On 13th January, Frontiers published an opinion piece entitled ‘CBT and graded exercise therapy studies have proven that ME/CFS and long Covid are physical diseases, yet no one is aware of that' (Vink &Vink-Niese 2025) that discusses the unfounded cognitive behavioural model in relation to the disease ME/CFS.
Extracts
The cognitive behavioral model (CBmodel) has dominated the world of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) since the 1990s. According to this model, a belief in an organic illness, known as dysfunctional beliefs, stops ME/CFS patients engaging in normal activities, resulting in avoidance behavior and deconditioning.
According to the CBmodel, symptoms of ME/CFS are caused by deconditioning and not by an underlying illness. Cognitive behavioral therapy with graded activity (CBTplus) and graded exercise therapy (GET) were designed to reverse the dysfunctional beliefs, the avoidance behavior and the deconditioning and lead to recovery. As many runners know, if you are a beginner and you start exercising three times a week, you can run half a marathon in 12 weeks.
In a healthy sedentary person who doesn't do physical exercise or work, that will take around 12 to 24 weeks. Let's keep that in mind and have a look at the largest CBTplus and GET trial for ME/CFS, the PACE trial (n=641), and its GET group, in particular. The 160 participants in that group were exercising five days a week for up to 30 minutes per day for 24 weeks. If there would be no underlying disease, and patients were merely deconditioned, then such an exercise regime would lead to a very substantial improvement in fitness. However, fitness did not improve.
Three Dutch studies showed the following: eight months of CBTplus in adults, five months of CBTplus in adolescents and at least 16 weeks of guided self-instructions in adults, based on CBTplus, did not lead to an objective improvement of activity (actometer) . A 12-week programme of GET , an 18-week programme combining CBTplus and GET in the more severely affected and the evaluation of the efficacy of CBTplus and GET in the Belgium reference centers showed no objective improvement in fitness, according to VO2peak, a timed step test, which “strongly and reliably predicts the maximal aerobic capacity VO2max” and VO2peak or VO2max, respectively.
This is not only important for ME/CFS patients, but also for those with long Covid because not only do around 60% of them fulfill ME/CFS criteria.