This review looked at research studies testing two treatments commonly recommended for ME/CFS: graded exercise therapy (GET) and cognitive behavioral therapy (CBT). The researchers found that patients were actually more likely to be unable to work after receiving these treatments than before, and that both treatments can be harmful. The authors conclude that doctors should stop encouraging ME/CFS patients to push themselves harder to recover, since these approaches don't work and may make things worse.
Why It Matters
This study is important because it directly challenges decades-old treatment guidelines that many ME/CFS patients have been encouraged or pressured to follow. The findings validate patient reports of harm from these treatments and provide evidence-based support for reconsidering medical approaches to ME/CFS, potentially reducing inappropriate patient management and unnecessary harm.
Observed Findings
- More patients were unable to work after CBT/GET treatment than before treatment
- Both GET and CBT were associated with safety concerns in ME/CFS populations
- The NICE guideline update concluded GET and CBT are not effective and do not lead to recovery
- No published trials of GET or CBT for long COVID were identified
Inferred Conclusions
- Questioning ME/CFS patients' recovery motivation is not justified by evidence and is counterproductive
- GET and CBT should not be recommended as primary treatments for ME/CFS
- Current medical practice of encouraging patients to push through symptoms may be iatrogenic
- Evidence-based guidelines should reflect that these widely-promoted treatments are ineffective and potentially harmful
Remaining Questions
- What are effective, safe treatment approaches for ME/CFS that should replace GET and CBT?
- Why do GET and CBT produce worse outcomes, and what are the mechanisms of harm?
- Are there specific ME/CFS patient subgroups for whom GET or CBT might have different risk-benefit profiles?
What This Study Does Not Prove
This review does not establish the optimal treatments for ME/CFS, only that GET and CBT are not effective. It also does not prove mechanisms of harm in individual patients or provide guidance on safe, alternative management approaches. The absence of long COVID studies means conclusions about that condition remain preliminary.