The ‘cognitive behavioural model’ of chronic fatigue syndrome: Critique of a flawed model

Abstract

Chronic fatigue syndrome/myalgic encephalomyelitis is a debilitating illness that greatly impacts the lives of sufferers. A cognitive behavioural model attempts to explain illness onset and continuance with a hypothesis that the illness is perpetuated by patients’ irrational beliefs and avoidance behaviours. This theory underpins the promotion of cognitive behavioural therapy, a treatment that aims to change beliefs and behaviours. This article reports on a detailed review of the cognitive behavioural model. Our review finds that the model lacks high-quality evidential support, conflicts with accounts given by most patients and fails to account for accumulating biological evidence of pathological and physiological abnormalities found in patients. There is little scientific credibility in the claim that psycho-behavioural therapies are a primary treatment for this illness.

The evidence base for physiotherapy in myalgic encephalomyelitis/chronic fatigue syndrome when considering post-exertional malaise: a systematic review and narrative synthesis

“…Previously, and still by some clinicians and research groups, ME/CFS was understood and approached by applying a psychogenic or psychosomatic model [ 4 , 5 ]. Onset and continuance of the illness were then considered to be perpetuated by patients’ irrational beliefs, avoidance behavior, health anxiety, hypochondriasis or personality traits.…”

Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified

“…The cognitive behavioural model of MUS of Deary et al, draws from a wide variety of literature and evidence concerning the efficacy of CBT in randomised controlled trials, with much emphasis on ME/ CFS treatment evidence. It is not feasible for us to consider all this evidence within the confines of this paper however, this evidence is critiqued elsewhere [21,22].…”

Rethinking the Standard of Care for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

“…One unfortunate consequence of the model is that ME/CFS has come to be viewed, not as a biologically based illness, but rather as a psychological ailment that is reversible with behavioral therapies. 29,30 This model stands in stark contrast to the harsh reality of this disabling condition and the significant evidence of neurological, immunological, autonomic, and energy metabolism impairment, as reviewed in an influential 2015 Institute of Medicine report. 31 The appropriate use of CBT, which may be selectively indicated in a number of chronic diseases, such as cancer, is intended to promote patients' ability to cope with their illnesses in order to improve quality of life, e.g., Daniels.…”