Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent.
Geraghty, Keith J, Blease, Charlotte · Journal of health psychology · 2018 · DOI
Quick Summary
This review looked at whether cognitive behavioural therapy (CBT)—a type of talk therapy focused on thoughts and behaviors—actually helps ME/CFS patients. The researchers found that CBT may help some people feel less tired in the short term, but there's little proof it works long-term or improves physical abilities. Importantly, CBT can sometimes make people feel worse if it's not done carefully, and much of any improvement might come from the therapist's skill or placebo effect rather than the therapy itself.
Why It Matters
This study is crucial because CBT is widely promoted for ME/CFS despite limited evidence of long-term benefit. It highlights the importance of informed consent—patients need to understand both potential benefits and harms before choosing treatment. The findings raise ethical concerns about whether patients are given complete, honest information about CBT's actual effectiveness and risks.
Observed Findings
- CBT may produce changes in self-reported fatigue in some patients in the short term
- Limited evidence exists for long-term benefits beyond the initial treatment period
- No clear evidence that CBT improves physical function or objective measures
- Therapist effects and placebo effects are important factors influencing outcomes
- CBT can cause distress when inappropriately prescribed to ME/CFS patients
Inferred Conclusions
- A complex and potentially problematic theoretical model underlies the rationale for psychotherapy in ME/CFS that may not align with disease biology
- Patients receiving CBT for ME/CFS are often not adequately informed about the limited evidence base, risks of harm, or the role of non-specific effects
- Current evidence does not support CBT as a primary or first-line treatment with proven long-term efficacy
- Informed consent for CBT in ME/CFS requires substantial improvement in transparency about uncertainties and potential adverse outcomes
Remaining Questions
- What patient characteristics or ME/CFS subtypes might benefit from CBT versus those at risk of harm?
What This Study Does Not Prove
This review does not prove CBT is ineffective for all ME/CFS patients, only that evidence for long-term benefit and physical improvement is lacking. It cannot establish causation regarding harm from CBT or determine which patients might benefit from it. The study does not identify which specific CBT approaches (if any) might be most appropriate for ME/CFS.