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.

Observed Findings

• Patient-reported substantial deterioration following CBT/GET treatment in a significant proportion of cases
• CBT/GET outcomes were not substantially superior to non-intervention controls or standard medical care
• Post-exertional malaise manifests as decreased physical performance, increased pain, neurocognitive impairment, and extended recovery times following exertion
• Physiological evidence suggests exertion may amplify underlying pathophysiological abnormalities including inflammation, immune dysfunction, oxidative stress, and channelopathy
• The biopsychosocial model's assumptions about deconditioning and psychogenic factors lack adequate validation in ME/CFS populations

Inferred Conclusions

• CBT and GET are not evidence-based treatments for ME/CFS and should be considered potentially harmful rather than therapeutic
• ME/CFS has biological underpinnings that make exercise-based rehabilitation contraindicated, as exertion worsens underlying pathophysiology
• Current medical recommendations promoting CBT/GET for ME/CFS are ethically problematic given lack of efficacy and documented patient harm
• Treatment approaches for ME/CFS should be based on its biological disease mechanisms rather than psychosocial models

Remaining Questions