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Pushing through symptoms
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==CBT and GET== [[Cognitive behavioral therapy]] (CBT) and [[graded exercise therapy]] (GET) for ME/CFS both encourage people to push through symptoms. In CBT patients are encouraged to view the fact that ME/CFS is a serious, physical illness - as the Institute of Medicine (2015) states it is - as an "[[illness beliefs|illness belief]]" to be challenged rather than a scientific fact.<ref name="SEID-IOM2015" /><ref name="Strassheim2021" /> In CBT patients are expected to set "realistic" goals for what they would like to achieve and work towards those goals<ref name="Vink2020LC" /> - but with no biomarker or physical way to measure symptoms,<ref name="Geraghty2016" /><ref name="SEID-IOM2015">{{Cite book | last = Institute of Medicine | authorlink = Institute of Medicine| title = Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness|location=Washington, DC|publisher=The National Academies Press | date = 2015 | url=https://www.ncbi.nlm.nih.gov/books/NBK284902/ |isbn=0309316898 | pmid = 25695122 |doi = 10.17226/19012 }}</ref> patients are unaware of the severity of their illness - they may be working towards goals that are actually not simply unrealistic but impossible. Patients may be told that they have a maladaptive [[kinesiophobia|fear of or avoidance of exertion]] that is causing them to reduce their activities,<ref name="Geraghty2016" /> and causing reversible [[deconditioning]],<ref name="Geraghty2016" /> but scientific research shows that people cannot push through their symptoms on consecutive days - the [[post-exertional malaise]] caused by ME/CFS prevents this. Patients in the [[United Kingdom|UK]] completing CBT for ME/CFS based on this [[biopsychosocial model]] were found to remain "severely disabled".<ref name="Vink2021-CBT" /><br> In [[graded exercise therapy]] (GET) ME/CFS patients are expected to commit to very gradually increasing their activity levels, and are told to "push through" regardless of how much their symptoms worsen - they are told increases in symptoms are temporary but evidence shows this is a false assumption. A very large survey of UK patients found this GET approach caused most people to become more ill.<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) | date = Feb 27, 2019}}</ref>
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