What about the cognitive-behavioral model of CFS?
Some researchers assume that, although CFS may be precipitated by a physical event (such as a viral infection), the illness is subsequently perpetuated by psychological and behavioural factors. According to this model, faulty cognitions (e.g., rigid somatic attributions and catastrophizing), sensory hypervigilance, activity avoidance, and enhanced interoception may play a key role in the etio-patho genesis of the illness.[54,55]
Certainly, a cognitive-perceptual bias and inadequate coping behaviour have been demonstrated in some CFS patients [56] but these findings have not always been confirmed.[57] Moreover, a purely cognitive-behavioural model of CFS seems less explanatory for the pathophysiological disturbances identified so far and more difficult to relate to findings about the patients’ history, personality, and premorbid lifestyle (as reviewed above).
Nonetheless, the latter model is the main rationale of cognitive-behavioral therapy (CBT) and graded exercise training (GET), which are currently both recommended as first-line treatments in CFS/FM. Particularly in the CFS literature, it has been stated that patients should be informed about the possibility that CBT may lead to “full recovery,” in order to enhance outcome.[58] Although there is evidence to support the efficacy and effectiveness of CBT and GET in subsets of CFS/FM patients,[59,60] these treatments have also been strongly criticized - not in the least by members of the ME commrmity - since relevant studies may be flawed because of diagnostic heterogeneity, recruitment bias, the use of outcome criteria with too little relevance for “real life" functioning, and the questionable definition of "recovery.”[14,61]