Is Cognitive Behavioral Therapy Harmful in CFS?

Published: August 6, 2012

Unfortunately, instead of the sane and obvious conclusion: “For any illness it is helpful to get counseling if needed and to walk as able so your body doesn't get deconditioned from being bedridden,” the questions of counseling and exercise in CFS have instead centered around whether the illness is real or whether people with the disease are crazy.

The obvious answer? The illness is real but the people who try to make believe that it is not are driving the patients crazy.

This is what is occurring in cognitive behavioral therapy (CBT). In simple terms, CBT simply teaches patients coping skills for dealing with any devastating illness — whether it is cancer, kidney failure, blindness, or CFS. To do so when needed is simply common sense. Unfortunately, some of those using it for CFS believe that they have to convince the patients that their disease is not real. Besides being abusive, this approach is insane and often makes the patients worse. Nonetheless, it can save insurance companies tons of money. When this is the case, even insane ideas can become the norm.

In this review, recognizing the harm done by those trying to make CFS a psychological disease, I suspect the review authors are also giving a fairly one-sided view.

The bottom line? CFS and fibromyalgia are of course real and physical diseases that have many causes and can benefit from many therapies. While doing these therapies, it is reasonable to learn coping skills and to exercise as able (which in some cases may be no more than walking a few minutes daily) to maintain the physical conditioning that you are able to. Meanwhile, use the SHINE protocol to address the sleep, hormonal, infectious and nutritional issues.


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
Frank Nm Twisk and Michael Maes.
Neuro Endocrinol Lett, August 26, 2009; 30(3): 284-299.
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 profes-sio-nals 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 address 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 pa-thophysiological abnormalities underpinning ME/CFS, such as inflammation, immune dysfunction, oxidative and nitrosative stress, channelopathy, defec-tive 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.

Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. His newest book (June 10, 2024) is You Can Heal From Long COVID. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.

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