TREATMENT DATABASE

Cognitive Behavioral Therapy (CBT) is a psychotherapeutic approach used by psychologists to treat dysfunctional behaviors.

CBT was primarily developed through an integration of behavior therapy, a form of therapy that utilizes behavioral conditioning, and cognitive therapy, a form of therapy developed in the 1960s that helps patients overcome dysfunctional beliefs. CBT is primarily used for psychological disorders that are rooted in the patient's basic concepts, ones that he or she may not be aware of. Through a partnership with the therapist, the patient learns to recognize and eliminate ideas which are contributing to dysfunctional behaviors.

CBT is best used for conditions in which dysfunctional behavior has a psychological or cognitive basis, such as bulemia, phobias, obsessive-compulsive disorder, post traumatic stress disorder, social phobia, generalized anxiety, and some forms of depression. It is particularly effective for eating disorders. CBT has not been shown to be an effective treatment for schizophrenia, bipolar disorder, addictions, major depression, or any disease.

USES IN ME/CFS. According to its proponents, CBT is a safe, effective treatment because “patients gradually shift their fixed ideas that they are helpless against the fatigue that dominates their lives and move to the perception that fatigue is only one negative experience among many positive ones.” Because ME/CFS is treated as a mental illness in the U.K., CBT has been officially endorsed as a ME/CFS treatment in Great Britain. Numerous studies, conducted primarily in the U.K., have appeared to support the efficacy of CBT for treating ME/CFS. However, these studies have not been replicated elsewhere.

In a special edition of the Journal of Chronic Fatigue Syndrome (Vol 11, (1) 2003), an article written by a panel of eleven ME/CFS physicians discussed the results of several CBT studies. The authors concluded that the U.K. studies were inherently flawed due to their use of Oxford case definition of ME/CFS, in which the only criterion is six months of unexplained fatigue.

This very broad case definition allows patients with other disorders, such as depression, to be included under the designation of ME/CFS. The authors of the article noted that “a systematic review of prognosis studies show that the less stringent the clinical criteria, the better the prognosis.” In short, studies demonstrating the efficacy of CBT for ME/CFS patients tend to yield much better results when subjects without ME/CFS are included. The authors concluded that “to ignore the demonstrated biological pathology of this illness, to disregard the patient's autonomy and experience and tell them to ignore their symptoms, all too often leads to blaming patients for their illness and withholding medical support and treatment.

Two Dutch researchers, Twisk and Maes, reviewed CBT and GET (graded exercise therapy) as treatments for ME/CFS. The authors determined that the success claim for CBT was “unjust” and that CBT was hardly more effective than no care at all. They concluded that “it is unethical to treat patients with ME/CFS with ineffective, non-evidence-based and potentially harmful "rehabilitation therapies," such as CBT/GET.”

While some forms of counseling may be useful for patients coping with anxiety, depression, and the upheaval caused by having a chronic, debilitating illness, there is no evidence that changing a style of thinking is curative.

Treatment rating for Cognitive Behavioral Therapy (CBT)