Interesting study.

Many patients with CFS experience the suggestion of CBT as the sole treatment modality as a placebo which minimizes the severity of their illness - in fact, they experience "treatment" which only offers CBT as a not-too-subtle way of denying CFS as a bona-fide illness.

The most useful finding of this study, as far as I am concerned, is the conclusion that CBT is not effective for severely ill CFS patients.

I highly agree with the above comment. That would be like telling someone with diabetes or cancer that CBT will be their sole treatment.

My chronic fatigue is due to three active Mono viruses, one of which I've had for 5 years. CBT has definite benefits, but it is not anti-viral therapy.

Yes, I understand the reaction, given the way CFS and FM were perceived for so many years to be a "non-condition, concocted by attention-seeking malingerers" by far too many medical people.

But the intention here might be similar to the motivation of the creators of the CBT programs created for cancer, cardio-vascular disease and M.S. patients: to reduce or alleviate some of the symptoms.

I fight the urge to go ballistic when I read that CBT is a potential treatment for Chronic Fatigue Syndrome. I was diagnosed for CFS for years before an alert doctor (the 14th I had tried) found both food intolerances I hadn't known about and Lyme Disease. With antibiotic treatment, and a change in diet, my condition improved 80-90%. (We don't know if the Lyme will ever be gone totally, as it was years before it was treated). All along I'd been getting cognitive therapy, thinking crushing fatigue like that had to be some conflict within; but it was the antibiotics and nutritional changes that gave me my life back. While CBT - even in the form of someone's perceived caring - may alleviate symptoms, I can't help but feel danger when anyone comes close to suggesting CBT as a treatment for CFS. My concern is that it becomes a too-ready answer for doctors who need to dig deeper for a potential organic cause. (For more info on Lyme and diagnosing it correctly, see www.ilads.org).

My understanding of how CBT is used is that is not intended to negate medical treatment. It is a psychotherapeutic method intended to address the impact of the illness on the person's life, and thus to ease as many symptoms as possible. It is based on the mind/body relationship. As a CBT, Clinical Hypnosis and Guided Imagery practitioner, I would never rule out medical treatment. I believe that to be the case with other such practitioners.

CBT lends itself to web-based programs, and we're seeing more and more of them - especially for emotional resilience, but they're also being set up to help people cope with hard core disease too. That's not the same as saying that CFS, FMS and Lyme are conditions that are "all in your head". But I think the outrage has to do with the way people with these diagnoses have been treated by the medical establishment in the past. At least I hope it's in the past. Most docs know better now, thanks to research and an active constituency of patients, setting them straight.

The place where people get bent out of shape in referencing CBT to CFS is in misunderstanding the application and intention of CBT. The moment you mention "cognitive" it evokes the specter of "psychosomatic", or worse yet, "psychogenic". People with CFS have already run a gauntlet of practitioners who, because they don't understand it or are uncomfortable with their own inadequacy in treating it, settle on the lazy way out -- blaming the patient and attributing CFS to psychological (i.e., "cognitive") causation. This of course is baloney (or is is bologna?). CFS is a real disease, and just because it is hard to grasp and treat doesn't justify this disrespect and neglect of people who suffer with it.
Where CBT does make a legitimate contribution is in two ways: its contribution to coping with stress, because CFS symptoms are extremely reactive to stress; and its contribution to raising mindfulness of how one's behavioral choices each day can influence symptom severity. In the absence of medical treatment, behavior and lifetyle management remain the most promising avenues for reducing suffering in CFS. Practicing mind/body techniques such as meditation and imagery ("cognitive" techniques) are helpful not because they treat CFS, but because they help cope with the stress associated with it, and they may also help with increased mindfulness of the subtle influences of behavior and lifestyle choices each day...