There are three interventions that have been shown to be effective for some people. These are Cognitive Behavioural Therapy (CBT), Graded Exercise (GE), and the Lightning Process (LP) in teenagers. All three interventions are confirmed with randomised controlled trials.1
The most cost-effective compared with specialist medical care (which, in fact, was not effective) was the LP at £1,474/ QALY, then CBT £18,374/QALY, then GE at £23,615/QALY and pacing £55,235. Pacing is popular with some support groups and may be the best option when the more effective treatments have not worked. CBT is not treating depression (about 1/3 of patients with CFS have depression) but illness behaviour. The NICE guidelines commented that “the evidence for pacing was meagre.” The NICE guidelines have been very controversial and have been heavily criticized by world experts in treating CFS. 2