The PACE trial was a large-scale study comparing CBT, graded exercise therapy (GET), and standard medical care for CFS. The results have been the matter of some debate, and graded exercise therapy is explicitly contraindicated in the most recent NICE guidelines (2021).
- CBT for CFS therapist manual
- CBT for CFS participant manual
- Post-exertional malaise avoidance toolkit | Solve ME/CFS Initiative download archived copy
- Pacing for people with M.E. – Action For M.E.
- Self-help guide to recovery for chronic fatigue syndrome and fibromyalgia download archived copy
- Understanding chronic fatigue syndrome download archived copy
- CFS self-help information – Cambridgeshire and Peterborough NHS
- CFS/ME Self-Management Workbook | Torbay & South Devon CFS/ME Service download archived copy
Centers For Disease Control And Prevention Toolkit
- ME/CFS Assessment Overview Table | CDC download archived copy
- What Is ME/CFS? | CDC download archived copy
- What Are ME/CFS Symptoms? | CDC download archived copy
- Managing Specific Symptoms | CDC download archived copy
- Managing Post-Exertional Malaise (PEM) | CDC download archived copy
- Other Supportive Strategies | CDC download archived copy
- Hartle, M., Bateman, L., & Vernon, S. D. (2021). Dissecting the nature of post-exertional malaise. Fatigue: Biomedicine, Health & Behavior, 9(1), 33-44. download
- Knoop, H., Prins, J. B., Moss-Morris, R., & Bleijenberg, G. (2010). The central role of cognitive processes in the perpetuation of chronic fatigue syndrome. Journal of psychosomatic research, 68(5), 489-494.
- Larun, L., Brurberg, K. G., Odgaard‐Jensen, J., & Price, J. R. (2016). Exercise therapy for chronic fatigue syndrome. Cochrane Database of Systematic Reviews, (2). download archived copy
- Marques, M. M., De Gucht, V., Gouveia, M. J., Leal, I., & Maes, S. (2015). Differential effects of behavioral interventions with a graded physical activity component in patients suffering from Chronic Fatigue (Syndrome): An updated systematic review and meta-analysis. Clinical psychology review, 40, 123-137.
- Nijhof, S. L., Bleijenberg, G., Uiterwaal, C. S., Kimpen, J. L., & van de Putte, E. M. (2012). Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial. The Lancet, 379(9824), 1412-1418. download archived copy
- White, P. D., Goldsmith, K., Johnson, A. L., Chalder, T., & Sharpe, M. (2013). Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychological medicine, 43(10), 2227-2235. download archived copy
What Is Chronic Fatigue Syndrome / Myalgic Encephalomyelitis?
Signs and Symptoms of CFS/ME
CFS/ME is characterized by disabling tiredness (fatigue) that lasts a long time and cannot be explained by other causes. CFS/ME should be considered if the fatigue prevents the individual from doing things that they used to be able to, if the fatigue gets worse after activity or gentle exercise, or if the following symptoms are present:
- sleep problems
- pain in the muscles or joints
- sore throat or sore glands that aren’t swollen
- problems thinking, remembering, concentrating, or planning
- flu-like symptoms
- feeling dizzy or sick or having palpitations
- exercising or concentrating on something makes your symptoms worse
Psychological Models and Theory of CFS/ME
Understanding of the causes and maintenance of CFS/ME is incomplete. Biomedical factors likely play a role. Like any physical illness it is normal to have thoughts and feelings about symptoms and what they mean, and so psychological approaches also have potential clinical value. Models of CFS/ME including psychological factors include:
- Browne and Chalder (2006)
- Burgess and Chalder (2004)
- Vercoulen et al. (1998)
- Harvey and Wessely (2009)
- Roche, Dawson, Moghaddam, Abey, and Gresswell (2017)
- Wiborg, Knoop, Frank, and Bleijenberg (2012)
- Browne, T., & Chalder, T. (2006). Chronic fatigue syndrome. Psychiatry, 5(2), 48–51.
- Burgess, M., & Chalder, T. (2004). Cognitive behaviourtherapy for CFS/ME: PACE manual for participants. MREC v. 2. Retrieved from: https://me-pedia.org/images/7/7a/PACE-cbt-participant-manual.pdf
- Harvey, S. B., & Wessely, S. (2009). Chronic fatigue syndrome: Identifying zebras amongst the horses. BMC Medicine, 7(1), 58. https://doi.org/10.1186/1741-7015-7-58
- Roche, L., Dawson, D. L., Moghaddam, N. G., Abey, A., & Gresswell, D. M. (2017). An Acceptance and Commitment Therapy (ACT) intervention for Chronic Fatigue Syndrome (CFS): A case series approach. Journal of Contextual Behavioral Science, 6(2), 178–186.
- Science Media Centre (2018). Science Media Centre Factsheet: CFS/ME—The illness and the controversy. Retrieved from: http://www.sciencemediacentre.org/wp-content/uploads/2018/03/Science-Media-Centre-Factsheet-CFS-ME.pdf
- Vercoulen, J. H. M. M., Swanink, C. M. A., Galama, J. M. D., Fennis, J. F. M., Jongen, P. J. H., Hommes, O. R., van der Meer, J. W., & Bleijenberg, G. (1998). The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: Development of a model. Journal of Psychosomatic Research, 45(6), 507–517.
- Wiborg, J. F., Knoop, H., Frank, L. E., & Bleijenberg, G. (2012). Towards an evidence-based treatment model for cognitive behavioral interventions focusing on chronic fatigue syndrome. Journal of Psychosomatic Research, 72(5), 399–404.