translation of the statement in Dutch]
According to common
opinion is Myalgic
Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS) a medically
unexplained syndrome and
behavorial therapy (CGT), in combination with graded exercise
therapy (GET), the only
evidence-based effective therapy.
In an article in
Tijdschrift voor Psychotherapie (July 2011), a Dutch scientific
magazine for psychologists/psychotherapists, Twisk, Arnoldus and Maes substantiate that these claims are false.
symptoms of ME/CFS, like exhaustion, pain, cognitive impairment and
an aggravation of
the various symptoms after minor exertion (post-exertional malaise), can (bio)logically
be explained at large by various organical abnormalities, which have been
found repeatedly in ME/CFS:
aberrations (amongst others intracellular inflammation),
nitrosative stress, hyperpermeability of the gut) and
mitochondrial dysfunction, hypoperfusion et cetera.
claim that CBT/GET is the only effective treatment for ME/CFS,
which could result
into recovery up to 70% of the patients, is false.
CBT/GET is not
significantly more effective than standard medical care,
and only results
into subjective improvement in Ī30% of people with “chronic fatigue”
(not ME/CFS), which is not
reflected in objective improvement, and by large not
sufficient to qualify as moderate effective.
Even worse, CBT/GET
has a potential negative effect in 30-50% of the ME/CFS patients.
The authors stress
the need for a drastic change of direction, from the current
psychological-oriented outlook towards a medical approach, aimed at:
an objective and
quick diagnosis, based upon clinical criteria;
objectively measure symptoms (e.g. repeated exercise tests) ;
demonstrated biological abnormalities in more detail
in the ME/CFS patient group and subgroups thereof (based upon
testing pharmaceuticals, supplements etc. that reverse the biological abnormalities established in
(individual) ME/CFS patients.
1 ME-de-patiŽnten Foundation,
Limmen, the Netherlands
Frank Twisk MBA
1906 HB Limmen
2 Clinical Research Center for
Mental Health (CRC-MH), Antwerp, Belgium.
Dr. Michael Maes
ME/CFS, the psychotherapist and the power(lessness) of the evidence
Psychother. 2011; (37)4: 233-258.
Frank N.M. Twisk,
Rob J.W. Arnoldus en Michael Maes.
Behavioral Therapy (CBT)/Graded Exercise Therapy (GET)
is often proclaimed
to be the only
evidence-based therapy for
Encephalo≠myelitis (ME)/Chronic Fatigue Syndrome (CFS).
research has proven that the
psychosocial explanatory models of Vercoulen and others – being the
justification for CBT/GET –
are invalid, and
that CBT/GET is not
only ineffective, but also
potentially harmful for many patients.
symptoms, like pain,
cognitive impairment, fatigue and post-exertional malaise, can plausibly be
explained by physical
inflammation, oxidative/nitrosative stress, metabolic
dysfunction, cardiovascular disturbances, gastro-intestinal
aberrations and ion channel dysfunction.
The dominance of
the psychosocial explanatory model and CBT/GET
financial/social and psycho/emotional consequences for patients.
Based upon these
psychologist/psychotherapist should question
his role as CBT/GET therapist, also because,
as a result of
psychologising ME/CFS, many patients are
reluctant to seek essential psychological counselling
aimed at coping with the disease.