Deary, Vincent · British journal of health psychology · 2008 · DOI
This study proposes a new way to understand ME/CFS by looking at how the body and mind try to adapt to living with the illness. The researchers suggest that people with ME/CFS develop a delicate balance with their condition, and when they try to fix things—like pushing through fatigue or avoiding activity—these efforts can sometimes backfire and make symptoms worse. The theory focuses on how physical sensations, emotions, and thoughts become tightly connected and reinforce each other in ME/CFS.
This mechanistic framework offers ME/CFS patients and clinicians an alternative conceptualization that may explain why some common coping strategies paradoxically worsen outcomes. Understanding how the body's adaptive responses can become counterproductive may guide development of more effective, personalized treatments that work with rather than against physiological and psychological regulation systems.
This is a theoretical paper that does not present new empirical data testing these hypotheses directly. It does not prove causation or demonstrate which self-regulation mechanisms are most important in ME/CFS, nor does it validate specific interventions. The proposed model requires prospective testing to confirm whether the described vicious cycles actually maintain CFS symptoms in affected individuals.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Deary, Vincent (2008). A precarious balance: using a self-regulation model to conceptualize and treat chronic fatigue syndrome.. British journal of health psychology. https://doi.org/10.1348/135910708X283760
BibTeX
@article{mecfsatlas-deary-2008-precarious-balance,
author = {Deary, Vincent},
title = {A precarious balance: using a self-regulation model to conceptualize and treat chronic fatigue syndrome.},
journal = {British journal of health psychology},
year = {2008},
doi = {10.1348/135910708X283760},
note = {PubMed: 18267050},
url = {https://www.mecfsatlas.com/evidence/deary-2008-precarious-balance},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/deary-2008-precarious-balance
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