An important issue with regard to efficacy is the aim of CBT. In many studies improvement and rehabilitation is the treatment goal. Our CBT studies86,88–92 aimed to cure (i.e. disappearance of symptoms and functional impairment as its defined goal, ability to return to work and other activities and no longer considering oneself as a patient).1 It should be realized that if cure is not the goal of treatment, it will never be attained. Of great interest is our observation that – as mentioned above – there is a regain of gray matter with successful CBT, underscoring that the loss of gray matter in CFS is neurobiologically important, that CBT induces morphologic changes that point to plasticity of the brain.68
Another important question is whether the effect of CBT is lasting; a number of follow-up studies have shown that there is a sustained effect.93,94 However, there are a couple of problems with CBT. The first is availability: although the term cognitive behavioral therapy is widely used, specific CBT, tailor-made for CFS, is hard to get. A second major problem – fed by some patient organizations – is that many CFS patients have strong somatic attributions and reject the idea that a psychologic intervention may help them.
