Response to Twisk and Corsius letter: “Cognitive behavioural therapy for chronic fatigue syndrome: neither efficacious nor safe”

Anna Cheshire, Damien Ridge, Lucy Clark, Peter White

Research output: Contribution to journalLetterpeer-review

4 Citations (Scopus)


We were surprised that the above named letter was published by the journal because of the errors contained within it. (1) Janse and colleagues may themselves respond to the letter, providing as it does a most partial critique of their trial of web-based CBT for chronic fatigue syndrome (CFS). We wish to draw readers’ attention to some of the errors, in which Twisk and Corsius misrepresent one of our own studies. They quote a conference abstract, describing our qualitative study of participant experiences of graded exercise therapy (GET), following involvement in a trial of guided graded exercise self-help, claiming that: “Several large-scale patient surveys and studies, for example Cheshire et al. (4), indicate that CBT, especially when combined with GET, can cause iatrogenic harm and is not safe” (1). Firstly, ours was a small-scale qualitative study. Secondly, it did not involve CBT. Finally, we did not find any evidence of iatrogenic harm or lack of safety. Instead, Twisk and Corsius may have meant to cite the main paper from the GETSET trial. However, this larger study also did not involve CBT, and it additionally revealed no evidence of harm or lack of safety, with no significant differences found in eight safety outcomes between graded exercise self-help and the control intervention of specialist medical care, once missing data were considered (2). A Cochrane systematic review of exercise therapies for chronic fatigue syndrome similarly concluded that: “Patients with CFS may generally benefit and feel less fatigued following exercise therapy, and no evidence suggests that exercise therapy may worsen outcomes” (3).

Our qualitative study, which is currently in press (5), suggests that patients found GET to be challenging. However, GET was reportedly most helpful when patients were well motivated and supported, not suffering from a comorbid condition, and when their illness had a shorter duration (4, 5). When so few successful treatments exist for such a chronic and disabling condition as CFS, it is critical that any criticisms of research suggesting that behavioural interventions may help, are accurate and do not misinterpret the evidence.
Original languageEnglish
JournalThe British Journal of Psychiatry
Issue number2
Early online date20 Jul 2018
Publication statusPublished - Aug 2018

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