Of the 6 reported studies using CBT in “ME/CFS” two selected patients as defined
by the Oxford (Deale et al, 1997;Sharpe et al, 1996) one using the Australian criteria
(Lloyd et al, 1993) and one using the Fukuda criteria “with the exception of the criterion
requiring four of eight additional symptoms to be present” (Prins et al, 2001). These
methods of patient selection allow for considerable heterogeneity and inclusion of psychiatrically ill patients with fatigue. Therefore, the results may not be applicable to the average Fukuda or Canadian defined patient. Of the remaining two studies using valid selection criteria, one found no benefit of CBT (Friedberg & Krupp, 1994). The only study reporting benefit (improved functional capacity and decreased fatigue) was conducted in adolescents (Stulemeijer et al, 2005).

It is important to note that no CBT study has reported that patients have been improved enough to return to work nor have they reported changes in the physical symptoms
of CFS eg. muscle pain, fever, lymphadenopathy, headache or orthostatic intolerance. Furthermore, clinical experience suggests that trying to convince a patient with ME/CFS that s/he does not have a physical disorder and should not rest when tired leads to conflict in the doctor-patient relationship and poor outcome for the patients. Therefore it would be prudent to await further research before recommending this CBT approach.

Despite the fact that worsening of symptoms after exercise is a compulsory criteria
for diagnosis of ME/CFS, graded exercise programs have often prescribed for such
patients. Presumably these recommendations are made on the assumption that exercise
will be accompanied by improved aerobic capacity, increased anaerobic threshold and
improved exercise tolerance. However, in patients with ME/CFS, neither exercise tolerance nor fitness has been shown to improve with exercise programs. This may be connected with abnormal responses to exercise in people with ME/CFS. The resting heart
rate of patients is elevated, and maximum oxygen uptake is reduced compared with
healthy sedentary controls (Riley et al, 1990;Farquhar et al, 2002;Fulcher & White,
1997;De Becker et al, 2000). SPECT scan brain analysis indicates worsening of hypoperfusion
(Goldstein, 1993) and decreased cerebral blood flow (Peterson et al, 1994) after
exercise. Decreased cognition (Blackwood et al, 1998a;LaManca et al, 1998), decreased
pain threshold (Whiteside et al, 2004a;Whiteside et al, 2004b) and reduced maximal muscle contraction (Paul et al, 1999) are also reported.

According to the recent Cochrane Collaboration metanalysis (Edmonds et al, 2004) there are five studies on exercise and ME/CFS that are methodologically sound. However three of these studies used the Oxford criteria for patient selection which requiring only fatigue of 6 months duration for diagnosis. One of these excluded patients with sleep disrupted sleep (Fulcher & White, 1997) meaning that virtually all patients seen in clinical practice would be excluded. There are two studies using valid diagnostic criteria and both report improved fatigue by self report (Chalder Fatigue Scale) (Wallman et al, 2004;Moss-Morris et al, 2005). Neither of these report follow-ups past 12 weeks. Neither report on core physical symptoms of ME/CFS such as pain, unrefreshing sleep, infective, autonomic, neurological or endocrine symptoms. It is unclear whether these findings are applicable to severely ill patients as none of these patients are well enough to participate in studies. It will require more study on a broader group of patients, reporting all symptoms to discern if graded exercise affects the core symptoms of ME/CFS.

From- ‘Chronic Fatigue Syndrome – Assessment and Treatment of Patients with ME/CFS:
Clinical Guidelines for Psychiatrists’ by Eleanor Stein MD FRCP(C)

Using CBT techniques combined with mindfulness (the ability to intentionally pay attention to the present moment, without judgment) is enormously helpful for becoming more aware of how negative thinking can spiral one down into more fatigue and a great perception of stress and pain, hence, greater suffering.

In my practice and online group, I have done a lot of work integrating mindfulness into daily life for relief around stress, anxiety, and depression. Both the research and my personal experience show the ability to cultivate a nonjudgmental present moment awareness of ourselves to be very effective. It also opens the person up to what is good that may be missed when in an uncomfortable place from stress, pain, or illness. Worth exploring.