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>>>> 28 October 2009 <<<<
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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 harmful for many
patients with ME/CFS
Authors:
Frank N.M. Twisk 1 and Michael Maes 2
Journal: Neuroendocrinol Lett 2009; 30(3):
284=96299 PMID: 19855350 NEL300309R02
Affiliations:
1. ME-de-patienten Foundation, Limmen, the
Netherlands.
2. Clinical Research Center for Mental Health
(CRC-MH), Antwerp, Belgium.
Correspondence to: frank.twisk@hetnet.nl
Key words: biopsychosocial; CBT; graded
exercise; GET; ME; CFS; therapy; exertion;
exercise; immunity; inflammation; oxidative stress
Abstract
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 performance/ 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.
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