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What's the evidence for using CBT?

We do not recommend any individual treatments or management approaches for people with M.E. Instead, we offer key information to allow people with M.E. to make informed decisions.

Some specialist services offer cognitive behavioural therapy (CBT) for M.E.

The NICE guideline describes CBT as: “An evidence-based psychological therapy that is used in many health settings, including cardiac rehabilitation and diabetes management. It is a collaborative treatment approach. When it is used for CFS/M.E., the aim is to reduce the levels of symptoms, disability and distress associated with the condition. A course of CBT is usually 12 to 16 sessions. The use of CBT does not assume or imply that symptoms are psychological or ‘made up’.”

The NICE guideline makes it clear that CBT “should be delivered: by a suitably trained [GET or CBT] therapist with experience in M.E., under appropriate clinical supervision.”

People with M.E. who wish to try CBT should ask to be referred to a specialist M.E. clinic, where this expertise exists, if at all possible. Details of clinics are available in our services directory.

NB. In July 2017, NICE held a consultation on their guideline for M.E., asking stakeholders to comment on their proposal to retain the guideline’s current recommendations. Action for M.E., as a registered stakeholder, responded to this consultation stating that the guideline must be reviewed in full because:

  • the evidence in support of CBT, which is recommended in the guideline, is not conclusive
  • the current evidence base has led major international health agencies, including the Centers for Disease Control and Prevention in the US, to alter their guidance regarding CBT
  • NICE has an ethical obligation to present a full, accurate and balanced picture of current international practice when it comes to managing and treating M.E.

We will keep you updated as NICE considers the responses to this consultation. 

Key things to consider

CBT is not a cure but it may help some people to cope with the impact of the illness.

In 2014, we surveyed more than 2,000 people with M.E. Our resulting M.E. Time to deliver report shows that:

  • 33% of respondents had tried CBT
  • of these, 54% said they found it helpful or very helpful, 34% said it resulted in no change, and 12% said it made them a bit or much worse.

A 2011 research study (the PACE trial) identified a improvement for those patients that undertook CBT and GET over and above any benefit of standard medical care alone (14-16% improvement), which included advice on self-management.

Scientific debate continues around the results of the PACE trial, with a number of researchers in the M.E. field and beyond questioning its findings. Following the release of anonymised data from the PACE trial, a December 2016 paper published in the peer-reviewed journal Fatigue: Biomedicine, Health and Behavior concluded that "the claim that patients can recover as a result of CBT and GET is not justified by the data."

There have been no published randomised controlled trials of CBT in children or those who are severely affected by M.E.

In May 2015, the M.E. Association published in-depth analysis of its 2012 survey, focusing specifically on management strategies including CBT. It found that:

  • 35% of respondents had undertaken a course of CBT
  • of these, 91% reported feeling that their symptoms were unaffected or made worse.

A 2004 membership survey by the UK charity the 25% M.E. Group, which focuses specifically on supporting the severely affected, found that 93% of those surveyed found CBT unhelpful.