Frank N.M. Twisk
1 and Michael Maes 2
1 ME-de-patiŽnten Foundation,
Limmen, the Netherlands
2 Clinical Research Center for
Mental Health (CRC-MH), Antwerp, Belgium.
Benign Myalgic Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS)
is a debilitating disease which, despite numerous biological abnormalities has
remained highly controversial.
Notwithstanding the medical pathogenesis of ME/CFS, the (bio)psychosocial
model is adopted by many governmental organizations and medical professionals
to legitimize the combination of Cognitive Behavioral Therapy (CBT) and Graded
Exercise Therapy (GET) for ME/CFS.
Justified by this model CBT and GET aim at
eliminating presumed psychogenic and socially induced maintaining factors and
reversing deconditioning, respectively.
In this review we invalidate the (bio)psychosocial model for ME/CFS and demonstrate
that the success claim for CBT/GET to treat ME/CFS is unjust. 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.
Moreover, this review shows that exertion and thus GET most likely have a negative
impact on many ME/CFS patients.
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.
This can be explained by findings that exertion may amplify pre-existing pathophysiological
abnormalities underpinning ME/CFS, such as inflammation,
immune dysfunction, oxidative and nitrosative stress, channelopathy, defective
stress response mechanisms and a hypoactive hypothalamic-pituitary-adrenal
We conclude that it is unethical to treat patients with ME/CFS with ineffective,
non-evidence-based and potentially harmful “rehabilitation therapies”, such as
The full-text version of the first article
can be obtained per individual
through the website of Neuroendocrinol Lett.
http://node.nel.edu/?node_id=8918 The full article is available from
Neuroendocrinology Letters Volume 30 No. 3 2009