A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in CFS

Neuro Endocrinol Lett. 2009 Aug 26;30(3):284-299. [Epub ahead of print]

A review on cognitive behavorial 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 harm.

Twisk FN, Maes M. ME-de-patiënten Foundation, Limmen, the Netherlands, the Netherlands.

Benign Myalgic Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS) is a debilitating disease which, despite numerous biological abnormalities has remained highly controversial. Notwithstanding the medical pathogenesis of ME/CFS, the (bio)psychosocial model is adopted by many governmental organizations and medical professionals to legitimize the combination of Cognitive Behavioral Therapy (CBT) and Graded Exercise Therapy (GET) for ME/CFS. Justified by this model CBT and GET aim at eliminating presumed psychogenic and socially induced maintaining factors and reversing deconditioning, respectively. In this review we invalidate the (bio)psychosocial model for ME/CFS and demonstrate that the success claim for CBT/GET to treat ME/CFS is unjust. CBT/GET is not only hardly more effective than non-interventions or standard medical care, but many patients report that the therapy had affected them adversely, the majority of them even reporting substantial deterioration. Moreover, this review shows that exertion and thus GET most likely have a negative impact on many ME/CFS patients.

Exertion induces post-exertional malaise with a decreased physical performan-ce/aerobic capacity, increased muscoskeletal pain, neurocognitive impairment, "fatigue", and weakness, and a long lasting "recovery" time. This can be explained by findings that exertion may amplify pre-existing pathophysiological abnormalities underpinning ME/CFS, such as inflammation, immune dysfunction, oxidative and nitrosative stress, channelopathy, defective stress response mechanisms and a hypoactive hypothalamic-pituitary-adrenal axis. We conclude that it is unethical to treat patients with ME/CFS with ineffective, non-evidence-based and potentially harmful "rehabilitation therapies", such as CBT/GET.

PMID: 19855350 [PubMed - as supplied by publisher]

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written by Maff, November 02, 2009

An excellent review that highlights what many ME/CFS patients have known for a long time - that CBT and GET are not effective treatments and can often cause aggravation of symptoms and relapses. The biological evidence and findings of poor response to CBT and GET presented in this review remove any credibility from this approach. It is time governments and health authorities really look at the evidence and stop insisting that CBT and GET be the first line treatment approach for what is undeniably a physical and disabling condition.