Tuesday, October 27, 2009

CBT/GET is not only ineffective, but potentially harmful

'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.
Neuro Endocrinol Lett. 2009 Aug 26;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 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 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.

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