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[A review on CBT and GET in ME/CFS: Not only ineffective and not evidence-based, but also potentially harmful] – Source: NeuroEndocrinology Letters, Sep 15, 2009

  [ 38 votes ]   [ 2 Comments ]
By Frank NM Twisk, Michael Maes • • October 27, 2009

[Note: the full title of this article, abbreviated above owing to length limitations, is "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."]

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.

Source: Neuro Endocrinology Letters, Sep 15, 2009;30(3):284-299. PMID: 19855350, by Twisk FN, Maes M. ME-de-patienten Foundation, Limmen, The Netherlands; Clinical Research Center for Mental Health (CRC-MH), Antwerp, Belgium. [E-mail:]

See also the accompanying article by Twisk and Maes - "Chronic Fatigue Syndrome: La Bete Noire of the Belgian Health Care System."

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Article Comments Post a Comment

Article Highly Misleading AND Lacks Proof
Posted by: lovereading
Nov 11, 2009
This article is so misleading and anything BUT objective. The author provides details only about GET but then slips CBT into his assessment without providing any facts to substantiate his claim. ProHealth: shame on you for publishing this on your website. You owe it to your readers to provide objective, unbiased information. If an author makes a claim, s/he should back it up at the same time (not later) with statistics, naming the study and where it was done, etc. You have actually done the entire CFS/FMS community a DISservice by publishing this article, because now health insurance companies can point to articles such as this to justify denying coverage of treatments that ARE in fact helpful.
Reply Reply

Posted by: coma
Nov 14, 2009
I haven't been able to read the full article, but I can confirm that in my experience as someeone who has cfs, GET is not a good idea.
Reply Reply
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