Investigation into cognitive behavioural therapy for Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis, by Catherine E Clark . DClinPsych Thesis, Canterbury Christ Church, April 2019


Thesis abstract:


In the UK, CBT is currently recommended as an intervention for CFS/ME. Physical and psychological outcomes of CBT for CFS/ME vary across studies, as does the CBT model adopted. There is some evidence to suggest that some participants experience improved psychological and physical outcomes post CBT. However, the specific nature of these changes and the factors facilitating them is not well understood. This was therefore the focus of the current study.


Semi-structured interviews were conducted with 13 service users who had engaged in CBT aimed at improved management of their condition. Interviews were analysed using a grounded theory methodology, in order to build a theory of participants’ experiences.


The theory suggests that CBT led to participants feeling more able to cope with CFS/ME. This was due to both a shift in perspective arising from the therapy room and taking a more adaptive approach to daily life. The theory also suggested that participants experienced increased acceptance of the condition, which facilitated further adaptive changes.


Findings extend existing literature in suggesting that CBT aimed to improve management of CFS/ME may result in improved coping and reduced distress, independently of changes in fatigue. Clinical and research implications are discussed.

Thesis summary:

Section A is a systematic review exploring service users’ and their families’ experiences of psycho-social interventions for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). A thematic analysis was completed on the qualitative literature to explore the experience of interventions, the intervention components perceived as helpful and unhelpful and facilitators and barriers to benefitting from interventions. Resulting themes are discussed and study methodologies critiqued. Clinical and research implications are discussed.

Section B presents the results of a grounded theory study of cognitive behavioural therapy (CBT) for CFS/ME, specifically focused on the changes experienced by service users and the therapy components and conditions perceived to facilitate these. Semi-structured interviews were conducted with 13 service users recruited via a specialist CFS/ME service.

In contrast to the NICE guidelines, the model of CBT delivered in this service was not one of ‘reconditioning’ in which service users are supported to increase their activity; instead the goal was better adjustment to CFS/ME to improve quality of life. A theorised model of the therapeutic process is discussed, in which CBT led to participants feeling more able to cope with CFS/ME and experience increased acceptance of the condition. Clinical and research implications are discussed.

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