John H Wolfe not all papers are equal. "avoidance behaviour" could mean the researcher notes that a patient is acting disabled, but the researcher doesn't believe the patient actually is disabled (see the comments on this thread for an evaluation of another such study). this it the age-old fallacy of: we haven't run the right tests or the right tests don't yet exist, so it must be entirely or partially a personal/behavioural problem of the patient. This has happened to MS, RA, and a host of other diseases, and it is far past time to be disavowed entirely. Most non-BPS practitioners use CBT to help people learn to cope with their disease and maybe teach pacing skills. Do you have a link of what you are talking about regarding Rowe? Rowe, incidentally, at the FDA conference mentioned the dismal results of the PACE Trial, which was among other things a trial of CBT based on the 'fear-avoidance model of illness'. I am not aware of any cases where avoidance behaviour could possibly be preventing anyone from reducing PEM/PER/PENE. The only thing we know for certain reduces this is pacing. Other than that, doctors can make recommendations for various things but in the end the patient is always the one who decides to take or not to take any medical treatment. And there is no evidence for a strong recommendation for any particular treatment. There is some risk of harm from any treatment or therapy or supplement or anything that we might try, and it risks coercion to try to convince people to try a certain thing when they have expressed a disinclination to that. Kina, yes, if you were thinking to spin off some of these posts to a new thread, that sounds fine to me. @thread The thing about people who improve with this or that treatment is that we generally don't have large-scale studies which prove it's from the treatment in question.