Hi Orla Yes- this is exactly what is happening - a belief, by LP or CBT proponents, in catastrophic thinking. The belief that patients 'catastrophize' it itself due to circular reasoning or affirming the consequent. What is 'catastrophization' is itself unstable also, in the way researchers think about it! (There's no agreed definition as such, for one thing!) And I think your argument is correct. When people first get ill (especially children), there does seem to be a lot of people just thinking they've recovered, carrying on as normal, then becoming adversely affected. Even then they may not make the link between activity/exertion and those adverse effects because that sort of problem is NOT publicised in the press, for example, or told to them by doctors. Post exertional adverse effects is not a well known phenomenon in lay knowledge discourses! So they have no reason to be 'catastrophizing' as such. It is only as they become iller and iller that they MIGHT start to realise what's happening (it might take years!) . THEN they get labelled as fear avoiders or catastrophizers. But while people are NOT making a link between their symptoms and exertion, they might be thought of as maladaptively 'driven'!! Years later, they get accused of both fear avoidance AND being compulsively 'driven'!! When you look at it like that, it's horrific. Sadly, I know of which I speak. My daughter was an active 12 year old enjoying her life when she got ill - she certainly did NOT make any connection between exertion and symptoms, nor did I, and her 'driven-ness' was to do going out with friends, playing badminton and going swimming, playing with our dogs, shopping, watching TV, doing very well in some subjects at school, not in others. Not worried about that (god it was only religious education lol!) etc. etc. Yet somehow, she found herself speculatively psycho-analysed when her illness started interfering with her getting to do what she wanted, and she was blamed for that (as was I). But it took us YEARS to work out her increasing disability was linked to exertion! The point I'm making is, the circle of fear avoidance and catastrophizing was only occurring in the minds of psychiatrists and the doctors who are influenced by them, not in me or my daughter. The model of deconditioning dreamt up seems to be divorced from the experience of most people, not only as 'CFS' sufferers, but in communities in general. People with flu might take things easy for a while, for example, but they know, usually, that they will recover eventually and be able to get back to what they are doing. Many 'CFS' ers experience, initially, flu-like or other viral illness. While people diagnosed with 'CFS' are peered at through the lens of a psychiatric paradigm in which circular reasoning, magical voluntarism, second-guessing and victim-blaming are key components of distortion, issues like this get missed and their actual experiences of the illness are misrepresented. So thank you Orla for actually bringing that up - it's an important point.