Cognitive behavior therapy (CBT) is therapy that is based on a person’s perception of his or her illness and the impact that it has on the person’s life. Working with a CBT therapist, the person can examine beliefs, concerns and coping behaviors and modify these as necessary, to develop constructive coping strategies. 

1. Research has shown that CBT can improve function and symptom management for people with CFS. It appears to have limited effect on pain and fatigue. CBT will not cure CFS, nor will it alleviate all symptoms for people with the illness. CBT does not address controversies surrounding the origins of CFS. It is simply intended to assist the individual to better manage the illness.
2. Psychological factors are relevant to any illness process. CBT has been shown to help people deal with these factors and better cope with the life-altering issues of chronic illness. Awareness of the role that stress can play in exacerbating the symptoms of CFS is essential. CBT assists people to better recognize and manage the stressors in their lives.
3. CBT often involves the introduction of paced, slowly graduated physical activity. It is imperative that any therapeutic activity plan (designed by a trained professional) be highly individualized for each person with CFS, based on their present activity tolerance. Even people with extremely limited tolerance can be helped to very gradually improve strength and conditioning. People with CFS often engage in "boom or bust" cycles: when feeling well, they do too much, and then become exhausted for an extended period (a phenomenon called post-exertional malaise). Managing energy by pacing activities is essential to improved function and symptom management.
4. It’s important to learn some essential facts about CBT and try to focus on the potential benefits that may be achieved. CBT is used to improve coping and symptom management of many chronic illnesses, including asthma, diabetes and heart disease.
5. Carefully adhering to CBT protocol is critically important to successful therapy. In research studies, people with CFS have higher drop-out rates in CBT compared to other types of therapy. For people with CFS, worsening symptoms is the main reason cited for discontinuing CBT. Again, this may be avoided if a paced, personalized plan is followed. When activities are tailored to the individual’s capabilities, a skilled professional can assist in setting and reaching realistic goals.
6. Multiple and varied biological, psychological and social factors all impact a person’s feelings about CBT, particularly if they are aware that CFS is commonly labeled as a psychiatric illness (for example, many people have probably been told that CFS "is all in your head").  Learning as much as possible about CBT and considering information based on facts can be beneficial when making a decision about this treatment method.
7. CBT requires special training and must be administered by a skilled specialist.  It should be noted that psychologists are not the only health care professionals that can successfully guide CBT. Nurses, physical and occupational therapists are examples of multidisciplinary providers who are trained in CBT. The CBT therapist needs to be familiar with CFS, be aware of the evidence for CFS as a biologically-based disorder and validate a person’s experience of living with a misunderstood illness.
8. The National Association of Cognitive Behavioral Therapists available at 1-800-853-1135 may be able to assist in finding a trained provider in your area. Contacting local mental health provider groups, physical and occupational therapy practitioners or health care organizations may be helpful as well.
9. CBT can be expensive and may not be covered by insurance.