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Harms associated with CBT and GET

Patient experiences of three commonly used psychotherapy-based treatments of ME and CFS—Cognitive Behavioral Therapy, Graded Exercise Therapy and Pacing—fail to match the benefit and safety claims of practitioners and researchers.

In a large survey of 1428 ME and CFS patients, undertaken by the ME Association (MEA) in the UK, a majority of participants reported their symptoms were unchanged or worsened by CBT, GET or Pacing treatment.

According to the MEA survey, CBT resulted in 91% of participants feeling their ME/CFS symptoms were unaffected or made worse, GET 88%, and Pacing 55%.


There is also a large body of biomedical research showing that exertion, whether mental or physical, can exacerbate the symptoms of ME and CFS.

Analytical reviews slam the use of CBT and GET

Several analytical reviews of the use of CBT and GET to manage ME and CFS have also found high rates of harm to patients undertaking the treatments.

Kindlon (2011) noted exercise-related physiological abnormalities and high rates of adverse reactions to exercise in a number of studies and patient surveys.

Kindlon found that 51 percent of survey respondents in eight surveys reported that GET worsened their health while 20 percent of respondents in five surveys reported similar results for CBT.


Kindon: Patients harmed by GET

Twisk and Maes (2009) concluded that it was unethical to treat patients with me/cfs with ineffective, non-evidence-based and potentially harmful ‘rehabilitation therapies’ such as CBT and GET.

“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.

“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.”

More patients receiving govt benefits after GET and CBT

According to the MEA survey mentioned earlier, the application of CBT resulted in 91% of participants feeling their ME/CFS symptoms were unaffected or made worse, for GET  this was 88%, and Pacing 55%.




The MEA survey also collected data relating to the receipt of government benefits, arguably an objective measure of the efficacy and safety of the therapies.

Alarmingly, 14% of patients treated with CBT and 13% with GET were forced to apply for government benefits or increased their benefits following treatment.

Also, there was a net overall increase in numbers of patients on benefits (and increased benefits) even when those who had their benefits decreased were taken into account.

Simply put, if CBT and GET were subject to the same safety and efficacy requirements applied to pharmaceutical treatments, they would be immediately withdrawn.


Biopsychosocial model used to justify GET and CBT

Despite a large body of evidence pointing to biological causes of ME and CFS, a biopsychosocial model is advocated by many governmental organizations and medical professionals to legitimize the combination of CBT and GET for treatment of the illness, often as the sole therapy.

In the biopsychosocial model, the patient can ‘recover’ by overcoming dysfunctional beliefs, sickness behaviour and deconditioning, which are suggested to be the maintaining factors in ME/CFS.

Further Reading

  • Kindlon, T., Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Bulletin of the IACFS/ME (peer-reviewed) 01/2011; 19:59-111. [abstract], [Full text]
  • Twisk FNM, Maes M. (2009) 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. Neuro Endocrinol Lett. 2009;30:284-299. [PubMed], [Full text]


FEATURED PHOTO: A111104_jb_contractors 001 by JBLM PAO


Written by Russell Logan


Russell Logan worked as a magazine publisher and editor until forced into early retirement through ill health with ME. He has battled with moderate to severe ME for 25 years. He now lives in Noosaville, Australia.

87 posts


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  1. Hmmm is anyuone else having problems with the pictures on this
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    • Hi Renate, they load okay for me, but the servers have been a bit sluggish lately. So unless I get confirmation for others, I can’t confirm where the problem is.

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