*2018, Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review<ref name=":5">{{Cite journal|last=Vink|first=Mark|author-link=Mark Vink|last2=Vink-Niese|first2=Alexandra|author-link2=Alexandra Vink-Niese|date=2018-10-08|title=Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176540/|journal=Health Psychology Open|volume=5|issue=2|pages=|doi=10.1177/2055102918805187|issn=2055-1029|pmc=|pmid=30305916|quote=|via=}}</ref>
*2018, Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review<ref name=":5">{{Cite journal | last = Vink|first = Mark | authorlink = Mark Vink | last2 = Vink-Niese | first2 = Alexandra | author-link2 = Alexandra Vink-Niese | date = 2018-10-08 | title = Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176540/ | journal = Health Psychology Open|volume=5 | issue = 2| pages=|doi=10.1177/2055102918805187|issn=2055-1029|pmc=|pmid=30305916|quote=|via=}}</ref>
*2018, [https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/cognitivebehavioural-therapy-for-chronic-fatigue-syndrome-neither-efficacious-nor-safe/C8B85E1E18395A44E4535281167FD413 Cognitive–behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe]<ref>{{Cite journal|last=Twisk|first=Frank|author-link=Frank Twisk|last2=Corsius|first2=Lou|date=Aug 2018|title=Cognitive–behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe|url=https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/cognitivebehavioural-therapy-for-chronic-fatigue-syndrome-neither-efficacious-nor-safe/C8B85E1E18395A44E4535281167FD413|journal=The British Journal of Psychiatry|language=en|volume=213|issue=2|pages=500–501|doi=10.1192/bjp.2018.136|issn=0007-1250|via=}}</ref>
*2018, [https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/cognitivebehavioural-therapy-for-chronic-fatigue-syndrome-neither-efficacious-nor-safe/C8B85E1E18395A44E4535281167FD413 Cognitive–behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe]<ref>{{Cite journal | last = Twisk|first = Frank | authorlink = Frank Twisk | last2 = Corsius | first2 = Lou | date = Aug 2018 | title = Cognitive–behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe | url = https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/cognitivebehavioural-therapy-for-chronic-fatigue-syndrome-neither-efficacious-nor-safe/C8B85E1E18395A44E4535281167FD413 | journal = The British Journal of Psychiatry|language=en|volume=213 | issue = 2 | pages = 500–501|doi=10.1192/bjp.2018.136|issn=0007-1250|via=}}</ref>
*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<ref name=":8" />
*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<ref name=":8" />
*2020, Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)<ref name=":9" />
*2020, Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)<ref name=":9" />
Line 78: Line 77:


==Learn more==
==Learn more==
*2001, [https://www.researchgate.net/profile/Leone-Ridsdale/publication/298134485_Cognitive_behaviour_therapy_and_chronic_fatigue_syndrome_-_Response/links/58c911a892851c2b9d570b70/Cognitive-behaviour-therapy-and-chronic-fatigue-syndrome-Response.pdf?origin=publication_detail Cognitive behaviour therapy and chronic fatigue syndrome]<ref name="Baschetti2001">{{Cite journal|url=https://www.researchgate.net/profile/Leone-Ridsdale/publication/298134485_Cognitive_behaviour_therapy_and_chronic_fatigue_syndrome_-_Response/links/58c911a892851c2b9d570b70/Cognitive-behaviour-therapy-and-chronic-fatigue-syndrome-Response.pdf?origin=publication_detail|title=Cognitive behaviour therapy and chronic fatigue syndrome|last=Baschetti|first=Riccardo|date=Apr 2001|pmc=1313986|journal=British Journal of General Practice|volume =51|issue =465|page=316 |archive-url=|archive-date=|access-date=}}</ref>
*2001, [https://www.researchgate.net/profile/Leone-Ridsdale/publication/298134485_Cognitive_behaviour_therapy_and_chronic_fatigue_syndrome_-_Response/links/58c911a892851c2b9d570b70/Cognitive-behaviour-therapy-and-chronic-fatigue-syndrome-Response.pdf?origin=publication_detail Cognitive behaviour therapy and chronic fatigue syndrome]<ref name="Baschetti2001">{{Cite journal | url = https://www.researchgate.net/profile/Leone-Ridsdale/publication/298134485_Cognitive_behaviour_therapy_and_chronic_fatigue_syndrome_-_Response/links/58c911a892851c2b9d570b70/Cognitive-behaviour-therapy-and-chronic-fatigue-syndrome-Response.pdf?origin=publication_detail | title = Cognitive behaviour therapy and chronic fatigue syndrome | last = Baschetti|first = Riccardo | date = Apr 2001|pmc=1313986 | journal = British Journal of General Practice|volume =51|issue =465 | page = 316 |archive-url=|archive-date=|access-date=}}</ref>
*2011, [https://pdfs.semanticscholar.org/e464/4b1ccceb7e10b0f1021b5abdbea791bc72c6.pdf Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]<ref name="Kindlon2011">{{Cite web|url=https://pdfs.semanticscholar.org/e464/4b1ccceb7e10b0f1021b5abdbea791bc72c6.pdf|title=Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|last=Kindlon|first=Tom|authorlink=Tom Kindlon|date=2011|website=|archive-url=|archive-date=|access-date=29 October 2018}}</ref>
*2011, [https://pdfs.semanticscholar.org/e464/4b1ccceb7e10b0f1021b5abdbea791bc72c6.pdf Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]<ref name="Kindlon2011">{{Cite web | url = https://pdfs.semanticscholar.org/e464/4b1ccceb7e10b0f1021b5abdbea791bc72c6.pdf | title=Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | last = Kindlon | first = Tom | authorlink = Tom Kindlon | date = 2011 | website = |archive-url=|archive-date=|access-date=29 October 2018}}</ref>
*2013, [http://onlinelibrary.wiley.com/doi/10.1002/9781118528563.wbcbt23/abstract Wiley - Chronic Fatigue Syndrome Part Two. Specific Disorders]<ref>{{Cite book|last=Chalder|first=Trudie|author-link =Trudie Chalder|title=The Wiley Handbook of Cognitive Behavioral Therapy|chapter=Chronic Fatigue Syndrome|volume=2|url=http://onlinelibrary.wiley.com/doi/10.1002/9781118528563.wbcbt23/abstract|language=en|doi=10.1002/9781118528563.wbcbt23/abstract|date=Nov 29, 2013|location =Chichester, West Sussex, UK|publisher =Wiley Blackwell|editor-last=Hofmann|editor-first=Stefan G.|isbn=1118533208}}</ref>
*2013, [http://onlinelibrary.wiley.com/doi/10.1002/9781118528563.wbcbt23/abstract Wiley - Chronic Fatigue Syndrome Part Two. Specific Disorders]<ref>{{Cite book | last = Chalder | first = Trudie | authorlink = Trudie Chalder | title = The Wiley Handbook of Cognitive Behavioral Therapy | chapter = Chronic Fatigue Syndrome | volume = 2 | url= http://onlinelibrary.wiley.com/doi/10.1002/9781118528563.wbcbt23/abstract | language=en| doi=10.1002/9781118528563.wbcbt23/abstract | date = Nov 29, 2013| location =Chichester, West Sussex, UK|publisher =Wiley Blackwell|editor-last = Hofmann|editor-first = Stefan G.|isbn=1118533208}}</ref>
*2015, [https://www.researchgate.net/publication/281294896_Statistical_Spin_Linguistic_Obfuscation_The_Art_of_Overselling_the_CBT_Evidence_Base Statistical Spin, Linguistic Obfuscation: The Art of Overselling the CBT Evidence Base]<ref name="Dalal2015">{{Cite web|last=Dalal|first=Farhad|journal =The Journal of Psychological Therapies in Primary Care|volume = 4|date=May 2015|pages= 1-25|url=https://www.researchgate.net/publication/281294896_Statistical_Spin_Linguistic_Obfuscation_The_Art_of_Overselling_the_CBT_Evidence_Base|type=pdf|title=Statistical Spin, Linguistic Obfuscation: The Art of Overselling the CBT Evidence Base|access-date=2019-02-20|authorlink=Farhad Dalal|archive-url=|archive-date=}}</ref>
*2015, [https://www.researchgate.net/publication/281294896_Statistical_Spin_Linguistic_Obfuscation_The_Art_of_Overselling_the_CBT_Evidence_Base Statistical Spin, Linguistic Obfuscation: The Art of Overselling the CBT Evidence Base]<ref name="Dalal2015">{{Cite web | last = Dalal|first = Farhad|journal =The Journal of Psychological Therapies in Primary Care|volume = 4 | date = May 2015 | pages = 1-25 | url = https://www.researchgate.net/publication/281294896_Statistical_Spin_Linguistic_Obfuscation_The_Art_of_Overselling_the_CBT_Evidence_Base|type=pdf | title = Statistical Spin, Linguistic Obfuscation: The Art of Overselling the CBT Evidence Base|access-date=2019-02-20 | authorlink = Farhad Dalal|archive-url=|archive-date=}}</ref>
*2016, [http://www.tandfonline.com/doi/full/10.1080/21641846.2016.1200884 Editorial: Cognitive-behavior therapy: why is it so vilified in the chronic fatigue syndrome community?]<ref name="Friedberg2016">{{Cite journal|last=Friedberg|first=Fred|date=2016-07-02|title=Cognitive-behavior therapy: why is it so vilified in the chronic fatigue syndrome community?|url=http://www.tandfonline.com/doi/full/10.1080/21641846.2016.1200884|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=4|issue=3|pages=127–131|doi=10.1080/21641846.2016.1200884|issn=2164-1846}}</ref>
*2016, [http://www.tandfonline.com/doi/full/10.1080/21641846.2016.1200884 Editorial: Cognitive-behavior therapy: why is it so vilified in the chronic fatigue syndrome community?]<ref name="Friedberg2016">{{Cite journal | last = Friedberg|first = Fred | date = 2016-07-02 | title = Cognitive-behavior therapy: why is it so vilified in the chronic fatigue syndrome community? | url = http://www.tandfonline.com/doi/full/10.1080/21641846.2016.1200884|journal = Fatigue: Biomedicine, Health & Behavior |language=en|volume=4 | issue = 3 | pages = 127–131|doi=10.1080/21641846.2016.1200884|issn=2164-1846}}</ref>
*2018, [https://medicalxpress.com/news/2018-07-therapy-treatment-schizophrenia.amp New study questions use of talking therapy as a treatment for schizophrenia]<ref>{{Cite news|url=https://medicalxpress.com/news/2018-07-therapy-treatment-schizophrenia.amp|title=New study questions use of talking therapy as a treatment for schizophrenia|last=|first=|date=Jul 20, 2018|work=Medical Xpress|access-date=2018-10-13|archive-url=|archive-date=|publisher=University of Hertfordshire|language=en}}</ref>
*2018, [https://medicalxpress.com/news/2018-07-therapy-treatment-schizophrenia.amp New study questions use of talking therapy as a treatment for schizophrenia]<ref>{{Cite news |url =https://medicalxpress.com/news/2018-07-therapy-treatment-schizophrenia.amp | title = New study questions use of talking therapy as a treatment for schizophrenia | last = | first = | date = Jul 20, 2018|work=Medical Xpress|access-date=2018-10-13|archive-url=|archive-date=| publisher = University of Hertfordshire|language=en}}</ref>
*2017, [https://www.researchgate.net/profile/Keith_Geraghty/publication/308181085_Cognitive_behavioural_therapy_in_the_treatment_of_chronic_fatigue_syndrome_A_narrative_review_on_efficacy_and_informed_consent/links/5a15a37e4585153b546ca7c7 Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent]<ref name="keith" />
*2017, [https://www.researchgate.net/profile/Keith_Geraghty/publication/308181085_Cognitive_behavioural_therapy_in_the_treatment_of_chronic_fatigue_syndrome_A_narrative_review_on_efficacy_and_informed_consent/links/5a15a37e4585153b546ca7c7 Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent]<ref name="keith" />
*2018, [https://www.researchgate.net/publication/328100169_CBT_The_Cognitive_Behavioural_Tsunami_Managerialism_Politics_and_the_Corruptions_of_Science CBT: The Cognitive Behavioural Tsunami: Managerialism, Politics and the Corruptions of Science]<ref name="Dalal2018">{{Cite book|url=https://www.researchgate.net/publication/328100169_CBT_The_Cognitive_Behavioural_Tsunami_Managerialism_Politics_and_the_Corruptions_of_Science|title=CBT: The Cognitive Behavioural Tsunami: Managerialism, Politics and the Corruptions of Science|last=Dalal|first=Farhad|authorlink=Farhad Dalal|date=Sep 2018|publisher=|doi=10.4324/9780429457814
*2018, [https://www.researchgate.net/publication/328100169_CBT_The_Cognitive_Behavioural_Tsunami_Managerialism_Politics_and_the_Corruptions_of_Science CBT: The Cognitive Behavioural Tsunami: Managerialism, Politics and the Corruptions of Science]<ref name="Dalal2018">{{Cite book | url = https://www.researchgate.net/publication/328100169_CBT_The_Cognitive_Behavioural_Tsunami_Managerialism_Politics_and_the_Corruptions_of_Science | title = CBT: The Cognitive Behavioural Tsunami: Managerialism, Politics and the Corruptions of Science | last = Dalal|first = Farhad | authorlink = Farhad Dalal | date = Sep 2018| publisher = |doi=10.4324/9780429457814
|isbn=9780429457814|archive-url=|archive-date=|access-date=2019-02-20}}</ref>  (Research Abstract)
|isbn=9780429457814|archive-url=|archive-date=|access-date=2019-02-20}}</ref>  (Research Abstract)


Latest revision as of 21:56, December 14, 2023

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,[1] 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.[1][2][3] 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.[4][5][6]

CBT is one of the therapies used in the controversial PACE trial.[7]

Cognitive Behavioral Therapy for ME/CFS: What's the issue? This is not an argument with psychiatry. Mental and physical illness are equally real and horrible. As with any long-term illness, some people with ME/CFS will develop comorbid depression and other mental health problems where CBT can be of help alongside good quality general management. The argument here is with a flawed model of causation assuming efficacy for CBT and GET while taking no significant account of varying clinical presentations and disease pathways. —Charles Shepherd, Journal of health psychology (2017)[8]
CBT for ME/CFS: What's the issue?[8]

United Kingdom[edit | edit source]

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[edit | edit source]

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.[9] 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.[9]

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.[10][11]

Harms of Cognitive Behavioural Therapy and Graded Exercise Therapy

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.

“
”
Dr Maik Speedy


Long term effects[edit | edit source]

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.[12]

Reports of harm[edit | edit source]

Surveys from patient organizations have found considerable rates of harm from CBT among the patients surveyed.[3][13] 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.[14] 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.[15]

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.[16][7]

Articles explaining CBT not appropriate for ME/CFS[edit | edit source]

CDC withdrawal of CBT treatment[edit | edit source]

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.[21][22]

Notable studies[edit | edit source]

  • 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[25] (Full text)
  • 2018, Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review[29]
  • 2018, Cognitive–behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe[30]
  • 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[10]
  • 2020, Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)[11]

See also[edit | edit source]

Critics

Other important links

Learn more[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Twisk, Frank N.M.; Maes, Michael (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". Neuro Endocrinology Letters. 30 (3): 284–299. ISSN 0172-780X. PMID 19855350.
  2. ↑ 2.0 2.1 Friedberg, Fred (July 2, 2016). "Cognitive-behavior therapy: why is it so vilified in the chronic fatigue syndrome community?". Fatigue: Biomedicine, Health & Behavior. 4 (3): 127–131. doi:10.1080/21641846.2016.1200884. ISSN 2164-1846.
  3. ↑ 3.0 3.1 3.2 Speedy, Maik (December 2015). "Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome" (PDF). Annals of Internal Medicine. 163 (11): 884–885. doi:10.7326/L15-5170. PMID 26618290. 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.
  4. ↑ Chalder, Trudie; Goldsmith, Kimberley A; White, Peter D; Sharpe, Michael; Pickles, Andrew R (2015). "Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial". The Lancet Psychiatry. 2 (2): 141–152. doi:10.1016/S2215-0366(14)00069-8. ISSN 2215-0366.
  5. ↑ 5.0 5.1 5.2 5.3 Geraghty, Keith J; Blease, Charlotte (September 15, 2016). "Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent" (PDF). Journal of Health Psychology. 23 (1): 127–138. doi:10.1177/1359105316667798. ISSN 1359-1053.
  6. ↑ World Health Organization. "8E49 Postviral fatigue syndrome | ICD-11 - Mortality and Morbidity Statistics". icd.who.int. Retrieved November 2, 2018. 8E49 Postviral fatigue syndrome
    Other disorders of the nervous system
    Inclusions Benign myalgic encephalomyelitis
    chronic fatigue syndrome
  7. ↑ 7.0 7.1 "Our Illness Management Report calls for major changes to therapies offered for ME/CFS | 29 May 2015". The ME Association. Retrieved October 13, 2018.
  8. ↑ 8.0 8.1 Shepherd, Charles B (2017). "PACE trial claims for recovery in myalgic encephalomyelitis/chronic fatigue syndrome – true or false? It's time for an independent review of the methodology and results". Journal of Health Psychology. doi:10.1177/1359105317703786.
    This is not an argument with psychiatry. Mental and physical illness are equally real and horrible. As with any long-term illness, some people with ME/CFS will develop comorbid depression and other mental health problems where CBT can be of help alongside good quality general management. The argument here is with a flawed model of causation assuming efficacy for CBT and GET while taking no significant account of varying clinical presentations and disease pathways.
  9. ↑ 9.0 9.1 Nijs, Jo; Roussel, Nathalie; Van Oosterwijck, Jessica; De Kooning, Margot; Ickmans, Kelly; Struyf, Filip; Meeus, Mira; Lundberg, Mari (May 3, 2013). "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). Clinical Rheumatology. 32 (8): 1121–1129. doi:10.1007/s10067-013-2277-4. ISSN 0770-3198.
  10. ↑ 10.0 10.1 Ahmed, SA; Mewes, JC; Vrijhoef, HJM (May 10, 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". Journal of Health Psychology. 25 (2): 240–255. doi:10.1177/1359105319847261. ISSN 1359-1053.
  11. ↑ 11.0 11.1 Kim, Do-Young; Lee, Jin-Seok; Park, Samuel-Young; Kim, Soo-Jin; Son, Chang-Gue (January 6, 2020). "Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)". Journal of Translational Medicine. 18 (1): 7. doi:10.1186/s12967-019-02196-9. ISSN 1479-5876. PMC 6943902. PMID 31906979.
  12. ↑ Westen, Drew; Novotny, Catherine M.; Thompson-Brenner, Heather (2004). "The Empirical Status of Empirically Supported Psychotherapies: Assumptions, Findings, and Reporting in Controlled Clinical Trials". Psychological Bulletin. 130 (4): 631–663. doi:10.1037/0033-2909.130.4.631. ISSN 1939-1455.
  13. ↑ 13.0 13.1 Kindlon, Tom (2011). "Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome" (PDF). Retrieved October 29, 2018.
  14. ↑ 14.0 14.1 "ME/CFS Illness Management Survey Results - "No decisions about me without me" Part 1" (PDF). ME Association. ME Association. May 2015.
  15. ↑ 15.0 15.1 Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS) (February 27, 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" (PDF). Oxford Brookes University.
  16. ↑ Brown, Robin. "NICE stop harming ME/CFS patients - Take CBT and GET out of the CFS guidelines NOW! | Sign the Petition". Change.org. Retrieved November 13, 2018.
  17. ↑ Johnson, Cort (November 14, 2015). "The Chokehold Behavioral Treatments Have on Chronic Fatigue Syndrome". Health Rising.
  18. ↑ "ME/CFS Australia (SA) Inc: ME/CFS Research UK Slams Lancet Psychiatry Report Advocating Exercise For Chronic Fatigue Syndrome Sufferers". sacfs.asn.au. Retrieved October 13, 2018.
  19. ↑ Goudsmit, Ellen; Howes, Sandra (May 29, 2017). "Bias, misleading information and lack of respect for alternative views have distorted perceptions of myalgic encephalomyelitis/chronic fatigue syndrome and its treatment". SAGE Journals. doi:10.1177/1359105317707216. Retrieved December 23, 2018.
  20. ↑ Geraghty, Keith; Jason, Leonard; Sunnquist, Madison; Blease, Charlotte; Tuller, David; Adeniji, Charles (February 2019). "The 'Cognitive Behavioural Model' of Chronic Fatigue Syndrome: Critique of a Flawed Model". Journal of Health Psychology. 6 (1): 2055102919838907. PMID 31041108.
  21. ↑ Tuller, David (July 10, 2017). "Trial By Error: The CDC Drops CBT/GET". Virology Blog.
  22. ↑ "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". CDC. Retrieved July 10, 2017.
  23. ↑ Núñez, Montserrat; Fernández-Solà, Joaquim; Nuñez, Esther; Fernández-Huerta, José-Manuel; Godás-Sieso, Teresa; Gomez-Gil, Esther (March 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". Clinical Rheumatology. 30 (3): 381–389. doi:10.1007/s10067-010-1677-y. ISSN 1434-9949. PMID 21234629.
  24. ↑ Illegems, Jela; Moorkens, Greta; Van Den Eede, Filip (2016). "Group Cognitive Behaviour Therapy for Chronic Fatigue Syndrome". Psychotherapy and Psychosomatics. 85 (5): 308. doi:10.1159/000445166. ISSN 1423-0348. PMID 27513528.
  25. ↑ Geraghty, Keith; Hann, Mark; Kurtev, Stoyan (August 29, 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". Journal of Health Psychology. doi:10.1177/1359105317726152.
  26. ↑ McPhee, Graham (2017). "Cognitive behaviour therapy and objective assessments in chronic fatigue syndrome". Journal of Health Psychology. 22 (9): 1181–1186. doi:10.1177/1359105317707215. ISSN 1461-7277. PMID 28805529.
  27. ↑ Wilshire, Carolyn E.; Kindlon, Tom; Courtney, Robert; Matthees, Alem; Tuller, David; Geraghty, Keith; Levin, Bruce (March 22, 2018). "Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT". BMC Psychology. 6 (1). doi:10.1186/s40359-018-0218-3. ISSN 2050-7283. PMC 5863477. PMID 29562932.
  28. ↑ Spandler, Helen; Allen, Meg (August 16, 2017). "Contesting the psychiatric framing of ME/CFS" (PDF). Social Theory & Health. 16 (2): 127–141. doi:10.1057/s41285-017-0047-0. ISSN 1477-8211.
  29. ↑ Vink, Mark; Vink-Niese, Alexandra (October 8, 2018). "Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review". Health Psychology Open. 5 (2). doi:10.1177/2055102918805187. ISSN 2055-1029. PMID 30305916.
  30. ↑ Twisk, Frank; Corsius, Lou (August 2018). "Cognitive–behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe". The British Journal of Psychiatry. 213 (2): 500–501. doi:10.1192/bjp.2018.136. ISSN 0007-1250.
  31. ↑ Baschetti, Riccardo (April 2001). "Cognitive behaviour therapy and chronic fatigue syndrome" (PDF). British Journal of General Practice. 51 (465): 316. PMC 1313986.
  32. ↑ Chalder, Trudie (November 29, 2013). "Chronic Fatigue Syndrome". In Hofmann, Stefan G. (ed.). The Wiley Handbook of Cognitive Behavioral Therapy. 2. Chichester, West Sussex, UK: Wiley Blackwell. doi:10.1002/9781118528563.wbcbt23/abstract. ISBN 1118533208.
  33. ↑ Dalal, Farhad (May 2015). "Statistical Spin, Linguistic Obfuscation: The Art of Overselling the CBT Evidence Base". The Journal of Psychological Therapies in Primary Care (pdf). pp. 1–25. Retrieved February 20, 2019.
  34. ↑ "New study questions use of talking therapy as a treatment for schizophrenia". Medical Xpress. University of Hertfordshire. July 20, 2018. Retrieved October 13, 2018.
  35. ↑ Dalal, Farhad (September 2018). CBT: The Cognitive Behavioural Tsunami: Managerialism, Politics and the Corruptions of Science. doi:10.4324/9780429457814. ISBN 9780429457814. Retrieved February 20, 2019.

cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

physiological Concerning living organisms, such as cells or the human body.  Physio logical (as in physio) is not to be confused with psych ological (emotional stress).

cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

bias Bias in research is "a systematic deviation of an observation from the true clinical state". (Learn more: me-pedia.org)

randomized controlled trial (RCT) - A trial in which participants are randomly assigned to two groups, with one group receiving the treatment being studied and a control or comparison group receiving a sham treatment, placebo, or comparison treatment.

cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

bias Bias in research is "a systematic deviation of an observation from the true clinical state". (Learn more: me-pedia.org)

cognition Thought processes, including attention, reasoning, and memory.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

cognition Thought processes, including attention, reasoning, and memory.

randomized controlled trial (RCT) - A trial in which participants are randomly assigned to two groups, with one group receiving the treatment being studied and a control or comparison group receiving a sham treatment, placebo, or comparison treatment.

cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

PACE trial A controversial study which claimed that CBT and GET were effective in treating "CFS/ME", despite the fact that its own data did not support this conclusion. Its results and methodology were widely disputed by patients, scientists, and the peer-reviewed scientific literature.

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