Geraghty, Keith, Hann, Mark, Kurtev, Stoyan · Journal of health psychology · 2019 · DOI
This study asked ME/CFS patients about their experiences with three different treatment approaches: cognitive behavioural therapy (CBT), graded exercise therapy (GET), and pacing. The researchers found that pacing—where patients carefully manage their activity levels without pushing beyond their limits—was reported as most helpful and caused the fewest problems. In contrast, GET led to significant symptom worsening in over half of patients, while CBT helped only a small percentage of people.
This research directly addresses a significant disconnect between current clinical guidelines promoting GET and CBT versus patient-reported experiences of harm, particularly with GET. The large sample size and consistency across multiple surveys strengthens the evidence that treatment responses are heterogeneous and that pacing may be undervalued despite patient preference and reported safety profiles. These findings support the need for individualised treatment approaches and greater patient involvement in treatment selection.
This study cannot establish causation or prove that GET causes harm in all patients, as it relies on patient recall and self-reported outcomes without objective biomarkers, control groups, or blinded assessment. The cross-sectional design prevents determination of whether baseline differences between treatment groups explain outcome variations. It does not identify which patient subgroups might benefit from each approach or explain the mechanisms underlying differential responses.
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 →
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